NS2502 The role of a nurse in responding to and planning for acute hyperglycaemia needs in hospitals NS2502

The role of a nurse in responding to and planning for acute hyperglycaemia needs in hospitals

Word count:2267

Student ID: 2101218

Date submitted: 02/12/2022

This literature review is going to look at the role of a nurse, in recognising and responding to hyperglycaemia. Tingen et al., (2009) stated that registered nurses prioritise the needs of people when assessing and reviewing their mental, physical, cognitive, behavioural, social, and spiritual needs. They use information obtained during assessments to identify the priorities and requirements for person-centred and evidence-based nursing interventions and support. For a patient who is known to have diabetes, the nurse would recognise the need to be observant of the patients individual specialised needs. They work in partnership with people to develop person-centred care plans that consider their circumstances, characteristics and preferences (Nursing and Midwifery Council [NMC] 2018).

The articles in this review were sourced using Onesearch, Pubmed, National Health Service [NHS] Websites. Boolean operators were used as conjunctions to combine or exclude keywords in the search, resulting in a more focused and productive result. Some of the keywords and phrases were hyperglycaemia in hospital patients, signs and symptoms of hyperglycaemia as well as diabetes management along with symptoms. Filters were also utilised, such as date range as well as peer-reviewed, to make sure the material was of good quality and relevance.

The National Diabetes Inpatient Audit [NDIA] (2020) raised concerns about the frequency of hospital-acquired diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state [HHS] cases, highlighting the need for improved inpatient hyperglycaemia management. Nurses need to supervise and note known diabetic patients glucose levels and observations to help early recognition and treatment of hyperglycaemia, as it could lead to serious health conditions if left untreated. Regularly having high blood sugar levels for long periods can lead to irreversible damage to the body, such as glaucoma, where blood vessels grow on the iris (Cai, 2018). Neuropathic damage may also occuri patients with diabetes which can lead to the loss of a limb, in particular, the feet or lower limb. (Beltramello et al.,2018) High blood glucose can also damage blood vessels and nephrons in the kidneys which could result in renal High blood glucose can also damage blood vessels and nephrons in the kidneys which could result in renal failure (Centre for Disease Control and Prevention [CDC] 2021).

Hyperglycaemic patients admitted to hospital tend to worse clinical outcomes with higher operational costs than normoglycaemic patients. (Clement et al, 2004) Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalisation (Beltramello et al, 2012). Betramello also discusses The Trialogue project,which is a questionnaire assimilated by a group of scientific experts from three scientific societies. This questionaire was created to set out guidelines for improving clinical practice in managing hyperglycaemia. The questionnaire contained 16 multiple-choice questions relating to the management of hyperglycaemia in a hospital ward and was answered by a small sample size (660) of doctors. Hackshaw (2008), described that whilst small studies can provide results quickly, they do not normally yield reliable or reliable results. One critical observation is that the study could have been more diverse in its participants and included other care professions. This could have achieved shared knowledge between the Multidisciplinary team [MDT] and resulted in more consistent care.This article is considered to be of high quality as it was published in the Italian Journal of Medicine, 2012, which is an official journal of the Federation of Associations of Hospital Doctors. This journal is professionally evaluated quarterly by at least two expert peer reviewers. Another critical observation was that the study was performed in Italy and may not be transferable or relevant to the United Kingdom [UK] healthcare system.

As an adult nurse intervening with a patient presenting with hyperglycaemia, the procedure is to administer prescribed medication which may include insulin and metformin. Insulin can be administered via intravenous (IV) meaning administered directly into the vein, subcutaneous which is administered into the fats underneath the skin, inhaler directly into the lung (BNF 2022), or orally. Along with medication management, the role of the nurse also includes educating patients about dietary intake, a healthy lifestyle including regular exercise and a reduced intake of toxins such as tobacco and alcohol (Moniquel, 2018). Baig et al (2015) stated, since family members can play a vital role in a patients disease management, involving them in self-care interventions may positively influence patients diabetes outcomes. This further backed up by Pamungkas et al, (2017) who suggested that continuing diabetes mellitus [DM] care, needs effective self-management, education and support for both patients and family members.

Warren et al (2003) performed a pilot study that was published by John Wiley and Sons, who are a world-leading publisher of academic, scientific, and professional books and journals. A reputable publisher is less likely to circulate poor-quality articles, for fear of it affecting their reputation, meaning the editors would have researched the source of its information. Warren et al (2003) aimed to identify and classify the symptoms of hyperglycaemia experienced by people with insulin-treated diabetes. In total, 361 participants (90.2%) reported experiencing hyperglycaemic symptoms. The common endorsed symptoms were thirst, dry mouth, weakness, needing to urinate, and tiredness.

