Poor Glycemic Control in ICU Patient

Poor Glycemic Control in ICU Patient

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Institution Affiliation

Table of Contents

TOC o “1-3” h z u HYPERLINK l “_Toc378244554″Task 1: Prospectus Task4

HYPERLINK l “_Toc378244555″Part A: Introduction4

HYPERLINK l “_Toc378244556″Part B: Role and bias of researcher PAGEREF _Toc378244556 h 5

HYPERLINK l “_Toc378244557″Part C: Sampling Techniques Applied PAGEREF _Toc378244557 h 6

HYPERLINK l “_Toc378244558″Part D: Hypothesis Statement PAGEREF _Toc378244558 h 6

HYPERLINK l “_Toc378244559″Part E: Generalized idea of the research from researcher’s perspective PAGEREF _Toc378244559 h 7

HYPERLINK l “_Toc378244560″Part F: Aims and objectives of the study8

HYPERLINK l “_Toc378244561″Task 2: IRB Task11HYPERLINK l “_Toc378244561”

Q1. Research methods utilized in the study 11

Q2. Research procedures utilized in the study 12

Q3. Data collection tools 11

Q4. Research methods utilized in the study 12

Q5. Vulnerable or the protected population participants 13

Q6. Magnitude of risk exposed to participants below the age of 18 14

Q7. Steps taken to minimize risk to the participants 14

Q8. Confidentiality of the participants and the research data 14

Q9. Procedure for gaining the informed consent of the participants 15

Q10. Attach an official letter for conducting the research 15

HYPERLINK l “_Toc378244562″Task 3: Literature review16

HYPERLINK l “_Toc378244563″Part A: Glycemic in the Early Days16

HYPERLINK l “_Toc378244564″Part B: Earlier studies on Glycemic Control16

HYPERLINK l “_Toc378244565″Part C: Description of the problem18

HYPERLINK l “_Toc378244566″Task 4: Methodology19

HYPERLINK l “_Toc378244567″Part A: Tool development19

HYPERLINK l “_Toc378244568″Part b: Tool description20

HYPERLINK l “_Toc378244569″Task 5: Data collection Methods20

HYPERLINK l “_Toc378244570″Part A: Method of Collecting Data20

HYPERLINK l “_Toc378244571″Part B: The survey questionnaire20

HYPERLINK l “_Toc378244572″Task 6: Data Administration21

HYPERLINK l “_Toc378244573″Part A: Appropriateness of the research methodology2 PAGEREF _Toc378244573 h 1

HYPERLINK l “_Toc378244574″Part B: Variables of the study22

HYPERLINK l “_Toc378244575″Part C: Data Management22

HYPERLINK l “_Toc378244576″Part D: Data interpretation and the merits of the research22

HYPERLINK l “_Toc378244577″Task 7: Presentation of the results23

HYPERLINK l “_Toc378244578″Part A: Ethical considerations23

HYPERLINK l “_Toc378244579″Part B: Results24

HYPERLINK l “_Toc378244580″Part C: Dissemination of the results24

HYPERLINK l “_Toc378244581″Part D: Limitations of the study24

HYPERLINK l “_Toc378244582″Part E: Recommendations PAGEREF _Toc378244582 h 25

HYPERLINK l “_Toc378244583″References PAGEREF _Toc378244583 h 26

TASK 1: PROSPECTUS TASKGood glycemic control is the sole recommended remedy for tragic outcomes in ICU patients against suffering from stroke, cardiac complications, and infarctions. Nurses attending to patients suffering from diabetes mellitus should hardly look in to the possible ways of worsening patient’s life. They should rather salvage them from diabetic conditions within the ICU sector. This paper entails various tasks that focus on nursing leadership in terms of the way nurses can help patients suffering from diabetes mellitus. Nurses in the medical field have to consider the possible ways of reducing the complications, which come up with treatment of type 2 diabetics in the ICU, according to this research. The paper also considers the possible constraints of the necessary nursing such as time, funds, and complexity among others. The ICU nurse are required to consider the situation establish a good way to improve the medical care quality and the management of the patients’ blood glucose. This research considers what ICU nurses can do to diabetes mellitus patients within their first 48 hours of their admission.

