CNA153 Nursing Practice
Question:
You are the District nurse who is visiting Violet, who has type 2 diabetes, osteoarthritis and a lower left leg ulcer. She is ambulant over short distances with a walking frame. Violet has been approved for residential aged care and has been waiting for a nursing home bed. During the last 3 months you have been visiting to attend to Violet’s BSL’s and daily dressings, until a suitable placement becomes available
Violet currently lives with her daughter Gemma, Matthew (Gemma’s husband), and their two young children, Scott aged 5 and Lucy aged 7, who both attend the local primary school. The family lives in a two-bedroom town house. Gemma works night shift as an enrolled nurse, and earlier in the year Matthew was made redundant from his job and is currently unemployed.
The house is becoming quite stressful. The children have given up their bedroom for their grandmother and are sleeping in the lounge room. Violet requires a lot of care and is demanding of her daughter’s time. Violet argues frequently with Matthew about him not working and his drinking of alcohol. You are very fond of the family and feel for the pressures that they are under. One day after you shower and attended Violets wound care you pass Matthew sitting on the front step of the house. He is drinking alcohol and it is 10am. You ask him how he is coping with having Violet staying with the family. He says he’s not doing so well and “lately I’ve had trouble controlling my temper with the kids”.
Assessment Task : Research / Evidence-based Practice Paper
Task description
Identify a clinical issue from the case study provided. Formulate both a qualitative and a quantitative clinical question to explore this issue. Search for evidence to answer or address your questions.
Instructions
1. From the scenario provided, identify the clinical issues apparent. Select an issue of clinical interest to explore further.
2. Develop a quantitative research question related to the clinical issue selected, demonstrating your understanding of this approach to research.
3. Explain the search strategy or process used to identify suitable research articles to assist in answering the question you have posed.
4. Identify relevant research articles and briefly explain how each article contributes to answering the question you have posed.
5. Develop a qualitative research question related to the clinical issue selected, demonstrating your understanding of this approach to research.
6. Explain the search strategy or process used to identify suitable research articles to assist in answering the question you have posed.
7. Identify relevant research articles and briefly explain how each article contributes to answering the question you have posed.
Answer:
Introduction:
The discussion revolves around the case study of an elderly female patient named violet suffering from multiple illness such as, type 2 diabetes, osteoarthritis and left leg ulcer. According to the study piloted by Vu (2018), ulcer in diabetic patient is the result of poor self-management of the disease. In addition to this, the prevalence rate of osteoarthritis in the elderly population suffering from type 2 diabetes is also high as compared to that of the other individual. Therefore, it can be stated that the major clinical issue identified in the case of violet is type 2 diabetes. The major cause evaluated by assessing the case study which is responsible for the clinical deterioration of the patient is the poor management of the illness and poor support of the family member that leads to elevation in the amount of psychological stress in the Patient, which is considered as one of the risk factor for increased blood glucose in diabetic patients. Healthcare needs of the elderly patient is high as compared to other individuals, which if not achieved can lead to further clinical deterioration. Based on the factors or the clinical issue, both qualitative and quantitative research questions are formulated.
Quantitive research question:
Quantitative research is demarcated as the reset which aims to evaluate the formulated research question based on following terms such as, how, when, where and what. It usually involves measurement of outcome to explain the efficiency rate of the intervention applied. Elements which are used in the quantitative research to answer the research question is the numerical data. It is mainly of four types such as, descriptive, experimental, quasi-experimental and correlation (Medlar et al. 2016). From the above discussion, it is evident that the target population is the elderly diabetic patient and the possible reason behind the clinical deterioration of the patient is psychological stress. Therefore, by observing the clinical issue and the risk factor behind the issue, the research question that has been formulated involves the association between the two. Hence, based on that, the formulated research question would be, ” what is the prevalence rate of diabetes among the elderly patient suffering from psychological stress?”.
Literature search:
Literature search is one of the most vital step which helps in evaluating answer to the research question. Along with that, it also helps in gaining efficient knowledge regarding the background of the issue discussed in the research question. Literature Search is the most vital step in conducting a literature review. It assists in finding the article relatable to the research with the aid of literature search strategy. To enhance the efficiency of the information, it is important to get information from the peer reviewed articles only from different scientific and authentic electronic database. The database which has been used in the assignment to evaluate relatable literature is PubMed, CINNAHL and MedLine. There are huge amount of literatures available on this database, hence to find the most relevant articles which provide answer to the research question, key words or search terms is used. To get more appropriate articles, Boolean operators (AND, OR, and NOT) is used between the search terms. Search terms used in the article to enhance the efficiency of the literature search is, type 2 diabetes OR diabetic patient AND elderly OR geriatric AND psychological stress OR stress OR anxiety. Along with that, truncation such as, diabeti*, elder* are also used to refine the search. The peer reviewed articles within 5 years of range is selected for the literature review. Inclusion and exclusion criteria is also used to refine the search and to get most adequate articles (Christmals and Gross 2017).
Literature review:
In the study performed by Harris et al. (2017), it is observed that type 2 diabetes is one of the main cause behind the increasing prevalence rate of morbidity and mortality due to diabetes in the elderly patient. One of the major factor behind the increasing morality rate is stress. On a quantitative study conducted by the research it is highlighted that around stress among the diabetic patient is responsible for increasing the blood glucose rate in the elderly patient by approximately 10-20%. According to the study piloted by Puig?Perez et al. (2017), it is observed that there is a link between diabetes and stress in elderly patient. In the article, it is highly that psychological stress in the patient can affect the diabetes control centre and mechanism which is used to regulate the blood glucose level thereby causing a sudden increase in the blood glucose level giving rise to other chronic illness such as, foot ulcer and osteoarthritis. It tends to increase the prevalence rate by 1.5 times as compared to the other individual. The article written by Hackett and Steptoe (2016) highlights that, the psychological complications lead to change in the structure of the brain thereby reducing the cognitive ability of the patient and also increasing the stress hormone which in turn increases the blood glucose level causing clinical deterioration.
