Running head: SEARCHING AND CRITIQUING THE EVIDENCE 1 SEARCHING AND CRITIQUING THE EVIDENCE 4 Searching and Critiquing the Evidence Student’s Name Institution Date Searching and Critiquing the Evidence There are various research studies that have been done on the outcome of self-care on Type 2 Diabetes Mellitus patients. In most of the studies, the most prevalent results are that self-care is an effective method of improving the health and lifestyle outcomes of Type 2 Diabetes patients. Krishna and Boren (2008) conducted a systematic review of evidence-based studies done between 1996 and 2007. The study analyzed 18 researches done within the selected time period and found that using phone calls and text messages to assist diabetes patients could improve the self-management outcomes. Shrivastava et al. (2013) analyzed the effectiveness of self-management for the diabetes mellitus patients. The study found that self-care helps to reduce the rate of morbidity and mortality among diabetes patients. In addition, Steinsbekk et al. (2013) conducted a meta-analysis comparing the differences between the outcomes of group based self-management education and routine treatment for Type 2 diabetes patients. The study analyzed 21 studies that included studied on 2833 participants. The results of the meta-analysis showed that group-based self-management education helped to improve the psychosocial, clinical, and lifestyle outcomes among the diabetes patients. Lastly, Tang et al. (2008) examined the impact of social support and quality of life on the self-care behaviors of African American Type 2 diabetes patients. The study followed an observational design with 89 African-American adults, who were aged 40 and above. The study found that social support is vital for self-management to be effective in diabetes treatment. The selected studies have helped to strengthen the merit of my selected theoretical framework. The theory selected for the study was Dorothea Orem’s Self Care Theory. These studies have helped to demonstrate some important evidence-based facts about the effectiveness of self-care for diabetes patients hence helping to prove the credibility of the theory. The scrutiny of these studies has helped to discover the degree of effectiveness of this theory and the best application methods that can make it an effective approach to improving the outcomes of patients with Type 2 Diabetes Mellitus. Levels of Evidence in the Articles The classification of the level of evidence of a given research is important in evidence-based studies because they help to show how accurate, credible, or reliable a research is (Gray, Grove & Sutherland, 2017). The most prevalent evidence in the research articles analyzed is Level II evidence. Level II evidence is one that is obtained from at least one randomized control trial (Moran, Burson & Conrad, 2017). The articles by Krishna and Boren (2008) and Steinsbekk et al. (2013) conducted meta-analyses of various rese ...

1. Running head: SEARCHING AND CRITIQUING THE
EVIDENCE 1
SEARCHING AND CRITIQUING THE EVIDENCE 4
Searching and Critiquing the Evidence
Student’s Name
Institution
Date
Searching and Critiquing the Evidence
There are various research studies that have been done on the
outcome of self-care on Type 2 Diabetes Mellitus patients. In
most of the studies, the most prevalent results are that self-care
is an effective method of improving the health and lifestyle
outcomes of Type 2 Diabetes patients. Krishna and Boren
(2008) conducted a systematic review of evidence-based studies
done between 1996 and 2007. The study analyzed 18 researches
done within the selected time period and found that using phone
calls and text messages to assist diabetes patients could improve
the self-management outcomes. Shrivastava et al. (2013)
analyzed the effectiveness of self-management for the diabetes
mellitus patients. The study found that self-care helps to reduce
the rate of morbidity and mortality among diabetes patients.
In addition, Steinsbekk et al. (2013) conducted a meta-analysis
comparing the differences between the outcomes of group based
self-management education and routine treatment for Type 2
diabetes patients. The study analyzed 21 studies that included
studied on 2833 participants. The results of the meta-analysis
showed that group-based self-management education helped to
improve the psychosocial, clinical, and lifestyle outcomes

