Nursing Research: Evidence-Based Practice, Ethics, and Diabetes

This nursing assignment delves into various aspects of research within the nursing context, covering reasons for undertaking research, credible information sources, and models of evidence-based practice. It discusses evaluating the validity of information, cultural and ethical considerations in research, and processes for analyzing gathered information. The assignment also addresses assessing the strength, relevance, reliability, and currency of information, along with feasibility, benefits, and risks. Furthermore, it explores the impact of beliefs and social support on diabetic patients' self-esteem, client-specific factors, cultural beliefs, and political issues affecting diabetes management. The assignment also touches upon social and economic factors influencing diabetes in Australia, the role of NDSS and Diabetes Australia, and the involvement of general practitioners and endocrinologists in diabetes care. Finally, it includes a case study focusing on factors contributing to high blood glucose levels in a diabetic patient.

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Nursing
Student’s Name
Student’s Number
University
Module Code
Module Name
Date

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Question one
a) Comparison: Role of clinical placement, nursing education and patient outcomes
(Donnelly and Wiechula, 2013).
b) Hypothesis testing: the relationship among motivational factors: the nursing work
environment and nurse caring i.e.
Hypothesis 1: Compassion satisfaction is positively correlated with nurse caring.
Hypothesis 2: Nurse Job satisfaction is positively correlated with nurse caring.
(Burtson and Stichler, 2010).
c) Trend identification: the use of social networking analysis to explore research topics and
trends in nursing associated with communication in intensive care units (Son et al., 2018).
d) Own knowledge extension. Exploring the perception of pharmacists regarding their
professional role
e) Strengthen the quality of own practice. Peer review by other experts is an example on
how one can strengthen the quality of one’s own research.
Question two
i. Government sources (.gov) such as Australian Bureau of Statistics
ii. Educational websites (.edu)
iii. Journals e.g. JSTOR, Oxford Academic
Question three
i. Stetler Model

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ii. Owa Model
iii. Rossworm And Larrabee Model
(Satterfield et al., 2009)
Question four
i. Face validity – this is used to measure the extent to which a method of measurement
appears “on its face” to ascertain the construct of interest. Under face validity, the
measurement is accepted by those responsible as being generally reasonable.
ii. Content validity – this is the degree to which the questions on a research tool and their
tallies represent all questions that could be put forth regarding the skill or content (Zohrabi,
2013). High content validity can be achieved with the increase in the items of scale that
represent the concept of the domain that is being measured.
iii. Predictive validity – this approach is important in foreseeing some type of behaviour. It
shows the ability of the tool of measurement to distinguish among people with regard to the
future criterion. Greater predictive validity is achieved when there is a higher correlation
between the predictor and the criterion (Drost, 2011).
Question five
i. The researcher should be aware of his or her own cultural background, attitudes, biases
and values that are likely to affect one’s ability to help clients from different cultural
populations.
ii. Aid clients to become cognizant of their own cultural norms and values, and foster
means through which the clients can apply this to their individual lives and to the community
at large.

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iii. Exercise respect towards the spiritual and/or cultural values and beliefs of the clients
(Gjersing, Caplehorn, and Clausen, 2010)
Question six
i. Informed consent. This is a major ethical issue that implies that an individual consciously,
willingly and intelligently, and the most appropriate way to give his consent. Informed
consent ensures that a respondent’s right to autonomy is secured. This should include an
introduction to the research and its aim in addition to a description of the study procedures
and any physical harm or invasion of privacy.
ii. Confidentiality and anonymity. Anonymity is secured when the identity of the subjects
cannot be associated with individual responses. Confidentiality is the management of private
information by the researcher so as to safeguard the identity of the researcher. Researches
which are likely to have social and psychological implications and breach of the
confidentiality of the participants requires that the participants be notified of their rights.
iii. Respect for privacy. This is the freedom one has to decide on the time, degree, and
overall situations in which private information will be shared or withdrawn from others.
(Roth-Cline et al., 2011).
Question seven
a) Comparing and contrasting. I will clearly articulate the differences and the similarities
between each of the items of comparisons using phrases of comparison
b) Challenging. This can be done by first stating the findings and then challenging them
using previous outcomes in other studies that were more accurate than the current research.

