CNA153 Foundations for Professional Practice 2
|Assessment Task 4: 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.|
|Task length||1500 words|
|Links to unit’s intended learning outcomes||3, 4|
Questions to support completing this task
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CNA153 ASSESSMENT 4 - CASE STUDY
1. Introduction to the clinical issues
The case study presents several clinical problems such as diabetes, osteoarthritis and an ulcer on the left leg for Violet. In addition to it, Matthew has a chronic drinking problem which is evident from his 10 am drinking in a house of two children. The clinical issues which this report will focus on are the diabetes of Violet. She has two types of diabetes. Diabetes can be a source of the ulcer on the left leg which needs to be investigated. The problems faced by Matthew would also be investigated to understand the root of his drinking problem. The research questions would be focused on them to draw interrelationship.
2. Quantitative research question
The PICO framework provides the best solution for the formation of quantitative research questions (Eriksen & Frandsen 2018, p. 420). They are:
Population: The diabetic old age females
Issue: Leg ulcers and persistent infections
Comparison: No diabetes treatment
Outcome: Diabetes control and Ulcer treatment
The research question for this essay is:
The question is relevant to find the quantitative information for the treatment of ulcers or infections which may have stemmed from diabetes. The answer would help determine the suitable and accurate diagnosis and interrelationship of diabetes and healing of wounds. Since Violet has a persistent infection in the left leg, which needs to be treated for the recovery. The question will help to determine if the diabetes is causing prolonged infection period, which may otherwise be healed in a few days.
3. Literature search
In order to find the answer to the quantitative research question developed search engines such as Google Scholar or PubMed was used. During the research process to find relevant studies, several studies related to diabetes and infection or wound healing were found. Some of them were helpful to understand the problem Violet is going through.
During the relevant research article search process keywords such as “diabetes and its effects on wound healing”, “quantitative study on diabetes” was used in the search engines. Several research studies were found, and some of these studies were reviewed. Only recent studies were taken into consideration, and among these studies, these studies were performed on diabetic patients. A study by Carbonell et al. (2018, p. 4) was found to be helpful and referred. This study found that wound healing and infections take time to heal because of blood sugar levels. Also, a study by Chang et al. (2016) has also found a correlation between wound healing, infections and blood glucose. High blood sugar level impairs the white blood cells functions. Thus the role of the immune system is severely affected in Violet’s case. As Violet has a type 2 diabetes, the high glucose level in her bloodstream, her immune system is finding it hard to cure her leg ulcer.4. Relevant literature
According to the studies referred to during the literature review, it is found that blood sugar level or glucose level is the reason behind the impairment of the immune system. These studies suggested reducing the glucose level to stay healthy. This is why, in Violet's case, it is utmost essential to lower her blood sugar level to cure her leg ulcer. Also, given the fact she is an elderly woman, it will also help her to stay healthy and keep her from any other infections. These studies also suggested the following key treatments while the patient is in the process of blood sugar reduction.
Tissue Debridement: This is the removal of the necrotic tissues from wounds or skin infections. This reduces the pressure and as a result, stimulates the healing process. This, as a result, allows for wound drainage or secretion in diabetic patients (Sohrabi & Russell 2017, p. 501).
Infection Control: Studies suggested that infections are the primary concern in a diabetic patient. Therefore, an infection control plan is necessary. As these patients are vulnerable to a small wound or cut as bacteria spreads the infection deeper quickly. This is why wound dressing is necessary to control the infections. This is why regular dressing of the leg ulcer is utmost important for Violet.
Moisture Balance: As discussed, regular dressing of wounds are utmost important for diabetic patients. This is essential to wound healing. To contain the infections in the ulcers or wounds, it is necessary to keep them dry. This is why cleaning of these wounds on a regular basis is necessary, and post-cleaning antibacterial powders should be used to keep the wound dry (Snyder, Fife & Moore 2016, p. 205). In the case of Violet, in order to cure her foot ulcer, the primary steps are to maintain moisture balance in the ulcer with the help of antibacterial powders.
5. Qualitative research question
The qualitative research can be effectively done through the use of the PEO framework. They are:
Problem: Violet is fighting two types of diabetes, osteoarthritis and ulcer infection in her lower left leg.
Exposure: The situation is dire as she needs constant attention and medical help which Gemma is not able to provide due to her work, children and a drinking husband.
Outcomes: Healthy lifestyle for Violet and diabetes control
The question of this research is:
The question includes the feelings of Violet for deciding on the best course of action to be followed by her and provides the best care for her as well. It is important for the patients to include their preferences in the treatment procedures for better cooperation. The nurse can use it to understand the severity and effectiveness of the treatment strategies.
6. Literature search
The research question was developed as such that extensive literature is used in order to answer the same elaborately. It would require outlining the concurrent lifestyles followed by diabetics and the recommended lifestyles, therefore implementing the use of qualitative evaluation of the issue. The help of Google Scholar and PubMed were taken to perform a literature search. Keywords such as “Lifestyle Changes to Control Diabetes” and ‘treatment for leg ulcers in the elderly" was used to narrow the search results.
As per the search results, there are several studies available on the internet. Some of these research papers were reviewed for information regarding the current question. Among these, a study by Riccardi, Vitale & Giacco (2018, p. 12) was helpful with finding some of the effective control mechanism a patient can take. Also, a study by Carro et al. (2019) about the leg ulcers in the elders also provided some important insights. According to these studies, a diabetic patient's lifestyle should be the main focus. Studies suggested healthy food, healthy daily routine, exercises and mental stress are the key elements to work with. Furthermore, these studies suggested that diabetes is one of the causes of leg ulcers among elders.
7. Relevant literature
According to the studies mentioned earlier, the following information can be gathered. In order to control her diabetes, Violet needs to change her lifestyle. Also, she needs to control and preferably reduce her blood sugar level to cure her leg ulcer because according to the studies, both are related.
Violet needs to follow these key changes in her daily life:
Eat healthily: For a diabetic patient maintaining a healthy diet is important. Diet affects blood sugar levels. Violet needs to eat vegetables and fruits, but only those who have low sugar and fat. This will help her with gaining fibre in her system because fibre increases the sugar absorption in the blood (Gilbert et al. 2019, p. 60).
Stay hydrated: Diabetic patients are suggested to drink enough water in those studies. Therefore, Violet should drink enough water because this will keep her blood sugar levels under healthy limits.
Daily Exercise: Regular exercise reduces fat in the bloodstreams, and low fat is good for insulins effectively. As Violet has a type 2 diabetes, she is insulin-dependent. Therefore physical activities will help her with her diabetes, and as a result, it will help with her leg ulcers as well.
Managing stress: Studies suggested that blood sugar levels increase when someone is stressed. A stress-free mind and body are important for Violet. This is where help from Matthew and Gemma is needed the most. They need to control their emotions and temper around Violet. Also, their children Scott and Lucy can be helpful to relieve their grandmother’s mental stress when they are around her.
This study was performed to find out the clinical issues of diabetes patients like Violet and its side effects such as foot ulcer in this case. To understand the clinical issues and to find possible solutions, both quantitative and qualitative methods were used. During both of the methods, several research articles, literature reviews were referred with the help of search engines such as Google Scholar and PubMed. Based on these studies, this current case study about Violet’s clinical issues was analysed. Studies about both of these methods provided practical information. The quantitative study has justified external validity, yet lacked the internal rationality. Qualitative research also provided practical value to the research and also provided vital details.