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Literature Review Assignment Paper
Literature Review Assignment Paper
The purpose of this assignment is to state a clinical/practice question and explore the literature pertaining to your clinical/practice problem. You may use the question you developed in the previous module. additionally, you may use this in future course including your capstone. When conducting a literature review, the goal is to obtain a representative sample of the literature which describes the concepts related to the phenomenon of interest and the research results applicable to the clinical/practice question and identify what gaps need to be further researched. Literature Review Assignment Paper
This assignment is due Wednesday, Week 6, by 11:59 PM EST. This assignment is worth 20% of Course Grade.
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- Please follow the rubric below
- You can use the rubric criteria as headings and subheadings for your paper
- Rubric: Construction of a Clinical Practice Question & Literature Review Rubric.docxActions
- Your work for this paper can be used to build upon your capstone project and a publishable manuscript
- Write your paper in APA 7th edition professional paper format
- Sample APA 7th edition professional paper: APA 7th Edition Professional Paper (APA Style).pdfActions
- Paper length is no more than 8 pages excluding references and title page
Clinical Practice Question and Literature Review
This is 20% of the total grade.
The purpose of this assignment is to state your clinical/practice question (PICOT) and explore the literature pertaining to your clinical/practice problem. When conducting a literature review, the goal is to obtain a representative sample of the literature which describes the concepts related to the phenomenon of interest and the research results applicable to the clinical/practice question and identify what gaps need to be further researched. Please follow the rubric below. Your work for this paper can be used as a foundation for your MSN capstone project. Paper length is no more than 8 pages excluding references and title page. Literature Review Assignment Paper
Criteria Points Comments Points Achieved Section I: Introduction and Question State the practice question you wish to address (include Independent Variable(s) and Dependent Variable(s) in PICOT format 5 State the population and setting being addressed 5 Introduction to the Literature Review on the topic 5 Section II: Review of Literature Includes most of the major studies conducted on the topic, including but not limited to, recent literature (last 5-7 years)—-a minimum of 10 articles is required. 10 Includes primarily research studies, systematic reviews and guidelines addressing the practice question you wish to address 10 Similar/discrepant research findings discussed 5 Section III: Critique and Synthesis Critiques the results and findings of the key studies. 5 Describes the weaknesses in existing studies
and identifies important gaps in the literature
5 Conceptually organized based on type of articles or findings 5 Succinctly summarizes and synthesizes findings 15 Section IV: Further Research Identifies what ideas need to be further researched 5 Preparation References congruent with initial proposal, i.e. PICOT 5 Ideas organized & clearly expressed/headings used appropriately, no more than 8 pages 5 Paraphrases the review with few quotes from original sources—Limit direct quotes. 5 Grammar, sentence structure is correct 5 Adheres to APA format/style and/or Plagiarism (Plagiarism – source material not adequately paraphrased; direct quotes not identified; source material not referenced. *Plagiarized papers will be given a grade of zero and could result in failure of the course) 5
LITERATURE REVIEW 1
Student Name School of Nursing, College of Health & Human Services,
Northern Kentucky University
Student Name completed this paper as part of an assignment for MSN 602. The student name has no conflict of interest to disclose.
LITERATURE REVIEW 2
Diabetes is a worldwide disease, often classified as a global epidemic (Lade et al., 2016). An
enormous issue with diabetes is the fact that it is typically a precursor to additional
comorbidities in many individuals, and will definitely be prevalent in clinical practice. Type 2
Diabetes is a preventable and manageable disease if an individual is given the proper resources
and education. By educating women on how to lower their hemoglobin A1C with resistance and
aerobic training, it is plausible that many other chronic conditions could also be eliminated.
