Sample paper/Developmental Assessment and the School-Aged Child

Physical assessment is one of the significant component in the nursing practice that is needed for the planning and providing family with a patient centered care. However, when doing physical assignment to the children, it’s essential to consider various techniques that are age appropriate. Firstly, school aged children should be accompanied by their parents as they may fail to give significant information regarding their health. Nurses should, however, inquire to the children if they feel comfortable when their parents are available (Cunha, Berkovits & Albuquerque, 2018). For instance, a 5 year old child may wish to have their parents available during the assessment while the 12 year may decide to do the assessment in absence of their parent. This implies that the school going children in many cases are conscious about their bodies and hence privacy is a great restriction to them and wouldn’t want to be exposed. Due to this, employing head to toe method would be effect to protect the privacy of the children and also ensure every step is explained in an age specific language. The child also be allowed to provide information regarding their activities, health and diet. 

The child I selected for this is Brian who is aged 10 years old. Perhaps, for a child of this age, he has the ability to communicate well and his imagination and memory are well heightened. As argued by Morse & Cangelosi (2017), children aged 10-15 years develop a sense of accomplishment and pride and showcase this by taking pride in social activities, school activities and sports. Brian has showed this in video games and he feels entitled to this game and he is always pride due to his competence in playing video games. While playing the video games, Brian never feels inferior but gets along well with his peers. He also understands the relationship between the future and the past and he is able to express the importance of this which in turn shows a stage of personality recognition. Based on this, it can be noted that the sense of morality of the child is based on the personal relationship with others and they grow older. For the case of Brian, he accepts rules and guidelines of the parents with the view that this is important to enhance a good relationship with his parents. At his age, Brian is able to know how to select his friends to play video games with and he feels comfortable playing with his peers than when playing with adults. 

According to the Piaget theory of development, Brian is in the pre-operational stage of development. Children at this stage are able to communicate well and their memory is up to date(Bjorklund, 2018). When doing developmental assessment for the Brain, the nurse should ask the parent about the physical and mental ability of the child to identify is there is any lost abilities. Second, the nurse should explain the assessment in a simple language that Brian can understand as his age cannot complex medical terminologies. As a nurse, I would also use imagination which is a significant aspect of communication that can be understood by young people during development assessment. The strategy that I would use to gain corporation is to give ownership in the process. This involves asking questions such as “what would you want to do next?” This is because the child should feel proud in the assessment process and the use of imagination can help to control their emotions. Additionally, to get effective and potential findings from the assessment, I would allow to speak about his historical view of his capabilities and what motivates him in life. This can help to enhance corporation during the assessment. 

References

Bjorklund, D. F. (2018). A metatheory for cognitive development (or “Piaget is dead” revisited). Child Development89(6), 2288-2302. https://doi.org/10.1111/cdev.13019

Cunha, A. C., Berkovits, M. D., & Albuquerque, K. A. (2018). Developmental Assessment withYoung Children. Infants & Young Children31(1), 69-90.https://doi.org/10.1097/IYC.0000000000000106

Morse, A. F., & Cangelosi, A. (2017). Why are there developmental stages in language learning? A developmental robotics model of language development. Cognitive Science41, 32-51.https://doi.org/10.1111/cogs.12390

Discussion/Child abuse and maltreatment

The most common age group that is prone to child abuse are preschool. This this is because these children do not know what is wrong nor cannot speak for themselves. As argued by Ashraf et al (2020), preschoolers shows the sign of abuse through unexplained bruises and injuries, signs of poor hygiene, nightmares as well as withdrawal from peers among others. Due to this, nurses and other healthcare professionals should familiarize themselves with the visible and invisible signs of child abuse in order to provide psychological and medical assistance and also protect the children from any possible harm or abuse. If the abuse is detected, nurses are required to report the case to the relevant authority and also provide medical help needed to enhance wellbeing of the child. 

It is also important for the nurses to be knowledgeable about different cultures and cultural practices. This is because some cultures has practices that can be misidentified as child abuse such as forehead cutting to mark a developmental stage among the boys. This is popularly known as “cupping” and its practices in Russia, Asia and Mexico. The reporting mechanisms includes channeling the matter to the supervisors for the appropriate measures to be taken. They should also use child abuse hotline numbers to report the matter.

Ashraf, I. J., Pekarsky, A. R., Race, J. E., & Botash, A. S. (2020). Making the most of clinical encounters: prevention of child abuse and maltreatment. Pediatric Clinics67(3), 481-498.https://doi.org/10.1016/j.pcl.2020.02.004

Sample paper/Environmental Factors and Health Promotion Presentation

The selected environmental factor. .

•Air pollution is the leading environmental factor affecting children health 

•Increased industrial activities leads to air borne related diseases and the children are the vulnerable population

•environmental exposure can take years to develop 

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The selected environmental factor. 

•children has low immune system which makes them prone to air borne diseases

• the annual increase by one unit of air pollution increases the average children mortality by 15.2%

•Infections related to air borne diseases includes asthma and childhood cancer 

Health promotion plan

•Practicing healthy behaviors while in indoors can prevent cognitive airborne diseases

•coughing or sneezing using a handkerchief 

•minimizing interaction with people and avoiding crowded areas 

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Health promotion plan

•indoor locations has a proper ventilation that ensures no bacteria and virus can enter into the house. 

•Caregivers should clean all the common surfaces such as doorknobs, counters and handles among others. 

