Web viewJourneying with the familiar but unknown through the labyrinth of care: Patterns of self-care decision making in women of

NURS 3600 Nursing Research Literature Review Matrix

Name: Kimberly Small

AUTHOR, TITLE,

JOURNAL

YEAR METHOD & DESIGN

STUDY PURPOSE

VARIABLES(Omit if a qualitative study)

SUBJECTS RESULTS COMMENTS*

Dependent Independent Number Characteristics Sample Method

Eckert-Norton, M. (2011). Journeying with the familiar but unknown through the labyrinth of care: Patterns of self-care decision making in women of African descent with type 2 diabetes

2011 Qualitative,Descriptive

The study was conducted using a hermeneutic-dialectic approach consistent with theprotocol described in Newman's (1994) publication, Health as Expanding Consciousness

The purpose of this study was to describe patterns of self-care decision-making in womenOf African descent with type 2 diabetes

The study also explored how nursing practice

16 recruits

15 met all inclusion and exclusion criteria

13 completed

2 interviews

African descent

Diagnosis of type 2 diabetes

Low-income or uninsured

Urban dwelling

Recruited by word of mouth and fliers

Narrative inquiry

Each interviewed as least twice

Upon reflection, all of the life patterns identified reveal a capacity to move forward under arduous situations

Having met manychallenges in their lives, the participants describe frustration and confusion in interactions withhealth care providers

Participants

I found it interesting that all of the participants demonstrated the ability to handle the complexity of daily life, yet struggled with the self-management skills needed when living with type 2 diabetes

Authenticrelationships between nurses and clients emerged from the narratives as central to the process oftransformation

living in urban America (Doctoral dissertation) Retrieved from http://search.proquest.com/docview/904570011?accountid=27045

Thisapproachembodies an action research method based on the forming of authentic relationships betweennurse and participants, and guided by a unitary-transformative paradigm

can assist participants to find personal meaning in their patterns of self-care decision-making.

stated that in this clinic setting nurses aremost available through diabetes education classes

Frustration and confusion can be countered by authentic nurse-client relationships

This study supported the theory that nursing education can improve patient outcomes for patients with T2DM

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Edelman, D. P., Dolor, R. J., Coffman, C. J., Pereira, K. C., & Granger, B. B. (2015).

2015 Quantitative,Comparative

Patient-level randomized controlled trial

To assess the effectiveness of nurse behavioral management of DM and HTN in

A1c or HTN Nurse telephone case management including DM- and HTN- focused behavioral

377 enrolled

193 were randomized to intervent

Adults

Diagnosis of both type 2 diabetes and HTN

Receiving care at

Patients received a call from a nurse once every 2 months over 2 years, for a total of 12

Expressing model estimated differences as (intervention – control), at 24 months, intervention patients had

Although telephone conversations give nurses an opportunity to interact with patients and relay information, they do not promote a nurse

Nurse-led behavioral management of diabetes and hypertension in community practices: A randomized trial. Journal of General Internal Medicine, 30(5), 626-633. doi:10.1007/s11606-014-3154-9

community practices among patients with both diseases

content

OR

Nurse telephone case management involving non-interactive information regarding health issues unrelated to DM and HTN

ion

184 to control

55% female

50 % white

one of nine community fee-for-service practices

Required to have inadequately controlled DM but could have well controlled HTN

calls

SBP and A1c were measured at 6, 12, and 24 months; 24 months was the primary time point

similar A1c [diff = 0.1 %, 95 % CI (−0.3, 0.5), p = 0.51] and SBP [diff = −0.9 mmH g, 95% CI (−5.4, 3.5), p = 0.68] values compared to control patients

In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP.

Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary

–patient relationship that is established in face-to-face interaction that was seen other studies in this review

Would the results have been different if the frequency of the calls had been more frequent? 2 months may be too long between phone calls

For me, this study provides reason for nurses to consider the format in which they present the information to the patient and its effectiveness toward better patient outcomes

care settings.AUTHOR,

TITLE, JOURNAL


STUDY PURPOSE




Azar, K. M. J., Chung, S., Wang, E. J., Zhao, B., Linde, R. B., Lederer, J., & Palaniappan, L. P. (2015). Impact of education on weight in newly diagnosed type 2 diabetes: Every little bit helps. PLoS One, 10(6), doi:10.1371/journal.pone.0129

2015 Quantitative,Experimental

A difference-in-differences approach was used to estimate pre-post weight change associated with treatment

Difference-in-differences estimates were drawn from multivariate models where the coefficients

To investigate the effectiveness of counseling/education in a real practice setting among individuals with newly diagnosed type 2 diabetes