Warren et al (2003) study was a combination of qualitative and quantitative research. The method used to agther qualatative data the was personal feedback of the cohort and whilst this is supportive in treatment therapy it can be subjective ( Tempelar et al, 2020) and emotionally driven. Quantitative research in contrast is the collection of statistics and data (Mcleod, 2019) Using a combination of research methods provides the reader with physical data of the experiment which includes information on participants, ranges, and the methods used to provide the data ( Creswell 2014). This study has demomstrated ethical consideratoins as is discussed that there is no financial reimbusment from the drug company. A benefit of using this type of research allowed the researchers to identify subgroups. The use of a combination of the methods analyses not only a cohort of patients experiencing hyperglycaemia but also identifies characteristics such as age and gender where experiences may differ. The results and conclusions of such method afford clinicians and National Institue of Clinical Excellence [NICE] guidelines the ability to utilise information based on protected characteristics and whether due to those characteristics, a treatment plan should differ.

Part of the nuses role is to reduce the risk of patient readmission and the symptomology of hyperglycaemia. Garca-Molina et al (2020) concluded that lifestyle interventions such as weight loss and diabetic self-management can have a positive impact on glycaemic control. Garcia-Molina et al (2020) analysed journal articles from accredited publications such as PubMed, Scopus, and web of science databases which are premier sources of biomedical literature that are also peer-reviewed. As practitioners, we understand that this method of research informs best practice due to the high level of experienced and educated professionals conducting the research, therefore, utilising the most up-to-date and relevant information available to review. A peer reviewed literature shows clinicians that a wider range of information has been scrutinised and that a wide range of knowledge and experience has been explored to develop a greater understanding of the topic.

The nurses role is to maintain and update their knowledge and compitance (NMC, 2018), with current evidence based policies, this will support the nurse in educating patients, their families and care givers of a modified dietary intake which would include a reduced sugar intake to reduce the risk of hypercalcemia. Diabetes education and management is key to improving self-care behaviors and reducing hospital readmissions (Drinic et al. 2017 & Sullivan & Alexander, 2019). They also understood that as part of any initial assessment of a patient that having a good holistic understanding of a patient's primary and secondary health needs is conducive in the risk of responding to critical or emergency treatment and that by equipping themselves with evidence and knowledge can prevent such event from occurring.

NICE guidelines (2022) are recommendations set out to aid health and social care professionals to prevent ill health. These guidelines look at circumstances, settings, needs and the conditions of individuals to ensure a holistic approach when health care professional are considering an individuals treatment plan. The guidelines have been developed by a large independent group of medical and non-medical people then consulted on by stakeholders. NICE guidelines (2022) allow for the public to read information which has been gathered from other organisations but accepts no responsibility as to whether the advice is accurate. The guidelines are reviewed and updated every 5 years, but a topic can be updated sooner if significant evidence emerges. NICE guidelines are also a good source of information for MDT, as the information is gathered from medical and non-medical professionals, However,as it is reviewed every 5 years, the information could be seen as outdated.

Patients with diabetes type two have a significantly lower readmission rate, should they follow a low sugar diet and an active lifestyle (Seery, 2022). What is understood regarding type one diabetes is that this is generally inherited and is formed within the patients physical makeup which develops early in life, this is where the bodys immune system attacks and destroys the cells that produce insulin. (Diabetes UK 2017). Therefore, by managing the bodys production of insulin and thus generating a synthetic formation result in the medication, replicating the bodies natural way of entering the blood cells to induce energy without the use of insulin patients would have a build-up of sugar in their bloodstream, which causes hyperglycaemia (Hyperglycemia in diabetes 2022). By taking medication such as Metformin, the body can better produce the glucose levels it requires BNF (2022). Type two diabetes, however, can have a significant reduction in diagnosis if we are aware of the causes such as high intake of sugars and carbohydrates and by having lifestyle choices conducive of healthiness (Type 2 diabetes 2017).

The role of the nurse and relationship the nurse has with the patient is vital to raise awareness of warning signs and symptoms, not only of hyperglycaemia but of the risk in developing type two diabetes (Independent.co.uk 2020). It is important that a nurse documents and shares in a peer forum information and best practice to provide health professionals with the understanding and skills to deliver optimal nursing, care as well as support for people with diabetes (Wu et al 2021).

