Analyzing Forms of Nursing Inquiry Presentation
There is confusion about how evidence-based practice is different yet similar to quality improvement and research. The overarching goal of this presentation is to evaluate 3 articles based on standards of care in quality improvement, a research article, and an evidence-based publication.
The problem identified was management of diabetes in hospital and as an outpatient while simultaneously using the American Diabetes Association Standards of Care in the forefront. Fundamentally, the problem, according to the Centers for Disease Control and Prevention [CDC] (2017, as cited by Russell, Durham, & Johnson): diabetes is the 7th leading cause of the underlying cause of other co-morbidities in the U.S. management of diabetes a reflection on quality improvement in hospitals, scientific research and evidence based practice. Diabetes related care also utilizes health care resources more and more, particularly as the population ages; further, the American Nurses Association’s social policy indicates that attention to cost containment to be fiscally and morally responsible in the use of resources ((2005). Therefore, this presentation focus on three different approaches: Quality Improvement, Research and Evidence Based Practice and how the DNP practice scholar applies each form of inquiry.
Management of patients both in hospital and as outpatients require that patient safety is the first consideration as these patients are at risk for hyperglycemia as well as hypoglycemia, both of which may be dangerous (American Diabetes Association, 2019 [ADA]). Additionally, the significance and scope of problem is that diabetes is a chronic, lifelong illness that requires ongoing disease management. Russell et al. (2017) indicate that the disease prevalence in the United States is 9% with 1.4 million people annually diagnosed with diabetes. This presentation will take a dive into the methodologies uses to research this costly health problem that annually costs an average of $245 billion (Russell et al.)Analyzing Forms of Nursing Inquiry Presentation .
Purpose of analysis
Selected nursing problem: Diabetes management
Significance and scope of the practice problem
Quality Improvement centered article (QI) (American Diabetes Association [ADA], 2019)
“Diabetes Care in the Hospital: Standards of Medical Care in Diabetes” (ADA, S173)
Best practice protocols, evaluations, and guidelines from admission to discharge
Report recommendations includes as a last step, a structured discharge information communicated with outpatient providers
The American Diabetes Association re-evaluates management of patients with diabetes annually to provide current standards of diabetes care, outline treatment and guidelines as well as share tools to use for further document and appraise care provided to patients with diabetes (Pugh). The underlying purpose of this report is patient safety as in the acute care setting, adverse outcomes are associated with hyperglycemia and hypoglycemia.
The ADA indicates in their report that “’Best practice’ protocols, reviews, and guidelines are inconsistently implemented within hospitals” (Moghissi et al., as cited by the ADA, p. S173)Analyzing Forms of Nursing Inquiry Presentation .
Included in this, the ADA recommends:
HbA1C testing if the patient has not had this test performed in the last 3 months.
Diabetes self-management and compliance should be evaluated upon admission. If warranted, diabetes education should such that patients have the appropriate skills to manage their health once discharged.
The standards also address using insulin in the acute care setting that includes written/computerized orders that follow protocols based on fluctuations in glycemic levels; recommendations for consults with specialized diabetes teams; insulin therapy that maintains glucose level of 140-180 mg/dL (moderate versus tight control); basal insulin administration plus corrective boluses in critically ill patients as the sole use of sliding scale is not recommended. Nutrition therapy as well as hypoglycemic event management protocols should be in place in the acute care setting, and in the event of a hypoglycemic incident (glucose level of less than 70 mg/dl) with a patient, the treatment regimen should be adjusted; and a tailored discharge plan fits the individual needs of patients with diabetes.
Not specifically outlined
Literature review with citations
Annual report sets national standards of patient care in the management of diabetes
Numerous opportunities for the DNP in the acute care setting and beyond (White et al., 2021)
Private practice (nurse practitioner)
Acute care leadership
Risk management in acute care setting
DNP role with and in QI
Leadership in diabetes management
Policy creation, review and updates
Research constructed article (Whitehead et al., 2016)
A nurse-led education and cognitive behavior therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomized controlled trial
Knowledge gap identified and quest for further knowledge development initiated by study
Chronic Care Model (CCM) used as framework
Study Design: randomized controlled trial
Research constructed article
Study conclusions (Whitehead et al.)
No evidence participants experienced hypoglycemic events
Study did not collect information on experiences of hypoglycemia or fear of hypoglycemia
Individual and group therapy components
Study did not identify which therapy setting was more effective
Inference: nurse-led intervention effective in reducing participants’ HbA1c is cost-effective in primary care setting
Additional areas for study identified were to examine the similarities and differences between group and individual cognitive-behavioral therapies.
