NR 439 Week 1: Role of Research and the Importance of the Searchable Clinical Question

The practice of nursing is deeply rooted in nursing knowledge, and nursing knowledge is generated and disseminated through reading, using, and creating nursing research. Professional nurses rely on research findings to inform their practice decisions; they use critical thinking to apply research directly to specific patient care situations. The research process allows nurses to ask and answer questions systematically that will ensure that decisions are based on sound science and rigorous inquiry. Nursing research helps nurses in a variety of settings answer questions about patient care, education, and administration.

As you contemplate your role in the research process, read the following article.

Kumar, S. (2015). Type 1 diabetes mellitus-common cases. Indian Journal of Endocrinology & Metabolism, 19, S76–S77. doi:10.4103/2230-8210.155409. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102354944&site=eds-live (Links to an external site.)Links to an external site.

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Choose one case study, and formulate one searchable, clinical question in the PICO(T) format. There are several potential questions that could be asked.

Identify whether the focus of your question is assessment, etiology, treatment, or prognosis.

Remember to integrate references.

Class, you may begin posting in this TD on Sunday, July 2nd for credit. 
Class, this week begins your journey into evidence-based practice or EBP.

Along the way, you’ll explore nursing research and its evolution from Florence Nightingale’s time until today.

You’ll build on knowledge gained in the informatics course as you choose a significant clinical issue, formulate a searchable clinical question, and search for research-based evidence.
This process lays the groundwork for a PICOT assignment that you’ll complete during the course as you discover sources of evidence for your own EBP. Nursing research critically advances our profession through the development of evidence upon which our practice standards are based. To determine what the best evidence is, a nurse needs to look at how the information was collected, how rigorous the methods used to develop the evidence was, and what source was used to share the evidence.

The Course Outcomes (CO) we will apply in our first week include:

Examine the sources of evidence that contribute to professional nursing practice.
Recognize the role of research findings in evidence-based practice.

Read the assigned case study and formulate searchable, clinical questions in the PICO(T) format. There are several potential questions that could be asked. Identify if the focus of your question is assessment, etiology, treatment, or prognosis. Remember to integrate references.

There are many possibilities for the research question. Make sure that you also Identify the focus of each question and explain WHY.  Don’t forget to give the “P”, “I”, “C”, “O” AND T 
You may want to review the lesson from Week One. NR 439 Week 1: Role of Research and the Importance of the Searchable Clinical Question

According to CCN 2017 week 1 lesson, evidence can form the basis of best practices for the nursing process (assessment, diagnosis, planning, implantation and evaluation). As we consider the who, what, where, when, why and how of the situation, we begin to formulate a clinical question that addresses these queries. The PICOT format is a way to develop a clinical question that leads itself to searching for evidence. PICOT is an acronym for:

P= Population of interest

I= Intervention of interest

C= Comparison of interest

O= Outcome of interest

T Time

The case study of a 57 year old female with a 13 year history of diabetes who presented to the hospital due to failure of oral hypoglycemic agents (OHAs) in controlling her sugar levels, for the last 3 years, and was using biphasic insulin aspart 30/70 for treatment. She is a regular swimmer and socially very active, which led to her to have irregular meals and so often goes into frequent hypoglycemia. Her lifestyle, eating habits, and the use of biphasic insulin are the contributing factors of her uncontrolled diabetes and hypoglycemia. In addressing this case study, I will formulate the PICOT as follows:

P= 57 year old female with 13 years history of diabetes

I=Teaching regarding diabetic management

C=No teaching regarding diabetic management

O=Improvement in diabetic management and reduction of diabetic crisis

T=Daily monitoring of fasting blood-sugar and postprandial blood-sugar levels x 3 months and monitoring HA1C levels every 3 months. Assessment of knowledge about diabetic management.

Clinical question after PICOT format:

Etiology and assessment: Does lifestyle (irregular meals )and biphasic insulin aspart 30/70 causes hypoglycemia on the female.

