Date of Graduation

Summer 8-21-2015

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions



First Advisor

Stefan Rowniak PhD, RN, MS, FNP

Second Advisor

Alexa Colgrove Curtis PhD, FNP-BC

Third Advisor



The prevalence of type 2 diabetes mellitus (T2DM) has increased substantially in the United States in recent years. Teaching self-management to diabetic patients is essential to help them control their chronic disease. Albert Bandura’s theory of self-efficacy is commonly used in chronic disease self-management programs and is the theoretical framework upon which this Doctor of Nursing Practice (DNP) pilot project was built.

This evidence-based change in practice project took place in a rural primary care clinic in the central valley of California, and involved the development of a diabetes logbook, which was a tool for patients to use to learn self-management of their disease. The logbook was created in response to an identified gap in knowledge among patients at the clinic. The book was composed based on current evidence in diabetes management and treatment. It was introduced to the patients and a validated tool (Diabetes Self-Efficacy Scale) was used before and after the project to determine the patients’ self-efficacy scores. The project implementation took place over a three-month period of time.

Though the number of project participants was small, and difficulties were encountered with follow-up with some patients, overall the pilot project was successful at increasing self-efficacy scores, with a mean pre-project score of 7.57, and a mean post-project score of 8.08, which is an increase of 0.51. The mean Hemoglobin A1c (HbA1c) pre-project was 8.75, and the mean HbA1c post-project was 8.19, indicating a decrease of 0.56. Any decrease in A1c can be seen as clinically significant, as even small reductions can decrease short and long term complications of diabetes.

This evidence-based change in practice project met its objective of increasing patients’ perception of diabetic self-management. This project was designed to be translatable to other primary practice settings. Sharing tools that are developed based on the current evidence will help to improve all patient healthcare outcomes.