NRHL 5503 Evidence Based Nursing Practice

1. Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.

2. Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment.

Answer

Introduction:

Diabetes can be understood as a medical condition, in which the blood glucose level drastically increases. This can be caused due to an underproduction of desensitization of insulin hormone (produced by pancreas). Diabetes can be of two types: Type 1 and Type 2. In Type 1, is caused by an underproduction of insulin and it mostly effects children or young adults, while type 2 is caused by a desensitization of the cells of the body to insulin and it occurs mostly in middle aged and older adults (however both these types can still occur at any age). Additionally Gestational Diabetes is also seen in some pregnant women, however the effects stops after the birth of the child. This report specifically provides evidence regarding one specific intervention that has been implemented for adult patients with diabetes. Its reviews the effects of the intervention on specific population group and determine its relevance for nursing practice.

Summary Of The Intervention:

The research by Karstoft et al., (2013) investigated about the effect and feasibility of free living walking training (specific intervention) on type 2 adult diabetic patients (specific population) on physical fitness, glycemic control and body composition. The specific focus on free living walking training as an intervention is considered important because physical inactivity is the strong predictor of all cause mortality in patients with type 2 diabetes.

A randomized controlled design was used to test the effect of free living walking training on diabetic patients. Participants with type 2 diabetes were selected by means of advertisement and contacting diabetes organization. Medical screening was done for all participants. . Efficacy of interval walking training (IWT) was evaluated by comparison with continous walking training (CWT). The participants were assigned to three groups such as control, IWT and CWT group. Each participant received a pedometer and those assigned to training group has to perform a grade walking V02 speak test. This was specifically important because the core aim of the research was also to compare efficacy of IWT and CWT by comparison with energy expenditure and VO2 peak test helped to measure energy expenditure. Subject in the IWT had to perform 3 minutes of fast walking and then 3 minutes of slow walking. The CWT group had to perform CWT above the target. The training participant were group were engaged in training session for 4 months consisting of 60 minutes/session per week (Karstoft et al., 2013).

The final outcome of the study was that IWT was found to be more effective compared to CWT in improving body composition, physical fitness and glyecmic control. Changes in physical fitness level were found in training group, however this was found only in IWT group and not CWT group. In addition, no improvement in body composition and glycemic control was seen in CWT group too (Karstoft et al., 2013). Hence, interval walking training can be regarded as an effective intervention to treat and maintain fitness of type 2 diabetic patient.

Evaluation Of The Study:

Free living walking or training programs are highly used in type 2 diabetic patients. However, the one main limitation found in studies supporting free living walking intervention was that minor benefits were observed in diabetic patient (Morton et al., 2010). This meant that intensity of such training might be affecting the result. Another contrasting result found in high intensity training program for diabetic patient was such intervention resulted in drastic improvement in health outcome; however it’s used was limiting due to feasibility issue found in many research (Little et al., 2011; Gillen & Gibala 2013). Such interventions could not be implemented without expert’s supervision. Hence, there was a need for intervention that improve health outcome of diabetic patient as well as easily used by all adult patient. Hence, research by Karstoft et al., (2013) is significant because it focused on the intensity of walking training and focused on evaluating the effect of interval-walking training, a repeated cycle of slow and fast walking activity. The emphasis on feasibility and effect of such intervention is a unique area of research.

Karstoft et al., (2013) proved the efficacy of IWT for diabetic patients on grounds of energy expenditure, improving symptoms of diabetic patient and feasibility in target population. This evidence gives new direction to considered IWT as an intervention to treat type 2 diabetic patient. It is also relevant to nursing practice because nurses can use such intervention to support diabetic patients in primary health care to live a healthy life. Sargent, Forrest & Parker, (2012) also showed that nurses in primary health provide chronic disease management and preventive lifestyle advice in large number. Hence, as part of the multidisciplinary primary health care team, nurses can support diabetic patient to adapt IWT as a regular activity in their life. In this way, they can help to prevent weight in diabetic patient, improve their physical fitness and achieve glycaemic control.

References:

American Diabetes Association. (2015). 2. Classification and diagnosis of diabetes. Diabetes care, 38(Supplement 1), S8-S16.

Gillen, J. B., & Gibala, M. J. (2013). Is high-intensity interval training a time-efficient exercise strategy to improve health and fitness?. Applied Physiology, Nutrition, and Metabolism, 39(3), 409-412.

Karstoft, K., Winding, K., Knudsen, S. H., Nielsen, J. S., Thomsen, C., Pedersen, B. K., & Solomon, T. P. (2013). The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients. Diabetes care, 36(2), 228-236.

Little, J. P., Gillen, J. B., Percival, M. E., Safdar, A., Tarnopolsky, M. A., Punthakee, Z., … & Gibala, M. J. (2011). Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. Journal of applied physiology, 111(6), 1554-1560.

Morton, R. D., West, D. J., Stephens, J. W., Bain, S. C., & Bracken, R. M. (2010). Heart rate prescribed walking training improves cardiorespiratory fitness but not glycaemic control in people with type 2 diabetes. Journal of sports sciences, 28(1), 93-99.

Sargent, G. M., Forrest, L. E., & Parker, R. M. (2012). Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. obesity reviews, 13(12), 1148-1171.