Table of Contents
In the current perspective, development of non-communicable conditions has raised awareness on effective management. Accordingly, many people contend that effective use of scientific evidence has an influence that can enable clinical professionals to provide the best quality health care services to patients diagnosed with chronic illnesses (Titler, 2008). In essence, extensive randomized research trials have proven to be effective by allowing clinical team to make informed decisions that are aimed at improving quality care.
For many years, nursing as a profession has a history of embracing the use of research. Scientific study for nursing practice was pioneered by Florence Nightingale, and in the mid-1900s, few nurses came on board to contribute to the foundation of nursing research. Recently, professional nurses have provided remarkable leadership in clinical practice by improving healthcare services through the application of evidence-based research findings into practice. For instance, Evidence-based practice (EBP) and Mētis-based practice (MBP) has been integrated into care plans for the management of chronic illness (Fulford et al., 2012). Despite the existence of various research practices, it is uncertain whether they are always implemented appropriately in care delivery, especially in chronic illnesses. In view of that, Patient Safety Research suggests that implementation of findings from evidence-based studies have a positive impact on improving safety to patients. Apparently, implementation of research tends to be a daunting task for nurses due to a myriad of clinical findings, some of which tend to yield conflicting results. Hence, this study aims at unraveling the complexity that is occasioned by the care for patients living with diabetes through an analysis of evidence-based healthcare practices. It will provide insights of integration of health research into clinical practice by exploring evidence-based practice and Mētis-based practice in the management of diabetes.
Outline of Evidence-based practice
According to Fulford et al. (2012), evidence-based practice refers to the conscientious, judicious and explicit implementation of best available evidence practice that concur with clinical expertise and patient values. In a nutshell, EBP denotes the integration of clinical expertise with the current external clinical evidence resulting from systematic research. Best available clinical evidence means that professional practice is guided by empirical evidence obtained through randomized control trials; use of information generated from expert opinions, scientific principles, and case reports. Besides, best evidence practice consist of findings that are yielded by scientific methods that include descriptive as well as qualitative research (Stetson, Ruggiero & Jack, 2010). Clinical expertise, on the other hand, refers to the proficiency and judgment acquired through clinical experience of practice. Therefore, quality of care for patients is an amalgamation of best research evidence as well as clinical expertise together with patient values and the circumstance of their condition.
Implementation of evidence-based healthcare practice commences with the EBP process. This consist of asking a well-thought of and answerable questions. This is consequently followed by searching for evidence in reputable databases. Subsequently, evaluation or appraisal of the searched evidence is performed to ascertain the truth, effect and applicability in clinical settings. Thereafter, the evidence is put to practice through integration with clinical expertise and existing healthcare policies. Integration also takes into account of the unique circumstances and value of care for patients. Finally, evaluation is undertaken to assess the effectiveness of the evidence-based practice (Titler, 2008). This determines its adoption in the next clinical case involving the same condition. Even though evidence-based health care practices were intended for doctors, other cadres of health including nurses have highly embraced its application. Nevertheless, EBPs are now available for the management of various medical conditions including diabetes, asthma and heart failure.
Integration of Evidence-based Practices in the Management of Diabetes
With the rapid growth in aging population and lifestyle factor coupled with technological environment, the prevalence of chronic illness has tremendously shown an increase. Precisely, diabetes has proven to be an alarming healthcare concern due to associated medical conditions exacerbated by the same. Hence, implementation of EBP comes handy as it changes health care cultures aimed at improving safety practice environment (Fulford et al., 2012). Ultimately, patient safety in regard to diabetes is enhanced through quality medical care rendered by nurses.
For nurses involved in diabetes practice, making an informed decision is guided by four guidelines. First, the nurse is expected to be conversant with the types of best available current evidence practice. Second, the nurse is required to know and become familiar with the best sources of evidence that guide practice. Third, the nurse is required to be up to date with the best current randomized control trials (RCTs) in the management of diabetes. Finally, the practice nurse is required to use the best available evidence to apply in the daily clinical practice for the management of diabetes.
An essential aspect of care management for diabetes is risk factor reduction. The nurse is expected to discuss approaches to risk factor reduction to conditions such as cardiovascular diseases (CVDs) and hypertension. Moreover, behavioral changes and dietary habits are important considerations for diabetes management. Intrinsically, the cognitive behavioral therapy (CBT) is the existing evidence suggested as an approach to risk factor reduction. Coincidentally, information source from the Evidence Analysis Library (EAL) affirms the benefit of CBT as a component of risk reduction in diabetes management. EAL provides information on specific conditions associated with diabetes, therapy type and outcome of the intervention. Fundamentally, the source document contains systematic reviews that explore CBT methods to health as well as food-related behavior that can be adopted to reduce the severity of diabetes and risk of CVDs. Besides, the article gives an analysis of weight loss promotion that supports risk factor reduction for diabetes. In the evaluation of the CBT approach that is supported by EAL, it is evident that the method provides benefit on dietary habit change as it encourages decreased sodium and fat intake while promoting increased consumption of vegetables and fruits at tolerable limits (Stetson, Ruggiero & Jack, 2010). Nonetheless, the finding also suggests prevention of CVD and hypertension, which are all risk factors for diabetes. Undoubtedly, the knowledge provided by the EAL can be used to guide decision making when counseling patient on the risk factors for diabetes and best approaches to manage these factors.
