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Use the “Literature Evaluation Table” to Complete this Assignment

Use the “Literature Evaluation Table” to Complete this Assignment

Use the Literature Evaluation Table to Complete this Assignment

Type 2 diabetes mellitus is one of the health problems that affect a significant proportion of people globally. It is estimated that one in every 11 adults has diabetes across the world. From this number, about 90% of the cases are attributed to type 2 diabetes mellitus. The high rate of diabetes mellitus type 2 has made it be ranked as the major cause of mortalities worldwide. It increases the risk of vascular disorders with almost 65% of patients with diabetes mellitus dying from cardiovascular disease. Other complications associated with type 2 diabetes mellitus include diabetic retinopathy, diabetic foot, and diabetic nephropathy (Kaiser et al., 2018). Diabetes mellitus type 2 arises from a combination of multiple risk factors. They include genetics, obesity, physical inactivity, and hypertension. Effective management of type 2 diabetes is important for the prevention of its complications and loss of lives. Accordingly, the management of type 2 diabetes relies mainly on the use of pharmacological and non-pharmacological interventions. Pharmacological interventions focus on the use of drugs to regulate the level of blood glucose. On the other hand, non-pharmacological interventions aim at utilizing lifestyle and behavioral approaches for glycemic control. It includes the provision of health education to the patients on the importance of healthy, balanced diet, engaging in active physical activity, and monitoring body weight (Bullard et al., 2018). The use of lifestyle and behavioral interventions has been shown in studies to be highly effective when used with medications for type 2 diabetes mellitus. Despite this, the use of the combined interventions has not been explored in our setting, hence, the proposed focus in this project.

Two factors must be examined in research or EBP projects (independent and dependent variables). The dependent variable is what occurs as a result of the independent variable, while the independent variable is what we expect to influence the dependent variable (National Library of Medicine, n.d.). Independent variables are conditions that can be altered in an experiment or project, whereas dependent variables measure reaction or consequences. On one hand, in a scientific experiment, the independent variable is the variable that is manipulated or altered to see how it affects the dependent variable (Polit & Beck, 2015). The dependent variable, on the other hand, is the variable being tested and measured in the study or experiment. As a result, the dependent variable is the one that is affected by the independent variable’s results. The independent variable is affected or changed by the experiment or study, which in turn impacts or changes the dependent variable (Polit & Beck, 2015).

PICOT Question:

In adult patients with type 2 diabetes mellitus, does the use of lifestyle and behavioral interventions with medications result in better treatment outcomes when compared to the use of medications alone in a period of six months?

 

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., … & Iepsen, U. W. (2017). Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Jama318(7), 637-646. https://jamanetwork.com/journals/jama/article-abstract/2648632 Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., McKenzie, A. L., Bhanpuri, N. H., Campbell, W. W., … & McCarter, J. P. (2019). Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2-year non-randomized clinical trial. Frontiers in endocrinology10, 348.  https://doi.org/10.3389/fendo.2019.00348 Moncrieft, A. E., Llabre, M. M., McCalla, J. R., Gutt, M., Mendez, A. J., Gellman, M. D., … & Schneiderman, N. (2016). Effects of a multicomponent life-style intervention on weight, glycemic control, depressive symptoms, and renal function in low-income, minority patients with type 2 diabetes: results of the community approach to lifestyle modification for diabetes randomized controlled trial. Psychosomatic medicine78(7), 851. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003734/
How Does the Article Relate to the PICOT Question? The article examines the effectiveness of lifestyle intervention on the glycemic control in patients with type 2 diabetes. The participants utilized the lifestyle intervention alongside the medications for treating the disease. Therefore, the outcomes provide insight into the outcomes associated with the use of lifestyle intervention alongside medications in type 2 diabetes mellitus. Lifestyle interventions in the management of type 2 diabetes include dietary modification for glycemic control. This study investigated the use of nutritional ketosis in the management of type 2 diabetes. The participants were also under medical treatment of the disease. Therefore, the research relates to the PICOT question since it shows the effectiveness of the lifestyle intervention in the management of type 2 diabetes. A comparison is made with use of standard care. The article explored the effectiveness of, multicomponent lifestyle intervention with medications use in the treatment of type 2 diabetes mellitus. The study shows that when compared to the usual care, multicomponent lifestyle interventions are effective for type 2 diabetes mellitus. Therefore, it shed light on the relevance of the proposed PICOT statement.
Quantitative, Qualitative (How do you know?) The study is a quantitative research. There was randomization of the study participants. The methods of the study also point towards a quantitative methodology. The research was a quantitative study. It can be seen from its methods such as randomization and use of statistical methods to analyze the data. The study is a quantitative study. There was the use of methods such as randomization of the participants and quantitative methods of data collection and analysis.
Purpose Statement To investigate the effect of lifestyle intervention on glycemic control in patients suffering from type 2 diabetes. To investigate the long-term effects of nutritional ketosis on the management of diabetes mellitus type 2. To determine the effects of multicomponent behavioral intervention on renal function, weight, depressive symptoms, and glycemic control in minority patients with type 2 diabetes mellitus.
Research Question What is the effect of intensive lifestyle intervention on glycemic control in patients suffering from type 2 diabetes? What are the long-term effects of nutritional ketosis on the management of diabetes mellitus type 2? What are the effects of multicomponent behavioral intervention on renal function, weight, depressive symptoms, and glycemic control in minority patients with type 2 diabetes mellitus?
Outcome The outcomes for this study included levels of hemoglobin A1c, symptom management, and quality of life of the patients. The primary outcomes in the study included fasting glucose, HbAic, c-peptide, fasting insulin, and weight. The secondary outcomes included bone mineral density, lower extremity lean mass and abdominal fat content. The primary outcomes in this study included glycemic control, weight, and depressive symptoms.
Setting

