Caralise W. Hunt

Technology and diabetes self-management: An integrative review

Technology can be used to supplement healthcare provider diabetes care by providing both educational and motivational support. Education can be provided using technology allowing patients to learn new practices and routines related to diabetes management. Technology can support daily diabetes self-management activities including blood glucose monitoring, exercising, healthy eating, taking medication, monitoring for complications, and problem-solving. This article describes an integrative review conducted to evaluate the types of technology being used to facilitate diabetes self-management and the effect of that technology on self-management and diabetes outcomes for adults living with type 2 diabetes mellitus. A literature review was conducted by searching Medline, PubMed, and Psych INFO databases using the search terms: diabetes self-management, technology, type 2 diabetes, smartphones, cell phones, and diabetes mellitus covering the years from 2008-2013. Articles relying on secondary data (editorials, systematic reviews) and articles describing study protocol only were excluded. Fourteen studies including qualitative, quasi-experimental, and randomized controlled trial designs were identified and included in the review. The review found that technological interventions had positive impacts on diabetes outcomes including improvements in hemoglobin A1C levels, diabetes self-management behaviors, and diabetes self-efficacy. Results indicate that technological interventions can benefit people living with diabetes when used in conjunction with diabetes care delivered by healthcare providers.

An Integrative Review of Community Health Advisors in Type 2 Diabetes

The purpose of this paper was to report findings from an integrative literature review conducted to identify the theoretical basis of interventions for studies using community health advisors; populations and settings served by community health advisors; characteristics, training, and roles and activities of community health advisors; and the effectiveness of interventions by community health advisors for improving self-management of patients living with type 2 diabetes mellitus. Community health advisors’ theoretical interventions were based on providing culturally appropriate care and resolution of health disparities within minority populations. Typically community health advisors were patients themselves living with type 2 diabetes mellitus. Major roles of community health advisors included: supporter, educator, case manager, advocate, and program facilitator. Activities of community health advisors were: coordinating educational programs, conducting educational courses for patients, serving as a link between patients and healthcare professionals, providing counseling, and leading peer support meetings. The effectiveness of interventions by community health advisors was mixed. Examples of outcome criteria were improvements in: knowledge, hemoglobin A1C, low density lipoprotein levels, blood pressure, and physical activity. Community health advisors provide culturally appropriate interventions to promote and restore health and prevent diseases while serving as links between community and healthcare providers.

Enhancing faculty resources through peer mentoring.

Peer mentoring is a relationship in which a more experienced person assists a less experienced person to achieve desired outcomes. Mentoring relationships provide benefits for both the mentor and the mentee. The authors describe a peer-mentoring strategy implemented in a skills laboratory to improve skills knowledge, decrease anxiety associated with skills demonstrations, and provide positive socialization and its outcomes.

Relationships among self-efficacy, social support, social problem solving, and self-management in a rural sample living with type 2 diabetes mellitus.

Self-management behaviors are important for control of type 2 diabetes mellitus. Therefore, determining factors that promote effective self-management behaviors may be significant for improving the well-being of patients with type 2 diabetes mellitus. This study examined relationships among self-efficacy, social support, social problem solving, and diabetes self-management behaviors. Further, this study evaluated whether social support and social problem solving were mediators of the relationship between self-efficacy and diabetes self-management behaviors in those living with type 2 diabetes mellitus. Using a cross-sectional, descriptive correlational design, data from a convenience sample of 152 rural people living with type 2 diabetes mellitus were examined. Findings indicated that self-efficacy was a strong predictor of diabetes self-management. The effect of social support on diabetes self-management differed among men and women in the sample. Social support and social problem solving were significantly associated with diabetes self-management in men. Neither social support nor social problem solving were mediators of the relationship between self-efficacy and diabetes self-management in this sample. These findings suggest that nurses need to consider implementing interventions to improve patients’ self-efficacy and potentially influence diabetes self-management.

An empirical study of self-efficacy and social support in diabetes self-management: implications for home healthcare nurses.

This pilot study was conducted to evaluate relationships among self-efficacy, social support, social problem solving, and diabetes self-management in people living with Type 2 diabetes mellitus. Self-efficacy, social support, and social problem solving were significantly correlated with diabetes self-management. These relationships indicate the importance of including interventions to promote self-efficacy, social support, and social problem solving in diabetes self-management programs.

