Discussion: Quantitative Research Studies
Nursing Practice Problem and PICOT
Diabetes is a chronic condition characterized by high levels of sugar in the blood. It is caused by the body’s inability to produce or properly use insulin, a hormone that regulates blood sugar levels. Diabetes mellitus has become a pressing and prevalent issue in recent decades, coinciding with the rise in obesity, and is now the seventh leading cause of death in the United States and worldwide, accounting for 5.2 million deaths (Glovaci et al., 2019). Diabetes is also a major risk factor for cardiovascular disease, which is the leading cause of death in people with diabetes.
Diabetes mellitus can be a significant practice problem for nurses because of its complexity, impact on quality of life, risk of complications, and the need for ongoing management and support for people with diabetes (Onishi et al., 2022). As a result, patients with diabetes require constant contact with healthcare providers to guide their treatment and help control their blood sugar levels. Additionally, the management of diabetes is a lifetime and requires multidisciplinary intervention and monitoring to prevent complications such as heart disease, stroke, kidney damage, and nerve damage. Nurses play an important role in educating patients on how to manage their diabetes through diet, exercise, and medication regimens, as well as monitoring blood sugar levels and administering insulin when necessary (O’Flynn, 2022). They also play a crucial role in identifying and managing diabetes-related complications. However, with the recent emergence of Covid-19, access to care for most patients was limited by directives that limited face-to-face care. Healthcare providers factored in some interventions including telemedicine to help in improving contact and continuity of care. This paper presents a research critique of two quantitative studies addressing telemedicine and diabetes.
The PICOT question: In diabetic patients with uncontrolled sugars (P), how does the use of telemedicine (I) compared to usual outpatient visits (C) on reducing blood sugar and HbA1C (O) during Covid 19 outbreak (T)?
Background of Studies
The need to improve care for patients with diabetes has resulted in various studies to avail evidence-based information on management. Telemedicine is one of the proposed interventions implemented during Covid-19 to help in reducing the spread of the virus while optimizing care for diabetic patients. The two quantitative studies by Onishi et al. (2022) and Wong et al. (2021) are examples of studies addressing telemedicine. The study by Onishi et al. (2022) aimed at comparing the effectiveness of either telemedicine or routine clinic visit on glycemic control as the main objective. The research question stated: how does care using telemedicine compared to clinic visits on glycemic control during the covid era? The primary outcomes were blood glucose levels, HbA1C levels, and body mass index. Similarly, Wong et al. (2021), shared the same broad objective as the aforementioned study. The research question stated: How does glycemic control differ between outpatient clinics and telehealth? This study provides more information required by nurses to make informed decisions about the type of care to give. Nurses can either use telehealth or clinic visits depending on the feasibility of either.
How Articles Support Nursing Practice Problems
Both studies by Onishi et al. (2022) and Wong et al. (2021) apply to the nursing practice problem and the PICOT question. My nursing problem addresses the management of diabetes and compares the effectiveness of telemedicine to the clinic visit. The broad objective of both studies compares the effectiveness of telehealth or face-to-face visits on glycemic control and long-term health outcomes of diabetes patients. Management of diabetes is a complex process comprising medication prescription, lifestyle modifications, monitoring, and education (O’Flynn, 2022). Healthcare providers use either clinic visits or telehealth to offer these various management techniques. The two studies provide evidence-based information regarding the effectiveness of telehealth in diabetes management. Nurses can use telehealth services such as web-based appointments, messaging, smartphone apps, or phone calls to converse with patients and offer appropriate care including education and monitoring glycemic levels for patients in remote settings (Wong et al., 2021). Using telehealth improves health outcomes, improve access to care, increase patient satisfaction, and reduce healthcare cost.
Methods of Studies
The quantitative studies presented used a different methodology. The study by Onishi et al. (2022) was a retrospective cohort study that compared pre-emergency and post-emergency HbA1C. Similarly, the study by Wong et al. (2021) was also a retrospective review study of patients with diabetes managed by telehealth consultation in Sydney. Retrospective studies are used to study cause-and-effect relationships between a disease and an outcome. The advantages of retrospective studies include being inexpensive, less time-consuming, and feasible. However, some limitations include bias and confounding variables, recall bias, and missing data.
