NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

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PICO(T) Questions and an Evidence Based Approach

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

The PICOT question’s objective is to pose a searchable and resolvable query in order to pinpoint the strongest supporting data. It ought to be considered in every examination of the data to advance practices. The present report aims to discuss the PICOT for the women suffering from gestational diabetes. It explains significant results from publications and the relevance of those important findings. Moreover, it identifies sources of evidence that may address the research topic.

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Use of the PICO(T) Approach when Caring for Patients with Gestational Diabetes

Negative perinatal outcomes and long-term risks of obesity and glucose intolerance in offspring are both associated with gestational diabetes Mellitus (GDM). These risks are minor but potentially significant. Mothers with GDM have a higher than average risk of acquiring hypertensive problems while pregnant and later developing diabetes Mellitus. Only a tiny percentage of pregnancies benefit from the reduction of perinatal problems caused by the diagnosis and treatment of GDM. The need to create care practices that efficiently control agitation in patients with gestational diabetes in residential care outside of pharmacological methods has been identified as a practice concern that needs to be resolved (Mcintyre et al., 2019).

The research question is: 

P = in women with gestational diabetes

I = versus a monitored diet and exercise program during pregnancy 

C = How much does the use of metformin alone versus a monitored diet and exercise program during pregnancy.

O = reduce the likelihood of high birth weight infants.

T = duration to carry out the research

It is a crucial element of evidence-based practise and a widely accepted strategy employed by nurse practitioners to improve patient outcomes. It follows that the researcher can create a thorough investigation using PICOT.

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

For the majority of women with GDM, lifestyle treatments that combine two or more of dietary recommendations, regular exercise, teaching, and self-monitoring of blood glucose are the first line of treatment. For the majority of GDM patients, exercise provides a safe and efficient alternative therapeutic option. Although it has been endorsed by professional organizations, exercise for patients with GDM has not been generally prescribed or performed (Alejandro et al., 2020).

Exercise has long been regarded as an adjuvant strategy in the management of diabetes in non-pregnant subjects. The American College of Obstetricians and Gynecologists (ACOG) holds that pregnant patients should continue exercising throughout their pregnancies and that, in the absence of any obstetric or medical complications, 30 minutes or more of moderate exercise a day is advised most days of the week, if not every day.

Furthermore, the intervention approach used to carry out this PICOT is patient centred care (PCC). This approach helps identifying the best treatment strategy for patient according to patient’s personal profile. Hence the strategy has achieved the higher patient outcomes especially when implemented with the collaboration of registered nurses. The population studied is of gestational diabetic mothers. The socio-political factors are taken as negligible during the research study (Edwards et al., 2018).

Identification of Sources of Evidence

The application of implementation science approaches acknowledges the need for a focused, theory-driven strategy to remove obstacles to service modifications . Briefly, after conducting a barrier analysis at the lead site, strategies were chosen to address the barriers to following recommendations using an evidence-based framework, such as the theoretical domains framework  and behaviour change wheel . Women with GDM experienced much better outcomes as a result of this deployment (Lee et al., 2019).

Nutrition, fitness, a balance of diet and physical activity, dietary supplements, pharmaceuticals, and the management of other health issues were all included in the interventions. Weight control, MNT, SMBG levels, exercise, and, if necessary, medication are all part of the therapy of GDM. To avoid excessive pregnancy weight gain and postpartum weight retention, it is essential that women gain the right amount of weight throughout pregnancy (Zheng et al., 2018).

Despite the fact that there was significant variance in screening techniques and who should be checked before 24 weeks, 61 percent of respondents reported early DIP screening. Only 50% of healthcare professionals felt competent discussing insulin use, compared to 88% who felt good discussing food, blood glucose monitoring, and lifestyle recommendations. 80 percent of patients used electronic medical records, but 55 percent also used paper ones. 40% of patients expressed dissatisfaction with the information provided by hospitals. The focus groups indicated enhancing information technology and communication systems as major issues.

