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.).
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).
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.