Evidence-Based Clinical Question Search Assignment

Clinical questions help improve nursing practice, education, and research. They require extensive research to validate or refute claims and gain insight into the topic to ensure it is of high quality and efficacy. A proper analysis of randomized control trials provides high-level evidence, and their results are applicable in various ways in healthcare settings. The information can also be used in various ways to inform care interventions. Advanced practice nurses are majorly managers of the healing environment, and they utilize research to prepare and improve care interventions. They also utilize their knowledge, skills, and positions to improve healthcare institutions and care delivery. This essay evaluates a clinical question and supporting literature and utilizes the evidence to improve FNP practice Evidence-Based Clinical Question Search Assignment

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Refined Clinical Question Review

Among elderly diabetic patients, does standardized patient education compared to traditional education improve self-management, adherence to treatment modalities, and follow-up visits in six months? This short review evaluates evidence that informed the clinical question and any modifications to ensure the change is impactful and relevant to the selected healthcare settings. The review also gives reasons and insights that led to the development of the question. Diabetes among elderly patients is a rummaging condition, affecting about 20-30% of adults above 65 years old (Sinclair et al., 2020)Evidence-Based Clinical Question Search Assignment. The condition is also very expensive due to the daily treatment modalities such as insulin. In addition, elderly patients have declining cognitive, physical, and physiologic functions primarily due to old age and associated conditions. Decreasing immunity, physiologic function, and activity are leading causes of poor prognosis in managing diabetes in the elderly. Thus, the group is exposed to higher mortalities and morbidities than other groups creating the need for vigorous management.

Standardized or structured patient education is education based on a checklist or education tailored to meet all patient needs and offer vital skills and knowledge. It focuses on the outlined components of health education that are carefully selected and appraised as vital to achieving the desired output (Chatterjee et al., 2018). For example, the care provider can teach patients specific exercises for older adults considering their physical and physiologic limitations instead of just telling them to exercise, as in traditional patient education. It is organized in chronological order of relevance and importance to promote patient understanding and minimize time wasted gathering education materials (Ernawati et al., 2021). The checklist also provides a vital follow-up tool that improves professionals’ responsibility and adherence to the interventions. Traditional education lacks order of education increases the chances of missing out on information or the education exercise because it provides no care provider follow-up intervention. Thus, structured education is integral for diabetic patients to promote better health outcomes.

The disease is preventable through education and collaborative intervention between healthcare providers and patients. Knowledge and skills to manage diabetes are vital. Educating patients to help ensure they adhere to routine medication administration, diet/ eating habits, and exercise/ physical activity. Individuals with skills have a likelihood of utilizing them (self-efficacy). Treatment adherence is also expected to increase when patients learn the importance of adhering to the modalities. Diabetes complications are notorious and take a long to manage, and thus, it is vital to prevent them (Ghisi et al., 2021)Evidence-Based Clinical Question Search Assignment. They are prevented through up and periodic visits to determine patterns leading to their development and thus preventing them from developing early in their development stages. Diabetes follow-up entails diabetic foot examination, eye examination, and HbA1c tests. Educating patients helps them understand the importance of adhering to these visits, thus increasing their adherence to follow-up care which helps prevent complications and promote effective glycemic control.

Diabetes management interventions take time to produce change. Individuals also take time to adapt to new interventions hence the need for six months. The change has been clearly and carefully crafted to produce an evidence-based change in diabetic patient outcomes.

Structured Diabetes patient Education Systematic Review

Traditional diabetes patient education does not provide clear instructions on content and chronology of implementations and leaves the liberty to choose to the healthcare institutions and healthcare providers. The education is ineffective, as evidenced by the rising rates of diabetes complications, mortalities, morbidity, healthcare costs, and poor quality of life. Diabetes self-management education is the recommended management intervention by institutions like the CDC, NDEP, ADA, and WHO. Ernawati et al. (2021) conducted a systematic review to help understand the effectiveness of DSME in diabetic patients. The review utilized fifteen articles from reputable databases. The DSME education, according to the review, increases an individual’s knowledge and adherence to various interventions such as diet, exercise, and follow-up. The lifestyle changes from the DSME were changes in exercises attitude and time allocation, changes in drinking and smoking habits, and increased fruits and vegetables diets. These changes were expected to increase various clinical outcomes of these patients.