Qualitative articles:
Qualitative research is demarcated as the research which primarily focusses on the description instead of numerical. The primary goal of the qualitative research is to evaluate the factors which is responsible for the outcome or impacts the intervention (Grewal, Kataria and Dhawan 2016). It is used in the evaluation of explanatory, descriptive and predictive answer to provide a detail insight of the question. In case study of violet, it is evident that the patient is suffering from stress due to the family complications which might be responsible for the clinical deterioration of the patient. Therefore based on this the clinical qualitative questions which has been formulated is “what are the factors responsible for psychological stress in an elderly patient and its impact on their mental and physical health?”.
Literature search:
In the study conducted by Cooper et al. (2018), it is highlighted that literature search is one of the most effective tool to get appropriate answer to a qualitative research question. In the discussion, the qualitative research question includes, factors behind psychological stress in elderly patient and its impact in their mental and physical well-being. Therefore to select the most relevant articles which can answer the question search strategy has been formulated. The electronic database which has been used to retrieve the peer reviewed article includes, PubMed, CINNAHL, Medline and Cochrane. To get the articles which can effectively answer the question, search terms has been used. Search terms has been used along with Boolean operators (AND, OR and NOT) and truncation (*). Used search terms are, psychological stress, stress, elderly patients, older, geriatric, impact of stress, anxiety. Inclusion and exclusion criteria has been used to include or exclude the articles appropriately (Atkinson and Cipri, 2018). Inclusion criteria are peer reviewed articles within five years of range and are published in the English language are used.
Literature review:
According to the study conducted by Kelly and Ismail (2015), psychological stress id responsible for increasing the mental and physical complications among the elderly patient. The factors which can lead to psychological complications in patient includes, low socioeconomic status, family dispute or complications, health inequalities and low literacy levels. The factors which has been observed un the case study of violet is the family problems, which can lead to the secretion of psychological stress hormone thereby leading to the activation of psychological stress response which in turn increase the risk of chronic illness such as type 2 diabetes in elderly patient. Rendering to the study conducted by Chen et al. (2015), elderly patients are one of the most vulnerable populations that can get easily affected by any physical and mental illness. Psychological stress is considered to be one of the most important factor that contributes to the clinical deterioration of the patient. Family issue is responsible in increasing the psychological complications in the patient thereby increasing the chances of clinical deterioration. Conferring to the study performed by Mayberry et al. (2015), complications among the family member of the patient increases the risk of diabetes and other mental health complications which possess negative impact on the future health of the patient.
Conclusion:
On a concluding note, it can be stated that the prevalence rate of diabetes among the elderly population is higher as compared to that of the other population. Diabetes cannot be cured and hence the only way to protect an individual from the further clinical deterioration due to the illness is the proper management of the illness which if ignores or avoided can lead to ulcer, osteoarthritis and other illness. From the discussion, it is also evident that , there are majority of risk factor which is responsible for the clinical deterioration of the disease, psychological stress is among one of them. In the discussion two research question, qualitative and quantitative research question has formulated based on the clinical issue identified. Search strategy which has been used to answer the questions is discussed in detail. The literature review conducted to answer the question states that the psychological stress due to family complications is one of the major factor for the further clinical deterioration in the elderly patient suffering from diabetes.
References:
Atkinson, L.Z. and Cipriani, A., 2018. How to carry out a literature search for a systematic review: a practical guide. BJPsych Advances, 24(2), pp.74-82.
Chen, H.M., Huang, M.F., Yeh, Y.C., Huang, W.H. and Chen, C.S., 2015. Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia. Psychogeriatrics, 15(1), pp.20-25.
Christmals, C.D. and Gross, J.J., 2017. An integrative literature review framework for postgraduate nursing research reviews. European Journal of Research in Medical Sciences Vol, 5(1).
Cooper, C., Dawson, S., Peters, J., Varley?Campbell, J., Cockcroft, E., Hendon, J. and Churchill, R., 2018. Revisiting the need for a literature search narrative: A brief methodological note. Research synthesis methods, 9(3), pp.361-365.
Grewal, A., Kataria, H. and Dhawan, I., 2016. Literature search for research planning and identification of research problem. Indian journal of anaesthesia, 60(9), p.635.
Hackett, R.A. and Steptoe, A., 2016. Psychosocial factors in diabetes and cardiovascular risk. Current cardiology reports, 18(10), p.95.
Harris, M.L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D. and Attia, J., 2017. Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), p.e0172126.
Kelly, S.J. and Ismail, M., 2015. Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes. Annual review of public health, 36, pp.441-462.
Mayberry, L.S., Egede, L.E., Wagner, J.A. and Osborn, C.Y., 2015. Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support. Journal of behavioral medicine, 38(2), pp.363-371.
Medlar, A., Ilves, K., Wang, P., Buntine, W. and Glowacka, D., 2016, July. Pulp: A system for exploratory search of scientific literature. In Proceedings of the 39th International ACM SIGIR conference on Research and Development in Information Retrieval (pp. 1133-1136). ACM.
Puig?Perez, S., Hackett, R.A., Salvador, A. and Steptoe, A., 2017. Optimism moderates psychophysiological responses to stress in older people with Type 2 diabetes. Psychophysiology, 54(4), pp.536-543.
Vu, H.T., 2018. Association between diabetes mellitus and urinary incontinence in elderly patients.
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