Part A: Introduction

A1: Description of the Problem

Usually, patients recovering from cardiac surgeries have a high probability of contacting infections given that their blood sugar levels remain high (Zerr, 1997). This view is based on various findings and complications that have made the ‘Poor glycemic control’ a topic worth research. Chronic and severe disorders such as stroke, obstructive pulmonary disease, congestive heart failure and kidney failure among others can be associated with persons suffering from Diabetes mellitus. The American Diabetes Association estimates that up to 7.8% of the the US population suffer from Diabetes (Xu, 2010). Again, the infection ranks the seventh of all killer diseases and illnesses (U.S. Department of Health and Human Services CfDCaP, 2011). High levels of blood sugar lead to traumatic effect on a person’s immune system, hemodynamic system, and vascular system. Besides, patients with high levels of blood sugar are vulnerable to further infection (Golden, 1999).

A2: Participants and target audiences of the research

The questionnaire was meant to target the nursing staff, which is specialized in the Intensive Care Unit services (ICU). These ICU nurses include only the nurses with at least 2 years of working experience. New nurses and fresh university graduate are excluded from the questionnaire exercise during the respondents’ selection process. The quantitative research method used survey as the best technique to cater for the needs of this kind of research. The selected nursing staff had to be experienced in serving over 100 patients in the Intensive Care Unit (Capes, 2000). The hospital’s authority permitted 64 participants to take part in to the study. These participants received the questionnaire along with the instructions explaining the criteria for filling the survey reports.

A3: Rationale for the Study Approach

The research used primary data that collected from the selected team of respondents. The respondents and participants provided reliable data viable for the research methodology. In this case, the primary data involved firsthand data obtained from different persons with hardly any cases of repetition. The data sources were survey questionnaires that were filled by the respondents. The major in data collection was based on the nature of primary data collection method, which is tiring and time-consuming. The method was however found to offer a more relevant and accurate data than a case of using secondary sources.

The survey questionnaires comprised of close-ended questions, which contributed to high data accuracy. The quantitative research employed scientific technique to study the events and to handle complications and problems concerning the study. The use of scientific study was because scientific techniques enhance accuracy in a research (O’Cathain, Murphy & Nicholl, 2007). Conversely, quantitative research normally aims at developing the aims and findings into statistical and thematic analysis; additionally the method is most preferred in collecting quantitative data for scientific research (Kim & Weaver, 2002). Furthermore, survey methods are favorite and most satisfactory for conducting research methodology (Flanagin & Metzger, 2001).

Quantitative methods are researchers’ most preferred data collection methods and are mainly initiated through surveys from a sample of population (Burns & Grove, 2007). Longitudinal research involves surveys within a specific population of people over a long period of time (Onwuegbuzie & Turner, 2007). The method involves the gathering of data over a long period at established intervals, like after some months or years.

A4: Description of the research Design and Approach

This research relies on the research study and analysis of a quantitative study. This kind of approach specializes in observing investigating information to ascertain the objectives of the research. This kind of study also observes to justify the proposed hypothesis upon which the research based on. The research methodology of quantitative study and its research plan concentrates on providing a systematic analysis of sets of data that can be quantified (Creswell, 2009).

Part B

B1: Role and Bias of ResearcherA researcher has a sole responsibility of fishing for the data and information needed for the research from the respective participants and interprets the gathered data. Quantitative research therefore subsides arbitrarily to the biasness of the researcher although the information and results for this research are stated and interpreted without swaying a bit of it.

The researcher discourages relationships with the participants. This measure checks on the effects of emotions towards the tone of research methodology (Lincoln & Reason, 1996). Additionally, the part of discussion seems to be very prone to kind of tone discussed above. Research claims that a picture of confusion or coherence comes up when discussing the findings of a research (Richardson, 2000). Researchers’ mind loads with dynamicity, lifelessness, false, or truth and ends up documenting personalized statements. The researcher aims at making all attempts possible to document the exact data and information gathered from during the interviews.