2. among the diabetes patients. Lastly, Tang et al. (2008)
examined the impact of social support and quality of life on the
self-care behaviors of African American Type 2 diabetes
patients. The study followed an observational design with 89
African-American adults, who were aged 40 and above. The
study found that social support is vital for self-management to
be effective in diabetes treatment.
The selected studies have helped to strengthen the merit of my
selected theoretical framework. The theory selected for the
study was Dorothea Orem’s Self Care Theory. These studies
have helped to demonstrate some important evidence-based
facts about the effectiveness of self-care for diabetes patients
hence helping to prove the credibility of the theory. The
scrutiny of these studies has helped to discover the degree of
effectiveness of this theory and the best application methods
that can make it an effective approach to improving the
outcomes of patients with Type 2 Diabetes Mellitus.
Levels of Evidence in the Articles
The classification of the level of evidence of a given research is
important in evidence-based studies because they help to show
how accurate, credible, or reliable a research is (Gray, Grove &
Sutherland, 2017). The most prevalent evidence in the research
articles analyzed is Level II evidence. Level II evidence is one
that is obtained from at least one randomized control trial
(Moran, Burson & Conrad, 2017). The articles by Krishna and
Boren (2008) and Steinsbekk et al. (2013) conducted meta-
analyses of various researches but not all of them were
randomized control trials hence the studies do not qualify for
Level I evidence.
The reason why Level II evidence is the most prevalent is
because it has a high degree of accuracy which is important
given the seriousness of the problem being studied. Other levels
of evidence that have been identified in the articles include
Level IV and VI. The article by Tang et al. (2008) can be
classified as Level IV evidence because it includes evidence
from well-designed case controls and cohort studies. On the

3. other hand, Shrivastava et al. (2013) is classified as Level VI
evidence because it is a single qualitative and descriptive study.
The article does not include any form of evidence based
research.
References
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and
Grove’s the practice of nursing research: Appraisal, synthesis,
and generation of evidence (8th ed.). St. Louis, MO:Saunders
Elsevier.
Krishna, S., & Boren, S. A. (2008). Diabetes self-management
care via cell phone: a systematic review. Journal of diabetes
science and technology, 2(3), 509-517.
Moran, K., Burson, R., & Conrad, D. (2017). The doctor of
nursing practice scholarly project: A framework for success
(2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013).
Role of self-care in management of diabetes mellitus. Journal of
Diabetes & Metabolic Disorders, 12(1), 14.
Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim,
A. (2012). Group based diabetes self-management education
compared to routine treatment for people with type 2 diabetes
mellitus. A systematic review with meta-analysis. BMC health
services research, 12(1), 213.
Tang, T. S., Brown, M. B., Funnell, M. M., & Anderson, R. M.
(2008). Social support, quality of life, and self-care behaviors
among African Americans with type 2 diabetes. The Diabetes
Educator, 34(2), 266-276.
Hello,
Below are details of the new assignment.
Thanks.
Hospital acquired pressure ulcers (HAPUs)
Identify the challenges and impediments to implementing a
quality improvement plan. In the analysis consider the

4. individuals affected by the change as well as the cost of
implementing the plans.
Post a description of some of the proposed action steps for
implementing improved practice, and explain where potential
challenges might compromise Prevention of hospital acquired
pressure ulcers (HAPUs). Describe what resources are needed
for your solution, and explain whether or not those resources
are cost-effective.
Then review peer-reviewed literature.
· Synthesize the purpose, methods, and findings from at least
five peer-reviewed, evidence-based practice articles that support
HAPUs.
· Two main components of successful synthesis include
evidence of the student's own ideas and a well-organized
presentation of evidence.
· Include an explanation of the quality management
measurement and data that were presented.
· Include a minimum of at least 5 peer-reviewed evidence-based
practice articles that support your practice problem.
This means that you describe these studies individually, their
findings and limitations as they apply to your subject matter.
You can utilize other references in addition if you like. You
need to cite 5 articles in detail with their methods, barriers and
findings that support HAPUs
Selecting a Theoretical Framework
Article Reviewed and the Theoretical Framework used to
Explore the Practice Problem.
In his article, Evans (2010) explores the effectiveness of
advanced practice nurse (APN)-led follow-up telephone
intervention to glycemic control in patients with type 2 DM (p.
318). To ensure the effectiveness of the intervention, the study
employed the interpretation of daily fasting blood glucose
results. The study used the Dorothea Orem's Self-Care Deficit
Theory of Nursing. The conceptual model theory has three

