****Based off the research article that I have created, what is the best way to do the following,

(with rationale please)

1) create a research design using descriptive, correlational, quasi-experimental, or experimental method?

2) Create a sampling method

(must include : inclusion and exclusion criteria, sample size, setting from which sample will be selected -Kaiser Hospital)

3) Data Collection Method

(* State the type of statistical analysis you will use, including brief explanation as to why the statistical analysis methods are appropriate (e.g. why would ANOVA or t-tests be appropriate for the type of data you are collecting)

I CREATED THIS ARTICLE, if you could help me with creating these 3 parts. Thank you!

Effective Self-Management Strategies for Low Income Individuals

Diabetes mellitus (DM) is a metabolic disease that causes imbalances in blood sugar due to abnormal levels of insulin (Gosmanov et al., 2021). Those diagnosed with type 1 diabetes have a pancreas that does not produce any insulin to support their body. Those diagnosed with DM type 2 have a pancreas that produces insulin, but not enough to transport the glucose readily available in the blood stream. Diabetic ketoacidosis (DKA) is a condition caused by an excess amount of glucose, lack of insulin, can cause a diabetic coma, and primarily affects DM type 1 (Gosmanov et al., 2021). About 90% of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) cases are those diagnosed with DM type 2. These conditions can develop into a life-threatening condition such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNS). DKA admissions accounted for 220,340 in the U.S. in 2017 and continue to rise, while the rate of HHNS admissions remains at only 1% (Gosmanov et al., 2021). With the rise in admissions for DKA, the rise in cost has increased to 5.1 billion USD in 2014 (Gosmanov et al., 2021). Although hospitalization rates are higher in DKA, the mortality rate of HHS is higher when compared.

Adults with type 1 diabetes are usually diagnosed at a young age and often have many years' experience with caring for themselves. DM type 2 can have years of experience or newly diagnosed with lack of knowledge. Whether the DM patient is experienced or newly diagnosed, it is clear that insulin is crucial for survival. One would question how these patients would allow their glucose levels to reach DKA or HHS status. There may be underlying causes of what can lead a person with years of experience in this chronic illness to not correctly self-manage their medication.

NINR agenda

The National Institute of Nursing Research's (NINR) mission is centered on promoting and improving health for people, families, and communities with support of clinical and basic research (National Institute of Nursing Research, 2020). The four newest strategic plan's the NINR is currently working on includes symptom science, wellness, self-management, and end-of-life and palliative care. The NINR's plan for wellness is focused on promoting health and preventing illness (National Institute of Nursing Research, 2020). Prevention is key to improving the quality of life and preventing comorbidities. This study relates to the NINR's research agenda by investigating effective self-management strategies for those who identify as low income.

Purpose Statement

This study will base its findings on effective self-management strategies to reduce insulin requirements among persons with low income. The purpose statement concerns the prevalence of type 2 diabetes in the United States of America and globally. For instance, type 2 diabetes has been identified as a very costly disease in the United States and worldwide. More than 300 million people in the world will have developed diabetes by the end of 2025 (Barko et al., 2011). Nearly 20% of adults are newly diagnosed with diabetes by presenting to the hospital in DKA status (Benoit et al., 2020). There is more and more evidence in research showing that improvements in self-management of diabetes help to promote health, improve health, and prevent comorbidities in those diagnosed with DM and identify as low income.

Literature Review

A study was done by Barko et al. (2011) to find differences in perceptions of DM symptoms and self-management strategies between Slavic immigrant Americans and nonimmigrant white American women. This study used qualitative-descriptive method with type 2 diabetes as an independent variable while the age, sex, income and the BMI are the dependent variables (Barko et al., 2011). The sample of 40 women, 55 years of age and older were chosen as the sample. From this sample, some interviews were done randomly by a selected Russian- Slavic immigrant women with type 2 diabetes and white American women having type 2 diabetes. Research was focused on the qualitative methods in the collection of data analysis by using the rate by which people are affected by type 2 diabetes (Barko et al., 2011). The immigrants had more symptoms of diabetes compared to the Americans. Data from the study indicate that immigrants due to the reliance on government assistance, hinders the ability to embrace the knowledge and behaviors that are foundational to diabetes and self-management. Understanding the basic concepts of diabetes management is difficult for this population because of their view of the illness and their beliefs about what can improve it. After data was collected from the interviews, participants attended a class explaining diet portions and dietary choices with a teacher that spoke their language. Results showed that the statistics had there was no significant differences in group means for the demographics and health related characteristics. In general, self-management interventions, especially culturally tailored approaches, showed promise in improving diabetes outcomes (Barko et al., 2011).

Another research study was held by Benoit et al. (2020) in an emergency department (ED) nationwide focused on ED visits and inpatient admissions for HHNS and DKA. The purpose of the study was to observe trends and rates in DKA and HHNS in adults in an inpatient and emergency department setting (Benoit et al., 2020). In this sample was 184,255 total participants with 27,532 events of DKA and HHNS (Benoit et al., 2020). The independent variables were diabetes type, age group, sex, race/ethnicity, while the dependent variables were DKA and HHNS. Linearization as well as Join-point Trend Analysis Software was used to evaluate the variance of the ratio of numerator and the denominator (Benoit et al., 2020). The results were that DKA was highest among ages 18-44 in DM 2, and 90% of DM 2 had episodes of HHNS in ages 45-64 (Benoit et al., 2020).

In addition to the previous studies, Ruggiero et al. (2014) held a randomized controlled trial, to develop, implement, evaluate, and teach those with DM. Four clinics conducted a randomized controlled trial with 2 groups consisting of Hispanic and African American ethnicity using interval levels of measurement including a control group, a group that had 6 months of intervention training, and another group that had 12 months of intervention training. A sample of 266 participants were included in the study. Staff were trained culturally sensitive techniques to teach participants diabetes self-management and behavioral counseling strategies. No significant differences were found in the baseline group, while the other groups showed an improvement in DM management overtime with interventions.

Research Question and Hypothesis

The incidence between insulin requirements and diabetes self-management strategies continues to be a key issue in low-income individuals. Literature reviews show that DKA and HHNS continue to be studied with hopes to find efficacious strategies for preventing DKA and HHNS. As previously stated in one of the NINR's stated goals, prevention is key to improving the quality of life and preventing comorbidities.

Question:

Will incorporating the teach back method upon discharge improve self-management skills in adult diabetics as compared to traditional basic discharge instructions in an ED setting?

Hypothesis

Implementation of educating after care instructions to a diabetic patient in an emergency care setting will encourage better understanding of diabetes, help to improve quality of life, and improved patient experience.

There will be no relationship between basic verbal and written after care teaching and the teach back method in improving understanding of diabetes, improving quality of life, and improved patient experience.

Variables

Intervention:

Aftercare instructions for diabetic patients will be taught verbally, patients will be provided with a handout, patients and will be asked to teach back what was taught to them. After patients have completed this, nurses will ask the patient questions to gage their understanding level.

Independent Variable

Implementation of the teach back method

Dependent Variable

Patient understanding of disease process

Patient understanding of how to care for diabetic needs.

Extraneous Variable

Age

Years of experience

Research Design

This experimental study will focus on whether an educational program based on diabetic self-care strategies will help to improve quality of life and prevent comorbidities. Two groups of healthcare workers have agreed to participate in this study in the emergency department. A control group, and an experimental group.