Evidenced Based Nursing

Subject: Nursing
Pages: 10
Words: 2538
Reading time:
12 min
Study level: College

Article

Krein, S., Heisler, M., Piette, J., Makki, F., & Kerr, E. (2005). The Effect of Chronic Pain on Diabetes Patients’ Self-Management, Diabetes Care 28(1), 65-70.

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Article Krein, S., Heisler, M., Piette, J., Makki, F., & Kerr, E. (2005). The Effect of Chronic Pain on Diabetes Patients’ Self-Management, Diabetes Care 28(1), 65-70.
Background information The purpose of the research study was to investigate the effect of chronic pain on self-management in diabetes patients. The purpose of the study is relevant. Self-management plays a significant role in the treatment and management of diabetes. The authors give detailed background information to justify their study. The authors stated their problems statement as the role that chronic pain plays as a barrier to effective self–management in Diabetes patients. The problem statement was structured into two research questions.
Review of Literature A literature review was brief. This briefness helped authors review other research studies and scholarly publications related to self-management in diabetes management. Most of the sources were currently ranging from 1998 to 2005.
Methodology A qualitative research methodology was adopted for the study. The authors conducted a survey using self-administered questionnaires and telephone interviews.
Data Analysis The authors used bivariate and multivariate analysis to analyze data collected in the survey. Bivariate analysis (Student’s t-test and Chi-Squared) were used to study the difference in socio-demographic factors and patients’ health status. Multivariate analysis was then used to find the relationship between the presence of chronic pain, the severity of pain, and the patient’s difficulty in self-management.
Conclusion The authors conclude that chronic pain hurts self-management in diabetes patients. They recommend that chronic pain be considered when providing care to diabetes patients

Assessment of Evidence

Diabetes is a major health issue not only not in the United States but also many other countries in the world. Self-management is very important in managing diabetes. Anything that might affect self-management would hurt diabetes management. The research study revealed that 60 percent of 993 participants experienced chronic pain. Although the presence of chronic pain does not affect some self-managempracticestice such as taking medication. It is stated that the effect is observed only after regular pain-management practice.

The authors can make their conclusion. The research study found out that about sixty percentages of the participants had continuous pain in more than six months. More than 70 percentages of participants who have has chronic pains reported the pain to affect self-care practice while 78 percent reported having used painkillers. Considering that pain can affect exercising, the authors are right in concluding chronic pain hurt self-management in diabetes patients.

Ethical Issues

The research study was based on a subject that does not involve ethical issues. Although issues related to ethics are not mentioned in the article, various ethical issues could be involved. One of the major ethical issues is the privacy of collected data. Medical information is usually sensitive. Many people are not comfortable in their medical information being exposed to a third party. Although the motive of the research study was good, the participants should be assured of confidentiality. Another ethical consideration in the research study is associated with the necessity to get the consent of the participants. Participation in the survey should be voluntary.

Type of research

The research study adopted a correlational design. The authors identified the variables to be examined in the study. The fundamental variables for the study were the overall self-management score together with five core self-care items. The researchers study individual items related to self-management as well as overall shore. The authors identified activities that they felt that could be affected most by chronic pain, and examined them in their survey. The participants were asked to evaluate themselves by a self-management score. The score was on a continuous scale with a high score representing better self-management. The independent variable considered in the study was self-reported chronic pain, where chronic pain was defined as pain experienced for more than six months. The research was able to answer the research questions. The data analysis was to provide a concise relationship between the research variables helping to address the research problem.

Problem

Role of nursing in Diabetes management.

Annotated Bibliography

Aubert, R., Herman, W., Waters, J., Moore, W., Sutton, D., Peterson, B., Bailer, C., & Koplan, J. (2004). Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization, Annals of Internal Medicine 129(8), 605-612.

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This article highlights on the control of hyperglycemia is vital in diabetes management. In this case, the authors deemed it appropriate to utilize a controlled experiment as a way of facilitating a comparative assessment of diabetes patients. The results of the study showed that patients receiving nurse case management had improved health status as compared to those who did not. The credibility of the article is high since the researchers had a high qualification in medical science while research design is reliable.

Debbie, H. (2009). New roles in diabetes care provision, Journal of Diabetes Nursing 7(2), 78-81.

Diabetes is a major health care challenge. The author notes that diabetes care provision should be broad. She notes the importance of information on diabetes in management. She suggests that diabetes patients should be provided with relevant information to enable the practice of proper self-management. The article is related to the research study considering the roles that nurses have in providing health information to patients.

Hutchinson, A., Peters, J., Mackinnon, M., Mcubtish, A., & Jones, R. (2001). What role do nurses play in Type 2 diabetes care in the community: a Delphi study, Journal of Advanced Nursing 34(2), 179-88.