(Where did the study take place?)

The study was conducted in Region Zealand as well as Capital Region of Denmark. The study was conducted in the Lafayette, USA. The study was conducted in Miami, USA.
Sample 98 patients with non-insulin dependent diabetes mellitus type 2 The sample consisted of 262 participants who were assigned to the continuous care intervention group including ketosis and 87 participants who were placed in the usual care group. The sample consisted of 111 adults with diabetes mellitus type 2. They were assigned randomly to treatment and control groups.
Method The method for the study was a randomized, assessor blinded single center study. The study was an open-label non-randomized control study. The participants in the treatment group received usual continuous care plus nutritional ketosis for two years. The participants in the control group received the usual care alone. The study was a randomized controlled trial. The participants in the treatment group were administered with interventions that included physical activity, dietary modification, cognitive behavioral therapy, and social learning therapy to manage depressive symptoms. The participants in this group were tracked to determine the effectiveness of the interventions. The participants in the control group however received the usual care that included the use of medications for the treatment of type 2 diabetes mellitus.
Key Findings of the Study There was a significant change in the level of HbA1c by the end of the 12 months follow-up period. The HbA1c level changed from 6.65% to 6.34% in the treatment group and 6.74% to 6.66% in the control group. There was a reduction in fasting glucose, HbA1c, weight, fasting insulin, systolic blood pressure, triglycerides, liver alanine transaminase, and diastolic blood pressure in the treatment group. There was also an increase in HDL-C. These outcomes remain unchanged in the control group. There was decrease in weight, HbA1c and levels of depressive symptoms in the participants in the treatment group. There was also an improvement in the overall glomerular filtration rate. There were insignificant changes in the participants in the usual care group.
Recommendations of the Researcher The use of intensive lifestyle intervention with medications is more beneficial than the standard care alone. However, further studies are needed to evaluate durability and generalizability of the findings. The use of lifestyle interventions such as nutritional ketosis has long-term benefits on multiple markets of diabetes. The use of the approach should be considered for clinical use. Multicomponent behavioral interventions are effective in not only managing the symptoms of diabetes mellitus type 2 but also depressive symptoms that affect the quality of life of these patients. Therefore, multicomponent interventions should be supported to ensure the realization of optimum outcomes of care for these patients.
Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink  Følling, I. S., Solbjør, M., Midthjell, K., Kulseng, B., & Helvik, A. S. (2016). Exploring lifestyle and risk in preventing type 2 diabetes-a nested qualitative study of older participants in a lifestyle intervention program (VEND-RISK). BMC public health16(1), 876. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997726/ Aujla, N., Yates, T., Dallosso, H., & Kai, J. (2019). Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: qualitative study. BMJ open9(8), e028491. https://bmjopen.bmj.com/content/9/8/e028491 Rygg, L.O., Lohre, A. and Hellzen, O. (2017) Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes—The Active Ingredient in the Education. A Qualitative Study. Open Journal of Nursing, 7, 1181- 1195. https://doi.org/10.4236/ojn.2017.710086
How Does the Article Relate to the PICOT Question? The article explores the perceptions of adults at risk of developing type 2 diabetes on the use of lifestyle interventions. It therefore relates to the PICOT question because it explores the acceptability, effectiveness, and use of lifestyle interventions in the prevention and management of type 2 diabetes. It also provides insights into the factors that should be considered for the successful utilization of lifestyle interventions in the management and prevention of the disease. The article provides insights into the acceptability and effectiveness of lifestyle intervention programs in the prevention and management of type 2 diabetes. As a result, it shows the enhanced effectiveness of the proposed intervention in this project, hence, its relevance to the PICOT statement. The article explores the experiences of participants in a lifestyle intervention program that aimed at promoting effective management of type 2 diabetes mellitus. The article reveals that the lifestyle interventions were effective in empowering the participants engage in healthy eating habits and physical activity. Therefore, it supports the PICOT question by showing the benefits of lifestyle interventions in the prevention and management of type 2 diabetes mellitus.
Quantitative, Qualitative (How do you know?) The study is a qualitative study. It can be seen from the use of qualitative methods of data analysis such as systematic text condensation. The study is a qualitative research. This can be seen from the use of thematic analysis of the audiotaped and transcribed data. The research is a qualitative study. It can be seen from the methods of data analysis such as thematic analysis and audio recording of participant data.
Purpose Statement To explore the ways in which older adults perceive their lifestyle as well as being at risk of type 2 diabetes while participating in a lifestyle intervention program. To explore the provider and user experience of the value and acceptability of the Let’s Prevent Diabetes program that used structured behavioral interventions for the prevention of the disease. To explore the experiences of the participants in diabetes self-management education in relation to physical activity and diet
Research Question In what ways do the older adults perceive their lifestyle as well as being at risk of type 2 diabetes while participating in a lifestyle intervention program? What is provider and user experience of the value and acceptability of the Let’s Prevent Diabetes program in prevention of type 2 diabetes? What are the experiences of the participants in diabetes self-management education in relation to physical activity and diet?
Outcome The outcomes of the study included perception of the participants towards lifestyle intervention program. The outcome for the study included the self-perceived user and provider experience with the behavioral interventions for the prevention of diabetes type 2. The perceived experiences of the participants with the lifestyle interventions targeting dietary modification and physical exercises
Setting