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Additionally, this can be done by citing the weaknesses of the current research against the
strengths of the previous research with different findings.
c) Reflecting. This involves giving individual opinions based on the outcomes of research.
This entails an assessment of an individual’s style of the strengths and weaknesses associated
with the learning and any application in future research.
d) Distinguishing relevant from irrelevant. This can be done by first citing the information
gathered during research and linking it with the research objectives. If the findings answer or
are linked to the aim of the research, then they are relevant but if not then they can be judged
as irrelevant.
e) Drawing interdisciplinary connections. This is aimed at disclosing the link, bond or the
association between ideas and objects in order to generate meaning. This can be achieved by
ascertaining the association between items, what distinguishes the items, and the connection
between the evidence.
(Creswell and Clark, 2017).
Question eight
a) Assessing the strength of information: this involves assessing the body of evidence,
consistency and relevance to the context. The research questions should be examined whether
they are aimed at isolating cause and effect and whether they are answered using quality
experimental and quasi-experimental research designs.
b) Assessing the relevance of information: the objective is to determine whether the
information helps in findings answers to the research question. The information is examined
based on the format, content, and whether it is up to date.

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c) Assessing the reliability of information: this entails the surety that the information is
correct, its credibility and objectivity. This involves the consideration of its origin and
quality. In other words, is the author authority in the field or recognized in the subject area
and any affiliation. Is the quality of the publications peer reviewed?
d) Assessing the currency of information: this refers to the most recent developments. In
order to ascertain the currency of information, one should ascertain whether it still a
reflection of the current situation. Articles published over a decade are not likely to reflect
any currency on the subject matter under investigation.
(Zohrabi, 2013)
Question nine
a) Assessing the feasibility of information: this can be done by considering a variety of
criteria such as the inclusion/exclusion criteria, clinical relevance, number of participants etc.
The information should be of interest or help to the clinical community and compatible with
the existing guidelines.
b) Assessing the benefits of information: this is determined by assessing whether the
information gathered answers the research question or is it of help to the population under
study.
c) Assessing the risks associated with information: risk of information is assessed by
ascertaining whether the magnitude or probability of the anticipated harm or discomfort in
the research is greater or not when compared to the daily experiences in life.
(Walker et al., 2013).
Question ten

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Beliefs and social support.
Beliefs affect the self-esteem of diabetic patients. For instance, there are some religious and
other belief systems that associate illnesses such as diabetes to other causes such as
punishment from a given deity. Such diabetic patients feel secluded and unworthy hence the
reason for the sickness, and as a result, they end up experiencing low self-esteem. Diabetic
patients require a lot of social support from family and friends, and in the absence of such
support, the patient is likely to be discouraged with life and become hopeless on ever getting
well, hence low self-esteem (Australian Institute of Health and Welfare, 2016). Grzywacz et
al. (2012) observe that low-self-esteem discourages self-care activities such as diet and
exercise which are essential in the management of diabetes.
Question eleven
a) Client specific. The effective management of diabetes is dependent on various factors of
the client such as resources, emotion etc. lack of financial resources makes care delivery
difficult because of a lack of medication.
b) Cultural beliefs: Different cultural practices and belief systems on the cause and
treatment of diabetes affect its management. This is attributed to low education. Grzywacz et
al. (2012) found out that health belief systems about the symptoms and medical management
of diabetes varied based on different ethnic groups.
c) Political issues: The prevention of chronic disease such as diabetes requires the
enactment of laws or policies that would improve access to care, consumer protections, and
lower costs of health care. However, political issues can hamper such progress especially
from lawmakers who may want to gain political mileage from the same.

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Question twelve
Social factors that influence diabetes mellitus in Australia include income levels, education
and social support. Individuals from low income earning populations are at a higher risk of
poor health compared to those from high income earning communities. Environmental factors
such as walkability, food, air pollution and proximity to roads affect diabetes management
because the physical environment influences choice and behaviours (Australian Institute of
Health and Welfare, 2016).
Question thirteen
Low social economic status among the Aboriginal people contributes to the lack of access to
education, income, housing and employment; which increase risk factors for diabetes. High
incidences of obesity, smoking, stroke, heart disease and physical inactivity also increase the
prevalence of risk factors of the Aboriginal people (Wang, Hoy, and Si, 2010).
Question fourteen
NDSS helps promote the capacity of the people diagnosed with diabetes to comprehend and
self-manage their condition. It also helps to support diabetic patients by providing them with
NDSS services in a timely and reliable manner. For instance, NDSS provide correct
information and support services nationally (NDSS, n.d).
Question fifteen
Diabetes Australia is responsible for the management and prevention of diabetes. The
organization works in partnership with the government and communities to conduct out
research with an objective of reducing the impact of diabetes. It also assists in administering
the NDSS and foster issues affecting diabetes in Australia (Diabetes Australia, n.d).
Question sixteen