A systematic review study showed a significant improvement in therapeutic tests such as cholesterol, FBS, and RBS tests results (Ernawati et al., 2021). HbA1c results are the best in evaluating glycemic controls over time. Cunningham et al. (2018), a study in the review, provides conflicting evidence and shows that DSME does not produce a significant change in HbA1c results. Other studies, such as Ghisi et al. (2021)Evidence-Based Clinical Question Search Assignment, showed a significant improvement in patient knowledge and possible behavior change. Knowledge greatly influences behaviors, and patients are highly likely to portray the right behaviors when they receive the right education. Adherence to treatment modalities, follow-up visits, and lifestyle changes in diet and exercise promotes better health outcomes.

DSME, according to the review, thus improves knowledge and the clinical health status of the patients. The study also identified the various barriers to implementing DSME, including scarce healthcare resources, cultural barriers, personal differences, and poor patient-clinic relationships. Poor professional commitment is another problem that negatively affects the education interventions, quantity instead of quality. Professionals want to manage more patients without paying attention to the quality of care (Ernawati et al., 2021; Chatterjee et al., 2018)Evidence-Based Clinical Question Search Assignment. The systematic review used a mixture of qualitative and quantitative studies. These studies present different levels of evidence hence presenting a huge problem in the reliability of the data produced. However, the review process was vigorous, thus leading to high-level evidence when informing the study.

Summary of The Database Used

Various databases provide reliable nursing studies and articles. These databases include PubMed (NCBI), CINAHL Plus with Full Text (EBSCO), Academic Search Complete (EBSCO), and Cochrane Library (Wiley) (Welch Medical Library, 2021). Cochrane Library is the best database for getting systematic reviews for broader insights into a topic. In addition, systematic reviews produce the highest level of evidence; hence the database is an important source of evidence-based practices. PubMed (NCBI) is a database developed and managed by the national center for biotechnology information. The database is a free search engine containing medical-related articles, abstracts, and references. PubMed aims to improve health both globally and personally hence it has a collection of healthcare research articles that provide reliable evidence for application in managing healthcare problems. The database is reputable in providing all kinds of publications. PubMed contains case studies, randomized controlled studies, quasi-experimental studies, and qualitative studies (Welch Medical Library, 2021)Evidence-Based Clinical Question Search Assignment. The focus on medical-related articles of all years makes the database reliable. The articles are also peer-reviewed, increasing the reliability of the database. The article used is also published in various journals, increasing the data’s reliability.

An evidence-based quantitative article containing an evidence-based randomized control trial

When exploring diabetes education programs studies, I came across many qualitative, quantitative studies, and systematic reviews during the search. Systematic reviews, majorly from the Cochrane library, showcased the importance of structured diabetes patient education. Randomized controlled studies are structured studies that use high-level data collection and analysis tools, and their results are useful in making clinical decisions. They use methods that filter out many biases, thus increasing the reliability of the results. The chosen study is an article by Rahaman et al. (2018) from the PubMed database. The study evaluated the effectiveness of a diabetic patient education module on foot care in an outpatient setting. The study is an open-label randomized controlled study. The education module was structured for diabetic patients in the outpatient department. Evidence-Based Clinical Question Search Assignment

Case Study Summary

The study describes the care gap in care provision where patients are unaware of diabetic foot complications and only realize their existence when they develop the complications. According to the study, foot care is the least emphasized component of diabetes education despite the risk for further complications, high healthcare costs, and poor-quality lives. The deficient knowledge makes it difficult to manage these preventable diabetes complications. Diabetic foot is a major diabetes complication resulting from poor foot care leading to poorly healing wounds. Diabetic foot leads to high healthcare costs due to daily dressing and medications. When poorly managed, they lead to amputations, significantly affecting a patient’s quality of life. The researchers used a unique tool (patient education module) for patient education, which they developed for the study.

The intervention was an audio-visual display and a pamphlet on diabetes foot care, while the control group received traditional care at baseline, 1 and 3 months. The intervention was given to the intervention group, besides the routine diabetes education on dietary advice, exercise, medication, and follow-up given to the control group. The study recruited 127 diabetes patients attending an endocrinology outpatient department in AIIMS, New Delhi, and assigned them to control (n=64) and intervention groups (n=63) (Rahaman et al., 2018)Evidence-Based Clinical Question Search Assignment. At baseline, both groups filled a questionnaire testing their foot care knowledge. The patients then filled out a questionnaire at 1 and 3 months to test their knowledge of diabetes foot care. The results were analyzed for the three periods to determine their differences after introducing the intervention.