•Wearing personal protective equipment 

Recommendations on accident prevention and safety promotion

•Pregnant women should avoid smoking 

•Smoking can lead to inflammation of lungs among the babies

•living with a smoker is equivalent to breathing that air and hence affecting the breathing system of the child

• contaminated air can damage their lungs and other body organs 

Recommendations on accident prevention and safety promotion

•Caregivers should install air purifier in their houses.

•Air purifier helps to trap small particulate matters

•It also let out fresh and breathable air 

•Air purifier helps to purify the air from any particles of smoke and bacteria

interventions, and suggestions from evidence-based research.

•Evidence based practices -administering antiviral drugs

•administering antibiotics and admitting the baby in the hospital for further checkup

•Antibiotics includes Macrolides erythromycin, clarithromycin, and azithromycin. 

interventions, and suggestions from evidence-based research.

• evidence based practices – administering Tamiflu

•prevents the virus from multiplying in infant’s body 

•Reduce the symptoms of the flu

•It also helps to keep infants from getting the flu if it’s taken before the baby gets sick 

Community resources 

•Air toxics community assessment and risk reduction project – provides resources of planned, completed and ongoing community level toxic assessment in New York

•Air pollution control tech series training tool – provides information about air pollution control methods

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National and web based resources 

•National Resource – Air Data – provides air pollution data for the entire U.S citizens

•Web based resource – AirNow – provide air quality information in the visual format in form of air quality index

Quantitative and Quantitative Studies

Quantitative and Quantitative Studies

Nursing Practice Problem and PICOT Question

The identified nursing problem for this study is poor compliance to the diabetic management guidelines among the patients with type 2 diabetics. The choice of this nursing problem is due to the increased number of mortalities among the diabetic patients which results from negligence and poor compliance to the medical guidelines. This study noted that noncompliance to the diabetic medical guidelines includes the risk of diabetic health constrains which includes cardiovascular infections, kidney failure, liver failure, nerve and eye damage as well as hearing impairment among others. 

The PICOT question investigated for this study is: Of all the older adults who have diabetes (P), how can compliance to the medical treatment (I) be compared to non-compliance to the medical guidelines for diabetes management (C) to reduce the risk and prevalence of diabetes-related health constraints (O) for a given period (T).

Background

The Schimke et al (2018) study is a qualitative study that aims to evaluate the differences in health condition between the diabetic patients who observe medical guidelines and those who do not comply with medical treatment guidelines. The objective of this study is to investigate the health challenges diabetes people face if they fail to comply with the medical guidelines provided by healthcare professionals. The research question for this study was: “What are the medical treatment outcome between the patients who comply with the medical guidelines and those do not comply with guidelines in Switzerland?”Another qualitative study done by Wollny et al (2018) study aimed to evaluate various factors that enhance compliance of diabetic patients with their dietary, hygiene and pharmacological treatment. The purpose of this study was to provide a guidelines that can help to manage diabetic more effectively and efficiently. The research question which is related to the PICOT question is “what factors affects the diabetes patient’s compliance with dietary hygiene and pharmaceutical treatment”? The significance of these two qualitative studies in nursing practice is to educate patients on some of the factors that can promote or hinder compliance of diabetic treatment.

A quantitative study done by Wilkinson et al (2020) aimed to evaluate the prevalence of the type 2 diabetes with the help of combination of various physical activities and lifestyle and also make inference on which combinations of physical activities such as stress, sleep and body mass index are likely to reduce the prevalence of type 2 diabetes through machine learning. The research question for this study is “how physical do and lifestyle activities influence the prevalence of type 2 diabetes? On the other hand, the Pinto et al (2017) aimed to investigate of type 2 diabetes was able to adhere to the lifestyle change behavior and nutritional therapy based on the adherence of the patients to the medical guidelines. The purpose of this study was to determine the value of the nutritional therapy on type 2 diabetes and showcase some of the barriers patients face to adhere to the nutritional therapy. The significance of these studies in the nursing practice is that they create awareness to the diabetic patients and clinicians on how to emphasize on the pharmacotherapy strategies to type 2 diabetes and also emphasize on lifestyle behavioral changes and nutritional therapies.

How do these four articles support the nurse practice issue you chose?

The Schimke et al (2018) article answers my PICOT question by investigating a sample size of 604 participants to evaluate the differences in the occurrence of diabetes among the patients who observe diabetic medical guidelines. On the other hand, Wollny et al (2018) answers my PICOT question by investigating the factors that enhance compliance or noncompliance to the medical guidelines in relation to dietary, hygiene and pharmacological treatment among the diabetic patients aged 75 years and above. Wilkinson et al (2020) answers PICOT question by investigating and predict type 2 diabetes risk using a full information continuous analysis of nationally sampled data for adults aged 45 years and above. Pinto et al (2017) study on the other hand answered the PICOT question by providing data that showed that pharmacotherapy and medical intervention in their pursuit to adhere to the medical guidelines more than lifestyle change behaviors and nutritional therapy.

The Schimke et al (2018) interventions and comparison groups are closely related to those identified in PICOT question in that it evaluated 604 participants with 40% type 1 diabetes and 60% type 2 diabetes to investigate the differences in occurrence of the diabetes health constraints between the diabetes patients who comply with the medical guidelines and those who do not comply with these guidelines. However, Wollny et al (2018) contrasted with the comparisons identified in the PICOT question by advocating to the patients to take six meals a day, observing hygiene and adhering to the dialysis plan. Wilkinson et al (2020) intervention program conformed to that of PICOT question by identifying physical activities that can reduce prevalence of diabetes such as nutritional and physical exercise. The intervention group for the Pinto et al (2017) were similar to that of the PICOT question as it advocated for the adherence of medical guidelines through nutritional education and physical activities which in turn can help to reduce the prevalence of diabetes among the elderly people. 

