Capstone Project - Essay Example

?Capstone Project of Task Develop a searchable question using the PICOT format. Components of PICOT in relation to juvenile diabetes: (P) Population of Focus – children with Type 1 Diabetes (I) Intervention – self-management through glycemic control (C) Comparison – clinical –based therapies (O) Outcome – sustainable and effective management of Type 1 Diabetes (T) Time – until they reach adulthood My PICOT question: For children with Type 1 Diabetes (Juvenile Onset Diabetes) or Insulin Dependent Diabetes Milletus (IDDM), will self-management education intervention through glycemic control or clinical-based therapies provide a sustainable and effective management of this disease such that it can minimize symptoms, prevent short and long-term health problems and allow children/adolescents to enjoy a normal physical, mental, emotional and social aspects of development until they reach adulthood? Task #2: Consider a clinical environment in which you are currently working or have recently worked. Identify a problem, issue or educational deficit upon which to build a proposal for change. Several children have been repeatedly brought to Kansas Hospital due to incidents of frequently repeating infections such as pneumonia, pyelonephritis and soft tissue infections to name a few (Zarbock, 2005). Symptoms of polyuria, polydipsia, polyphagia, weight loss, fatigue and increased frequency of infections were also observed from the young patients (Banaga-Perez, 2008). The children were taken to undergo a more accurate assessment for the possibility of having diabetes. Indeed, most of them go back and forth to the hospital because they are positive with Type 1 Diabetes. This incidence has been increasing for the past years. Parents of the patients have been agitated on the medical condition that their children are facing. They also have learned that Type 1 diabetes or Juvenile Onset Diabetes has put their children in a delicate condition that it is actually life-threatening if not properly treated. Since there is no known cure yet for diabetes, its management, especially when implemented in a home setting, is critical. However, more Type 1 Diabetes patients have been diagnosed in the hospital. Families of patients have become stressed and worried on the fact that it is a serious disease that have made the children suffer and some had near-death experience. The nursing team of Kansas Hospital has then decided that Type 1 Diabetes patients and their families need more assistance aside from the medical attention they require. They knew that because of the prevalence of the disease, it can affect many people in various settings. That whether a patient has been hospitalized for another case, they cannot just administer any medicine or treatment if the patient is diabetic. Thus the nursing care they provide becomes more complex specializing on the needs of a diabetic patient. To address more appropriately the needs of increasing diabetic patients, the nursing team decided to initiate a Diabetes Clinic within the hospital. The Diabetes Clinic aims to provide and disseminate more information to the patients and their families, and also other people who may be concerned about this disease. It aims to educate its stakeholders on proper management of Type 1 diabetes so home care can be done effectively especially that diabetes is largely a patient-managed disease (Zarbock, 2005). The Diabetes Clinic also aims to provide motivation to the patients and their relatives about the perseverance to care for their health and that all their efforts will produce good results. The nurses will inform them about the new medicines, intervention programmes and treatments available and, how this can be appropriate their specific cases. Importantly, being able to help patients handle diabetes management in a less stressful manner is also the goal of the team. They understand that diabetes complications include emotional shifting as well leading to anger, frustration and fear and this affects the patient’s ability or inability to manage the disease (Zarbock, 2005). Thus the nursing team is driven to design effective strategies on how they can serve better the patients with Type 1 diabetes. References: Banaga-Perez, N.S. (2008). Diabetes Mellitus [Online]. Available at: