NRS 433V Assignment: Research Critiques and PICOT Statement Final 

NRS 433V Assignment: Research Critiques and PICOT Statement Final

NRS 433V Assignment: Research Critiques and PICOT Statement Final

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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 required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Attachments
Research Critiques and PICOT Question Guidelines – Final DraftUse this document to organize the content from your four studies into your final draft. Quantitative and Quantitative StudiesNursing Practice Problem and PICOT Question1.What is your identified nursing practice problem? 2.List your PICOT question, following one of the templated formats reviewed in the course.Background1.Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.How do these four articles support the nurse practice issue you chose? 1.Discuss how these articles will be used to answer your PICOT question.2.Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.Method of Study:1.State the methods of the articles you are comparing and describe how they are different.2.Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method. Results of Study1.Summarize the key findings of each of the studies into a comprehensive summary.2.What are the implications of the four studies you chose in nursing practice?Ethical Considerations1.Discuss two ethical consideration in conducting research.2.Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research.Outcomes Comparison1.What are the anticipated outcomes for your PICOT question?2.How do the outcomes of the four articles you chose compare to your anticipated outcomes? Proposed Evidence-Based Practice Change1.What is the link between the PICOT question, the research articles, and the nursing practice problem you identified? 2.Based on this information, propose an evidence-based practice change for your identified
Research Critiques and PICOT Question Guidelines – Final DraftUse this document to organize the content from your four studies into your final draft. Quantitative and Quantitative StudiesBackground1.Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.How do these two articles support the nurse practice issue you chose?1.Discuss how these articles will be used to answer your PICOT question.2.Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.Method of Study:1.State the methods of the articles you are comparing and describe how they are different.2.Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method. Results of Study1.Summarize the key findings of each of the studies into a comprehensive summary.2.What are the implications of the four studies you chose in nursing practice?Ethical Considerations1.Discuss two ethical consideration in conducting research.2.Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research.Outcomes Comparison1.What are the anticipated outcomes for your PICOT question?2.How do the outcomes of the four articles you chose compare to your anticipated

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Research Critiques and PICOT Statement Final

 Diabetic ketoacidosis (DKA) is a medical emergency that is brought about by the metabolism of fats in the body in place of glucose due to the lack of insulin in type I diabetic patients. Most of these patients are usually children and adolescents because type I diabetes mellitus is strongly genetic and affects victims right from childhood. The metabolism of fats to produce the energy molecule adenosine triphosphate (ATP) for cellular activity results in the production of ketones that are toxic by-products. The ketones are acidic in nature and hence lower the pH of the blood to levels that are not optimum for normal physiology. At those low pH levels, the enzymes in the body cannot function properly and acidosis sets in. The patient begins to breathe deeply and in a labored way (Kussmaul breathing) in an attempt to get rid of as much carbon dioxide as possible so that it does not worsen the acidosis (Hammer & McPhee, 2018). If the patient with DKA is not attended to immediately and the acidosis corrected, they will die. This is the reason why education about the prevention of DKA is absolutely necessary and important for patients, parents, and nurses. DKA accounts for half of the mortality figures of type I diabetic patients below the age of 34 years. It also presents a significant financial burden to both the patient’s family and the government (Vitale et al., 2018). The purpose of this paper is to critique two quantitative and two qualitative articles providing evidence as to the best measures to prevent DKA.

Identified Nursing Practice Problem and the PICOT Question

            The identified nursing practice problem is a rise in the incidence of DKA in patients with type I diabetes and a paucity of knowledge on DKA in patients, parents, and providers. This has necessitated the need to find evidence-based strategies from current literature that can be used to correct the situation. For this, a PICOT question was formulated to guide this research for evidence from research databases. The PICOT question is presented here below.

PICOT Question

In the population of type I diabetic patients who suffer DKA (P), does the application of a hospital-based educational program for both patients and providers (I) compared to no education at the hospital (C) result in a reduction of cases of DKA (O) over a period of six months (T)?

Background

Summary of Studies

Iovane et al. (2018) conducted a study aimed at addressing the problem of the lack of DKA prevention in children under the age of five years who have been diagnosed with type I diabetes mellitus. The significance of this to nursing is that prevention is the best strategy to prevent the negative effects of disease. This is why nurses are the agents of health education for both primary and secondary prevention. Their involvement in educating the parents of these under-five children will be invaluable in preventing DKA. The purpose and objective of the study was to find out the whether a tailored campaign for DKA prevention in children under the age of five would be effective. The study’s research question was what the characteristics of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) in children aged <5 years are. 

The problem that spurred Vitale et al. (2018) to do their study was the need to find an effective preventive intervention for diabetic ketoacidosis in children with type I diabetes mellitus (T1DM). The significance of this problem to nursing is that prevention of DKA would reduce the disease burden and mortality in this population demographic. The goal of this study was to see how successful a brief, office-based educational program would be at increasing parent or patient knowledge of diabetic ketoacidosis’ early warning signs and symptoms (DKA). The authors’ research question was whether an office-based educational intervention would be an effective prevention of diabetic ketoacidosis.

For Parrot (2019), the problem was why patients with DKA were being readmitted to the hospital at a higher rate. The significance of this to nursing is that readmission within one month of discharge is an indication of poor quality of care that necessitates quality improvement (QI) through evidence-based measures. The purpose of this study was to learn more about the social determinants of health (SDoH) that can lead to diabetic ketoacidosis hospital readmissions (DKA). The research question was what the social determinants of health are that contribute to DKA readmissions.