Method of Study:

Schimke et al (2018) study applied a prospective observational cohort study of patients treated at Swiss tertiary diabetes centers. Data was collected using standardized annual health examination. Wollny et al (2018) study evaluated a sample of 15 diabetic patients who were recruited at the private health center where the data was collected using a participantcompleted diaries using qualitative analysis method. Wilkinson et al (2020) and Pinto et al (2017) used almost similar methods of study where the former used correlational research method while the latter used survey research method with the help of semi structured interviews to ascertain the behavioral changes during adherence to the medical guidance. 

The benefit of observational qualitative interview method is that it provides a good opportunity for the researcher to collect a reliable and accurate in relation to the subject of study. It is however time consuming and it’s prone to bias and confounding and cannot be used to showcase causality. On the other hand, the benefit of correlational research is that it allows the researcher to collect quality and adequate data than in the experimental research. This method is limited in that it uncovers the relationship of variables and doesn’t provide a reason for the occurrence of these relationships.

Results of Study

Schimke et al (2018) study found that patients who comply with the diabetes medical guidelines and procedures are likely to have a low incidence of diabetic related complications and health constraints. Wollny  et al (2018) study on the other hand found that un-readiness, passivity, ignorance about the illness, poor doctor patient relationship, insufficient family support, insufficient variety of dietary foods as well as chronic exhaustion are detrimental for the patient’s progress. The study also found that health education helps to address issues such as dietary and exercise and also recommend healthy dietary program that regulates glucose level and prevent any unforeseen complications.

Wilkinson et al (2020) study showed that in relation to sleep, stress, physical activity and body mass index among the elderly black Americans has high yields which increases the prevalence of diabetes as compared to the white people. On the other hand, Pinto et al (2017) study is that type 2 diabetes patients doesn’t value nutritional therapy and behavioral changes as one of the ways to medical guideline adherence. These studies are significant to nursing since it shows the need for the nurses to provide customized and alternative behavioral and lifestyle combinations as way to adhere to the medical guidelines regarding diabetes treatment. They also help nurses and other medical practitioners to understand factors that can promote or hinder compliance of diabetic patients to the medical guidelines and offer cognitive help to these patients such as health education among others.

Ethical Considerations

Obtaining an informed consent from the study participants was the ethical considered by the authors involved in this study. The importance of informed consent in clinical trial is it gives the potential participants all the relevant information they need to understand regarding the research study. Another ethical issue considered by the authors is privacy and confidentiality. This ensure that the study does not violate with the personal and private data of the participants and also prevent exposing private data of participants to the public domain.

All the researchers put these ethical considerations into account by taking enough time to brief and educate the research participants about the research process, purpose and obtained their consent to participate in the study. Additionally, the researchers ensured that privacy of the participants is observed and kept all the private data confidential such as their names, marital status and family status.

Outcomes Comparison

The outcome for my PICOT question is that failure to adhere and comply with the medical guidelines increase the prevalence of diabetes especially among the old aged patients and hence worsening their health status. The guidelines that can help to enhance a positive health outcome includes nutritional and dietary guidelines, observing physical exercise and good sleep. The outcome of the four researches conformed to the PICOT outcome in that they showed that failure to adhere to these medical guidelines related to good sleep, nutritional and dietary education as well as physical activities can help to improve the health condition among the diabetic patients. Therefore, these relevant to this study and hence they can be applied by the healthcare professionals to improve their medical service provision to the diabetic patients. 

Proposed Evidence-Based Practice Change

The research articles used in this study are all relevant in answering the PICOT question and helps to understand how old aged diabetic patients complies with the medical treatment and how compliance reduces the risk and prevalence of diabetes related health constraints. This research is helpful to the nurses and other clinicians to understand how to offer dietetic and nutritional therapy as well as physical therapy to the patients with diabetes and ensure a positive health outcome. The proposed evidence based practice change that can help to reduce prevalence of diabetes among the old aged patients is observing healthy nutrition and increased physical activities. 

References

Pinto, E., Braz, N., Nascimento, T., & Gomes, E. (2017). Postprandial glycaemia in type-2 diabetes: A non-random trial according to glucose control. Journal of Nutrition and Diabetes Research1(1), 1-5. http://hdl.handle.net/10400.1/10296

Schimke, K. E., Renström, F., Meier, S., Stettler, C., & Brändle, M. (2018). Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Research and Care6(1), e000454. DOI: 10.1136/bmjdrc-2017-000454

Wilkinson, L., Yi, N., Mehta, T., Judd, S., & Garvey, W. T. (2020). Development and validation of a model for predicting incident type 2 diabetes using quantitative clinical data and a Bayesian logistic model: a nationwide cohort and modeling study. PLoS medicine17(8), e1003232. https://doi.org/10.1371/journal.pmed.1003232

Wollny, A., Pentzek, M., Herber, O. R., Abholz, H. H., Icks, A., Wilm, S., & Gummersbach, E. (2018). General practitioners’ attitudes towards patients with poorly controlled type 2 diabetes: a qualitative study. BMC family practice19(1), 1-7. DOI: 10.1186/s12875-018-0751-4

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Research Critique Guidelines – Part II

Background

Wilkinson et al (2020) study aimed to assess the prevalence of type 2 diabetes using a combination of different physical activities and lifestyle and make inferences on which combinations of physical activities such as stress, sleep and body mass index are likely to reduce the prevalence of type 2 diabetes through machine learning. Thus, the purpose of this study aimed to determine if different physical activities and lifestyles among various races influences the prevalence of type 2 diabetes among the black and white people using machine learning. The research question for Wilkinson et al (2020) was “among the black and white people, which combination (sleep, physical activity, stress and body mass index) is likely to provide the lowest prevalence of type 2 diabetes using machine learning. This study is significant to the nursing practices because it provides insights to the healthcare professionals to provide personalized and alternative behavioral and lifestyle medical services to the Black Americans as opposed to the generic national and physical activity recommendations which in turn can help to reduce cases of diabetes among the black Americans and white people. 