http://www.slideshare.net/nhelzki/nursing-management-for-diabetes-mellitus-presentation [10 Jan 2013]. Zarbock, S. (2005). Infections in Patients with Diabetes [Online]. Medscape Today News. Available at: http://www.medscape.com/viewarticle/510525 [10 Jan 2013]. Task #3: Locate a minimum of 15 peer-reviewed articles that describe the problem or issue and which support the proposed solution. Eight of the 15 articles must be research-based (e.g., a study which is qualitative, quantitative, descriptive or longitudinal). Perform a rapid appraisal of each article by answering the following questions (one to two sentences are sufficient to answer each question: 1. How does each article describe the nature of the problem, issue or deficit you have identified? 2. Does each article provide statistical information to demonstrate the gravity of the issue, problem or deficit? 3. What are example(s) of morbidity, mortality and rate of incidence or rate of occurrence in the general population? 4. Does each article support your proposed change? Ref 1: Nadeem, T., Qamar, F. & Mehmood, K.T. (2010). Management of Juvenile Diabetes. Journal of Pharmaceutical Sciences and Research, 2(12): 827-831. 1. The article described the issue of juvenile diabetes shortly but comprehensively. 2. This article provided significant statistical information that supported the gravity of juvenile diabetes. 3. Examples of rate of incidence show that juvenile diabetes was present in 55% in male and 45 % in females. This is a evidence that diabetes is more common in male patients than females. 4. Yes, this article supports the glycemic control care for juvenile diabetes. Ref 2: Soltesz, G., Patterson, C. & Dahlquist, G. (2009). Diabetes in the Young: A Global Perspective. IDF Diabetes Atlas Fourth Edition. 36pp. 1. The article described the issue of juvenile diabetes by reporting the clinical severity of the disease and, prevalence in country regions and age brackets. 2. Yes, it provided statistical information on the incidence rate per 100,000 population to show the gravity of the disease. 3. Example shown is the incidence rates of the 1 diabetes with onset in the age range 0-29 years in 1996-1997 for three European countries. 4. No, this article only tackles the details of prevalence of juvenile diabetes in the world and didn’t mention about solutions. Ref 3: Ivvala, A.S., Inampudi, S., Bulakh P.M. & Vikhe, B.B. (2012). Evaluation of Oxidative Stress in Juvenile Diabetes. International Journal of PharmTech Research, 4(2): 602-608. 1. The article described the complications of stress in juvenile diabetes which is not good for management of the disease. 2. Yes it provided a statistical comparison on production of ROS by the glycated proteins, on the one hand, and the inactivation of GPx and GSH activity by glycation, on the other hand, which may enhance the accumulation of ROS leading to the serious complications in diabetes. 3. Example of rate of occurrence in general population is a demonstration of the negative effect of stress in juvenile diabetes through general parameters of age, gender, FPG, hematological data and lipid profiles in normal healthy subjects and juvenile diabetic patient. 4. Yes, it agrees with the implementation of glycemic control . Ref 4: Koton, S. (2007). Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel population, 1997–2003. Pediatric Diabetes 2007: 8: 60–66. 1. This article described juvenile diabetes by reporting the epidemiology of juvenile diabetes in children in the age-group 0–17 year in Israel during 1997–2003. 2. Yes, it provided statistics on the frequency of juvenile diabetes within 0-17 years to demonstrate the gravity of the disease. 3. Example of rate of incidence in general population is the given rising of incidence rate by 34% during the study period: from 8.0 per 100 000 (95% CI 6.8–9.3) in 1997 to 10.7 per 100 000 (95% CI 9.4–12.1) in 2003. 4. Yes, the article supports the management of juvenile diabetes. Ref 5: Skocic, M., Darko Marcinko, D., Razic, A., Stipcevic, M. &Rudan V. (2012). Relationship between Psychopathological Factors and Metabolic Control in Children and Adolescents with Insulin-Dependent Diabetes mellitus Coll. Antropol. 36 (2): 467–472. 1. The article described juvenile diabetes through a critical overview of the literature on the relationship between psychological/psychopathological factors and metabolic control in children and adolescents with juvenile diabetes. 