Fluent Essays

In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:BackgroundProblem statementPurpose of the change proposalPICOTLiterature search strategy employedEvaluation of the literatureApplicable change or nursing theory utilizedProposed implementation plan with outcome measuresIdentification of potential barriers to plan implementation, and a discussion of how these could be overcomeAppendix section, if tables, graphs, surveys, educational materials, etc. are createdReview your PICOT Statement Paper, Literature Review. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. diabetes_literature.docx picotstatementpaper.docx literature_evaluation_table.docx Unformatted Attachment Preview Running head: LITERATURE REVIEW ON DIABETES IN PREGNANCY Literature Review on Diabetes Management in Pregnancy 1 LITERATURE REVIEW ON DIABETES IN PREGNANCY 2 Literature Review on Diabetes Management in Pregnancy Introduction Diabetes remains one of the problems that women deal with during pregnancy. Some women are usually aware that they have diabetes before getting pregnant, and they can manage it throughout their pregnancy period. Nevertheless, statistics reveal that between 6 and 9 percent of women in the United States develop gestational diabetes. The Centers for Disease and Prevention Control defines gestational diabetes as a type of diabetes that occurs in a woman during her pregnancy phase. Gestational diabetes is not present during the first weeks of pregnancy and can be detected during the second trimester. Diabetes poses a serious problem during pregnancy as it could cause high blood pressure, low blood sugar, and an extra-large baby who could require an emergency caesarian section for delivery. It is, therefore, necessary for women to monitor their blood sugar level to ensure that they remain healthy throughout the pregnancy period. Traditionally, clinicians have recommended the lancet device to control blood sugar, where the individual pricks their finger to measure blood sugar. Over time, technological advancements have led to the development of new tools for blood sugar testing, such as the Dexcom G6, for testing blood sugar. The technology is preferred since the individual does not have to prick their finger to test their blood sugar. A comparison of research questions The literature involved in the study consists of several recent articles that add knowledge on the issue of diabetes in pregnancy. The first research question addresses the importance of continuous glucose monitoring in pregnancy. The research identifies the benefits associated with continuous glucose monitoring in pregnant women since it allows them to monitor the progress LITERATURE REVIEW ON DIABETES IN PREGNANCY 3 of the fetus and therefore reduce any complications that may occur during the pregnancy. The first research question is related to the second research question, which addresses the importance of diabetes management for pregnant women. The research reveals that glucose management helps in clarifying glucose metabolism in pregnant women, and this supports the continuous glucose monitoring approach. The third research question is concerned with the use of the Dexcom G6 device for continuous glucose monitoring. Since the device is new in the clinical industry, the researchers are concerned with the safest approach through which diabetic patients can use the tool. This is related to the fourth research question that discusses the best technique for blood glucose testing and monitoring. The article provides insights into the use of continuous glucose monitoring, which is made possible through the use of the Dexcom G6 device. The fifth and sixth research questions are related to the fact that they address the issue of technology in the development of the most appropriate strategy for continuous glucose monitoring. Both research papers reveal that diabetic patients should have a tool for monitoring their blood sugar level, and technology provides several tools for blood sugar monitoring, including the Dexcom G6 device, Ap, and insulin pumps. The seventh and eight research questions address the issue of glucose monitoring for diabetic patients using continuous glucose monitoring techniques. In both cases, the authors seek to establish a relationship between glucose variability and continuous glucose monitoring and its importance during pregnancy. A comparison of sample populations LITERATURE REVIEW ON DIABETES IN PREGNANCY 4 In all cases, the study population had either type 1 or type 2 diabetes, and they supported continuous glucose monitoring using different devices. The first research paper utilizes a descriptive analysis of recent literature related to CGM, and the sample size involved women with gestational diabetes. The second article also uses a detailed review of articles dealing with diabetic patients, with all of them having pregnancy during the period of research. The third research uses an undisclosed sample of children and adolescents with Type 1 diabetes to determine how they monitor their