| Course | D031 Advancing Evidence-Based Innovation in Nursing Practice |
|---|---|
| Task | Task 1 |
| Paper type | Nurse innovator role and sources table |
| Length | About 1,000 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for D031 Task 1
The Nurse Innovator's Role and an Appraised Sources Table: Continuous Glucose Monitoring for Insulin-Treated Adults on General Hospital Floors
Student Name
Leavitt School of Health, Western Governors University
D031: Advancing Evidence-Based Innovation in Nursing Practice, Task 1
Course Instructor
Month Day, Year
The Nurse Innovator's Role and an Appraised Sources Table: Continuous Glucose Monitoring for Insulin-Treated Adults on General Hospital Floors
The Role and Responsibilities of a Nurse Innovator
A nurse innovator is a nurse who finds problems in how care is delivered and develops, tests and spreads new solutions to them, whether those solutions are devices, processes, roles or uses of technology. The role differs from that of a manager, who keeps existing systems running well, and from that of a researcher, who generates new knowledge. The innovator works between the two, using evidence and frontline knowledge to change how care is actually done.
The responsibilities follow the life of an innovation. The first is identifying a problem worth solving, using data and bedside observation; for this project, it is the gap between the four fingerstick glucose checks a day that insulin-treated patients receive on general floors and the swings in glucose that happen between them, especially overnight. The second is appraising evidence to judge whether a proposed solution works, which the sources table below does for continuous glucose monitoring (CGM). The third is designing the innovation for the real workflow, which means asking who will see the data, who will respond to alarms and how the information will enter the electronic health record. The fourth is building a coalition across nursing, endocrinology, pharmacy, informatics and biomedical engineering, and securing leadership support. The fifth is testing on a small scale, measuring results and deciding whether to adapt, scale or stop. Throughout, the nurse innovator protects patient safety and keeps the patient's experience at the center of the design.
Sources Table
The five sources below were published within the last five years in peer-reviewed journals. Levels are assigned using a common seven-tier evidence pyramid (Melnyk & Fineout-Overholt, 2023), in which systematic reviews of randomized controlled trials sit at Level I and single randomized trials at Level II; students should use the leveling tool their course provides.
| Source | Design and sample | Level | Key finding | Relevance to the innovation |
|---|---|---|---|---|
| Lara-Gálvez et al. (2025) | Systematic review and meta-analysis of 7 randomized trials, 1,106 non-ICU adults with type 2 diabetes | I | CGM increased time in range by about 8 percentage points and lowered mean glucose and time above range versus fingerstick testing | Strongest summary that CGM improves glucose control on general floors |
| Spanakis et al. (2022) | Randomized trial, 185 medical and surgical inpatients on basal-bolus insulin | II | Similar time in range overall, but among patients with hypoglycemia, CGM-guided insulin reduced recurrent hypoglycemia and time below 70 mg/dL | Shows safety and a specific benefit: fewer repeat lows |
| Fortmann et al. (2020) | Randomized trial, 110 adults with type 2 diabetes on a non-ICU floor with remote monitoring by telemetry staff | II | Lower mean glucose and less time above 250 mg/dL, more time in range; very little hypoglycemia | Tests a nursing workflow in which alerts go to bedside nurses |
| Galindo et al. (2020) | Prospective comparison of CGM and fingerstick testing in hospitalized adults with type 2 diabetes | IV | CGM detected far more hypoglycemia, including nocturnal episodes, than fingersticks; accuracy was lower in the hypoglycemic range | Shows what current practice misses and the device's limits |
| American Diabetes Association Professional Practice Committee (2025) | Clinical practice guideline, Standards of Care, hospital section | VII | Sets expectations for inpatient glucose targets and addresses the use of CGM in hospital settings | Guideline context for policy and protocols |
What the Evidence Shows
Taken together, the sources support a cautious but positive conclusion. The highest-level source pooled seven randomized trials and showed that CGM improves time in range and lowers mean glucose for non-ICU adults with type 2 diabetes (Lara-Gálvez et al., 2025). The trials add detail: CGM guided by a nursing workflow in which telemetry staff forwarded alerts to bedside nurses improved control (Fortmann et al., 2020), and CGM-guided insulin adjustment reduced recurrent hypoglycemia among patients who had low readings (Spanakis et al., 2022). An observational comparison shows how much low blood sugar fingerstick testing misses, particularly overnight, while warning that sensor accuracy is weaker at low values, so low readings still need confirmation with a fingerstick (Galindo et al., 2020). The hospital guideline provides the frame for targets and protocols (American Diabetes Association Professional Practice Committee, 2025). The main gaps are workflow, cost and alarm burden, which the innovation plan will have to address.
