Please read the attached file.

Student name: Samikshya Khadgi




Alarm safety




Diabetes management

Discharge teaching


Functional ability

Health and wellbeing of nurses

Hospital readmission rates

Infection control



Prenatal teaching

Prevention of post operative complications

Prevention of pressure ulcers

Sleep disturbances



Take one of the above topics and form a PICO(T) question with it. Fill in your topic and PICO(T) question in the spaces provided below. After you have completed this worksheet, submit it in Canvas by Saturday of week 1. If there are problems with your question, you will receive feedback. You have until Saturday of week 2 to correct it, but there will be a 5% deduction for each day after the Saturday of week 1.

First, identify each element of your PICO on the line below, then take a look at the templates below to help you formulate a PICO(T) question.

P: Population/disease (i.e. age, gender, ethnicity, with a certain disorder)

P: Older adults having Type II diabetes _______________________________________________________________

I: Intervention or Variable of Interest (exposure to a disease, risk behavior, prognostic factor) Note: Not every question will have an intervention (as in a meaning question – see below).

I: Practicing healthy diet and lifestyle changes _______________________________________________________________

C: Comparison: (could be a placebo or “business as usual” as in no disease, absence of risk factor). Note: This is not used in a meaning question – see below.

C: Older adults who do not practice healthy diet and lifestyle changes


O: Outcome: (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)

O: lower glycated hemoglobin and blood sugar level _______________________________________________________________


Time: The time it takes to demonstrate an outcome (e.g. the time it takes for the intervention to achieve an outcome or how long participants are observed). This is an optional “add-on” for a PICO question.


For PICO questions about a nursing intervention/therapy: level

In older adults having Type II diabetes (P), what is the effect of practicing healthy diet and lifestyle changes (I) on lowering glycated hemoglobin and blood sugar level (O) com

Evidence Based Practice Project:Finding the Evidence (2)

Evidence Based Practice Project:Finding the Evidence (2)




This criterion is linked to a Learning OutcomeInitial PICO question completed / nursing research article selected.

5 to >3.0 pts


Research article is a quantitative article, nursing focused, and is 5 years or less from current publication date. Please note: if you forget to upload your nursing quantitative research article, a 5 point penalty will be applied to your paper

3 to >2.0 pts


Research article is a quantitative article that is nursing focused but is greater than 5 years old.

2 to >0 pts

Needs Improvement

Research article is not nursing focused or is a qualitative article, systematic review, meta-synthesis, meta-analysis, meta-summary, integrative review, clinical information article or “how-to” article. No article uploaded.

5 pts

This criterion is linked to a Learning OutcomeOpening Paragraph(Paragraph #1)

10 to >8.0 pts


Introduction statement(s) present. PICO question with all elements present. Statement of importance with two facts such as costs, morbidity, mortality, safety. Include related statistics with citation and is 5 years or less from current publication date.

8 to >3.0 pts


No introduction statement(s). PICO statement is incomplete. Statement of importance incomplete or missing. Citation is incomplete or missing.

3 to >0 pts

Needs Improvement

No introduction statement(s). PICO statement grossly incomplete or missing. Statement of importance missing. No citation

10 pts

This criterion is linked to a Learning OutcomeSummary paragraph for your nursing quantitative research article. (Paragraph #2)

15 to >14.0 pts


Correctly identified design, sampling method, and setting of study. Identified major findings of study. Major findings include information from the Results and / or Discussion sections. Major findings clearly tied to PICO question. Facts connected to your nursing practice.

14 to >3.0 pts


Design, sampling method, or setting incorrect. Identified findings are not the most impo


NOTE: This is a formal APA paper. Do not use first- or second-person language in this paper. Points will be taken off if you do. Look at the Rubric for more APA information for this paper. APA points will be taken off for spelling, grammar, and usage errors.

Your paper must be between five and six pages (double spaced), not including the cover page and references. Use the following headings for paragraphs 2 through 7: Summary of Research Article, Major Variables, Strengths and Weaknesses, Practice Guideline, Fourth Resource, Conclusion


Paragraph #1: This is your opening paragraph. Start with an introduction statement. What is your PICO question? Describe why was it important (share the dollars, morbidity / mortality, statistics, safety stats you found with citation)?

Find a credible scholarly or government resource published within the past 5 years that provides you with at least two facts (ex. costs, morbidity, mortality, safety, or other related statistics) for why your clinical problem is important (provide statistics). (The internet is a great place to get this information…just don’t forget to cite this information and add it to your reference page).


