Module 4 Assignment: Investigating a Critical Practice Question Through a Literature Review
Module 4 Assignment: Investigating a Critical Practice Question Through a Literature Review
The advancement of nursing practices that prioritize patient safety, high-quality care, and effective use of resources is critical for the nursing and healthcare industries. The promotion of health and the implementation of interventions that address complications resulting from a variety of health issues are both areas in which nurses play an extremely important part. Over the past few years, the majority of states have reported an increase in the prevalence of non-communicable diseases. Diabetes and other chronic illnesses have placed a significant financial load on the public healthcare systems of the world.
The adoption of evidence-based interventions that combat the effects of diabetes is a responsibility that has been delegated to the nursing profession. They also work together with other medical professionals to ensure that patients with diabetes receive the best possible treatment and that the best possible outcomes are realized as a result of that care. As a result, the objective of this research is to conduct a literature review on the nursing interventions that are now accessible and that may be utilized in an effort to lower the prevalence of diabetes-related comorbidities. Additionally, the statistics that pertain to diabetes in the United States of America are investigated throughout the course of this study.
Statistics
One of the challenges that the United States faces right now in terms of public health is diabetes. The prevalence of the disease in the community is frightening, according to the numbers that are currently available. According to estimates provided by the Centers for Disease Control and Prevention (CDC), around 34.2 million persons in the United States were living with diabetes in 2018. A little over 10.5 percent of the population was afflicted with the disease. The aforementioned population included 34.1 million adults who were older than 18 years old as its primary component. The fact that 7.3 million adults in the United States do not realize they have diabetes is indicative of the poor level of awareness on diabetes that exists throughout the country. In recent years, there has been a discernible upward trend in the incidence of diabetes. As an illustration, the estimated prevalence of diabetes ranged from 9.5 percent between the years 1999 and 2002 and 12.0 percent between the years 2013 and 2016. In 2018, it was estimated that the incidence rate of diabetes was 6.9 per 1000 persons, with a high rate being noted in adults between the ages of 45 and 54 years old.
The incidence rate was highest in non-Hispanic blacks, which came in at 8.2 per 1000 people, followed by those of Hispanic origin, which came in at 9.7 per 1000 people, and then non-Hispanic whites, which came in at 5.0 per 1000 people (CDC, 2020). In the United States of America, diabetes is connected with a major burden. To begin, diabetes raises the likelihood of needing inpatient care as well as outpatient hospital visits. According to the statistics that was released by the CDC, persons who were over the age of 18 and had diabetes made 16 million trips to emergency rooms in 2016. Some 35,000 cases of hypoglycemia and 224 thousand cases of hyperglycemia were among the primary causes of diabetes. Patients who have diabetes are also more likely to have complications, such as diabetic foot, diabetic kidney disease, and eyesight loss. According to the data that is currently available, between 2013 and 2016, individuals who had diabetes and chronic renal disease made up 37.0% of the total population, with 24.9% of those individuals suffering from moderate to severe chronic disease. In 2018, it was also reported that the rate of vision disability owing to diabetes was 11.7 percent.
The danger of passing away as a result of diabetes is very significant. Diabetes, for instance, was classified as the seventh biggest cause of fatalities in the United States in the year 2017. The management of diabetes comes with significant financial burdens in the United States. For instance, the combined direct and indirect expenditures that were incurred in the United States in 2017 amounted to $327 billion. In 2017, the average cost of treating diabetes was $9601, which was a significant rise from the previous year’s figure of $8417. (ADA, 2021; CDC, 2020). According to the figures presented above, diabetes is a significant problem in public health that has to be addressed in the United States in order to improve the health and wellbeing of the general population.
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Examination of Nursing Procedures and Interventions
The growing incidence of diabetes in countries all over the world, including the United States, has resulted in an increased demand for nurses to take an active part in the diagnosis, treatment, and management of complications related to diabetes. As a result, nurses implement a variety of preventative measures and measures to lessen the likelihood of problems caused by diabetes. The research that is now available demonstrates that nurses play a wide variety of roles in aiding the proper treatment and avoidance of problems associated with diabetes. The teaching of patients stands out as the nursing profession’s most prominent contribution across the majority of studies. Historically, nurses have been recognized for playing roles that include educating patients and populations at risk about the origins of diabetes, risk factors associated with the disease, as well as preventative and management strategies. The population as a whole has been educated with the primary goal of increasing their level of awareness regarding the condition and the damage it can cause to one’s health.
