Role of Nurses in Self-Care

Role of Nurses in Self-Care

This Role of Nurses in Self-Care assignment is a revision of previous assignments. It includes revising highlighted areas done by my professor.  Documents to be revised PICOT , quantitative, and qualitative research critiques(each document attached separately). After revision to be placed in one attachment.  Will be submitted to turnitin. Rubric, and assignment requirements attached.

 NRS-433V Introduction to Nursing Research

Role of Nurses in Self-Care

Based on evidence-based practice (EBP) and PICOT analysis, the research question to be evaluated is as follows:

Do Type 2 Diabetes Mellitus patients assisted by nurses under self-care have high chances of glycemic control than those not assisted by nurses in their diabetic self-care? (Please revise this questions.. Your patient population is (For patients diagnosed with Type 2 Diabetes Mellitus does the addition of a nurse-led ….. or something to that effect. I think what you are asking if there if periodic monitoring of the patient will that effect glycemic control. If I am let me know) Please search the literature to see if you can find research articles that provide positive results of nurse-led intervention to improve glycemic control. You do have one article. There is a lot of information regarding this subject. If you have any questions, please let me know. Professor Farley

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The practice research question for the consequent capstone research can be broken down into components of the PICO (T) as follows:

Patient Population: Type 2 Diabetes Mellitus patients.

Intervention: Assistance of nurses in self-care of glycemic control.

Comparison: Type 2 Diabetes Mellitus patients under self-care programs but lack the assistance of nurses.

Outcome: Improvements in glycemic control.

Role of Nurses in Self-Care References

Chlebowy, D. O., Hood, S., & LaJoie, A. S. (2010). Facilitators and barriers to self-management of type 2 diabetes among urban African American adults focus group findings. The diabetes educator, 36(6), 897-905.

Abstract

Purpose

The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults.

Methods

Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected.

Results

Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes.

Conclusions

African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

Goetz, K., Szecsenyi, J., Campbell, S., Rosemann, T., Rueter, G., Raum, E., … & Miksch, A. (2012). The importance of social support for people with type 2 diabetes–a qualitative study with general practitioners, practice nurses and patients. GMS Psycho-Social-Medicine, 9.

Abstract

Objective: Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner’s, practice nurse’s and people with type 2 diabetes’ views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support.

Methods: Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring.

Results: All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling.

Conclusions: Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual’s diabetes management.

Keywords: social support, type 2 diabetes, qualitative approach, primary health care, Role of Nurses in Self-Care

Malanda, U. L., Welschen, L., Riphagen, I. I., Dekker, J. M., Nijpels, G., & Bot, S. D. (2012). Self‐monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. The Cochrane Library. We still need the Journal, volume, issue and page numbers to complete this reference.

Abstract

Background

Self-monitoring of blood glucose (SMBG) has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin. There is much debate on the effectiveness of SMBG as a tool in the self-management for patients with type 2 diabetes who are not using insulin.(this is talking about self care)

Objectives

To assess the effects of SMBG in patients with type 2 diabetes mellitus who are not using insulin.

Search methods

Multiple electronic bibliographic and ongoing trial databases were searched supplemented with handsearches of references of retrieved articles (date of last search: 07 July 2011).

Selection criteria

Randomised controlled trials investigating the effects of SMBG compared with usual care, self-monitoring of urine glucose (SMUG) or both in patients with type 2 diabetes who where not using insulin. Studies that used glycosylated haemoglobin A_1c (HbA_1c) as primary outcome were eligible for inclusion. Role of Nurses in Self-Care.

Data collection and analysis

Two authors independently extracted data from included studies and evaluated the studies’ risk of bias. Data from the studies were compared to decide whether they were sufficiently homogeneous to pool in a meta-analysis. Primary outcomes were HbA_1c, health-related quality of life, well-being and patient satisfaction. Secondary outcomes were fasting plasma glucose level, hypoglycaemic episodes, morbidity, adverse effects and costs.