(Article Name: Improving Glycemic Control and Quality of Life With Diabetes Self-Management Education: A Pilot Project)


Fact 1: (T2DM is a prominent chronic disease in the United States, with the total medical cost of diagnosing and treating diabetes exceeding $245 billion per year)

Fact 2: (Estimates indicate as many as 25.9% of American older adults age 65 and older have T2DM)

(Despite new pharmacological innovations and advances in diabetes research, only 14.3% of patients with diabetes are at their glycemic goal)


My PICO(T) question: Are older adults having type II diabetes (P) who have practiced healthy diet and lifestyle changes (I) at decreased risk for higher glycated hemoglobin and blood sugar level (O) compared with (P) older adults who do not practice healthy diet and lifestyle changes?

Paragraph #2: What did your nursing quantitative research article add to your knowledge on this topic? State the design (descriptive, correlational, predictive correlational, experimental, or quasi-experimental), sampling

REVIEW Open Access

Behaviour change techniques targeting both
diet and physical activity in type 2 diabetes:
A systematic review and meta-analysis
Kevin A. Cradock1,2, Gearóid ÓLaighin2,3, Francis M. Finucane4, Heather L. Gainforth5, Leo R. Quinlan1*

and Kathleen A. Martin Ginis6


Background: Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes
treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change
techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2
diabetes that are associated with changes in HbA1c and body weight.

Methods: We performed a systematic review of papers published between 1975–2015 describing randomised
controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention
features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight
were meta-analysed and examined in relation to use of BCTs.

Results: Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1.
11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall
reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, P < 0.00001]) in intervention groups compared to control
groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12
and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002).
Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: ‘instruction on how to perform a
behaviour’, ‘behavioural practice/rehearsal’, ‘demonstration of the behaviour’ and ‘action planning’, as were
intervention features ‘supervised physical activity’, ‘group sessions’, ‘contact with an exercise physiologist’, ‘contact
with an exercise physiologist and a dietitian’, ‘baseline HbA1c >8 %’ and interventions of greater frequency and

Conclusions: Diet and physical activity interventions achieved clinically significant reductions in HbA1c at three and
six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more
effective structured lifestyle intervention treatment strategies for type 2 diabetes.

Keywords: Behaviour change techniques, Diet, Physical activity, Type 2 diabetes, HbA1c, Systematic review,

* Correspondence: [email protected]
1Physiology, School of Medicine, NUI Galway, University Road, Galway,
Full list of author information is available at the end of the article

© The Author(s). 2016 Open Access This

Clinical Nursing Research
2020, Vol. 29(5) 293 –303
© The Author(s) 2018
Article reuse guidelines:
DOI: 10.1177/1054773818792480

Research Article


Globally, type 2 diabetes mellitus (DM) was the direct cause
of an estimated 1.5 million deaths in 2012, whereas hyper-
glycemia accounted for another 2.2 million deaths (World
Health Organization [WHO], 2016). In Singapore, type 2
DM was the second leading cause of morbidity and mortality
in 2015 (Ministry of Health [MOH], 2016). Complications
arising from type 2 DM included an increase in new inci-
dences of kidney failure from 46% in 1999 to 62% in 2009,
with a corresponding increase in end stage renal disease from
28% in 1999 to 44% in 2009 (Singapore Health Promotion
Board, 2011). In addition, it was reported that about one in
two heart attack cases and two in five stroke cases had type 2
DM in 2014 (MOH, 2016). Type 2 DM was also associated
with a 3-fold increase in mortality, of which most were
related to cardiovascular diseases, and a 3-fold to 7-fold
increase in the risk of coronary artery disease (MOH, 2016).
A recent study also revealed that there are now more than
1,500 diabetes-related amputations per year, and one in five

of these patients died within a year of their amputation in
Singapore (Ang, Yap, Saxena, Lin, & Heng, 2016).


Given the global shift in aging population, the inevitable
demographic change in the prevalence of diabetes and related
complications would see a further increase in older adults.
The fundamental measure to prevent diabetes-related com-
plications is an active lifestyle modification including dietary
control, regular physical exercise, medication adherence,

792480CNRXXX10.1177/1054773818792480Clinical Nursing ResearchTan et al.