Middle age women have the opportunity to implement strength and aerobic training into their
daily lives in efforts to reduce their hemoglobin A1C. Consistently implementing these exercises
for more than three months can reduce hemoglobin A1C and prevent other chronic diseases from
developing. Literature Review Assignment Paper
Keywords: pre-diabetes, strength training, aerobic training, middle-aged women, hemoglobin
LITERATURE REVIEW 3
According to the Centers for Disease Control and Prevention (2017), “Nearly 1 in 4
adults living with diabetes – 7.2 million Americans – didn’t know they had the condition. Only
11.6 percent of adults with prediabetes knew they had it.” The World Health Organization stated
the number of individuals with diabetes mellitus increased to 422 million in 2014, which is
quadruple the amount since 1980 (Sawada et al., 2018). It is expected if appropriate measures are
not taken, and primary providers do not implement a positive change, the number of individuals
with diabetes will reach 700 million in the world by 2025 (Sawada et al., 2018).
Introduction and Question
This issue contributes to nursing practice and education because there are millions of
Americans living with Type 2 diabetes, a disease that can be managed extremely well and/or
prevented. Diabetes can lead to many other chronic conditions such as hypertension, neuropathy,
glaucoma, kidney disease, and stroke (Centers for Disease Control and Prevention, 2017). The
focus is to prevent diabetes and chronic conditions before they develop. Advanced practice
registered nurses (APRNs) have the unique opportunity to educate patients on how to lower a
patient’s risk of getting diabetes. However, most of the time the patient will come to a clinic with
underlying diabetes, and these articles suggest specific interventions on how to reduce and
manage the prevalence of Type 2 diabetes, resulting in lower Hemoglobin A1C. It is important to
note hemoglobin A1C is a blood test that measures average glucose levels over three months. By
educating women on how to lower their hemoglobin A1C with resistance and aerobic training,
many other chronic conditions could also be eliminated. With diabetes, eating a healthy diet
seems to be the main focus in research on how to prevent and manage diabetes. Diet is extremely
important, but the question at hand is if adding resistance and aerobic training to a weekly
LITERATURE REVIEW 4
routine will lower hemoglobin A1C in comparison to those that are not active. Do middle aged-
women, ages 40-64, with type 2 diabetes who use resistant/aerobic training have lower
hemoglobin A1C compared to those who were sedentary over three months? The independent
variable in this review is strength and aerobic training and the dependent variable is hemoglobin
Population and Setting
Middle-aged women have many things going on in their lives such as menopause and
busy lifestyles, but another issue is diabetes. Having diabetes puts women at risk for many other
health-related complications, and the goal is to keep their Hemoglobin A1C within a normal
range, below 5.7%. In particular, women aged 40-64, also do not workout or make it to the gym
as often as they probably should. Many middle-aged women are not taking the time to implement
physical activity into their weekly routines. The focus is to implement strength and aerobic
training into their daily lives. Women can implement aerobic and strength training in gyms or
within their homes.
Review of Literature
While searching for related literature, I used Northern Kentucky University’s Steely
Library to locate peer-reviewed and academic journals. CINAHL, EBSCOhost, and Academic
Search Complete are the main databases used, along with PubMed. A few keywords such as
“pre-diabetes, strength training, aerobic training, middle-aged women, and hemoglobin A1C”
were used to strengthen results. Quite a few results were located, the search is narrowed by date,
using only the last 5-6 years. The search is narrowed down further by eliminating and excluding
studies that did not include women and those that used different types of training such as
heavyweight training. The studies retrieved are classified as mixed-method research, however, a
LITERATURE REVIEW 5
focus on randomized controlled trials is the main method used amongst the various studies
included in this review. Literature Review Assignment Paper
Strength and Aerobic Training
Various implementations of strength and aerobic training are using amongst the studies.