Lastly but not least, Ogunrinu et al. (2017) investigated the problem of insufficient health education and self-management skills among diabetic patients in a developing country. The significance of this to nursing is that health education and self-management skills are critical factors in the prevention of disease. More importantly, nurses are the key facilitators of both. The goal of this study was to learn about diabetic patients’ perceptions and experiences with health education and self-management techniques in a developing country hospital. The research question was what are the perceptions and health education experiences of type II diabetic patients admitted to the hospital in a third world country?  

How the Four Studies Support the Nursing Practice Issue Chosen

 The above four studies support the nursing practice problem identified in that they are all done to determine the best effective evidence-based strategies that can be used to prevent the occurrence of complications of diabetes such as DKA.

How the Articles Will be Used to Answer the PICOT Question

 During the evidence search, the four publications picked were all acquired from research databases. To accomplish so, search terms and phrases based on the PICOT question had to be created, which could then be used to direct the evidence search (Melnyk & Fineout-Overholt, 2019). As a result, these papers deal with the PICOT issue in extremely particular terms. Because they are all about preventing DKA in children and teenagers, they will be utilized to answer the PICOT question. These publications would be able to answer this issue, as the PICOT is looking to investigate if an educational program for both providers and patients can be beneficial in preventing DKA.

How the Interventions and Comparison Groups in the Articles Compare to Those in the PICOT Question

 The interventions and comparison groups in the articles and the PICOT question compare very favorably. The PICOT question identifies the population of interest as children and teenagers who have been diagnosed with type I DM and who are at risk of DKA. In the studies, the samples are also very clearly those of children and adolescents. For instance, the sample for Iovane et al. (2018) was made up of children under the age of five. That for Vitale et al. (2018) was made up of teenagers above 13 years (n=42) and children below the age of 13 years (n=34). On interventions, the PICOT question talks of an educational intervention and the studies also use the same educational approach in their interventions.  

Method of Study

The Methodologies and Differences

 Iovane et al. (2018) and Vitale et al. (2018) are quantitative studies that have employed robust statistical tools to analyze data. The former used a sample of sixty children between one and ten years old while the latter used a mixed sample of children and teenagers (n=76). For data collection, Iovane et al. (2018) used previous historical medical data while Vitale et al. (2018) administered multiple choice questions to collect fresh data.

 Both Parrot (2019) and Ogunrinu et al. (2017) are qualitative studies. The former collected data through face-to-face interviews and also phone calls. The latter on the other hand collected data through focus group discussions and key informant interviews or KIIs. The sample for Parrot (2019) was made up of readmitted type I diabetics who had suffered DKA. The sample for Ogunrinu et al. (2017) was made up of type II diabetic patients admitted for care.      

One Benefit and One Limitation

 For Iovane et al. (2018) the benefit is the readily available data from medical records of the patients. The limitation is that this data may have been documented with errors that would be transferred to the study results. For Vitale et al. (2018), the benefit is that they are uncovering new knowledge by asking the participants questions. The limitation is that the veracity of the answers or the honesty of the participants in answering the questions cannot be guaranteed. In Parrot (2019), the benefit is that by determining the SDoH it would be possible to design appropriate educational interventions that address those specific SDoH. The limitation is that being a qualitative study, generalizability of the findings would be a challenge due to the small sample size. Lastly in Ogunrinu et al. (2017), the benefit is the use of key informant interviews and focus groups because these produce a high quality of data. The limitation is in the weak thematic data analysis techniques that may produce conclusions that are not very valid.

Results of the Studies

Summary of Findings

 According to Iovane et al. (2018), the incidence of DKA was higher in children under the age of five (21.8%) than in those above the age of five (3.75%) (p=0.021). The DKA symptoms improved significantly following the therapies, according to Vitale et al. (2018). Poor self-care priority, social support dependency, and financial volatility are all risk factors for readmission, according to Parrot (2019). Finally, Ogunrinu et al. (2017) discovered that respondents had a positive experience with diabetes education. The participants also indicated their willingness and capability to incorporate diabetes education, such as the importance of exercise, into their daily routine. They acknowledged, however, that they had minimal experience dealing with diabetes-related complications such as DKA.

Implications to Nursing Practice

 The implications of the four studies to nursing practice are that they provide evidence for the application of an educational intervention in the prevention and amelioration of outcomes of DKA in type I diabetic patients. For this reason, they will add to the body of knowledge available for evidence-based practice or EBP.

Ethical Considerations

 Two ethical considerations in conducting research are autonomy and nonmaleficence (Haswell, 2019). Autonomy refers to the fact that the participants must be given all the information about the research project truthfully without hiding anything from them. After that they are to be allowed to make the informed choice to participate in the research or not. This is what is called informed consent. Nonmaleficence or primum non nocere refers to the act of not deliberately harming the participants or exposing them to danger in the name of research. The researchers in the above four studies took the above two ethical principles into account because they did not coerce the participants but allowed for informed consent. They also did not expose the participants to any deleterious experimentation. They only exposed them to education about DKA and a few questions.

Outcomes Comparison

The anticipated outcomes from the PICOT question are improvements in knowledge about DKA as well as improvement n the outcomes of DKA. The outcomes in the four articles therefore compare very well with those that were anticipated in the PICOT question. In the studies, incidence of DKA went down after educational intervention and also awareness and personal self-care skills improved.

Proposed Evidence-Based Practice Change

The link running through the PICOT question, the four research articles, and the identified nursing practice problem is that the articles provide the scholarly evidence that prove the efficacy of the educational intervention suggested by the PICOT question. This then forms the basis for evidence-based clinical practice that solves the nursing practice problem. With that, the evidence-based practice change for the identified practice problem is a hospital-based educational program for both patients and providers.

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

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

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

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

Parrott, M.G. (2019). Factors leading to DKA readmissions: A qualitative study. Honors Thesis, East Carolina University 8 (1). https://thescholarship.ecu.edu/handle/10342/7343

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