Please reply to each of these 3 individual discussions using the same APA format with 3 references each no older than 5 years old. Be reflective on the answers and give insight into the response but do not ask any questions to the author. The post is intended as a reply and to expand on the topic that was written about.  Please write at least 3-4 small paragraphs for each of the replies.

#1

     In January of this year, I  transferred from the Intensive Care Unit (ICU) to the Post Acute Care Unit (PACU). Since the transfer, managing pain after surgery and educating patients on managing pain after discharge has been a priority. In the preoperative unit, prophylactic measures to minimize pain and the use of opioids are carried out before the operation; Despite increased awareness and clinical advances in pain management, postoperative pain, as measured by this survey of postoperative patients, has barely improved (Gan et al., 2014, p. 149). I’m interested in seeing the research results of your PICOT questions. In searching for your essential PICOT answers, we need to use databases to find the sources that contain the best evidence (Melnyk & Fineout-Overholt, 2018). I agree that using the boolean operators reduces and filters out irrelevant data. Another strategy I would recommend is using the Medline database, where you can sort research done by healthcare professionals. In addition, truncating root words by adding an asterisk to the end of the root word (example: surgical*) directs the database to search for the phrase with any ending, thereby expanding the search for additional articles (Walden University Library, n J.)

References

Gan, T. J., Habib, A. S., Miller, T. E., White, W., & Apfelbaum, J. L. (2014). Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Current      medical research and opinion, 30(1), 149–160. https://doi.org/10.1185/03007995.2013.860019

Library of Congress. (n.d.). Search/browse help  Boolean operators and nesting. Retrieved September 21, 2022, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help…

Melnyk, B.M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare. A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved September 21, 2022, from 

# 2 

Sandslia Lima : Clinical Issue

In terms of quality improvement, it is a framework that systematically improves care. By standardizing processes and structures, quality improvement can reduce variation, increase predictability, and reduce errors for patients, healthcare systems, and organizations. The improvement of the quality and efficiency of the healthcare environment can have many benefits, including improving the quality and efficiency of care delivery, improving patient outcomes, and making the healthcare system more sustainable. By benchmarking quality measures, healthcare providers are able to improve their performance and improve the quality of care they provide (LoBiondo-Wood et al., 2018). Through benchmarking, it is possible to identify the best practices in health care (Naqib et al., 2018). Analyzing variation in quality measures can help identify research opportunities that will contribute to advancing professional knowledge (Grealish et al., 2018). A quality measure benchmark can also be used to track the progress of quality improvement. 

PICOT Question

Can a quality improvement in nursing workload compared to usual shifts result in a substantial improvement in patient care and safety in the next six months for hospitalized patients?

P hospitalized patients

I quality improvement in regard to nursing workload

C usual shift hours

O patient care and safety

T six months

Searching Databases

Searching for misspellings, reducing the number of concepts researcher searches, using a broader search term, or using a thesaurus term are all ways to increase the rigor and effectiveness of a database search. Searching Google Scholar, PubMed, CINHL, EMBASE, Cochrane Library, and UpToDate databases resulted in 73 results based on original research. Based on the Boolean operators, 43 relevant articles are retrieved.

To ensure that the database search is as rigorous and as effective as possible, it is important to examine PICO(T) questions for missing or incorrect field qualifiers. The term should also be removed if it is unlikely to be used by authors, replaced if it is too broad or too narrow, and have synonyms or alternatives added if necessary. Strategies that are effective include relevant concepts and terms, topic headings or keywords, and keyword alternatives.

References

Grealish, L., van de Mortel, T., Brown, C., Frommolt, V., Grafton, E., Havell, M., Needham, J., Shaw, J., Henderson, A., & Armit, L. (2018). Redesigning clinical education for nursing students and newly qualified nurses: A quality improvement study. Nurse Education in Practice, 33, 84–89.

LoBiondo-Wood, G., Haber, J., & Titler, M. G. (2018). Evidence-based practice for nursing and healthcare quality improvement. Elsevier Health Sciences.

Naqib, D., Purvin, M., Prasad, R., Hanna, I. M., Dimitri, S., Llufrio, A., & Hanna, M. N. (2018). Quality improvement initiative to improve postoperative pain with a clinical pathway and nursing education program. Pain Management Nursing, 19(5), 447–

#3 

 Meighan Austin:  The clinical issue of interest to me is giving insulin before meals-based on glycemic index instead of meal contents. Often it is assumed that carbohydrates and sugar are the only food items that affect blood glucose levels, but research is proving that this is not always true. The practice at my current facility is to treat the glycemic index prior to the meal which led me to my PICOT question. In adult patients with diabetes, how effective is insulin administration based on a blood glucose sliding scale compared to meal content in controlling a patient’s blood glucose levels? According to Krzymien & Ladyzynski (2019), “Inappropriate therapeutic decisions regarding insulin dosing may lead to significant hyperglycemia or hypoglycemia” (p. 607). This article was one of the original articles that I used because it offered information that assisted in answering my PICOT question. At the beginning of my research there were 685 articles that were displayed. Once I changed the publication date within the last five years and marked peer reviewed articles it took me down to 91 articles. I added insulin to my top box and glycemic control or index to my second box and meal to my third box using the Boolan method which narrowed my search down to my specific topic. The next article by Diabetes Teaching Center at the University of California (2022) reported, “The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio” (para. 3). My final article offers information on type 1 diabetics. Patients find it less stressful and easier to administer insulin based on a set dose verse giving an insulin dose that is based upon the amount of carbohydrates in the meal (Diaz & Felner, 2021). To find these articles, I began reading information in several of the articles found on my first search. As I read, I noted that the articles were using different terminology which would allow me to adjust the wording in my search.

References

Diabetes Teaching Center at the University of California. (2022). Calculating insulin dose. Diabetes education online. https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/calculating-insulin-dose/

Diaz, J. V. R., & Felner, E. (2021). Mealtime insulin in new-onset type 1 diabetes mellitus: Fixed dose vs. insulin: Carbohydrate ratio. Diabetes, 70(1), 937. https://doi.org/10.2337/db21-937-P

Krzymien, J. & Ladyzynski, P. (2019). Insulin in type 1 and type 2 diabetes—Should the dose of insulin before a meal be based on glycemia or meal content. Nutrients 2019, 11(3), 607. https://doi.org/10.3390/nu11030607