The researcher considers all the ethical contemplation and shall seek for the informed consent from the relevant authority, including the officials from the University, hospitals and the dissertation authority. The researcher is also obligated to contact the nursing staff and the participants. The researcher handles the accessed patient data with ultimate confidentiality, but he or she modifies or customizes the filled questionnaire for any other respondent.

B2: Problem Outline

The scope as well as the significant of the problem is the given time frame for looking into the situation. The problem involves the best way possible of managing time. The first 48 hours of ICU admission of the diabetes mellitus patients requires that the ICU nurses establish a way to control the patient’s blood glucose and manage their health (Zerr et al., 1997). Again, to control the cost is problematic especially given that requirements like insulin and nursing care are expensive. Besides, there is inadequate funding for such requirements. Generally, the cost is immense and the time frame is relatively too short, which require strict consideration.

B3. Possible Causes of Problem

The problem in this case arises due to the limited time and funds for the project. The material cost is relatively high. Besides, the expenditure could exceed the project budget because the cost of materials to be used is based on estimates. The process could also be erroneous especially in the case of admitting diagnoses by the ICU nurses and admission of diabetes 2 patients. The 48-hour policy in the management of blood sugar could as well be faced with time constraint. The possible outcomes include the inability to control the patients suffering from stroke, cardiac complications, and infarctions due to these factors.

B4. Proposed Solution 

The problems in this case have possible solutions. The best solutions are achieved with good management of the entire process. First, a strict and meaningful budget has to be drawn in order to reflect the exact cost for the project. The time frame should be practical and relatively applicable. With regard to the possibility of errors, the necessary approaches should be taken such as handling all tasks carefully and considering the outcome of every action. Good glycemic control should be used to control the patients suffering from stroke, cardiac complications, and infarctions due to these factors. Typical examples include management protocol in ICU hyperglycemia, treatment plan for the first 48 hours, and the use of standardized insulin drip or individualized plan of care. Again, improving the 48 hours of glucose control by staffing and initiating high RN education level knowledge would see the problem (Zerr et al., 1997). The blood sugar coverage period would be highly utilized thereby reducing the time taken to decide on covering the blood sugar management.

Part C

C1: Sampling Techniques AppliedThis research employs Survey Questionnaire to collect data from the respondents and participants. The participants, who are nurses by default, are selected based on expertise and deployment in the Intensive Care Unit. The questionnaire contains a complete set of instructions explaining the conducting process, filled then submitted to the Dissertation authority. The researcher aims to visit a single provincial hospital to reach the participating nurses of the same hospital. The researcher is required to conduct the participating nurses with the permission from the hospital head Authority. The researcher aims to do this on every participating nurse in order to verify his or her willingness and availability for the survey.

C2: Research Question

The main research questions to be addressed by the questionnaire are:

How does poor quality glycemic care causes mortality among diabetic mellitus in-hospital patients admitted in the ICU?

What results to the poor quality glycemic care in ICU?

How does poor quality glycemic control for these patients results to other acute infections?

How can the problems be controlled or eliminated?

The criteria to be used are as follows:

Inclusion Criteria: Only the registered nurses who work in the Intensive Care Unit shall take part in the research.

Exclusion criteria: The nurses who specialize to work and serve in the Agency nursing section and the pediatric Care department shall not take part in the research.

Part D

D1. Data 

The research shall use primary data. Primary data is data obtained directly from respondents based on their views. The data in this case is collected using a survey technique with questionnaires being the method of obtaining information from the respondents.

D2. Data Analysis Techniques 

The data analysis technique to be used involves quantitative methods. Questionnaires are very good in obtaining data in a quantitative research. Computer statistical software such as SPSS is to be used in analyzing the results (Holloway, Wheeler, & Holloway, 2010). The analysis process will establish the quantitative trends in the data such as the mortality trend according to the collected data.

D3: Hypothesis StatementH1: Poor quality glycemic care causes mortality among diabetics in-hospital patients admitted in the Intensive Care Unit.

H2: Poor quality glycemic care does not mortality among diabetics in-hospital patients admitted in the Intensive Care Unit.

