NR 439 Assignment Role of Research and the Importance of the Searchable Clinical Question

Along the way, you’ll explore nursing research and its evolution from Florence Nightingale’s time until today.

You’ll build on knowledge gained in the informatics course as you choose a significant clinical issue, formulate a searchable clinical question, and search for research-based evidence.
This process lays the groundwork for a PICOT assignment that you’ll complete during the course as you discover sources of evidence for your own EBP. Nursing research critically advances our profession through the development of evidence upon which our practice standards are based. To determine what the best evidence is, a nurse needs to look at how the information was collected, how rigorous the methods used to develop the evidence was, and what source was used to share the evidence.

The Course Outcomes (CO) we will apply in our first week include:

Examine the sources of evidence that contribute to professional nursing practice.
Recognize the role of research findings in evidence-based practice.

Read the assigned case study and formulate searchable, clinical questions in the PICO(T) format. There are several potential questions that could be asked. Identify if the focus of your question is assessment, etiology, treatment, or prognosis. Remember to integrate references.

There are many possibilities for the research question. Make sure that you also Identify the focus of each question and explain WHY. Don’t forget to give the “P”, “I”, “C”, “O” AND T
You may want to review the lesson from Week One.

According to CCN 2017 week 1 lesson, evidence can form the basis of best practices for the nursing process (assessment, diagnosis, planning, implantation and evaluation). As we consider the who, what, where, when, why and how of the situation, we begin to formulate a clinical question that addresses these queries. The PICOT format is a way to develop a clinical question that leads itself to searching for evidence. PICOT is an acronym for:

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P= Population of interest

I= Intervention of interest

C= Comparison of interest

O= Outcome of interest

T Time

The case study of a 57 year old female with a 13 year history of diabetes who presented to the hospital due to failure of oral hypoglycemic agents (OHAs) in controlling her sugar levels, for the last 3 years, and was using biphasic insulin aspart 30/70 for treatment. She is a regular swimmer and socially very active, which led to her to have irregular meals and so often goes into frequent hypoglycemia. Her lifestyle, eating habits, and the use of biphasic insulin are the contributing factors of her uncontrolled diabetes and hypoglycemia. In addressing this case study, I will formulate the PICOT as follows:

NR 439 Assignment Role of Research and the Importance of the Searchable Clinical Question

P= 57 year old female with 13 years history of diabetes

I=Teaching regarding diabetic management

C=No teaching regarding diabetic management

O=Improvement in diabetic management and reduction of diabetic crisis

T=Daily monitoring of fasting blood-sugar and postprandial blood-sugar levels x 3 months and monitoring HA1C levels every 3 months. Assessment of knowledge about diabetic management.

Clinical question after PICOT format:

1. Etiology and assessment: Does lifestyle (irregular meals )and biphasic insulin aspart 30/70 causes hypoglycemia on the female.

Treatment and Prognosis: With lifestyle modification(regular meals), teaching on diabetic management and insulin degludec help in controlling the ladies diabetes by maintaining her blood-sugar levels and HA1C within normal limits?

References

CCN (2017). Week 1 Lesson. NR-439 RN Evidence-Based Practice. Online lesson. Downers Grove, IL: DeVry Education. Group.CCN (2016).

It is a very accurate observation you have made regarding the patient’s perspective of a liberated diet with the use of insulin, and I agree with you as I have seen this myself.

I have to say though, one of the endocrinologists that I work with almost, inadvertently, leads patients to practice this in that he has them count their carbs for every meal and give a sliding scale accordingly with any additional amount for every 25 mg/dl above 100 mg/dl reading in their blood sugar. I don’t think that is his intention because he still gives nutritional education and encourages limited, consistent carbs, but I can almost see that’s why they start to think that way.

This conversation has helped me to identify this trend and now I will be sure to implement in my diabetic education for my patients as we have many diabetic patients!!!

It is a very accurate observation you have made regarding the patient’s perspective of a liberated diet with the use of insulin, and I agree with you as I have seen this myself.

This conversation has helped me to identify this trend and now I will be sure to implement in my diabetic education for my patients as we have many diabetic patients!!!

“The PICO(T) format is a way to develop a clinical question that lends itself to searching for evidence. PICO(T) is an acronym for

P = population of interest

I = intervention of interest

C = comparison of interest

O = outcome of interest

T = time”. (Lesson, week 1)

“Research is used as evidence in the evaluation and determination of best nursing practices. Nurse researches use a variety of methods to generate new knowledge or summarize existing study results”. In one of the given scenarios, we will try to generate new knowledge about the effects of the new medication. (Houser. 2018).

I chose the scenario about a 6 year old boy.

P=a 6 year old type 1 diabetic boy.

I=Using the new medication-Degludec/injection tresiba.

C=Standard IV insulin basal bolus therapy.

O=The diabetes type 2 stable control was achieved, with no reported hypoglycemic reaction, and diet compliance was achieved.

T=3 months.

My question is in assessment. Assess if the new medication can control diabetes type 2 with no episodes of hypoglycemia for 3 months.

