NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
Grand Canyon University NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission– Step-By-Step Guide
This guide will demonstrate how to complete the Grand Canyon University NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
Whether one passes or fails an academic assignment such as the Grand Canyon University NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
The introduction for the Grand Canyon University NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
After the introduction, move into the main part of the NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
The attainment of patient safety requires nurses and other healthcare providers to establish interventions that will enhance quality care and minimize adverse events like hospital acquired infections (HAIs). Nurses must apply and leverage existing evidence-based practice interventions that include hand hygiene protocols and measures like handwashing with soap and water alongside sanitizers in the prevention and mitigation of hospital acquired infections (HAIs). Hospital acquired infections constitute a significant part of mortality and morbidity as well as poor patient outcomes and increased cost burden of care. The purpose of this paper is to offer a literature review of the articles that support the PICOT statement on using handwashing with soap and water alongside sanitizer compared to handwashing with soap and water alone to reduce hospital acquired infections among healthcare workers in a period of six months. The paper addresses the search methods used in review of literature, synthesizes relevant articles based on the PICOT question, compares the articles and makes suggestions for future research on ways to mitigate hospital acquired infections.
Among healthcare workers in different settings (P), how does hand hygiene practices like handwashing with soap and water alongside using hand sanitizer (I), compared to handwashing with soap and water alone (C), reduce hospital acquired infections (O), within six months (T)?
Search Methods
Effective search for articles entails using appropriate approaches and terms. In this case, I used the university library to get to the databases of journals and their published peer reviewed articles. Using terms like peer review and scholarly works on hospital acquired infections (HAIs), I got the articles that I will be analyzing in this paper. I ensured that these articles have been published in the last five years and were relevant to nursing use and content. I also ensure that they were on the aspects in my PICOT question and statement and supported my EBP project.
Synthesis of Literature
Article 1
The first article by Ni et al. (2020) explores an intervention project on hand hygiene improvement in a large healthcare facility in China. The objective of the article is to investigate the importance of implementing a hand hygiene initiative among healthcare workers to reduce and prevent hospital acquired infections. Using a qualitative design, the authors provide a summary of the effectiveness of the implementation of the hand hygiene measures in a 2500-bed teaching hospital. The findings from the study emphasizes the significance of implementing evidence-based practice interventions to prevent infections and enhance patient safety. The article recommends having handwashing measures that will reduce infections by healthcare workers. The article supports the PICOT as it explores the benefits of using translational research to implement hand hygiene measures. The article also supports the project by providing insightful information about the effectiveness of hand hygiene measures by healthcare workers in different settings.
Article 2
The second article is by Setty et al. (2019) on adapting translational research methods in water, sanitation and hygiene. The goal if the
study was to delineate existing translational research principles from different professions that include healthcare workers on the importance of applying the interventions in care practice. The authors use a narrative review approach to suggest interventions that can improve hand hygiene. The findings from the article demonstrate the need for increased hand hygiene measures in hospitals and other health settings to reduce infections and enhance patient safety. The article supports the PICOT by illustrating the importance of using translational research approaches in improving hand hygiene measures in healthcare. The article will also support the project by enhancing effective understanding of different approaches to hand hygiene in multiple settings.
Article 3
The article by Zhao et al. (2017) discusses the need to make hand hygiene interventions more attractive to nurses. Using a discrete choice experiment, the authors’ aim is to improve understanding about the kind of interventions that can make nurses embrace effective hand hygiene measures. Conducted in three tertiary settings where 200 nurses participated, the study shows that healthcare providers can develop effective interventions that attract these professionals to embrace handwashing. Outlining five different interventions, the authors show that with better training and awareness, nurses can make better decisions and take effective actions to prevent hospital acquired infections. The article supports the PICOT by giving more information on different approaches that nurses can use to prevent hospital acquired infections within a certain period.
Article 4
The by Staniford et al. (2020) is a systematic review of hand hygiene and environmental-disinfection interventions to improve hygiene in children’s settings. The authors identify interventions like behavioral change as essential in enhancing hand hygiene measures in these settings. The findings show that these interventions are effective and supported by research. The article supports the PICOT as it demonstrates the need to integrate research-supported interventions in hand hygiene. The article also supports the need to use different approaches focused on health populations like nurses.
