NURS FPX 4025 Assessment 3

Developing a PICO(T)

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Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

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Developing a PICO(T)

A Population, Intervention, Comparison, Outcome, and Time (PICOT) question is a significant area of clinical research and especially when handling cases of diabetic ketoacidosis, where critical cases are involved. It is an evaluation of the performance of patients treated with the help of trained nurses as compared to that of patients in normal care in terms of closure of the anion gap in a period of twenty-four hours (Hamdy, 2024). The PICOT time can be used to demonstrate the outcome of the education that will lead to faster stabilization and better treatment. Its findings can support the introduction of new hospital operations and patient recovery.

PICO (T) Framework to Explore the Issue

Diabetic ketoacidosis is a condition in which the body contains extremely low insulin, and, therefore, ketones are in the blood. Unless addressed promptly, this condition may lead to the development of such severe complications as swelling of the brain, damage to the kidneys, irregularities in the pace of heartbeats, or even death (CDC, 2024). The individuals who reside in underserved localities or lack health literacy are also especially vulnerable because, in many cases, they may not have access to diagnosis and proper care (Shubrook et 2023). The minority patients would also have a greater likelihood of experiencing communication barriers or even discrimination within the care setting, resulting in treatment delays and leading to a worse outcome, such as an extended hospital stay or an increased intensive care unit (ICU) admission rate (CDC, 2024). These contrasts show that the standardization of nursing education is needed to enhance the chances of timely diagnosing and treating DKA appropriately. The organized training of nurses regarding DKA recognition and protocol-driven treatment can initiate the earlier metabolic recovery, thus reducing the time of anion gap restoration during the initial 24 hours, and the general results.

PICO(T) Research Question

In adult inpatients with DKA (P), does structured nursing education on DKA recognition and protocol-driven management (I), as compared to usual care without structured education (C), reduce time to anion gap closure (O) within twenty-four hours of admission (T)?

• Population (P): Adult inpatients presenting with DKA
• Intervention (I): Structured nursing education on DKA recognition and protocol-driven management
• Comparison (C): Usual care without structured education
• Outcome (O): Reduced time to anion gap closure
• Timeframe (T): Within twenty-four hours of admission

Benefits of a PICO(T) Approach

This PICOT question is aimed at understanding whether structured nursing interventions in regards to DKA recognition and management can positively impact the inpatient returns in adults. It compares the patient that is being handled by nurses with DKA skills to those that are handled by an average level of care in terms of anion gap closure within 24 hours of hospitalization (Hamdy, 2024). The comparison of this period will help to understand whether education is a contributor to retention and a more successful treatment process. The results apply to hospitals in the optimization of the process, reduction of complications, and more patients with diabetic ketoacidosis recover.

Identification of Sources of Evidence

To extend the applicability of the studies regarding the PICOT question, a grid literature search was conducted to identify scholarly research of quantitative, qualitative, and outcome research in DKA management and nursing education. Cochrane Library, PubMed, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were selected due to their reputations for having evidence-based and peer-reviewed content. The key search terms were diabetic ketoacidosis, adult patients, structured nursing training, DKA protocols, anion gap closure, and outcome of managing them. The search was filtered using the logical operators such as AND and OR, and all studies that satisfied the elements of PICOT were considered. To make the articles accurate and current, the filters were articles that were published within the past five years, peer-reviewed journals, and those available in full-text. Quantitative studies were also determined by the fact that the outcome could be measured in time (to anion gap closure, to the normalization of glucose, and length of hospital stay). The qualitative studies were also investigated to identify perceptions and experiences of nurses who apply structured education on DKA care. Since, as Lazar et al. (2023) found, there was a correlation between anion gap normalization time delay and anion gap indicators of DKA severity, anion gap normalization time (AGNT) can be useful in measuring DKA recovery. The inclusion of outcomes research articles was also to identify the impact of their educational interventions on patient safety, complication rates, and other quality of care. The credibility was also facilitated through the choice of studies that are published by authoritative sources, which included the government health organizations, such as the Centers for Disease Control and Prevention (CDC), and also studies in reputable and peer-reviewed journals as BioMed Central (BMC) Nursing. Such a methodological manner enabled the incorporation of the evidence of various kinds of research that guaranteed a comprehensive explanation of findings connected to DKA.

