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).
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.
Literature Evaluation Table
Student Name:
Summary of Clinical Issue (200-250 words):
The clinical issue selected for study in this paper is Diabetic ketoacidosis (DKA), which is a complication of diabetes mellitus. Diabetes mellitus is among the most common chronic diseases that affect individuals everywhere in the world. Diabetes mellitus affects both children and adults across the lifespan due to various reasons. Narrowing down to Diabetic ketoacidosis (DKA), it often occurs in individuals with diabetes mellitus when the body accumulates high levels of acids recognized as ketones. Diabetic ketoacidosis (DKA) accounts for about 50% of deaths in individuals below 34 years diagnosed with diabetes. Vitale et al. (2018) stated that cases of DKA have been increasing over the past years leading to about 75% of deaths occurring among women below the age of 30 years. Additionally, DKA is recognized as the leading cause of mortality and morbidity in young people, particularly those suffering from diabetes mellitus.
Other than mortality and morbidity, diabetic ketoacidosis (DKA) has a negative influence on the financial status of individual patients and families. According to Vitale et al. (2018), the financial burden associated with DKA is significant for patients and families concerning treatment and management expenses. The author goes ahead to provide specific examples, for instance, the patient may have to pay $11,000 for the treatment of a single episode of the disease. The total cost for the whole year may cost the United States more than US$1.8 billion.
PICOT Question:
In patients with diabetic ketoacidosis (DKA) (P), what impact does hospital based education program for both patients and providers have (I) compared with no education (C) on reducing the incidences of diabetic ketoacidosis (O) for six months (T).
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Iovane, B., Cangelosi, A. M., Bonaccini, I., Di Mauro, D., Scarabello, C., Panigari, A., … & Vanelli, M. (2018). Diabetic ketoacidosis at the onset of Type 1 diabetes in young children: Is it time to launch a tailored campaign for DKA prevention in children< 5 years?. Acta Bio Medica: Atenei Parmensis, 89(1), 67. doi: 10.23750/abm.v89i1.6936
Permalink: https://www.ncbi.nlm.nih.gov /pmc/articles/ PMC6357617/
|
Vitale, R. J., Card, C. E., Lichtman, J. H., Weyman, K., Michaud, C., Sikes, K., … & Weinzimer, S. A. (2018). An Effective Diabetic Ketoacidosis Prevention Intervention in Children with Type 1 Diabetes. SAGE Open Nursing, 4, 2377960818804742. https://doi.org/10.1177/ 2377960818804742
Permalink: https://journals.sagepub.com/doi/full/ 10.1177/2377960818804742#article CitationDownloadContainer |
Bett, S. J., & Ade-Oshifogun, J. (2021). Effectiveness of Educational Intervention on Diabetic Knowledge, Self-Efficacy, and Hba1c Levels of Kenyan Adults with T2DM. Michigan Academician, 48(1), 64-65.
Permalink: https://www.proquest. com/scholarlyjournals/ effectiveness-educational-intervention-on/docview/2576699347/se-2?accountid=147094 |
| How Does the Article Relate to the PICOT Question? | The paper is related to the PICOT question because it addresses DKA and the information can be used in patient and caregiver education. | The article assesses the effectiveness of a hospital based education to increase DKA awareness. | The article looks into the effectiveness of diabetes education to prevent health complications. |
| Quantitative, Qualitative (How do you know?) | This was a quantitative study because it included statistical analysis. Descriptive statistics was used. | This was a quantitative study. Statistical data analysis methods were used. | This is quantitative study because descriptive statistics and T-test were both used. |
| Purpose Statement | The purpose of the study is to analyze
clinical characteristics associated with the occurrence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) in children aged <5 years in order to identify early signs or symptoms useful to prevent DKA appearance. |
To evaluate the effectiveness of a brief, office-based educational intervention to increase parent or patient recognition of the early warning signs and symptoms of diabetic ketoacidosis (DKA). | To determine effectiveness of structured diabetes education intervention in increasing diabetic knowledge, self-efficacy, and improving overall well-being. |
| Research Question | What are the characteristics of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) in children aged <5 years? | is an office-based educational intervention an effective prevention of diabetic ketoacidosis. | Is structured diabetes education intervention effective in preventing diabetic complications? |
