Evidence Synthesis Comprehensive Nursing Paper Sample

Evidence Synthesis Comprehensive Nursing Paper Sample

Purpose Statement

The purpose of this paper is to develop a synthesis of evidence on diabetes as a national health problem using three quantitative study articles and three non-research evidence sources.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Practice Problem 

Diabetes is a significant health problem in the United States. 34.2 million Americans have diabetes, i.e., one in every 10 Americans (CDC, 2020). Diabetes is associated with various health impacts, including complications and comorbidities, which cause significant health burdens and costs due to lost productivity for affected individuals and families (Arslanian et al., 2018). Equally, diabetes reduces the government’s income tax revenue, increases the government’s expenditure on healthcare costs and payments of welfare benefits. (Evidence Synthesis Comprehensive Nursing Paper Sample)

 Evidence Synthesis Comprehensive Nursing Paper Sample

Evidence-Based Intervention

Since diabetes is a chronic condition, there is a need for adequate management to prevent further exacerbation and adverse outcomes on quality of life that would reduce productivity and increase expenditure on health services. Diabetes self-management (DSME) and behavioral support are the appropriate intervention measures for diabetes and associated complications (Boels et al., 2019). DSME provides the necessary knowledge and support for diabetes management, including glycemic control, prevention, and management of complications. Common complications such as diabetic foot ulcers (DFUs) and chronic venous leg ulcers (CVLUs) are better managed through knowledge dissemination. Together, these interventions enable individuals diagnosed with diabetes can live an everyday and healthy life without complications.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Analysis of the Practice Problem


Diabetes is a significant health issue affecting Americans across all age groups. With one in ten Americans having diabetes, the high cost of treatment, particularly with insulin, and the associated health impact on individuals and families, including the local and national government, presents a significant challenge for the government (The Washington Post, 2021). Comorbid conditions and complications such as CVLUs and DFU affect individuals’ wellbeing and quality of life (Wiegard et al., 2017; Boels et al., 2019). For instance, DFU can lead to limb amputation if not treated early and effectively. Comorbid conditions and complications also contribute to financial strain due to the inability to work and costly therapy.  Furthermore, there are various disparities in diabetes risks, including ethnic groups, minorities, and old age acts as crucial risk factors to diabetes (HealthyPeople.gov, 2021), making diabetes a significant national health condition.(Evidence Synthesis Comprehensive Nursing Paper Sample)


As of 2018, the total number of people diagnosed with diabetes in the USA across all ages was 34.2 million, representing about 10.5% of the total US population (CDC, 2020). Out of this number, 34.1% were adults aged 18 and above, representing about 13% of the total adult population in the USA. The CDC report also indicated that about 7.3 million adults aged 18 and above met the criterion for diabetes diagnosis, albeit having no information on their health status regarding diabetes. The undiagnosed population alone represented 2.8% of the total US adult population. Furthermore, about 88 million of the adult population in the USA had prediabetes as of 2018. Along racial lines, the prevalence of diabetes is 2 to 5 times higher among Indian Americans than whites, while the prevalence among African Americans is 1.7 times higher than whites (HealthyPeople.gov, 2021). Lastly, the prevalence of diabetes among Puerto Ricans and Mexican Americans is two times higher than white Americans. These numbers reveal the disturbing status of diabetes in the USA and the need for evidence-based intervention measures to preserve and protect life.(Evidence Synthesis Comprehensive Nursing Paper Sample)


Diabetes complications and comorbidities constitute significant death in the USA. Diabetes was ranked as the seventh leading cause of death in the USA in 2017 (CDC, 2020). 25.7 deaths in every 100,000 persons were attributed to diabetes as the underlying cause. Moreover, diabetes was recorded as the underlying contributing factor to 83.1 deaths in every 100,000 persons.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Economic Ramifications of the Practice Problem

It is estimated that the USA incurred direct and indirect costs of $327billion on diagnosed diabetes in 2017 alone (CDC, 2020). The cost included lost revenue due to diminished productivity, costs of welfare benefits, and supply of medicines and equipment. Moreover, the direct cost of diagnosed diabetes in the same year was estimated at $237 billion, a significant increase from $188billion in 2012 (CDC, 2020). Equally, the indirect costs of diabetes were estimated to be $90billion, an increase from $73billion in the year 2012. Significantly, the excess medical costs per individual were $9,601 in 2017, increasing by $ 1184 since 2012.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Evidence Synthesis


The themes presented in the sources include diabetes self-management and support and the management of diabetes complications and comorbid conditions, including DFUs and CVLUs. Other themes presented include the rising costs of indulging therapy, the health impact of diabetes on individuals and families. Lastly, the impact of diabetes on the government is attributed to loss of income tax revenue, welfare, and medical costs.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Compare and Contrast the Main Points

Elsaid et al. (2019) and Wiengand et al. (2017) provide evidence-based information crucial to managing diabetes complications and comorbid conditions, respectively. Elsaid et al. (2019) focused on managing non-healing diabetic foot ulcers as a significant challenge for those diagnosed with diabetes. Equally, Wiengand et al. (2017) focused on managing chronic venous leg ulcers, a complication and comorbid condition among individuals diagnosed with diabetes. On the other hand, Boels et al. (2019) determined the impact of smartphone-enabled digital self-management education and support for diabetic individuals taking insulin therapy.(Evidence Synthesis Comprehensive Nursing Paper Sample)

The non-research sources focused on outlining the significance of diabetes in the USA and its impact on individuals, families, and the government.  The CDC (2020) presents statistics on the increasing prevalence of diabetes and prediabetes, the associated mortality, risk factors, coexisting conditions, and complications. HealthPeople.gov (2021) provides an overview of diabetes statistics, disparities, risk factors, and significance. Lastly, the Washington Post (2021) presents an expert opinion of the status of diabetes, including the rising cost of insulin therapy and the significance of diabetes as a national health problem. Together, the non-evidence sources present diabetes as a significant health issue, which continues to rise with impacts on the individuals, their families, and the government.(Evidence Synthesis Comprehensive Nursing Paper Sample)