Treatment and Prognosis: With lifestyle modification(regular meals), teaching on diabetic management and insulin degludec help in controlling the ladies diabetes by maintaining her blood-sugar levels and HA1C within normal limits?

  References

CCN (2017). Week 1 Lesson. NR-439 RN Evidence-Based Practice. Online lesson. Downers Grove, IL: DeVry Education. Group.CCN (2016).

A common method for nursing to use when searching for evidence to improve practice with the goal of asking a searchable and answerable question is to use a PICOT question format.  Placing the clinical, searchable problem question in PICO(T) format helps to clarify the population, intervention, comparison or variables, outcome, and time frame involved (Chamberlain College of Nursing, 2018).  You have written a very well defined PICOT for this case study. Good work. What words would you use for searching for information in the library on your topic?  Dr Joy

Chamberlain College of Nursing (2017). NR-439 RN Evidence-Based Practice: Week 1 lesson. Downers Grove, IL: Online Publication.

Thanks for reading my post and for the kind remarks. I think I would use the following words when searching for information in the library for this particular topic: Would lifestyle modification and the use of insulin degludec reduce incidence of hypoglycemia in patients with type 2 diabetes?. I hope I answered your question, and if not I would be glad to receive any feed back from you. These are good terms to use. You may also want to consider what you mean by lifestyle modification?  

Thanks for the feedback. In the scenario of the woman with diabetes and with irregular eating habits, lifestyle modification will involve altering her long-term habits of irregular eating. So the question will be: Would regular meals and insulin degludec reduce incidence of hypoglycemia in patients with type 2 diabetes? Hopefully this makes more sense.

     Great post, I think understanding the control of insulin regulation is challenging.  I know patients who feel that if I they take their medication they can eat anything they want.  Teaching proper meal plans as well as activity is key to the maintenance of insulin control for each individual. 

Thanks for your contribution. I agree with you that most patients with type 2 diabetes feel that they can eat anything as long as they adhere to thier medication regimen, but this is not true. In type 2 diabetes, the body may not produce enough insulin, or might be resisitance to insulin. It is the responsibility of the to teach their patients about type 2 diabetes and it’s management by providing them with evidence based literatures. I agree with you that combining a healthy meal plan, exercise and diabetes medication is key to the management of type 2 diabetes.

     I enjoyed your post and agree with your plan. My friend  mother at age 60 was diagnosed last year with type 2 diabetes. She went to the hospital with polyuria, polydipsia and flu like symptoms when they found out her blood glucose was over 600. She started out with having blood sugars at AC/HS with sliding scale coverage, standing coverage at meal times and long acting Levemir once daily. After adhering to a strict diet and exercise plan like you suggest, a year later she has lost weight and is off all diabetic medication!

It is a very accurate observation you have made regarding the patient’s perspective of a liberated diet with the use of insulin, and I agree with you as I have seen this myself.

I have to say though, one of the endocrinologists that I work with almost, inadvertently, leads patients to practice this in that he has them count their carbs for every meal and give a sliding scale accordingly with any additional amount for every 25 mg/dl above 100 mg/dl reading in their blood sugar. I don’t think that is his intention because he still gives nutritional education and encourages limited, consistent carbs, but I can almost see that’s why they start to think that way.

This conversation has helped me to identify this trend and now I will be sure to implement in my diabetic education for my patients as we have many diabetic patients!!!

The control of insulin regulation can be very challenging and I hear it all the time I do not know why my sugar is high, I did not eat much or I took my insulin so I should be okay to eat what I want. I educate patients on the physiology of things, on how insulin works, the pancreas etc, and the risk factors and complications that can occur. Teaching and making sure that patients and family verbalized understanding as well as demonstrating to have proper and safe medication regimens and to be compliance. When food, exercise and insulin are not balance, blood sugar levels arises. Also patients are unaware that stress, emotions can play a role in causing hyperglycemia and this should not be used as an excuse for poor control of diabetes.