Pinto et al (2017) study adopted quantitative method to determine whether type 2 diabetes were able to adhere to the lifestyle change behaviors and nutritional therapy as they had adhered to other interventions like pharmacotherapy.  According to this study, many of diabetes patients does not value nutritional therapy but instead value other interventions and tends to ignore the advice they receive regarding lifestyle changes. The primary purpose of this study was to determine the value of the nutritional therapy on type 2 diabetes and showcase some of the barriers patients face to adhere to the nutritional therapy. The research question was “among the type 2 diabetes patients, what value do nutritional therapy add as compared to pharmacotherapy and what are some of the barriers they face”. The significant of this study in nursing practices is that it educates healthcare professionals to emphasize on the pharmacotherapy strategies to type 2 diabetes and also emphasize on lifestyle behavioral changes and nutritional therapies. 

How do these two articles support the nurse practice issue you chose?

Wilkinson et al (2020) helps to provide data that is useful to establish the PICOT question. The study shows how black Americans and especially elderly people are able to utilize physical activities as one of the medical guideline to treat type 2 diabetes. This implies that there is need for the healthcare professionals to provide dietary and nutritional therapy and education related to the type 2 diabetes among the elderly people. Pinto et al (2017) study on the other hand answered the PICOT question by providing data that showed that pharmacotherapy and medical intervention in their pursuit to adhere to the medical guidelines more than lifestyle change behaviors and nutritional therapy.

Wilkinson et al (2020) intervention program involved physical activities that were similar to the PICOT question. These were dietary and nutritional education and physical activities. The comparison group for this study differed with the PICOT question as it involved black Americans while the PICOT question involved elderly people. The intervention group for the Pinto et al (2017) were similar to that of the PICOT question as it advocated for the adherence of medical guidelines through nutritional education and physical activities which in turn can help to reduce the prevalence of diabetes among the elderly people. 

Method of Study:

Wilkinson et al (2020) adopted the correlational research method to investigate the relationship between the two variables; physical activity and prevalence of type 2 diabetes. Pinto et al on the other hand adopted survey research method with the help of semi structured interviews to ascertain the behavioral changes during adherence to the medical guidance. The correlational research differs with survey research in that it focus on the relationship between the identified variables while the survey research helps to understand a certain phenomenon as argued by Curtis, Comiskey & Dempsey (2016). 

The advantage of the correlational research is that it allows the researcher to collect quality and adequate data than in the experimental research. It also provides results which are more applicable in people’s daily activities. However, this method is limited in that it uncovers the relationship of variables and doesn’t provide a reason for the occurrence of these relationships. On the other hand, the advantage of survey is that it’s cost effective. It is however limited as it’s prone to errors due to assumptions made on the sample which are not accurate. This implies that although two methods are effective to investigate the prevalence and adherence of diabetics among the patients, researcher should ensure quality collection of data. 

Results of Study

The results of the Wilkinson et al (2020) study showed that in relation to sleep, stress, physical activity and body mass index among the elderly black Americans has high yields which increases the prevalence of diabetes as compared to the white people. Therefore, this study is significant to nursing since it shows the need for the nurses to provide customized and alternative behavioral and lifestyle combinations as way to adhere to the medical guidelines regarding diabetes treatment. 

The results of the Pinto et al (2017) study is that type 2 diabetes patients doesn’t value nutritional therapy and behavioral changes as one of the ways to medical guideline adherence. The study also showed that many patient with diabetes disregard physical activities and does not adhere to the nutritional and dietary education offered by the healthcare professionals. Therefore, these two studies shows some of the aspects neglected by the diabetic patients and the health effects these patients are likely to encounter due to failure to adhere to the medical guidelines. 

Outcomes Comparison

The anticipated outcome for the raised PICOT question is that lack of adherence to the medical guidelines is likely to increase the prevalence of type 2 diabetic and hence worsening their health conditions. These guidelines includes nutritional and dietary guidelines, observing physical exercise and good sleep. The outcome for these two studies are similar to the expected outcome as they investigate the effects of lack of adherence to the dietary and physical abdication on the type 2 diabetic patients. The studies showed that failure to adhere to these medical guidelines related to good sleep, nutritional and dietary education as well as physical activities can help to improve the health condition among the diabetic patients. This is the expected results of the PICOT question and hence they are relevant to this study and hence they can be applied by the healthcare professionals to improve their medical service provision to the diabetic patients. 