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General practitioners are the major source of care for diabetic patients and are required to
offer a complete full medical review after diagnosis while factoring in any other medical
complications. They also ensure that all necessary team members of the primary care team
are informed on the current patient’s progress either in writing or verbally or both (Malkani,
Keitz, and Harlan, 2016).
Question seventeen
An endocrinologist offers professional advice on diabetes management. They treat diabetes
by reducing medications such as insulin and using diet and blood sugar. Moreover, they also
help patients in controlling blood sugar and assess them to prevent any associated health
complications (Handelsman et al., 2011).
Question eighteen
The Australian Diabetes Society plays significant roles in diabetes prevention and its
complications, offer excellence in education for health experts, foster partnership, research
and education, collaborate with other like-minded organizations devoted to better the
treatment and management of diabetes and campaign for health policies regarding diabetes
and its prevention (NADC, n.d).
Question nineteen
The understanding of the family or carer about his or her involvement in the personal care of
a diabetic patient can be gained by inquiring about the health status of the diabetic patient
from the carer. This can be about the frequency of medication and Information level on the
dietary requirements of the diabetic patient can also be an indication of the carer’s
understanding and involvement in care (Sinclair et al., 2010).
Question twenty

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An insight into the understanding of the carer or family’s involvement in the care of a
diabetic patient is important because it helps to ascertain the factors that might be affecting
the health of the patient. For instance, social determinants such as social support from the
family affect the health and improvement of the diabetic patient which might lead to
depression (Sinclair et al., 2010).
PART B: CASE STUDY QUESTIONS
Question 1
Stopping T. Metformin medication is a factor that contributed to high BGL. The increased
BGL is because of stopping to take the medication because the drug works in type 2 diabetic
patients to increase the effect of insulin in the body or by lowering the amount of sugar
absorbed by the body.
Stress. Mental and emotional stress can alter blood glucose levels in type 2 diabetes by
increasing blood glucose levels (Rains and Jain, 2011; Egede, and Ellis, 2010).
Question 2
The most appropriate action is to consider any possible and viable options. For instance, I can
notify the dietician and diabetic nurse educator of the scenario and see if it’s possible for any
changes to be made or allocate wither of the duties to another nurse as much as possible.
Question 3
i. Training on how to take insulin and other diabetic medications in the right dose and time
ii. Emphasize on the importance of taking diabetic meals and its effect on the blood sugar
levels and ketones in the blood

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iii. Train them on how to test blood sugar levels before meals and at bedtime to ascertain
the fluctuations in blood sugar levels
iv. They should be trained on the importance of doctor visits on regular basis or as advised
by the doctor
v. Emphasize the importance of paying involving the family members in their home care
Question 4
Intravenous (IV) injection of glucose infusion. Hypoglycaemia patients with diabetes have
extremely low blood sugar levels in their blood which leads to unconsciousness. An IV
injection of glucose directly to the blood will immediately increase blood glucose levels and
thus providing a constant, steady supply of glucose to the brain (Kedia, 2011).
Question 5
A positive test for ketone in urine is an indication of diabetic ketoacidosis (DKA) in addition
to the symptoms of vomiting and abdominal cramps. High blood glucose levels and dry
mouth are also evidence that the patient is suffering from type 1 diabetes (Wolfsdorf et al.,
2009).
Question 6
The BGL of Henry seems to be high at 1400 hours which is likely after meals and also at
2200 hours and 0200 hours when asleep. BGL should be low while asleep unless meals are
consumed some few hours to sleep. This affects effective BGL regulation. Therefore, Henry
should avoid the intake of meals just before sleep in order to avoid high glucose levels at
night which is likely to lead to more complications
Question 7

