Malene D

Searching and Critiquing the Evidence

The nursing shortage has been a practice problem that has plagued our country and other countries for decades.  It has been an issue in small and impoverished countries due to nurses’ recruitment from their home countries, leaving a population in trouble for care.

The literature has a plethora of information regarding niche nursing and the effects of the shortage on that area.  The pandemic has created another layer of complexity on top of an already aged profession retiring from the profession with decades of information and critical best practices.  This, paired with the fact that nursing faculty positions are not the most desired of the field, lends itself to individuals not inspired to join the esteemed group of professionals and those descended from Florence Nightingale.    The literature reiterates the issues: management, flexibility, culture, pay rates and counteracting burnout.

Literature Strengthens the Merit of Selected Framework and Practice Problem

The literature strengthened the merit of the selected theoretical framework by validating and underscoring that purposeful tactics necessary to reduce turnover and inspire nurses to stay in the field.  In the first article by Park and Yu (2019), the level of evidence is systematic or Level C in the new AACN’s level of the evidence-leveling system (Armola et al. 2009).

In this systematic study, the multi-dimensional approach is the key to advancing the concept and theory that applies to the nursing shortage.  In the second article, by Auerbach and Zangaro et al. (2017), the literature is shown to strengthen the framework that forecast models can help policymakers, educators, and others anticipate and take action to forestall mitigate surpluses or shortages of key healthcare providers.  This level of evidence is Level C on the ACCN pyramid of evidence.  In the third article, Hazelton and Berthelsen (2020) investigate nurse leaders’ experiences and turnover strategies concerning culture and work environment.

This speaks directly to the Nightingale theory that administration has much to do with the nursing field’s progression.  In the fourth article by Uchmanowicz et al. (2020), the relationship between burnout, job satisfaction, and nursing care rationing is studied.  In this study, rationing is defined as care that is missed, withheld due to time limitations, staffing levels, and staffing mix.  This level of evidence is Level C on the AACN level of evidence.

Most prevalent levels of evidence, and why?

The articles fall into level C of the AACN levels of evidence since they are fairly new to be published and a predictive review.  This level includes the systematic review and meta-analysis evidence that underscored the areas that attributed to the nursing shortage.  The most prevalent levels of evidence are Level C or Level 1 throughout the articles. (Armola et al., 2009).  This practice problem of the nursing shortage will continue to plague the world until government policies surrounding the training, the treatment, and the education of the field are addressed.


Armola RR, Bourgault AM, Halm MA, Board RM, Bucher L, Harrington L, Heafey CA, Lee R,

Shellner PK, & Medina J. (2009). AACN levels of evidence: what’s new? Critical Care

Nurse29(4), 70–73.

Auerbach, D, Zangaro, G, (2017), Improving nursing workforce forecast:  comparative

analysis of the cohort supply model and the health workforce simulation model.

Nursing Economics.  November-December 35, 6.

Gray, J., Groves, S., Sutherland, S. (2017).  The practice of nursing research: appraisal,

synthesis, and generation of evidence.  8th edition.  Saunders.  St. Louis MO. Elsevier

Hazelton, B., Berthelsen, C. (2020). Leading unique cultures in departments with low

turnover of nurses.  A positive deviance approach study.  Journal of Nursing

            Management. 28, 6.

Park, H. & Yu, Soyoung, (2019).  Effective policies for eliminating nursing workforce shortages:

A systematic review.  Health Policy and Technology. 8, 296-303.

Uchmanowicz, I. et al. (2020) The relationship between job burnout, job satisfaction and the

rationing of nursing care a cross-sectional study.  Journal of Nursing Management.


Brunette B

How does the literature strengthen or weaken the merit of your selected theoretical framework and practice problem?