References

Curtis, E. A., Comiskey, C., & Dempsey, O. (2016). Importance and use of correlational research. Nurse researcher23(6). doi: 10.7748/nr.2016.e1382

Pinto, E., Braz, N., Nascimento, T., & Gomes, E. (2017). Postprandial glycaemia in type-2 diabetes: A non-random trial according to glucose control. Journal of Nutrition and Diabetes Research1(1), 1-5. http://hdl.handle.net/10400.1/10296

Wilkinson, L., Yi, N., Mehta, T., Judd, S., & Garvey, W. T. (2020). Development and validation of a model for predicting incident type 2 diabetes using quantitative clinical data and a Bayesian logistic model: a nationwide cohort and modeling study. PLoS medicine17(8), e1003232. https://doi.org/10.1371/journal.pmed.1003232

Research Critique Guidelines

Background of Study

Schimke et al.’s (2018) study focus on evaluating the differences in the occurrence of diabetes-related health constraints between the patients who observe medical guidelines and those who do not comply with medical treatment guidelines. The research problem for this study was that lack of patient compliance with the medical guidelines increases the risk and prevalence of diabetes. The research question raised by the authors was, “What is the medical treatment outcome between the patients who comply with the medical guidelines and those who do not comply with guidelines in Switzerland?” This shows that the purpose of this study was to investigate the health challenges diabetes people face if they fail to comply with the medical guidelines provided by healthcare professionals. This study is significant to the nursing practice as it creates awareness to the nurses and other medical practitioners on how to educate diabetes patients to comply with the guidelines laid down by the healthcare professionals.

On the other hand, Krepia et al.’s (2016) study aim to investigate some of the factors that enhance the compliance of diabetic patients with their dietary, hygiene, and pharmacological treatment. These are considered the main guidelines that are used to enhance diabetes management. The research question investigated by the authors is “what factors affects the diabetes patient’s compliance with dietary hygiene and pharmaceutical treatment”? This study is related to nursing as it educates the patients on some factors that can promote or hinder compliance with diabetic treatment. 

How do these two articles support the nurse practice issue you chose?

Schimke et al.’s (2018) article answers my PICOT question relating to compliance to the medical diabetic treatment by evaluating the differences in the occurrence of diabetes-related health constraints between the patients who observe medical guidelines and those who do not comply with medical treatment guidelines. The study investigated 604 participants to showcase the comparison of compliance and non-compliance to diabetic medical treatment. Krepia et al. (2016) answer my PICOT question by investigating the factors that enhance compliance of diabetic patients with their dietary, hygiene, and pharmacological treatment. Thus, these two studies answer the PICOT question raised, and hence they are reliable to this study. 

The intervention and comparison groups of Schimke et al. (2018) were similar to those of the PICOT question in that the study investigated a group of 604 participants to evaluate the differences in the occurrence of the diabetes health constraints between the diabetes patients who comply with the medical guidelines and those who do not comply with these guidelines. The study comprised of two groups of patients, diabetes mellitus type 1 (40%) and type 2 (60%), to provide an intervention plan for the patients who have diabetes. In contrast, Krepia et al.’s (2016) intervention plan was similar to that of the PICOT question as it advocated for the patients to take six meals a day, observe hygiene and adhere to the dialysis plan. 

Method of Study:

Both studies adopted the use of qualitative research. However, Schimke et al. (2018) used a prospective observational method to collect the data through standardized annual health examinations. On the other hand, Krepia et al. (2016) collected data using participant-completed diaries where a list of categories and subclasses was developed to understand the factors that influence compliance to the diabetes medical treatment. 

The main benefit of the observational qualitative interview method is that it provides a good opportunity for the researcher to collect a reliable and accurate in relation to the subject of study. As advocated by Rohrer (2018), observational data produce meaningful and reliable data that enhance the success of any qualitative data. However, this is limited in time consumption, is prone to bias and confounding, and cannot showcase causality. The benefit of participant-completed diaries is that they provide a valid and useful tool to collect data involving complex and sensitive healthcare matters. However, this method is limited in that it is redundant, irrelevant, and inconsistent during data collection. 

Results of Study

The Schimke et al. (2018) study found that patients who comply with the diabetes medical guidelines and procedures have a low incidence of diabetic-related complications and health constraints. The study also showed that diabetes management could be achieved in the time of enrollment of patients, and nutritional counseling can help patients comply with medical guidelines and enhance a positive health outcome. On the other hand, the Krepia et al. (2016) findings showed that un-readiness, passivity, ignorance about the illness, poor doctor-patient relationship, insufficient family support, insufficient variety of dietary foods, and chronic exhaustion are detrimental for the patient’s progress. This study also showed that health education plays an essential role in helping diabetic patients to address various issues like dietary and exercise while also recommending a healthy nutritional program that regulates glucose level and prevent any unforeseen complications. 

These two studies imply that they help understand the importance of compliance to medical treatment among patients with diabetes. These studies also help nurses and other medical practitioners to understand factors that can promote or hinder compliance of diabetic patients to the medical guidelines and offer cognitive help to these patients, such as health education, among others. Therefore, nurses can benefit greatly from these studies on how to manage diabetes and enhance a positive health outcome. 

Ethical Considerations

One of the ethical considerations observed when conducting research is obtaining informed consent from the study participants. This is a significant part of a clinical trial since it gives the potential participants all the relevant information they need to understand regarding the research study. This can help the participants understand why they are volunteering to participate in the research. Privacy and confidentiality are other ethical considerations considered when doing an investigation. This ensures that the study does not violate the participants’ personal and private data and prevents exposing the private data of participants to the public domain. 

Schimke et al. (2018) and Krepia et al. (2016) studies ensured that they took time to brief and educate the research participants about the research process, purpose and obtained their consent to participate in the study. The researchers also ensured that the participants’ privacy was observed and kept all the private data confidential such as their names, marital status, and family status. 

References

Krepia, V., Tzenalis, A., Lavdaniti, M., Beneka, A., Psychogiou, M., Serpanou, I., & Sapountzi-Krepia, D. (2016). Diabetic patients’ compliance to the recommended treatment: A qualitative study in Greece. International Journal of Caring Sciences4(3), 126-132.