blood glucose level with the Dexcom G5 device. The fourth study utilizes a sample of Italian diabetes experts to get their view concerning real-time glucose monitoring on patients with diabetes. The fifth study used a sample of 16 pregnant women who were put through four weeks of closed-room therapy and another four weeks of SAP control until discharge from hospital after delivery. The sixth article utilizes a total of 124 pregnant women ranging between the ages of 18 and 24 months. The participants had to have spent at least 12 months of standard insulin delivery. The seventh study involved a sample of 24 women between the ages of 17 and 65 with Type 1 diabetes. The participants were taken through 48 hours of outpatient insulin management to determine changes in blood sugar levels after meals and exercise. The eighth article utilizes a detailed review of the literature associated with continuous glucose monitoring among diabetic patients in general. The research used a sample of children and adults with both Type 1 and Type 2 diabetes, and the participants were put through continuous glucose monitoring over one year. A comparison of the limitations of the study The primary flaw in the first study lies in the fact that all the studies examined had a small sample size, which means that they are not a true representative of the population. The LITERATURE REVIEW ON DIABETES IN PREGNANCY 5 second study was limited by the fact that devices for CCGM are expensive, and this reduces the sample size. The third study is limited by the lack of clinical trials that have used the provided approach, which makes it difficult to compare results. The small sample size of the study participants may have limited the effectiveness of the research since it does not represent the views of the entire population. The limitations of the fifth research article included the fact that the four weeks under which the participants were subjected to SAP and closed room therapies were not enough to train individuals on how to use the devices. Additionally, the crossover design may not be effective in addressing patients with a variability in their lifestyles. The limitations in the sixth article include the fact that a deficiency in the devices used could cause even more severe consequences on the individuals involved in the study, and this could have limited the number of participants. The limitations of the seventh study included the fact that the exercise was strenuous, given that the participants had to make four on-site visits over a short period, which could have contributed to a high drop out rate. Moreover, the 48-hour management required for monitoring patients in home settings may not have been enough to assess the patients’ progress. One of the limitations of the eight study is the lack of standardization of reporting programs, which makes it difficult for the comparison of different CGM devices. Conclusion Diabetes poses a severe problem for women in their pregnancy phase. For women who have diabetes before getting pregnant, they are likely to have received advice concerning blood glucose monitoring. Nevertheless, it gets difficult for pregnant women who are newly diagnosed with diabetes since they do not understand the most appropriate device for blood glucose monitoring. Clinicians recommend continuous glucose monitoring approaches since they enable LITERATURE REVIEW ON DIABETES IN PREGNANCY 6 patients to monitor their blood sugar and enhance the safety of their fetus. The literature review shows that continuous glucose monitoring is the safest approach towards monitoring their blood glucose level for pregnant women since it provides them with the ability to control their health conditions in real-time. Further research is recommended into the use of the Dexcom G6 device, which has proven more effective in monitoring blood glucose without the patients having to prick their skin. LITERATURE REVIEW ON DIABETES IN PREGNANCY 7 References American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80. Benhalima, K., Devlieger, R., & Van Assche, A. (2015). Screening and management of gestational diabetes. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(3), 339-349. Hunt, K. J., & Schuller, K. L. (2007). The increasing prevalence of diabetes in pregnancy. Obstetrics and gynecology clinics of North America, 34(2), 173-199. DERDZINSKI, M., WELSH, J., PUHR, S., WALKER, T. C., PARKER, A., & JIMENEZ, A. (2019). 