Aerobic training is a type of exercise used to enhance cardiovascular and respiratory functional
capacity (Sawada et al., 2018). Resistance training is used to enhance muscle strength (Sawada et
al., 2018). In a study completed by Dai et al., (2019), resistance training involved major muscle
group exercises such as leg presses and extensions, chest presses, pull-downs, and shoulder
presses. Dancing was used for a warm-up aerobic exercise (Dai et al., 2019). The participants
implemented these exercises for 60-minutes, 3 times a week for 24 months resulting in the
decreased progression towards type 2 diabetes (Dai et al., 2019). Another study implemented 5
to 6 weekly aerobic training sessions along with resistant training 3 times a week, and after 12
months, there is a decrease in hemoglobin A1C by 0.4% (Johansen et al., 2017). A randomized
clinical trial with sedentary and obese participants implemented a supervised 3-month strength
training with outstanding results of 34% of the participants no longer being pre-diabetic (Davy et
al., 2017). According to Sawarda et al., (2018), “Aerobic exercise can delay and/or prevent the
development of type 2 diabetes by improving insulin resistance through modification of muscle
quality, including reduction of adiposity and increase of glucose transported in muscle
cells.” Resistance training has been linked to an increase in muscle mass, improved insulin
sensitivity, and increase glucose transport (Shiroma et al., 2017). Overall, these studies suggest
that a higher frequency of combined aerobic and resistance training is related to lowering the
prevalence of developing type 2 diabetes, including hemoglobin A1C. Implementing resistance
and aerobic training into an individual’s life can be challenging. An additional study with a
LITERATURE REVIEW 6
discrepant finding suggested that implementing high-intensity interval training (HIIT) is more
suitable in comparison to strength and resistance training because it is a time-efficient exercise
modality (Jelleyman et al., 2015). The study determined that completing 35-minute workouts
three times per week is more maintainable over longer periods of time.
Women that participated in higher amounts of combined strength training and aerobic
activity had a higher reduction in type 2 diabetes prevalence in comparison to those who did
strength and aerobic training individually (Shiroma et al., 2017). After reviewing multiple
studies, as long as an individual implement some sort of significant exercise regimen, it will
assist in lowering hemoglobin A1C in comparison to living a sedentary lifestyle.
The continual implementation of these exercises improves their overall health, however,
compliance with these regimens can be difficult. In some cases, there were adverse events. This
type of training can be difficult for individuals to maintain, especially if they do not enjoy
exercising. Additionally, adverse events were reported resulting in decreased compliance, most
commonly muscle pain and discomfort, sometimes hypoglycemia (Johansen et al., 2017).
Limitations were discussed such as some participants had a history of smoking and
drinking (Sawada et al., 2018). An individual’s social history can have a significant impact on
whether they can maintain a healthy lifestyle. Smoking and drinking can cause setbacks with
implementing physical activity, and the studies did not clarify their histories before the
research. Many of the studies used a “self-report” method when it came to disclosing the type
and amount of exercise that they did, which could have changed the results depending on if the
reports were accurate. In other cases, follow-ups showed the participants were not adhering to
the exercise regimen long-term. Literature Review Assignment Paper
LITERATURE REVIEW 7
Critique and Synthesis
Regarding the prevention of type 2 diabetes and reducing hemoglobin A1C levels, there
is a substantial decrease when resistance and aerobic training are added to an
individual’s lifestyle. Resistance and aerobic training have been effective in providing glycemic
and metabolic control amongst individuals. It also shows that in comparison to women who did
not exercise, there was a 30% reduction in type 2 diabetes. (Shiroma et al., 2017). Resistance and
aerobic training is a maintainable strategy if properly implemented to reduce prediabetes and
developing muscle strength (Davy et al., 2017). The majority of the studies specifically identified
a reduction in hemoglobin A1C, such as a 0.4% reduction in 20 weeks (Johansen et al., 2017).
The literature consisted of different lengths in studies, while some continued to follow up
with their participants up to two years later. In regards to the designated PICOT question, three
months is the minimal amount of time to possibly reduce an individual’s level. Some of these
studies had a short duration of 20 weeks, while others collected data for 9 months with various
follow-up times. To improve the research, lengthier studies should be used to provide succinct
data due to hemoglobin A1C ability to change only fractions in short amounts of time. To
strengthen these studies, it is also important to have supervised workouts, such as the study
conducted by Davy et al., (2017). This aids in compliance and proper implementation.