Rohrer, J. M. (2018). Thinking clearly about correlations and causation: Graphical causal models for observational data. Advances in Methods and Practices in Psychological Science1(1), 27-42. https://doi.org/10.1177/2515245917745629

Schimke, K. E., Renström, F., Meier, S., Stettler, C., & Brändle, M. (2018). Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Research and Care6(1), e000454. http://dx.doi.org/10.1136/bmjdrc-2017-000454

Discussion/Qualitative data


Qualitative data is unstructured kind of data which is subjective opinions and judgments and is expressed in form of texts. Unlike quantitate data, qualitative data cannot be fixed into the text sheets. Perhaps, to manage a voluminous qualitative data, trustworthy is highly needed to ensure credibility and reliability of data. One of the strategy that can help researchers to manage and organize qualitative data is credibility. This involves enhancing consistency in data collection such as standard interview tracking and demographic data, user manual details as well as technical application among others (Artamonov et al., 2018). Credibility also involves having a training session with interviewees and explain to them about the need to participate in the data collection process. Another strategy that a researcher can use to manage and organize qualitative data is dependability. Here researchers are required to use a consistent template for easy documentation, technology based data storage and indexing which helps to ensure data processing. Dependability also involves transcriptionist standardization of data which in turn ensures accuracy and reliability of data. Therefore, these two approaches plays an essential role in ensuring proper management and organization of data in an efficient manner. 

Artamonov, A., Ionkina, K., Tretyakov, E., & Timofeev, A. (2018). Electronic document processing operating map development for the implementation of the data management system in a scientific organization. Procedia computer science145, 248-253.https://doi.org/10.1016/j.procs.2018.11.053

Literature Evaluation Table 


Summary of 
Clinical Issue: Compliance to Diabetes management guidelines 

For the past few decades, diabetes has emerged as one of the chronic condition that affects quite a large population across the world. According to WHO, about 420 million (9.3% of the world population) globally had diabetes by 2019 with majority of them living in middle in low and middle income countries. Annually, around 1.5 million deaths are directly attributed to diabetes worldwide. Amongthese numbers, only 7% of the total population has been diagnosed with diabetes with at least 15 million people in U.S having diabetes and not yet diagnosed (Alsayed et al., 2019). Various studies has shown that diabetes can be effectively managed with compliance with the disease management practices such as taking insulin, eating nutritious and healthy foods and staying physically active. However, noncompliance to the medical guidelines can increase the risk of diabetes health constraints such as cardiovascular diseases,kidney and liver failure, nerve and eye damages as well as hearing impairment among others. Therefore it is important  to investigate differences in outcomes of diabetes patients has complied with the medical guidelines to those who do not comply to determine which of the two groups has a high susceptibility of diabetes related health constraints. 

PICOT Question: Of all the elderly people suffering from diabetes (P), how does compliance to the medical treatment (I) can be compared to non-compliance to the medical guidelines for the diabetes management (C) to reduce the risk and prevalence of diabetes related health constraint (O) for a given period of time (T).

