Rough Draft Qualitative Research Critique And Ethical Considerations assignment

The main topic of interest is the management of type 2 diabetes. Type 2 diabetes mellitus (T2DM) is one of the diseases that affect a significant proportion of people globally. My interest in researching the management of T2DM is to determine the best interventions that can reduce diabetes complications among vulnerable patients. The topic is also of great interest since it attempts to identify the best treatments that can be employed to prevent T2DM among vulnerable populations. The research in this topic is also essential in determining the critical processes in the management of complications related to T2DM. This paper will summarize the content from the four study articles, including the background, method of study, results of the study, and in the articles.

PICO Question and Relevance to the Topic

PICO Question: In adult patients with type 2 diabetes mellitus, does the use of lifestyle and behavioral interventions with medications result in better treatment outcomes compared to the use of medications alone in a period of six months?

The PICO question is related to the topic of the management of T2DM since it aims at establishing whether diabetes management with lifestyle and behavioral interventions in addition to medication can result in better

Background

The study by Følling et al. (2016) aimed to identify the best interventions in managing T2DM for patients, both in the communities and within the . The study was informed by the increasing mortality rates attributed to T2DM.  It was also informed by the high cost of treatment of T2DM, increased patient’s suffering, and the rising number of diabetic conditions (Følling et al., 2016). The purpose of the study by Rygg et al. (2017) was to explore participants’ experiences in diabetes self-management education concerning physical activity and diet. The main clinical problem informing the study was the increasing cases of T2DM and the lack of the best intervention strategies for managing the rising population of diabetic patients.

The study by Kempf et al. (2017) explored the efficacy of utilizing a telemedical lifestyle intervention program on advanced stages of T2DM. The study was informed by the increasing rates of patients affected by T2DM. The purpose of the study was to evaluate the efficacy of the telemedical lifestyle intervention program in advanced stages of T2DM (Kempf et al., 2017).The article by Moncrieft et al. (2016) aimed at determining the effect of multicomponent lifestyle intervention on outcome measures such as weight, depressive symptoms, and glycemic control in patients with T2DM. The study was informed by the high mortality rates due to diabetes in patients affected by the disease.

The four articles share similarities in their comparison and the intervention groups, which will serve as a source of counterfactual causal inference. The studies are significant to nursing since they provide evidence-based information on the effectiveness of lifestyle interventions with medications on the management of diabetes. The articles relate to my PICO since they will help determine the best interventions that can be employed in the management of patients with T2DM to reduce diabetes-related complications among vulnerable patients. They will assist in answering my PICOT question by determining the efficacy of lifestyle and behavioral modifications with medications on the management of diabetes type 2.

Method of Study

The study by Følling et al. (2016) employed a nested qualitative approach with individual semi-structured in-depth interviews. The

researchers found appropriate and adequate for the study as the sample reflected the characteristics of the entire population under the study. The advantage of the case study method is that it allows a lot of details to be gathered, a scenario that cannot be easily achieved by other research designs. The disadvantage is that some case studies may not be scientific, and the data collected cannot be necessarily generalized to the wider population (Liang, 2019). The study article by Rygg et al., (2017) was phenomenological since it focused on the commonality of life experience within the diabetic patients in the study. The researcher felt that the sample was adequate and represented the true characteristics of the entire population. The advantage of the phenomenological method is that it helps adjust to new issues and ideas as they emerge (Liang, 2019). The disadvantage is that there are always challenges with the analysis and interpretation of the result.

The study by Kempf et al. (2017) employed a randomized, controlled, interventional study. The outcome measures comprised changes in HbA1c in groups, body weight composition, cardiovascular disease risk factors, and eating behaviors between the participants in the treatment and control groups. The study by Moncrieft et al. (2016) also employed a randomized controlled trial. The study participants in the treatment group received usual care in addition to multicomponent behavioral interventions on glycemic control, weight, renal function, and depressive symptoms. Quantitative research is valuable when examining the management of T2DM since the benefits and limitations of the quantitative methods can be generalized (Liang, 2019). The randomized controlled trials are valuable to my topic of interest since the data has high reliability attributed to the randomization of the participants into the treatment and control groups.

