Evidence Based Practice - Essay Example

? Evidence Based Practice Total Number of Words: 2,563 Part One Brief Background Diabetes mellitus is a health condition wherein the “amount of glucose (sugar) in the blood is too high” (Diabetes UK, 2010, p. 3). When left untreated, diabetes is considered as a serious illness because it can trigger heart-related problems, stroke, kidney failure and/or blindness. Aside from the 500,000 undiagnosed individuals who are suspected to have diabetes, approximately 2.6 million people in UK were already diagnosed with diabetes back in 2009 (Diabetes UK, 2010, p. 4). This figure can double up to 4 million by 2025 (p. 4). Part of the duty and responsibility of the nurses is to deliver self-management education to diabetes patients (Chan and Zang, 2007). For this reason, nurses should know by heart the differences between the juvenile diabetes (type I) and the adult-onset diabetes (type II) on top of the diagnostic tests, importance of weight management, and other related healthcare management and treatment for this particular health disorder. Rationale for the Selection of this Topic Area As a diabetic educator and diabetes nurse, I used to work with diabetic patients. Since I work part time as a member of continuing nursing education in my region, I decided to conduct a systematic research study with regards to the nurses’ actual knowledge on diabetes mellitus. Search Process Unlike a narrative review, systematic review is different in the sense that its research “methods are explicit and open to scrutiny” (Torgerson, 2003, p. 6). In search for related literature, this study will conduct a systematic review to answer the main research question: “What is the actual knowledge of nurses on diabetes mellitus?”. To discuss the actual knowledge of nurses on how to manage and care for patients with diabetes mellitus, inclusion criteria for this study includes the American, Australian, British literature, etc. that were already published between 2002 to 2012. Basically, the rationale for including a wide-range of existing journals is to avoid limiting the actual research findings. On the other hand, gathering data from the most recent academic journals is necessary to ensure that the most recent and most up-dated information is gathered in this study. According to Randolph (2009), the principle of inclusion and exclusion method is to segregate relevant journals from those that are irrelevant. In order to address the research questions highlighted in this study, the gathered journals were segregated using the inclusion and exclusion method depending on the degree of relevance of each study. As part of the research study inclusion, the gathered journals will be pre-screened based on the research method and the author(s)’ research findings (Cronin, Ryan and Coughlan, 2008). To ensure the quality and relevance of the gathered journals with the chosen research topic, the gathered journals were critically appraised by using the guidelines specified under the Critical Appraisal Skills Programme (CASP). When critically appraising a peer-reviewed journal, it is important to take note whether or not the authors made a clear statement with regards to the aims of the research study. It is equally important to examine the research study’s overall research design. For instance, was the researcher able to justify the research method used in the study or was the strategy used in recruiting the research survey participants appropriate to the aims of the study? (NHS, 2006). In this study, databases such as the Cochrane Database of Systematic Reviews (CDSR), NCBI / PubMed, and Education Resources Information Centre (ERIC) will be used in search for electronically available peer-reviewed journals. According to Ely and Scott (2007), keyword searches are often used when gathering relevant literature. When making keyword and phrases search; Younger (2004) mentioned the importance of acknowledging the differences between the American and British English [cited in Cronin, Ryan and Coughlan, 2008]. With this in mind, the following key words and phrases were used in search for online articles: (1) diabetes mellitus nurse management; (2) diabetes mellitus nurse actual knowledge; (3) diabetes mellitus nurses; and (4) diabetes mellitus nurse knowledge. (See Appendix I – Search Strategies on page ) The available journals on NCIB / PubMed database it too many. In order to narrow down the search for related reviews, the following filters were used: (1) 10 years publication dates; (2) human species; and (3) three different article types (clinical trial, meta-analysis, and randomized controlled trial). In search for journal articles from the ERIC database, publication date was narrowed down between 2002 to 2012. After entering the key words and phrases on databases such as the Cochrane Database of Systematic Reviews (CDSR), NCBI / PubMed, and Education Resources Information Centre (ERIC), the researcher was able to gather the following number of hits: Key Words / Phrases Cochrane