Results of Studies
The study findings from the two studies, Onishi et al. (2022) and Wong et al. (2021) were relevant and relevant to nursing practice. The study by Onishi et al. (2022) that compared the effectiveness of telemedicine and standard clinic visit on glycemic control reported improved glycemic control for telemedicine and clinic visits independently. This study supports the integration of clinic visits and telemedicine in the management of chronic conditions including diabetes to improve glycemic control and health outcomes. Comparatively, Wong et al. (2021), reported improved glycemic control for telehealth to outpatient visits. Additionally, the number of consultations were higher when using telehealth compared to outpatient visit. This study emphasizes the importance of telehealth consultation in providing care for the management of diabetes during the crisis. Using telehealth enhances access to care, reduce cost, and improve health outcomes. Nurses and other healthcare providers should embrace feasible methods while offering care.
Ethical Considerations
Ethical principles guide every biomedical research to protect the participants from any harm or stress. The various ethical considerations include informed consent, privacy, confidentiality, the right to withdraw, and deception. Informed consent requires every participant to be informed about the risks and benefits of participating in research before agreeing to take part in a study voluntarily by signing off (Mardani et al., 2019)`. Of the two studies, informed consent was obtained by opt-out line in a study by Onishi et al. (2022) and approved by the Human Subjects Review Committee at the institute of medical science.
Privacy and confidentiality are other ethical principles applied in biomedical research. While privacy relates to an individual`s right to control access to their personal information, confidentiality relates to the extent to which the researcher protects the participant`s private information (Mardani et al., 2019). Privacy and confidentiality ensure the anonymity of participants. For instance, in the study by Wong et al. (2021), the confidentiality of participants was upheld. The data collected for the study included age, gender, type of diabetes, and ethnic background was collected from the electronic medical record while excluding the names and potential identifiers.
Conclusion
Management of diabetes is a nursing problem due to the complexity of the disease, complications, and life-long follow-up. Effective management requires collaboration between healthcare providers and patients for better health outcomes. The use of telemedicine has gained popularity in the healthcare system as supported by evidence from various articles. Telemedicine has been shown to improve glycemic control, and health outcomes, and reduce complications related to diabetes. Therefore, nurses and other healthcare providers are encouraged to adopt feasible methods to improve the health outcomes of patients.
References
Glovaci, D., Fan, W., & Wong, N. D. (2019). Epidemiology of diabetes mellitus and cardiovascular disease. Current Cardiology Reports, 21(4), 21. https://doi.org/10.1007/s11886-019-1107-y
Mardani, A., Nakhoda, M., Noruzi, A., & Shamsi Gooshki, E. (2019). Ethical considerations in the biomedical research: analysis of national biomedical research ethics guidelines in Iran. Journal of Medical Ethics and History of Medicine, 12, 4. https://doi.org/10.18502/jmehm.v12i4.767
O’Flynn, S. (2022). Nurses’ role in diabetes management and prevention in community care. British Journal of Community Nursing, 27(8), 374–376. https://doi.org/10.12968/bjcn.2022.27.8.374
Onishi, Y., Yoshida, Y., Takao, T., Tahara, T., Kikuchi, T., Kobori, T., Kubota, T., Shimmei, A., Iwamoto, M., & Kasuga, M. (2022). Diabetes management by either telemedicine or clinic visit improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan. Journal of Diabetes Investigation, 13(2), 386–390. https://doi.org/10.1111/jdi.13546
Wong, V. W., Wang, A., & Manoharan, M. (2021). Utilisation of telehealth for outpatient diabetes management during COVID-19 pandemic: how did the patients fare? Internal Medicine Journal, 51(12), 2021–2026. https://doi.org/10.1111/imj.15441