Diabetes and Evidence Based Nursing - Research Paper Example

Introduction Evidence based nursing draws on some of the traditions of evidence based medicine. Nurses are required to identify solid research findings and implement them in their practice as a way of increasing quality patient care. For nurses to practice evidence based nursing, they should understand the concept of research and know how to evaluate it. Ideas used usually come from different sources but are categorized into: Problem focused triggers and Knowledge focused triggers. Problem focused triggers are identified by health care staff and they could be either clinical problems or risk management issues. On the other hand Knowledge based problems are created when health care officials read new research findings that help improve nursing of the patients. At a minimum inpatient nurses usually receive institution specific diabetes care educational updates supported by their institutions (Bethel and Califf, 2007). Dozens of methods exist for keeping staff nurses informed. In order for a nurse to be competent in diabetes nursing in general practice, he/she should have the necessary knowledge and skills required. A competent nurse should be able to identify whether the patient has a blood history of diabetes that has not been controlled by the administration of oral drugs, and or, if the patient’s blood glucose levels were over 300 for the fasting plasma glucose (FPG) test or with the random plasma glucose test (Bethel and Califf, 2007). The nurse should measure blood glucose and determine how much insulin is required, administer insulin according to the results of the blood glucose test performed, help patients commencing insulin develop management techniques within guidelines and access secondary care specialist services when needed. The nurse should as well demonstrate clear knowledge of the pathophysiology of diabetes (Bethel and Califf, 2007). It is also important for the nurse to be able to monitor patient’s progress and management of their condition, appropriately help patients achieve self management of their diabetes condition, make proper clinical referrals within the practice, have enough and appropriate material for patient education, initiate discussion to provide necessary advice to the patient when required to, provide psychological support to patients and their families, have an organized objective approach for the diagnosis of diabetes according to protocols, use results of the diagnosis for the treatment and incorporating patient preferences in the process (Bethel and Califf, 2007). In addition there are other basic procedures that can also improve the quality of services offered by a nurse such as maintaining a disease register, educating the patient on who or when to call for hell in case of any complications during the administration of a self-test, acquiring knowledge for symptoms and foods for hypoglycemia condition, advising patients on when and how to take medications and the importance of having consistent eating patterns, taking key follow up contact information and giving the patient appointments for follow up education. Lastly, the nurse should encourage the patient to develop habits of positive thinking, willingness to undertake different activities and self-reflection. In summary competent nurse for diabetes should the following knowledge and skills Identify whether the patient has a blood history of diabetes that has not been controlled by the administration of oral drugs and or if the patient’s blood glucose levels were over 300 for the fasting plasma glucose (FPG) test or with the random plasma glucose test. Measure blood glucose and determine how much insulin is required. Know how to measure and administer insulin according to the results of the blood glucose test performed. Help patients commencing insulin develop management techniques within guidelines and access secondary care specialist services when needed. Demonstrate clear knowledge of the pathophysiology of diabetes To monitor patient’s progress and management of their condition. Explaining diabetes Diabetes is a condition in which the pancreas is unable to produce insulin required by the body or use the produced insulin in the proper way. When a person takes a meal, some of the food is broken down to sugar (glucose).The glucose passes into the bloodstream and the cell through a hormone called insulin that is produced in the pancreas. The pancreas usually produces the right amount of insulin to accommodate the quantity of glucose. However in people with diabetes, the pancreas produces little or no insulin or the cells fail to respond normally to the insulin. Diabetes increases the risk for many health problems but with lifestyle changes and correct treatment, many people are able to prevent the onset of complications. For the blood sugar level to remain within a healthy range (60 to 120 mg/dl), patients should avoid foods high in sugar and consume fiber-rich foods like whole grain cereals, vegetables and fruits. They should also eat complex carbohydrates like dried beans, peas, potatoes, rice, pasta, grains and avoid saturated fats such as cream, bacon, fatty meats, whole milk cheeses, butter and some kind of cooking oils. Exercise is important in controlling diabetes. The patient should talk with the doctor about what exercise program is appropriate for them. Mostly, patients are encouraged to exercise three or four times a week for 15 to 30 minute sessions (Finkelman and Kenner, 2009). A gradual introduction to exercise is usually recommended and a fitness specialist can guide you on individual exercise needs and limitations. A person suffering from diabetes should monitor blood glucose levels. A daily or weekly glucose level test is required. Self-blood glucose tests that are easy to perform and that can be administered at home are available. A device is used to obtain the blood and test for blood sugar level. If the dietary changes and exercise does not bring the blood sugar levels within normal range, Insulin injections are necessary. The doctor will explain to the patient the right insulin amount to take and when to take it. He/she will also explain the different kinds of insulin and how to change the