Rationale

Using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) model in evaluating evidence for this PICOT question. The CRAAP test is a concept that was developed by Sarah Blakeslee and her colleagues in the library department of the California State University at Chico, and it was designed to evaluate the reliability of sources in different academic disciplines (Kalidas, 2021). The currency is significant because recommendations on how to manage DKA and how to educate nurses are subject to change with the new evidence appearing; the recent publications regarding the topic are useful to implement the latest evidence-based disease management guidelines. Relevance is the period when a study is implemented for adult patients in DKA hospitals, with the results of reduced time to anion gap closure within twenty-four hours, with the help of structured nursing education or conventional care. The authority is reached when evidence is presented by reputable experts in diabetes care and critical care nursing and released in peer-reviewed journals or released by authoritative bodies like the American Diabetes Association. The validity of any given research is verified when the methodology is transparent, reliable outcome measures can be proven, and those are consistent with other sources. Finally, Purpose may be demonstrated when the evidence aims to improve patient outcomes and clinical practices rather than a commercial interest. Through this model, the data to support the favorability of structured nurse management of DKA will be dependable, clinically supported, and patient-specific to stabilize metabolism within less than twenty-four hours of admission.

Relevance of Findings from Evidence

Proper nursing education is more important in the detection and early treatment of DKA, and this can successfully close the anion gap within 24 hours of admission. Organized learning provides nurses with evidence-based and clearly formulated guidelines and skills training to recognize the symptoms of DKA early enough and adhere to instructions in a procedural manner. This approach will ensure consistency in practice by clinicians and reduce error and maximize timely interventions compared to unstructured methods (National Diabetes Services Scheme, 2021). In one peer-reviewed article on nursing and palliative care, Shaker et al. (2025) give valid evidence that structured nursing education on the use of DKA protocols has a tremendous effect on the capability of nurses to conduct accurate assessment and prompt interventions, thereby leading to a faster anion gap closure than normal care. According to the recognized leader of diabetes care, the American Diabetes Association (2023), standardized education is the key to empowerment of nurses, depending upon the possibility to interpret lab values, glucose trending, and timely reaction to the metabolic changes, which is similar to the PICOT question of reducing the time to anion gap closure. According to Jerreat (2020) in the Journal of Nursing Standard, extensive training has a beneficial impact on not only clinical competency but also teamwork and communication in the process of transitioning care to ensure that during the process of handoffs, no essential tasks are left out in the successful provision of care to patients with DKA. These sources have proved that structured nursing education and protocol-driven management are better compared to regular care by being used collectively to prove their credibility and relevance.

Evidence Analysis for DKA PICOT Question

Early identification and protocol-based care with organized nursing education intervention has been established to have a tremendous outcome in adult inpatients with diabetic ketoacidosis (DKA) compared to standard care without organized constructive education. Carrying out a standardized education of nurses on the DKA guidelines, such as the demonstration of symptoms, correct administration of insulin, prompt fluid replacement, monitoring of the level of blood glucose and ketones, will help them to be prepared to render effective care during the first 24 hours of hospitalization. Umpierrez et al. (2024) described that companies that put in place a holistic nursing education into DKA management schemes demonstrated faster anion gap resolution and general metabolic balance as compared to those that stuck to traditional care models. Similarly, Ruiz et al. (2024) observed that, with structured training, nurses will be able to respond instantly to changes in clinical settings, reducing the time-lapses in the critical treatment. The authors noted that DKA education as a measure to eradicate post-surgery ICU hospital admissions minimized ICU transfers, since the nurses could take action in time and prevent complications (Moustafa et al., 2025). In general, it is possible to state that structured education should be integrated in the nursing practice as it reduces the time spent on closing anion gap, as well as improves the coordination of care and safety of adult DKA patients in the hospital.

Assumptions

To give a reasonable evaluation of the importance of structured nursing education in the management of DKA, there were several assumptions were made. It was assumed that all nurses, regardless of the intervention and control groups, worked under similar conditions and had equal opportunities to use medical tools, protocols, and support from the staff members (Ruiz et al., 2024). Further, it was assumed that patients were equal, such as their age, the extent of the DKA, and the general state of health, did not serve as a confounding factor in the results of the educational intervention. Both groups were treated using standardized evidence-based guidelines to treat DKA.

Conclusion

Nurse education on DKA identification and compliance with treatment regimens creates power in nurses to provide feasible care promptly, thus, normalization of blood glucose and ketones in a period of twenty-four hours. Plans have been documented to improve patient outcomes by reducing complications and faster stabilization as compared to the conventional approach of care that lacks systematic education. A consistent practice across unit-wide standard educational programs enhances patient safety. Through evidence-based protocols, the time-to-anion gap metric will be easily brought down by nurses in adult inpatients with DKA.

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