PICOT QUESTION AND LITERATURE RESEARCH NRS 433
PICOT QUESTION AND LITERATURE RESEARCH NRS 433
Summary of Clinical Issue (200-250 words):
Type 2 diabetes mellitus is one of the health problems that affect a significant proportion of people globally. It is estimated that one in every 11 adults has diabetes across the world. From this number, about 90% of the cases are attributed to type 2 diabetes mellitus. The high rate of diabetes mellitus type 2 has made it be ranked as the major cause of mortalities worldwide. It increases the risk of vascular disorders with almost 65% of patients with diabetes mellitus dying from cardiovascular disease. Other complications associated with type 2 diabetes mellitus include diabetic retinopathy, diabetic foot, and diabetic nephropathy (Kaiser et al., 2018). Diabetes mellitus type 2 arises from a combination of multiple risk factors. They include genetics, obesity, physical inactivity, and hypertension. Effective management of type 2 diabetes is important for the prevention of its complications and loss of lives. Accordingly, the management of type 2 diabetes relies mainly on the use of pharmacological and non-pharmacological interventions. Pharmacological interventions focus on the use of drugs to regulate the level of blood glucose. On the other hand, non-pharmacological interventions aim at utilizing lifestyle and behavioral approaches for glycemic control. It includes the provision of health education to the patients on the importance of healthy, balanced diet, engaging in active physical activity, and monitoring body weight (Bullard et al., 2018). The use of lifestyle and behavioral interventions has been shown in studies to be highly effective when used with medications for type 2 diabetes mellitus. Despite this, the use of the combined interventions has not been explored in our setting, hence, the proposed focus in this project.
PICOT Question:
In adult patients with type 2 diabetes mellitus, does the use of lifestyle and behavioral interventions with medications result in better treatment outcomes when compared to the use of medications alone in a period of six months?
| Criteria | Article 1 | Article 2 | Article 3 |
| APA-Formatted Article Citation with Permalink | Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., … & Iepsen, U. W. (2017). Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Jama, 318(7), 637-646. https://jamanetwork.com/journals/jama/article-abstract/2648632 | Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., McKenzie, A. L., Bhanpuri, N. H., Campbell, W. W., … & McCarter, J. P. (2019). Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2-year non-randomized clinical trial. Frontiers in endocrinology, 10, 348. https://doi.org/10.3389/fendo.2019.00348 | Moncrieft, A. E., Llabre, M. M., McCalla, J. R., Gutt, M., Mendez, A. J., Gellman, M. D., … & Schneiderman, N. (2016). Effects of a multicomponent life-style intervention on weight, glycemic control, depressive symptoms, and renal function in low-income, minority patients with type 2 diabetes: results of the community approach to lifestyle modification for diabetes randomized controlled trial. Psychosomatic medicine, 78(7), 851. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003734/ |
| How Does the Article Relate to the PICOT Question? | The article examines the effectiveness of lifestyle intervention on the glycemic control in patients with type 2 diabetes. The participants utilized the lifestyle intervention alongside the medications for treating the disease. Therefore, the outcomes provide insight into the outcomes associated with the use of lifestyle intervention alongside medications in type 2 diabetes mellitus. | Lifestyle interventions in the management of type 2 diabetes include dietary modification for glycemic control. This study investigated the use of nutritional ketosis in the management of type 2 diabetes. The participants were also under medical treatment of the disease. Therefore, the research relates to the PICOT question since it shows the effectiveness of the lifestyle intervention in the management of type 2 diabetes. A comparison is made with use of standard care. | The article explored the effectiveness of, multicomponent lifestyle intervention with medications use in the treatment of type 2 diabetes mellitus. The study shows that when compared to the usual care, multicomponent lifestyle interventions are effective for type 2 diabetes mellitus. Therefore, it shed light on the relevance of the proposed PICOT statement. |
| Quantitative, Qualitative (How do you know?) | The study is a quantitative research. There was randomization of the study participants. The methods of the study also point towards a quantitative methodology. | The research was a quantitative study. It can be seen from its methods such as randomization and use of statistical methods to analyze the data. | The study is a quantitative study. There was the use of methods such as randomization of the participants and quantitative methods of data collection and analysis. |
| Purpose Statement | To investigate the effect of lifestyle intervention on glycemic control in patients suffering from type 2 diabetes. | To investigate the long-term effects of nutritional ketosis on the management of diabetes mellitus type 2. | To determine the effects of multicomponent behavioral intervention on renal function, weight, depressive symptoms, and glycemic control in minority patients with type 2 diabetes mellitus. |
| Research Question | What is the effect of intensive lifestyle intervention on glycemic control in patients suffering from type 2 diabetes? | What are the long-term effects of nutritional ketosis on the management of diabetes mellitus type 2? | What are the effects of multicomponent behavioral intervention on renal function, weight, depressive symptoms, and glycemic control in minority patients with type 2 diabetes mellitus? |