Body weight

Formal behavioral lifestyle counseling/education only

Diabetes medication prescription only

Both counseling/education and prescription of medication

Monitoring only

(Monitoring only is not a lack of diabetes care, but rather

1,314

599(45.6%) pts received counseling/education with (26.2%) and without (19.4%) medication

298(22.7%) pts received a prescription for medicati

Participants were extracted from the EHRs in a large multi-specialty, mixed-payer, outpatient, group practice organization in northern California

Age 35-74

Newly diagnosed with T2DM between January 1, 2007 and June 30, 2010

Required weight measurement during the observation period

Participation in counseling/education was identified if a patient participated in individual counseling with a registered dietitian or nutritionist or a group-based class focused on behavioral lifestyle modification, weight management, and/or type 2 diabetes

Average weight loss associated with counseling/education only (no medication) was 6.3 lbs

Weight loss associated with medication prescription only (no counseling/education) was 3.5 lbs

Weight loss among those who received both counseling/education and medication prescription was 8.1 lbs

Even a small dose of formal behavioral lifestyle counseling and/or education (i.e., attending one session) offered at outpatient clinics can be beneficial and promote modest weight loss

It was interesting to me that this study had a larger sample size than some of the other studies and results were still similar

This sample has common characteristics to the patients that I would regularly care

348 for main treatment indicators represent pre-post weight change associated with each treatment.

The multivariate models incorporated propensity score adjustment.

“active monitoring” as patients in this group made follow-up visits addressing diabetes)

on alone

417(31.7%) pts were only monitored

41% female

Average age 54

49.7% non-Hispanic white

36.8% Asian

Among those who participated in any counseling/education, the number of sessions attended within 12 months of diagnosis ranged from 1 to 11, but most received 2 sessions

No significant weight change was observed in the monitoring only group

Pts lost more weight as the frequency of counseling/education increased, but the relationship is not linear

This study made me curious if newly diagnosed patients are more receptive to counseling/ education

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Ozgul, E. (2015). An individualized education programme with empower

2015 Qualitative,Descriptive

Case study

Empowerment approach was used in

Explore the effectivene

ss of an empowerment based

approach in a health

education

1 42 year oldwoman with type 2 diabetes

Graduated from a primary school

Married with

Patient was randomly selected from a group ofindividuals receiving medical

At the beginning, it wasfound that she felt herself near to constrained, weak,dependent, worthless, tense

Patient empowerment is an effectiveapproach to developing educational interventionsincluding the

ment approach: A case study. International Journal of Caring Sciences, 8(2), 451-457. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/1685874188?accountid=27045

thisindividualized health education program

program of a patient

with type 2 diabetes in

order to assist

nurses who are

working in this area to

providemore

effective diabetes

health education and care

two childrenHer husband is an unemployed cook

lives in a small town and worksat a textile factory

Economic problems due to low income

Sedentary lifestyle, during the day she wassitting and sewing at work

After long working hours,she became tired, came home, ate meal and thenslept

She has health insurance

treatment and care ininpatient clinic of Endocrinology

Attitude Measurement Scale was used

A Diabetes KnowledgeTest was used at the beginning and again at the end in order to evaluate herdiabetes knowledge

The health educator nurse toldher not to blame herself and

and unsafe

Her diabetes knowledge increased and she began togive decisions about her diabetes management

Her wrong beliefs changed and she adhered theinsulin therapyShe expressed the beneficial effectsof insulin therapy

She could test her blood glucose, make insulininjection, interpret the results and be aware of whatwas going on

She also knew the effects of diet and

psychosocial aspects of living with type 2diabetes

Health educators need to takepsychosocial factors into account and start where thepatient is

Due to the complex nature of T2DM management, small steps toward change and frequent education sessions lead to the desired patient outcome

Her mother, father and aunt also have diabetes, but theyare not taking any medicine and not continued on aregular diabetes control program They did notknow much about diabetes and give it no importance

She was diagnosed 10 years ago but she didn’tgive importance to diabetes

She feels guiltyabout past years

She does not smoke or drinkAlcohol

to look to the future

The health education sessions’ contents and timeswere planned according to patient’s needs andpreferences with the common decisions of the healtheducator and the patient

exercise onblood glucose control

After 3 months, she stated that shewas feeling lighter and this made her happy

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Rothschild, S. K., Martin, M. A., Swider, S. M., Lynas, C. M., & Janssen, I. (2014). Mexican American trial of community health workers: A randomized controlled trial of a community health worker intervention for Mexican

2014 Quantitative,Comparative

Single-blinded, randomized controlled study

Whether community health workers (CHWs) could improve glycemic control among Mexican Americans with diabetes