When exploring the integration of systems and health care provision, there is a need for further advancement in preventative and reversible education to the symptomology of this disease (Garcia-Barbero, 2005) Ommen et al (2018) suggests that the barriers to change lay within the economic, social, psychological and biological factors and this. multifactorial change should be integrated into personalised health optimisation. Ommen et al (2018) also discussed redesigning strategies to develop patient understanding universally and to target all economic and social structures and systems whilst understanding the differences between patients cultural and religious beliefs. There is a clear correlation between lower incomed patients in managing their dietary intake and weight management, Gaal et al (2015) concurs that diabetes is a growing global health concern as is obesity in first world countries and the two are undoubtedly intrinsically linked. Their research concludes that managing the weight of patients with type two diabetes reduces its risks of complications and thus hyperglycaemia. Barbie (2021) reviewed that the way in which health care professionals approach patients is crucial to their understanding of health implications and a better quality of health in diabetes management and this is transferrable to all health conditions.

In conclusion to this research, it is evident that a wide range of knowledge and research methods are imperative in understanding patient care and treatment. It is important to firstly understand the patient experience which includes understanding their lifestyle, characteristics, and biopsychosocial needs and that not only is a medication regime crucial in treating a patient who is hyperglycaemic that the treatment is in conjunction with well informed and educated ideology regarding lifestyle choices, exercise, and dietary intake.

Literature suggests that whether qualitative, quantitative or literature review, that the information gathered is consistent in terms of a treatment plan for patients with either type 1 or 2 diabetes and that nearly all research concludes that healthy lifestyle, exercise, diet and reduced alcohol and tobacco consumption is conducive of a reduction in risk to hyperglycaemia and transferable to multiple health conditions. Utilising the methods of qualitative and quantitative research as well as identifying peer reviewed literature that a combination of these methods is conducive for evidence-based research. Qualitative research methods are positive for evidencing insight into statistics by using core subjects and can derive at an expected outcome. However, having the knowledge base from varied peer review journal articles allows the reader to retrieve more detailed and specific information. Research is important to inform decision-making as well as develop legislation, which sets out the law. This helps produce policies and guidelines that benefit service users and health professionals to minimises human error, as well as poor communication around medical care and sets out a road map for day-to-day operations, aiding in continuity within health care (The Access Group 2022).

The role of the nurse within the treatment and reduction of hyperglycaemia in patients is to observe them, and ensure that they respond to signs or symptoms of hyperglycaemia. The response to symptoms is to administer appropriate medication. The research shows that the role of the nurse and MDT moreover is to ensure that prior to any admission to hospital that the patient is taught to check their blood glucose levels and are educated in a healthy lifestyle. The nurse should give patients and their families advice on self care, diet and reducing risks of hyperglycaemia to prevent further hospital admission.

Baig, Arshiya A., et al. Family Interventions to Improve Diabetes Outcomes for Adults.Annals of the New York Academy of Sciences, vol. 1353, no. 1, 6 Aug. 2015, pp. 89112, www.ncbi.nlm.nih.gov/pmc/articles/PMC4624026/?fbclid=IwAR1eaCFUEPE1CCSFYzE-c9k_Wj-cmEzEkIBsuV45KFLtTCd8JTxqwFdiPH0, https://doi.org/10.1111/nyas.12844.

Barbie Cervoni MS, R.D. (2021) Cultural considerations in diabetes management, Verywell Health. Verywell Health. Available at: https://www.verywellhealth.com/cultural-considerations-in-diabetes-management-5094207 (Accessed: December 6, 2022).

Cai, C. (2020) Ophthalmology: John Hopkins University School of Medicine: Available at https: www.hopkinsmedicine.org.com

CDC. Diabetes and Chronic Kidney Disease.Centers for Disease Control and Prevention, 2021, www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html.

Clement, S., et al. Management of Diabetes and Hyperglycemia in Hospitals.Diabetes Care, vol. 27, no. 2, 27 Jan. 2004, pp. 553591, care.diabetesjournals.org/content/27/2/553, https://doi.org/10.2337/diacare.27.2.553.

Cresswell, J. (2014) Research design. Sage Publications.

Diabetes UK (2022) Diabetes UK - Know diabetes. Fight diabetes. Available at: https://www.diabetes.org.uk/ (Accessed: November 27, 2022).