The article is the summary of a Delphi study capturing views of nurses on their roles in care for type 2 diabetes patients. Random samples of practice nurses were evaluated. The study shows the key areas of agreement on diabetes management among practice nurses and in areas where they differ.

Miguel, M., Adelantado, J., Garcia-Patterson, A., Martin, E., Ubeda, J., Ginovart, G., Leiva, A., & Corcoy, R. (2003). Nurse-based Management in Patients with Gestational Diabetes, Diabetes Care 26(4), 998-1001.

This is a research study investigating the role that nurses played in the management of gestational diabetes. Gestational diabetes is a major health issue in pregnant women. Expectant women have to be provided with proper to ensure the safety and safety of their children during pregnancy. Endocrinologist-based care is usually advocated for the management of gestational diabetes. Using an experimental design, the authors compare endocrinologist-based care and nurse-based care in managing gestational diabetes. The authors found no significant difference between the two forms of gestational diabetes. They conclude that nurse-based care is equally effective as endocrinologist-based care in gestational diabetes management. Some of the variables to the research study that the authors emphasized include the age of the respondents, their BMI, and family history with diabetes. The research study seems to be credible considering that experiments were professional, involved a sufficient sample of 283 participants, and were conducted by professional individuals.

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Mclean, D., McAlister, F., Johnson, J., King, K., Makowsky, M., & Jones, C. (2008). A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients with Diabetes Mellitus, Archives of Internal Medicine 168(21), 2355-2361.

Blood Pressure (BP) control is vital to diabetes mellitus patients. The authors investigate the efficiency of community pharmacists and nurses in intervening in BP control. Using a sample of 227 eligible patients in the controlled trial, they conclude the pharmacist and nurse team-based intervention had a positive effect on Blood pressure control.

Nesbeth, H., Rosenthall, W. (2009).Breaking down the barriers to good glycaemic control in type2 diabetes: a debate on the role of nurses. European Diabetes Nursing 6(1) 29-33.

Most complications in diabetes are associated with poor glycaemic control. The authors investigate the barriers to better glycaemic control. They identify hemoglobin (HbA1c) testing as one of the best ways to achieve glycaemic control. It is concluded that nurses have an important role in helping patients achieve proper HbA1c.

Saudek, C. (2002).The Role of Primary Care Professional in Managing Diabetes, Clinical Diabetes 20(2), 65-66.

The article addresses the role that primary care professionals have in diabetes management. The author asserts that only 20% of diabetes cases are taken by specialists in the area such as endocrinologists. According to Saudek, patients with diabetes do not receive adequate health care from their primary health care providers. He concludes that for success in diabetes prevention and management, primary care providers should play a larger role. He proposes that more diabetes management resources be directed to primary care providers. As president of the American Diabetes Association, his article is credible. The articles show the importance of auxiliary health cares providers such as nurses in diabetes management.

Siminerio, L., Funnell, M., Peyrot, M., & Rubin, R. (2007). US Nurses’ Perceptions of Their Role in Diabetes Care: Results of the Cross-national Diabetes Attitude Wishes and Needs (DAWN) Study, The Diabetes Educator 33(1), 152-162.

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Nurses have a very important role in health care provision. The authors investigate how nurses and physicians perceive the role of nurses in diabetes management. The researchers ua used a cross-section design where they interviewed health care professionals involved with diabetes in 13 countries. Samples for the study were picked from medical professionals involved in diabetes management hence the outcome was credible. The study is related to the proposed research study.

Stevenson, K., Baker, R. Farooqi, A., Sorrie, R., & Khunti, K. (2001). Features of Primary health care teams associated with successful quality improvement of diabetes care: a qualitative study. Family Practice 18(1), 21-26.

The authors investigate qualities in primary care teams that improve the quality of diabetes care. Data for the study was obtained by interviewing lead general practitioners and practice nurses. The authors conclude that diabetes care was highly dependent on primary care teams and suggest the need for teamwork in diabetes management. The article is relevant to the proposed study since it correlates nursing care and success in diabetes management.

Wilson, A., Pearson, D., & Hassey, A. (2002). Barriers to developing the nurse practitioner role in Primary care- the GP perspective, Family Practice 19(6), 641-646.

The role of nurses in primary care provision is highly being recognized. The author investigates the barriers that limit their participation in this role. They identify the barriers to nurses’ practitioner role as nursing capabilities, job, and financial security, and structural and organizational structure. The literature is relevant to the proposed study taking into consideration of expanded responsibility of nurses in diabetes management.