Article 5
The fifth article is by Moura et al. (2017) who explore the use of translational research in attaining hand hygiene compliance. The authors discuss interventions that support hand hygiene measures, especially in healthcare setting in low-income areas and regions. The findings from the study show that most of the interventions reviewed are effective in supporting hand hygiene measures and preventing hospital acquired infections. The article supports the EBP project by illustrating the significance of hand hygiene compliance among healthcare workers. The article supports the PICOT by offering more insightful view of interventions like handwashing with soap and water alongside sanitizer. The article shows that compared to no interventions, these strategies have the potential to improve care delivery.
Article 6
The article by Hillier (2020) is about effective use of hand hygiene practices to prevent and control infections. The aim of the study was to demonstrate to nurses and other healthcare workers correct procedure required for effective hand hygiene. The author also emphasizes the importance of nurses having current knowledge on evidence-based guidelines like increased use of sanitizers alongside washing hands with soap and water. The findings show that the use of hand hygiene measures and guideline is critical for healthcare workers to control and stop the spread of emerging diseases like the Coronavirus disease of 2019 (COVID-19). The study supports the PICOT since it shows that evidence-based interventions can increase compliance to hand hygiene measures among nurses and other healthcare workers.
Article 7
The seventh article by Akanji et al. (2017) is about the effectiveness of instituting formal hand hygiene education and feedback on compliance to hand hygiene standards by nurses to reduce and prevent hospital acquired infections. The aim of the study was to synthesize evidence to show the effective use of formal hand hygiene. In their findings, the authors assert the need for increased engagement of nurses to provide feedback on the most appropriate interventions to enhance hand hygiene measures and reduce and prevent HAIs. The article is important since it offers more insight on some of the protocols and measures that healthcare workers can use like using sanitizers alongside soap and water in handwashing.
Article 8
In their study, Azar et al. (2017) explore the use of agile implementation model in reducing central line-associated bloodstream infections (CLABIs) which are some the leading types of HAIs. The objective of the study is show how healthcare providers can use agile methodology to reduce and prevent CLABIs. Their finding indicate that healthcare workers can use agile model to reduce HAIs. The article supports the PICOT as illustrates the various interventions that healthcare workers can execute to prevent and reduce possible catheter-line infections which are common among the HAIs. The article allows for the development of translational approaches to improve quality care delivery.
Comparison of the Articles
The articles share a common aspect that entails approaches to reducing and preventing the occurrence of HAIs. The articles are also similar because their focus is to enhance patient safety and improve the quality of care. The articles also emphasize the need for healthcare workers to apply evidence-based interventions in mitigating hospital acquired infections. A majority of the articles use systematic reviews to show the various interventions based on evidence that can enhance quality care and lead to reduced chances of adverse medical events. A systematic review allows one to assess evidence from multiple sources to attain validity and reliability of their findings. The articles also have similarities as they make effective review of literature to demonstrate that HAIs are a public health concern but healthcare workers, particularly nurses, can develop EBP measures to enhance hand hygiene practices and embrace effective interventions. The articles share a common aspect of hand hygiene and other associated components that can lead to a reduction of HAIs).
The main themes of the article include hygiene, handwashing, need for patient safety and use of translational research and evidence-based project interventions for improved patient care and quality. The articles use different methods as some are systematic reviews while others are primary studies on their respective subjects. The articles have a common conclusion that stakeholders should develop more interventions to reduce and prevent HAIs, especially the use of evidence-based practice interventions. Each article has its unique limitations. However, a majority identify the need for more resources for better research studies in the future on how to prevent HAIs. No controversies exist in the article as in each, the researchers followed set guidelines to enhance validity and reliability of their findings.
Suggestion for Future Research
Based on the review and analysis of the literature, it is evident that more studies should be conducted to evaluate the effectiveness of hand hygiene measures like handwashing with soap and water alone or with sanitizer. Gaps in effective research demonstrating the relationship between enhanced hand hygiene measures and poor patient information is essential in demonstrating the need for all stakeholders to adhere to hand hygiene measures and not just healthcare workers alone.
Conclusion
Hospital acquired infections (HAIs) remain a patient safety concern that impacts quality care and safety, especially for inpatient patients in different health care settings. While nurses play a critical role in care delivery, they should not be the only professionals required to improve their hand hygiene measures to reduce and prevent HAIs. The findings show that nurse practitioners and other healthcare workers can prevent and reduce HAIs through effective use of EBP interventions on hand hygiene. The articles demonstrate the need for improved care quality for better patient outcomes.
