Module Two Project Preparation:
Evidence-Based Practice Inquiry
NUR 302: Nursing Research and Evidence-Based Practice
Southern New Hampshire University
Department of Nursing
June 10, 2026
Abstract
This project preparation document establishes the foundational framework for an
Evidence-Based Practice (EBP) inquiry examining the impact of culturally tailored,
community health worker-led discharge education on health outcomes for adult patients
with Type 2 Diabetes Mellitus (T2DM) who face Social Determinants of Health (SDOH)
barriers, including limited health literacy and food insecurity. The document identifies the
clinical problem of elevated hospital readmission rates among this population, formulates a
structured PICOT question, outlines a systematic database search strategy using CINAHL,
PubMed, and the Cochrane Library, and evaluates three preliminary scholarly sources.
The inquiry integrates the National Council of State Boards of Nursing (NCSBN) Clinical
Judgment Measurement Model (NCJMM), the Campinha-Bacote Cultural Competence
Model, and Healthy People 2030 SDOH objectives to ensure alignment with the NUR 302
curriculum's emphasis on holistic, equitable, patient-centered nursing practice.
Keywords: evidence-based practice, PICOT question, Type 2 Diabetes, SDOH, community health workers,
cultural humility, discharge education
, NUR 302 Module Two Project Preparation
1. Introduction
Evidence-Based Practice (EBP) forms the cornerstone of contemporary nursing, requiring
practitioners to integrate the best available research evidence with clinical expertise and patient
values to inform healthcare decisions (Melnyk & Fineout-Overholt, 2023). The NUR 302 Module
Two Project Preparation assignment serves as the foundational step in the EBP capstone sequence,
challenging nursing students to identify a clinically significant problem, formulate a structured
inquiry using the PICOT framework, develop a systematic search strategy, and critically evaluate
preliminary scholarly literature. This document addresses each of these requirements through the
lens of a specific clinical problem: the disproportionate hospital readmission rates among adult
patients with Type 2 Diabetes Mellitus who face compounding Social Determinants of Health
(SDOH) barriers.
The clinical significance of this problem is well-documented. The American Diabetes
Association (2024) reports that approximately 38.4 million Americans have diabetes, with T2DM
accounting for 90-95% of all diagnosed cases. Hospital readmission rates for diabetic patients
remain substantially higher than the national average, with the Centers for Medicare & Medicaid
Services (CMS, 2023) identifying diabetes-related complications as a leading driver of preventable
30-day readmissions. These readmissions disproportionately affect patients from marginalized
communities who face structural barriers including low health literacy, food insecurity, limited
English proficiency, and inadequate access to follow-up care. Standard discharge
education—typically consisting of generic pamphlets written at a reading level exceeding the
average patient's literacy—fails to address these contextual factors, perpetuating a cycle of poor
glycemic control and recurrent hospitalization.
2. Identification of the Clinical Problem
A significant clinical problem in adult medical-surgical and primary care settings is the
elevated rate of hospital readmissions among patients with Type 2 Diabetes Mellitus (T2DM) who
simultaneously face Social Determinants of Health barriers, particularly low health literacy and
food insecurity. Despite receiving standard discharge education protocols upon hospital release,
these patients frequently struggle to manage their condition at home, resulting in poorly controlled
HbA1c levels, preventable acute complications such as hyperglycemic crises and diabetic foot
infections, and recurrent hospital admissions within 30 days of discharge. The consequences extend
beyond individual patient suffering: each preventable readmission costs an estimated
$15,000-$25,000 and contributes to healthcare system strain (CMS, 2023).
This gap in practice persists because standard discharge interventions operate under a deficit
model that attributes poor self-management to patient non-compliance rather than examining the
structural barriers that impede adherence. Patients with limited health literacy may not understand
complex medication regimens or dietary instructions presented in medical terminology. Patients
experiencing food insecurity cannot implement dietary recommendations when they lack reliable
access to nutritious food. Patients with limited transportation may miss follow-up appointments
essential for medication adjustment. This clinical problem demands discharge interventions that
move beyond generic, one-size-fits-all approaches to actively address the socioeconomic, cultural,
and educational context in which patients live and manage their chronic conditions.
