Date of Graduation

Fall 12-12-2014

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Dr. Crow

Second Advisor

Dr. Curtis

Third Advisor

Dr. DeBourgh


The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam.

Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed.

The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual Nursing Grand Rounds. The author collaborated with the head nurse to develop new patient education resources. The author also utilized the Internet and a train-the-trainer approach to educate nurses, and to ensure nurse competency in applying the patient assessments and documentation of findings. The author tracked implementation success by reviewing weekly chart audit reports and provided continual guidance and support via videoconferences and email.

Outcomes identified 100% compliance with implementing and maintaining the new evidence-based standard of care. A survey taken five months after data collection was completed revealed that the nurses’ and physicians perceived that the nurse role has improved patient care and provided early detection of diabetic foot complications. In fact, because of their successes, nurses have expanded their practice beyond what was originally projected.