References
Akanji, J., Walker, J. &Christian, R. (2017). Effectiveness of formal hand hygiene education and
feedback on healthcare workers’ hand hygiene compliance and hospital-associated. JBI Database System Review and Implementation Repository, 15(5): 1272-1279. doi: 10.11124/JBISRIR-2016-003019.
Azar, J., Kelley, K., Dunscomb, J., Perkins, A., Wang, Y., Beeler, C., … & Boustani, M. (2017).
Using the agile implementation model to reduce central line-associated bloodstream infections. American journal of infection control, 47(1), 33-37. doi: 10.1016/j.ajic.2018.07.008.
Hillier, M. D. (2020). Using effective hand hygiene practice to prevent and control infection.
Nursing Standard. doi: 10.7748/ns.2020.e11552
Moura, M. L., Fenley, J., Baraldi, M. & Boszozowski, I. (2017). Translational Research in Hand
Hygiene. Current Treatment Options in Infectious Diseases, 7(1). DOI:10.1007/s40506-015-0041-9
Ni, L., Wang, Q., Wang, F., Ni, Z., Zhang, S., Zhong, Z., & Chen, Z. (2020). An interventional
implementation project: hand hygiene improvement. Annals of Translational Medicine, 8(18). doi: 10.21037/atm-20-5480
Setty, K., Cronk, R., George, S., Anderson, D., O’Flaherty, G., & Bartram, J. (2019). Adapting
translational research methods to water, sanitation, and hygiene. International journal of environmental research and public health, 16(20), 4049. https://doi.org/10.3390/ijerph16204049
Staniford, L. J. & Schmidtke, K. A. (2020). A systematic review of hand-hygiene and
environmental-disinfection interventions in settings with children. BMC Public Health, 20(195). https://doi.org/10.1186/s12889-020-8301-0
Zhao, Q., Yang, M. M., Huang, Y. Y. & Chen, W. (2017). How to make hand hygiene
interventions more attractive to nurses: A discrete choice experiment. PLoS ONE 13(8): e0202014. https://doi.org/10.1371/journal.pone.0202014
Sample Answer 2 for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
Patient safety and improved quality of care requires providers and organization to use evidence-based practice (EBP) interventions to tackle issues that may cause adverse events like patient falls. Patients in medical-surgical units are susceptible to falls because of their delicate nature. The Centers for Medicare and Medicaid Services (CMS) considers falls as never events since they are preventable (Melnyk et al., 2022). Falls lead to increased stay in hospitals, poor patient outcome and serious fractures and head injuries that can lead to death. The use of bundled care approach through TIPS (tailoring interventions for patient safety) is considered one of the most effective ways to reduce and prevent falls in medical-surgical settings. The purpose of this literature review paper of the EBP project is to compare articles on the use of TIPS toolkit to reduce and prevent falls in medical-surgical settings.
PICOT Statement and Question
Nationwide, patient falls while in hospitals, particularly in medical-surgical units, are a leading cause of permanent disability and even death. Further, hospitalization increases one’s fall risk as close to three percent of patients fall while in hospitals. Nearly 30% of those who experience falls sustain injuries with a rise in the number of days in hospitals by close to 7 days. Again, under Medicare, the CMS does not reimburse falls and hospitals cannot get a Magnet designation when their fall rates are not below the national average (Khasnabish et al., 2020). The implication is that hospital managers and leaders must seek ways, through the use of evidence-based practice, to reduce the occurrence of falls. The use of TIPS toolkit is considered one of the most effective ways to reduce and mitigate falls and their occurrences as well as effects on patients in medical-surgical units.
PICOT Question
Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?
Search Methods
The evidence-based practice process implores researchers to seek evidence from previous research articles when doing their literature to obtain findings that support their proposed projects or interventions. The use terms, phrases and words associated with the topic under investigation and exploring databases to generate scholarly sources are some of the standard search strategies that one can deploy to attain relevant evidence. The study employed these strategies, starting with key terms and words in different databases. These included PubMed, Cochrane and Google Scholar as well as CINAHL. The strategy also entailed the use of CRAAP approach that involves searching for articles which are current, relevant, accurate, authoritative and purposeful to the area or topic under investigations (Melnyk et al., 2022). Using this criteria, the paper identified the reviewed articles and describes how they support the proposed EBP project to reduce and prevent the occurrence of falls in medical-surgical settings.