| Outcome | The differences in clinical symptoms of DKA at the onset of type 1 diabetes (T1D) between children below and above 5 years | Reduction in emergency department (ED) visits and hospital admissions for DKA. | Knowledge of diabetes, self-efficacy, and HbA1c level. |
| Setting
(Where did the study take place?) |
University Children Hospital of Parma, Italy. | Our Lady’s Children’s Hospital, Dublin, Ireland. | Reale Hospital in Eldoret, Kenya. |
| Sample | Sample included 60 children aged 1 to 10 years. | 42 patients above the age of 13 and 34 patients of ages 13 and below. | A total of 123 participants were included in the study; 63 in the experimental group and 60 in the control group. |
| Method | children were divided into two groups: < 5 years (Group 1) and 6-10 years old (Group 2). Data was obtained from medical records of the patients. ISPAD criteria were used to define DKA: absent (pH ≥7.30), mild (7.2≤ pH <7.30), moderate (7.1≤ pH <7.20), and severe (pH <7.1). Other measurements included 3HB serum levels and HbA1c levels. Analysis included mean, standard deviation, T-test, and Chi-square test. | pre intervention consisting of multiple choice questions were provided to participants. Parents or patients were provided with sick day diabetes management guideline copies after administering patient education. Post intervention evaluation was administered 6 to 12 months later. Data was analyzed using SAS (version 9.4, SAS Inc. Cary, NC), Paired t tests, Wilcoxon signed-rank test and a χ2 test. | A questionnaire was used to collect demographic and research data. The experimental group received diabetes education while the control group did not. Post and pre intervention analysis was applied. |
| Key Findings of the Study | incidences of DKA was escalated in children below 5 (21.8%) than in those over 5 years of age (3.75%; p=0.021). | There was a significant improvement in the DKA symptoms after the interventions. | The experimental group showed significant knowledge of diabetes, high self-efficacy scores, and improvement in HbA1c level. |
| Recommendations of the Researcher | Healthcare givers to have special education to better their understanding of DKA signs in children and apply proper treatment regimen. | A short educational intervention and printed management tool is effective in improving sick day, improving DKA knowledge, reducing emergency visits, and general improvement of the patient. | Recommendations is that patient education should be part of medical intervention to improve patient condition and prevent and manage DKA. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | James, S., Annetts, K., Frakking, T., Broadbent, M., Waugh, J., Perry, L., … & Clark, S. (2021). Diabetic ketoacidosis presentations in a low socio-economic area: are services suitable? BMC Health Services Research, 21(1), 1-8. https://doi.org/10. 1186/s12913021-06715-7
Permalink: https://bmchealthservres.biomedcentral .com/articles/10.1186/s12913-021-06715-7#citeas |
Parrott, Mattie Grace. (2019). Factors Leading to DKA Readmissions: A Qualitative Study. Honors Thesis, East Carolina University 8 (1).
Permalink: https://thescholarship.ecu. edu/handle/10342/7343 |
Ogunrinu, T., Gamboa-Maldonado, T., Ngewa, R. N., Saunders, J., Crounse, J., & Misiri, J. (2017). A qualitative study of health education experiences and self-management practices among patients with type 2 diabetes at Malamulo Adventist Hospital in Thyolo District, Malawi. Malawi Medical Journal, 29(2), 118-123. https://doi.org/ 10.4314/mmj.v29i2.8
Permalink: https://www.ncbi .nlm.nih.gov/pmc/articles/ PMC5610281/ |
| How Does the Article Relate to the PICOT Question? | The article supports that lack of knowledge among patients is a risk factor for DKA. | The article looks into how social factors may lead to DKA readmissions. | The article is related to the PICOT because it tries to support patient education in improving wellbeing of diabetic patients. |
| Quantitative, Qualitative (How do you know?) | This is a qualitative study because there was no use of statistical methods of analysis. | This is a qualitative study. The study used non-numerical methods of data analysis. | This is a qualitative study due to non-numerical methods of data analysis. |
| Purpose Statement | To explore healthcare professionals’ perceptions of factors affecting presentation of people with type 1 diabetes in a low socioeconomic area of Queensland, Australia. | To describe the contributors to DKA readmission from a Social determinants of Health (SDOH) perspective. | To understand the perceptions and experiences of health education and self-management practices on Malamulo Adventist Hospital type 2 diabetic patients. |
| Research Question | What are healthcare professionals’ perceptions of factors affecting presentation of people with type 1 diabetes in a low socioeconomic area of Queensland, Australia? | What are Social determinants of Health that contribute to DKA readmission?