1SingHealth Polyclinics, Singapore
2National University of Singapore, Singapore
3Auckland University of Technology, New Zealand

Corresponding Author:
Wenru Wang, Alice Lee Centre for Nursing Studies, Yong Loo Lin School
of Medicine, National University of Singapore, Level 2, Clinical Research
Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
Email: [email protected]

Effect of a Diabetes Self-Efficacy
Enhancing Program on Older Adults
With Type 2 Diabetes: A Randomized
Controlled Trial

Cherry Chay Lee Tan, PhD, RN1, Karis Kin Fong Cheng, PhD, RN2,
Siew Wai Hwang, MBBS, DR1, Ning Zhang, BScN, RN1,
Eleanor Holroyd, PhD, RN3, and Wenru Wang, PhD, RN2

This randomized controlled trial examined the effect of a diabetes self-efficacy enhancing program (DSEEP) on older adults
with type 2

119The Journal of Continuing Education in Nursing · Vol 51, No 3, 2020

Improving Glycemic Control and Quality of Life
With Diabetes Self-Management Education:
A Pilot Project
Djurdja Andrich, DNP, ARNP, FNP-C; and Cynthia Foronda, PhD, RN, CNE, CHSE, ANEF

Type 2 diabetes mellitus (T2DM) and associated complications are leading causes of death in the United States (American Diabetes Association
[ADA], 2017). T2DM is a prominent chronic disease in
the United States, with the total medical cost of diagnos-
ing and treating diabetes exceeding $245 billion per year
(Centers for Disease Control and Prevention, 2015). In
2012, the ADA (2017) reported 29.1 million Americans
had T2DM, representing 9.3% of the overall population.
Estimates indicate as many as 25.9% of American older

adults age 65 and older have T2DM (ADA, 2017).
T2DM and its related complications present major so-

cial and economic burdens for society, and 1.4 million new
cases of T2DM are diagnosed every year (ADA, 2017).
Despite new pharmacological innovations and advances
in diabetes research, only 14.3% of patients with diabetes
are at their glycemic goal (ADA, 2017). The ADA and
the American Association of Clinical Endocrinologists re-
leased standards of care for individuals with T2DM, and
both of these standards include DSME/S at their core
(Powers et al., 2015).

The patient-centered care aspect of DSME/S relies on
five guiding principles of patient engagement. These guid-
ing principles are: (a) information sharing, (b) psychoso-
cial support, (c) behavioral support, (d) multidisciplinary
integration of care, and (e) care coordination (Powers et
al., 2015). This practice change initiative integrated all of
these aspects in the care of patients with T2DM, specifi-
cally targeting patients age 65 and older. The behaviors in-
volved in DSME/S are culturally sensitive, dynamic, and
multidimensional, which play a significant role in setting
goals and developing a plan of care (Powers et al., 2015).
In this context, each patient received specific, individual-
ized, and attainable goals to follow for a period of 4 weeks
and beyond.

Diabetes self-management education and support

(DSME/S) has been demonstrated as an effective inter-
vention and a billable service; however, DSME/S has yet
to be successfully translated and diffused into main-
stream practice. This project sought to improve glyce-
mic control (measured by A1C or fasting blood glucose
[FBG]) and quality of life (QOL) of Medicare patients
age 65 years and older with type 2 diabetes (T2DM)
using DSME/S. DSME/S included information sharing
between patients and providers, psychosocial support,
behavioral support with lifestyle modification, multi-
disciplinary integration, and care coordination. Patient-
specific data were compared before and 4 weeks after
project implementation. Use of DSME/S


Treatment of Diabetes in Older Adults: An Endocrine
Society* Clinical Practice Guideline

Derek LeRoith,1 Geert Jan Biessels,2 Susan S. Braithwaite,3,4 Felipe F. Casanueva,5

Boris Draznin,6 Jeffrey B. Halter,7,8 Irl B. Hirsch,9 Marie E. McDonnell,10

Mark E. Molitch,11 M. Hassan Murad,12 and Alan J. Sinclair13

1Icahn School of Medicine at Mount Sinai, New York, New York 10029; 2University Medical Center Utrecht,
3584 CX Utrecht, Netherlands; 3Presence Saint Francis Hospital, Evanston, Illinois 60202; 4Presence Saint
Joseph Hospital, Chicago, Illinois 60657; 5Complejo Hospitalario Universitario de Santiago, CIBER de
Fisiopatologia Obesidad y Nutricion, Instituto Salud Carlos III, 15782 Santiago de Compostela, Spain;
6University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado 80045; 7University of
Michigan, Ann Arbor, Michigan 48109; 8National University of Singapore, Singapore 119077, Singapore;
9University of Washington Medical Center–Roosevelt, Seattle, Washington 98105; 10Brigham and Women’s
Hospital, Harvard Medical School, Boston, Massachusetts 02115; 11Northwestern University Feinberg
School of Medicine, Chicago, Illinois 60611; 12Division of Preventive Medicine, Mayo Clinic, Rochester,
Minnesota 55905; and 13King’s College, London SE1 9NH, United Kingdom

ORCiD numbers: 0000-0002-7920-8474 (D. LeRoith).

