The Practical guidelines on the management - MyAssignmenthelp.com

Question: 1. Identify and briefly describe a specific area of your practice in which you have a particular interest or where there is uncertainty differing opinions about the provision of care. 2. Develop a specific searchable question using the PICO format or similar based on the area of practice described in task 1 3. Conduct a search for the highest levels of evidence that you can find to answer your question. The 3 highest pieces of research evidence found should be selected. Succinctly describe your search process and provide justification of the resources that you chose to search and the evidence selected. Include the abstract/s or summary/summaries of the high level evidence to your final assignment. 4. Compare and contrast the answer to your question found in the high level evidence to the current practice in this area. Your discussion should highlight the level of evidence or strength of the recommendations and clearly discuss any differences that exist between the evidence based recommendations and your existing practices, and whether the practice adheres to the current research evidence. If you are unable to find high level evidence and/or clear evidence based answers to your question then this should be discussed, including reasons why you think this evidence does not exist or is poorer quality evidence. 5. Discuss the barriers to using/implementing EBP that may exist in your specific clinical setting and how these barriers may be overcome, and/or strategies that exist to promote EBP within your practice setting. Answer: Introduction The occurrence of foot ulcers is common in any individual and the foot ulcers are referred to a small region of broken surficial skin especially beneath the feet or lower leg. However, when the level of sugar in blood rises and due to the damage in the nerves, skin loses its capability to heal itself. The worst part is that even a small injury to the skin can initiate the formation of foot ulcers. Foot ulcers are closely linked with the diabetic nerve pain and diabetic neuropathy and this is the reason, many people with diabetes are frequently affected by foot ulcers. Studies have revealed that 10 percent of people with type 2 diabetes have a tendency to develop foot ulcers. People suffering from both the type 1 and type 2 diabetes are both affected by foot ulcers. Foot ulcers are influenced by diabetes and the people suffering from diabetes must understand the fact that, if foot ulcers are left untreated then there are severe consequences (Bakker, Apelqvist and Schaper 2012). This s tudy focusses on the nursing intervention required for the reduction of the diabetes in patients and also to reduce foot ulcers in patients with diabetes mellitus. Answer 1 In diabetic patients, the awareness regarding injury and healing is very scarce. Which makes it an effective field to carry out nursing intervention for effective dealing the issues which arise in such patients. Regarding the identification of a specific area which I have a particular interest is for the reduction of diabetic foot ulcers in patients suffering from type 2 diabetes mellitus through nursing intervention. The occurrence of the foot ulcers is approximately 1 to 2 percent and the prevalence is slightly high in older adult people. Venous ulcers are considered to be the most common form of foot ulcers which accounts around 80 percent of all the ulcers that occur in the lower extremities (O'Meara et al. 2012). The incidence of the venous ulcers is majorly seen within people aged between 60 to 80 years. Also studies have shown that, patients with the chronic venous insufficiency have a tendency to develop venous ulceration around 40 years of age. Whereas, it was also found tha t venous ulcers have the highest occurrence and as well as has the highest chances of recurrence. Majority of the ulcers that occur in adults are a direct result of the sense of sensation. Around 15 percent of persons having diabetes have an increased chance of having foot ulcers during their lifetime. At the same time, nursing interventions on foot ulcers have differing opinions regarding which procedure is proper. Nursing intervention like education from a specialist nurse, anti-fungal management of the injured area, decompression, dressing and debridement (Dorresteijn and Valk 2012). There are other sorts of treatments which include drugs that control the glucose level in blood, drugs that work to nourish the nerves, improvement in the supply of blood to the lower extremities of the body through the proper administration of drug. Answer 2 Foot ulcers are common in diabetic patients exhibiting the type 2 diabetes mellitus. Thus, a nursing intervention is required for effective treatment of the diabetic foot ulcers. There is an effective