2. No. This article provided a long literature analysis instead. 3. This study suggests that juvenile diabetic patients in dysfunctional families and children of parents with high degrees of psychopathology are those with poor glycemic control. 4. Yes it supports glycemic control. Ref 6: Knip, M., Veijola, R., Virtanen, S.M., Hyoty, H.,Vaarala, O. &Akerblom, H.K. (2005). Environmental Triggers and Determinants of Type 1Diabetes. DIABETES, 54(2) S125-S136. 1. The article described juvenile diabetes by defining its cause and the physiological process that characterizes the nature of the disease. 2. Yes, it provided statistical information that shows the gravity of juvenile diabetes through the series of evidence that supports the critical role of exogenous factors in the development of type 1 diabetes. 3. One example comes from migration studies that indicate that the disease incidence has increased in population groups who have moved from a low-incidence to a high-incidence region. 4. Yes it supports glycemic control. Ref 7: Cosgrove, M. (2004). Do stressful life events cause type 1 diabetes? Occupational Medicin. 54:250–254. DOI: 10.1093/occmed/kqh047. 1. The article described juvenile diabetes by suggesting how the recent stressful events cause the onset of diabetes. 2. Yes,to demonstrate the gravity of diabetes being caused by stressful events, a statistics of number and severity of life events is compared with controls. 3. An example provided is the outcome measures of studies in systematic review comparing life events prior to diagnosis in individuals who had developed type 1 diabetes with controls. 4. Yes it supports glycemic control. Ref 8: D. Lopes Souto, D.L. & de Miranda, M.P.(2011). Physical excercises on glycemic control in type 1 diabetes mellitus. Nutr Hosp. 26(3):425-429. DOI:10.3305/nh.2011.26.3.4962. 1. The article described juvenile diabetes by the destructive characteristics it does to the body and how management and physical activity can control it. 2. Yes, the article showed the positive influences of exercise of long-term glycemic control in type 1 diabetes. 3. Example of rate of occurrence mentioned is: 100% of insulin dose was associated with an increased risk of hypoglycemia for all exercise intensity and 75% reduction of the insulin dose was required for adequate glucose concentration at 75% of VO2max. 4. Yes it supports glycemic control. Ref 9: Allen, N.A. (2009). Continuous glucose monitoring improved glucose control in adults but not in young adults or children with type 1 diabetes. Evid. Based Nurs. 12(2):44. doi:10.1136/ebn.12.2.44 1. The article described the nature of the problem by proposing continuous glucose monitoring (CGM) to improve glucose control in adults and children with type 1 diabetes. 2. Yes, the article provided statistical information on continuous glucose monitoring and home blood glucose monitoring to demonstrate the effects on juvenile diabetes. 3. Example was demonstrated when the rate of occurrence on the use of CGM in adults (>25 years of age) with type 1 diabetes have improved metabolic control without increasing hypoglycaemia. 4. Yes it supports glycemic control. Ref 10: Iafusco D., Prisco F., Romano M.R., Dell’Omo R., Libondi T. & Costagliola C. (2011). Acute juvenile cataract in newly diagnosed type 1 diabetic patients: a description of six cases. Pediatric Diabetes, 12: 642–648. 1. The article described juvenile diabetes by citing a frequent eye complications of the disease, that is cataract. 2. Yes the article provided statistical information on six cases of acute cataract in adolescents at the onset of juvenile diabetes. 3. The examples provided are the metabolic and ophthalmologic characteristics of patients who developed acute cataract in relation to having juvenile diabetes. 4. Yes it supports glycemic control. Ref 11: Dantzer C., Swendsen J., Maurice-Tison, S. & Salamon, R. (2003). Anxiety and depression in juvenile diabetes:A critical review. Clinical Psychology Review 23:787–800. 1. The article described juvenile diabetes in association of psychological factors such as anxiety and depression. 2. Yes, the article states that psychiatric disorders have been prevalent subsequent to the diagnosis of juvenile diabetes in adolescents. 