Patients and populations at risk who receive health education are more likely to adopt healthy lifestyles and participate in behavioral interventions, which can decrease and prevent problems connected to diabetes (Daly et al., 2017). In the most recent few years, there has been a considerable surge in the number of studies that evaluate the effectiveness of nurse-led interventions to the effectiveness of the standard care in terms of improving the treatment results in diabetes and preventing complications. According to Daly et al. (2017), the primary goal of nurse-led interventions is to educate patients through either face-to-face or virtual interventions using electronic modes of contact, including the telephone. The goal of nurse-led interventions is to improve one or more of the primary risk factors that are associated with complications of diabetes. These interventions also aim to monitor blood tests, promote medication adherence, support patients in adopting healthy lifestyles, and titrate patients’ doses. Because nurse-led interventions are so beneficial, nurses may choose to use them as a means of lowering the risk of problems. For instance, the research carried out by Daly et al., (2017) revealed that nurse-led interventions were responsible for significant reductions in serum triglyceride and HbA1c levels, in addition to the cessation of smoking by diabetic patients.
The findings of the research conducted by Coppell et al. (2017) highlight the significance of nurse-led interventions in the reduction or elimination of diabetic complications. The purpose of this study was to determine whether or not a nursing-led nutrition intervention was beneficial in lowering the risk of progression in pre-diabetes and diabetic complications. When compared to the group that did not receive the intervention, those who received it lost an average of 1.3 kg of body weight during the course of the trial. The control group did not receive the intervention. Additionally, there was a notable decrease in both the patients’ waist circumference and their overall waist circumference, which resulted in a reduction in the patients’ risk for developing problems (Coppell et al., 2017). Dietary interventions that are nurse-led can therefore be implemented by nurses in order to decrease and avoid problems linked with diabetes.
The introduction of self-management programs to decrease and prevent complications in diabetic patients can also be led by nurses, who are in a unique position to do so. Patients diagnosed with diabetes need to engage in rigorous and ongoing self-management in addition to receiving regular medical attention in order to achieve the best possible outcomes from their treatment (Ajibade Olapeju & Salawu Rasidi, 2020). It is therefore vital that patients with diabetes be provided with self-care management interventions in order to imbue patients with the knowledge and skills that are needed to prevent and delay problems. Self-care management interventions may be found here. Education on self-management is also crucial for developing the abilities that will help patients to reinforce and maintain the important coping skills for the prevention of complications. This is because patients who are able to do so are less likely to experience difficulties (Subramanian et al., 2020). Therefore, in order to enhance treatment results and prevent complications in diabetic patients, nurse-led interventions on self-management should be introduced. Studies have demonstrated that instruction on self-management that is led by nurses is beneficial in reducing the risk of problems arising from diabetes.
According to the findings of a study that was conducted by Azami et al., (2018), nurse-led education on self-management was linked with a significant improvement in blood pressure, HbA1c, body weight, efficacy expectation, and adoption of self-management practices for diabetes patients. According to the findings of the research conducted by Nayeri and colleagues (2020), nurse-led education on self-management led to improvements in both the quality of care provided and HbA1c levels. Because of these advancements, the burden of the disease in diabetes individuals who have foot problems has been significantly reduced. According to the findings of the study that was conducted by Ajibade Olapeju and Salawu Rasidi (2020), nurse-led interventions on self-management were associated with improvements in knowledge and abilities about self-monitoring of blood glucose as well as foot care.
Similar findings were found in the research conducted by Subramanian et al., (2020), which showed that nurse-led interventions on self-management led to improvements in patients’ levels of self-efficacy, fasting blood sugar, and post-prandial blood sugar. The expected prevention and reduction in the danger and rate of complications in diabetes individuals was the effect of this action. It is also possible for nurses to work together with other medical professionals in an effort to lessen the likelihood of complications occurring in diabetic patients and to avoid their occurrence altogether. As a result, nurses are able to collaborate with other healthcare professionals, such as physicians, nutritionists, and counselors, to give patients with diabetes with care that is efficient, of high quality, and risk-free (Saint-Pierre et al., 2018). It is possible for nurses to collaborate with nutritionists in order to educate diabetes patients and provide support in their efforts to adopt dietary treatments that reduce the risk of complications associated with the disease.
