Description
Much effort should be devoted to this section as it is a key component of your work. This should be a synthesis of the literature, not a catalog of studies or simply an analysis of the research you discover.
Perform a literature review using a minimum of seven (7) peer-reviewed articles and books, as well as non-research literature such as evidence-based guidelines, toolkits, standardized procedures, etc.
Review of areas in relationship to medicine, nursing, public health, etc.
The review should be critical and synthesize rather than just being a catalog of studies.
Summarize the key findings of the research and its relevancy to your project that point out the scientific status of the phenomenon under question. Such a statement includes:
What we know and how well we know it.
What we do not know.
Describe any gaps in knowledge that you found and the effects this may have on advanced practice nursing as it relates to your project topic.
Your integrative literature review should be 5–6 pages in length, not including the cover or reference pages. You must reference a minimum of 7 scholarly articles published within the past 5–7 years.
Use current APA format to style your paper and to cite your sources. Review the rubric for more information on how the assignment will be graded.
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Problem Identification and Description
Darinka Pozo
West Coast University
Course: NURS 691 A Culminating Experience I
Professor: Tracy Macdonald DNP
Date: January 19, 2024
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Problem Identification and Description
Evidence-based practice involves the identification of a priority health and quality issue
in the clinical setting and the implementation of a solution backed by evidence. This process
requires a clear problem definition and identification of the target population and setting. The
PICOT question statement is important in clearly defining these aspects of the research question,
specifically outlining the intervention, comparison, and expected outcomes. In this project, the
problem identified is wound therapy, especially among patients with chronic wounds. Therapy is
used to enhance wound healing and prevent infections. The proposed project will research
methods to improve wound healing in diabetic patients with diabetic foot ulcer.
Description of the Problem
The identified problem is the prevalence of diabetic foot ulcers mostly common among
older adults with type 2 diabetes. The clinical setting is a community health center which mostly
serves racial minorities, especially older adults and people with chronic conditions. Majority of
the patients attended at the health center have chronic conditions including but not limited to
diabetes, hypertension, and arthritis. In this older adult population, self-management of chronic
conditions is a priority. The risk of chronic condition diagnosis increases with age and in this
target population, diabetes is very prevalent. Chronic condition management includes managing
the complications associated with the condition.
The problem identified was that in a significant number of patients with diabetes
complications, foot ulcers are quite common. Diabetic foot ulcers are a complication of diabetes,
mostly associated with peripheral neuropathy (Armstrong et al., 2023). These are wounds that
develop due to several factors including lack of feeling on the legs, poor circulation, and pressure
ulcers. In patients with type 2 diabetes, foot ulcers may take long to heal and are the leading
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cause of amputation (Armstrong et al., 2023). Given the chronic nature of diabetic foot ulcers, it
is important to consider effective methods of managing the diabetes complication and improving
health outcomes. This project, therefore, will focus on adequate management of diabetic foot
ulcers to promote healing.
Problem Statement and Target Population
The problem identified is that a huge proportion of diabetic patients with foot ulcers
experience a prolonged period of healing. On average, patients treated for diabetic ulcers in the
clinic take up to 20 weeks for the wound to heal. The long healing period affects the quality of
life for patients with diabetes. The problem identified here is that a huge proportion of patients
with type 2 diabetes mellitus present with slow healing wounds which are challenging for the
clinicians to handle. The long healing period is a problem because it affects the health outcomes
of patients, quality of life, and increases risk of infection.
The target population is older adults with type 2 diabetes mellitus. The clinical setting is a
community health center. The population served in this population are typically older adults with
chronic conditions, with the majority of the population being racial minorities. The uniqueness of
this population is that the prevalence of chronic conditions such as diabetes is relatively high
compared to the general population (Sinclair et al., 2020). In addressing the identified problem,
the proposed solution is negative pressure wound therapy (NPWT). The PICOT question
developed for this problem is: Among older adults with diabetic foot ulcer attended in a
community health clinic (P), does negative wound therapy (NPWT) (I), compared to standard
care (C), reduce time for wound healing (O)? Based on this PICOT question, the problem and
population are diabetic foot ulcer healing period and older adults. The intervention is NPWT,
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comparison is standard practice that is current wound treatment approaches, and the expected
outcome is time for healing.
Significance of the Evidence-Based Project
Chronic wounds are a common complication for people with type II diabetes and a major
determinant of the quality of life the patient leads. Diabetic foot ulcers affect quality of life by
determining the patient’s independence in completing activities of daily living (ADLs), engaging
in other social activities, and risk of amputations. Most patients who have diabetes and undergo
foot amputations are due to wounds that do not heal (Rodrigues et al., 2022.). This is a
significant cause for disability in patients with diabetes. Therefore, methods for promoting
healing and suitable health outcomes for patients who have diabetes are necessary in promoting
the quality of life for these patients.
Other than quality of life, chronic wounds have significant cost, psychological, and
infection implications on patients. Having a chronic wound means an increase in healthcare
resources utilization, a factor that affects individual and systemic costs. Additionally, patients
who have chronic wounds are more likely to experience stress, anxiety, and even depression due
to the limitations that wounds may cause on their lifestyle (Basu et al., 2022). Having a wound is
also a risk factor for infections. Infections may cause sepsis, a life-threatening condition, and
also cause a significant effect on the health outcomes and management of comorbidities such as
diabetes. Therefore, given the quality of life, costs, health, and psychological impact of chronic
wounds, it is imperative to find solutions that promote wound healing in diabetic patients.
Conclusion
The evidence-based project focuses in improving wound healing for older adults with
diabetic foot ulcer. The problem identified is that for many patients with diabetic foot ulcer, the
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healing time is prolonged, increasing the risk of infection, poor quality of life, and poor health
outcomes. In the proposed project, NPWT is proposed as the evidence-based intervention to
enhance wound healing. This project is important because it promises to improve health
management for people with diabetes through better prevention of wound complications and
enhancing health outcomes. It is anticipated that the proposed approach will enhance wound
healing and hence the health and quality of life for diabetic patients who have foot ulcers.
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References
Armstrong, D. G., Tan, T. W., Boulton, A. J., & Bus, S. A. (2023). Diabetic foot ulcers: A review.
Jama, 330(1), 62-75. https://doi.org/10.1001/jama.2023.10578
Basu, S., Goswami, A. G., David, L. E., & Mudge, E. (2022). Psychological stress on wound
healing: A silent player in a complex background. The International Journal of Lower
Extremity Wounds, 15347346221077571. https://doi.org/10.1177/15347346221077571
Rodrigues, B. T., Vangaveti, V. N., Urkude, R., Biros, E., & Malabu, U. H. (2022). Prevalence
and risk factors of lower limb amputations in patients with diabetic foot ulcers: A
systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research
& Reviews, 16(2), 102397. https://doi.org/10.1016/j.dsx.2022.102397
Sinclair, A., Saeedi, P., Kaundal, A., Karuranga, S., Malanda, B., & Williams, R. (2020).
Diabetes and global ageing among 65–99-year-old adults: Findings from the International
Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice, 162,
108078. https://doi.org/10.1016/j.diabres.2020.108078
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