Ideally, every clinical interaction is a steppingstone toward discoveries that could improve or transform our work as diabetes care and education specialists (DCESs). Clinical inquiry, or the systematic process of asking questions, investigating, and analyzing information, begins with our practice and with the lessons in diabetes self-management we learn every day from people living with diabetes.1,2 Although this might bring to mind an image of spending hours alone, poring over cumbersome spreadsheets of data, the reality is that clinical inquiry is as much of a team activity as our care and education.
In the first article in a 3-part series, we explore the concept of clinical inquiry and the benefits and opportunities it can provide DCESs. We also provide a practical overview of benefits and opportunities for the DCES to engage in clinical inquiry. The second and third articles in this series will provide more detailed information and examples of practical ways to get involved specifically in evidence-based quality improvement (EBQI) and research, respectively.
The purpose of clinical inquiry in diabetes care and education is to improve practice and improve health outcomes. To answer clinical and practicerelated questions with clinical inquiry, you can engage in 2 different approaches—EBQI or research.3 To determine if you should use an EBQI or research approach, you first need to explore what is currently known about your question.4 You do not have to take this step alone! Clinicians, health science librarians, and mentors with expertise in EBQI and/or research can help guide you in knowing whether EBQI or research is the right approach to answer your important clinical and practice-related questions. EBQI combines principles of evidence-based practice and quality improvement in one systematic and coordinated process to improve your practice or the delivery of care in your institution. The process of EBQI includes identifying clinical or practice problems, systematically using evidence and data, designing and selecting solutions using methods and tools, and measuring practice changes over time.5-7 You might choose to conduct EBQI if there is sufficient evidence from the literature and from internal data within your institution to answer your clinical or practice-related question. In the second article in this clinical inquiry series, we will provide several key models of the EBQI process. Research involves carrying out carefully planned and organized studies to discover new knowledge that can apply to a wider group of people beyond the individuals being studied.8,9 You might choose to conduct research if there is insufficient evidence to answer your clinical or practicerelated question.10 Although other broad types of research exist, the DCES usually focuses on studies involving people, which is considered human subjects research.11 In the third article in this clinical inquiry series, we will explain the key types of research that are most relevant to the DCES.
Table 1 summarizes some of the important features of clinical inquiry, distinguishing between EBQI and research and providing some examples relevant to the DCES. Keep in mind that after determining the appropriate approach, it is important to work with the institutional review board at your institution to determine regulatory requirements before moving to the next steps.
A large body of evidence generated by EBQI and research initiatives emphasizes the value of diabetes self-management education and support (DSMES).12 This evidence serves as the foundation for the National Standards for DSMES13 and for best practices used by the DCES across the spectrum of diabetes care and education delivery settings to improve health outcomes.
The DCES is well positioned to engage in clinical inquiry. If you are a DCES, you are already translating evidence into practice. Evidence that has resulted from previous EBQI and research are used as you deliver care and education in inpatient, outpatient, and community settings. However, you may discover that you have clinical or practice-related questions that have not yet been answered with EBQI or research. This is the time to raise your questions in your practice setting and consider whether your questions can be answered with EBQI or research!
Getting involved in clinical inquiry is beneficial for the discipline of diabetes care and education. When the DCES engages in EBQI or research, they can reflect on ways to improve their practice and the care of people living with diabetes. Another benefit is enhancing teamwork through interdisciplinary collaboration among health care professionals and other stakeholders. Getting involved in clinical inquiry can also fuel DCES job satisfaction by creating a sense of connection and purpose to care, and it can enhance respect for the discipline and for the work of individual DCES.
Several opportunities are available to get involved with clinical inquiry! A few common options for involvement are the following:
Documenting what you are already doing in clinical practice. There may be general areas of clinical practice that you would like to share with the broader DCES community. For example, perhaps you have learned a new strategy or technique to improve engagement in diabetes care and education or to make technology more accessible for vulnerable people living with diabetes. These are likely areas that other clinicians would be interested in as well. Consider ways you can share this knowledge informally, such as posting your experience on an ADCES Community of Interest platform or formally by publishing an article in a journal like ADCES in Practice.
Submitting your own educational or research session abstract to the annual ADCES conference. The ADCES annual conference and other diabetes-focused conferences are a great place to learn about diabetes EBQI projects and research studies. Educational and research session ideas are accepted for the ADCES annual conference, as are original educational abstract and research abstract submissions. Either option is a great choice for showcasing your own research and knowledge! Research and educational session proposals typically close in January. If you would like the opportunity to present at the annual ADCES conference, you can submit a brief abstract outlining what you would like to present. Research and educational abstract submissions typically close in July. Abstracts may be selected for poster or oral presentations. Visit the conference website for information about submitting your work to be presented! By maintaining active ADCES membership, you can update your communication preferences for regular communications about upcoming events and opportunities to engage.
Participating in an EBQI project or research study related to a topic of interest to you. This is the time to consider your clinical or practice-related questions and start talking with others about their interest in pursuing answers to these questions using EBQI or research. In the second and third articles in this clinical inquiry series, we will describe how to make getting involved in EBQI projects or research studies more approachable.
Clinical inquiry is a valuable avenue for the DCES to enhance their practice and contribute to the science of diabetes care and education. Through 2 clinical inquiry approaches—EBQI and research—the DCES can address unanswered questions, collaborate across disciplines, deepen their sense of purpose in their care, and strengthen respect for their discipline. Join us in the next 2 articles in this clinical inquiry series of ADCES in Practice as we explore practical information that can support you in getting involved in either EBQI or research and making a lasting impact!
Jorden Rieke, BSN, RN, CCRN, is a predoctoral fellow at the Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, OH; Megan Visser is a postdoctoral fellow at the Children’s Hospital Los Angeles in Los Angeles, CA; Rebecca Barber is a research nurse scientist for the Institute for Nursing and Interprofessional Research at the Children’s Hospital Los Angeles in Los, Angeles, CA; Jennifer Rosselli is a clinical professor at the Southern Illinois University Edwardsville School of Pharmacy in Edwardsville, IL; Lisa Letourneau-Freiberg is employed at the University of Chicago in Chicago, IL; Michelle Magee is the director of the Medstar Diabetes Institute in Washington, DC; Nancy Allen is an associate professor at the University of Utah College of Nursing in Salt Lake City, UT.
Jennifer Rosselli-Lynch serves on the Diabetes Care and Education Specialists Advisory Council for Medtronic, Inc.
The authors declare having received no specific grant from a funding agency in the public, commercial, or not-for-profit sectors related to the content or development of this article.
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