Moderate physical exercise based on tolerance also form an important aspect of management in diabetes. The nursing care provider is intended to consider the safety of the exercise so that the diabetic patients, especially those with peripheral neuropathy, do not develop other complications. In accord, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes of 2010 provide extensive information on resistance exercise for type 2 diabetes. The source document outlines various well-designed RCTs mainly addressing type 2 diabetes in adults. Consequently, the trials affirm the benefit of resistance training on improving A1C for diabetic management.
Cochrane Database of Systematic Reviews (Cochrane Reviews) also provides a searchable platform for topics on diabetes including resistance training. Moreover, the reviews offer heterogeneous samples for various medical illnesses associated with diabetes and the impact of resistance exercise on these conditions. Even though review studies suggest that resistance training improves muscle strengths for adult patients with complications of peripheral neuropathy, these study designs do not provide adequate information for diabetic patients with a disability that alters mobility. However, both the 2010 ADA Standards of Medical Care in Diabetes and Cochrane Reviews provide information to nurses on evidence-based practice for diabetes management. Therefore, the nurse can use the information to encourage diabetic patients on the best approaches and benefits of weight training.
Other aspect of diabetes management is on the medications. Several therapies have been proposed for use by those with diabetes. Hormonal therapy by use of insulin is recommended for patients with insulin-dependent diabetes mellitus. Evidently, multicenter trials have led to the publication of landmark RCTs that provide evidence on therapy for diabetes. These include but are not limited to Diabetes Prevention Program (DPP), Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS). Apparently, these landmark trials do not provide overall optimal approaches for all persons with diabetes (Stetson, Ruggiero & Jack, 2010). Hence, a nurse needs to have individualized goals of care for patients with various complications secondary to diabetes.
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Overview of Mētis-based Practices
Mētis are aboriginal communities in Canada that are considered to be immigrants from Europe. These populations are distinct from the natives in terms of history, culture, socioeconomic and sociopolitical factors. Prevalence of diabetes is highest among the Mētis populations in relation to the natives. Supposedly, the high incidence rates are attributed to undiagnosed diabetes, pre-diabetes, and cardiovascular risk factors (Ralph-Campbell et al., 2009). Besides, the biological and genetic composition of the Mētis predisposes them to Type 2 Diabetes. This is because children among the Mētis community are at high chances of being born by mothers diagnosed with gestational diabetes, thus, increases their possibility of developing type 2 diabetes in the old age. Seemingly, Mētis experience early onset of diabetes making them to develop greater severity during diagnosis, hence, are at higher risk of developing associated complications. According to Shah, Cauch-Dudek and Wu (2012), Mētis-based practice for management of diabetes takes into consideration the aspect that the magnitude of diagnosed diabetes among the Mētis community could be much greater than is reported.
Integration of Mētis-based practices in the management of diabetes
According to Institute of Clinical Evaluative Sciences (ICES), the Mētis population has similar complications associated with diabetes, just like the general population. However, the research documents higher rates of myocardial infarction among the Mētis who are diagnosed with diabetes. Besides, the Mētis community was at higher risk of lower limb amputation due to foot ulceration (Shah, Cauch-Dudek & Wu, 2012). The latter confirm the duration of diabetes and lack of metabolic control to avert the same.
Systematic research findings by Mētis National Council reports that Mētis population have limited access to diabetes assistance programs. The management of care, therefore, is expected to incorporate screening for limb, I-eye as well as Cardiovascular together with Kidney (SLICK). This Mētis-based practice is aimed at early detection and prompt management of diabetes-related complications among the Mētis community.
Source document of Aboriginal People Survey (APS) of 2006 associate the Mētis with binge eating and lifestyle habit of smoking. This MBP is consistent with the existing knowledge that associates binge eating with lack of glycemic control, therefore, predisposing the community to risk factors for diabetes. Moreover, smoking increases the heart arrhythmia, thus, exposing the Mētis to diabetes and high risk of heart attack (Ralph-Campbell et al., 2009). As a result, care plan among the Mētis incorporates an assessment of lifestyle habits involving smoking. Besides, CBT approaches are encouraged as they help to address a range of mental, social, physical and spiritual factors that have a causal link to the risk of diabetes among the Mētis people.
As illustrated in the preceding discussion, nurses strive to provide the best quality of care as per the available protocol. Quintessentially, evidence-based healthcare practice can be used to support efforts to improve quality care as they incorporate medical, behavioral and educational interventions. Conversely, as per the context of chronic illnesses including diabetes, nurses may lack relevant sources on the latest guide on practice. Hence, nurses are expected to be familiar with sources of information on current evidence-based researches (Stetson, Ruggiero & Jack, 2010). Moreover, the nurses need to be conversant with current landmark randomized trials that will guide decision making on adoption of new clinical evidence for practice.
- Fulford, K. W. M., Peile, E., & Carroll, H. (2012). Essential values-based practice: Clinical stories linking science with people. Cambridge: Cambridge University Press.
- Ralph-Campbell, K., Oster, R. T., Connor, T., Pick, M., Pohar, S., Thompson, P., … & Toth, E. L. (2009). Increasing rates of diabetes and cardiovascular risk in Métis settlements in northern Alberta. International Journal of Circumpolar Health, 68(5), 433-442.
- Shah, B. R., Cauch-Dudek, K., & Wu, C. F. (2012). IN THE MÉTIS NATION OF ONTARIO.
- Stetson, B. A., Ruggiero, L., & Jack, L. L. (2010). Strategies for improving the acquisition and integration of evidence into diabetes care. Diabetes Spectrum, 23(4), 246-253.
- Titler, M. G. (2008). The evidence for evidence-based practice implementation.