Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christina M. Hernandez


Angela Adams


Of people age 65 and older residing in a long-term care facility, 1 in 4 has Type 2 diabetes (Smide & Nygren, 2013). Care and management of this population is a challenge for nurses and other providers. Results of a needs assessment in a local long-term care facility identified deficiencies in the provision of evidence-based Type 2 diabetes care for this target population. American Diabetes Association Guidelines (2017) recommend application of individualized HbA1c targets for the elderly residing in long-term care facilities, especially for those with compromises in clinical and functional status. This two prong quality improvement project strove to educate nurses about these residents’ needs, and incorporate the use of best practice diabetes standards in the nurse practitioner’s practice. Specifically, emphasis was placed on HbA1c and finger stick monitoring, eye exams, and foot care. Results indicated that educational in-services designed for nurses were an effective approach to improving knowledge concerning care of complex Type 2 diabetes patients. Although ophthalmology and podiatry referrals were not ordered routinely because of APRN, staff, and organizational resistance; utilization of standardized orders improved routine Type 2 diabetes care pertaining to ordering HbA1c, renal panel, and urine to albumin creatinine ratio. The APRN now has the awareness to evaluate discrepancies between HbA1c results and finger stick values. QI projects in long-term care facilities may be difficult to implement and sustain related to staff turnover, understaffing, high patient acuity, and organizational and provider opposition. APRNs must advocate for continual utilization of evidence-based practice guidelines for all LTC residents.