dosage. A typical dosage begins with a small dose of regular insulin taken once or twice daily. Diabetes can easily go undiagnosed because most of its symptoms may appear harmless. Early detection of diabetes symptoms and treatment can help reduce the complications associated with diabetes. Some of the symptoms of diabetes are extreme hunger, extreme fatigue, extreme irritability, unusual thirst, unusual weight loss and frequent urination for type 1 diabetes. For type 2 diabetes the symptoms include any of the symptoms associated with type 1 diabetes, blurred vision, cuts or bruises that are slow in healing, frequent infections and numbness in the hands and/or feet. It is also good to note that people with type 2 diabetes often have no symptoms (Bethel and Califf, 2007). One applicable medical diagnosis test for diabetes is the fasting plasma glucose test (FPG) which usually follows eight hours of testing. The FPG is the preferred diabetes diagnostic test and if it returns positive, should be repeated in a few days to confirm the condition of pre-diabetes or onset diabetes. PFG levels are considered normal up to 100mg/dl. Between 100 and 150 mg/dl levels, the condition is referred to as impaired fasting glucose or pre-diabetes. Diabetes is said to be diagnosed when FPG levels are 126 mg/dl or higher (American diabetes association, 2001). The major goal in the treatment of diabetes is usually to minimize elevation of any blood sugar without causing abnormally low blood sugar levels. The preferred treatment carried out by the nurse for type 1 diabetes is the administration of insulin to the patient, advising the patient to exercise and take a diabetic diet that includes foods with low sugar content. For type 2 diabetes the patient is first treated with weight reduction, exercise and a diabetic diet (Gillies, et al. 2007). If this fails to lower the blood sugar levels oral medications are used and if they are also insufficient, treatment with insulin is administered. The diabetic diet should be a balanced diet that is low in fat, cholesterol and simple sugars. Weight reduction and exercise help control elevation of blood sugar levels by increasing the body’s sensitivity to insulin. However, the above treatment excludes women who are pregnant or breastfeeding. The only recommended way of controlling diabetes in pregnant or breastfeeding women at present is by diet, exercise and insulin therapy. A drug that can provide more than one benefit is preferred. For example, some drugs can lower blood sugar level and also have a beneficial effect on cholesterol. Some of the nursing concepts include; case management, hospice/palliative care and extended care/elder care. Hospice care is the care of the terminally ill for as long as possible. Hospice care can be provided in the patient’s home. Nursing staff are taught to support the patient and family during the last critical stages of an ailment. Palliative care focuses on alleviating symptoms and meeting the needs of the patient and family. Case management is a system that ensures that a patient gets the right services at the right time to avoid and avoid unnecessary care that can be costly (Clement et al, 2004). It requires collaborative efforts between the health care providers and the necessary resources that the patient may require for the treatment of his/her condition. Nurses who are case managers work directly with the patient and their families to assess patient’s needs, monitor patient’s progress and direct the patient to care when needed. Case management has proved to be effective in supporting patients access the care they need in an otherwise complex health care system. The outcome of the Evidence Based Nursing Practice is that patience experience improved care, it enlightens nurses and helps them be able to attend to the patients with ease, it avoids cases of complications due to wrong diagnosis by the nurses and it also improves the society’s image on the healthcare provider institutions (Gillies, et al. 2007). This leads to better services and effective treatment of diseases. Education in hospitals is very essential. There are actions that when taken by a nurse can improve patient or professional outcomes such as assessing current knowledge on diabetes and self-management skills for use by the patient, initiating a diabetes education forum for patients newly diagnosed with diabetes with the help of the institution and providing information concerning community resources for diabetes education programs for continuing education. Conclusion In the light of all of the above, it is clear that evidence based nursing is very beneficial as it increases the efficiency of nurses. They are able to make decisions based on knowledge that is backed by research. The patients are likely to observe a better outcome because they receive care based on proven methods. It also helps to keep the nursing practice current as nurses are able to keep in touch with new discoveries. Evidence based practice also helps ease the process of decision making for the nurses increasing their confidence. This is because they know they are using valid information that has been thoroughly researched. The end result is that the patient receives high-quality care based on research helping the hospital achieve magnet status. Being a magnet facility, patients are assured that they are getting excellent nursing service. References: American diabetes association (2001): Uncomplicated guide to diabetes complications (3rd edition). Alexandria. Anita F. and Carole K. (2009): Professional nursing concepts: Competencies for quality leadership. Jones and Bartlett Publishers: Massachusetts. Bethel M & Califf R (2007): Role of lifestyle and oral anti-diabetic agents to prevent type 2 diabetes mellitus and cardiovascular disease. Am J Cardiology; 99:726–31. Clement S, Braithwaite S.S., Magee M. F., Ahmann A., Smith E. P., Schafer R. G., Hirsch I. B., American Diabetes Association Diabetes in Hospitals Writing Committee (2004): Management of diabetes and hyperglycemia in hospitals: Diabetes Care27. Washington: Georgetown University Hospital. Gillies CL, Abrams KR, Lambert PC, et al. (2007): Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ; 334-:399 Read More