NR 439 Assignment Research Article Critique Paper
NR 439 Assignment Research Article Critique Paper
An article was written by Allen, Murfet and Hingston (2014) giving detailed account of new nurse led care model for pregnant women who suffer from diabetes. This paper is a research based evaluation of that article only. Diabetes in Pregnancy (DIP) is a common occurrence and the cases of it have increased in the past decade that has led to development of measures to counter this issue. There are two major reasons that have led to increase in cases of DIP; first as asserted by Thompson and Masso women who live in areas that don’t have access to specialist doctors suffer from this issue and second those women who aren’t that well informed about management of diabetes. This paper is an attempt to present an in-depth analysis of a method suggested for the management of diabetes among pregnant women.
Rural setting in this context applies to those areas that don’t have enough number of medical specialists and this study is an attempt to determine that can the situations be improved by applying a nurse practitioner model in such settings, which is the research question of this study.
The expectant mother isn’t the only one who is effected due to DIP as the unborn child inside her womb also suffers from healthcare fatalities as suggested by various cases. Those children are known to suffer from Jaundice, growth retardation, Thrombosis and macrosomia. This makes it all the more essential to consider this issue seriously and devise a solution for overcoming it so that not just the mother but also the unborn child could live a healthy life. This is one such topic that needs to be researched further considering the seriousness of the situation (Murfet, Allen, and Hingston, 2014)
Design of the Study
Uncontrolled before-after intervention design of study has been used in for this study which involves comparison of results prior to the implementation of intervention and after its implementation. The results of sample population are compared with that of a controlled group as denoted by the term uncontrolled where information related to management of DIP is collected before and after the implementation of the intervention program.
Since the sample population that is used for this process comprises of individuals who are from rural areas therefore this design of study is the most suited one. Control groups cannot be used in these settings as it would lead to biasness in results along with other factors that can affect the results. There’s a distinct disadvantage of not using control groups that it becomes difficult to reach at conclusions and the design of the study also doesn’t allow to achieve desired results.
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The results along with benefits of treatment could have been overestimated if a controlled group would have been used for this study instead of an uncontrolled group. Correct design of study needs to be implemented because otherwise the results would be wrong leading to misleading suggestions as asserted by Goodacre (2015). It is essential to follow correct design because the conclusions that would be made otherwise would not be right. Although clinical practices cannot be based on the results of this study performed on an uncontrolled group due to lack of basis related to medical actions.
Maximum usage of resources that was found in the local environment was assured by making use of DIPC models. General practitioners weren’t tasked with the responsibility of monitoring the women as it was allotted to CDEs. The success of this design is fundamentally dependent on the support that is available via this model and the information provision.
The women who can suffer from the issue of diabetes can be identified due to this design of study as it makes use of the ICD criteria. This was a major positive of using this study design along with ensuring that there wasn’t any sort of biasness anywhere in the whole process as the searching process was done based on codes that were collected from the ICDs in antenatal clinics. This ensured total clarity in the process (Goodacre, 2015)
Sample/ Population of the Study
All the pregnant women from the North West of Tasmania who suffered from the health complication of diabetes from July 2003 to June 2006 were included as sample population for the pre-intervention audit. Several parameters were set to include women as sample population for this study like the women needs to be pregnant and suffering from diabetes and at the time of study she should be getting treated at a government or private hospital for that.
Next parameter was that the women who was diagnosed with GDM during the duration of this study at the same healthcare would be included for this study as sample population and the need for pre-intervention audit solidified the requirement of International Classification of Diagnosis ease codes (ICD). There were a total of 261 participants in this study and out of them 37 of them were diagnosed with diabetes and 26 out of that had type 1 diabetes while eleven had type 2. Along with that among the participants of the study 195 women suffered from gestational diabetes along with referrals from physicians also being there.
Due to the fact that the sample population only includes women who are pregnant and suffer from diabetes, the process of selecting sample population becomes feasible for the population. This selection process makes it easier to study the effect that the nurse practitioner led model would have on nursing women who are pregnant and suffer from diabetes (Murfet, Allen, and Hingston, 2014)
Data Collection Methods
Credentialed Diabetes Educators (CDEs) are the ones who are tasked with the responsibility of recording data about pregnant women who accesses maternity service records for that. He accesses those records and then marks that data onto data collection audit registering sheet including cases of those women also who suffer from diabetes and are suspected to be pregnant. The correctness of the entries in the form along with completeness of it is ensured by the lead DNP who only references some part of the form to keep a check on the work of CDE that whether he is doing his job efficiently or not.
CDEs record variety of information related to women on the form like the monitoring that has been done related to diabetes on them, specific GDM screening they have gained, demographics, treatment process for diabetes during pregnancy along with maternal results observed in that process. Local experts like diabetes nurse educator and diabetes physicians are the ones who check the validity of the contents of the form.
The best practices that are available in the current medical scenario and the ones that are suggested based on the information presented in the form are compared by a panel who reviews the findings of the form and an endocrinologist who validates it. Height and weight of pregnant women isn’t regularly measured and that’s why for the pre-intervention group the Body Mass index wasn’t available. Australian Bureau of Statistics was referenced for collecting information related to social and economic status of individuals who participated in the study.