Main results

Twelve randomised controlled trials were included and evaluated outcomes in 3259 randomised patients. Intervention duration ranged from 6 months (26 weeks) to 12 months (52 weeks). Nine trials compared SMBG with usual care without monitoring, one study compared SMBG with SMUG, one study was a three-armed trial comparing SMBG and SMUG with usual care and one study was a three-armed trial comparing less intensive SMBG and more intensive SMBG with a control group. Seven out of 11 studies had a low risk of bias for most indicators. Meta-analysis of studies including patients with a diabetes duration of one year or more showed a statistically significant SMBG induced decrease in HbA_1c at up to six months follow-up (-0.3; 95% confidence interval (CI) -0.4 to -0.1; 2324 participants, nine trials), yet an overall statistically non-significant SMBG induced decrease was seen at 12 month follow-up (-0.1; 95% CI -0.3 to 0.04; 493 participants, two trials). Qualitative analysis of the effect of SMBG on well-being and quality of life showed no effect on patient satisfaction, general well-being or general health-related quality of life. Two trials reported costs of self-monitoring: One trial compared the costs of self-monitoring of blood glucose with self-monitoring of urine glucose based on nine measurements per week and with the prices in US dollars for self-monitoring in 1990. Authors concluded that total costs in the first year of self-monitoring of blood glucose, with the purchase of a reflectance meter were 12 times more expensive than self-monitoring of urine glucose ($481 or 361 EURO [11/2011 conversion] versus $40 or 30 EURO [11/2011 conversion]). Another trial reported a full economical evaluation of the costs and effects of self-monitoring. At the end of the trial, costs for the intervention were £89 (104 EURO [11/2011 conversion]) for standardized usual care (control group), £181 (212 EURO [11/2011 conversion]) for the less intensive self-monitoring group and £173 (203 EURO [11/2011 conversion]) for the more intensive self-monitoring group. Higher losses to follow-up in the more intensive self-monitoring group were responsible for the difference in costs, compared to the less intensive self-monitoring group.

There were few data on the effects on other outcomes and these effects were not statistically significant. None of the studies reported data on morbidity.

Authors’ conclusions

From this review, we conclude that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months. Furthermore, based on a best-evidence synthesis, there is no evidence that SMBG affects patient satisfaction, general well-being or general health-related quality of life. This does not seem favorable to your question. I think you are looking for a studies related to nurses overseeing these patients periodically  More research is needed to explore the psychological impact of SMBG and its impact on diabetes specific quality of life and well-being, as well as the impact of SMBG on hypoglycaemia and diabetic compl

Moser, A., van der Bruggen, H., Widdershoven, G., & Spreeuwenberg, C. (2008). Self-management of type 2 diabetes mellitus: a qualitative investigation from the perspective of participants in a nurse-led, shared-care programme (I think this is the topic you are looking for) in the Netherlands. BMC public health, 8(1), 91.

Abstract

Background

Diabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes.

Methods

This study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory.

Results

People with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring.

Conclusion

Self-management consists of a complex and dynamic set of processes and it is deeply embedded in one’s unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.

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Oftedal, B., Karlsen, B., & Bru, E. (2010). Perceived support from healthcare practitioners among adults with type 2 diabetes. Journal of advanced nursing, 66(7), 1500-1509.

Abstract

Title. Perceived support from healthcare practitioners among adults with type 2 diabetes.

Aim.  This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence people’s motivation to self-manage their disease. This qualitative study appears to be beneficial to your question because it is asking whether the patient feels that support may or may not influence their self-management.

Background.  Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves.

Methods.  A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis.

Findings.  Five themes were identified, reflecting perceived attributes of support from healthcare practitioners: (1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support.

Conclusion.  Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support. Role of Nurses in Self-Care

Stellefson, M., Dipnarine, K., & Stopka, C. (2013). Peer reviewed: The chronic care model and diabetes management in US primary care settings: A systematic review. Preventing chronic disease, 10.

Abstract

Introduction

The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation.

Methods

We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies.

Results

The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. This would be appropriate for your question.

Conclusion

CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. Role of Nurses in Self-Care. Role of Nurses in Self-Care. Role of Nurses in Self-Care. Role of Nurses in Self-Care.