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Diabetes Mellitus
Introduction
Diabetes is a condition in which the body is unable to properly breakdown food for use as
energy. It is a metabolic illness of several aetiology characterised by high or low blood
glucose levels with disturbances of the metabolism of fat, protein and carbohydrates caused
by the defects in the secretion or action of insulin or both.
The significance of the Diabetes mellitus in the Australian Context
The topic of diabetes mellitus is important to Australia because of its substantial impact on
the Australian population. According to the Australian Institute of Health and Welfare,
diabetes mellitus has been on the increase over the last 30 years, with the rates doubling each
decade. Approximately 1.2 million people were affected by diabetes in 2014-15. This
represents 5.1% of the population. About 6,091 children were diagnosed with diabetes in
2013. Additionally, Australia is one of the leading nations with risk factors for diabetes such
as cardiovascular and chronic kidney diseases which account for 25% of Australia’s disease
burden (The Department of Health, 2016).
According to the study by Schofield et al. (2017), the cost burden of diabetic Australians in
2015 was $2.1 billion worth of lost labour. It is expected that such cost will increase to $2.9
billion by 2030. Moreover, the burden of diabetes is also linked to the disability and
associated symptoms such as kidney complications and blurred vision. The National Diabetic
Services Scheme reported in 2018 that the government spent over $215 million in treating
and preventing type 2 diabetes. Therefore, this topic is significant to the Australian context
because it will provide more insight into the prevention and management of diabetes as ways
of reducing the burden of the disease and improving the health and well-being of the

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Australians. The objective of this essay is to provide more information on diabetes mellitus
regarding its anatomy, physiology, and pathophysiological changes.
Anatomy and physiology of glucose metabolism and absorption in the Human body
The role of the pancreas in glucose metabolism and absorption
The pancreas maintains blood glucose levels through it’s the secretion of glucagon and
insulin. This is achieved by the opposing and equilibrium activities of glucagon and insulin
known as glucose homeostasis. When asleep or in between meals, the blood glucose level is
low, and glucagon is secreted from the alpha cells in the pancreas. On the other hand, beta
cells secrete insulin through the stimulation of increased glucose levels, such as after meals.
After reaching to its receptor on muscles and adipose tissues, insulin enables the absorption
of glucose into such tissues and thus decreasing the level of blood glucose by eliminating the
exogenous glucose from the bloodstream (Röder et al., 2016).
Roles of insulin and glucagon in maintaining the glucose level in our body
Glucagon
The receptors in the pancreas detect blood glucose levels and in response, its alpha cells
secrete glucagon hormone which has multiple effects on the regulation of blood glucose
levels. Glucagon triggers the liver to transform the glucagon stored to glucose which is then
released into the bloodstream for use by the body. It also triggers the liver to absorb amino
acids from the blood and change them into glucose thus increasing blood glucose levels. This
can also be achieved through lipolysis in which triglycerides are broken down into free fatty
acids and glycerol, some of which are secreted into the blood and into the liver to be
converted to glucose (Gylfe, 2016).
Insulin

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Insulin primarily works to foster the uptake of glucose into the body cells. The presence of
food in the digestive system initiates the secretion of gastrointestinal tract hormones which in
turn trigger the secretion of insulin by the beta cells of the pancreas. After nutrient
absorption, the blood glucose levels increase which further triggers the secretion of insulin
(Rains and Jain, 2011).
Pathophysiological changes of type 1 diabetes
Type 1 diabetes is a chronic autoimmune illness that takes place among people who are
genetically vulnerable and may be advanced by environmental factors. In the case of
vulnerable people, the immune system is prompted to develop an autoimmune response
against the transformed pancreatic beta cell antigens. Environmental factors induce islet
autoimmunity and the destruction of beta-cells in people that are genetically vulnerable,
resulting in a series of prediabetic phases and finally the clinical onset of type 1 diabetes. The
disorder is as a result of very low or absent insulin or high levels of glucagon in addition to
the failure of the pancreas to respond to the stimuli of insulin secretion. This leads to
physiologic impacts such as the disruption of glucose uptake to adipose tissues and muscles
leading to symptoms such as nausea, vomiting, excess urination and thirst, sweating, hunger
etc. (Atkinson, Eisenbarth, and Michels, 2014).
Pathophysiological changes of type 2 diabetes
Type 2 diabetes is as a result of either insufficient secretion of insulin hormone or lack of
stimuli response to insulin by multiple body cells. Insulin resistance is when body cells such
as the ones found in the adipose tissues do not respond to insulin even when they are elevated
levels. The triglycerides are broken down in fat cells to generate free fatty acids for energy;
the muscle cells also lack adequate energy source and liver cells also do not build up
glycogen stores. As a result, the blood glucose levels increases and glycogen reserves are also