According to the text, a 6 year old type 1 diabetic boy experienced the side effects from the standard IV insulin basal bolus therapy that he is usually getting. According to S. Kumar. (2015) “Tight glycemic control in type 1 diabetes mellitus patients is associated with the risk of hypoglycemia”. The major side effect in this study, were two severe hypoglycemic reactions. The other inconveniences were frequent blood glucose monitoring, severe anxiety, depression and frustration of the client and his parents. Our assessment is based on the results that we get over the period of three months, after the client and his parents agree to start the new medication Degludec. As we can see, the client’s blood glucose level has become stable, client demonstrates diet compliance, no hypoglycemic reactions were reported over the period of three months. The client can monitor his blood sugar level only once a day. The client is happier in his life, no anxiety or depression were reported. We conclude that the new medication Degludec can definitely control diabetes type 2 with no episodes of hypoglycemia for at least three months.

References:

Chamberlain College of Nursing. (2017). Week 1: Introduction to Evidence-Based Practice: Basic concepts.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). The importance of research as evidence in nursing. What is nursing research? pp.5.

Kumar, S. (2015). Type 1 diabetes mellitus-common cases. Indian Journal of Endocrinology& Metabolism, 19, S76-S77. Retrieve fromhttp://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102354944&site=eds-liv

According to this week’s lesson, “Evidence can form the basis of the best practices for the nursing care process, including assessment diagnosis, planning, implementation, and evaluation” (CCN, 2016). Today, there is a push for better healthcare, better delivery, and better technology. Our profession is constantly looking for the best practice and look to Evidence Based Practice to guide us in the right direction. At my currently position I do not have a large hand in changing the care we deliver. As new ideas come across based on EBP our unit (L&D) take them to the manager for further review. These ideas are then passed to Perinatal Committee before being implemented into our unit.
Looking at the case study for this week evidence is gathered about Mary to provide the best practice for her nursing care. “Finding and developing significant problems for nursing research is critical to improving processes and outcomes for patients, nursing staff, organizations, and communities” (Houser p. 77). Clinical questions that could be asked regarding Mary’s case study would be:

Does physical activity and diet effect blood sugars in diabetic patients? This questions focuses on treatment ad prognosis. As nurses we are aware how diet and physical activity effects diabetic patients. This question can be used in reference to treatment and prognosis as an education tool for Mary and her risks in regards to her lifestyle choices.

P- Diabetic patients

I- Does diet and physical activity effect blood sugars

C- Diet and physical activity vs sedentary lifestyles in diabetic patients

O-Improve diet and physical activity to improve blood sugars in diabetic patients

T- No time noted.

For patients with co-morbidity does the use of discharge programs reduce the risk of hospital readmission rates compared to no discharge programs? This question focuses on treatment of Mary. Hospital discharge programs and f/u would potentially decrease hospital readmission by addressing s/s in a timely fashion and addressing additional educational needs.

P- Patients with co-morbidity

I- Does discharge programs decrease hospital readmission rates with patients with co-morbidity?

C-hospital readmission rates without discharge programs.

O- To decrease hospital readmission with hospital discharge programs and patient f/u.

T- No time noted.

References:

Chamberlain College of Nursing. (2017). NR439 Evidence- Based Practice: Week 1 Lesson. Downers Grove IL: Online Publication

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4^rd ed.).

According to this week’s lesson, “The movement to base practice on evidence began in the early 1990s and has become a worldwide standard not only for nursing but also for many other health disciplines” (Chamberlain, 2017). The use of extensive research to gather evidence in order to make decisions pertinent to patient care is the ultimate goal for successful patient outcomes. The acronym PICOT creates the frame for the question being researched.

P=Population

I= Intervention

C=Comparison

O= Outcome

T=Time

Using the case study of the 6 year old boy with Type-1 Diabetes Mellitus that has had two episodes of severe hypoglycemia and the need to check his blood sugar consistently, the question I would pose is, do the episodes of hypoglycemia decrease as well as the frequency of blood sugar checks with the use of dulgedec/injection tresiba?

The focus of this question is based on both assessment and treatment by researching the effectiveness of the injection to reach the ultimate patient goal of decreased episodes of hypoglycemia as well as a decrease in frequent glucose checks which seem to be a tremendous burden for both the patient and his parents. According to the Mayo Clinic, “Type 1 diabetes in children requires consistent care. But advances in blood sugar monitoring and insulin delivery have improved the daily management of the condition” (Mayoclinic. Com, 2017).

P= 6 Year old boy with classic features of diabetic ketoacidosis

I= Decrease episodes of severe hypoglycemia and frequent glucose checks

C= No change in amount of episodes of severe hypoglycemia

O= By using dulgedec/injection tresiba, the number of episodes of hypoglycemia and the frequency of daily glucose checks did/did not decrease

T= within a 3 month time span

References

Chamberlain College of Nursing. (2017). Week 1: Introduction to Evidence-Based Practice: Basic concepts Type 1 Diabetes in Children. Retrieved on July 5, 2017 from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/diagnosis-treatment/diagnosis/dxc-20311490Links to an external site.

NR 439 Assignment Role of Research and the Importance of the Searchable Clinical Question