Supervised training also provides support for the participants and also makes sure the training is
done properly, also reducing the risk of injury. For these studies to be accurate, it would be
necessary to ensure the blood tests were collected at appropriate times, and in some studies, it
was reported that there was a lapse between the time of the last exercise and post-test blood
collection (Jelleyman et al., 2015). Overall, the posed question concluded that implementing
LITERATURE REVIEW 8
exercise into a weekly routine will greatly reduce the prevalence of type 2 diabetes and prevent
high hemoglobin A1C levels. Literature Review Assignment Paper
Gaps in Literature
Certain areas relate to gaps in the literature. The literature did not discuss the availability
of gyms to the participants when it comes to cost, location, and availability. Some women do not
have access to a gym or weights they can use at their homes. Other issues are many of the studies
did not provide the participants’ prior fitness abilities or their medical history, such as their
average initial hemoglobin A1C.
Further research is needed to determine if strength and aerobic training play a significant
role in reducing hemoglobin A1C and type 2 diabetes prevalence amongst middle-aged women.
For example, researchers need to evaluate the precise amount and intensity of these muscle-
building exercises needed for desired results (Shiroma et al., 2017). Additionally, future
randomized controlled trials with individuals without diabetes need to be conducted to clarify if
combined aerobic and resistance training reduces the risk of type 2 diabetes (Sawada et al.,
2018). A control group of participants who participate in less intense or more intense workouts
needs to be added. Random assignment of one group to strength training, one group to aerobic,
and another to combined training needs to be further researched as well. Literature Review Assignment Paper
As a future APRN, it will be necessary to educate patients on disease prevention.
Diabetes can cause many other cardiovascular, renal, and other chronic conditions. By providing
information and resources to middle-aged women regarding resistance and aerobic training, it
will greatly reduce their hemoglobin A1C and aide in the prevention of other preventable
LITERATURE REVIEW 9
diseases. I will be their guide and support to make sure they can comply with an active lifestyle
and also provide education on a healthy diet to promote overall well-being. It will be important
to educate that maintaining an active lifestyle is optimal, and not something to be done for only a
few months. Literature Review Assignment Paper
LITERATURE REVIEW 10
Al-Hamdan, R., Avery, A., Salter, A., Al-Disi, D., Al-Daghri, N. M., & McCullough, F. (2019).
Identification of education models to improve health outcomes in arab women with pre-
diabetes. Nutrients, 11(5), 1113. https://doi.org/10.3390/nu11051113
Centers for Disease Control and Prevention. (2017, August 18). New CDC report: More than
100 million Americans have diabetes or pre-diabetes.
Dai, X., Zhai, L., Chen, Q., Miller, J. D., Lu, L., Hsue, C., Liu, L., Yuan, X., Wei, W., Ma, X.,
Fang, Z., Zhao, W., Liu, Y., Huang, F., & Lou, Q. (2019). Two‐year‐supervised
resistance training prevented diabetes incidence in people with prediabetes: A
randomised control trial. Diabetes/Metabolism Research and Reviews, 35(5).
Davy, B. M., Winett, R. A., Savla, J., Marinik, E. L., Baugh, M., Flack, K. D., Halliday, T. M.,
Kelleher, S. A., Winett, S. G., Williams, D. M., & Boshra, S. (2017). Resist diabetes: A
randomized clinical trial for resistance training maintenance in adults with prediabetes.
PLOS ONE, 12(2), e0172610. https://doi.org/10.1371/journal.pone.0172610
De Sousa, R. (2017). Brief report of the effects of the aerobic, resistance, and high-intensity
interval training in type 2 diabetes mellitus individuals. International Journal of Diabetes
in Developing Countries, 38(2), 138–145. https://doi.org/10.1007/s13410-017-0582-1
Heiskanen, M. A., Motiani, K. K., Mari, A., Saunavaara, V., Eskelinen, J.-J., Virtanen, K. A.,
Koivumäki, M., Löyttyniemi, E., Nuutila, P., Kalliokoski, K. K., & Hannukainen, J. C.