Diabetes UK. Differences between Type 1 and Type 2 Diabetes.Diabetes UK, 2017, www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes.

Future nurse: Standards of proficiency for registered nurses (no date). Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nurses/future-nurse-proficiencies.pdf (Accessed: November 17, 2022).

Clement, S., et al. Management of Diabetes and Hyperglycemia in Hospitals.Diabetes Care, vol. 27, no. 2, 27 Jan. 2004, pp. 553591, care.diabetesjournals.org/content/27/2/553, https://doi.org/10.2337/diacare.27.2.553.

Garca-Molina, Laura et al. Improving Type 2 Diabetes Mellitus Glycaemic Control through Lifestyle Modification Implementing Diet Intervention: a Systematic Review and Meta-Analysis.European journal of nutrition59.4 (2020): 13131328. Web.

Hackshaw, A. (2008) Small studies: Strengths and Limitations, European Respiratory Society. European Respiratory Society. Available at: https://erj.ersjournals.com/content/32/5/1141 (Accessed: November 17, 2022).

Home (2022) Straight A Nursing. Available at: https://straightanursingstudent.com/ (Accessed: November 27, 2022).

Howard E. LeWine, M.D. (2015) People with type 1 diabetes are living longer, Harvard Health. Available at: https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611 (Accessed: November 27, 2022).

Hyperglycaemia (high blood sugar) - illnesses & conditions (no date) Illnesses & conditions | NHS inform. Available at: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar/ (Accessed

Hyperglycemia in diabetes (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 (Accessed: December 7, 2022).

Mcleod, S.A. (2019) Qualitative vs. quantitative research. Simply Psychology. Available at: www.simplypsychology.org/qualitative-quantitative.html

Monique Tello, M.D. (2018) Healthy lifestyle can prevent diabetes (and even reverse it), Harvard Health. Available at: https://www.health.harvard.edu/blog/healthy-lifestyle-can-prevent-diabetes-and-even-reverse-it-2018090514698 (Accessed: December 6, 2022).

NHS choices. NHS. Available at: https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-inpatient-audit (Accessed: November 23, 2022).

NMC. The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates.Nmc.org.uk, NMC, 2018, www.nmc.org.uk/standards/code/.

NICE. BNF | NICE.NICE, NICE, 31 Aug. 2022, bnf.nice.org.uk/.

Pamungkas, Rian, et al. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients.Behavioral Sciences, vol. 7, no. 4, 15 Sept. 2017, p. 62, www.ncbi.nlm.nih.gov/pmc/articles/PMC5618070/, https://doi.org/10.3390/bs7030062.

Published guidance, Nice Advice and Quality Standards: Guidance (no date) NICE. Available at: https://www.nice.org.uk/guidance/published (Accessed: November 27, 2022).

Seery, C. (2022) Having high blood sugar levels can be discomforting and many people wish to know what they can do to help to bring down high blood glucose levels., Diabetes. Available at: https://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.html (Accessed: November 27, 2022).

Tempelaar, D., Rienties, B. and Nguyen, Q. (2020) Subjective data, objective data and the role of bias in predictive modelling: Lessons from a dispositional learning analytics application, PLOS ONE, 15(6). Available at: https://doi.org/10.1371/journal.pone.0233977.

The Access Group. What Are Policies and Procedures.Www.theaccessgroup.com, 2022, www.theaccessgroup.com/en-gb/health-social-care/care-management software/policies-and-procedures/what-are-policies-and-procedures/.

Tingen, M.S. et al. (2009) The importance of nursing research, The Journal of nursing education. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677814/ (Accessed: November 17, 2022).

Type 2 diabetes (2017) National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Department of Health and Human Services. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes (Accessed: December 7, 2022).

Van Gaal, L. and Scheen, A. (2015) Weight management in type 2 diabetes: Current and emerging approaches to treatment, Diabetes Care, 38(6), pp. 11611172. Available at: https://doi.org/10.2337/dc14-1630.

van Ommen, B. et al. (2018) From diabetes care to diabetes curethe integration of systems biology, eHealth, and behavioral change, Frontiers in Endocrinology, 8. Available at: https://doi.org/10.3389/fendo.2017.00381.

Warren, Roderick E., Ian J. Deary, and Brian M. Frier. The Symptoms of Hyperglycaemia in People with Insulin-Treated Diabetes: Classification Using Principal Components Analysis.Diabetes/metabolism research and reviews19.5 (2003)

Wint, Carmella. Everything You Should Know about Diabetic Neuropathy.Healthline, Healthline Media, 3 Dec. 2018, www.healthline.com/health/type-2-diabetes/diabetic-neuropathy.