NCBI / PubMed ERIC Cochrane Reviews Other Reviews Trials Economic Evaluations Total Diabetes mellitus nurse management 2 1 69 3 2 203 2 Diabetes mellitus nurse actual knowledge 0 0 0 0 0 1 0 Diabetes mellitus nurses 3 8 242 14 267 320 0 Diabetes mellitus nurse knowledge 0 2 26 0 28 55 0 In general, data collection is a significant part of a successful literature review (Randolph, 2009). Therefore, it is a challenge on the part of the researchers to be able to locate journals that can address the research question presented in this study. Upon analyzing the search process used in this study, the use of filters from databases like the NCBI / PubMed is useful in terms of narrowing down the search for related literature. Using this option, researchers could enjoy the benefit of easily locating highly relevant and up-to-date journals. Thus, increasing the success rate of the search process. Part II Since I am interested in nursing education, I have chosen the article written by Chan and Zang (2007) entitled “Nurses' perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis”. Eventually, the checklist for case-control studies which can be found in the website of CASP will be used as a guide in critically analysing the context of this article (http://www.casp-uk.net/). Screening Question 1 – Did the study address a clearly focused issue? Ans. Yes. When appraising a case control study, it is important to check on the validity of the results. Although not in question form, the authors clearly stated that the study aims to explore the relationships between the perceived and actual diabetes knowledge of nurses who are working in two hospitals in Hong Kong. Screening Question 2 – Did the authors use an appropriate method to answer their question? Ans. Yes. Earlier, it was mentioned that the main objectives of the study is not limited in identifying the characteristics of nurses based on their demographic variables, competency and perceived and actual knowledge of diabetes mellitus but also investigate the differences among the nurses’ demographic, competency level and perceived and actual DM knowledge levels among different profile groups. Therefore, it makes sense for the authors to divide the questionnaire into two part: (1) demographic information of nurses (i.e. age, marital status and working unit), work experiences (i.e. number of years working as a nurse), and one perceived competence question ‘How competent do you feel you are in taking care with a diabetes patient?’; and (2) modified diabetes self-report tool (MDSRT) which aims to measure the nurses’ perceptions of diabetes knowledge (i.e. aetiology of diabetes, basic treatment plan for Type II diabetes, hypoglycaemia and insulin use, diabetic ketoacidosis, impact of stress on diabetes control, long-term complications, and the importance of diet and exercise) and the modified diabetes basic knowledge test (MDBKT) which aims to evaluate the nurses’ basic knowledge of diabetes mellitus. In addressing the main purpose of this study, the authors conducted a descriptive correlational survey between the period of September 2004 to July 2005. Aside from determining the extent of different conditions or situations among the subjects, a descriptive survey is usually conducted to determine whether or not the subjects of the study vary among themselves (Paler-Calmorin and Calmorin, 2007, p. 70). According to Hitchcock, Schubert and Thomas (2003, p. 328), descriptive correlational survey is only one type of descriptive studies aside from cross-sectional surveys and case reports. In most cases, a correlational study is being conducted to investigate or assess a group of people in relation to a particular disease among others (Hitchcock, Schubert and Thomas, 2003, p. 328). In the study of Chan and Zang (2007), the authors were trying to identify not only the characteristics of nurses based on their demographic variables, competency and perceived and actual knowledge of diabetes mellitus but also investigate the differences among the nurses’ demographic, competency level and perceived and actual DM knowledge levels among different profile groups. Therefore, a descriptive correlational survey is an appropriate method for the main purpose of the authors’ study (Chan and Zang, 2007). The authors were able to clearly define not only the aims or main purpose of this study but also provide a brief background, research method, research findings and study conclusion. In line with this, Chan and Zang (2007) mentioned that they had utilized the 64 Likert-scale item questionnaire that were initially designed and developed by Drass et al. (1989) as research instruments when critically assessing the nurses’ perceived and actual knowledge. Back then, there were panel of experts who evaluated not only the format but also the content of these questionnaires. In fact, the Content Validity Index (CVI) of Drass et al.’s research instruments scored 0.99 (with usual score between 0.75 to 1.00). Detailed Question 3 – Were the cases recruited in an