Nursing Intervention in Patients with Diabetes Mellitus Type-2: A Critical Appraisal

This critical appraisal evaluates a study on nursing interventions for elderly patients with diabetes mellitus type-2. The study highlights the importance of designing appropriate interventions for long-term care patients and those in transition units. The paper discusses the prevalence of diabetes in the adult population, associated complications, and the need for specialized transitional care. The study concludes that nursing interventions play a crucial role in improving the quality of life of elderly patients with diabetes mellitus type-2.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student:
Name of the University:
Author Note:

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Introduction:
The paper that has been selected by me for critical appraisal revolves around the
central theme of ‘nursing intervention in patients diagnosed with Diabetes mellitus type-2’.
The paper essentially deals with the treatment specifically targeting the diabetes type-2 adult
patients (Munshi et al.2016). Diabetes is known to affect adults at an elderly age and has
been reported to have long-term effects on the individuals thereby requiring special care and
primary interventions. This journal primarily focuses on identifying the problems related to
long term care of elderly diabetic patients and thereby design appropriate interventions in
order to help facilitate an improved quality of life and reduced risks pertaining to advent of
hypoglycaemia and other complications related to diabetic type-II disorder (Munshi et
al.2016).
Key Words:
Diabetes mellitus, nursing care, intervention, LTC, hypoglycaemia, insulin
Background:
Diabetes type-II has been recorded to be the most common disorder affecting the
adult male and female population world-wide with statistical evidences showing that every 3
out of 5 adults are diabetic (Rathert et al.2013). The disorder is known to possess a prolong
effect on the individual with the maintenance recovery cost extremely high such that
individuals belonging to the old age group who are placed under the long term care, find it
extremely difficult to be able to bear the expenses associated with the treatment of the
disorder (Powers et al.2017). The possibility of developing diabetes at an increased age group
increases the risk factor by 25 to 30% as revealed by the research studies (Munshi et al.2016).
Studies also reveal that the expenditure involved with the treatment and care of diabetes
involved expenses as high as 2.3 times the expense prevalent among common individuals

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who did not have diabetes (Munshi et al.2016). Also certain factors that contributed in the
predominant development of diabetes among common people incorporated reasons such as
accumulation of abdominal fat, increased insulin resistance, sarcopenia and low grade
inflammation. Diabetes is also accompanied with several other physiological problems such
as cardiovascular complications, depression and geriatric syndrome (Lo-Biondo-Wood et
al.2013). However the most vital aspect of the study includes the presence of heterogeneity in
individuals with issues pertaining to functional impairments and comorbid illness measures.
The presence of heterogeneity in the population and the lack of ample amount of
substantial data in favour of developing interventions make it difficult in designing strategies
that could be implied to combat the problem (Elissen et al.2013). Therefore, in order to
critically deal with the patients placed under long term care, the pattern of the prevalence of
the heterogeneity must first be truly accessed and accordingly interventions should be
designed. Therefore the study presents strategic designing of interventions that can be utilised
in order to cater to need of the old age adults and at the same time guide the patients
efficiently through the transition phase keeping in mind the comfort level of the patients
(Chappel et al. 2013). The literature sited in the paper is relevant to the topic as it clearly
presents the statistical data that portrays the proportion of the adult population affected with
diabetes and other associated disorders and also the factors that must be considered while
designing interventions especially focusing on those who are placed under long term care or
are required to be transitioned.
The study:
The study has been conducted by critically reviewing the statistics of type II diabetes
prevalent in the United States of America and the study specifically highlights the data
obtained through the meta-analysis of the literatures dealing with nursing interventions in
type II diabetes across the globe. It should be noted that the study revolves around two