391-P: Hypoglycemia Reductions with the Dexcom G6 CGM System’s Predictive Alert. Running head: PICOT STATEMENT 1 PICOT STATEMENT 2 Picot question How do pregnant women (P) newly diagnosed with diabetes (I) perceive monitoring their blood sugar levels (O) using the lancet device compared to the Dexcom G6 (C) during their first weeks of pregnancy (T)? Evidence-Based Solution For a long time, medical practitioners have promoted the use of the lancet device as a self-management technique to monitor the blood glucose level of their patients. The device works by enabling the patient to prick their finger, after which they squeeze a single drop of blood on the strip and read the measurements of their blood glucose level. Over time, technology has enabled medical assistants to develop blood sugar monitoring devices that do not require pricking. Derdzinski et al. (2019) describe the Dexcom G6 device that inserts a sensor beneath the skin. The sensor measures the information reflects on a smart device. Nursing Intervention Nurses play a crucial role in the development of strategies towards the management of diabetes in pregnant women. Planning goals for such patients include the administration of effective treatment techniques to normalize the blood glucose level, such as insulin replacement therapies, exercise, and a balanced diet. The role of nurses in the treatment and management of diabetes includes stressing the importance of complying with the treatment plan to reduce the risk of unstable glucose level in the blood, and risk for infection. Patient Care Diabetes affects approximately 204 million women between the ages of 20 and 79 years across the globe, and the rate is expected to increase further. The implication is that women of childbearing age are at an increased risk of developing diabetes during pregnancy, a condition PICOT STATEMENT 3 that is referred to as gestational diabetes (Hunt and Schuller, 2007). The standard treatment plan for diabetes includes insulin. However, an increased number of healthcare providers are shifting towards the use of oral agents such as glyburide and metformin, which have proven to have fewer side effects during pregnancy as compared to insulin. Health Care Agency Diabetes health care professionals have a role in preventing diabetes by helping the patients to understand the importance of proper diabetes management. These include the development of a dietary plan that can help to control the blood glucose level instead of always relying on medication. A nutritional plan is necessary for women with gestational diabetes because it could promote the healthy development of the fetus and at the same time, reduce the side effects of medication on the health of the fetus. Healthcare agencies often find themselves taking up the role of legal advocacy for patients with diabetes who may face discrimination in the workplace (American Diabetes Association. 2014). Such could include the lack of a caregiver while in the workplace or the risk of getting fired when the employer discovers that a patient is on insulin therapy. Nursing Practice Nursing management for pregnant women with diabetes emphasizes the need to individualize healthcare and promotes the development of a nursing management approach that reflects the needs of the individual and their family. Nurses have a role in subjecting individuals to regular screenings to enhance early detection of diabetes, especially in pregnant women (Benhalima, Devlieger and van Assche, 2015). In this case, they have to describe the risk factors associated with diabetes and the role that exercise plays in the prevention of diabetes. Nurses should also promote self-care for individuals with diabetes. Support, in this case, includes PICOT STATEMENT assisting patients in developing their self-care plan. The nurses could also point out any factors that may limit the patient’s ability to adhere to their healthcare plan. 4 PICOT STATEMENT 5 References American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80. Benhalima, K., Devlieger, R., & Van Assche, A. (2015). Screening and management of gestational diabetes. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(3), 339-349. Hunt, K. J., & Schuller, K. L. (2007). The increasing prevalence of diabetes in pregnancy. Obstetrics and gynecology clinics of North America, 34(2), 173-199. DERDZINSKI, M., WELSH, J., PUHR, S., WALKER, T. C., PARKER, A., & JIMENEZ, A. (2019). 391-P: Hypoglycemia Reductions with the Dexcom G6 CGM System’s Predictive Alert. Literature Evaluation Table Literature Evaluation Table Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article 1 Article 2 Article 3 Article 4 Sarit Polsky, MPH author and Rachel Garcetti, P Diabetes Technol Ther. Joyce F. Sung, M.D., Masoud Mark Taslimi, M.D., and Jeffrey C. Faig, M.D. J Diabetes Sci Technol. https://www.ncbi.nl m.nih.gov/pmc/articl es/PMC5467097/ Lori M Laffel, Grazia Aleppo, Bruce A Buckingham, Gregory P Forlenza, Lisa E Rasbach, Eva Tsalikian, Stuart A Weinzimer, Dennis R Harris Journal of the Endocrine Society .BruttomessoaL. Laviolab A. Avogaroa E. Bonorac S. Del Pratod S .Frontonie E .OrsifI . Rabboneg G. Sestih F. Purrello Nutrition, Metabolism and Cardiovascular Diseases Article Title and Year Published CGM, Pregnancy, and Remote Monitorin g Continuous Glucose Monitoring in Pregnancy: New Frontiers in Clinical Applications and Research 2017 2014 A Practical Approach to Using Trend Arrows on the Dexcom G6 CGM System to Manage Children and Adolescents With Diabetes 2017 https://www.scien cedirect.com/scie nce/article/pii/S0 93947531930049. The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: A