acceptable way? Ans. Yes. There is nothing special about the case. Basically, the purpose of this study is to explore the perception and actual diabetes knowledge of nurses who are working in two hospitals in Hong Kong. Therefore, part of the selection qualification is that the nurses who should have participated in this study should be working within the two annonymous hospitals. Furthremore, the authors were able to gather a total of 245 nurses from two local anonymous hospitals between September 2004 to July 2005 (Chan and Zang, 2007). Since the sample population is more than 100, the number of nurses who agreed to participate in this study is more than enough to avoid sampling error (Somekh and Lewin, 2005, p. 218). With these in mind, it is safe to conclude that there are no selection biases in this study that could compromise the validity of the research findings. Detailed Question 4 – Were the controls selected in an acceptable way? Ans. Yes. The controls were selected in an acceptable way. First of all, researchers should be aware that the generalisability of the research findings is highly dependent on the quantitative research study results. Since a very small sample size can trigger the occurrence of sampling error, it is necessary to take a closer look at the sample population size used by Chan and Zang (2007). When conducting a quantitative research survey study, the sample population size is very important with regards to the validity and reliability of the quantitative results. In line with this, Fan et al. (2001, p. 17) explained that “the number of samples drawn under a particular sample size condition will greatly influence the accuracy of the stimulated sampling distribution of correlation coefficients”. Although it is better if the authors were able to gather more than 1,000 sample size, Somekh and Lewin (2005, p. 218) mentioned that the sample size should be at least 100 to avoid unnecessary sampling errors. Basically, the research study of Chan and Zang (2007) has a very high levels of non-response. In line with this, out of 401 research survey questionnaires that were distributed to highly qualified research survey respondents, only 61.1% or 245 out of 401 questionnaires were completed and given back to the authors. In other words, Chan and Zang (2007) were able to gather a total of 245 nurses to participate in this study. Since 245 is a lot more than the minimum requirement of 100 research survey respondents (Somekh and Lewin, 2005, p. 218), the high number of non-response will not affect the validity and reliability of the quantitative research findings. Even though the authors failed to mention how they were able to gather a total of 245 research survey respondents (i.e. randomly searched, etc.), it is safe to conclude that there are no selection biases that could compromise the generalisability of the research findings. Detailed Question 5 – Was the exposure accurately measured to minimise bias? Ans. Yes. The authors used an objective measurement in testing the accuracy of the research study. In general, reliability and validity are two important components of a research design. In line with this, the Cronbach’s alpha is a test for “internal consistency reliability” parameter (De Vet et al., 2011, p. 137) whereas the “exploratory factor analysis, principal component analysis, and confirmatory factor analysis measures the construct validity” (Andrew, Pedersen and McEvoy, 2011, p. 202). In order to measure the questionnaire’s construct validity and internal consistency, Chan and Zang (2007) adopted the use of Factor analysis and Cronbach’s alpha. In general, Cronbach alpha (?) value of 0 means that there is no reliability to the variables being tested whereas 1 means there is a perfect reliability (Olagbemi, 2011, p. 60). In most cases, Cronbach’s alpha value of between 0.70 to 0.80 is accepted (p. 61). Since the Cronbach’s alpha result of MDSRT and MDBKT is 0.90 and 0.79 respectively, it is safe to conclude that the research questionnaire used in the study of Chan and Zang (2007) is highly reliable. With regards to construct validity, the factor analysis result for MDSRT accounted for “31.6% of the variance and reflected concerns related to nurses’ management of hypoglycaemia and management and complications of diabetes (Factor 1), 24.2% of the variance and focused on knowledge on insulin, hypoglycaemic agent and ketoacidosis / hyperglycaemia and aetiology of diabetes (Factor 2), and 9.3% of the variance and focused on basic treatment plan, stress affects on glycaemic control, exercise and diet (Factor 3)” (Chan and Zang, 2007, p. 237). In the case of MDBKT, the construct validity of factor 1, 2, and 3 accounted for 19.1%, 16.2%, and 15.5% of the variance respectively. After measuring the research survey questionnaire’s construct validity and internal consistency, the authors validated their own validity and reliability measurements by comparing their actual measurement results with the actual measurements in the previous study of Baxlet et