Research Synthesis
Article 1
The first article by Dykes et al. (2020) evaluates the use of a patient-centered fall prevention TIPS to lower falls and their associated injuries. Using non-randomized controlled trials with the study set in 14 medical units in Boston and New York, the researchers show a positive link between the intervention and a decline in number of falls. The researchers are categorical that nurse-led interventions can reduce injurious falls through providing information to families on fall management and prevention. The article demonstrates the efficacy of using TIPS as an intervention as depicted by the PICOT question.
Article 2
The second article by Tzeng et al. (2021) focuses on the impact of using TIPS program in reducing falls among older adults in nursing homes. Using a mixed method approach in a 15-bed nursing unit, the findings from the study shows that fall TIPS can reduce the rate of falls, especially injurious falls among older patients or adults. The TIPS program entails different approaches that include patient education and creating awareness about the harmful effects of falls. The article is critical to the EBP proposed project as it illustrates the increased role of TIPS initiative to reduce falls as depicted in the PICOT question. The article supports the EBP project since it shows that TIPS as an intervention is effective.
Article 3
In this article by Morris et al. (2022) the researchers conduct a systematic review of literature and meta-analysis on diverse interventions that can reduce falls. The researchers identify a host of interventions based on the data collected from the 43 studies that met their inclusion criteria. The findings show that tailoring or customization of interventions leads to reduced rates of falls for patients in such facilities. These interventions are effective when they consider the different components and factors impacting patient situations. As such, the article supports the EBP proposed project by demonstrating the effectiveness of diverse and tailored interventions for patients based on their level of acuity.
Article 4
The fourth article by Heng et al. (2020) is a scoping review of how hospitals can use patient education as a strategy to prevent falls. The researchers focused on 43 articles when analyzing the different approaches in patient education that confer benefits to patients to reduce their susceptibility to falls. The analysis shows that patient educational interventions can reduce falls that lead to injuries and bruises as well as lacerations and fractures. The study recommends the need to deploy TIPS as an effective approach to reducing and mitigating falls among patients. The article supports the EBP proposed project as it shows the need for diverse interventions like different approaches to educating patients on fall risks that they may be exposed to in their activities of daily living.
Article 5
In their article, LeLaurin et al. (201) aim at familiarizing different stakeholders about the benefits as well as the cons of various types of research studies on testing fall prevention interventions. The researchers opine that organizations and providers should focus on diverse interventions, one point at a time, to attain their efficacy and impact on patient fall management. The study’s findings are categorical that the effectiveness of each type of interventions depends on a host of factors. Therefore, customizing or tailoring these interventions is essential to attaining quality outcomes and helping patients avoid and reduce their susceptibility to falls. The article is important in the EBP project as it shows the need for tailoring each intervention to suit patient needs and situations.
Article 6
The article by Dykes et al. (2019) focuses on the effectiveness of tailoring interventions through a collaborative approach among providers. Using a qualitative approach or design, the article demonstrates that fall TIPS program is effective in reducing and preventing falls in diverse patient settings. The study is emphatic that TIPS model is important for providers to reduce and prevent falls. The article supports the EBP proposed project as it illustrates the importance of customizing interventions to meet patient needs and reduce susceptibility to falls.
Article 7
In this article by Cuttloer et al. (2018), the researchers aim at reducing inpatient falls in medical-surgical settings through technology-enabled TIPS initiative. The researchers use a four-minute video to provide patient education and collect their views on the implementation based on their situation. The findings are consistent that TIPS initiatives reduce and prevent falls. Therefore, the article supports the EBP project by showing that tailoring interventions is essential in addressing patient falls in medical-surgical settings.
Article 8
In their study, Bargmann et al. (2020) evaluates the effects of implementing a multicomponent fall prevention program to improve patient safety because of risks associated with falls. Set in a 26-bed medical surgical telemetry unit, the study shows that these interventions are effective in reducing falls and risks associated with falling for fragile patients. The article supports the EBP project since it is categorical that TIPS model reduce and prevents the occurrence of falls.