| Outcome | The outcomes for this study included levels of hemoglobin A1c, symptom management, and quality of life of the patients. | The primary outcomes in the study included fasting glucose, HbAic, c-peptide, fasting insulin, and weight. The secondary outcomes included bone mineral density, lower extremity lean mass and abdominal fat content. | The primary outcomes in this study included glycemic control, weight, and depressive symptoms. |
| Setting (Where did the study take place?) | The study was conducted in Region Zealand as well as Capital Region of Denmark. | The study was conducted in the Lafayette, USA. | The study was conducted in Miami, USA. |
| Sample | 98 patients with non-insulin dependent diabetes mellitus type 2 | The sample consisted of 262 participants who were assigned to the continuous care intervention group including ketosis and 87 participants who were placed in the usual care group. | The sample consisted of 111 adults with diabetes mellitus type 2. They were assigned randomly to treatment and control groups. |
| Method | The method for the study was a randomized, assessor blinded single center study. | The study was an open-label non-randomized control study. The participants in the treatment group received usual continuous care plus nutritional ketosis for two years. The participants in the control group received the usual care alone. | The study was a randomized controlled trial. The participants in the treatment group were administered with interventions that included physical activity, dietary modification, cognitive behavioral therapy, and social learning therapy to manage depressive symptoms. The participants in this group were tracked to determine the effectiveness of the interventions. The participants in the control group however received the usual care that included the use of medications for the treatment of type 2 diabetes mellitus. |
| Key Findings of the Study | There was a significant change in the level of HbA1c by the end of the 12 months follow-up period. The HbA1c level changed from 6.65% to 6.34% in the treatment group and 6.74% to 6.66% in the control group. | There was a reduction in fasting glucose, HbA1c, weight, fasting insulin, systolic blood pressure, triglycerides, liver alanine transaminase, and diastolic blood pressure in the treatment group. There was also an increase in HDL-C. These outcomes remain unchanged in the control group. | There was decrease in weight, HbA1c and levels of depressive symptoms in the participants in the treatment group. There was also an improvement in the overall glomerular filtration rate. There were insignificant changes in the participants in the usual care group. |
| Recommendations of the Researcher | The use of intensive lifestyle intervention with medications is more beneficial than the standard care alone. However, further studies are needed to evaluate durability and generalizability of the findings. | The use of lifestyle interventions such as nutritional ketosis has long-term benefits on multiple markets of diabetes. The use of the approach should be considered for clinical use. | Multicomponent behavioral interventions are effective in not only managing the symptoms of diabetes mellitus type 2 but also depressive symptoms that affect the quality of life of these patients. Therefore, multicomponent interventions should be supported to ensure the realization of optimum outcomes of care for these patients. |
| Criteria | Article 4 | Article 5 | Article 6 |
| APA-Formatted Article Citation with Permalink | Følling, I. S., Solbjør, M., Midthjell, K., Kulseng, B., & Helvik, A. S. (2016). Exploring lifestyle and risk in preventing type 2 diabetes-a nested qualitative study of older participants in a lifestyle intervention program (VEND-RISK). BMC public health, 16(1), 876. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997726/ | Aujla, N., Yates, T., Dallosso, H., & Kai, J. (2019). Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: qualitative study. BMJ open, 9(8), e028491. https://bmjopen.bmj.com/content/9/8/e028491 | Rygg, L.O., Lohre, A. and Hellzen, O. (2017) Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes—The Active Ingredient in the Education. A Qualitative Study. Open Journal of Nursing, 7, 1181- 1195. https://doi.org/10.4236/ojn.2017.710086 |
| How Does the Article Relate to the PICOT Question? | The article explores the perceptions of adults at risk of developing type 2 diabetes on the use of lifestyle interventions. It therefore relates to the PICOT question because it explores the acceptability, effectiveness, and use of lifestyle interventions in the prevention and management of type 2 diabetes. It also provides insights into the factors that should be considered for the successful utilization of lifestyle interventions in the management and prevention of the disease. | The article provides insights into the acceptability and effectiveness of lifestyle intervention programs in the prevention and management of type 2 diabetes. As a result, it shows the enhanced effectiveness of the proposed intervention in this project, hence, its relevance to the PICOT statement. | The article explores the experiences of participants in a lifestyle intervention program that aimed at promoting effective management of type 2 diabetes mellitus. The article reveals that the lifestyle interventions were effective in empowering the participants engage in healthy eating habits and physical activity. Therefore, it supports the PICOT question by showing the benefits of lifestyle interventions in the prevention and management of type 2 diabetes mellitus. |
| Quantitative, Qualitative (How do you know?) | The study is a qualitative study. It can be seen from the use of qualitative methods of data analysis such as systematic text condensation. | The study is a qualitative research. This can be seen from the use of thematic analysis of the audiotaped and transcribed data. | The research is a qualitative study. It can be seen from the methods of data analysis such as thematic analysis and audio recording of participant data. |