therapy called the Hyperbaric Oxygen Therapy which can effectively reduce and treat the diabetic foot ulcers. A PICO analysis of this therapy can consolidate its validity. Population- Type 2 diabetes mellitus adult patient that are experiencing the diabetic foot ulcers. Intervention- Hyperbaric Oxygen Therapy for the individuals suffering from the type 2 diabetes mellitus. Comparison- Wound dressing management versus Hyperbaric Oxygen Therapy in patients that are having diabetic foot ulcers. Outcome- Reduction of the diabetic foot ulcers within a period of 12 months. PICO QUESTION: Does the Hyperbaric Oxygen Therapy is able to reduce the occurrence of Diabetic foot ulcers in the individuals suffering from the type 2 diabetes mellitus within 12 months, compared to the wound dressing management therapy? Answer 3 The search for the highest levels of evidence related to the hyperbaric oxygen therapy can be found in the research journals and articles that emphasize on the reduction and treatment of the diabetic foot ulcer. The search process includes searching in various databases like ResearchGate, PubMed, NCBI, Elsevier, ProQuest. Whereas, the searching keyword used for the search is Prevention and Treatment of Leg and Foot Ulcers in Diabetes Mellitus, Hyperbaric oxygen therapy to cure the diabetic foot ulcer. The papers were shortlisted based on the exclusion and inclusion criteria. The inclusion criteria were based on the treatment of diabetic foot ulcer. Whereas, the exclusion criteria were based on the hyperbaric oxygen therapy for the cure of other types of ulcers. The resources selected emphasize curing of the diabetic foot ulcers, efficiency of the hyperbaric oxygen therapy for the cure of diabetic foot ulcers Abstract 1- the objective of the essay is the efficiency and the safety of the hyperbaric oxygenation therapy for the cure of diabetic foot ulcers and includes the meta-analysis and systematic review of the literature. The methods employed are searching the Embase, Medline and Cochrane library database for the relevant articles published. The controlled trials based on the management and cure of diabetic foot ulcers through the hyperbaric foot ulcers. Also a meta-analysis was carried out for the safety and efficiency of the hyperbaric oxygen therapy. The results of the study include thirteen trials (624 patients), involves the 7 prospective randomized trials. the analysis revealed that the hyperbaric oxygen therapy treatment procedure yielded significant reduction in risk associated with the amputations. The adverse events of amputations were rare and not frequent. From the study it can be concluded that, treatment with the hyperbaric oxygen therapy improves the healing rate and as w ell as reduces the rate of amputations in patients affected by the diabetic foot ulcers (Liu et al. 2013). Abstract 2- the study speaks that 10 to 15 percent of the individuals with the diabetes mellitus have a tendency to develop the foot ulcers. These percentage of the individuals also experience of amputations which is 85 percent. The hyperbaric oxygen therapy along with the increased incidence of oxygen can encourage the healing process and it reduces the risk associated with amputation. The main objective of the study is to evaluate the efficiency of the hyperbaric oxygen therapy for the treatment of diabetic ulcers in the lower limbs. The methods employ a systematic search using a keyword lower limb diabetic ulcer, HBOT. Databases that were used for the initial searches include Embase, Medline, Biosis, PubMed, CINAHL, Wileys Cochrane Library. The Randomized control trials were included for the observational studies. The pooled estimates of the data were determined as per its appropriateness. the results of the study indicate that of the 654 papers identified, around 157 articles cam e under a full text review. Data from the 12 publications were abstracted among which 6 papers were based on the comparative analysis and 6 were based on the randomized controlled trials. After the pooled data were analyzed then it was found that, hyperbaric oxygen therapy reduced the risk of amputation when compared with the standard form of wound of care by 60 percent. The conclusions stated that, due to the limited randomized control trial evidence, the harms and the benefits of the hyperbaric oxygen therapy. No significant difference was found within the data reflecting the randomized control trail over the usage of the hyperbaric oxygen therapy (O'Reilly et al. 2013). Abstract 3- the background of the study reflects the role of the hyperbaric oxygen therapy to treat the diabetic foot ulcers. This has been analyzed from the medical literature for over a decade. The study has been undertaken by the Undersea and Hyperbaric Medical Society, Grading of Recommendations Assessment Development