Wu, Su-Ying, et al. Knowledge Sharing among Healthcare Practitioners: Identifying the Psychological and Motivational Facilitating Factors.Frontiers in Psychology, vol. 12, 14 Dec. 2021, 10.3389/fpsyg.2021.736277.

Module Code: NS2502

Assessment Brief:

Module Title Developing Nursing Practice - Adult

Module Code NS2502

Module Leader Claire James

Level 5

Pass Criteria 40%

Assessment Title The role of the nurse in responding to and planning for peoples acute/crisis needs, which minimises the risk of acute/inpatient admission.

Assessment Type Descriptive literature review

Mode of submission Canvas

Restrictions on time/length 2500 words +/- 10%

Individual/Group Individual

Weighting 100%

Submission date 7th December 2022

Planned Feedback/grade release date 5th January 2023

The aim of the module is to build upon the Foundations of Nursing Practice in year 1, focussing in on meeting the acute/crisis and longer-term health needs of adults, accounting for their physical, psychological, social and cultural contexts. Students will hone their skills in searching and critically analysing research literature and policy, considering findings in relation to the reality of practice environments.

Assessment Title:

The role of the nurse in responding to and planning for peoples acute/crisis needs, which minimises the risk of acute/inpatient admission.

Learning Outcomes:

Demonstrate the ability to collate and critically evaluate information when a person presents with acute or crisis needs, formulate an appropriate response and evaluate the outcome of any intervention. (Duty 1&2: S2; Duty 4: S24,25; Duty 5: K28,30; S35, B1,2; Duty 6&7: K38,42; S44,48; Duty 8: S51)

Articulate how the Adult nurse works with people and families beyond the acute/crisis phase of ill-health to co-design plans of care to support ongoing recovery and well-being across different settings. This takes account of the physical, psychological, social, and cultural needs of individuals and families. (Duty 3: S18,19; Duty 4: K16,17; S22,24,29; Duty 5: B1,2; Duty 6&7: K38,42; S44,48; Duty 8: K50; S49,50,51)

Demonstrate an enhanced knowledge of the main methods of enquiry, including features of sampling, data collection processes and data analysis (SDG 10.2) (Duty 1&2: K4, S2; Duty 4: S22; Duty 8: K49)

Suggested Format:

Please ensure you have titled your uploaded file with your name, student number, module codeand assessment type (e.g. Student ID 12345678, NS2502,Literature Review).Page numbers should be utilised.

Title Page:

Title of literature review

Your student ID number only

The date of submission

The number of words (excluding references)

Introduction:

Set the scene

Relate to a placement experience or topic of interest

Third person writing throughout

Identify how you found your literature

Main body:

Critique the literature you have found

Relate it to practice, what does the evidence say? why we do what we do? Is it best practice? Are there any ethical considerations for the nurse?

Is the literature valid, whats the sample size, what type of research was utilised?

How is the patients physical, psychological, social and cultural needs considered?

How were families involved and what are the longer-term plans for the patient?

What is the nurses role?

Use 4-5 main pieces of literature tocritiquethroughout your assignment.Thisdoes notmean you only need 4-5 references. Youwillneed moreliterature/references to support the points discussed around these articles.

Conclusion:

Summary of the literature and implications on future practice

Reference List:

All research included within the assessment should be referenced using Harvard. Please see the guide below:

University Harvard Referencing Guide Revised 07-09-17 (1).pdfEssay Structure: SkillsNet (instructure.com)Grading:

The module will be marked against the Level 5 marking rubric below:

https://winchester.instructure.com/courses/13030/files/1729987/download?wrap=1Extenuating Circumstances:

Please refer to the guidance below regarding extenuating circumstances:

Extenuating Circumstances - Guidance Leaflet (sharepoint.com)Self-certification:

Please refer to the attached guidance on self-certification of an assessment:

Self Certification for Extenuating Circumstances Policy (sharepoint.com)Resubmission of Assessments:

For a second attempt at written coursework, students are asked to submit the original assignment.

It has also been agreed that within nursing the student uploads their feedback sheet from the first submission to allow the marker to review and ensure feedback has been addressed.

The assessments will be marked anonymously where appropriate and will not necessarily be marked by the same person. This highlights the importance that you are encouraged to upload your first submission and feedback with your resubmission.