CriteriaArticle 1Article 2Article 3
APAFormatted Article Citation with PermalinkSchimke, K. E., Renström, F., Meier, S., Stettler, C., & Brändle, M. (2018). Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Research and Care6(1), e000454.Jackson, H. T., Anekwe, C., Chang, J., Haskins, I. N., & Stanford, F. C. (2019). The role of bariatric surgery on diabetes and diabetic care compliance. Current diabetes reports19(11), 1-9.https://doi.org/10.1007/s11892-019-1236-0Alsayed, K. A., & Ghoraba, M. K. (2019). Assessment of diabetic patients’ adherence to insulin injections on basal-bolus regimen in diabetic care center in Saudi Arabia 2018: cross sectional survey. Journal of family medicine and primary care8(6), 1964.
How Does the Article Relate to the PICOT Question?This article relates to PICOT question in that it evaluates the differences in the occurrence of diabetes related health constraints between the patients who observe medical guidelines and those who do not comply with medical treatment guidelines This article evaluates the role of bariatric surgery on the diabetes care compliance and the barriers of medical compliance among the diabetes patientsThis article investigate some of the factors that influence compliance of diabetes patients with regard to insulin injection, hygiene and dietary. 
Quantitative, Qualitative(How do you know?)The study adopted the use of observational study approach and hence it was a qualitative researchThe article is a qualitative research since it utilized questionnaire method of data collection that involved semi structured interviews. The study used a clinical control trial that comprised of open ended questions and hence it was qualitative data
Purpose StatementLack of patient compliance to the medical guidelines increase the risk and prevalence of diabetes To understand the role of bariatric surgery and the barriers of medical adherence among the patients with diabetesLack of patient compliance to the medical treatment and guidelinessuch as insulin injection, hygiene and dietary increases the risk of diabetes. 
Research QuestionWhat are the medical treatment outcome between the patients who comply with the medical guidelines and those do not comply with guidelines in Switzerland. What is the importance of the bariatric surgery and the barriers to medical compliance and adherence among the diabetes patients What factors affects diabetes patients’ compliance with insulin injection, dietary and hygiene. 
OutcomeThe study showed that patients who comply with medical guidelines on diabetes management experience low incidences of diabetes related complications than those who do not comply with these guidelines The barriers to medical that affects proper compliance to medial guidelines includes patient related factors, environmental issues and societal factors and health provider factors. Insulin injection reduces the prevalence of diabetes by 65%. The study also showed that ignorance, patients denying of diabetes and insufficient family support are factors that affects compliance to the medical guidelines. 
Setting (Where did the study take place?)Two healthcare centers in SwitzerlandPrivate doctors office in Athens, Greece.Security Forces Hospital, Riyadh, Saudi Arabia 
Sample604 participants were involved in the study 336 patients with diabetes 225 diabetic patients
MethodObservational method.The study used a convenient sampling technique Thematic analysis using open ended questions 
Key Findings of the StudyThe findings of the study is that patients who comply with the diabetes medical guidelines and procedures has low incidence of diabetic related complications and health constraints. Patients related factors such as mental functioning, demographics and environmental factors affects the compliance of the patients to the diabetes medication. Lack of family support, ignorance and lack of awareness can affects the patient’s adherence to the medical guidelines and treatment procedures. 
Recommendations of the ResearcherPatients should be provided with diabetes management guidelinesand education should be provided to ensure patients are awareness of the medical guidelines and procedures. Healthcare centers should adopt multidimensional efforts to overcome the barriers that hinder the patient’s ability to comply with the management guidelines. Enforcing health education to the community can help to ensure that diabetes patients on the importance of medical compliance and adherence to the diabetes management. 
CriteriaArticle 4Article 5Article 6
APA-Formatted Article Citation with PermalinkAl-Majed, H. T., Ismael, A. E., Al-Khatlan, H. M., & El-Shazly, M. K. (2014). Adherence of type-2 diabetic patients to treatment. Kuwait Med J46(3), 225-232.Vluggen, S., Hoving, C., Schaper, N. C., & De Vries, H. (2018). Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers. Patient education and counseling101(1), 92-98https://doi.org/10.1016/j.pec.2017.07.009Naqvi, A. A., AlShayban, D. M., Ghori, S. A., Haseeb, A. … & Jamshed, S. (2019). Assessment of medication adherence in saudi patients with type II diabetes mellitus in Khobar City, Saudi Arabia. Frontiers in pharmacology10, 1306. https://doi.org/10.3389/fphar.2019.01306 
How Does the Article Relate to the PICOT Question?This article relates to the PICOT question in that it aims to determine the percentage of non-adherence to the medical guidelines among the type 2 diabetes patients. This study aims to explore different beliefs on diabetes that hinders adherence to the management guidelines among the type 2 patients This study reviews medication adherence among the type 2 diabetes patients and how it influence effective diabetes management
Quantitative, Qualitative (How do you know?)The study used quantitative research methods and hence it’s a quantitative study Thea study used quantitative research study as it used semi structured interviews The study used quantitative cross sectional study to collect and analyze its data. 
Purpose StatementTo determine the percentage of the non-adherence patients with type 2 diabetes to the primary healthcare. To explore how the treatment adherence success factors can enhance effective management of type 2 diabetes. To investigate the importance of adherence to medical guidelines among the type 2 patients in Saudi Arabia  
Research QuestionWhat is the total number of type 2 diabetes patients who visits healthcare centers and do not adhere to the medical guidelines What are some of the beliefs on diabetes treatment among type 2 diabetes patients in Dutch What is the proportion of patients suffering from type 2 diabetes who adheres to diabetes in Khobar City, Saudi Arabia? 
Outcome28% of the patients who attends healthcare centers are likely to be non-compliant to the diabetes management guidelines Medical and treatment adherence success factors are not effectively applied and hence treatment adherence self-efficacy should be improved About 36% of patients had a high adherence rate to type 2 diabetes medication procedure 
Setting (Where did the study take place?) Kuwait NetherlandsKhobar City, Saudi Arabia
Sample693 participants.19 patients 178 participants.
MethodComparison method using univariate analysis and logistic regression analysis. Deductive coding analysis using Nvivo.Quantitative cross sectional method using general medication adherence scale
Key Findings of the StudyAlthough about 28% of the type 2 diabetes patients attended healthcare centers and did not adhere to the medical requirements, the patients were affected by lack of efficient education and family support. Medical and treatment adherence success factors are not effectively applied and hence treatment adherence self-efficacy should be improvedOnly a small portion of the total type 2 diabetes patients adhered to the medical management requirements and hence education is highly required
Recommendations of the ResearcherHealth education can help to improve the patient adherence and compliance to the medical management of type 2 diabetesHealthcare centers should have the awareness program to create more awareness to the patients on the importance of observing medical guidelines. Religious and social factors has a great influence on the compliance and adherence of the type 2 diabetes to the medical guidelines

References

Al-Majed, H. T., Ismael, A. E., Al-Khatlan, H. M., & El-Shazly, M. K. (2014). Adherence of type-2 diabetic patients to treatment. Kuwait Med J46(3), 225-232. doi: 10.1007/s13300-013-0034-y

Alsayed, K. A., & Ghoraba, M. K. (2019). Assessment of diabetic patients’ adherence to insulin injections on basal-bolus regimen in diabetic care center in Saudi Arabia 2018: cross sectional survey. Journal of family medicine and primary care8(6), 1964.doi: 10.4103/jfmpc.jfmpc_276_19

Jackson, H. T., Anekwe, C., Chang, J., Haskins, I. N., & Stanford, F. C. (2019). The role of bariatric surgery on diabetes and diabetic care compliance. Current diabetes reports19(11), 1-9. https://doi.org/10.1007/s11892-019-1236-0

Naqvi, A. A., AlShayban, D. M., Ghori, S. A., Haseeb, A. … & Jamshed, S. (2019). Assessment of medication adherence in Saudipatients with type II diabetes mellitus in Khobar City, Saudi Arabia. Frontiers in pharmacology10, 1306.https://doi.org/10.3389/fphar.2019.01306