and Evaluation Working Group (GRADE). The study included a literature review and focused on the assessment of the evidences and generate the correct practices for the care of diabetic foot ulcers. The results indicated that, hyperbaric oxygen therapy is beneficial in both promoting healing and preventing amputation in the patients. However, in comparison to the surgical debridement of the foot ulcers, the hyper oxygen therapy yielded much better results. From the conclusion it can be derived that the policy makers, patients and the clinicians must include hyperbaric oxygen therapy for the effective cure of the diabetic oxygen therapy. The current state of evidence s uggest that this therapy is underutilized (Huang et al. 2015). Answer 4 The cure of the diabetic foot ulcer with the assistance of the hyperbaric oxygen therapy involves cross reference from the high level evidences like the research journals that were previously done. However, with the development of the medical science of the, newer procedures are developed like the management of the diabetic foot ulcer medically, surgical management, percutaneous transluminal angioplasty of the occluded and the stenosed lower extremity arteries (Sinwar 2015). Management of the wound area through the usage of alginate, hydrofiber, transparent film, low-adherence dressing, hydrogel, hydrocolloid debriding agents, foam. Surgical options include skin grafts, tissue cultured skin substitution, surgical wound closure, xenograft (Zelen et al. 2013). The efficiency and potentiality of Hyperbaric Oxygen Therapy can be established from the high level evidences from the research articles and journals. According to the Liu et al. (2013), the primary outcome of the study was based on the haling of the ulcer which is categorized as the epithelization of the wound. The secondary outcomes of the study on the other hand included the minor and major amputations. A study was conducted based on thirteen trials which included a total of 624 patients, which also included 7 randomized trials (meta- analysis) and a search of the relevant articles on database like Embase, Medline and Cochrane database. A total of 89 relevant articles which were also used for the comparison of the hyperbaric oxygen therapy with the conventional therapy for the cure of the diabetic foot ulcer. Healing of the ulcers over the short term and the long term follow up were considered. The short term follow-up was taken as less than 6 months, while the long term follow up included a period of more than one year. The short term follow-up included 10 studies that showed that healing to occur within the short term follow-up. Healing according to evidence based nursing practice was defined as the complete cover of the wound area with the epithelial tissue. The pooled data showed a positive response on the patients who were treated with the hyperbaric oxygen therapy. The short term follow-up revealed that the hyperbaric oxygen therapy effectively reduced the diabetic foot ulcer and improved the rate of healing without any heterogeneity. Whereas long term follow-up included an over the 1-year period included 7 trails of 366 patients which almost included about 58.6 percent of the patients of the whole study process. The results showed that there is a large increase in the healing process of the diabetic foot ulcers in the patients who were administered with the hyperbaric oxygen therapy. The long term follow-up showed more positive response in comparison to the short term follow up. For the Randomized control trial, a total of 300 patients were used for the 4 randomized control trial. This randomized control trial was assessed based on the primary outcome. A large amount of heterogeneity was noticed in the sub analysis and also in the total population. The major and the minor amputations are also considered for the secondary outcome, and after the assessment 11 patients undergoing amputations. Considering the size of the study the number of patients with the amputations were considerably low. The minor amputations showed amputations of the ankle joint. Thus, from this study, the Hyperbaric oxygen therapy demonstrated a better outcome in comparison with the conventional therapy (Liu et al. 2013). The existing practice of the hyperbaric oxygen therapy for the patients having diabetic foot ulcer is in accordance with the current research practice. The current research emphasizes on the positive outcome of patients having the diabetic foot ulcers. The foot ulcers of the patients have shown total recovery over the period of both the 6 months and 1 year. Although, there is only a marginal number of patients who had undergone amputations. However, the complete recovery of the wound region with the growth of epithelial tissue consolidates the validity of the hyperbaric oxygen therapy. Answer 