Tools of Research

The studies used mainly systematic review, experimental tools, and explorative tools such as questionnaires and interviews. There was not a great variation of the tools used for studies except a few trials. The reason why questionnaires could have been preferred is that they are very easy when it comes to analysis and in most cases, some software can help process them. In terms of cost, they are economically more efficient in comparison with interviews. Due to their widespread use, they are also acceptable by many people because of familiarity and are very comprehensive and less intrusive like interviews.

In general, the tools that were used for the researches are different. This may be explained by the statement that all the researchers needed to use various approaches for identifying the obesity rates. The tools that were used for the problem research are mainly qualitative, as the aspects of chronic pain which generally require self-management should be researched from the perspective of effectiveness and quality of the applied management principles.

Effect on Result

The tools used in the studies influenced the result. Experimental and exploration tools influenced the result. Experimental tools were thorough as compared to the other tools and could have led to more accurate results. The effect of the tool selection is not sufficient, as the actual importance of the tools is explained by the necessity to analyze the effectiveness of the self-management principles. Because qualitative analysis presupposes some variation of the estimation principles, hence, some differences are observed. Nevertheless, the analysis of the patients with chronic pain is based on the necessity to research their pain-management habits. Because these habits will not change because of the varied research technique, the results will not vary.

Evidence summary

Diabetes is a major health challenge in the world. Complications and high costs associated with diabetes call for more effort in management. Nurses have a central role in health care provision. In diabetes, nurses have very important roles that contribute positively to diabetes management. The articles were reviewed to address the contribution of nurses in various areas of diabetes management. In one of the research studies, the researchers demonstrate that nurses play a vital role in managing hyperglycemia. Three of the research studies show the importance of nurses in providing information to diabetes patients, therefore contributing significantly to the success of self-management.

Glycaemic control is vital in managing Type II diabetes. Two of the studies demonstrate the role that nurses play in glycaemic control, therefore, contributing positively to diabetes management. Two studies address the importance of primary care providers; nurses included, and show that they have an important role success of diabetes management. Endocrinologist-based care is usually advocated for the management of gestational diabetes. However, one of the studies shows that nurses also have significant in gestational diabetes management.

The evidence summary which should be made based on the regarded researches is closely associated with the effectiveness of pain management. Patients with diabetes often experience chronic pain, hence, the techniques of pain management should be regarded as the key factor of the research activity. In general, most self-administered techniques are based on the doctors’ prescriptions; consequently, they can not be regarded as self-managed in full measure. On the other hand, the methodology of the research can not be regarded as an effective tool, as people are not sincere enough when they are interviewed over the phone. Questionnaires presuppose more anonymity; consequently, people feel less restricted. The conclusion that chronic pain causes negative consequences on the self-management process is evident. Considering the type of the research, it should be stated that the actual evidence of the research is closely associated with the necessity to improve the data collection principles, as the importance of correct and accurate data collection is explained by the fact that information collected by the means of interviews and questionnaires is the basis of the proper research and correct conclusions, associated with pain management.

Recommendations

Nurses have an important role to play in diabetes management. Considering the high number of diabetes patients, nurses can increase their support in diabetes management. To enable nurses to contribute more to diabetes management, they require training to expand their capacity.

Importance of Theory in Nursing Research

Research is an integral part of nursing. Nursing research has gained popularity in recent years where nurses are involved in research at various levels. Evidence-based nursing calls for research to support or improve nursing practice. Considering the importance of research in nursing, it is appropriate for nurses to have skills in research. Theory in nursing research provides a nurse with important research concepts. With skills obtained from theory in nursing, nursing can be designed and conducted research more effectively thus contributing to knowledge in health care.

Reference List

Aubert, R., Herman, W., Waters, J., Moore, W., Sutton, D., Peterson, B., Bailer, C., & Koplan, J. (2004). Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization, Annals of Internal Medicine 129(8), 605-612.

Debbie, H. (2009). New roles in diabetes care provision, Journal of Diabetes Nursing 7(2), 78-81.

Hutchinson, A., Peters, J., Mackinnon, M., Mcubtish, A., & Jones, R. (2001). What role do nurses play in Type 2 diabetes care in the community: a Delphi study, Journal of Advanced Nursing 34(2), 179-88.

Mclean, D., McAlister, F., Johnson, J., King, K., Makowsky, M., & Jones, C. (2008). A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients with Diabetes Mellitus, Archives of Internal Medicine 168(21), 2355-2361.

Miguel, M., Adelantado, J., Garcia-Patterson, A., Martin, E., Ubeda, J., Ginovart, G., Leiva, A., & Corcoy, R. (2003). Nurse-based Management in Patients with Gestational Diabetes, Diabetes Care 26(4), 998-1001.

Nesbeth, H., Rosenthall, W. (2009).Breaking down the barriers to good glycaemic control in type2 diabetes: a debate on the role of nurses. European Diabetes Nursing 6(1) 29-33.