(Where did the study take place?)

The study was conducted in Norway in Nord-Trondelag County. The study was conducted in East Midlands, UK. The study was conducted in Central Norway
Sample The sample consisted of 26 participants who were at a risk of developing type 2 diabetes mellitus The sample consisted of 32. They included 22 participants who attended the program and 10 providers who implemented it. The study used 16 participants
Method In-depth interviews were conducted with the participants for six weeks. Notes as well as reflections were written down at the end of the interviews. The interviews were audio-recorded. Data was transcribed verbatim and text condensation done to obtain relevant themes from it. The participants engaged in in-depth interviews that were audio-recorded. The data was then transcribed verbatim and thematic analysis performed to identify the common themes in the narratives. Semi-structured interviews were conducted with the participants who were newly diagnosed with type 2 diabetes. The participants also had history of difficulties in regulating their blood sugar levels alongside expressing interest to attend the program. The audio-recorded interviews were transcribed verbatim and thematic analysis performed.
Key Findings of the Study The findings revealed two themes that relate to the use of lifestyle intervention in prevention of type 2 diabetes mellitus. The first theme was the need for resources to maintain active lifestyle. The second them included the increased level of awareness about the risk behavior and health related worries that are needed for diabetes prevention. Therefore, the participants perceived that the lifestyle interventions were applicable and acceptable for their use in preventing diabetes. The findings of the study revealed that the lifestyle and behavioral program was acceptable for use in the prevention of type 2 diabetes. However, it should be structured to address the cultural needs of the different participants. There is also the need for the provision of resources and facilitation of the participants at the locality or general practice level. Despite these challenges, the participants reported that the lifestyle and behavioral interventions increased their level of awareness on preventive measures for type 2 diabetes mellitus. The findings of the study revealed that lifestyle intervention program transformed the dietary and physical exercises habits of the participants. The participants were optimistic of changing their diets alongside engaging in multiple active physical exercises to maintain their blood glucose levels. Therefore, the use of lifestyle interventions such as the diabetes self-management education is effective in promoting the management of symptoms of type 2 diabetes mellitus.
Recommendations of the Researcher Effective implementation of lifestyle interventions for prevention and management of diabetes requires adequate resource availability. Health organizations and providers should ensure that optimum support is provided to patients with diabetes for the goals of self-care management to be achieved. Lifestyle and behavioral interventions are acceptable for use in the prevention of type 2 diabetes mellitus. Therefore, prevention information should be structured in a manner that increases user engagement and integration of services for increased uptake and effectiveness of the interventions. Interactive learning should be incorporated into lifestyle and behavioral interventions that target prevention and management of type 2 diabetes. Interactive learning motivates the patients to play an active role in the self-management of their conditions.

References

Bullard, K. M., Cowie, C. C., Lessem, S. E., Saydah, S. H., Menke, A., Geiss, L. S., … & Imperatore, G. (2018). Prevalence of diagnosed diabetes in adults by diabetes type—United States, 2016. Morbidity and Mortality Weekly Report67(12), 359.

Kaiser, A. B., Zhang, N., & Van Der Pluijm, W. (2018). Global prevalence of type 2 diabetes over the next ten years (2018-2028).

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-reviewed research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).