Part E: Generalized Idea of the Research from Researcher’s PerspectiveThis research seeks to identify the areas that nurses overlook while attending to diabetics. In the medical field, very little information is required to raise an alarm, thus this research does not seek to obtain the real statistics but rather just the neglected requirements of the services in accordance with the accords of the profession. The treatment of diabetics seems to be taken in a simple way even when the disease happens to be the seventh killer of all the other diseases (Wiener, Wiener & Larson, 2008). The lack of seriousness is by the fact that there are several details left out in the protocols of administering the glycemic control.

Part F: Aims and objectives of the studyThis research seeks to meet the following aims and objectives:

The determination of the need for a good quality glycemic control in diabetes patients admitted in the Intensive Care Unit.

The determination of the quality of glycemic control in patients admitted in the Intensive Care Unit.

The repercussions of a poor glycemic control in patients admitted in the Intensive care Unit.

TASK 2: IRB TASKThe researcher downloaded and completed the University’s Study Approval Template then submitted it to the Task Stream.

Q1. Research methods utilized in the study

The research methods utilized in the study involved a survey conducted among the nurses who attend to the patients of type 2 diabetes in a provincial hospital. Participation of the human participants shall be necessary because the research’s intention is to find out the eventualities in the ICU when attending the type diabetics. The research questions included:

How does poor quality glycemic care causes mortality among diabetics’ in-hospital patients admitted in the Intensive Care Unit?

How does poor quality glycemic control for the in-hospital patients in the Intensive Care Unit results to other acute infections?

Q2. Research procedures utilized

The researcher shall administer a questionnaire if 10 items to the nurses just a few moments after they attend to the type 2 diabetic patients inside the ICU. The questionnaire had open-ended questions to allow for open responses. The data collected shall be analyzed against the nursing recommendations and references of attending to type 2 diabetics in an ICU in order to identify the faults that arise when treating the patients in the ICU.

Q3. Data collection tools used

The research shall employ the use of survey methods. The survey exercise shall contain a questionnaire of 10 items. The exact questionnaire used is as follows:

Do you get adequate time to diagnose a critically ill type 2 diabetic before administering the glycemic control?

How does the diabetes history of the critically ill patient influence the medication process during the glycemic control?

What are the exact differences between the old IV insulin protocols and the new IV Insulin protocols?

Does age and sex of the critically ill patient count in administering glycemic control?

Do you record the nutrition of the patients admitted in the Intensive Care Unit?

What are the strategies for reducing the average length of stay in the Intensive care Unit, instances of Acute Renal Failure, and the period spent in the ventilator?

Does the facility carry out tests to verify if the patients use steroids and other hardcore drugs before their admission to the Integrated Care Unit?

What are the effects of using the steroids and common hardcore drugs like tobacco among the patients?

What are the quickest interventions for lowering the risks of implications related organ failures like blindness, kidney failure, limp amputation, and heart disease?

Do the patient records include the patients’ conditions like anemia, hypoper-fusion, or polycythemia when interpreting the glucose readings of the patients at the Intensive Care Unit?

Q4. Human subject participant population

The research involves the participation of the nursing staff that has attained lots of experience in Intensive Care Unit services. The researcher would carry out the quantitative research methods in the form of survey to cater for the needs of the research of this nature (Holloway, Wheeler, & Holloway, 2010). The selected nursing staff must be experienced in serving over 100 patients in the Intensive Care Unit. The hospital’s authority also permitted up to 64 participants to take part in to the study. Though the nursing staff does not align by gender, there are no forms of disability among the staff. The age varies between 24 and 55.

Q5. Vulnerable or the protected population participants

The inclusion criteria employed only the registered nurses who work in the Intensive Care Unit. Only these participants shall take part in the research. Such a population does not incorporate the vulnerable or protected parsons. This provides a reason why new nurses or new university graduate nurses are excluded. Vulnerable individuals like pregnant women, children, prisoners, residents of a facility such as a nursing home or group home, individuals with mental or emotional disabilities, non-English speakers, individuals at or above the age of 65, traumatized individuals, economically disadvantaged individuals, employees of the researcher, or students of the researcher are not considered in the inclusion criteria. This is because such individuals lack medical experience and information that could be useful for the research (Holloway, Wheeler, & Holloway, 2010). They could also be subjected to possible risks thereby adding more problems to the research process.