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

The prediction model will cover pregnant women who are deemed to be at a high risk for GDM at less than 14 gestational weeks. Women with pre-existing chronic conditions, such as pregestational diabetes, or who are already taking medications that have a negative impact on glucose levels, will be disqualified. Using a computerized randomization approach, allocation will be made in a 1:1 ratio to intervention and control groups. Before the oral glucose tolerance test, the intervention group will fill out 3-day food diaries and receive 3 individualized nutritional counselling from registered dietitian. 

The intervention’s main goals are to encourage long-term healthy eating habits and prevent excessive gestational weight gain during pregnancy. At specific gestational weeks, the control group will fill out 3-day food diaries and get routine prenatal care in accordance with local regulations.

Oral glucose tolerance testing is the term used to describe the test for gestational diabetes (OGTT). The patient must observe a 10-hour fast (generally overnight, missing breakfast). Blood is drawn first, then a 75g glucose drink is consumed, and then blood is drawn again one and two hours later. The patient must stay for the entire 2-hour test at the lab (McLean et al., 2019).

Relevance of Finding From Articles

The study by McLean et al (2019)  was picked as the publication that was most pertinent. A complex health systems intervention being carried out by the DIP will focus on a number of crucial areas, including communication, information technology systems, coordination of care, and education for health professionals (Diabetes In Pregnancy).

A wide variety of healthcare providers took part; 96 percent of them had experience working with Indigenous women, and 63 percent of them worked in distant or regional settings. Despite the fact that there was significant variance in screening techniques and who should be checked before 24 weeks, 61 percent of respondents reported early DIP screening. Only 50% of healthcare professionals felt competent discussing insulin use, compared to 88% who felt good discussing food, blood glucose monitoring, and lifestyle recommendations. 80 percent of patients used electronic medical records, but 55 percent also used paper ones. 40% of patients expressed dissatisfaction with the information provided by hospitals. Focus groups revealed areas for improvement in communication and IT systems.

The study found that a team of professionals with years of clinical and academic experience controlling NPS in gestational diabetes patients developed the MOC model. It was discovered that the techniques developed using this methodology had a solid evidence base. The method’s evidence-based nature may make it useful for clinicians working in a variety of situations. The study by McLean et al. (2019) comes to a close with a discussion of the approach’s potential to improve clinical procedures and guarantee the treatment of agitated behavior in patients with gestational diabetes.

References

Alejandro, E. U., Memento, T. P., Chung, G., Villagize, A., Gauss, N. L., Morgan, E., & Pineda-Cortel, M. R. B. (2020). Gestational diabetes mellitus: a harbinger of the vicious cycle of diabetes. International journal of molecular sciences21(14), 5003. https://doi.org/10.3390/ijms21145003  

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach

Edwards, L., Connors, C., Whitbread, C., Brown, A., Oats, J., Maple-Brown, L., & NT Diabetes in Pregnancy Partnership (2014). Improving health service delivery for women with diabetes in pregnancy in remote Australia: survey of care in the Northern Territory Diabetes in Pregnancy Partnership. The Australian & New Zealand journal of obstetrics & gynecology54(6), 534–540. https://doi.org/10.1111/ajo.12246 

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Lee, K. W., Ching, S. M., Ramachandran, V., Yee, A., Hoo, F. K., Chia, Y. C., & Vettel, S. K. (2018). Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC pregnancy and childbirth18(1), 1-20. https://doi.org/10.1037/t78426-000 

McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus. Nature reviews Disease primers5(1), 1-19. https://doi.org/10.1038/s41572-019-0098-8 

McLean, A., Kirkham, R., Campbell, S., Whitbread, C., Barrett, J., Connors, C., Boyle, J., Brown, A., Mein, J., Wanting, M., McIntyre, H. D., Bari, F., Oats, J., Sinha, A., & Maple-Brown, L. (2019). Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia. Frontiers in public health7, 192. https://doi.org/10.3389/fpubh.2019.00192Zheng, J., Wang, H. & Ren, M. Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis. J Endocrinol Invest 40, 1027–1033 (2017). https://doi.org/10.1007/s40618-017-0673-3