Reflection on the Appraisal Process
Leveling the sources changed how I read them. I began with a strong impression, formed from vendor materials and a conference talk, that inpatient CGM clearly improves outcomes. Assigning levels forced me to separate what each study actually tested. The Spanakis trial, for example, did not show better overall time in range, and I had remembered it as a positive trial; its benefit was specific to patients who had already had hypoglycemia. The Galindo study was not randomized at all, so its striking hypoglycemia figures describe what CGM detects, not what it changes.
Placing the sources side by side also showed me which questions the evidence does not yet answer. None of the trials measured nurse workload or alarm response times in detail, and most were conducted at academic centers. That gap will shape my innovation proposal: I will plan a small test on one unit with nurse workload and alarm counts measured from the start, rather than assuming the benefits in the trials will carry over unchanged to a community hospital.
Implications for the Innovation
The appraisal points to a specific design for the innovation rather than a general one. The evidence is strongest for adults with type 2 diabetes on basal-bolus insulin on general floors, so that is the population the pilot will start with. Because the trial that showed the clearest workflow benefit routed alerts to bedside nurses through an existing monitoring team, the design will use the hospital's central telemetry staff in the same way instead of adding alarms to every nurse's phone. Because sensor accuracy is weaker at low values, any reading below 70 mg/dL will still be confirmed with a fingerstick before treatment. And because none of the sources measured nursing time, the pilot will measure it directly. The nurse innovator's job is to turn the evidence into those concrete choices, and this table is the first step.
References
American Diabetes Association Professional Practice Committee. (2025). 16. Diabetes care in the hospital: Standards of care in diabetes, 2025. Diabetes Care, 48(Suppl. 1), S321-S334. https://doi.org/10.2337/dc25-S016
Fortmann, A. L., Spierling Bagsic, S. R., Talavera, L., Garcia, I. M., Sandoval, H., Hottinger, A., & Philis-Tsimikas, A. (2020). Glucose as the fifth vital sign: A randomized controlled trial of continuous glucose monitoring in a non-ICU hospital setting. Diabetes Care, 43(11), 2873-2877. https://doi.org/10.2337/dc20-1016
Galindo, R. J., Migdal, A. L., Davis, G. M., Urrutia, M. A., Albury, B., Zambrano, C., Vellanki, P., Pasquel, F. J., Fayfman, M., Peng, L., & Umpierrez, G. E. (2020). Comparison of the FreeStyle Libre Pro flash continuous glucose monitoring (CGM) system and point-of-care capillary glucose testing in hospitalized patients with type 2 diabetes treated with basal-bolus insulin regimen. Diabetes Care, 43(11), 2730-2735. https://doi.org/10.2337/dc19-2073
Lara-Gálvez, D., Rubio-Almanza, M., Aparicio-Ródenas, Y., Sanchis-Pascual, D., Masdeu-López-Cerón, P., Pérez-Cervantes, V., & Merino-Torres, J. F. (2025). Continuous glucose monitoring in non-ICU hospitalized adults with type 2 diabetes: A systematic review. Journal of Clinical Medicine, 15(1), 34. https://doi.org/10.3390/jcm15010034
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Spanakis, E. K., Urrutia, A., Galindo, R. J., Vellanki, P., Migdal, A. L., Davis, G., Fayfman, M., Idrees, T., Pasquel, F. J., Coronado, W. Z., Albury, B., Moreno, E., Singh, L. G., Marcano, I., Lizama, S., Gothong, C., Munir, K., Chesney, C., Maguire, R., . . . Umpierrez, G. E. (2022). Continuous glucose monitoring-guided insulin administration in hospitalized patients with diabetes: A randomized clinical trial. Diabetes Care, 45(10), 2369-2375. https://doi.org/10.2337/dc22-0716
What the D031 Task 1 instructions ask
The first D031 task asks you to describe the role and responsibilities of a nurse innovator and to appraise evidence for an innovation. Most versions ask for a role description, a sources table of recent peer-reviewed sources with levels of evidence and key findings, a summary of what the evidence shows, a reflection on the appraisal process and implications for the innovation. Sources usually must fall within a recent date range. The evaluator reads for correct evidence levels based on study design, findings reported accurately and a summary that weighs the evidence rather than listing it. Some versions ask for a specific number of sources.
