2806NRS Evidence Based Nursing Case Study 1 Sample

2806NRS Evidence Based Nursing Case Study 1

Assignment Brief

Case Study

Aunty Rosie is a 58-year-old woman from a rural Indigenous community. She has a long- standing history of type 2 diabetes, hypertension, and obesity. Over the last several months, she has been experiencing fatigue, increased swelling in her legs, and difficulty breathing after physical activity. After multiple visits to her local health centre, her primary healthcare provider referred her to the regional hospital for further evaluation.

She underwent blood tests, including serum creatinine and eGFR (estimated Glomerular Filtration Rate), which indicated early-stage chronic kidney disease (CKD), Stage 3. Aunty Rosie has been struggling to manage her diabetes and hypertension consistently and has limited access to specialised care and medications due to her remote location. She is currently admitted to the Nephrology ward to receive education related to CKD and stabilisation of her diabetes. She has an intravenous (IV) cannula inserted, is on a strict fluid balance chart and prescribed Metformin.

For this assessment, you need to search the literature to find articles that are relevant to Aunty Rosie’s case, write an annotated bibliography for three (3) articles and then provide evidence-based nursing recommendations based on the literature search and annotated bibliography.

There are three (3 parts) to this task.

Part 1: Search strategy (Complete the template) and reflection

You are required to plan a search strategy using the template provided and then undertake the Cumulated Index in Nursing and Allied Health Literature (CINAHL) database search to find literature to support evidence-based nursing practice for Auntie Rosie.

You need to complete the Search Strategy template, undertake the search using CINAHL via Griffith University library, take screenshots of your search results and then choose three (3) articles from your search to support the nursing recommendations which will be used in part 3

After conducting the search, write a personal reflection on how you found the search strategy. You could include information on how easy/hard it was, did you need to change your search strategy to find more relevant information, will you use CINAHL again, etc. (200 words)

Part 2: Annotated Bibliography

Based on Auntie Rosie’s case, choose three (3) research articles from the reference list below to complete Part 2. Select the three articles that you think provide the best evidence-based guidance for the nursing care of Auntie Rosie.

Write an annotation* for each of the three (3) research articles you select from the Reference List below (300 words each annotation).

In each annotation you need to include:

• The full bibliographic citation;

• Outline the main aim/objective;

• Identify the research methods;

• State the strengths and limitations of the article;

• Discuss the quality of the article; and

• Identify any conclusions/recommendations made by the authors.

Part 3: Evidence based nursing recommendations

Now, you have 6 articles from three (3) articles from your literature search (Part 1) and three (3) articles from annotated bibliography (Part 2).
Provide two (2) nursing recommendations based on the evidence you have read from the six (6) articles to enhance professional and safe nursing practice for Aunty Rosie (400 words).

Other elements:

• You need to adhere strictly to the word limit of 1500 words. The word limit for an assessment item includes in text citations, tables and quotations. The word limit DOES NOT include the reference list. Please note the marker will cease marking your submitted work once they have reached the allocated word limit.

• Use APA 7 referencing style.

Solution

PART 1

Throughout the search, I found the process challenging and interesting. I started by searching using the direct key terms relating to Aunty Rosie’s case, i.e., type 2 diabetes, Indigenous, chronic kidney disease, and rural. I presumed that these would give me plenty of relevant articles, but I soon discovered that the majority of the results were too broad or did not address specifically the special case of Indigenous people living in rural areas and having multiple health conditions.

For better results, I also used other keywords including Aboriginal, First Nations, renal disease, and access to health. This helped me get articles that were much more relevant and useful to know about Aunty Rosie’s case. I noted that the use of several keywords gave me more targeted and detailed research on chronic disease management among rural Indigenous populations.

All things considered, although taking extra time and some adjustments, I found the searching experience to be worthwhile. I learned the importance of being flexible in searching strategy to get the most useful information. I would definitely use CINAHL again, for MBA assignment expert as it provided credible and useful articles to this assignment.

PART 2 Annotated Bibliography

Article 1 Citation: Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., Fraser, J., Rickard, C. (2016). Skin Glue Reduces the Failure Rate of Emergency Department–Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial. Annals of Emergency Medicine, 68, 196-201.

Objective: This study was designed to ascertain whether the use of cyanoacrylate skin glue would decrease the failure of peripheral intravenous catheters (PIVCs) inserted among adult emergency department patients. The authors aimed to ascertain whether application of skin glue as an adjunct to standard securement practice stabilizes catheters and prevents early failure.