The Study Outcomes, Validity, Reliability, and Bias.

The study excluded patients with vision problems, hearing impairment, and present or past foot ulcer cases. These conditions in these patients would have negatively affected the reliability of the study’s results. The unique approach used by this study was the intervention prepared by the researchers. The intervention was structured to improve patient foot care and improve the patients’ knowledge and entailed an audio-visual on foot care and a pamphlet on foot care. The pamphlet covered all diabetic foot and diabetic care areas according to National Diabetes Education Program and American Diabetes Association recommendations. Only 51 patients from the intervention group and 50 patients in the control group completed the three visits; hence they are the only ones included in the results. The knowledge scores at baseline for the intervention and control groups were 9.8 ± 1.8 and 9.9 ± 1.7, at 1 month; 10.2 ± 1.6 and 9.8 ± 1.6, and 3 months, respectively. Evidence-Based Clinical Question Search Assignment

As seen from the results, the intervention group showed statistically higher scores which rose steadily from the baseline test scores. The control group scores showed a drop in the first month and a slight rise in the third. The changes were not statistically significant in the control group. The results showed significant statistically significant differences at 1 and 3 months, which were not observed in the control group. In the beginning, the results from both groups were low and had very few differences in the control and intervention groups. Still, these differences were significantly different in the first and third months. The study shows significant improvement in patient knowledge and practices.

The study’s validity depends on the objectives, the study interventions, and the congruent evaluation methods. The intervention was education using the audio-visual display and a pamphlet on diabetic foot care. These interventions are geared towards increasing patients’ knowledge, and the evaluation methods used, a questionnaire, testing changes in the patient’s knowledge and practice hence the validity of the research. The study results were also analyzed using a students’ t-test, which determines changes in mean scores. The study creates the need for further research on the effectiveness of diabetes patient education on the behaviors associated with increased knowledge.

The data evaluation methods provided for the reliability of the data; questionnaires. Questionnaires are reliable because they provide reliable first-hand data from the study participants. The questionnaires were prepared from the diabetic foot care education components, which align with NDEP and ADA recommendations. The unique education tool was comprehensive and created by reputable healthcare professionals and recommendations from ADA and NDEP. However, the study does not mention how the tools were tested statistically for reliability. Reliability is integral in ensuring that the data is valid, and reliability must be present to ensure data validity. Evidence-Based Clinical Question Search Assignment

Bias in research interferes with the study results and significantly affects their generalizability and implementation of the data produced. There are three types of bias: confounding, information, and selection biases. The study was a randomized control trial which removes selection bias leading to better representative results. During the study, confounding bias was present. There were no interventions to prevent patients from sharing the pamphlets or education in their social interactions, significantly affecting study results. There was no information bias noted in this study, thus making the results more reliable and the data generalizable.

Applying the Evidence from the Review to FNP.

Study results could be useless when not utilized in clinical practice. After evaluating and appraising evidence, advanced practice nurses use the knowledge in their practice areas to improve care quality and promote patient safety. FNPs utilize abstractions and evidence from studies to change practices. The randomized clinical trial shows the importance of testing the patients’ level of understanding, retention, and recall of information given during their care. APRNs in primary care (FNPs and other specialists) should also ensure they test if their patients understand what they were taught. The whole study is based on testing knowledge levels after the education intervention using questionnaires. During education programs, patients may fail to retain knowledge or become inattentive, and thus the education becomes less impactful. Testing their level of understanding helps understand the likelihood of improving their behavior (Rahman et al., 2018). Strategies such as the teach-back where patients are expected to recall information taught after patient education are integral in determining their level of understanding. Testing their knowledge also ensures they pay attention to educational interventions.

The primary takeaway is the emphasis on patient education for self-care in primary settings. The results showed that focused patient education is integral in improving patient knowledge and possibly changing health behavior (Rahaman et al., 2018)Evidence-Based Clinical Question Search Assignment. The study results are congruent with other studies on the importance of patient education (Wittink & Oosterhaven, 2018). Diabetic patient education from the randomized control study improved patients’ knowledge in the intervention group compared to the control group. FNPs should leverage the benefits of patient education to improve knowledge and care of other healthcare conditions. Increased patient knowledge also increases care collaboration and adherence to their responsibilities, thus increasing healthcare efficiency.