Results of Study

The qualitative study by Følling et al. (2016) found that the lifestyle and behavioral program was acceptable for implementation in the prevention of T2DM. Nonetheless, the lifestyle and behavioral program should be designed to meet the cultural needs of different participants (Følling et al., 2016). The participants reported that lifestyle and behavioral interventions increased their awareness of preventive measures for T2DM. The study by Rygg et al., (2017) revealed that after the Diabetes self-management education, the participants were more optimistic about diet since they had learned how to interpret food labels and compose their meals (Rygg et al., 2017). They also perceived the benefit of physical activity in relation to their blood glucose levels.

The results in the two articles are similar in that they revealed that lifestyle modification on diet and physical activity in the prevention and management of T2DM.  However, Article 1 revealed the need to design lifestyle interventions based on an individual’s cultural needs, which was not the case in Article 2. The study results would help make a change in nursing practice by introducing newly diagnosed T2DM patients on a lifestyle modification program designed to meet their cultural needs to help manage the condition and prevent T2DM related complications.

The study by Kempf et al. (2017) found that the use of a telemedical lifestyle intervention program was associated with a significant reduction in HbA1c in the treatment group. Besides, the implementation of the telemedical lifestyle intervention program led to significant improvements in secondary outcomes. The study by Moncrieft et al. (2016) showed that the application of multicomponent interventions resulted in significant improvements in the management of T2DM. Furthermore, there was a substantial decrease in the weight of the participants in the treatment group compared to participants in the control group.  The multicomponent intervention was also associated with a reduction in depression symptoms and glycosylated hemoglobin and improvement in glomerular filtration rate in the treatment group than the control group.

The articles reveal that the implementation of lifestyle and behavioral interventions together with medications is associated with better treatment outcomes in patients T2DM. The information from the articles’ result findings relates to nursing practice as they provide immense knowledge on nursing practices that can be implemented in the management of patients with T2DM to prevent complications and promote better health outcomes. Therefore, it is crucial for nurses and other health providers to implement the use of lifestyle and behavioral interventions in the management of diabetic patients. The articles’ findings provide essential information that can be applied in my project to determine the best interventions that can be employed to reduce diabetes complications among vulnerable patients. The findings can also determine the best treatment that can be used to prevent T2DM among vulnerable populations.

Ethical Considerations

Research ethics are a set of ethics that direct how scientific and other research are performed at research institutions and how it is disseminated. They are based on three fundamental principles: Respect for persons, which state that participants should be treated as autonomous, and those with diminished autonomy should be protected. Beneficence requires the researcher to do no harm, maximize benefits for participants, and minimize risks (Woodfield & Iphofen, 2017). Justice requires that researchers designing trials consider what is fair in terms of recruitment of participants and choice of location to conduct a trial. Research ethics are vital since they promote the aims of the research and support the values required for collaborative work such as mutual respect and fairness (Woodfield & Iphofen, 2017). Furthermore, they signify that researchers can be held accountable for their actions and ensure that the public can trust research (Woodfield & Iphofen, 2017). Research ethics also support essential social and moral values, such as the principle of nonmaleficence.

The researchers on the four articles employed ethical practices such as confidentiality of information and respect for human dignity. They were able to protect participant’s data and information obtained and managed to conduct the studies in line with the standards that protect human dignity, especially for the study participants (Woodfield & Iphofen, 2017). The researchers adhered to the confidentiality standards and respect for human dignity and upheld the protection of privacy in the study.

Conclusion

Anticipated outcome from the PICOT question is that the implementation of lifestyle interventions and behavioral modifications with medications will result in better treatment outcomes in patients with T2DM compared to the usual care of medications use alone. The articles by Kempf et al. and Moncrieft et al. reveal improvement in outcomes in measures such as level of HbA1c, weight, symptoms, glucose monitoring, and hospital visits and admission due to diabetic-related complications from lifestyle and behavioral modifications.  Furthermore, the studies by Følling et al. (2016) and Rygg et al. (2017) reveal the effectiveness of lifestyle intervention programs in the prevention and management of T2DM. The study articles demonstrate the enhanced effectiveness of the proposed lifestyle and behavioral interventions, hence, their relevance to the PICOT statement. In addition, they support the PICOT question by establishing the benefits of lifestyle interventions in the prevention and management of T2DM.

References

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://doi.org/10.1186/s12889-016-3559-y

Kempf, K., Altpeter, B., Berger, J., Reuß, O., Fuchs, M., Schneider, M., Gärtner, B., Niedermeier, K., & Martin, S. (2017). Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care, 40(7), 863-871.