Q6. Magnitude of risk exposed to participants below the age of 18.

The research does not allow the participation of persons under the age of 18. If this population were used, the risks would be great than minimal, but with no benefits to the participants. This is because the group involves inexperienced members in medical procedures and members are considered as minors thereby protected by law.

Q7. Steps taken to minimize risk to the participants

To minimize the risk of the participants, ensuring adequate measures would of significant importance. Possible risks to the participants are minimal, but precautious measures would be important to avoid the provision of some personal secretes that could be identified on particular participants. Again, hospital environments are a bit hazardous for non-medical professionals (Wiener, Wiener & Larson, 2008). Adequate training for these kinds of participants is thus highly advocated. Again, providing clear instruction on the participation process would greatly minimize mistakes, risks, and possible errors.

Q8. Confidentiality of the participants and the research data

The identities of the respondents get security, and shall not be included in the records of data collected. The gathered data undergoes compiling then stored in a secure folder, which will get protection using a password. A copy of the data is meant to be stored in a hidden folder then written in to a compact disk. The compact disc remains in a lockable safe that belongs to the researcher. All these protocols helped in securing the confidentiality of the data collected during the research period.

Q9. Procedure for gaining the informed consent of the participants

I, the researcher, agree to the demands and terms of conducting a study on the poor glycemic control on the type 2 diabetics admitted in the ICU of the provincial hospitals. The research shall be conducted within a period of two weeks at the provincial hospital. Any person taking part in the research process should take his/her tasks as voluntary and has the right to terminate the tasks at any given time without being penalized. It is also good to note that the research would benefit both the institution and the nurses taking part in the research especially after getting feasible solutions to the study questions. Conversely, there are possible risks such as medical accidents and errors that could lead to significant problems. I shall ensure all the confidentiality measures as stated in Q8. Conflict of interest is also expected, but this shall be resolved as much as possible. Kindly, be informed that the participants shall be at least 18 year of age, which brings about the need for parental consent. All these conditions/issues shall be considered strictly.

Q10. Attach an official letter for conducting the research.

{The Managing Director,

Institution Address}

{Team leader

Student Address}

Dear Sir/madam,

RE: Seeking Permission to Conduct Research in your Institution

I am writing this letter to kindly seek you consent about conducting a study within your health institution. The study will be of significant advantage to both health professionals and patients within and beyond the institution. It would also be a privilege to allow adequate time for the activity. During the study, none of the institutional property will be altered. Participants from the institutions will rather benefit than losing during their research.

Your approval is highly appreciated.

Yours Sincerely,

Research team

TASK 3: LITERATURE REVIEWPart A: Glycemic in the Early DaysGlycemic control began early in the 21 century whereby the medics used the insulin sliding scales on both diabetics and non-diabetics. However, clinical data ascertains that poor glycemic control results to the poor outcomes in in-hospital patients (Zerr, 1997). Conversely, despite the use of intensive insulin therapy in keeping the blood sugar under control, the statistics on mortality and morbidity in both medical and surgical Intensive Care Units reveals that type 2 diabetics are still at risk, especially those in the ICU. The trend prompts further research in to the possible contributions and remedies for the complications that arise when attending to the type 2 diabetics in the ICU. The research is vital for students pursuing nursing because at one time. It is important to place the vulnerable lives of the type 2 diabetics on their care.

Part B: Earlier studies on Glycemic ControlStudies have found that there was a reduction of deaths in the hospitals after medics placed the admitted diabetics under medical ventilation in the surgical Intensive Care Unit (Berghe et al., 2001). The underlying message in his findings was the improvement of glycemic control for the critically ill diabetics. Wiener et al. (2008), in their issue called JAMA, categorically state that tight glycemic control does reduce mortality among the in-hospital by any significant margin citing that the clinicians may find a surprise. They drew the conclusion after undertaking several meta-analyses on tight glycemic control cases.