al. (1997) and Drass et al. (1989). In line with this, Chan and Zang (2007) mentioned that their research findngs is similar to Baxlet et al. (1997) who had a Cronbach’s alpha of 0.84 and 0.68 for DSRT and DBKT respectively and Drass et al. (1989) who had a Cronbach’s alpha of 0.91 and 0.79 for DSRT and DBKT respectively. Detailed Question 6 – What confounding factors have the authors accounted for? Although the authors did consider the importance of the nurses’ educational background, training and work experiences over their knowledge and competency when managing patients with diabetes mellitus, the authors failed to determine the significance of environment and each nurses’ socio-economic status. In most cases, nurses who are better off in terms of financial difficulty are the ones who have more access to higher education as compared to those nurses with average monthly income. Likewise, the authors included all nurses regardless of their rank, work experiences, the department where they are assigned to work, etc. Since nurses who are still attending their school training were included in this study, the research study results may be inaccurate in terms of determining the actual perception and knowledge of the registered nurses when it comes to managing patients with diabetes mellitus. With regards to regression analysis results, the authors mentioned that one of the potential confounding factors that could afect their research study analysis is the limited sample size and the honesty of the research survey respondents. References Andrew, D., Pedersen, P. and McEvoy, C. (2011). Research Methods and Design in Sport Management. IL: Human Kinetics. Baxley, S., Brown, S. and Pokorny, M. (1997). Perceived competence and actual level of knowledge of diabetes mellitus among nurses. In Chan, M.F. and Zang, Y-L. (eds) "Nurses’ perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis". Journal of Clinical Nursing, 16(7B):234-242. Chan, M. and Zang, Y.-L. (2007). Nurses’ perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis. Journal of Clinical Nursing, 16(7B):234-242. Cronin P., Ryan F., and Coughlan M. (eds) "Undertaking a literature review: a step-by-step approach" British Journal of Nursing. 2008. 17(1), pp. 38-43. [Online] Available at: http://www.fchs.ac.ae/fchs/uploads/Files/Semester%202%20-%202010-2011/4120FCH/Week%202%20%5BCompatibility%20Mode%5D.pdf [Accessed 11 May 2012]. DeVet, H., Terwee, C., Mokkink, L. and Knol, D. (2011). Measurement in Medicine: A Practical Guide. NY: Cambridge University Press. Diabetes UK (2010). Diabetes in the UK 2010: Key statistics on diabetes. [Online] Available at: http://www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf [Accessed 11 May 2012]. Drass, J., Muir-Nash, J., Boykin, P., Turek, J. and Baker, K. (1989). Perceived and actual level of knowledge of diabetes mellitus among nurses. In Chan, M.F. and Zang, Y-L. (eds) "Nurses’ perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis". Journal of Clinical Nursing, 16(7B):234-242. Ely, C. and Scott, I., 2007. Essential Study Skills for Nursing. In Cronin P., Ryan F., and Coughlan M. (eds) "Undertaking a literature review: a step-by-step approach" British Journal of Nursing. 2008. 17(1), pp. 38-43. [Online] Available at: http://www.cin.ufpe.br/~in1002/leituras/2008-undertaking-a-literature-review-a-step-by-step-approach.pdf [Accessed 11 May 2012]. Fan, X., Felsovalyi, A., Sivo, S. and Keenan, S. (2001). SAS® for Monte Carlo Studies: A Guide for Quantitative Researchers. NC: SAS Institute Inc. Hitchcock, J., Schubert, P. and Thomas, S. (2003). Community Health Nursing: Caring in Action. NY: Thomson Delmar Learning. NHS, 2006. Critical Appraisal Skills Programme (CASP). Making sense of evidence. 10 questions to help you make sense of qualitative research. [Online] Available at: http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/Qualitative%20Appraisal%20Tool.pdf [Accessed 11 May 2012]. Olagbemi, F. (2011). The Effectiveness of Federal Regulations and Corporate Reputation in Migating Corporate Accounting. US: Xlibris Corporation. Paler-Calmorin, L. and Calmorin, M. (2007). Research Methods and Thesis Writing. 2nd Edition. Manila: Rex Bookstore. Randolph, J., 2009. A Guide to Writing the Dissertation Literature Review. Practical Assessment, Research & Evaluation 14(13), pp. 1-13. [Online] Available at: http://pareonline.net/pdf/v14n13.pdf [Accessed 11 May 2012]. Somekh, B. and Lewin, C. (2005). Research Methods in the Social Sciences. London: Sage Publication. Torgerson, C. (2003). Systematic Reviews. London: Continuum International Publishing. Younger, P., 2004. Using the internet to conduct a literature search. In Cronin P., Ryan F., and Coughlan M. (eds) "Undertaking a literature review: a step-by-step approach" British Journal of Nursing. 2008. 17(1), pp. 38-43. [Online] Available at: http://www.fchs.ac.ae/fchs/uploads/Files/Semester%202%20-%202010-2011/4120FCH/Week%202%20%5BCompatibility%20Mode%5D.pdf [Accessed 11 May 2012]. Appendix I – Search Strategies Read More