5. theories expressed in it: the theory of self-care deficit, the
theory of nursing systems, and theory of self-care. However, the
study is based on Orem's Mid-Range Theory of Self-Care. The
theory defines self-care as "a human regulatory function that
people must, with deliberation, perform themselves or have
performed them to maintain life, health, development, and
wellbeing (p.319)". The research revealed that the bi-weekly
telephone contact would help to guide individuals in the
assumption of self-care and improved observance to the
treatment administration.
Appropriateness of the Theoretical Framework
The framework was appropriate for the research because it
provided sound guidelines to address the main purpose of the
research decisively. The theory got selected for the evidence-
based practice protocol (EBPP) since patients with type 2
diabetes mellitus should adhere to treatment guidelines (self-
care) for them to maintain health, development, life, and well-
being. Additionally, Orem's Mid-Range Theory of Self-Care is
important because it is the framework which provides
fundamental elements of caring. It is through periodic follow-
ups that there is increased adoption of self-care among the
patients which in turn ensures that they maintain their life,
health, well-being, and general development (Weld, Padden,
Ramsey, & Garmon Bibb, 2008). The framework is also
necessary for that the nurses are able to get in touch with the
patients. This is an important aspect of the nursing profession
which provides an avenue for the proper administration of cure
among the DM patients.
New Insights Gained
From the Orem's Mid-Range Theory of Self-Care, I could
deduce several insights on the concept of self-care. The
treatment process is a collaborative activity that requires
collaboration between the caregivers and the patients. For
chronic illness and dependent care individuals, self-care plays a
central role in the treatment process. Patients should care for
themselves, but the nursing intention is needed especially when

6. there is an imbalance between self-care and self-care needs. The
intervention can be in different forms. In the case of the article
discussed here, the author recommends one nurse’s visit and bi-
weekly follow-ups meant to ensure the patients adhere to the
treatment process. The theory promotes self-care maintenance
which is key in preserving well-being and maintaining physical
as well as emotional stability. In everyday life, individuals
maintain self-care behaviors (Plummer & Molzahn, 2009).
However, the intervention of nurses is required in the event of
chronic illness.
Applicability of the Theory
This theory can be applied to a practice problem in my clinical
setting; I’m a critical care nurse, and I deal with patients that
are in critical condition, which means that I cannot rely on them
to give me information with regard to their health progress.
However, in the case of Diabetes Mellitus patients, I can rely on
the records made during the course of their treatment. Since the
information that patients give to healthcare providers with
regard to their progress is recorded, I can take a look at the
records to determine the cause of the patient’s current
condition. I would rely on the records of the patient’s self-care
practice to assist in my decision regarding the treatment to give
them.
References
Evans, M. M. (2010). Evidence-based practice protocol to
improve glucose control in individuals with type 2 diabetes
mellitus.MEDSURG Nursing, 19(6), 317–3 22. Retrieved from:
https://search-proquest-com.ezp.waldenulibrary.org
Plummer, M., & Molzahn, A. (2009). Quality of life in
contemporary nursing theory: A concept analysis. Nursing
Science Quarterly, 22(2), 134–140. DOI:
abs/10.1177/0894318409332807
Weld, K., Padden, D., Ramsey, G., & Garmon Bibb, S. C.
(2008). A framework for guiding health literacy research in
populations with universal access to healthcare. Advances in
Nursing Science, 31(4), 308–318. Retrieved from:

7. http://web.b.ebscohost.com.ezp.waldenulibrary.org