Wiener et al. (2008) sought after identifying the researches concerning diabetics admitted in the Intensive Care Unit. They analyzed 29 researches and found out that, studies had reported up to 1869 deaths among 8432 patients. Among those treated with tight glucose control, there was 0.95 relative risk of death whereby 95% was the interval of confidence (between 0.83 – 1.03). However analysis based on the type of Intensive Care Unit (Medical, surgical or medical-surgical ICUs) did not demonstrate any sort of trend in mortality. The study eradicated chances of biasness by employing a trial design (Attrition, blinding, allocation concealment and randomization) using the Jadad Scale (Jadad, 1996).

According to Shulman et al. (2007), it is difficult to maintain the blood sugar of critically ill patient between the range 4.4 – 6.1 mmol/L (80 mg/dl to 110mg/dL). Most clinical studies report that up to 80% of the blood sugar falls outside this range (Chase et al., 2008). As a result, the nurses have to very cautious in taking readings of blood sugar level, especially among the patients admitted in the Intensive Care Unit.

Bergha et al. (2006) raises several unanswered questions. The researchers found out that even bedside testing of blood glucose in the critically ill diabetics might not give an accurate data. Further still, the medical community cannot ascertain the magnitude of the effects of such error readings during the in-clinical practice and trials.

Part C: Description of the ProblemGlycemic control implies to maintaining a typical level of glucose (blood sugar) in a patient suffering from diabetes mellitus. The long-term implications of diabetes mellitus result from a chronic elevated level of blood sugar, especially the complications involving micro-vascular complications. Most of the complications associated with diabetes can be brought to control by checking the adequate level of blood sugar, thus appropriate diabetes care. However, some of the problems have been associated with continued autoimmune disease, which is because of type 1 diabetes (Adams, 2008). Studies consider genetic factors to provoke the condition to make the pancreas to lose it ability to produce insulin (Tarnow, et al., 2008).

A perfect glycolic control keeps the levels of glucose between 3.9 to 7.2 mill-moles per liter (70 to 130 milligrams per deciliter). However, this is not possible to differentiate from a person not suffering from diabetes mellitus. Hence, a good Glycemic control checks the average blood level, which is somewhat higher in a diabetic than in a normal person. Conversely, interventions to control the blood level in a type 2 diabetic are equally harmful to their quality of life due to complications associated with the diabetes (Huang, et al., 2007). “Patient’s Perceptions of Quality of Life with Diabetes-Related Complications and Treatments”. Diabetes Care 30 (10): 2478–83.). Thus, they need a special kind of care.

Poor Glycemic control implies that there are persistent elevated glycosylated hemoglobin and blood sugar levels, which lies between 11-28 mmol/L (200 – 500 mg/dl). These levels tend to be higher during the initial months and years before the complications become severe (Kim, et al., 2005). Hence, poor Glycemic controls in the Intensive Care Unit (ICU) implies that the patients are in critical conditions whereby their glucose levels would even be higher than an ordinary diabetic. A patient in the Intensive Care Unit for diabetic care requires an urgent intervention to restore the metabolism of carbohydrate close to the normal state. This is usually achieved through a therapy referred to as insulin replacement. However, in cases where the diabetes attack is not severe, and that there in a resistance for insulin, the patients are instructed to take up exercises and modified diets.

The type 2 Diabetes mellitus is associated with deficient production of insulin from the cells of pancreas. The condition is the most common of all the diabetic cases. It also links to medical complications such as obesity, family history, physical inactivity, old age and genetic factors (Davachi et al., 2005). Regions most at risk of contracting Type 2 diabetes include the Afro-Americans, South Asians and Hispanics (Hossain, 2007).

There is an urgent need to check the levels of blood sugar in timely and continuous manner. This realization is through the intensive administration of insulin or through administration of hypoglycemic drugs in response to the level of the blood sugar. Therefore, the monitoring of the blood sugar should be in a timely and continuous manner. The patients admitted in the Intensive care unit are very predisposed as the hypoglycemic after the therapy. In poor instance glycemic control, the patient may end up with irreversible complications such as death, coma, neuropathy, ketoacidosi