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distinct objectives, the first involving addressing of the elderly people affected with type II
diabetes and the second involving the adults placed under the long term care and in the
transition units (Munshi et al. 2016). As perceived by the data, it was recorded that the
population considered in the study is known to possess a high incidence of hypoglycemia
pertaining to the age related unavoidable physiological complications and other related
factors (Carman et al.2013). As already discussed, the population considered in the study
constitutes of old age people, hence the people resort to inexpensive interventions and rely
solely on the sliding scale insulin treatment. However, this treatment should not be favoured
and steps should be taken in order to restrict the use of Insulin except for unavoidable cases.
Findings:
Better nursing intervention techniques in terms of designing a liberal diet
incorporating all the important constituents of a proper balanced diet and thorough exercise
plans helped in the improvement of the unhealthy diet and beverage intake pattern of the
population. Adopted measures also included minimalistic fitness exercise and fitness therapy
in order to help the population stay fit and closely monitor the blood sugar level, thereby not
letting the glycemic index fluctuate (Bohanny et al.2013). In addition to this, the paper also
focuses on the long term care patients who are supposed to be placed under transition care.
Most of the diabetes type-II patients are transitioned from one care unit to another care unit
and at the time of transition, the procedure is expected to be carried out by the nursing
professional, but it has been found that in most of the cases with reference to the population
considered the transition is not managed in an efficient way and interventions should be
adopted in order to make the procedure more convenient for the patients as well as their
family members (Blackberry et al.2013). The interventions highlighted at the time of
transition should include the proper medicine reconciliation, the appropriate education being

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imparted to the family members of the patient about the medications and a detailed overview
and explanation of the treatment given so far.
In addition, at the time of transition, it is important that a systematic file of the patient
is handed over to the family members as well to the next care unit where the patient would be
admitted and the file should elaborate specifically all the details of the patient including the
medical reports testifying the present insulin and the glucose in the blood level and the
current meal plan that is being followed by the patient (Blackberry et al.2013). The document
should also include the present activity level of the patient and the ability of the patient to
cope up with complications in case of an acute hypoglycaemia attack as trained by the
previous care unit (Thom et al.2013). Transition care is extremely important and should not
be overlooked in any cases be it the scenario of transition from the hospital to home or from
home to the clinical care (Sapkota 2015). It is important to consider the psychological stress
factors that engulf the old age patients while transitioning from hospital to home. On the basis
of the level of impairment caused by the disease and the associated complications the old age
patients become extremely vulnerable as they are not able to carry out the daily chore and
also the cognitive behaviour becomes impaired, hence it becomes extremely important to
place them under critical care while transitioning from one care unit with a different
environment to another care unit with an entirely different environment.
Limitations:
The limitations of the paper could be defined as the non-addressal of the occurrence
of the disease in any other age group except in the older population and also the limited
discussion on the self-awareness training imparted to the patients for self care and also the
paper is based on the systematic review and does not incorporate any novel findings.

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Conclusion:
Hence on critical evaluation of the study it can be concluded that nursing
interventions form an integral part in the process of catering to the elderly patients with type-
II diabetes and other associated physical complications. The paper is well structured and the
findings are based on the systematic analysis of the reputed journals and statistical evidences
that have been gathered from scientific papers published in high impact factor value journals,
which ensures that the authenticity of data presented in the journal is appropriate with
accuracy. Diabetes is the most common disorder that is found to affect a major proportion of
the population with a major occurrence in the old-age adults. The old age people that are
affected with type-II diabetes are mostly in their terminal age group and are placed under
long term care. Under these circumstances, it is extremely important for the care-givers, here
the nursing professionals to appropriately understand the complications related to the
disorder, the associated symptoms and all the associated characteristics with the occurrence
of the disease. Accordingly the interventions should be planned while dispensing care. The
traditional use of sliding scale insulin should be avoided. Prior to devising an intervention it
is important to understand the social determinants that affect the treatment requirement of the
patient, as in this paper it was evident that the poor economic background of the patient
played an important role in proceeding with the available treatment options. Also, this paper
highlights another important aspect that must not be neglected while designing an
intervention for the elderly people and it incorporates the specialised transitional care that
must be observed while placing a patient from one care unit to the other.
Many factors play a role in determining the process and it includes handling the
patients with utmost care and ensuring the fact that that the documentation of the treatment
covered till date along the exercise and the diet regimen being followed is maintained
specifically and along with it special training must be provided to the care-givers of the

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patient and some self-training to the patient should also be provided so that the patient can
tackle an emergency situation. Therefore increased efficacy of the treatment by the facility
providers would ultimately lead to the improvement of the standard of life of the adults.

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