Glycemic control among Mexican Americans with diabetes

Community Health Worker Intervention, delivering self-management training through 36 home visits over 2 years

OR

Bilingual control newsletter delivering the same information on the same schedule

144 Mexican Americans

Live in metropolitan Chicago

Diagnosed with T2DM

18 years or older

Being treated with at least 1 oral hypoglycemic agent

Required to have health insurance or to receive primary care through a free clinic or public facility at the

Recruitment strategies for the study consisted of direct mailings, outreach at community events and churches, partnerships with primary care clinics, and direct outreach by the CHWs themselves

Participants were randomized and followed for 2 years

Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 = -Δ0.55; P = .021) and year 2 ( = -Δ0.69; P = .005)

No effect on blood pressure control, glucose self-monitoring, or adherence to medications or diet was observed

Intervention participants

In my original question, I did not specify WHO was providing the education, only that education was being provided

The Community Health Workers in this study were not nurses, but received more than 100 hours of training on diabetes, behavioral self-management support, and home visiting

Because CHWs share culture, language, and knowledge of the community, they effectively engaged

Americans with type 2 diabetes mellitus. American Journal of Public Health, 104(8), 1540-1548. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/1549549165?accountid=27045

time of enrollment Participants

were told that the study was comparing 2 forms of diabetes education and were blinded to the study hypothesis

Research assistants blinded to participants' group assignments collected outcome data at 12 and 24 months after randomization

increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years

minority populations

This study supports the theory that patient education can improve patient outcomes in patients with T2DM

In my opinion, nurses are more prepared to educate these patients, but I also appreciate the positive effect that the CHW’s had the patients in the study. Some effect is better than none.

I also appreciated that the control group did not go without any education. This allowed these participants to still potentially benefit from the study

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Soner Cander, O. G. (2014). The impact of patient education on anthropometric, lipidemic, and glycemic parameters among patients with poorly controlled type II diabetes mellitus: A 3-month prospective single-center

2014 Quantitative,correlational

Prospective observational single-center study

This study evaluated the impact of patient education on adherence to a diabetes care plan (e.g., anthropometric, lipidemic,and glycemic parameters) among adults with type II diabetes mellitus without adequate glycemic

Adherence to a diabetes care plan as evidenced by Anthropometric,lipidemic, and glycemic parameters among ambulatoryadults with type II diabetes mellitus

Education on regularself-monitoring of blood glucose, standard diabeticdiet, and exercise

61 Ambulatory adults

Diagnosis of T2DM between 1 and 20years

Mean age: 53.6 ± 8.2 years

70.5% female29.5% male

Age 35 - 65

HbA1c levels of 7.5 to 10

Data on participants was collected for each individualduring the baseline visit at study enrollment

All participants were reevaluated 3 months after initialtraining to assess changes in each study parameter

Eachparticipant

A 5.1% HbA1c decrement was shown at 3 months

Decrease inbody weight and fat percentage(p < .001 for each)

Increase in uric acid levels (p = .002)

No differencewas observed in total cholesterol and triglyceridelevels

Decrease in nighttime (2300) capillary bloodglucose levels

This study was interesting to me because part of its theory was that helping employees manage their T2DM helps to maintain a healthy workforce, and avoid the health and economic burdens

Study findings indicatedthat education about adherence to diabetic care plansshould include regular self-monitoring of blood glucose,standard diabetic diet, and routine exercise

Turkish study. Workplace Health & Safety, 62(12)500-507. doi:10.3928/21650799-20140826-02

control took part in diabetes-related education in a 30- to 45-minute one-on-one instructionby a training team that included an endocrinologyspecialist, a diabetes nurse, a licensed dietician and a sports physician

I also found it interesting that the education in this study reinforced the importance of closeand frequent self-monitoring of blood glucose in maintaining achieved glycemic control

I also appreciated the inclusion of specialists in addition to the nurse in this study

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Walker, E. A., Stevens, K. A., & Persaud, S. P. (2010). Promoting

2010 Quantitative

Quasi-experimental pre-test/post-test

Increase knowledge and self-management of diabetes

Knowledge and self-management of diabetes among

Educational intervention

OR

No

195

145 participants in the

African American

Adult

40 years of age

Participants were assigned to intervention and comparison

Significantly increased knowledge among intervention group

I thought it was interesting that the researchers in this study used a Healthy People 2010 objective as

diabetes self-management among African Americans: An educational intervention. Journal of Health Care for the Poor and Underserved, 21(3), 169-186. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/747083882?accountid=27045

comparison group design

among African American adults 40 years of age and older diagnosed with type II diabetes