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The PICOT question will provide a framework for your capstone project.
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Attachments

Hospital acquired infections (HAI) occur frequently in the healthcare environment and represent major issues compromising care giving and recovery of hospitalized patients. HAI are infections that patients contract during their treatment in a medical or surgical unit of a health facility. According to the WHO epidemiology report, approximately 1.4 million people suffer from hospital acquired infections or nosocomial infections at any given time (WHO, 2009). In the United States alone, about 9.3 in every 100 hospitalized patients contract a nosocomial illness in duration of hospitalization. Some of the HAI are severe and may potentially threaten the life of a patient. Hospital acquired infections are more prevalent in the inpatient departments than in the outpatient’s department and hospitalized patients may be used to best examine this clinical issue (Boev & Kiss, 2017).

Many factors have been attributed to hospital acquired infections ranging from contamination of instruments, substances and objects to medical malpractices and congestion of the health facilities. Congested hospital wards with beds in proximity to each other are highly susceptible to spreading HAI in numerous healthcare settings. Studies of HAI have tended to investigate the relationship between ward layouts and possibility or impossibility of patients getting another illness while being treated at a health facility (Yallew, Kumie & Yehuala, 2017). The hospital infections are caused by the presence of microorganisms that are common in human populations (Nekkab et al., 2017). When patients are placed in close contact, the infectious microbes can invade the next patient during hospitalization. This literature evaluation examines studies show connection between congestion and bed distance and hospital acquired infections.

PICOT Question: For the inpatients’ population, (P) how does decongestion of wards and widening of spaces between ward beds (I) as compared to congestion and narrowing of spaces between ward beds (C) reduce hospital acquired infections (O) for the period of hospitalization?

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Borg, M. A., Suda, D., & Scicluna, E. (2008). Time-series analysis of the impact of bed occupancy rates on the incidence of methicillin-resistant Staphylococcus aureus infection in overcrowded general wards. Infection Control & Hospital Epidemiology, 29(6), 496-502.

Permalink

https://doi.org/10.1086/588157

 

Kaier, K., Mutters, N. T., & Frank, U. (2012). Bed occupancy rates and hospital-acquired infections—should beds be kept empty? Clinical Microbiology and Infection, 18(10), 941-945.

Permalink

https://www.sciencedirect.com/science/article/pii/S1198743X14610909

 

Virtanen, M., Terho, K., Oksanen, T., Kurvinen, T., Pentti, J., Routamaa, M., … & Kivimäki, M. (2011). Patients with infectious diseases, overcrowding, and health in hospital staff. Archives of internal medicine, 171(14), 1296-1298.

Permalink

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1105845

 

How Does the Article Relate to the PICOT Question? This article is related to the PICOT question because it examines bed occupancy and overcrowding as factors that trigger NRSA infections within the inpatient setting. This article is related to the PICOT question because it examines the connection between rates of bed occupancy and the spread HAI such as those arising from staphylococcus infections. This study conforms to the PICOT question because it investigates patient overcrowding as the cause of transmission for infectious diseases.
Quantitative, Qualitative (How do you know?) This study was a quantitative research that because it utilized a time series mixed ANOVA for monthly incidences of MRSA infections This is a qualitative study because it conducts investigation of the findings from studies regarding the subject matter to ascertain the relationship between the findings and the underlying factors of bed capacity and overcrowding. This is a quantitative study because it gathers numerical data from participants and applies quantitative approaches to justify the study question.
Purpose Statement This study intended to ascertain the implication of capacity of beds and overcrowding on the incidences of MRSA infections in the general ward setting. The intention of the research was to establish whether rates of bed occupancy and overcrowding contributed to HAI in the inpatient setting. The intention of this study was to find out whether the prevalence of hospital acquired infections is caused by staffs or overcrowding within the patients’ environment.
Research Question What is the effect of bed occupancy, such as overcrowding on the incidents of MRSA infections in general ward setting? Do rates of bed occupancy and overcrowding contribute to HAIs in the inpatient setting? Does ward overcrowding increase infection of infectious diseases to the patient or HIA is caused by ill health of the medical staff.
Outcome Fluctuations in occupied beds were found not to have direct implication on incidences of MRSA infections as long as the bed occupancy was within the levels designated by the hospital. However, episodes of significance overcrowding with excess bed occupancy levels directly triggered infection rates. The study established that hospital overcrowding and bed occupancy rates directly influenced HAI incidents. Overcrowding was found to directly contribute to prevalence of infectious diseases in the wards. In wards that were not overcrowded, there was no connection between health workers and disease infections to their patients
Setting

(Where did the study take place?)

The research was conducted at St. Luke’s Hospital which is tertiary care facility in Malta with 900 beds capacity. The study identifies 43 studies conducted across various hospitals on the subject matter to ascertain the possibility of bed occupancy and overcrowding as the cause of HAI. The research was conducted in Finland where 54 hospitals wards were involved in the treatment of somatic diseases. Five acute care hospitals were selected.
 