Research Methods: One-center, non-blinded, randomized controlled trial of 380 PIVCs was conducted by the authors among 360 adult subjects. The subjects were randomized to either one of the following two groups: one group received standard catheter securement and the other received standard securement and application of skin glue. Catheter failure within 48 hours due to infection, phlebitis, occlusion, or dislodgement was the primary end point.

Strengths and Limitations: One of the research's greatest strengths lies in its randomized controlled trial (RCT) design, considered the 'gold standard' of clinical research. The trial was of high sample size and was demonstrated to be of practical relevance to emergency and acute care settings. The trial was non-blinded, though, and this can result in bias. The trial was conducted at one hospital, and this can limit the power to generalize. The 48-hour follow-up may not be sufficient to capture long-term complications.

Standard of the Article: It is high-quality research because it includes good methodology, ethical approval, and statistical significance of findings. It is clinically applicable as well, especially to those individuals who require long-term IV access, i.e., those who are suffering from chronic diseases such as CKD.

Conclusion/Recommendations: It was discovered that the use of skin glue as an adjunct to standard securement considerably reduces PIVC failure, particularly by reducing dislodgement rates. The authors recommend that skin glue be incorporated as part of standard PIVC securement as a practice in emergency and inpatient departments.

Article 2 citation: Aquino, J., Marshall, A.P., Ranse, K., & Mills, K. (2025). The Urban Hospitalisation Experience of Rural People: A Scoping Review. J Adv Nurs. https://doi.org/10.1111/jan.16675

Objectives: The primary aim of this article is to research and document the experiences of rural patients and their families who travel and migrate for hospitalization. The study aimed to map existing research on this subject and determine the challenges and pressures rural patients face when hospitalized in urban hospitals.

Research Methods: This research utilized the design of a scoping review, conducting systematic searches through databases such as CINAHL, MEDLINE, PsycINFO, and EMBASE. Thirty-four papers were included and an inductive narrative approach was utilized to extract, sort, and synthesize the information. The review followed the PRISMA-ScR guidelines to promote transparency and rigour.

Strengths and Limitations: One of the strengths of the study is that it is systematic and broad in its scope, enabling an understanding of the rural patient experience from several studies. The application of the methodology of the scoping review facilitated the authors to capture an extensive range of literature and views. The study's limitation lies in the diversity of studies included, and these may have varying contexts, populations, and health systems, and hence may prove difficult to generalize. The review was primarily focused on published papers, and hence grey literature may be missed.

Quality of the article: The paper is high quality as it is peer-reviewed, sound methodology-wise, and fills the gap in the health literature. It offers helpful insights on the social, cultural, and psychological concerns of rural patients, particularly Indigenous people, and these are highly applicable to Aunty Rosie’s case.
Conclusion/Recommendations: Authors believed that rural patients, especially Indigenous populations, are subjected to additional psychological distress due to isolation, disconnection from support systems, and unfamiliar hospital environments. They recommend that health professionals use culturally safe practice, increase communication, and offer more support to rural patients when hospitalized to prevent distress and maximize outcomes.
 
Article 3 citation: Huria, T., Pitama, S., Beckert, L., Hughes, J, Monk, N., Lacey, C., & Palmer,S.C. (2021). Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health, 21(1):1471-2458. https://doi.org/10.1186/s12889-021-11180-2
Objective: This research set out to systematically review and synthesize quantitative research on the determinants of health inequities among Indigenous Peoples who have chronic kidney disease (CKD). The objective was to identify the biological, social, and structural determinants of poorer CKD outcomes among Indigenous populations globally, including Aboriginal and Torres Strait Islander peoples, Māori, and other colonised Indigenous populations.

Research Methods: Authors utilized systematic review and meta-synthesis methodology, grounded in Kaupapa Māori methodology and David R. Williams' framework. 180 studies were included after screening more than 4,000 papers from major databases. Analysis looked at causes of health inequities as reported, categorized as biological, social, cultural, and structural determinants.

Strengths and Limitations: One of the strengths of this review is the Indigenous-led research methodology, guaranteeing that Indigenous perspectives were prioritised throughout the analysis. It provides a broad picture of health inequities beyond clinical determinants, identifying systemic racism and colonization as key drivers. A limitation is that the majority of the studies reviewed did not use Indigenous methodologies or perspectives to their full potential, potentially limiting the depth of the evidence. An additional limitation is that the majority of the studies looked at biological risk factors more than social determinants.