Overarching Synthesis

Elsaid et al. (2019) found out that platelet-rich plasma (PRP) effectively treats hard-to-health DFU. PRP supports DFU healing by reducing the wound surface area and accelerating the healing process. Other factors such as age, type, and ulcer size determine the healing rate. Wiengand et al. (2017) present noncontact low-frequency ultrasound (NLFU) as a crucial therapy to managing diabetes and other types of ulcers associated with diabetes. This research’s central theme is that NLFU is crucial for managing diabetes and associated ulcers by stimulating the growth of cells surrounding the wound to health by promoting blood flow, reducing bacterial cells, and suppressing inflammation (Wiengad et al., 2017). Boels and colleagues (2019) highlighted the role of DSME/S in managing diabetes by acting as a reminder of the diet, physical activity, medication, and motivation to make healthy life choices. Moreover, Boels et al. (2019) noted that DSME/S should be tailored to meet individual needs since every person has unique needs unmet by healthcare professionals.(Evidence Synthesis Comprehensive Nursing Paper Sample)

 Evidence Synthesis Comprehensive Nursing Paper Sample
Evidence Synthesis Comprehensive Nursing Paper Sample


Diabetes is a chronic condition associated with significant health outcomes among individuals, families, and the government. Significantly, the prevalence of diabetes continues to rise across all ages within the USA. Diabetes affects an individual’s wellbeing and quality of life. Equally, diabetes affects individuals’ productivity and incomes, which reduces income tax revenue for the local and federal governments. Because of these challenges, there is a need to manage diabetes effectively, and self-management and support are considered crucial interventions. With the knowledge of managing complications such as DFU and CVLUs, individuals can live with diabetes and continue working.(Evidence Synthesis Comprehensive Nursing Paper Sample)


Boels, A. M., Vos, R. C., Dijkhorst-Oei, L. T., & Rutten, G. E. (2019). Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: Results of a randomized controlled trial (TRIGGER study).(Evidence Synthesis Comprehensive Nursing Paper Sample) BMJ Open Diabetes Research and Care7(1), e000981.http://dx.doi.org/10.1136/bmjdrc-2019-000981

Elsaid, A., El-Said, M., Emile, S., Youssef, M., Khafagy, W., & Elshobaky, A. (2020). A randomized controlled trial on autologous platelet-rich plasma versus saline dressing in the treatment of non-healing diabetic foot ulcers. World Journal of Surgery44(4), 1294-1301(Evidence Synthesis Comprehensive Nursing Paper Sample). https://doi.org/10.1007/s00268-019-05316-0

Wiegand, C., Bittenger, K., Galiano, R. D., Driver, V. R., & Gibbons, G. W. (2017). Does noncontact low‐frequency ultrasound therapy contribute to wound healing at the molecular level? Wound Repair and Regeneration25(5), 871–882(Evidence Synthesis Comprehensive Nursing Paper Sample). https://doi.org/10.1111/wrr.12595

HealthyPeople.gov. (October 2021).  Diabetes. (Evidence Synthesis Comprehensive Nursing Paper Sample)Retrieved 23 November, from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

The Washington Post. (May 2021). Diabetes in America with Aaron Neinstein, MD, Rita Rastogi Kalyani, MD, MHS & Jennifer Raymond, MD, MCR. Retrieved 23 November 2021, from https://www.washingtonpost.com/washington-post-live/2021/05/04/diabetes-america/

Centers for Disease Control and Prevention. (February 2020). National Diabetes Statistics Report, 2020: Estimates of Diabetes and Its Burden in the United States. Retrieved 24 November 2021, (Evidence Synthesis Comprehensive Nursing Paper Sample)from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf



Appendix A: Summary Tool

Article Number Author and Date Evidence Type Sample, Sample Size, Setting Findings That Help Answer the EBP Question Observable Measures Limitations Evidence Level, Quality
31811339 Elsaid, A., El-Said, M., Emile, S., Youssef, M., Khafagy, W., & Elshobaky, A.
Quantitative 24 patients
The General Surgery Department of Mansoura
University Hospital (MUH)
·         PRP gel dressing is superior in reducing the surface area of ulcers and accelerating healing compared to saline dressing.

·         Wound status and response to therapy can influence the efficacy of PRP gel dressing compared to saline dressing.

Percentage reduction in the size of DFU. ·         Differences in patient characteristics.

·         The saline dressing compared to PRP. The former is not usually considered an optimal DFU treatment.

·         Researcher bias.

Level I, High-quality rating.


e000981 Boels, A. M., Vos, R. C., Dijkhorst-Oei, L. T., & Rutten, G. E..

9/ 11/ 2019

Quantitative 228 patients

Outpatient practices and clinics across the Netherlands

·         Smartphone-enabled digital self-management education and support are vital for individuals under insulin therapy.

·         DSME/S should be tailored to meet individual patient needs.

Glycemic (HbA1c) and patient rating of intervention usability and applicability. ·         The results have limited generalizability.

·         Individual use of diabetes apps was not monitored.

Level I, High-quality rating.


871-882 Wiegand, C., Bittenger, K., Galiano, R. D., Driver, V. R., & Gibbons, G. W.

9/10/ 2017

Quantitative Fifteen clinical sites and 42 subjects ·         NLFU improves wound healing by promoting blood flow, reducing bacterial cells, and suppressing inflammation. Size of CLVU

Amount of bacterial cells

The impact of NLFU therapy is limited by infections and the size of the wound. Level I, High-quality rating.


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