consensus view of Italian diabetes experts using the Delphi method 2019 Research Questions (Qualitative)/Hypot hesis (Quantitative), and Purposes/Aim of Study The aim of this paper is analysis is to assess the use of CGM in pregnancy The aim of the article is assess literature regarding diabetes management among pregnant women This source endeavors to offer a safe way of using Dexcom G6 arrow for various patients with diabetes The purpose of the analysis was to delineate the best technique to test and manage diabetes Design (Type of Quantitative, or Type of Qualitative) Quantitativ e Qualitative Qualitative Quantitative Setting/Sample Secondary sources used by review of past studies Review of past studies Evaluation of various descriptive studies Use of past literature Italy Evaluation of past studies descriptive analyses modified Delphi method This work aims at establishin g the suitability of CGM in pregnancy The findings approve the use of CGM in pregnancy It is recommen ded that more study to be conducted in this area to enhance the outcome This topic validate the use of CGM amid pregnancy on pregnant patients with diabetes The source explain monitoring of glucose level in pregnancy The article evaluates the safest approach of using Dexcom G5 in various patients The source endeavor to propose an effective method of management of diabetes in Italy Constant monitoring of glucose present an opportunity in clarifying glucose metabolism in pregnancy It is recommended that CGM must be compared to similar instrument rtCGM can be used to adjust the insulin dosage Patient prefer to use rtCGM and FGM than SMBG It is recommended that the appropriate approaches be added to adjust the parameters of insulin Patients should be educated to optimize the adoption and use of rtCGM and FGM It supports the use of Dexcom G5 in various settings This provide important literature to my topic of study. Methods: Intervention/Instru ments Analysis Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project This provide important literature on the management of diabetes in pregnancy Criteria Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Article Title and Year Published Article 5 *Yael Lefkovits, Zoe Stewart, Helen Murphy EUROPEAN MEDICAL JOURNAL https://emj.emghealth.com/wpcontent/uploads/sites/2/20 19/06/Using-the-NovelApproach-of-an-ArtificialPancreas....pdf Using the Novel Approach of an Artificial Pancreas to Manage Type 1 Diabetes Mellitus in Pregnancy 2019 Article 6 Article 7 Article 8 Helen R Murphy, Emily Woodhouse Ann Marie Swart Lee Shepstone file:///C:/Users/ User/Document s/3029783.pdf Marc D. Breton, PhD, Stephen D. Patek, PhD, Dayu Lv, PhD, Elaine Schertz, BS, Jessica Robic, BS, Jennifer Pinnata, RN, Laura Kollar, RN, Charlotte Barnett, BS, Christian Wakeman, MS, Mary Oliveri, MS, Chiara Fabris, PhD, Daniel Chernavvsky, MD, Boris P. Kovatchev, PhD, and Stacey M. Anderson, MD Larry A Distiller Automated insulin Delivery Amongst Pregnant women with Type 1 diabetes 2019 Diabetes Technol Ther https://www.ncb i.nlm.nih.gov/pm c/articles/PMC60 80127/ Continuous Glucose Monitoring and Insulin Informed Advisory System with Automated Titration and Journal of Endocrinology, Metabolism and Diabetes of South Africa https://medphar m.tandfonline.co m/doi/full/10.10 80/16089677.20 18.1515164#.Xe xtLOgzaM8. Should all patients on insulin be using continuous glucose monitoring? 2018 Dosing of Insulin Reduces Glucose Variability in Type 1 Diabetes Mellitus 2018 The goal of thisanalysis is to establish relationship between Glucose variability and CGM Research Questions (Qualitative)/ Hypothesis (Quantitative ), and Purposes/Aim of Study The purpose of the research is to delineate the use of technology in the management of diabetes in pregnant women The study aim is to test the impact of automated insulin administration in pregnant women The aim of the article is to assess the use of CGM on patients using insulin Design (Type of Quantitative, or Type of Qualitative) Quantitative Quantitative Quantitative Quantitative Setting/Sampl e Review of secondary sources NHS antenatal diabetes clinics South Africa Methods: Intervention/I nstruments Descriptive review quantitative research 24 respondent with type 1 diabetes mellitus Administration of questionnaires Analysis This analysis discuss the best tool for diabetes management in pregnancy This study evaluates the importance of dosage in glucose variability The source endeavors to validate the use of CGM when using CGM Key Findings CGM, insulin pumps, and the AP are important in diabetes nurisng The study will validate the impact of automated administration of diabetes The findings indicate that automated insulin administration is potential approach DSS decreased GV CGM will become the preferred tool for managemen t and diagnosis of diabetes Recommenda tions It is recommended that further research must be done to come up with the most effective tool More research and development should be done to enhance this tool Futur ... Purchase answer to see full attachment