Sample

 

The sample size included 1300 participants who were hospitalized during the time of study.

 

The sample size comprised of a selection of 43 studies out of the 179 participants to analyze the implication of the phenomena across various hospitals.

 

The sample comprises of 993 physicians and nurses and case records of 1102 patients in the wards.

Method The study utilized a mixed method Analysis of variance (ANOVA) of monthly infections over a period of 65 months. The method involved sample selection of nosocomial studies and their findings analyzed to determine the rate of infections. The study utilized both random and non-random selection of participants whose infectious status were analyzed in the findings.
Key Findings of the Study -Hospital crowding increased MRSA infections during hospitalization of patients.

-Excessive bed occupancy rates trigger increase in infectious rates.

Hospital overcrowding and bed occupancy rated increased the tendency of acquiring infections during treatment period. The study established that there was a significant relationship between overcrowding and infectious diseases in the ward settings. Furthermore, the study also found that there were no infections in wards that were not crowded.
Recommendations of the Researcher -Hospitals should decongest their wards to reduce infections by balancing the number of sick people occupying the inpatient departments.

-The hospital should reduce bed occupancy to avoid rates of infections because of congested wards. The hospitals, according to the researcher, should be equipped with enough beds distantly placed as a way of ensuring disease preventions.

-Hospitals should balance the number of patients in the wards in relation to the space and beds available to prevent reinfections.

– The problem of overcrowding was found to be prevalent in most hospitals. The researcher recommends the need for hospitals to invest in beds and wards because from these placing that infections spread faster.

-Reduce the number of patients in acute care setting and ensure that there is enough space between the hospital beds.

-The health of patients and staff while in hospitals is crucial for the recovery of patients and protection of the staff from infections. The two aspects go hand in hand and therefore there is the need for hospitals to ensure a good balance of the two issues.

 

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink  

Schwab, F., Meyer, E., Geffers, C., & Gastmeier, P. (2012). Understaffing, overcrowding, inappropriate nurse: ventilated patient ratio and nosocomial infections: which parameter is the best reflection of deficits? Journal of Hospital Infection, 80(2), 133-139.

Permalink

https://www.sciencedirect.com/science/article/abs/pii/S019567011100449X

 

Andersen, B. M., Rasch, M., Hochlin, K., Tollefsen, T., & Sandvik, L. (2009). Hospital-acquired infections before and after healthcare reorganization in a tertiary university hospital in Norway. Journal of public health, 31(1), 98-104.

Permalink

https://academic.oup.com/jpubhealth/article/31/1/98/1590590

 

Haley, R. W., & Bregman, D. A. (1982). The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. Journal of Infectious Diseases, 145(6), 875-885.

Permalink

https://academic.oup.com/jid/article-abstract/145/6/875/856050

 

How Does the Article Relate to the PICOT Question? This study connects to the PICOT question as it investigates overcrowding among other factors as a cause of HAI. This study is in connection to the PICOT question because it examines the reduction of HAI before restructuring and after restructuring of a tertiary hospital in Norway over years. This article relates to the PICOT question because it investigates the impacts of understaffing and overcrowding as the major causes of outbreaks of staphylococcal infections in the special care unit.
Quantitative, Qualitative (How do you know?) This study is quantitative because it investigates quantified data of participants in the study who are used to ascertain the validity or invalidity of the study question. This is a qualitative study because it examines the performance of a particular measure in a healthcare institution to ascertain its effectiveness. This study is qualitative in nature because it investigates recurrent epidemics in the hospitals and their effects on unspecified number of patients.
Purpose Statement This study intended to find out the impact of bed occupancy and understaffing as risk factors of hospital acquired infections. This study aims at evaluating HAI before and after the restructuring of Norwegian health system. One of the activities measured was the expanded bed capacity. The intention of this study is to find out how understaffing and overcrowding contribute to staphylococcal infections in hospital setting. The study majorly focuses on the staphylococcus because of the prevalence of this type of infection in the hospital environment.
Research Question Does overcrowding and understaffing increase the rate of HAI in the inpatient setting? Does HAI decrease significantly with decreased workload and improved health environment? Do understaffing and overcrowding contribute to HAI in a neonatal special care unit?
Outcome Fewer HAI were linked to a good balance of nurse to patient ration and spacious bed capacity. More infections were associated with overcrowding and understaffing. A reducing trend was noted between 1995 and 2002 at the tertiary university hospital regarding HAI and workload and improved hospital environment. The findings of the stud indicate that staphylococcal outbreaks occurred majorly during overcrowding and in a seriously understaffed healthcare environment. Removal of the problems significantly reduced the rates of infections amongst the patients.
Setting

(Where did the study take place?)