Comparison of the Articles
The reviewed articles share certain aspects in their research findings and also differ in other areas. for instance, all the articles agree that tailoring interventions on falls is an effective strategy that all providers and facilities should leverage in their settings. Again, the article agree that the TIPS model gives hospitals and providers increased leeway to implement interventions that are appropriate to their facilities based on their cost and other components. Thirdly, all the articles demonstrate that multiple interventions are complementary to the efforts and policies developed by organizations to reduce and prevent falls in their articles.
None of the article demonstrates controversies but all agree conclusively that more studies are required to provide significant outcomes. The articles also share limitations like timelines to conduct the studies, use of same settings and need for beet support from management and other stakeholders (Khasnabish et al., 2020). The articles do not have significant differences as they are emphatic that these diverse interventions are necessary in reducing falls, especially injurious falls among older patients.
Suggestions for Future Research
An analytical perspective of the eight articles and others demonstrate the need for more research to tackle some of the gaps. For instance, the articles do not offer a standard TIPS approach that can be used across all facilities, irrespective of their patient’s acuity and needs. As such, it is important to have more studies on the development of a standardized tool or approach to falls based on the nature of the respective setting, from medical-surgical units to outpatient facilities.
Conclusion
Falls are a major health issue that impact overall quality of care and life for patients, especially the elderly admitted to medical-surgical units. The use of TIPS toolkit; either patient-centered or nurse-driven, is critical to reducing these falls because of their adverse effects like injuries and long-term fractures and disabilities. The articles are emphatic that using TIPS allows providers to offer the most effective interventions to reduce and prevent their occurrence. The review illustrates that sufficient evidence exists to support the proposed interventions based on the TIPS framework to reduce falls.
References
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall
prevention program: Contracting with patients for fall safety. Military medicine, 185(Supplement_2), 28-34. https://doi.org/10.1093/milmed/usz411
Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2018). Reducing medical-surgical inpatient falls and
injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119.
DOI: 10.1136/bmjoq-2017-000119
Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.
- (2019). The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls. Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros,
- E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889. https://doi.org/10
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital
falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w
Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best
practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the
science. Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007
Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.
(2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077
Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.
(2021). Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. Journal of Nursing Care Quality, https://doi.org/10.1097/ncq.0000000000000547
Sample Answer 3 for NUR-590 Assignment 1- NUR 550 Literature Review-Resubmission
Practice problems are widespread in healthcare and are linked to adverse outcomes, including workplace incivility, high healthcare costs, and job dissatisfaction. The high prevalence of type 2 diabetes among older adults is a significant nursing problem that deserves much attention from care providers, policymakers, and leaders. Nursing research shows that type 2 diabetes is associated with increased patient visits, increased healthcare costs, and high vulnerability to cardiovascular disease (Cigolle et al., 2022; Evans et al., 2022). These outcomes underline the need for effective interventions at healthcare facilities and communities. Besides, type 2 diabetes inhibits functional performance and independence among older adults (Ahmad et al., 2022). Due to their central role in primary care and change implementation, nurses should explore interventions tailored to improve older adults’ functional capacity and independence. Such interventions are the foundation of healthy living among this unique group, which reduces clinical visits and healthcare costs. The purpose of this paper is to review current, peer-reviewed literature on articles supporting the PICOT.
PICOT statement: In older adults with type 2 diabetes (P), does a twice-weekly tailored physical exercise training program (I), compared to no exercise interventions (C), improve functional fitness and independent living (O) in 8 weeks (T)?
Search Methods
Many research articles evaluating the link between physical exercise and functional ability among older adults are available online. However, many do not fit the criteria for translational research. As a result, specific keywords were used to retrieve appropriate articles from the leading databases such as CINAHL Plus, PubMed, Embase, Medline, and the Cochrane Library. Google Scholar was also used due to the ease of access to articles and other appropriate research materials. The keywords and phrases include “older adults with type 2 adults and physical exercises,” “effects of physical exercises among older adults with type 2 diabetes,” “physical exercises and functional ability among older adults with type 2 diabetes,” and “physical exercises and health among older adults.” In the search process, Boolean Operators (and, or, no) help to filter and improve results (Gray et al., 2020). From the above phrases, the operator “and” was used to refine the search process to get better results.
