Chiung-Jung Wu

Innovative self-management programme for diabetics following coronary care unit admission.

BACKGROUND Evidence indicates self-management programmes based on improving self-efficacy in managing diabetes can reduce the risk of a further cardiac event. Many current cardiac rehabilitation or diabetes self-management programmes do not address the needs of people with both type 2 diabetes and a critical cardiac condition in their transition from coronary care unit (CCU) to home. AIMS/METHODS The aim was to develop and pilot test a Cardiac-Diabetes Self-Management Program (CDSMP) using an experimental design. FINDINGS/CONCLUSION Results demonstrated the feasibility of the CDSMP for CCU patients with type 2 diabetes in their transition to home, and a full study is warranted.

Audit of patients with type 2 diabetes following a critical cardiac event.

BACKGROUND Evidence indicates that type 2 diabetes leads to complications such as a cardiac event, which often requires admission to a coronary care unit (CCU). Although there is a considerable body of knowledge about the management and characteristics of people with type 2 diabetes and myocardial infraction, there are few reports of the disease and demographic characteristics of the entire group of patients with diabetes admitted to a CCU. PURPOSE To gain greater understanding of the characteristics of patients with diabetes hospitalized for a critical cardiac event in order to assist in the development of an appropriate self-management programme for CCU patients with diabetes. METHODS Data were collected retrospectively from computerized records and charts of all patients with diabetes admitted to the CCU from 1 January 2000 to 31 December 2003. FINDINGS The proportion of type 2 diabetic patients admitted to CCU with a critical cardiac event over the 4-year study period was consistent at 14.7%, 233 in 1589 patients. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days compared with only 6% of CCU patients without diabetes. Predictors for readmission and length of stay were also examined. CONCLUSIONS A considerable proportion of a CCU population had type 2 diabetes and these patients had significantly higher readmission rates. The implications of this study for the development of a self-management programme for patients with diabetes who experienced a critical cardiac event are discussed. IMPLICATIONS FOR PRACTICE Innovative programmes are required to reduce the rate of readmission for patients with both diabetes and a critical cardiac event. These should: 1 ensure transition programmes, such as self-management, commence within the CCU environment and continue following discharge, and 2 integrate diabetes and cardiac self-management programmes to condense the large amount of information provided to patients for managing two serious conditions.

Application of a theoretical framework to foster a cardiac-diabetes self-management programme.

Aim This paper analyses and illustrates the application of Banduras self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. Background Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Banduras self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. Sources of Evidence The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. Discussion This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. Conclusion Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. Implications for Nursing Practice or Health Policy Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.AIM This paper analyses and illustrates the application of Banduras self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. BACKGROUND Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Banduras self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. SOURCES OF EVIDENCE The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. DISCUSSION This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. CONCLUSION Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. IMPLICATIONS FOR NURSING PRACTICE OR HEALTH POLICY Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.

Technological Caring for Complexities of Patients with Cardiac Disease Comorbid with Diabetes

Abstract Cardiac disease and diabetes are the most prevalent and resource-intensive health conditions globally. Integrating technologies with the art of caring in nursing for patients with complex needs is growing rapidly. Informational technologies have great potential to be cost efficient and effective in assisting patients with comorbidities, but pose a great challenge to maintain human caring relationships to balance caring and technology economics and science when nurses are engaged in the provision of care from hospital/clinic environments to self-management at home (Cardiac–Diabetes Self-Management Program). This paper discusses nursings role in addressing the complex issue of technological caring and our ethical responsibility in terms of the use of virtual technologies or telehealth remotely for diverse patients and their significant others.