The investigation was conducted in 182 intensive care units in Germany. The study was conducted in the Norwegian healthcare subsystem. The study was conducted in a neonatal healthcare facility in England.
Sample The sample size consisted of 1313 study cases of patients who acquired pneumonia and blood infection during their hospitalization. The study conducted studies over a total of 57 360 patients during the entire period of investigations. The sample size of the study was not specified because it examined recurring incidents in infants and therefore the size was progressive with the infections.
Method The study utilized structural parameter which obtained questionnaires from occupants and staff which were later analyzed by use of generalized estimation of question model. The study involved point prevalent studies conducted four times in a year between 1995 and 2007. A multivariate statistical model was applied in this study which properly predicted the occurrence of infections.
Key Findings of the Study -Overcrowding and understaffing were established to be major contributors of hospital acquired infections. Fewer cases of infections were associated with spacious inpatient settings.

 

-Restructuring of a healthcare organization may bring positive impact in preventing in preventing hospital acquired infections if total workload per position increases.

-Improvements that make hospital wards spacious and conducive contribute magnificently in reducing HAI due to congestion of the facilities.

-The findings of the stud indicate that staphylococcal outbreaks occurred majorly during overcrowding and in a seriously understaffed healthcare environment. -Removal of the problems significantly reduced the rates of infections amongst the patients
Recommendations of the Researcher -There is the need to have enough staff in the facility to ensure that patient to nurse ratio is equally considered to avoid infections.

-There is the need to increase hospital bed capacities in hospitals that exhibited lower capacities to address issues of the inpatients.

-Understaffing and overcrowding should be considered collectively as factors that compromise health of inpatients and require to be properly addressed by health administrators.

-Hospitals must expand their services especially when the numbers of their patients prove to be growing very fast to avoid the possibility of contracting infections in the ward settings.

-There is also the need to increase the number of staff to ensure that they are not burdened by the patients as this may increase the rate of infections.

-Overcrowding of hospital facilities are associated with infections such as the staphylococcus and there is the need to decongest hospital environment to avoid such infections in the hospitals.

-If staff is overworked, the probability of them to deliver the highest quality of services to the healthcare environment becomes compromised. Therefore, there is the need to ensure that a health facility is properly staffed to avoid similar infections.

References

Boev, C., & Kiss, E. (2017). Hospital-acquired infections: current trends and prevention. Critical Care Nursing Clinics, 29(1), 51-65.

Nekkab, N., Astagneau, P., Temime, L., & Crepey, P. (2017). Spread of hospital-acquired infections: A comparison of healthcare

networks. PLoS computational biology, 13(8).

World Health Organization. (2009). The world health report 2000: health systems: improving performance. World Health

Organization.                                            

Yallew, W. W., Kumie, A., & Yehuala, F. M. (2017). Risk factors for hospital-acquired infections in teaching hospitals of Amhara

regional state, Ethiopia: A matched-case control study. PloS one, 12(7).

 

Proper identification and use of research in nursing profession is crucial in attaining successful outcomes. The skill to communicate data and examine peer-reviewed articles effectively in an intellectual manner is vital in promoting the ability of students to understand and synthesize complex topics that are addressed by the capstone projects. This literature evaluation table seeks to identify and analyze peer-reviewed articles about health education to address childhood obesity. The proposed intervention is the adoption of lifestyle health education as the nursing intervention to mitigate obesity among children

PICOT Question

In obese children (P), does health education on healthy lifestyle (I) compared to no intervention (C) lessen childhood obesity rates (O) in six months (T)?

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

 

Mastrocola, M. R., Roque, S. S., Benning, L. V., & Stanford, F. C.

International Journal of Obesity

https://doi.org/10.1038/s41366-019-0453-6

 

 

Pereira, A. R., & Oliveira, A.

Nutrients.

https://doi.org/10.3390/nu13103447

Martin, A., Booth, J.N., Laird, Y., Sproule, J., Reilly, J.J. & Saunders, D.H. Cochrane Database.

https://doi.org/10.1002/14651858.CD009728.pub3

 

 Scott-Sheldon, L. A., Hedges, L. V., Cyr, C., Young-Hyman, D., Khan, L. K., Magnus, M., King, H., Arteaga, S., Cawley, J., Economos, C. D., Haire-Joshu, D., Hunter, C. M., Lee, B. Y.,  Kumanyika, S. K., Ritchie, L. D., Robinson, T. N., & Schwartz, M. B. (2020)

Childhood Obesity.

https://doi.org/10.1089/chi.2020.0139

Article Title and Year Published

 

Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review.

Published in 2020

Dietary interventions to prevent childhood obesity: A literature review.

Published in 2021

Physical activity, diet and other behavioral interventions for improving cognition and school achievement in children and adolescents with obesity or overweight.