Liang, J. (2019). Qualitative research methods: Collecting evidence, crafting analysis, communicating impact: by SJ Tracy, West Sussex, UK, John Wiley & Sons, Ltd. 368 pp., $115.50 (hardback), ISBN: 978-1-4051-9202-3.

Moncrieft, A. E., Llabre, M. M., McCalla, J. R., Gutt, M., Mendez, A. J., Gellman, M. D., Goldberg, R. B., & Schneiderman, N. (2016). Effects of a Multicomponent Lifestyle 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), 851–860. https://doi.org/10.1097/PSY.0000000000000348

Rygg, L. Ø., Løhre, A., & Hellzèn, P. 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.

Qualitative Studies

Background of Study

There are different research methodologies that can be utilized in the research processes. There are both qualitative and quantitative research processes. Qualitative research involves the collection and analysis of non-numerical data such as texts, videos, or audio documents in order to understand concepts, experiences, and opinions. Qualitative research processes can also be utilized to gather in-depth insights into the problem and generate unique or new ideas for the research process. Qualitative research is the opposite of quantitative research which often involves the collection, and the analysis of the numerical data. The qualitative study I, “Qualitative study of telemonitoring of blood glucose and blood pressure in type 2 diabetes” by Hanley et al., (2015) involves an investigation of the experiences of professionals and patients taking part in the randomized controlled trials of blood pressure, blood glucose, and weight. The problem under consideration is type 2 diabetes. The article is significant to nursing because it entails different approaches geared towards enhancing evidence-based practices. The purpose of the article is to determine the best interventions for the patients suffering from type 2 diabetes. One of the research question is: Does telemonitoring of blood glucose, blood pressure and weight in primary care a promising approach of improving diabetes management?

The qualitative article II considered is: “Physical activity/exercise and diabetes: a position statement of the American Diabetes Association” by Colberg et al. (2016). The main objective of the article is to determine the impacts of physical activity/exercise on the management of diabetes. The article is significant to nursing since it involves consideration of different nursing approaches or interventions when it come to the management of diseases. The purpose of the article is to determine the best interventions that can be applied in the management of type 2 diabetes (Colberg et al., 2016). The objective of the research article II is to determine the best interventions for the individuals suffering from type 2 diabetes. The article focuses on the physical activity as the best approach when it comes to the management of type 2 diabetes. From the research article, the American Diabetes association recommend physical activities/exercise in the management of type 2 diabetes. There are different other interventions mentioned in the article; however, the focus is on the physical activities. The main research question in the article is: does the physical activity/exercise aids in the reduction of type 2 diabetes? The question covers all the aspect of the paper. In other words, it reflects the research objectives, the purpose of the research and literature review.

How the Two Articles Support the Nurse Practice Issue Chosen

These articles provide helpful information that can be applied in answering the PICOT question on diabetes. The issue is type 2 diabetes. From the research articles, there are literature reviews consisting of advanced information required in the understanding of the topic and the main issues surrounding the PICOT question. Article I elaborates on the effective interventions that can be undertaken to reduce type 2 diabetes. Also, with the established outcomes from the research processes, the two articles provide elaborate and conclusive information that can be used to answer or address different aspects of the PICOT question. Article II elaborates on the physical activities or the exercise as one of the main practice of reducing type 2 diabetes.

The research question is well elaborated and it provides a conclusive information about the importance of physical activities on reducing type 2 diabetes. This can therefore be applied in the development of interventions required in the management of type 2 diabetes. Some of the physical activities movement that enhances the use of energy. Structured physical activities are always required to ensure effective outcomes (Hanley et al., 2015). Physical exercise often improves glucose control when it comes to the management of type 2 diabetes. Also, physical activities reduce cardiovascular risks which are also associated with the management of type 2 diabetes. Regular physical exercise can stop or delay type 2 diabetes.

How the Interventions and Comparison Groups in the Articles Compare

To Those Identified in Your PICOT Question

The interventions and comparison groups from the two articles are comparable to the ones that have been identified in the PICOT statement. There is a high similarity between the comparison and the intervention groups in all the two articles identified for the study. The PICOT question is about type 2 diabetes or the best interventions required in the management of type two diabetes. The comparison in the groups in the two research articles serves as a source of counterfactual causal inference. The goal of the comparison group in the research articles and the ones in the PICOT question is to estimate the effects of treatment.