Page 2
Evidence-Based Practice Inquiry
NUR 302: Nursing Research and Evidence-Based Practice
Southern New Hampshire University
Department of Nursing
June 10, 2026
Abstract
This project preparation document establishes the foundational framework for an
Evidence-Based Practice (EBP) inquiry examining the impact of culturally tailored,
community health worker-led discharge education on health outcomes for adult patients
with Type 2 Diabetes Mellitus (T2DM) who face Social Determinants of Health (SDOH)
barriers, including limited health literacy and food insecurity. The document identifies the
clinical problem of elevated hospital readmission rates among this population, formulates a
structured PICOT question, outlines a systematic database search strategy using CINAHL,
PubMed, and the Cochrane Library, and evaluates three preliminary scholarly sources.
The inquiry integrates the National Council of State Boards of Nursing (NCSBN) Clinical
Judgment Measurement Model (NCJMM), the Campinha-Bacote Cultural Competence
Model, and Healthy People 2030 SDOH objectives to ensure alignment with the NUR 302
curriculum's emphasis on holistic, equitable, patient-centered nursing practice.
Keywords: evidence-based practice, PICOT question, Type 2 Diabetes, SDOH, community health workers,
cultural humility, discharge education
, NUR 302 Module Two Project Preparation
1. Introduction
Evidence-Based Practice (EBP) forms the cornerstone of contemporary nursing, requiring
practitioners to integrate the best available research evidence with clinical expertise and patient
values to inform healthcare decisions (Melnyk & Fineout-Overholt, 2023). The NUR 302 Module
Two Project Preparation assignment serves as the foundational step in the EBP capstone sequence,
challenging nursing students to identify a clinically significant problem, formulate a structured
inquiry using the PICOT framework, develop a systematic search strategy, and critically evaluate
preliminary scholarly literature. This document addresses each of these requirements through the
lens of a specific clinical problem: the disproportionate hospital readmission rates among adult
patients with Type 2 Diabetes Mellitus who face compounding Social Determinants of Health
(SDOH) barriers.
The clinical significance of this problem is well-documented. The American Diabetes
Association (2024) reports that approximately 38.4 million Americans have diabetes, with T2DM
accounting for 90-95% of all diagnosed cases. Hospital readmission rates for diabetic patients
remain substantially higher than the national average, with the Centers for Medicare & Medicaid
Services (CMS, 2023) identifying diabetes-related complications as a leading driver of preventable
30-day readmissions. These readmissions disproportionately affect patients from marginalized
communities who face structural barriers including low health literacy, food insecurity, limited
English proficiency, and inadequate access to follow-up care. Standard discharge
education—typically consisting of generic pamphlets written at a reading level exceeding the
average patient's literacy—fails to address these contextual factors, perpetuating a cycle of poor
glycemic control and recurrent hospitalization.
2. Identification of the Clinical Problem
A significant clinical problem in adult medical-surgical and primary care settings is the
elevated rate of hospital readmissions among patients with Type 2 Diabetes Mellitus (T2DM) who
simultaneously face Social Determinants of Health barriers, particularly low health literacy and
food insecurity. Despite receiving standard discharge education protocols upon hospital release,
these patients frequently struggle to manage their condition at home, resulting in poorly controlled
HbA1c levels, preventable acute complications such as hyperglycemic crises and diabetic foot
infections, and recurrent hospital admissions within 30 days of discharge. The consequences extend
beyond individual patient suffering: each preventable readmission costs an estimated
$15,000-$25,000 and contributes to healthcare system strain (CMS, 2023).
This gap in practice persists because standard discharge interventions operate under a deficit
model that attributes poor self-management to patient non-compliance rather than examining the
structural barriers that impede adherence. Patients with limited health literacy may not understand
complex medication regimens or dietary instructions presented in medical terminology. Patients
experiencing food insecurity cannot implement dietary recommendations when they lack reliable
access to nutritious food. Patients with limited transportation may miss follow-up appointments
essential for medication adjustment. This clinical problem demands discharge interventions that
move beyond generic, one-size-fits-all approaches to actively address the socioeconomic, cultural,
and educational context in which patients live and manage their chronic conditions.
Page 2