Published in 2018

Childhood Obesity Evidence Base Project: A systematic review and meta-analysis of a new taxonomy of intervention components to improve weight status in children 2–5 years of age, 2005–2019.

Published in 2020.

Research Questions (Qualitative)/Hypothesis (Quantitative)

 

Implicit: To determine whether obesity education in medical schools, residencies, and fellowships throughout the world is effective.

 

Hypothesis: Prevention of childhood obesity needs multidimensional actions at critical levels such as personal, family, institutional, and environmental. Implicit: Does healthy weight interventions lead to enhanced thinking skills and school performance among obese children and teenagers? Hypothesis: Children receiving interventions to prevent obesity or improve weight status would experience less gain in BMI, or perhaps reductions in BMI, relative to children comparable in age, who did not receive the intervention.
Purposes/Aim of Study To explore obesity education in medical students, resident, and fellow physicians throughout the world from 2005 to 2018. To review the existing literature on dietary interventions for the prevention of childhood obesity and their effectiveness. To assess whether lifestyle interventions such as diet, physical activity, sedentary behavior and behavioral can improve school achievement, cognitive function, and/or future success in children and adolescents with obesity or overweight. To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2–5 years of age.
Design (Type of Quantitative, or Type of Qualitative)

 

Quantitative study Qualitative literature analysis. RCTs of behavioral interventions in obese children. Quantitative study.
Setting/Sample

 

27 studies for review. 52 references obtained through literature search. 18 studies involving 2384 obese and overweight children and adolescents. The study was conducted 10 different countries. 51 studies evaluating 58 interventions.
Methods: Intervention/Instruments

 

Systematic review of MEDLINE, EMBASE, PsycINFO, and ERIC databases.  Using the PubMed Central® for literature search. Randomized and quasi-RCTs of behavioral intervention. Systematic review of 17 databases for information. Effect sizes confidence intervals (CIs) were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs.
Analysis

 

Using an evidence grading system in which each outcome measure was graded on a scale from A to D. Literature review on studies that focused on dietary interventions to prevent childhood obesity. Used single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. This systematic review and meta-analysis was performed by using established meta-analytic methods and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.
Key Findings

 

There is currently a paucity of obesity education programs for medical students, residents, and fellow physicians in training programs throughout the world despite high disease prevalence. Most of the intervention studies showed no consistent effects on changing the body mass index of children. School and community-based physical activity interventions benefit executive functions of children with obesity or overweight. Also, school-based dietary interventions may benefit the general school achievement in children with obesity. Early childhood obesity interventions are effective in reducing BMI in preschool children.
Recommendations

 

More obesity education should be administered to undergraduate and graduate medical education to ensure optimal treatment of patients with obesity. Further research is needed on sustainability of interventions over time. More research is needed to evaluate the cognitive, academic, and physical outcomes in children. Facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

 

Explanation of How the Article Supports EBP/Capstone Project

 

Supporting education on childhood obesity. Advances educational approaches on nutrition, physical activity, and behavioral changes. This article advances the need for obesity management education including lifestyle changes in children to reduce obesity. Supporting obesity management intervention from early childhood.

 

 

Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

 

Salam, R. A., Padhani, Z. A., Das, J. K., Shaikh, A. Y., Hoodbhoy, Z., Jeelani, S. M., Lassi, Z.S., & Bhutta, Z. A.

Nutrients.

doi: 10.3390/nu12082208

 

Pan, H. J., Hung, L. J., & Chen, C. Y.

Obesity Research & Clinical Practice.

 

https://doi.org/10.1016/j.orcp.2020.03.007

 

Atkins, M., Castro, I., Sharifi, M., Perkins, M., O’Connor, G., Luo, M., Sandel, M., Taveras, E. M., & Fiechtner, L.

American Journal of Public Health.

https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305772

 

 Jacob, C. M., Hardy-Johnson, P. L., Inskip, H. M., Morris, T., Parsons, C. M., Barrett, M., Hanson, M., Woods-Townsend, K., & Baird, J.

International Journal of Behavioral Nutrition and Physical Activity.

https://doi.org/10.1186/s12966-020-01065-9

Article Title and Year Published

 

Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review and meta-analysis.

Published in 2020

 

Effect of class-based lifestyle intervention on the management of childhood obesity.

 

Published in 2020

Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017–2019.

Published in 2020.

A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years.

Published in 2021.

Research Questions (Qualitative)/Hypothesis (Quantitative)

 

Hypothesis: Lifestyle interventions such as diet, physical activity, behavioral therapy, or any combination of these interventions coupled with contextual factors can prevent and manage childhood and adolescent obesity. Implicit: Whether lifestyle interventions for the management of childhood obesity could change unhealthy behaviors and reduce obesity tendency among elementary students. Hypothesis:  Families who screened positively for unmet social needs would have fewer completed contact hours over the 1-year intervention period. Implicit: To determine effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents?
Purposes/Aim of Study To assess the impact of lifestyle interventions along with the contextual factors to prevent and manage childhood and adolescent obesity. To determine Effect of class-based lifestyle intervention on the management of childhood obesity. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI). To synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.
Design (Type of Quantitative, or Type of Qualitative) Quantitative study. Qualitative study Qualitative study Quantitative design
Setting/Sample

 

654 studies used for meta-analysis. 279 students.