Research & the DNP
The DNP can use research to implement projects (White et al.; Dang & Dearhold, 2018)
Diabetes self-management education (DSME) with goal of minimizing diabetes associated complications
Cognitive-behavioral interventions in group or individual settings
Foundational science with room for more studies that DNP could participate in
Further studies to confirm findings
Evidence Based Practice article (Russell et al., 2019)
Problem: Diabetes Self Management (DSME)
Framework: Chronic Care Model (CCM)
Promote DSME to minimize the complications associated with diabetes
Patient education combined with mobile text
messaging to improve diabetes self-management
Evidence Based Practice (Russell et al., 2017)
“Knowledge gap in best available evidence” (p. 5)
Practice Question, Evidence, Translation (PET)
Amalgamation of evidence for practice adoption
Decrease in participants’ average fasting blood glucose level after text messaging that encouraged supportive DSME
Evidence Based Practice (Pugh, 2018)
Performance gap identified in primary practice
Methodology: Plan-Do-Study-Act (PDSA)
Evidence produced for application
Decrease in participants’ mean fasting blood glucose levels after education and text messaging
Evidence based practice & the DNP
As a DNP, utilization of EBP is the fundamental proficiency for professionals (Institute of Medicine, as cited by Dearholt & Allan, 2018)
Translation of knowledge gained by literature review to establish and implement care based on patient/family and community goals (White et al., 2021)
Further skill and knowledge development with interprofessional collaboration (White et al.)
Of the three articles reviewed, ways to the three different articles are below:
QI: Based on the Standards of Care in this report (ADA), the DNP could work in a team with nursing leadership, medicine, laboratory and pharmacy leadership to ensure current standards of care are reviewed annually and policy and procedures match with standard of care.
Research: The DNP could use the literature to work with a multidisciplinary team including clinical therapist and/or psychologists, nursing staff and medicine to implement a cognitive behavioral therapy-based intervention program in an outpatient clinic setting. The DNP could also work with other researchers to springboard from this study to research the differences between group therapy compared to individual therapy as suggested by the authors (Whitehead et al.)
Evidence-based practice: In a rural community setting the DNP could use this model to text message patients in a community setting to improve outcomes for patients with diabetes (Russell et al.)Analyzing Forms of Nursing Inquiry Presentation .
ADA report: Identify best practice guidelines
Research article: Broaden scientific knowledge as foundation to improve patient outcomes
EBP: Improve DSME in outpatients with diabetes
ADA report: Literature review
Research article: Randomized controlled trial
EBP: Implementation of intervention through text messaging patients
All of these articles used literature review as a foundation for the creation of standards or the framework for the study performed. While they may differ in approach, the underlying purpose is to improve the care and wellbeing of the patients served. All used teamwork based on the evidence reviewed to create standards of care, develop research between nursing and psychology, or develop a practical and simple intervention to improve DMSE.
Overall, the outcomes should be positive based on the streamlining care of patients with diabetes with annual standards, research that can be the catalyst for further research, and innovative practice programs. Analyzing Forms of Nursing Inquiry Presentation
ADA: Standardized treatment of patients with diabetes
Research: Cognitive-behavioral intervention improved patient outcomes; however, more research is needed to tease out if group or individual therapies have a greater influence on improved glycemic control
EBP: Improved patient outcomes through implementation of text messaging program
American Diabetes Association (2019). Diabetes care in the hospital: Standards of medical
care in diabetes. American Diabetes Association. (2018). doi: 10.2337/dc19-S015
Accessed, 18 September, 2020.
American Nurses Association (2005). Nursing’s Social Policy Statement (2nd ed.). nursebooks.org
Dearholt, S.L. & Allan, S.H. (2018). The Johns Hopkins nursing evidence-based practice model
and process overview. In D. Dang & S.L. Dearholt (Eds.), Johns Hopkins Nursing Evidence-
Based Practice: Models and Guidelines (3rd ed., pp. 3-13). Sigma Nursing.
Pugh, L.C. (2019). Evidence-based practice: Context, concerns and challenges. In D.
Dang & S.L. Dearholt (Eds.), Johns Hopkins Nursing Evidence-Based Practice:
Models and Guidelines (3rd ed., pp. 3-13). Sigma Nursing.
Russell, N.M., Durham, C. & Johnson, E. (2017). Text messaging to support diabetes self
management in a rural health clinic: A quality improvement project. Online Journal of Nursing Informatics, 2(2), 9-1. doi: 128848064 Accessed, 18 September, 2020.
White, K.M. (2021). Interprofessional collaboration and teamwork for translation. In K.M. White, S. Dudley-Brown, & M.F. Terhaar (Eds.), Translation of Evidence into Nursing and Healthcare (3rd ed., pp. 299-314). Springer Publishing Company.
Whitehead, L.C. Crowe. M.T., Carter, J.D., Maskill, V.R., Carlyle, D., Bugge, C., &
Frampton, C.M.A. (2017). A nurse-led education and cognitive behavior
therapy-based intervention among adults with uncontrolled type 2 diabetes: A
randomized controlled trial. Journal of Eval Clin Practice, 23, p. 821-829. doi: Analyzing Forms of Nursing Inquiry Presentation