The impact of inpatient education on self-management for patients with acute coronary syndrome and type 2 diabetes mellitus: a cross-sectional study in China

This study examined the impact of inpatient education on diabetes knowledge, acute coronary syndrome (ACS) symptom management and diabetes self-management on discharge for patients with ACS and type 2 diabetes mellitus (T2DM). A cross-sectional survey and patient health record review of 160 patients was conducted in a major hospital in Shanghai. Patient education received was measured using a visual analogue scale. The survey included valid and reliable measures of diabetes knowledge, self-efficacy, attitudes to ACS and clinical outcomes. Inpatient education contributed to improvements in fasting blood glucose on discharge (P < 0.05). ACS symptom management [Chinese language version of the ACS response index (C-ACSRI) scores] and self-management of T2DM [Chinese version of diabetes management self-efficacy scale (C-DMSES) scores] on discharge differed for the limited education group and sufficient education group (P < 0.001). Based on the multiple regression analyses, increasing scores for the C-ASCRI and C-DMSES could be explained by higher scores for perceived health education. Education relating to ACS and T2DM delivered during an acute admission was associated with improved scores in ACS symptom management and T2DM self-management, preparing some patients to manage both conditions on discharge.

‘Better to save one life than build a seven-storied pagoda’: a qualitative study of health education for patients with acute coronary syndrome and type 2 diabetes mellitus in Shanghai, China

Objective To describe, from the perspectives of health professionals, the health education currently being provided from hospital admission to discharge to home to patients who present with acute coronary syndrome who also have type 2 diabetes mellitus (T2DM). Methods A qualitative study using semistructured interviews was undertaken in the coronary care unit (CCU) of a major hospital in Shanghai, China. Fifteen health professionals (nine registered nurses and six physicians) from the CCU who delivered health education to patients with acute coronary syndrome and T2DM participated. Participants also completed an Education Content Checklist containing topics consistent with existing national guidelines. Findings Major themes identified included: health education is an essential embedded component of treatment; health education comprises varied strategies to facilitate behavioural change; and barriers and required resources to deliver effective health education. Conclusions Surviving the initial symptoms and providing immediate treatment is the first step in recovery for patients with acute coronary syndrome and T2DM. Health education is an essential component of the management of these patients, and content and focus that is responsive to the recovery stage of the patient is required. Teaching and supporting strategies appropriate for the inpatient phase prior to discharging to the community phase are required.

Effectiveness of the cardiac-diabetes transcare program: protocol for a randomised controlled trial

BackgroundThis paper presents a protocol for a randomised controlled trial of the Cardiac-Diabetes Transcare program which is a transitional care, multi-modal self-management program for patients with acute coronary syndrome comorbid with type 2 diabetes. Prior research has indicated people hospitalised with dual cardiac and diabetes diagnoses are at an elevated risk of hospital readmissions, morbidity and mortality. The primary aim of this study is to evaluate the effectiveness (and cost-effectiveness) of a Cardiac-Diabetes Transcare intervention program on 6-month readmission rate in comparison to usual care.Methods/DesignA two-armed, randomised controlled trial with blinded outcome assessment will be conducted to evaluate the comparative effectiveness of two modes of care, including a Usual Care Group and a Cardiac-Diabetes Transcare Intervention (in addition to usual care) Group. The primary outcome is 6-month readmission rate, although a range of secondary outcomes will be collected (including self-efficacy) at baseline, 1, 3 and 6 month reassessments. The intervention group will receive in-hospital education tailored for people recovering from an acute coronary syndrome-related hospital admission who have comorbid diabetes, and they will also receive home visits and telephone follow-up by a trained Research Nurse to reinforce and facilitate disease-management-related behaviour change. Both groups will receive usual care interventions offered or referred from participating hospital facilities. A sample size of 432 participants from participating hospitals in the Australian states of Queensland and Victoria will be recruited for 90% power based on the most conservative scenarios modelled for sample size estimates.DiscussionThe study outlined in this protocol will provide valuable insight into the effectiveness of a transitional care intervention targeted for people admitted to hospital with cardiac-related presentations commencing in the inpatient hospital setting and transition to the home environment. The purpose of theory-based intervention comprising face-to-face sessions and telephone follow up for patients with acute coronary syndrome and type 2 diabetes is to increase self-efficacy to enhance self-management behaviours and thus improve health outcomes and reduce hospital readmissions.Trial registrationThis study has been registered with the Australian New Zealand Clinical Trials Registry dated 16/12/2014: ACTRN12614001317684.