They are also able to collaborate with professionals in the field of physical activity to assist patients in engaging in activities that will impede the advancement of diabetes and the onset of its consequences (Szafran et al., 2019). It has been demonstrated that the use of multidisciplinary teams in the management of diabetes is effective in maximizing the outcomes of care. The investigation of patient-tailored therapies that are beneficial to patients’ health is another responsibility of multidisciplinary teams. A doctor-nurse collaboration model was shown to be highly beneficial in a study conducted by Ru et al., (2021), which aimed to prevent and reduce the risk of complications that are associated with diabetes in patients. The findings of the study demonstrated that the utilization of the doctor-nurse collaboration model resulted in enhancements to patient comfort, reductions in the incidence of complications, and shorter lengths of hospital stays for diabetic patients who suffered from diabetic foot and renal failure (Ru et al., 2021). The study that was conducted by Wan et al., (2018) demonstrated that multidisciplinary teams are essential to the process of minimizing the likelihood of complications and preventing their occurrence. Greater reductions in the risk and rate of cardiovascular disease, micro-vascular complications, and mortality were related with the utilization of a risk assessment and management program that incorporated a multidisciplinary approach. There were also improvements in the costs of managing diabetes, as evidenced by the reduction in the rate of specialist attendance, emergency attendance, and hospitalizations in patients with diabetes.
This reduction in the rate of diabetes-related complications was one of the factors that contributed to the improvement in diabetes-related costs. As a result, nurses can utilize interventions from other disciplines in order to lessen and possibly avoid the consequences that are linked with diabetes. Adopting interventions that aim at boosting the psychological health and welfare of patients is another way in which nurses can help lower the risk of problems associated with diabetes. Patients who have diabetes have a far higher risk of experiencing non-specific emotional discomfort, which can negatively impact not just their health but also their quality of life (Kalra et al., 2018). Diabetes distress is defined by concealed concerns, frustrations, and worries, and it is something that individuals with diabetes encounter when managing and living with diabetes on a regular basis. Emotional anguish is one of the reasons of diabetes distress.
Patients who suffer from diabetes distress are more likely to develop complications as a result of poor glucose control and a lack of involvement in lifestyle and behavioral therapies that can decrease and prevent the course of illness (Schmidt et al., 2018; Vileikyte et al., 2020). The body of research that has been conducted thus far demonstrates that psychosocial therapies are helpful in lowering and even eliminating the risk of complications in diabetic patients. Psychosocial therapies have been shown to be beneficial in lowering the levels of diabetic distress as well as HbA1c, according to the findings of a systematic review that was carried out by Schmidt et al., (2018). It was observed that the improvements also increased the number of patients who participated in self-management programs, which helped to lower the risk of complications associated with diabetes.
Whitehead et al., (2017) observed similar findings in their research where the use of nurse-led cognitive behavioral therapy in diabetes was connected with the reduction in the levels of HbA1c as well as the quality of life in patients who had diabetes. [Citation needed] A reduction in the risk of depression, premature death, and poor medication adherence, all of which can raise the risk of complications in diabetes, is one of the extra benefits that can be realized through the use of psychosocial therapies (Vileikyte et al., 2020). Therefore, nurses caring for diabetic patients should investigate the possibility of utilizing psychosocial therapies in order to improve treatment outcomes while also lowering the risk of developing complications.
Conclusion
In a nutshell, diabetes is one of the most significant problems facing the public’s health not only in America but also in the US. Diabetes is linked to negative health outcomes, some of which include problems that lower patients’ overall quality of life. As a result of an increased number of hospital visits, hospitalizations, and calls to emergency services, diabetes is also associated with a rise in healthcare expenses. The prevention of problems caused by diabetes is one of the most important responsibilities that nurses have. Interventions that have been shown to be effective in preventing and lowering the risk of complications in diabetes patients are implemented by nurses. As a result, the importance of the problem posed by diabetes and the nursing strategies that may be used to reduce the risk of complications have been brought to light by this review.
Critical Assessment
Medical personnel play a key role in ensuring that patients get the best treatment and disease management services available. Therefore, it is their ethical, moral, and professional obligation and responsibility to ensure that the services they offer meet the expected standards of care. In addition, such services need to meet patients’ needs and lead to patient satisfaction. Therefore there is always a need to ensure that these medical personnel are well trained and on a frequent basis to focus better on various aspects of care and improve care outcomes (Xu & Wenhu, 2021). The training is also key to preparing medical personnel for interdisciplinary care, as disciplinary care has been shown to effectively improve patient outcomes. The need for training the medical personnel may mean that a practice change is undertaken. Therefore, the purpose of this assignment is to formulate a critical assessment of the search outcomes that synthesizes the evidence from the literature review performed.