| Purpose Statement | To explore the ways in which older adults perceive their lifestyle as well as being at risk of type 2 diabetes while participating in a lifestyle intervention program. | To explore the provider and user experience of the value and acceptability of the Let’s Prevent Diabetes program that used structured behavioral interventions for the prevention of the disease. | To explore the experiences of the participants in diabetes self-management education in relation to physical activity and diet |
| Research Question | In what ways do the older adults perceive their lifestyle as well as being at risk of type 2 diabetes while participating in a lifestyle intervention program? | What is provider and user experience of the value and acceptability of the Let’s Prevent Diabetes program in prevention of type 2 diabetes? | What are the experiences of the participants in diabetes self-management education in relation to physical activity and diet? |
| Outcome | The outcomes of the study included perception of the participants towards lifestyle intervention program. | The outcome for the study included the self-perceived user and provider experience with the behavioral interventions for the prevention of diabetes type 2. | The perceived experiences of the participants with the lifestyle interventions targeting dietary modification and physical exercises |
| Setting (Where did the study take place?) | The study was conducted in Norway in Nord-Trondelag County. | The study was conducted in East Midlands, UK. | The study was conducted in Central Norway |
| Sample | The sample consisted of 26 participants who were at a risk of developing type 2 diabetes mellitus | The sample consisted of 32. They included 22 participants who attended the program and 10 providers who implemented it. | The study used 16 participants |
| Method | In-depth interviews were conducted with the participants for six weeks. Notes as well as reflections were written down at the end of the interviews. The interviews were audio-recorded. Data was transcribed verbatim and text condensation done to obtain relevant themes from it. | The participants engaged in in-depth interviews that were audio-recorded. The data was then transcribed verbatim and thematic analysis performed to identify the common themes in the narratives. | Semi-structured interviews were conducted with the participants who were newly diagnosed with type 2 diabetes. The participants also had history of difficulties in regulating their blood sugar levels alongside expressing interest to attend the program. The audio-recorded interviews were transcribed verbatim and thematic analysis performed. |
| Key Findings of the Study | The findings revealed two themes that relate to the use of lifestyle intervention in prevention of type 2 diabetes mellitus. The first theme was the need for resources to maintain active lifestyle. The second them included the increased level of awareness about the risk behavior and health related worries that are needed for diabetes prevention. Therefore, the participants perceived that the lifestyle interventions were applicable and acceptable for their use in preventing diabetes. | The findings of the study revealed that the lifestyle and behavioral program was acceptable for use in the prevention of type 2 diabetes. However, it should be structured to address the cultural needs of the different participants. There is also the need for the provision of resources and facilitation of the participants at the locality or general practice level. Despite these challenges, the participants reported that the lifestyle and behavioral interventions increased their level of awareness on preventive measures for type 2 diabetes mellitus. | The findings of the study revealed that lifestyle intervention program transformed the dietary and physical exercises habits of the participants. The participants were optimistic of changing their diets alongside engaging in multiple active physical exercises to maintain their blood glucose levels. Therefore, the use of lifestyle interventions such as the diabetes self-management education is effective in promoting the management of symptoms of type 2 diabetes mellitus. |
| Recommendations of the Researcher | Effective implementation of lifestyle interventions for prevention and management of diabetes requires adequate resource availability. Health organizations and providers should ensure that optimum support is provided to patients with diabetes for the goals of self-care management to be achieved. | Lifestyle and behavioral interventions are acceptable for use in the prevention of type 2 diabetes mellitus. Therefore, prevention information should be structured in a manner that increases user engagement and integration of services for increased uptake and effectiveness of the interventions. | Interactive learning should be incorporated into lifestyle and behavioral interventions that target prevention and management of type 2 diabetes. Interactive learning motivates the patients to play an active role in the self-management of their conditions. |
References
Bullard, K. M., Cowie, C. C., Lessem, S. E., Saydah, S. H., Menke, A., Geiss, L. S., … & Imperatore, G. (2018). Prevalence of diagnosed diabetes in adults by diabetes type—United States, 2016. Morbidity and Mortality Weekly Report, 67(12), 359.
Kaiser, A. B., Zhang, N., & Van Der Pluijm, W. (2018). Global prevalence of type 2 diabetes over the next ten years (2018-2028).
Assessment Description
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.
Use the “Literature Evaluation Table” to complete this assignment. Prior to starting the “Literature Evaluation Table,” complete the following:
- 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.
- Following the PICOT format, write a PICOT question in your selected 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).
- Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. Note: This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem. A mixed methods article can qualify towards meeting a qualitative or quantitative methodology.
Articles must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments. The PICOT question will also provide a framework for your capstone project.
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.