Common Caregiver Issues and Nursing Interventions After a Stroke

After rehabilitation, most stroke survivors return to the community and continue with their daily lives, despite stroke-related functional, cognitive, and behavioral changes.1 Caregivers are the primary support system for these survivors after discharge and an integral part of the healthcare team that contributes to survivors’ rehabilitation and recovery.2,3 However, caregiving is stressful, and caregivers often experience a variety of interrelated individual, interpersonal, and organizational issues in managing stroke-related deficits. These issues and potential nursing interventions for addressing them will be discussed in this article. Individual caregiver issues commonly relate to insufficient knowledge and skills to understand and manage stroke survivors’ physical, cognitive, emotional, and behavioral problems.4 Initially, caregivers request information about the stroke diagnosis, prognosis, complications, and predicted recovery.5 As stroke survivors begin the transition to home care, caregivers require information about assuring their safety, including fall prevention, medications, and prescriptions; adequate nutrition; and management of physical, instrumental, psychological, and behavioral problems.3 Empirical data support caregivers who also require information and support about how to manage complex feelings and interactions with stroke survivors who experience memory problems, depression, anxiety, frustration, withdrawal, and are argumentative.6–8 Empirical literature also indicates that caregivers feel uncertain and unprepared in the caregiving role.9 Caregivers need open and honest communication about their role and stroke survivors’ abilities,3,10 while also offering hope. Conducting a comprehensive predischarge nursing assessment of caregiver physical and psychological health and social, financial, and spiritual needs initially and during follow-up is essential.11 This assessment is vital to understand how caregivers’ skills, abilities, and resources match stroke survivors’ needs for follow-up care better. On the basis of this assessment, nurses should develop a highly individualized case management plan to help caregivers attain skills and services necessary to facilitate success …

A program to provide resources and support for clinical associates.

Clinical associates are necessary and valued contributors to nursing education. All those involved in student instruction need to have clearly defined expectations that are aligned with the conceptual framework and program outcomes. Additionally, they must have the necessary resources to facilitate their ability to effectively instruct and evaluate nursing students in the clinical setting. Preparing competent clinical associates to provide effective clinical instruction requires detailed planning and development that includes guided mentoring from faculty. This article describes the development of an orientation course and ongoing resources and support designed to facilitate the transition into a clinical instructor role for registered nurses teaching in a baccalaureate nursing program. The Clinical Associate Resources and Support program was designed to enhance learning experiences for both clinical associates and the recipients of clinical education, nursing students.

Community health advisors in diabetes care.

Lay liaisons can improve health care outcomes, especially in underserved communities.

Using Simulation to Promote Professional Development of Clinical Instructors.

BACKGROUND Clinical instructors play an important role in the education of nursing students. Nursing faculty must provide orientation and support for clinical instructors to ensure quality clinical experiences for students. Simulation can be used as a teaching strategy to prepare clinical instructors for clinical teaching. The purpose of this article is to describe the use of simulation to prepare clinical instructors in the role of teaching and increase confidence to provide clinical education to students. METHOD Clinical instructors attended an orientation program that included simulation. During the simulation, nursing student volunteers role-played situations that required instructors to intervene for patient safety. Following the simulation, clinical instructors completed an online survey to measure confidence in teaching students. RESULTS Twenty-six clinical instructors participated in the simulation with student volunteers and completed the survey. CONCLUSION Clinical instructors thought the simulation prepared them for clinical teaching, increased their confidence, and assisted them to provide student feedback.

Facilitators of diabetes self-management among rural individuals.

The prevalence of Type 2 diabetes mellitus has increased dramatically with a higher rate in rural populations. Diabetes self-management behaviors such as medication administration, blood glucose testing, and appropriate diet and exercise regimens must be implemented daily to increase chances of achieving therapeutic patient outcomes. Home healthcare clinicians are pivotal in assisting these individuals to be more self-confident and independent in managing their diabetes, achieving therapeutic goals, and addressing diabetes-related complications. This article will discuss facilitators of diabetes self-management in rural populations and implications for home healthcare clinicians.