Questions and an Evidence-Based Approach: COPD

Questions and an Evidence-Based Approach: COPD


The term PICOT abbreviates the elements of a clinical research question, i.e., population, intervention, comparison, outcome, and time. In nursing care, PICOT helps a researcher to summarize research questions that explore the effect of treatment. When developing a PICOT question, nurses use EBP approaches which provide them with methods of using critically appraised and scientifically proved evidence to deliver quality care to a specific population. In this paper, the researcher will define a practice issue surrounding patients with diabetic ketoacidosis (DKA), explore the issue using the PICOT approach, identify sources of evidence that could potentially be effective in answering the PICOT question, and describe the relevance of the key findings in the decision-making process…

Use of the PICO(T) Approach when Managing Patients with Diabetic Ketoacidosis (DKA)

The practice issue to be explored via the PICO(T) approach is management of diabetic ketoacidosis (DKA) in adults. According to (Evans, 2019), DKA is a potentially deadly condition especially if misdiagnosed and mistreated. Over the last decade, DKA management and treatment have changed, with medical guidelines being introduced to standardize care, reduce morbidity and mortality, and spread best practices. In this study, the PICOT question is: Among diabetic ketoacidosis patients, is insulin therapy (pharmacological approach) more effective than taking low-calorie diet (non-pharmacological approach) in managing and treating DKA complications over a one (1) year period? The various elements of this clinical question include population (P): diabetic ketoacidosis adult patients, intervention (I): insulin therapy, comparison (C):  taking low-calorie diet, outcomes (O): management of DKA complications, and time (T): one year. The intervention identified is pharmacological/ use of medication therapy, i.e., insulin intake, which is a recommended treatment for people diagnosed with DKA, type 1 diabetes, and type 2 diabetes. The aim of insulin therapy is keeping blood sugar levels within the correct range. In exploring this clinical question, only the approved measures of managing DKA in both nursing and home-based care are considered (French et al., 2019).

Identifying Sources of Evidence for use in Answering the PICOT Question

To answer clinical questions, both models and sources of external evidence are used. In nursing care, sources of external evidence include BMJ clinical evidence, CINAHL, ACP Journal Club, Cochrane Databases, Medscape, PubMed, and more. The commonly used models in DKA management include the Chronic Care Model, self-intervention model, and care staff-directed model.

Chronic Care Model (CCM): The Chronic Care Model for Diabetes is designed to provide chronic diabetic ketoacidosis patients with self-care methods to track their recovery processes. This framework is population-based and develops supportive, practical, evidence-based interactions between an activated, informed, and prepare patient with a proactive nursing care provider (Misra & Oliver, 2015). In the management of DKA patients, CCM synthesizes several elements of disease management programs, helping boost self-care management and support, delivery system design, decision support, and clinical information systems. By searching Cochrane Library databases and Medline, efficacy CCM models for DKA management and treatment can be obtained.

Self-Intervention Model: This model empowers patients with diabetic ketoacidosis to manage their insulin levels. Patients are encouraged to set treatment goals, identify challenges and barriers, and monitor their progress towards recovery. Using effective self-management support approaches, such as self-assessment, action planning, goal setting, problem-solving, and follow-up, are recommended resources (Dhatariya et al., 2019). Under the self-intervention model, DKA patients work to ensure clearance of ketones, restoration of circulatory volume, and correction of electrolyte imbalance. Evidence about this model can be found in CINAHL, BMJ Clinical Evidence, and Cochrane Databases.

Care Staff-Directed Model: Nurses and pharmacists play a major role in directing care for DKA patients. DKA patients experience higher mortality and morbidity rates. The American Diabetes Association recommends evidence-based approaches and outcomes measures as interventions to improve DKA care (Misra & Oliver, 2015). This model is utilized under hospital settings, and thus a pharmacological approach. The use of medications like insulin are guided by care staff, e.g., nurses. They offer regular feedback to the patient, and this process can take between 6 months to two years.

Findings from Articles

The treatment and management of DKA take two forms, i.e., pharmacological and non-pharmacological approaches. Insulin therapy is a good example of a pharmacological approach, while taking low-calorie diet is a good example of a non-pharmacological treatment approach. Studies by (Evans, 2019) show that DKA management has three elements: ketones clearance, circulatory volume restoration, and electrolyte imbalance correction. As a pharmacological approach, standard low insulin therapy helps DKA patients keep their blood sugar levels within the required range. Both individualized management and care staff-directed models are used in the administration of insulin therapy. Besides, DKA is managed and treated using non-pharmacological approaches, for example, taking low-calorie diet. According to (Tran, et al., 2017), a very low-calorie diet has been proved to help DKA patients control their blood sugar. After one year, DKA patients are expected to be able to manage their blood sugar levels without medication. Applying a chronic care model and a self-intervention model helps achieve this goal.

Relevance of Findings

The study by (Evans, 2019) is credible in this paper because it explains the various approaches to managing diabetic ketoacidosis. In the study, the author argues that DKA management has significantly changed over the last decade, helping standardize care. Also, the article summarizes the basis for DKA diagnosis. Besides, the article explores the complications associated with DKA to its patients. Also, the article explores the pitfalls in DKA management, recommends EBP approaches of DKA management, and explains the ways for preventing its recurrence once controlled. Tran et al., (2017) studies were chosen as the article reviews evidence for adult diabetic ketoacidosis and is published in PubMed. The article investigates ways of DKA management in adults, focusing on insulin administration and the use of intravenous (IV) fluids. Also, the study advocates for ketone measurement as key in DKA assessment, diagnosis, and management. The study also enumerates the benefits of using low-calorie diet as a non-pharmacological approach to DKA management.


The management of diabetic ketoacidosis in adults can follow either pharmacological or non-pharmacological approaches. The goal of DKA patients’ management and treatment is to control the complications associated with the condition. In this paper, the PICO(T) model was utilized to determine whether adopting insulin therapy, a pharmacological treatment approach, was more effective than taking a low-calorie diet, a non-pharmacological approach when managing and treating patients with DKA complications. The articles by (Evans, 2019) and Tran et al. (2017) provide relevant, reliable, and contextual information to answer this clinical PICOT question adequately.


  • Dhatariya, K. K. (2019). Defining and characterizing diabetic ketoacidosis in adults. Diabetes Research and Clinical Practice, 155. doi:
  • Evans, K. (2019). Diabetic ketoacidosis: update on management. Clinical Medicine Journal. doi:
  • French, E. K., Donihi, A. C., & Korytkowski, M. T. (2019). Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: Review of acute decompensated diabetes in adult patients. BMJ, 365. doi:
  • Misra, S., & Oliver, N. S. (2015). Utility of ketone measurement in the prevention, diagnosis and management of diabetic ketoacidosis. Diabetic Medicine, 32(1), 14-23. doi:
  • Tran, T. T., Pease, A., Wood, A. J., Zajac, J. D., Martensson, J., Bellomo, R., & Ekinci, E. I. (2017). Review of evidence for adult diabetic ketoacidosis management protocols. Frontiers of Endocrinology, 106.