NSG 6101 Week 5 Assignment Part 1 Article Critique Form

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Student name South University NSG 6101 Professor Name Submission Date NSG 6101 Article Critique Form APA reference García, J. F., Abad, J. F., López, & Fernández. (2024). British Journal of Nursing, 33(15), S4–S15. https://doi.org/10.12968/bjon.2024.0006 Purpose 1. Describe the profile/characteristics of patients with neuropathic and neuro-ischaemic diabetic foot ulcers who get referred to an advanced practice nurse (APN) in advanced chronic wounds. 2. Determine whether a given intervention program on primary-care and nursing-home nurses (professional performance, knowledge, referral behavior, and product use) affected professional performance. 3. Follow-up, assessment, and outcome (healing, amputations, deaths) of the patients with neuropathic and neuro-ischaemic ulcers referred to the APN prior to the training and post-training. Hypothesis or Research Question The article has not indicated a formal null/alternative hypothesis. It rather explains particular study objectives/ research questions: What are the peculiarities of the patients of neuropathic and neuro-ischaemic DFUs of the specialist APN? Are APN-led nurse training sessions associated with the positive outcomes (in terms of professional performance (knowledge, proper referrals, product use), and continuity of care)? Are there any changes in the outcomes (healing time, rates, amputations, mortality) after intervention/ introduction of the role? These are called research questions/objectives that direct the study as compared to hypothesis testing. Theoretical Framework To organize the study, there is no clear statement or application of the theoretical framework (e.g., behavioural, nursing-theory model). Instead, the paper is a retrospective descriptive / quality-improvement study of a service change in the integrated diabetic-foot pathway of Andalusia. The authors locate the work within the framework of clinical practice guidelines and health-service pathway logic (referrals made to the Andalusia integrated diabetic foot pathway and IWGDF guidelines), and the rationale behind the study is the service-delivery / care-coordination and quality-improvement concepts as compared to a formal mid-range nursing theory. Research Design The research was a retrospective descriptive study aimed at determining the outcomes of patients with diabetic foot ulcers (DFUs) who were referred to an Advanced Practice Nurse (APN) in complex chronic wounds. It also evaluated the effectiveness of a training intervention on primary care and nursing home nurses in terms of diabetic foot management. Clinical records and the Andalusian electronic wound registry system were used to generate data in the 6.5-year (2015-2021) period. Statistical Methods The analysis of the data was conducted by descriptive sequential statistics: Frequencies and percentages of categoric variables (type of ulcer, amputation, death). Continuous variables (healing time, age) means and standard deviation. Data were analyzed with the help of Excel PivotTables and SPSS v21.0. Pre and post training intervention were compared to assess changes in knowledge of the nurse, continuity of care, and patient outcomes. Variables A. Dependent Variables: Patient outcomes: The percentage of healing, healing time, rates of amputation (major/minor), and mortality. Nurse outcomes: Pre/post questionnaire provides knowledge and performance improvement after training. B. Independent Variables: Type of ulcer (neuropathic/neuro-ischaemic). Setting / Population / Sample Population: The group of adult patients is an APN population with diabetic foot disease who refer to the APN to manage a wound. Sample: 103 patients (78 men and 25 women; mean age [?] 69 years) who had been referred between June 2015 and December 2021. Sampling strategy: Convenience random non-probability sampling of all qualified patients who fit the referral criteria. Inclusion criteria: Patients who had neuropathic ulcers or neuro-ischaemic ulcers that appeared difficult to heal despite an appropriate treatment period of 2-4 weeks. Exclusion criteria: Patients were transferred to another district where follow-up could not be done. Validity / Reliability Internal validity in the study is supported by uniform data collection by use of a centralized electronic registry of data (Diraya) and validated by the district management. The centralized approach of one Advanced Practice Nurse (APN) who carried out all data collection over 6.5 years made everything standardized and reduced inter-rater variability. The retrospective design and non-random sampling, however, reduce the reliability. They did not employ any psychometric tools other than descriptive statistics and did not have any control or randomization to consider external confounding variables, including comorbidities or COVID-19 disruptions. Procedural validity was enhanced through ethical approval and data verification procedures. Generalizability The study can only be generalized to similar healthcare settings, namely, the regions with integrated diabetic foot pathways and APN-led chronic wound management programs. The sample (n = 103) is too small, and it is geographically confined to Andalusia, Spain. Results might not be completely applicable to health systems without similar systems of care coordination and nurse specialists’ positions. However, findings are valuable to other European and global health systems that might be taking into account nurse-led diabetic wound care pathways. Findings ·       Among 103 patients (average age of 69 years), 59% patients healed their ulcers, and the mean healing time was 13.1 months. ·       Amputation rate 50 total (32 neuro-ischaemic, 18 neuropathic). ·       Mortality rate: 36; half of the deaths are within one year of diagnosis. ·       Intervention training: 168 nurses were enrolled in a 7-hour training; after the training, there was more than a 10 percent reduction in the use of inappropriate products, and the quality of referrals increased. ·       There was a worse outcome (increased amputation and mortality rates) with neuro-ischaemic ulcers. ·       COVID-19 had a bad influence on follow-up, which postponed healing and complicated it. ·       In general, the APN role enhanced coordination and early referral, but had a relatively insignificant positive effect on the outcomes, which is why a more expedited referral system and multidisciplinary teamwork are essential. Implications of the research for a.     nursing b.     education c.     policy making a. Nursing: Strengthens the importance of Advanced Practice Nurses in the inter-setting coordination and chronic wound management. It highlights the importance of nurse-led education to enhance the ability to detect early, referrals, and evidence-based management of ulcers. Favors lifelong learning in the management of diabetic feet and the detection of risks. b. Education: Finds that short, intensive training programs are effective in enhancing nurse competence and quality care. Instructs the necessity of the involvement of diabetic foot management and multidisciplinary communication in continuing education programs. Promotes simulation and case education to enhance

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