Schimke, K. E., Renström, F., Meier, S., Stettler, C., & Brändle, M. (2018). Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Research and Care6(1), e000454.http://dx.doi.org/10.1136/bmjdrc-2017-000454

Vluggen, S., Hoving, C., Schaper, N. C., & De Vries, H. (2018). Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers. Patient education and counseling101(1), 92-98 https://doi.org/10.1016/j.pec.2017.07.009

Descriptive statistics

Descriptive statistics

Metrics American Indian / Alaska Native (includes Hispanic)Asian / Pacific Islander (includes Hispanic)Black (includes Hispanic)Hispanic (any race)White (includes Hispanic)
Mean 43.2538.5270.0631.4955.6 
Median 43.8638.971.432.164.55
Mode 36.634.165.8
Standard deviation5.272.386.732.895.11
sample variance 27.725.6745.428.426.16
Range 19.77.821.6915.6

Discussion

Based on the above descriptive statistics computations, it can be noted that the mean of each of the data sets shows that the black that comprises Hispanic are greatly affected by cancer. The rate for this group per 100,000 people s highest than the other groups with a mean rate of above 70. On the other hand, Hispanics, comprised of mixed races, recorded the lowest mean rate of experiencing cancer. 

The range of the data obtained from the difference between the highest and lowest values showed that black (including Hispanic) was highest within different years 2000 -2015 while Asian / Pacific Islander (includes Hispanic) recorded the lowest range value. On the other hand, the standard deviation was least for the Asian group. This implies that there was no significant difference in the number of reported cases than the other groups for the past 15 years, that is, from 2000-2015. The black group topped the category of standard deviation for all the groups, which shows the risk and prevalence of this group experiencing cancer. Therefore, it can be noted that among all the groups investigated, the black group, which included Hispanic, had a great chance of experiencing cancer, and hence preventive measures should be employed to this group to protect them from the prevalence of cancer.

Article Analysis and Evaluation of Research Ethics

Article Analysis and Evaluation of Research Ethics

Article Citation and Permalink(APA format)Article 1Anuar, A., Ang, W. C., Ahmad Musadad, N. M., Abdol Wahab, S. N., Abdul Sukor, N., & Warijo, O. (2021). Knowledge, attitude and practice towards COVID-19 and perceived challenges of working during the Movement Control Order: A quantitative analysis among healthcare workers in a northwestern Malaysian state. Current medical research and opinion, (just-accepted), 1-19.
PointDescription
Broad Topic Area/TitleKnowledge, attitude, and practice towards covid19
Problem StatementThere are increased perceived challenges of working during the movement control order among the healthcare providers. 
Purpose StatementTo identify the challenges faced by the healthcare providers during the movement control order.
Research QuestionsWhat are some of the challenges of working faced by healthcare providers during the movement control order?
Define Hypothesis The majority of healthcare providers lack knowledge, an optimistic attitude, and covid19 preventive measures practices that increase challenges in healthcare provision.
Identify Dependent and Independent Variables and Type of Data for the VariablesDependent Variable: Knowledge and optimistic attitude about covid19 Independent variable: prevalence of healthcare challenges 
The population of Interest for StudyHealthcare workers (HCW)
Sample 373 respondents 
Sampling Method multi-centric cross-sectional  sampling 
Identify Data CollectionQuestionnaire 
Summarize Data Collection ApproachThe study used a multi-centric sectional web-based study to collect data from healthcare workers in Malaysia using a 19-item validated questionnaire. 
Discuss Data AnalysisMultiple logistic regression was used to analyze the data 
Summarize Results of StudyHealthcare workers in Malaysia had good knowledge, attitude, and practice about covid19 infection and the related preventive measures. The challenges faced by healthcare workers included increased workload, challenges of shopping for daily expenses, and meeting with family members regularly. 
Summary of Assumptions and Limitations The study didn’t specify the types of healthcare workers investigated, and hence the author generalized the findings. Nurses, medical doctors, and other clinicians have different knowledge, attitude, and practice about covid19 infection and experience different challenges, and hence the author could have given the category of each healthcare worker. 

Ethical Considerations

In the Anuar et al. (2021) study, numerous ethical considerations occurred during sampling, data collection, data analysis, and publishing the results. These involved active sensitization of the perceptive in different studies on the need of the research and the role the participants will play in the study. One of the ethical considerations in the study was informed consent. The researcher sought informed consent from the participants to let them participate in the study. The researcher wrote a letter of consent explaining to the healthcare workers the purpose of the study and why it was necessary for them to participate in the study. 

Another ethical consideration observed by the researcher during data collection and analysis was to ensure that the participants did not face any harm. In this case, the researcher ensured confidentiality and privacy of the participants and ensured that no private or confidential information about the participants was disclosed to the public domain. The private data in the study was not captured while the participants were not identified, and the area of residence was not revealed. This was to ensure confidentiality and protect any harm that could face the participants. Lastly, the researcher ensured effective and transparent communication with all the participants and communicated effectively the purpose of the study and the role played by the participants. This allowed the participants to provide reliable and accurate information that enhanced publish of the quality research paper. 

Reference 

Anuar, A., Ang, W. C., Ahmad Musadad, N. M., Abdol Wahab, S. N., Abdul Sukor, N., & Warijo, O. (2021). Knowledge, attitude and practice towards COVID-19 and perceived challenges of working during the Movement Control Order: A quantitative analysis among healthcare workers in a northwestern Malaysian state. Current medical research and opinion, (just-accepted), 1-19.

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