Article “Evidence-Based Practice Protocol to Improve Glucose Control in Individuals with Type 2 Diabetes Mellitus”

The study aims to present evidence of alternative clinical implementation to limit the gaps in care delivery of type 2 DM. The research meets the hypothesis of the sample. The interdisciplinary team gathering the sample by the selection of patients with type 2 diabetes mellitus who meet the criteria and may be compliant with the continuity of education and follow-ups with blood sugar level. The design appropriate sample with adequate implementation to the ideal purpose outcome. The article applies computer-aided analysis data such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source: Nursing/Academic Edition, MEDLINE, Educational Resource Information Center (ERIC), the Cochrane Library, and Diabetes Pro (professional resources online) (Evans, 2010). However, the weakness is the limitation of the sample to conclude the effectiveness of the study. The experiment eliminates people who restricted means of communication (Evans, 2010).

What levels of evidence are most prevalent in these articles?

Type 2 diabetes mellitus characterized as a metabolic dysfunction with insulin resistance that may contribute to health complexities causing morbidity and even deaths (Buehler, et al. 2013). Research subjects discuss the relevance of health complications with uncontrolled type 2 diabetes mellitus (type 2 DM). The article indicates Dorthea Orem’s Mid-Range Theory of Self-Care of wellbeing and treatment guidelines for Advanced Practice Nurse (APN) and interdisciplinary team implementation by contacted the patients biweekly through telephone calls for continuous coaching on glycemic control at home and meal planning. The article also discusses steps to promote care for preventative measures such as pneumococcal and annual influenza vaccines, manage weight gain, and comorbidity prevention (Evans, 2010).

Why do you think that level of evidence is most prevalent?

Type 2 DM is one of the most chronic common conditions in primary care offices. The diabetic guideline for glycemic control implementation is essential to prevent comorbidity. The article provides additional evidence to improve patient compliance with self-care. Many studies contribute a viewpoint to expand the subject in proposal literature and guidelines to manage glycemic control through evidence into practice.

Evans, M. M. (2010). Evidence-based practice protocol to improve glucose control in individuals with type 2 diabetes mellitus. MEDSURG Nursing, 19(6), 317-322.

Mimenza-Alvarado, A. J., Jiménez-Castillo, G. A., Yeverino-Castro, S. G., Barragán-Berlanga, A. J., Pérez-Zepeda, M. U., Ávila-Funes, J. A., & Aguilar-Navarro, S. G. (2020). Effect of poor glycemic control in cognitive performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study. BMC Geriatrics20(1), 424.

Linkeviciute-Ulinskiene, D., Kaceniene, A., Dulskas, A., Patasius, A., Zabuliene, L., & Smailyte, G. (2020). Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania. International Journal of Environmental Research and Public Health17(18).

Wang, S., Cui, H., Ji, K., Song, C., Ren, C., Guo, H., Zhu, C., Wang, S., & Lai, Y. (2020). Impact of type 2 diabetes mellitus on mid-term mortality for hypertrophic cardiomyopathy patients who underwent septal myectomy. Cardiovascular Diabetology19(1), 64.


Your information presented showed a “valid contribution of evidence generated by a range of different types of research” (Evans, 2003, p. 77). A basic application of an evidence-based practice is handwashing to prevent the spread of pathogens. Unfortunately, though it may seem like a simple component used universally it still shows up as a noncompliant factor in healthcare settings. A behavioral theory was used in a study to examine noncompliance for future interventions. The two behavioral areas that were linked to noncompliance were the categories of Memory/Attention/Decision Making and Knowledge. The domain of Memory/Attention/Decision making refers to forgetting to complete the task, preoccupation or distractions, or deciding not to complete the task as it was seen as non-emergent. The Knowledge category refers to lack of knowledge of protocols, thinking gloves were sufficient, and unawareness of needs or requirements of the hand hygiene. An interesting conclusion noted was that hand hygiene interventions should aim at “automatic associative learning processes and conscious decision making” (Fuller et al., 2014, p. 106). A strong component of this research was that ‘real time’ was used, showing the noncompliance immediately after a task and it was directly observed (Fuller et al., 2014).


Evans, D., (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare

interventions. Journal of Clinical Nursing, 12(1), 77-84. doi: 10.1046/j.1365-2702.2003.00662.x

Fuller, C., Besser, S., Savage, J., McAteer, J., Stone, S., & Michie, S. (2014). American Journal of Infection

Control, 42(2), 106-110.


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