Saudek, C. (2002). The Role of Primary Care Professional in Managing Diabetes, Clinical Diabetes 20(2), 65-66.

Siminerio, L., Funnell, M., Peyrot, M., & Rubin, R. (2007). US Nurses’ Perceptions of Their Role in Diabetes Care: Results of the Cross-national Diabetes Attitude Wishes and Needs (DAWN) Study, The Diabetes Educator 33(1), 152-162.

Stevenson, K., Baker, R. Farooqi, A., Sorrie, R., & Khunti, K. (2001). Features of Primary health care teams associated with successful quality improvement of diabetes care: a qualitative study. Family Practice 18(1), 21-26.

Wilson, A., Pearson, D., & Hassey, A. (2002). Barriers to developing the nurse practitioner role in Primary care- the GP perspective, Family Practice 19(6), 641-646.

Appendix

Matrix

Author, Title Source Date Research Type Population/Sample size Outcome Measure Pertinent data from the result Suggested Conclusion Comments

Ali Wilson, David Pearson,and Alan Hassey, Barriers to developing the nurse practitioner role in primary care—the GP perspective

Family Practice Vol. 19 No. 6 2002 Explorative research British general practitioners, 33, 6-8 groups The study highlighted significant concerns by GPs about the nurse practitioner role in general practice Bp concerns over nurses involvement in primary care should be acknowledged to allow debate on the appropriate mix

Peters J, Hutchinson A, MacKinnon M, McIntosh A, Cooke J, Jones R. What role do nurses play in Type 2 diabetes care in the community: a Delphi study.

Journal of Advanced Nursing Vol. 34 No. 2 2001 Delphi study Practice nurses in Great Britain, 97 practice nurses, and 69 diabetes specialist 85% of the 165 items achieved greater than 80% agreement Many areas of consensus in health care to type 2 diabetes patients were found Shows greater responsibility of nurses in diabetes management
Maria, M., Adelantado, J., Garcia-Patterson, A., Martin, E., Ubeda, J., Ginovart, G., Leiva, A., & Corcoy, R. Nurse-based Management in Patients with Gestational Diabetes Diabetes Care 26(4) 2003 experimental design patients with GDM delivering between 1 January 1995 and 30 June 1997 No difference in maternal characteristics between groups treated during the two periods Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and prenatal outcome More role of nurses in diabetes management
Siminerio, L., Funnell, M., Peyrot, M., & Rubin, R., US Nurses’ Perceptions of Their Role in Diabetes Care: Results of the Cross-national Diabetes Attitude Wishes and Needs (DAWN) Study The Diabetes Educator 33(1), 2007 cross-sectional design Diabetes health care professionals. 51 generalist nurses, 50 diabetes specialist nurses, 166 generalist physicians, and 50 diabetes specialist physicians Nurses and physicians agreed that nurses should take a larger role in managing diabetes need for more involvement by nurses, particularly specialist nurses, in diabetes care The increased role of nurses in diabetes care
Saudek, C., The Role of Primary Care Professional in Managing Diabetes Clinical Diabetes 20(2) 2002 Qualitative

Primary Care Professionals

Primary care professionals play a big role in diabetes management Primary care professionals should take more roles in diabetes management
Debbie, H., New roles in diabetes care provision, Journal of Diabetes Nursing 7(2) 2009 Qualitative
Aubert, R., Herman, W., Waters, J., Moore, W., Sutton, D., Peterson, B., Bailer, C., & Koplan, J. Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization Annals of Internal Medicine 129(8) 2004 Controlled experiment Type 1 and Type 2 diabetes patients, 17 patients with type 1 diabetes mellitus, and 121 patients with type 2 diabetes mellitus Self-reported health status improved in the nurse case management group P=0.02 A nurse case manager with considerable management responsibility can help improve glycemic control in diabetic patients A study conducted in a Home Model
Stevenson, K., Baker, R. Farooqi, A., Sorrie, R., & Khunti, K., Features of Primary health care teams associated with successful quality improvement of diabetes care: a qualitative study Family Practice 18(1), 2001 Structured survey Gps and practice nurses in Leicestershire Features of Primary health care teams associated with successful quality improvement of diabetes care: a qualitative study Features of Primary health care teams associated with successful quality improvement of diabetes care: a qualitative study Nurse has a positive role in the overall performance of diabetes management
Nesbeth, H., Rosenthall, W., Breaking down the barriers to good glycaemic control in type2 diabetes: a debate on the role of nurses European Diabetes Nursing 6(1) 2009 Experiment Type 2 diabetes patients through patient support and education, nurses have a notable, positive impact on the proportion of patients achieving HbA1ctargets Importance of nurses in diabetes management in increasing