Synthesis of Literature
The articles explore the value of physical exercises among older adults in various dimensions and provide detailed information to support the PICOT. In the first article, Zarco et al. (2021) engaged nine older adults at Adelphi University in a guided exercise program (Essentrics). The primary objective was to examine the perceived benefits of the program as far as physical health is concerned. Typically, Essentrics involve eccentric training and stretching (Esmonde-White, 2023; Zarco et al., 2021). To determine the link between variables, older adults participated in a one-hour Essentrics program twice weekly for a year. Zarco et al. (2021) then conducted focus group discussions with open-ended and close-ended questions on motivation for trying and proceeding with the program and its benefits. Data transcription and thematic analysis revealed that older adults perceived the Essentrics program positively since it improved their functional mobility, balance, energy, and flexibility. These findings support the PICOT by demonstrating the value of physical exercises in improving functional fitness and independence among older adults.
In a different study, Kirwan et al. (2021) evaluated the effectiveness of the Beat It program on anthropometric measures, physical fitness, and psychological outcomes among older adults with type 2 diabetes. Pivotal in improving diabetes management, the Beat It is a clinician-led, twice-weekly supervised group exercise and education program (Kirwan et al., 2021; Kirwan et al., 2022). Participants were 588 older adults with type 2 diabetes mellitus (T2DM) from separate locations in New South Wales and the Australian Capital territory. After guiding older adults in the twice-weekly group exercises for eight weeks, Kirwan et al. (2021) collected data on anthropometric measures and physical fitness levels and compared it with baseline data. Height and weight measures were used to calculate body mass index (BMI), while the program’s effectiveness was assessed via paired T-tests. Researchers found a significant improvement in weight, physical fitness, and waist circumference post-program. Based on these findings, physical exercises are a foundation of improved functional fitness and healthy independent living, as the PICOT hypothesizes.
Harrison et al. (2020) focused on the motivators, barriers, and benefits associated with active engagement in physical activity and exercises among urban-community-residing older adults. In this qualitative study, 58 older adults enrolled in Senior Companion and Respite Aid programs in Washington and participating in various physical activities at the community level were enrolled. Researchers collected data on critical variables such as physical activity and exercise levels, food intake, and demographics through focus group discussions. Participants answered a short survey of about 5-8 questions assessing the health benefits of physical exercises among the participants. The thematic analysis demonstrated physical activities as a healthy living approach that prolonged life, increased physical energy, and strengthened the body. Strong bodies and high physical energy are essentials of body fitness and instrumental to independent living among older adults. As a result, the article supports the PICOT by demonstrating the value of physical exercises in improving functional fitness and independence among older adults with type 2 diabetes by increasing physical energy and body strength.
In the fourth article, Syue et al. (2022) studied how physical activity, functional fitness, and life satisfaction are related among community-dwelling older adults. Guided by the hypothesis that higher physical fitness leads to better functional fitness and life satisfaction, researchers conducted a cross-sectional study among 623 older adults in functional fitness and health screen stations in Chi-Yi City. Participants engaged in physical activity exercises of varying intensities, primarily dancing and strenuous household chores, and data was collected via the International Activity Questionnaire (IPAQ) form in 2016 and 2017. Multiple tests, such as the curl, chair, and stand tests, were used to assess functional fitness. Data post-study revealed that physical activity increases functional fitness and life satisfaction among older adults. Accordingly, the findings support the PICOT by positively linking physical exercises with better functional fitness, which is the proposed project’s primary objective.
Comparison of Articles
The four articles’ main similarity is that they evaluate how physical exercises improve functional fitness and independent living among older adults. Their findings are also positive, underlining the significance of physical exercise programs in healthcare facilities and at home for healthy, independent living among older adults with type 2 diabetes. Concerning differences, Kirwan et al. (2021) and Syue et al. (2022) are quantitative, while Harrison et al. (2020) and Zarco et al. (2021) are qualitative articles. The settings where the studies took place, and the intensity and length of physical exercise sessions also differ. Overall, the central theme is the value of physical exercises in improving functional fitness and how older adults perceive them positively. Guided participation is highly recommended for improved outcomes.