5 When an evidence based practice is implemented, there are certain barriers that acts to inhibit and hinder the nursing practice within a clinical setting. The same way there exists numerous barriers in the implementation of care to the diabetic foot ulcer patients. The barriers involved are: beliefs and attitudes of the doctors and patients as well as the other healthcare professionals; the structure of the healthcare system also pose as a barrier in the care delivery to the diabetic foot ulcer; the other problems include; unavailability of the healthcare in some geographical areas; patient related factors (Houtum 2012). A study conducted on the barriers to the care delivered to the patients of diabetic foot ulcer. The study involved a questionnaire which showed that, whether the patients had experienced any barrier in the foot care. It was found that 52 percent of the patients responded yes, whereas 48 percent of the patients responded no. For the identification of the barriers, a total of 162 respondents were used. Among which, 92 respondents (56.8%) cited that poor communication between the health care providers and the patients. Whereas, 82 respondents (50.6%) reported to be neutral or have no idea. While 72 respondents reported inconveniency for work (Seid and Tsige 2015). In certain geographical areas visit to the healthcare clinics is not feasible due to the distance and thus makes regular visits impossible. Even if the clinics are available, the proper healthcare professionals are not available who can be properly administer the necessary care in a clinical setting. The variations that exist in clinical decision making affect the different layers of care. It has been found that some clinicians might not have the idea to consult another expert from a different field before performing an intervention. For an example, a general surgeon might not consult a vascular surgeon before performing an amputation (Margolis et al. 2013). Medical treatments also depend on the local attitudes, beliefs and conventions which to a great extent influence the outcomes of health. The cultural aspects influence the health care delivery because the specialists that are involved in a diabetic foot team belong from different communities. Effective care delivery to the patients is also affected by the barriers. If patients exhibit neuropathy, then it results into inability to perceive the pain and it renders the patients to unaware of the ulceration or the trauma (Callaghan et al. 2012). Whereas, retinopathy results in to inability of a patient to detect and inspect foot problems. Also, lack of u nderstanding plays a major role in which patients who are aware of the risk associated with the diabetic foot ulcer, might avoid referring to a clinic. This further increases the severity of amputation. Overcoming the barriers, incorporate an effective intervention strategy. The effective intervention includes policies by the government that focusses on the set up of clinics geographically that can effectively work to treat the diabetic foot ulcer patients that stay away from the city limits (Batta, Lejeune and Prasad 2014). Communication has been found to be the major barrier that hinder the care and treatment delivery to the patients. Thus promotion of the effective communication between the patients and the health professionals can to a great extent reduce the time period required for the treatment of the diabetic foot ulcer (Monteiro?Soares et al. 2014). The diabetic team that assist the patients to recover from the diabetic foot ulcer sometimes include team members that belong from the different cultural community. Thus to overcome such barriers, it is necessary to act on building team which will have members from the same cultural background (Rubio et al. 2014). There are also other issues that hinder a patient to recover from a diabetic foot ulcer, like the food habit and uncontrolled glucose concentration in blood (Inzucchi et al. 2012). Effective medication is one of the best strategy that will reduce the concentration of glucose in blood (Kahn et al. 2014). At the same time a strict diet plan can effectively work to prevent the occurrence of diabetic foot ulcer (Ley et al. 2014). Conclusion Thus from the above study it can be concluded that, diabetic foot ulcer is common in patients having type 2 diabetes mellitus. There are several developments in this field for the effective management and cure of the diabetic foot ulcer. The effective cure strategy involves the usage of the hyperbaric oxygen therapy; this therapy has been found to effectively heal the wound with the epithelial tissue. Reference Bakker, K., Apelqvist, J. and Schaper, N.C., 2012. Practical guidelines on the management and prevention of the diabetic foot 2011. 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