Key Elements Of Evidence Based Practice


  1. Define the clinical key question of interest.
  2. Identify the studies of the database search that represent the highest levels of evidence found Identify the statistics discussed in the study as it relates to confidence intervals or statistical description.
  3. Discuss the statistical results of the studies identified.


Descriptive Statistics Overview

Advanced nursing utilizes advanced knowledge and skills in education, practice, and research. The knowledge and skills required evidence-based practice from rigorous research and empirical studies. Evidence-based practices have the best outcomes, and hence advanced nursing practice and education should be evidence-based. Studies selected as evidence for practices should be high-level evidence studies. Globally recognized databases such as CINAHL, PubMed, Medline, ESCO, and the Cochrane Library (Wiley) should also be selected to provide these studies for evidence-based practice. This essay reviews a clinical question and examines descriptive statistics supporting the clinical question.

The clinical question is: Among elderly diabetic patients, does standardized patient education compared to traditional education improve self-management, adherence to interventions, and follow-up visits in six months?

Analysis of the RCTs and Systematic Review

Cunningham et al. (2018) presented a systematic review and meta-analysis. Systematic reviews of randomized control trials provide the strongest evidence in research. The systematic review focused on diabetes self-management education recommended for diabetes patient education. The research focused on the African-American population. The systematic review utilized 279 abstracts, 352 citations, and 44 full articles, with a p-factor of 92%. The studies were evaluated for HbA1c and quality of life improvement. The studies eligible for HbA1C were 8, while those eligible for quality of life evaluation were 5. Hence the sample was too small to generalize the study to the population. Meta-analysis showed no clinical significance of the structured diabetes education on the HbA1c measurements using 95%CI. The quality of life is a complex measure, and the study showed a significant improvement in the quality relative to other prior meta-analyses. The systematic review thus showed significant change in the quality of life.

Sharoni et al. (2018) conducted a randomized controlled trial for twelve weeks among elderly adults with diabetes to examine the effects of a self-care behavior education program on diabetes foot care. Randomized controlled trials are high-level evidence studies with a level II evidence level; hence the results were significant to the clinical question. Assessments were done at the beginning, 4, and 12 weeks. The study used 76 individuals who met the selection criteria from six elderly care facilities. A 95% CI (p<0.05) was used in data analysis and analyzed the aspects of life quality such as foot self-care behavior, self-efficacy, outcome expectation, and foot care knowledge. These aspects were derived from the Neuropathy and Foot Ulcer Specific Quality of Life (FS-QoL). Data was collected through questions, and the scores were analyzed for all the aspects measured. The questions were crafted to determine the patients’ understanding and the efficacy of the education program hence the reliability of the data. Various institutions were used hence the validity of the data. The study used a p-value of less than 0.05, and the results showed a significant change in self-efficacy, self-care behavior, foot care outcome expectation, knowledge of foot care. The study thus provides high-level evidence on the efficacy of structured patient education on diabetes care and diabetic patient outcomes.

Dong et al. (2018) conducted a randomized controlled trial using 120 type 2 diabetes patients. Wechat platform diabetes education was compared to usual care on the effects on biochemical parameters such as fasting plasma glucose (FPG), 2-hour PG, HbA1c, and self-efficacy (SE). The measurements were taken at baseline, 6, and 12 months. A p-factor of 0,05 was used throughout the study. The study results showed significant differences in HbA1c and SE intervention, while FPB and 2hrPG concentrations had no significant differences between the control and study groups. The results presented high-level evidence on the efficacy of structured patient education on improving HbA1c tests and self-efficacy.

Summary of the Results from Studies

The globally recognized databases produced several high-level evidence studies, randomized control trials, and systematic reviews of randomized control studies on structured patient education as compared to traditional education and provided empirical evidence. Evidence from the studies selected showed a lot of significance of the topic. Diabetes is an expensive chronic condition that requires collaboration between healthcare providers and patients (Zheng et al. 2019). Sharoni et al. (2018) show that diabetes education influences diabetic patient outcomes. The diabetes education program improved patient adherence to follow-up care and achieved the therapeutic care targets. According to Sharoni et al. (2018), educating patients increased their overall adherence to hospital follow-up and significantly improved their quality of life. The programs emphasize the importance of follow-up visits and provoke patient initiative to attend these clinical visits. They also increase patient knowledge, eliminating illiteracy and negligence associated with illiteracy. Cunningham et al. (2021) showed that diabetes education significantly improves the patients’ quality of life. According to Ghisi et al. (2020), structured education ensures uniformity in patient education, reducing missed opportunities in diabetes education. Dong et al. (2018) showed that diabetes education significantly improves patients’ HbA1c results.


From the evidence presented above, structured diabetes education is integral in improving patient self-efficacy and HbA1c therapeutic targets. However, more research on other therapeutic targets is required. Diabetic patient education is integral in improving foot self-care behavior, self-efficacy, outcome expectation, foot care knowledge, and overall quality of life. Structured patient education generally has better outcomes compared to the usual care. Healthcare providers should focus on structured education instead of the usual care for better patient outcomes.


Ahmad Sharoni, S. K., Abdul Rahman, H., Minhat, H. S., Shariff-Ghazali, S., & Azman Ong, M. H. (2018). The effects of self-efficacy enhancing program on foot self-care behavior of older adults with diabetes: A randomized controlled trial in elderly care facility, Peninsular Malaysia. PloS One, 13(3), e0192417.

Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis. BMC Health Services Research, 18(1), 1-13.

Dong, Y., Wang, P., Dai, Z., Liu, K., Jin, Y., Li, A., … & Zheng, J. (2018). Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: a randomized clinical trial. Medicine, 97(50).

Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16.

Zheng, F., Liu, S., Liu, Y., & Deng, L. (2019). Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China: a randomized controlled trial. Journal of Diabetes Research, 2019.

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