In the qualitative articles (Harrison et al., 2020; Zarco et al., 2021), researchers conducted focus group discussions and analyzed data thematically. Kirwan et al. (2021) analyzed the outcomes of the Beat It program, while Syue et al. (2022) conducted a cross-sectional study. Regarding the conclusions, the researchers conclude that interventions focused on promoting and improving physical exercises are essential to increase older adults’ potential for better health and well-being. Governments and care providers should prioritize policies to encourage and sustain such exercises. Limitations include limited generalizability due to a small sample size (Zarco et al., 2021), a lack of a comparison group (Kirwan et al., 2021), a short survey period (Harrison et al., 2020), and the inability of a cross-sectional study to demonstrate the cause-effect relationship between variables (Syue et al., 2022). No controversies have been identified since all researchers found a positive link between physical exercises and better functional ability.
Suggestions for Future Research
Translational researchers find different gaps that should guide future research. For instance, Kirwan et al. (2021) suggested longer-term follow-up studies to establish whether the positive changes from the Beat It program can be maintained beyond the program’s delivery period. Based on the overall findings, another area of future research is the potential risks of physical exercises, considering the frailty of older adults with type 2 diabetes. In this case, their implementers should be guided effectively to ensure that the intensity does not exceed the healthy limit. Another important focus area is whether significant differences exist between rural and urban community-dwelling adults based on their lifestyles and health perceptions.
Conclusion
Nursing literature on interventions to improve health among older adults is extensive. As the reviewed literature demonstrates, moderate physical exercises effectively improve functional fitness and independence among older adults with type 2 diabetes. To achieve the desired results, older adults should be guided and monitored appropriately. Nursing professionals should also ensure barriers and motivators are adequately evaluated to encourage participation in physical exercises and maximize their benefits.
References
Ahmad, E., Sargeant, J. A., Yates, T., Webb, D. R., & Davies, M. J. (2022). Type 2 diabetes and impaired physical function: a growing problem. Diabetology, 3(1), 30-45. https://doi.org/10.3390/diabetology3010003
Cigolle, C. T., Blaum, C. S., Lyu, C., Ha, J., Kabeto, M., & Zhong, J. (2022). Associations of age at diagnosis and duration of diabetes with morbidity and mortality among older adults. JAMA Network Open, 5(9), e2232766-e2232766. doi:10.1001/jamanetworkopen.2022.32766
Esmonde-White, M. (2023). The miracle of flexibility: a head-to-toe program to increase strength, improve mobility, and become pain free. Simon and Schuster.
Evans, M., Chandramouli, A. S., Faurby, M., Matthiessen, K. S., Mogensen, P. B., & Verma, S. (2022). Healthcare costs and hospitalizations in US patients with type 2 diabetes and cardiovascular disease: a retrospective database study (OFFSET). Diabetes, Obesity & Metabolism, 24(7), 1300–1309. https://doi.org/10.1111/dom.14703
Gray, J. R., Grove, S. K., & Sutherland, S. (2020). Burns and Grove’s the practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.
Harrison, E. A., Lord, L. M., Asongwed, E., Jackson, P., Johnson-Largent, T., Jean Baptiste, A. M., … & Jeffery, T. (2020). Perceptions, opinions, beliefs, and attitudes about physical activity and exercise in urban-community-residing older adults. Journal of Primary Care & Community Health, 11, 2150132720924137. https://doi.org/10.1177/2150132720924137
Kirwan, M., Chiu, C. L., Hay, M., & Laing, T. (2021). Community-based exercise and lifestyle program improves health outcomes in older adults with type 2 diabetes. International Journal of Environmental Research and Public Health, 18(11), 6147. https://doi.org/10.3390/ijerph18116147
Kirwan, M., Chiu, C. L., Laing, T., Chowdhury, N., & Gwynne, K. (2022). A web-delivered, clinician-led group exercise intervention for older adults with type 2 diabetes: Single-arm pre-post intervention. Journal of Medical Internet Research, 24(9), e39800. https://doi.org/10.2196/39800
Syue, S. H., Yang, H. F., Wang, C. W., Hung, S. Y., Lee, P. H., & Fan, S. Y. (2022). The associations between physical activity, functional fitness, and life satisfaction among community-dwelling older adults. International Journal of Environmental Research and Public Health, 19(13), 8043. https://doi.org/10.3390/ijerph19138043
Zarco, E. P. T., Aquino, M., Petrizzo, J., Wygand, J., & McGorry, A. (2021). Perceived benefits of a guided exercise program among older adults. Gerontology and Geriatric Medicine, 7, 23337214211060147. https://doi.org/10.1177/23337214211060147