(2018). Exercise training decreases pancreatic fat content and improves beta cell function
LITERATURE REVIEW 11
regardless of baseline glucose tolerance: A randomised controlled trial. Diabetologia,
61(8), 1817–1828. https://doi.org/10.1007/s00125-018-4627-x
Jelleyman, C., Yates, T., O’Donovan, G., Gray, L. J., King, J. A., Khunti, K., & Davies, M. J.
(2015). The effects of high-intensity interval training on glucose regulation and insulin
resistance: A meta-analysis. Obesity Reviews, 16(11), 942–961.
Johansen, M., MacDonald, C., Hansen, K., Karstoft, K., Christensen, R., Pedersen, M., Hansen,
L., Zacho, M., Wedell-Neergaard, A.-S., Nielsen, S., Iepsen, U., Langberg, H., Vaag, A.,
Pedersen, B., & Ried-Larsen, M. (2017). Effect of an intensive lifestyle intervention on
glycemic control in patients with type 2 diabetes. JAMA, 318(7), 637.
Lade, C., Marins, J., Lima, L., Carvalho, C., Teixeira, R., Albuquerque, M., Reis, J., & Amorim,
P. (2016). Effects of different exercise programs and minimal detectable changes in
hemoglobin a1c in patients with type 2 diabetes. Diabetology & Metabolic Syndrome,
Mansourian, M., Yazdani, A., Faghihimani, E., Aminorraya, A., Amini, M., & Jafari-Koshki, T.
(2018). Factors associated with progression to pre-diabetes: A recurrent events analysis.
Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 25(1), 135–
Sawada, S. S., Gando, Y., Kawakami, R., Blair, S. N., Lee, I.-M., Tamura, Y., Tsuda, H., Saito,
H., & Miyachi, M. (2018). Combined aerobic and resistance training, and incidence of
diabetes: A retrospective cohort study in japanese older women.
LITERATURE REVIEW 12
Shiroma, E. J., Cook, N. R., Manson, J. E., Moorthy, M., Buring, J. E., Rimm, E. B., & Lee, I.
(2017). Strength training and the risk of type 2 diabetes and cardiovascular disease.
MSN 602 Construction of a CP Question and ROL
MSN 602 Construction of a CP Question and ROL Criteria Ratings Pts This criterion is linked to a Learning OutcomeSECTION 1 INTRODUCTION AND QUESTION State the practice question you wish to address (include independent variable and dependent variable) in PICOT format 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeState the population and setting being addressed 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeIntroduction to the Literature Review on the topic 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeSECTION II REVIEW OF LITERATURE Includes most of the major studies conducted on the topic, including but not limited to, recent literature (last 5-7 years)—-a minimum of 10 articles is required. 10 to >0.0 pts
10 pts This criterion is linked to a Learning OutcomeIncludes primarily research studies, systematic reviews and guidelines addressing the practice question you wish to address. 10 to >0.0 pts
10 pts This criterion is linked to a Learning OutcomeSimilar and discrepant research findings discussed. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeSECTION III CRITIQUE AND SYNTHESIS Critiques the results and findings of the key studies. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeDescribes the weaknesses in existing studies and identifies important gaps in the literature. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeConceptually organized based on type of articles and findings. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomeSuccinctly summarizes and synthesizes findings. 15 to >0.0 pts
15 pts This criterion is linked to a Learning OutcomeSECTION IV FURTHER RESEARCH Identifies what ideas need to be further researched. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomePREPARATION–References congruent with initial proposal, i.e. PICOT 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomePREPARATION–Ideas organized & clearly expressed/headings used appropriately, NO MORE THAN 8 PAGES. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomePREPARATION-Paraphrases the review with few quotes from original sources. Limit direct quotes. 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomePREPARATION–Grammar, sentence structure correct 5 to >0.0 pts
5 pts This criterion is linked to a Learning OutcomePREPARATION–Adheres to APA format 5 to >0.0 pts
No Marks and/or Plagiarism
Plagiarism – source material not adequately paraphrased; direct quotes not identified; source material not referenced. *Plagiarized papers will be given a grade of zero and could result in failure of the course
5 pts Total Points: 100