How this D031 Task 1 example is built
The paper opens with the nurse innovator role defined through responsibilities, not titles. The sources table is organized so each row shows citation, design, level, findings and limitations, which lets the reader compare sources quickly. Levels are assigned from design using a named pyramid. The evidence summary moves from the highest-level source to the others and states the overall conclusion with its limits. The reflection describes how the writer's early impression changed after leveling, a sign of real appraisal. The implications section turns the evidence into design choices, such as which patients the innovation should target first. The table sits near the start so the rest of the paper can refer to it.
Where the D031 Task 1 rubric puts the marks
D031 Task 1 aspects are rated competent, approaching competence or not evident. A role aspect checks that the nurse innovator's role and responsibilities are described accurately. A sources table aspect looks for recent, credible sources with correct levels and accurate findings. An evidence summary aspect asks what the sources show together. A reflection aspect wants insight into the appraisal process. An implications aspect asks how the evidence shapes the innovation. Evaluators check that levels match designs and that APA citations are correct. Professional writing is assessed throughout. Evaluators notice when limitations are recorded for each source, since appraisal without limitations reads as summary. A reflection that describes a change in the writer's thinking usually meets that aspect clearly.
D031 Task 1 help: what sends it back
The most common problem is evidence levels assigned from titles rather than designs. Read the methods and level each source by what was actually done. Second, findings are overstated; report effect sizes or key results accurately, with limits. Third, the summary lists sources one by one. Say what they agree on and how strong the combined evidence is. Fourth, reflections describe the task rather than the thinking. Explain how your view changed as you appraised. Finally, check dates against your instructions, since sources outside the required range can cost you an aspect regardless of their quality. Record each study's sample size in the table. Note where evidence is thin rather than hiding it.
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D031 Task 1 questions, answered
How do I level evidence in the D031 sources table?
Use the evidence leveling tool your course provides. Most leveling tools rank systematic reviews of randomized trials highest, then individual randomized trials, then nonrandomized and observational designs, with expert opinion lowest. Identify the design first, then assign the level.
How recent must D031 sources be?
Your instructions set the window, and current versions ask for peer-reviewed sources from the last five years. Check each publication date, and choose sources that speak directly to your innovation.
Do I include my CPE schedule in the written part of D031?
No. Schedules, logs and recordings are completed separately under your instructions. The role description, sources table and reflection are the written pieces a sample can model.
How do I level evidence in the D031 sources table?
Assign each source a level from its design using a named hierarchy, such as a seven-tier pyramid with systematic reviews of trials at the top. The sample shows the design and level side by side.
Where can I find a free D031 Task 1 sample paper?
The role description and sources table are reproduced above with commentary. Share your innovation topic with the D031 instructions and the first tailored table and paper are free.