The Research Question and The Search Conducted
It was important to formulate a research question to guide the literature search and analysis. Therefore, the research question formulated was: Can the medical personnel be trained to effectively facilitate interdisciplinary care, resulting in exceptional patient-centered care and fewer emergency room or hospital readmissions? In an effort to answer this research question and explore suitable evidence that can inform practice change, a comprehensive literature search was conducted. Various databases were instrumental in obtaining the relevant articles. They include google scholar, the Cochrane Database of Systematic Reviews, Ovid, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medline. Suitable keywords were used to retrieve the articles, and only articles published in the last five years were included for synthesis.
Critical Assessment of Search Outcomes
Critical assessment and evidence synthesis is a comprehensive process that can be used to guide the project implementers into finding the best evidence, which can then be used to introduce a practice change. One of the things which informed the formulation of the research question is the need to offer exceptional patient-centered care, fewer emergency room visits, and hospital readmissions. It is important to note that various problems were noticed at the practice site, such as increased rates of emergency room use or visit and higher incidences of hospital readmissions which lead to other undesirable problems among the patient population. Therefore, the literature search for relevant evidence yielded several articles, which were reviewed in the literature review part.
According to Fortin et al.(2021), training of medical personnel led to improved patient outcomes. The researchers engaged in training various medical personnel, such as nurses, nutritionists, and kinesiologists, to offer specific patient care to patients through interdisciplinary care for multimorbidity. Through their efforts, the patients were able to increasingly engage in health behaviors such as the use of appropriate nutrition and engaging in physical exercise.
The focus of this research was also similar to the report by Uslu-Sahan et al. (2020), which also focused on the interprofessional aspects of care. This study entailed an exploration of the impact of interprofessional simulation-based training in gynecologic oncology palliative care. Such interprofessional simulation-based training led to the participants acquiring improved teamwork attitudes, interdisciplinary perception, and palliative care knowledge, which are considered as important to improved patient-centered care and other patient outcomes. Therefore, these two studies show the importance of training medical personnel to offer effective patient care.
Another source of evidence for the practice change was provided by the article published by Jeon et al.(2020). This study was conducted with the major aim of assessing the effectiveness and feasibility of an interdisciplinary home-based program that integrates various evidence-based strategies and cognitive rehabilitation strategies for dementia intervention. The strategies were used by various medical personnel, such as psychologists, occupational therapists, and registered nurses.
The efforts made by these professionals led to notable improvements. For example, the patients showed improved functional dependence as well as physical functioning. Therefore, similar to the work reported by Fortin et al.(2021), this source also entails an interdisciplinary approach where various professionals were trained to offer the intervention. It is worth noting that this intervention also led to various improvements, which further underlined the suitability of this evidence as well the possibility of using the findings to inform practice change.
The report by Liu et al.(2023) also focused on improving outcomes among the geriatric population. The researchers focused on using a multidisciplinary treatment approach led by nurses. The team was offered adequate training to help focus on offering care that would help reduce the rates of unplanned readmission among this group of patients and improve independence in activities of daily living. Therefore this is another source that offered high-quality evidence and level I evidence as it was a randomized controlled trial. As such, the strategies used in this research can be used to inform practice change and drive the same change.
Similarly, Schapira et al. (2022) also focused on the geriatric population, where they managed to use an interdisciplinary care approach to improve various care outcomes. For instance, the use of this approach led to a substantial reduction in hospital readmissions and emergency room visits among frail elderly adults, hence highlighting the importance of training the medical personnel to offer the needed or required care.
In another source of evidence, Spies et al. (2023) also conducted a study to explore the effectiveness of a program run by trained medical personnel. The intervention was based on a telehealth program to improve process quality. Therefore, medical personnel were offered adequate training to offer care efforts that would enhance the patient’s ability to access care. As such, upon the use of the intervention, the researchers noted that the patients had improved quality indicators, especially those connected to delirium. The patients were capable of weaning from ventilation faster and engaged in earlier mobilization. As such, this is another piece of evidence that can be used to trigger practice change as appropriate.
This study is similar to the study conducted by Yan et al. (2022), which also focused on quality of life as part of the major aims. The study was conducted with the aim of exploring the impact made by a trained multidisciplinary team in the management of cardiovascular hospitalizations and quality of life among patients hospitalized with atrial fibrillation. Upon the use of the intervention, the researchers observed that the patients randomized into the intervention group reported fewer cases of cardiovascular hospitalizations. In addition, the patients also showed a general improvement in their quality of life which also underlined the importance of the trained multidisciplinary team composed of various medical personnel.