Quality of the Article: This paper is of high quality as it is critically and culturally aware. It makes an original contribution to the body of knowledge by identifying social and structural determinants of health inequality among Indigenous individuals with CKD, and this is extremely pertinent to Aunty Rosie's case.
Conclusion/Recommendations: The authors believed that while biological etiologies of diabetes and hypertension are the causes of CKD among Indigenous Peoples, systemic determinants of inequity such as racism, colonisation, and poor access to health services are the primary drivers. They recommend that research and health interventions of the future must address these structural determinants and engage Indigenous people and their leaders.

Part 3

Recommendation 1: Offer Culturally Safe and Individualised Education to Aunty Rosie

Aunty Rosie's situation reflects that of numerous Indigenous and rural hospitalised patients. Literature (Aquino et al., 2025) has all identified that Indigenous people are often subjected to hospitalization that is filled with fear, anxiety, and mistrust, particularly when their communication is not culturally appropriate. As Aunty Rosie's diagnosis involves early-stage chronic kidney disease (CKD) and diabetes and hypertension, culturally safe and person-centred education is important.

Nurses are required to provide education that reflects Aunty Rosie’s cultural identity, community connections, and learning style. This is more than just telling medical facts—it involves actively discussing Aunty Rosie’s care with her in plain English, frequently assessing understanding, and avoiding the use of jargon.

Storytelling (yarning) and the use of visual aids have been shown to be more accessible to Indigenous patients than Western pedagogy. Having Aboriginal Health Workers or Cultural Liaison Officers involved during teaching sessions may also provide a familiar cultural presence and facilitate bridging communication gaps. Nurses should also be sensitive to how illness, medication, and treatment may intersect with customary practices and beliefs Aunty Rosie may hold. Through this approach, nurses will facilitate Aunty Rosie to become an active participant in her own care, build her confidence to take control of CKD and diabetes, and avoidable complications and hospital readmissions.

Recommendation 2: Culturally Safe and Sensitive IV Cannula Insertion and Maintenance to Aunty Rosie

It is important to manage Aunty Rosie's vascular access carefully based on her current therapy on an intravenous (IV) cannula and comorbid conditions of early chronic kidney disease and diabetes. Evidence from Bugden et al., (2016) supports the use of the application of skin glue when placing the cannula to prevent complications of dislodgement, blockage, and infection, to which Aunty Rosie is particularly vulnerable due to the fragility of her veins. Nurses should employ evidence-based practice interventions of the application of skin glue (if possible) and perform frequent assessments of phlebitis, occlusion, or infection to prevent delays.
Also important is the application of culturally safe communication. Nurses must clearly and respectfully explain the reason, procedure, and cannula care, respecting Aunty Rosie’s distress and disconnection from her people. Involvement of Aunty Rosie in decision-making relating to her care and the incorporation of Aboriginal Health Workers can facilitate trust and reassurance (Barton, Anderson & Thommasen, 2005). Clinical safety and cultural sensitivity are fostered by this practice, and Aunty Rosie’s hospital experience and health outcomes are improved.

Reference

Aquino, J., Marshall, A.P., Ranse, K., & Mills, K. (2025). The Urban Hospitalisation Experience of Rural People: A Scoping Review. J Adv Nurs. https://doi.org/10.1111/jan.16675

Barton, S. S., Anderson, N., & Thommasen, H. V. (2005). The diabetes experiences of Aboriginal people living in a rural Canadian community. Australian Journal of Rural Health, 13(4), 242–246. https://doi.org/10.1111/j.1440-1584.2005.00709.x

Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., Fraser, J., Rickard, C. (2016). Skin Glue Reduces the Failure Rate of Emergency Department–Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial. Annals of Emergency Medicine, 68, 196-201.

Huria, T., Pitama, S., Beckert, L., Hughes, J, Monk, N., Lacey, C., & Palmer,S.C. (2021). Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health, 21(1):1471-2458. https://doi.org/10.1186/s12889-021-11180-2

Janssen, J., & Nelson, K. (2014). MEETING THE NEEDS OF MĀORI WITH DIABETES: EVALUATION OF A NURSE-LED SERVICE. Nursing Praxis in New Zealand, 30(3).

Lee, R. S., Brown, H. K., Salih, S., & Benoit, A. C. (2022). Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations. Australian & New Zealand Journal of Psychiatry, 56(10), 1230-1251. https://doi.org/10.1177/00048674221089837