African American adults 40 years of age and older diagnosed with type II diabetes

educational intervention

intervention group

50 in the comparison group

old and olderDiagnosed with type 2 diabetes

Residents of Prince George's County, Maryland

groups by self-selection

Three two- hour educational sessions were provided to participants in the intervention group

The educational intervention was developed by the researchers in collaboration with two Certified Diabetes Educators, one a registered

participants between the pre- and post-test

Findings for HbA1c values, body mass index, and weight were not significant

one basis for the study

An interesting side finding if the study was that patients responded well to interactive learning activities, including games like Jeopardy, and these games were an effective way to reinforce information

Although the participants demonstrated an increase in knowledge, what really needs to happen is that the knowledge is applied and then evidenced through improvements in factors such as HbA1c and weight. I do not think that phone call follow up

nurse and the other a dietitian

Teaching strategies included discussion, games, and demonstrations. Patient navigators provided follow-up by phone at scheduled intervals

is enough. Other studies have supported face-to-face interactions with individualized discussion resulted in better patient outcomes

I think of the patients I care for at the hospital who may not have any opportunity for follow up or support after discharge

AUTHOR, TITLE,

JOURNAL


STUDY PURPOSE




Morrison, F., Shubina, M., & Turchin, A. (2012). Lifestyle counseling

2012 Quantitative

Retrospective cohort study

To determine whether lifestyle counseling is associated with time

A1C, blood pressure, and LDL cholesterol levels in patients with diabetes

Average counseling rate and time

30,897 Documented diagnosis of diabetes or HgA1C >= 7.0%

Pts seen by physicians affiliated with

Lifestyle counseling instances were defined as distinct days when a PCP provided

Lifestyle counseling in the primary care setting is strongly associated with faster achievement of A1C, blood

I chose this study because it focused on long-term effects of education for patients with type diabetes

The other studies I

in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes. Diabetes Care. 35(2), 334-341. doi:10.2337/dcll-1635

to A1C, blood pressure, and LDL cholesterol control in patients with diabetes

the Brigham and Women’s Hospital and Massachusetts General Hospital for at least 2 years between January 2000 and January 2010

At least 18 years old

diet, exercise, or weight counseling.Documentation of lifestyle counseling was computationally abstracted from notes.

pressure, and LDL cholesterol control

In all treatment categories, time to treatment target rose progressively at the less frequent rates of lifestyle counseling

As counseling rates decreased, the proportion of patients who never reached treatment targets rose steadily

read demonstrated positive results over considerably short periods of time. The real truth is if patients can maintain self-management over a long period of time, they are likely to have better quality of life and healthier outcomes

I realize the education was provided by physicians and not nurses, but the content is the same and it was interesting to see that the outcome was similar

*Include under Comments anything that may be of interest to you in the article, would be helpful in considering whether contributes to answering your clinical question, or to application of the research findings to your practice; e.g. “Small sample size, no race info.” “Subjects very unlike my patients.” “Innovative intervention, not sure if my manager would go for it.”

Now that you have summarized the articles you obtained, please answer the following questions:

1. Does the evidence answer your clinical question? YES

2. If the evidence answered your clinical question, what is the answer?

Based on studies I reviewed the answer is that patients who receive any amount of diabetic education experience a remission of their diabetes.If I was to clarify my question, remission could mean any of the following:

Decreased HgA1c, Blood Pressure, Cholesterol levels, Weight, and Body Mass Index -or-Increased Patient Self-Management, Patient Self-Efficacy, and Patient Outcomes

The studies I reviewed supported each of these. I could however narrow down my question and be able to a literature review on just one of them.

3. If the evidence did not answer your clinical question, what are your next steps?

Although my question was answered, I am going to respond to this question by saying that not only could I clarify my definition of remission; I could narrow in on some other aspects of my question and refine my research.

For example: Who provides the education? The studies I read included nurses, physicians, specialists, and specifically trained coaches. I could do a study on which

of these is the most effective. What type of information should be included? The studies I read referred to not only management of physiological variables, but psychological,

cultural and emotional aspects as well. What format of teaching is most effective? The studies I read favored face-to-face teaching because it helps to develop an instructor-patient

relationship. I wonder about written, visual, and auditory; is one more effective than another? There are all different types of learners and patients are more likely to retain information when it is in a format they respond to.

When should the education start and how frequent should the information be reinforced? How long should the education continue? Is there an advantage between individual versus group instruction?

This assignment was very interesting and opened my eyes to the value of nursing research. There is so much to be learned about how to best support patients with type 2 diabetes.

Documents

Web viewJourneying with the familiar but unknown through the labyrinth of care: Patterns of self-care decision making in women of