As opposed to all the evidence synthesized so far, the evidence reported by Lewis et al. (2019) is level II evidence, though it offers high-quality evidence as it is a systematic review. This source focused on training done to nurses using simulation methods to help them be more competent in offering patient care services. The sources showed that the trained nurses were able to help the patient have better clinical patient safety outcomes. In addition, the patients showed improvement in the symptoms related to respiratory failure, which further showed the importance of the trained medical personnel. Some of the reviewed sources also showed improvement in terms of reduced cases of the development of pressure ulcers. In terms of similarity of evidence, this evidence source dealt with various care outcomes similar to the findings of Schapira et al. (2022) and Liu et al.(2023), which both focused on the readmission rates among patients upon the use of patient care services offered by trained medical personnel.
According to the evidence provided by Cheung et al. (2021), training medical personnel on various aspects, such as communication skills, can go a long way toward promoting interdisciplinary collaboration among medical personnel to help advance care planning and care outcomes in palliative care among patients on dialysis. Therefore, this study focused on exploring the impact of using trained nurses and social workers to offer the needed care to this patient population. It is worth noting that, according to this source, training the medical personnel led to improvements in various aspects, such as improved empathetic behaviors, effective response to the end of life, and emotional concerns, which all played a critical role in improving patient outcomes.
The approach and findings are also corroborated by another study conducted by Strauven et al. (2019), which also focused on improving patient outcomes related to the offered prescription. Therefore, as part of this research effort, the medical personnel was trained on various aspects of patient care to deliver multifaceted interventions focusing on improving prescriptions. Therefore, upon using this approach, the patients showed improved outcomes and reported better life quality. It is evident that the synthesized evidence was all relevant to the research question. Every single source showed that training the medical personnel involved in the patient care aspects was key to the improvement of patient outcomes.
The Evidence Appraisal
As part of the critical assessment, it is important to review the quality appraisal of the individual pieces of evidence and integrate consistencies in the findings. In addition, it is important to evaluate the meaning and relevance of the findings. Therefore, a total of ten articles were reviewed during the literature review exercise. Out of the ten articles, eight of them were randomized controlled trials, while the two remaining ones were a systematic review and a source that applied a mixed study approach. Therefore, it is important to note that the majority of the articles were level I evidence as they were randomized controlled trials which are considered a golden standard for evidence and evidence-based practice. The implication is that there is greater confidence in recommending the practice change, which in this case has coming up with modalities to train the medical personnel which can offer appropriate patient care practices to reduce the rates of hospital readmissions and reduce the incidences of emergency room visits.
As earlier indicated, all the articles were either level I or II. In addition, in terms of quality, the sources reviewed were also of high quality since they were consistent and generalizable results. In addition, all of the articles had a sufficient sample size for the study design, except for one article authored by Jeon et al.(2020), which considered only eighteen participants. The reviewed articles also had consistent recommendations, basing their recommendations on a comprehensive literature review, including appropriate references to scientific evidence. For example, Schapira et al. (2022) recommended that their intervention be tried or used in institutions that use standards of usual care since their intervention show effectiveness even in environments with no standards of care. The reviewed articles also had definitive conclusions which stated the general findings and potential implications for practice. In all the cases, the conclusions are in line with the research question, which further shows the quality and credibility of the sources used.
The reviewed literature also presented notable consistency in the findings. For example, all the sources reported the importance of training medical personnel to offer better patient care in various settings. The consistency observed in the findings reported by these sources is an indication that these sources can be used to appropriately inform a change in practice. The absence of levels III, IV, and V is also an indication that the proposed practice change should be accomplished as the levels I and II presented are considered the best and the highest levels of evidence.
Even though the findings had so many consistencies, there were also inconsistencies noted, which should be taken into consideration when using the evidence presented to inform a practice change. For example, the sources presented greatly varied training strategies, with others reporting simulation-based strategies while others reported traditional types of training such as following various protocols to train the medical personnel or communication. Therefore, as part of the recommendation, the training methods which produce the best outcomes should be adopted in training the medical personnel to help offer the needed care.
Conclusion
There is a need to continuously train medical personnel regarding various care aspects to help them offer the level of care needed to improve patient outcomes, carry out patient-centered care, reduce cases of emergency department visits and reduce the cases of hospital readmissions. The synthesized evidence shows that a practice change can be successful since the majority of the evidence are level I. In addition, the evidence presented in these articles is also of high quality.
References
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