|
There was no research question. Possible research question is: What is the perceptions and experiences of health education and self-management practices on diabetes patients? |
| Outcome | Factors affecting presentation of people with type 1 diabetes in a low socioeconomic communities. | How SDOH such as social, financial and others, can impact DKA readmission. | Patients knowledge on diabetes management and self-management practices associated with patient education. |
| Setting
(Where did the study take place?) |
In a local socio-economic area of metropolitan Queensland, Australia | At a southeastern medical center. | Malamulo Adventist Hospital in Malawi. |
| Sample | 3 patients, 1 patient, and 18 healthcare professionals. | Study participants included those readmitted frequently for DKA. Majority of these were male (75%). | Sixteen patients participated in the FGDs; 3 men and 13 women. 3 men and 1 woman participated in the KIIs. |
| Method | Interviews were conducted with the participants. | Interviews from the parent study were conducted through phone calls or in-person at the southeastern medical center where patients were admitted.
|
Researcher utilized key informant interviews (KIIs) and focus group discussions (FGDs). Trained interviewers conducted three (3) FGDs and four (4) KIIs between March and May 2016. |
| Key Findings of the Study | Socioeconomic factors are widely documented as important determinants of health and wellbeing. Lack of awareness of DKA is also a risk factor. | It was found that poor self-care prioritization, social support reliance, and financial unpredictability are risk factors for readmission. | Participants had positive experience for the diabetes education. Participants expressed their ability to integrate diabetes education, such as exercise into their lifestyle. However, they admitted having limited knowledge dealing with diabetes complications. |
| Recommendations of the Researcher | Having a diabetes educator present in the hospital is highly recommended to provided education to care givers and patients. | Care providers to address these issues through education and support to reduce education. | Diabetes education is recommended that focuses on prevention and management of diabetes complications such as DKA. |
References
Bett, S. J., & Ade-Oshifogun, J. (2021). Effectiveness of Educational Intervention on Diabetic Knowledge, Self-Efficacy, and Hba1c Levels of Kenyan Adults with T2DM. Michigan Academician, 48(1), 64-65. https://www.proquest.com/scholarly-journals/effectivenesseducational-intervention-on/docview/2576699347/se-2?accountid=147094
Iovane, B., Cangelosi, A. M., Bonaccini, I., Di Mauro, D., Scarabello, C., Panigari, A., … & Vanelli, M. (2018). Diabetic ketoacidosis at the onset of Type 1 diabetes in young children: Is it time to launch a tailored campaign for DKA prevention in children< 5 years?. Acta Bio Medica: Atenei Parmensis, 89(1), 67. https://doi.org/10.23750/abm.v89i1.6936
James, S., Annetts, K., Frakking, T., Broadbent, M., Waugh, J., Perry, L., … & Clark, S. (2021). Diabetic ketoacidosis presentations in a low socio-economic area: are services suitable? BMC Health Services Research, 21(1), 1-8. https://doi.org/10.1186/s12913021-06715-7
Parrott, Mattie Grace. (2019). Factors Leading to DKA Readmissions: A Qualitative Study. Honors Thesis, East Carolina University 8 (1). https://thescholarship.ecu.edu/handle/10342/7343
Ogunrinu, T., Gamboa-Maldonado, T., Ngewa, R. N., Saunders, J., Crounse, J., & Misiri, J. (2017). A qualitative study of health education experiences and self-management practices among patients with type 2 diabetes at Malamulo Adventist Hospital in Thyolo District, Malawi. Malawi Medical Journal, 29(2), 118-123. https://doi.org/10.4314/mmj.v29i2.8
Vitale, R. J., Card, C. E., Lichtman, J. H., Weyman, K., Michaud, C., Sikes, K., … & Weinzimer, S. A. (2018). An Effective Diabetic Ketoacidosis Prevention Intervention in Children with Type 1 Diabetes. SAGE Open Nursing, 4, 2377960818804742. https://doi.org/10.1177/ 2377960818804742