3. It reports that over 40% of the sample developed at least one episode of psychiatric disorder during follow-up, 26% had major depressive or dysthymic disorder, nearly 20% developed some type of anxiety disorder, and 16% had behaviour disorders. 4. Yes it supports glycemic control. Ref 12: Kocic, G., Pavlovic, R., Najman, S., Nikolic, G., Sokolovic, D., Tatjana Jevtovic-Stoimenov, T., Musovic, D., Veljkovic, A., Kocic, R. & Djindjic, N. (2011). Circulating Ribonucleic Acids and Metabolic Stress Parameters May Reflect Progression of Autoimmune or Inflammatory Conditions in Juvenile Type 1 Diabetes. TheScientificWorldJOURNAL, 11: 1496–1508. DOI 10.1100/tsw.2011.133 1. The article described juvenile diabetes by methods of exploring the effect of metabolic stress parameters in order to define the major contributors for the inflammatory cascade in the disease. 2. Yes, statistical information on the comparison of effects of metabolic stress parameters (hyperglycemia, oxidative and nitrosative stress) show the gravity of juvenile diabetes. 3. An example shown is the quantitation of TLR8, MyD88, RIG-I, and MDA-5 in PBMCs exposed to circulating RNAs which contributes to the prevalence of the disease. 4. Yes it supports glycemic control. Ref 13: Rajashree R., Kholkute, S.D. & Goudar, S.S. (2011). Effects of Duration of Diabetes on Behavioural and Cognitive Parameters in Streptozotocin-Induced Juvenile Diabetic Rats. Malaysian J Med Sci. 18(4): 26-31. 1. The article described juvenile diabetes by defining a recognized complication, that is diabetic encephalopathy. 2. Yes, statistical information on using the elevated plus maze (EPM) in streptozotocin (STZ)-induced diabetic rat pups to demonstrate effects of different diabetic durations on various behavioural and cognitive parameters. 3. Example of rate of incidence was shown in the effects of diabetes duration on fasting blood sugar (FBS) level in normal control and streptozotocin-induced diabetic rats and, effects of diabetes duration on learning and memory in control and STZ-induced diabetic rats in the elevated plus maze . 4. No, this article is focused on the deleterious effect of diabetes in the central nervous system, and didn’t cover management. Ref 14: Sandra L. Fritsch, S.L., Mark W. Overton, M.W. & Robbins, D.R. (2010)The Interface of Child Mental Health and Juvenile Diabetes Mellitus, Child Adolesc Psychiatric Clin N Am 19: 335–352. doi:10.1016/j.chc.2010.01.008. 1. The article described juvenile diabetes by stating how it has been a recognized common chronic lifelong illness and that it has become prevalent. 2. Yes the article provided statistical information of overweight children and adolescents that have increased in the last decades, which increased the risk of them acquiring diabetes. 3. Examples shown are the incidence of overweight children and adolescents (above the 95th percentile for weight) has been increasing during the last few decades, with 17.1%of all children and adolescents being defined as overweight in 2003 and 2004. 4. Yes it supports glycemic control. Ref 15: A Systematic Review of Psychological Interventions for Adolescents and Sansom-Daly, U.M., Peate, M., Wakefield, C.E., Bryant, R.A. & Cohn, R.J. (2011). Young Adults Living With Chronic Illness. American Psychological Association, 31(3): 380–393. DOI: 10.1037/a0025977 1. The article described juvenile diabetes as a recognized chronic illness with common psychological challenges in adolescents and young adults and therefore need psychological interventions. 2. Yes, statistic information that demonstrate gravity of juvenile diabetes was given on recent estimates indicative of 20–30% adolescents in Western countries living with a chronic illness, and 10–13% this condition significantly limits their daily functioning. 3. Example given on the rate of occurrence is on theSample, Methodology, and Intervention Characteristics of Trials Reporting >=1Significant Effect on a Psychological Outcome Measure. It shows that synthesizing evidence across studies in adolescents and young adults with chronic illnesses such as juvenile diabetes may inform the selection of viable, evidence-based models of psychological intervention to ensure positive adjustment in this population. 4. Yes it supports glycemic control. Read More