Another takeaway is the often-ignored importance of diabetic patient education materials such as pamphlets. These resources are common in chronic conditions management, and healthcare professionals and individuals should strive to ensure they are properly utilized in healthcare institutions (Wittink & Oosterhaven, 2018). FNPs in primary care should advocate for the materials to be availed to the populations in healthcare settings to help manage preventable conditions of public importance, such as diabetes, hypertension, and cancer.

The study utilized a unique intervention where they developed a diabetes foot care pamphlet and an audio-visual display to help educate the patients. The components are based on the recommendations by reputable international organizations such as ADA, increasing the relevance and validity of the data produced. APRNs can assist in developing healthcare tools and materials for patient education to fill the gaps in care provision in healthcare settings. Many healthcare conditions can be prevented, but there lacks practice-level interventions to help nurses and other healthcare providers prevent them. FNPs in primary care are responsible for improving the health of individuals and families and should this prepare tools and materials to improve practice at the department or institution levels. Thus, the study results are integral in improving FNPs’ practice in primary care settings Evidence-Based Clinical Question Search Assignment.

Conclusion

Diabetes education is an important intervention, especially in older adults with many needs due to the conditions of old age. The review and systematic review provide significant insight into structured patient education and the importance of diabetic self-management education (DSME). The randomized clinical trial presented increased knowledge and practice among patients after audio-visual display and pamphlets on diabetes foot care. The basis of the education is that diabetes prevention and effective management depend on patient education because most of the care requires collaborative interventions between patient and caregiver. FNPs have several takeaways from the study they can utilize in primary care settings to promote better patient outcomes and improve their quality of life. FNP utilize patient education and education resources such as checklists and pamphlets to improve patients’ knowledge. FNPs should also collaborate with other care providers to develop modified care interventions where clear frameworks are unavailable. By doing so, they will help increase healthcare efficiency and health outcomes Evidence-Based Clinical Question Search Assignment.

References

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018). Diabetes structured self-management education programs: a narrative review and current innovations. The Lancet Diabetes & Endocrinology, 6(2), 130-142. https://doi.org/10.1016/S2213-8587(17)30239-5

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2). https://dx.doi.org/10.4081/jphr.2021.2240

Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y

Rahaman, H. S., Jyotsna, V. P., Sreenivas, V., Krishnan, A., & Tandon, N. (2018). Effectiveness of a patient education module on diabetic foot care in an outpatient setting: An open-label randomized controlled study. Indian Journal of Endocrinology and Metabolism, 22(1), 74. https://dx.doi.org/10.4103/ijem.IJEM_148_17 Evidence-Based Clinical Question Search Assignment

Sinclair, A., Saeedi, P., Kaundal, A., Karuranga, S., Malanda, B., & Williams, R. (2020). Diabetes and global aging among 65–99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas. Diabetes Research And Clinical Practice, 162, 108078. https://doi.org/10.1016/j.diabres.2020.108078

Welch Medical Library (2021). Databases for Nursing Research. Nursing Resources. The John Hopkins University of Medicine. https://browse.welch.jhmi.edu/nursing_resources

Wittink, H., & Oosterhaven, J. (2018). Patient education and health literacy. Musculoskeletal Science and Practice, 38, 120-127. https://doi.org/10.1016/j.msksp.2018.06.004

MN504-3: Differentiate statistical output for data analysis.

Assignment Details

Evidence-Based Clinical Question Search Assignment

Purpose:

The purpose of this assignment is to give you a practical application to implement your compelling clinical question idea, supported by the evidence-based research you have obtained during your systematic review. You will apply evidence-based research findings discovered from your clinical question, and then integrate those to support your suggested change in nursing practice.

Directions:

1. Identify your refined clinical question.
2. Provide a summary of the database used.
3. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.
4. Summarize the case study selected.
5. Describe the study approach, sample size, and population studied.
6. Apply the evidence from this review to your practice specifically in your overview.
7. Evaluate the outcomes, identifying the validity and reliability.
8. Discuss if the study contained any bias.
9. Determine the level of evidence identified in the review.
10. The length should be no less than 10 pages in APA 7th edition format.
    

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Minimum Submission Requirements

• This Assessment should be a Microsoft Word document.
• Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your paper should be highly organized, logical, and focused.
• Your paper must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
• Your paper should provide a clearly established and sustained viewpoint and purpose.
• Your writing should be well ordered, logical and unified, as well as original and insightful.
• A separate page at the end of your research paper should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
• Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.) Evidence-Based Clinical Question Search Assignment