Method of Study

The two qualitative articles adhere to the qualitative approach. However, study II incorporates observational approaches to the institute findings on the basis of the objectives and the research questions. On the other hand, the qualitative study I applies survey techniques to establish significant findings. One of the benefits of the observational method of the qualitative research is that it is simpler and easier to use. The disadvantage of the method is that there is always lack of in-depth analysis leading to the lack of comprehensive outcomes.

Results of Study

The qualitative study II concludes that physical activities/ exercise reduce the cases of type 2 diabetes. In other words, physical exercise is one of the best interventions in the management of type 2 diabetes. From the information obtained from different sources, qualitative research article II concludes that the adoption and maintenance of physical activities are essential for the blood glucose management and overall health among the individuals suffering from type 2 diabetes (Latimer et al., 2017). The recommendations and precautions vary depending on individual characteristics and health status.

The two qualitative studies have different implications in the nursing practice. The studies facilitate the acquisition of knowledge and practical skills when it comes to the management of type 2 diabetes. In other words, the two studies provide new knowledge in the nursing practices and the understanding of the steps that ought to be undertaken to reduce health complications associated with type 2 diabetes.

Ethical Considerations

Ethical considerations are significant in the research processes. From the two qualitative research articles, there is the portrayal of confidentiality and respect for human dignity. These are some of the ethical considerations that have been applied in the two research articles. Before engaging in a research process, the acquisition of consent from the respondents is always necessary. Also, there is always the need to keep patients’ information safe so as to avoid the loss of important information. When undertaking the above qualitative studies, researchers adhered to the confidentiality of information which is considered to be one of the major ethical concerns. Also, they managed to do their studies in line with the requirements that protect human dignity, especially for the study participants.

References

Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., … & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(11), 2065-2079.

Hanley, J., Fairbrother, P., McCloughan, L., Pagliari, C., Paterson, M., Pinnock, H., … & McKinstry, B. (2015). Qualitative study of telemonitoring of blood glucose and blood pressure in type 2 diabetes. BMJ open, 5(12).

Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students’ awareness of medication errors and their prevention.

Replies

You used a great example of how your hospital used EBP for ileostomy or colostomy. From a previous class I found that EBP takes a while for a hospital to adopt the new practice. “Evidence-based practice is held as the gold standard in patient care, yet research suggests it takes hospitals and clinics about 17 years to adopt a practice or treatment after the first systematic evidence shows it helps patients.” (Luciano, 2019). How does your hospital decide when to adopt a new EBP? Since you have adopted the most up to date EBP, have you noticed the enhanced recovery than the traditional?

Luciano, M. (2019). 4 Ways to make Evidence-Based Practive the Norm in Healthcare. Harvard Business Review. https://hbr.org/2019/08/4-ways-to-make-evidence-based-practice-the-norm-in-health-care

Replies

Hi Justina! I enjoyed reading your post. I found it interesting that surgical recovery can be similar across the board. In the cardiovascular ICU, fresh open heart patients are on a pretty strict time frame. They need to have the ventilator removed by 4-6 hours after surgery, need to be up to the chair within 2 hours of extubation, and need to be walking with 4 hours after that! These protocols are put into place because of evidence-based practice.

References:

Adams, E. (2018). Implementing Fast-Track Extubation Protocols for Cardiac-Surgical Patients: A Review of the Literature. .

Mary-Korine Insunsa

Aug 26, 2022, 9:09 PM

Replies to Justina Aguilar

Nurses adopt evidence based practice because it is our duty to give the best care to our patients. As referenced by Faubion, (2022), “Evidence-based practice in nursing is an approach to providing nursing care that uses the most current research available to improve the safety, health, and well-being of patients. This practice focuses on delivering high-quality patient care while reducing healthcare costs and variations in patient outcomes.”

Although I do not know all details, currently in my hospital, infectious and disease control, wants to treat all patients for MRSA without testing the patients. Whereas the CEO does not agree with treating the patient, as it not cost effective. The CEO has given the task to pharmacy to find EBP to counter act what infectious disease is proposing.

In the nursing field, spirituality is integrated into our care already such as active listening, therapeutic touch, and humor. “In addition to being aware of and nurturing their own spirituality, nurses must practice “intentionality,” or focused consciousness. For example, it is important to enter a patient’s room with a clear mind—to be truly present.”

Faubion, D. (2022). Understanding Evidence-Based Practice in Nursing. Nursing Process.

Savel, R. (2014). The Importance of Spirituality in Patient-Centered Care. American Journal of Critical Care.