*Cosponsoring Associations: European Society of Endocrinology, The
Gerontological Society of America, and The Obesity Society.

Objective: The objective is to formulate clinical practice guidelines for the treatment of diabetes in
older adults.

Conclusions: Diabetes, particularly type 2, is becoming more prevalent in the general population,
especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in
these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging
effects interact with diabetes to accelerate the progression of many common diabetes compli-
cations. Each section in this guideline covers all aspects of the etiology and available evidence,
primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is
to give guidance to practicing health care providers that will benefit patients with diabetes (both
type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse
effects. (J Clin Endocrinol Metab 104: 1520–1574, 2019)

ISSN Print 0021-972X ISSN Online 1945-7197
Printed in USA
Copyright © 2019 Endocrine Society
Received 25 January 2019. Accepted 25 January 2019.
First Published Online 23 March 2019

Abbreviations: ACE, angiotensin-converting enzyme; ACCORD, Action to Control Car-
diovascular Risk in Diabetes; ADA, American Diabetes Association; ADL, activity of daily
living; ARB, angiotensin receptor

EBP Project – Finding the Evidence

Assignment Instructions

In this assignment, students will be asked to create the initial steps of an evidence based practice project using your topic and the article you found in Finding a Quantitative Nursing Research Article II (so long as it was approved).  You will also need your PICO(T) question that was approved in the Topic and PICO(T) Question assignment. The student will locate several additional resources to answer their PICO question, and write this information into a paper using APA style. Please click on the link below for more information, and watch your due dates and times carefully. For additional help, use the Module 4 discussion board.


Finding the Evidence Paper Instructions-1.docx


Be very careful not to plagiarize in this assignment. Remember, if you use a source and do not cite it, that is plagiarism. If you have a direct quote from any source and it is not clearly indicated as a quote in your paper, then even if you cite it that is plagiarism. IF SEVEN OR MORE WORDS ARE THE SAME AS ANY SOURCE THAT IS A QUOTE AND MUST BE MARKED AS SUCH. If you only change one or two words from the source but keep the order of the ideas the same as in the original, that is plagiarism. Go back to the plagiarism tutorial or ask a librarian if you have any questions. Any instances of plagiarism detected will result in your failing the course and being referred to the Office of Community Standards.

Submit your EBP Project – Finding the Evidence assignment and your nursing quantitative research article to the link above. 


Effect of Self-efficacy and Depression on Quality of Life in Outpatients with CHF

Ashmita Singh

College of Nursing and Health Innovation, The University of Texas Arlington

NURS-3321: Nursing Research

Maxine Adegbola, PhD, CNE, RN, ANEF

October 2, 2021

Effect of Self-efficacy and Depression on Quality of Life in Outpatients with CHF

Heart disease is one of the leading causes of death among people with different racial and ethnic groups all over the world. Heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in our body. Although it is a very serious condition, it doesn’t mean that the heart has stopped beating but it causes people to have difficult time performing their daily activities. About 6.2 million adults in United States have heart failure and 659,000 people die from the heart disease each year which is 1 in every 4 deaths (CDC, 2020). According to CDC guidelines, the total cost of health disease was estimated $363 billion from 2016 to 2017 which includes the cost of health care services, medication and missed days of work from an individual. Likewise, heart failure was mentioned on 379,800 death certificates in 2018 (CDC, 2020). Living with Chronic Heart Failure can be very challenging as many of them report poor quality of life and emotional distress. The PICO question based on the topic of heart failure is, in outpatient (25-50 years old) with chronic heart failure (P), how does self-efficacy and depression (I) influence quality of life (O) compared to having family support (C) over one year(T)?

In research study, participants were recruited through outpatient cardiology clinics at a tertiary hospital in Singapore. Based on the literature review, the study selected six factors (physical and emotional dimensions, depression, self-efficacy, social demographics, length of diagnosis and social support) to identify the predictive factors of health-related quality of life of outpatient with CHF by using multiple linear regression analysis. Among these factors, only depression measured by SF-CDS (ß= 0.637, p<0.001, 95%CI: 2.04-3.01) and self-efficacy assessed by CSS (ß=-0.220, p<0.001,95%CI: -10.70 to -3.23) were significant predictive factors of health-related quality of life for outpatients with CHF accounting for nearly 70% of the variance (Loo et al., 2016). Being able to perform daily living activities increases the sense of living with the illness in the patient. Higher level of self-efficacy like confidence in managing the symptoms and self-care among the participants have reported improved quality of life. Similarly, the patients who don’t have adequate resources to deal with the challenges associated with CHF should also be considered. CHF result in limiting mental health along with the