Participants included children aged 6 to 12 years with a body mass index (BMI)  greater than or equal to 85th percentile seen in primary care at the 2 federally qualified community health centers.

The study included 33 interventions based on 39 publications in the review.
Methods: Intervention/Instrument Comprehensive search strategy for database search. A lifestyle questionnaire to assess the students’ dietary habits and physical activities before the intervention. A randomized controlled trial in 2 communities in Massachusetts with large populations of low-income families. The University of York Centre for Reviews and Dissemination (CRD) Guidelines and PRISMA Tools.
Analysis

 

 Utilization of two pairs of review authors (ZAP and AYS; ZH and RAS) to independently assess potential study eligibility based on predefined screening criteria.

Analysis was done by categorizing the BMI of the students as underweight, normal, overweight, and obese according to the age-specific BMI.

 

Descriptive analysis of the exposures, outcomes, and covariates. Using CRD and PRISMA to conduct a meta-analysis on studies with data on BMI z-score.
Key Findings

 

Blending various interventions is effective in childhood obesity management.

 

Lunchtime education is an innovative way to provide class-based education programs in school that yielded behavior changes and are effective approaches for delaying childhood obesity. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. School-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents.
Recommendations

 

Combine various interventions to achieve optimal better results in obesity management. Adoption of lunchtime education. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity. To explore the effectiveness of multi-component interventions involving key stakeholders.
Explanation of How the Article Supports EBP/Capstone

 

Advancing implementation of various lifestyle interventions such as physical activity, dietary interventions, behavioral therapy to manage childhood obesity. Supporting health education in obesity management. Addresses obesity management in children.   Supporting health education in childhood obesity management.

 

 

Conclusion

The literature evaluation table provided a synopsis of the review of eight peer-reviewed articles. The articles were reviewed based a predetermined criteria that delved into the specific areas such as the author, journal, working link to access the article, article title, year published, research questions and the aim of the study. Additional criteria used include design, setting/sample, methods, analysis, key findings, recommendations, and how the article supports capstone project.

References

Atkins, M., Castro, I., Sharifi, M., Perkins, M., O’Connor, G., Luo, M., Sandel, M., Taveras, E. M., & Fiechtner, L. (2020). Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017–2019. American Journal of Public Health, 110(S2), S251-S257. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305772

Jacob, C. M., Hardy-Johnson, P. L., Inskip, H. M., Morris, T., Parsons, C. M., Barrett, M., Hanson, M., Woods-Townsend, K., & Baird, J. (2021). A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 1-22. https://doi.org/10.1186/s12966-020-01065-9

Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, (1). DOI: 10.1002/14651858.CD009728.pub3

Mastrocola, M. R., Roque, S. S., Benning, L. V., & Stanford, F. C. (2020). Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review. International Journal of Obesity, 44(2), 269-279. https://doi.org/10.1038/s41366-019-0453-6

Pan, H. J., Hung, L. J., & Chen, C. Y. (2020). Effect of class-based lifestyle intervention on the management of childhood obesity. Obesity Research & Clinical Practice, 14(2), 184-190. https://doi.org/10.1016/j.orcp.2020.03.007

Pereira, A. R., & Oliveira, A. (2021). Dietary interventions to prevent childhood obesity: A literature review. Nutrients, 13(10), 3447. https://doi.org/10.3390/nu13103447

Salam, R. A., Padhani, Z. A., Das, J. K., Shaikh, A. Y., Hoodbhoy, Z., Jeelani, S. M., Lassi, Z.S., & Bhutta, Z. A. (2020). Effects of lifestyle modification interventions to prevent and manage child and adolescent obesity: a systematic review and meta-analysis. Nutrients, 12(8), 2208. Doi: 10.3390/nu12082208

Scott-Sheldon, L. A., Hedges, L. V., Cyr, C., Young-Hyman, D., Khan, L. K., Magnus, M., King, H., Arteaga, S., Cawley, J., Economos, C. D., Haire-Joshu, D., Hunter, C. M., Lee, B. Y.,  Kumanyika, S. K., Ritchie, L. D., Robinson, T. N., & Schwartz, M. B. (2020). Childhood Obesity Evidence Base Project: A systematic review and meta-analysis of a new taxonomy of intervention components to improve weight status in children 2–5 years of age, 2005–2019. Childhood Obesity, 16(S2), S2-21. https://doi.org/10.1089/chi.2020.0139