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depleted until no glucose is available to be released when needed. These lead to symptoms
such as obesity, blurred vision, poor healing of wounds, fatigue etc (Kohei, 2010).
Pathophysiological changes in gestational diabetes mellitus
The pathophysiology of gestational diabetes has been attributed to insulin resistance, in
which the cells of the body are unable to respond to the stimuli of the insulin hormone in the
usual manner. Multiple pregnancy hormones are responsible for the disruption of the normal
activity of insulin since it binds to its receptors, thus interfering with the cell signalling
pathways. Insulin resistance, therefore, prevents the blood glucose uptake leading elevated
blood glucose levels. The glucose in the blood enters the placenta through GLUT1 carrier to
the fetus, and if gestational diabetes is not treated, the fetus is open to high levels of glucose
causing an increase in the amount of insulin produced by the fetus. The high exposure to high
glucose level is removed after birth, but still, the child has high rates of insulin production,
and vulnerable to low glucose levels (Gauster et al., 2012).
Hypoglycemia
This is a condition caused by extremely low glucose levels in the body and is commonly
attributed to diabetes. It is usually caused by the side effects of diabetes medications. If the
blood sugar levels are below 3.9 mmol/L, then there is a need for immediate treatment which
involves getting the blood back to its normal range. Symptoms include weakness, irregular
heartbeat, hunger, irritability. Advanced symptoms can include seizures, blurred vision and
confusion (Desouza, Bolli, and Fonseca, 2010).
Hyperglycaemia
Hyperglycaemia or high blood glucose level affects diabetic people but can also be caused by
several factors such as poor food choices, physical activity, sickness, irregularity in

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medications of lowering glucose. Blood glucose levels of over 10mmol/L leads to
hyperglycaemia and symptoms such as fatigue, headache, blurred vision etc. are evident. This
disorder can be prevented and managed by living a healthy lifestyle and taking medications
as directed by the physician (Negre-Salvayre et al., 2009).
Ketoacidosis
This is an advance disorder of diabetes that takes place when the body produces excessive
amounts of ketones. The disorder occurs when the body is not capable of producing sufficient
insulin and as a result, the body starts to breakdown fat as a source of energy. This
mechanism produces an increase of acidic ketones into the blood causing diabetic
ketoacidosis. Symptoms include abdominal pain, excessive thirst, vomiting and nausea, etc.
These lead to symptoms such as dry mouth, fatigue, yeast infection etc. the disorder can be
treated through fluid or electrolyte replacement, and insulin therapy (Wolfsdorf et al., 2009).
Hyperosmolar nonketotic coma
This is a syndrome due to an advanced condition caused by very high levels of blood glucose
and is prevalent among type diabetic patients. As a result of the syndrome, the body attempts
to eliminate excess blood sugar by channelling it into the urine. Symptoms include dry
mouth, excessive thirst, fever, vision loss, convulsions and even coma. It is treated using
intravenous fluids to counter water loss or intravenous insulin to decrease blood sugar levels
(Pasquel, and Umpierrez, 2014).
Diabetic retinopathy
This is a diabetes complication that affects the eyes and is caused by the destruction of the
retina. The symptoms include blurred vision, fluctuating vision and finally vision loss. The

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condition can be treated using fluorescein angiography, optical coherence tomography etc
(Tarr et al., 2013).
Infection
Infection is an illness caused by microorganisms that invade body tissue. Diabetic infections
is increases the risks for multiple infections such as urinary tract infection, yeast infections
etc.
Psychosocial issues
These are disorders that major affect mental function, and are patterns of behavioural
symptoms that affect normal functioning in several areas of life. Examples include
intellectual disability, communication disorders etc (Bikson et al., 2009).
Microvascular and macrovascular disease
Microvascular complications of diabetes are the long-term disorders that impact small blood
vessels. These include retinopathy, neuropathy and nephropathy. On the other hand,
macrovascular illnesses are the illnesses that affect the coronary arteries, cerebrovasculature
and peripheral arteries (Fowler, 2011).
Conclusion
Diabetes mellitus is a chronic disorder that is preventable and management when detected
early. Its pathophysiology needs to be understood by the patients in order to appreciate the
need for a healthy lifestyle as a way of its prevention. The prevalence and burden of the
disorder to the government of Australian and its citizens calls for additional research into its
prevention more than treatment.

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