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

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

NR 439 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:

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

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

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:

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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.

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!!!

I believe you are spot on with the importance of lifestyle modification.

Many times I have gone into give diabetic teaching and I hear, “I hardly eat anything.”, or “I only eat once a day.” “My sugars should not be that high”. These are serious problems. I see many times patients are busy or don’t have time to prepare or plan meals. That is a huge lifestyle change to manage.

We as a nation are spoiled with fast food, and although now the focus is shifted for them to have healthy selections, it is still easy to say, “oh, I guess I can have a small fry with it.” Even this is a lot of carbs and trans fat that should be avoided.

I focus on a meal plan for my patients that contains consistent carbs. We use the direction from our dietician on how many but usually it consists of at least four, fifteen gm carb, each day (60gm carb/day) so 1 carb with a meal and this keeps their urges at bay. It may be 1 slice of bread, or 1 small cookie, 1/2 cup mashed potatoes, etc… I think it helps to see what they can eat instead of hearing all that they can’t. They need to understand when you starve the body and they overload it is when they are most at danger, so eating nothing all day and then having a huge meal at the end of the day, puts them at increased risk for complication.

It is a hard habit to break. I am not diabetic but I am overweight and trying to lose weight with Nutri-System. It consists of 3 smalls meals a day, a shake, a snack and 4 servings of vegetables, and it is hard to plan all of that in a day, everyday.

“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