Data collection is also done via the audit forms that are kept in healthcare facilities for women who are pregnant and visit the hospital. Along with that information is also collected from database that is originally stored there by the application of International Classification of Disease Codes.
Several ethical considerations are followed in the process of collecting data to keep the process on line. The research material was approved by Patient Care Committee of the Quality and Safety Executive Unite at the North West Regional Hospital and the Executive Board of the North West Private Hospital was also invited by the management of the hospital to participate in the Research Ethics committee (Murfet, Allen, and Hingston, 2014). The identity of patient is kept hidden at any cost and that’s why no information related to identity of patient is recorded at any stage of the study like the name or address of the patient. At no point is this study was any such information recorded by the researchers that could give up the identity of the participant women of this study.
There are several limitations of this study that need to be worked upon in order to provide better level of care to pregnant women who suffer from diabetes in times to come. They would be able to treat such women better if such situations are taken care of now. Since the height and weight of pregnant women isn’t recorded every time they visit hospital therefore Body Mass Index (BMI) for the pre-intervention group isn’t available. BMI is an essential part of the process and since there weren’t any definite values available related to that therefore assumptions had to be mad about it which was a major drawback of the whole process.
The number of women who took part in this study weren’t enough and that’s why there was good amount of difficulty that they had to experience while adjusting values related to HbA1c level. Such women who have been suffering from diabetes from long time need to be included more in number with the application of multivariate regression model. This all highlights on the need to have a control trial before the study and the women who suffer from type 1 and type 2 diabetes should go through regular testing. That would allow for inclusion of HbA1c level in future studies on statistical tests.
There isn’t any data available based on previously collected information that could be used here for reference purpose which makes it difficult to analyze the results of intervention process that have been implemented. Along with that the absence of control groups also adds to the worries. Another major limitation of the study is due to lack of enough staff members which leads to making more number of assumptions in the study instead of collecting data. Shortage of resources is also a factor that mounts to a considerable challenge.
Other than the intervention measures that have been discussed in this study, there are several other factors too that have lifted the level of maternal services that are provided in the hospitals like the enhancement in the level of specialist care and services that are provided to patients. These are the factors that have no indulgence in the improvement of neonatal care provided to patients based on which it is suggested in the conclusions drawn from the study that effects of other processes of healthcare management are also considered during this course while keeping remaining other factors constant.
About the issue of usage of BMI, it is suggested to record the height and weight of pregnant women when they visit healthcare as other than helping in this process of researching the impacts of nurse practitioner model it would also be quite useful in providing them better level of care. Medical practice is affected by several factors and those several factors could be determined by the application of control measures. It is essential to put into considerations all these limitations that are mentioned here for future researchers as it will assist them in their research process. These limitations are vital in suggesting the difficulties and limitations that were faced by current researchers while discovering the impacts of using a nurse led practitioner care model for diabetes among pregnant women.
The neonatal results in rural settings have been observed to show considerable improvement with the application of this nurse practitioner led model of care as indicated by the findings of this research. Rural setting in this situation applies to those areas who don’t have enough number of healthcare practitioners to take care of their health.
A considerable reduction of around 24 to 40 percent was observed in adverse neonatal risks among the women who were suffering from GDM after the nurse practitioner led model of care. The rates of macrosomia also came down considerably from 49 percent to 19 percent and the congenital abnormalities have reduced too to zero percent from 8 percent.
The research question that is in consideration here has been answered by the findings of this study based research. This research is dedicated to studying the effects of using a nurse practitioner led model of care in supplying care to patients whose results suggest that this model of care surely has a positive influence on the whole system. There are several other factors too that can positively impact the level of neonatal and maternal services provided to the patients but they aren’t considered due to absence of credible support to back it up. That is what increases the need to have methods that can control the proceedings while makings sure that all other factors are unchanged (Murfet, Allen, and Hingston, 2014)
The referrals that were made to dieticians increased with the implementation of the practitioner led model of care as depicted by the results of the findings of this study. Also the number of patients who paid visit to diabetes educator decreased considerably with this model of care coming into practice with subsequent fall in the number of individuals attending diabetes education program.
There has been considerable rise in the number of cases of patients who suffer from diabetes during their pregnancy which has caught the attention of medical professionals throughout the world thus stressing upon the need to come up with suitable measures to counter this issue. This study is aimed at suggesting the effects of implementing a practitioner led model of care on the neonatal and maternal outcomes. An uncontrolled before-after design of study was used by Allen, Hingston and Murfet (2014) in which data collection was done by the CDEs. Assigning identifiers to sample population was one of the several ethical considerations that were made during this process which also ensured that the identification of the individuals who participated in this study wasn’t revealed at any point of time. All these studies suggest based on their results suggest that the neonatal outcomes in rural settings improved vitally.
Goodacre, S. (2015). Uncontrolled before-after studies: discouraged by Cochrane and the EMJ.
Masso, M., & Thompson, C. (2016). Australian research investigating the role of nurse practitioners: A view from implementation science. Collegian.
Murfet, G. O., Allen, P., &Hingston, T. J. (2014). Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy. Journal of Advanced Nursing, 70(5), 1150-1163.doi:10.1111/jan.12277. (14p.) Persistent link to this record (Permalink):