James A. Fain

Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: A randomized clinical trial

AIMS Despite the known benefits, 60% of individuals with diabetes do not engage in regular physical activity (PA). This pilot study tested the effects of a counseling intervention using continuous glucose monitoring system (CGMS) feedback on PA self-efficacy, PA levels, and physiological variables. METHODS Adults (N=52) with type 2 diabetes (non-insulin requiring, inactive) were randomized to intervention (n=27) or control (n=25) groups. Both groups received 90min of diabetes education with a follow-up phone call 4 weeks later. The intervention group also received counseling derived from self-efficacy theory. This intervention included feedback on each participants CGMS graph and used role model CGMS graphs to clearly depict glucose reductions in response to PA. Outcomes were assessed at baseline and 8 weeks. RESULTS Participants receiving the intervention had higher self-efficacy scores than the control group for sticking to activity/resisting relapse at 8 weeks (p<0.05), indicating more confidence in maintaining a PA program. Intervention group participants light/sedentary activity minutes decreased significantly (p<0.05), moderate activity minutes increased significantly (p<0.05), and, HbA1c and BMI decreased significantly (p<0.05). CONCLUSIONS These data suggest that PA counseling interventions using CGMS feedback for individuals with type 2 diabetes may improve PA levels and reduce risk factors for diabetes-related complications.

Psychometric testing of the heart failure somatic awareness scale.

Background: Self-management of heart failure relies on patients to assess their symptoms, but their ability to do so is often difficult to determine. The 12-item self-report Heart Failure Somatic Awareness Scale (HFSAS) was developed to measure awareness of and distress secondary to heart failure symptoms. The purpose of this study was to test the psychometric properties of the HFSAS. Methods and Results: Feasibility and discriminant validity of the HFSAS were tested in 49 patients admitted for an exacerbation of heart failure. The HFSAS was acceptable to patients and discriminated between heart failure symptoms and anxiety (r = 0.25, P = .08). When reliability and validity were tested in 201 patients with acute heart failure, theta reliability was adequate (0.71). The HFSAS was low to moderately correlated with general bodily awareness (r = 0.48). No difference was found based on gender, but younger patients had higher mean and median HFSAS scores (more distress). The HFSAS was a significant predictor of symptom duration prior to seeking care for heart failure; higher scores were associated with longer delay before seeking care. Conclusion: The HFSAS is reliable with content, discriminant, and construct validity. Evaluation of its usefulness in teaching patients to monitor daily symptoms is needed.

Diabetes Patient Education Research: An Integrative Literature Review:

PURPOSE The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered. METHODS An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed. RESULTS Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA,, was the most frequently employed outcome measure, with little, if any, description of the interventions. CONCLUSIONS Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

Nurse Practitioner Practice Patterns Based on Standards of Medical Care for Patients With Diabetes

OBJECTIVE To determine to what extent nurse practitioner (NP) practice patterns of diabetes care are consistent with standards of care suggested by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS A descriptive study was conducted to examine practice patterns. A convenience sample of 78 charts was audited, representing a proportionate number of charts for each of the six masters-prepared, certified NPs employed in an ambulatory primary-care center. RESULTS Practice patterns related to diabetes care revealed a discrepancy between established standards of care and the degree to which care was documented. All six NPs acknowledged that they became clinically competent to care for patients with diabeteson the job. CONCLUSIONS Results of this small study suggest that NPs are not consistently following standards of care suggested by the ADA.

Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses: a pilot study.

A mixed-method study was conducted to determine whether nurses’ participation in a reflective practice continuing education program using a structured reflection model makes a difference in nurses’ self-reflection, insight, and reflective thinking about clinical practice situations. Findings suggested that use of structured reflection using question cues, written narratives, and peer-facilitated reflection increased nurses’ engagement in self-reflection and enhanced reflective thinking in practice. Including reflective practice education in novice orientation and preceptor training may be beneficial.

A Multidimensional sense of humor scale for school-aged children: Issues of reliability and validity

The Multidimensional Sense of Humor Scale (MSHS) was revised to assess sense of humor in school-aged children. One hundred sixteen children completed the modified MSHS. Chronbach alpha coefficients were .88 for the total scale and ranged from .78 to .85 for the subscales. Item to total MSHS score correlations ranged from .35 to .71. Concurrent validity was supported with a positive correlation between total MSHS score and childrens rating of their degree of sense of humor (r = .42, P < .001). Although further testing is suggested, the modified MSHS can be used in clinical and research settings to assess a childs sense of humor and determine the appropriateness and effectiveness of using humor with children as they cope with childhood stressors.

Should We Publish Pilot/Feasibility Studies?:

A pilot, or feasibility, study is a small scale version, or trial run, of a full-scale study to test logistics and gather information to improve the overall research design and assess whether the research protocol is realistic. Several advantages of conducting pilot/feasibility studies include developing and testing adequacy of research instruments, establishing whether sampling techniques are effective, assessing likelihood of proposed recruitment strategies, determining what resources are needed for a full-scale study, training researchers on elements of the research process, and collecting preliminary data. The main goal or focus of conducting pilot/feasibility studies is to assess the feasibility so as to avoid unfortunate consequences when embarking on a fullscale study. Pilot/feasibility studies should pose questions as to the adequacy, appropriateness, acceptability, and workability of methods planned for a larger study. Thus, pilot studies should be designed specifically to answer these questions. Such methodological questions may pertain to instrumentation, sampling, recruitment, and analytic methods or procedures. While pilot studies are very informative in helping to guide the planning of a full-scale study, there are challenges and misconceptions associated with conducting and publishing pilot/feasibility studies. Too often, the emphasis is placed on statistical significance, not on feasibility. Thus, pilot studies are not well designed with no clear feasibility objectives or criteria for success. Pilot studies often present a challenge when data are generated from small sample sizes. In many instances, pilot/feasibility studies with small sample sizes lack statistical power to make generalizations to the larger population of interest. While it is important that the sample be representative of the target population, it should be large enough to first and foremost, provide information about aspects of the study being assessed for feasibility. In this issue of The Diabetes Educator (TDE), there are several pilot/feasibility studies that provide practical information with respect to feasibility. While TDE welcomes for consideration potential publication of pilot/feasibility studies, the Editorial Advisory Board will take into consideration editorial needs and determine if such manuscripts add to the state of the science and provide reasonable evidence for the generalization of the data.

Insulin Resistance and the Use of U-500 Insulin: A Case Report

U-500 regular pork insulin offers some patients with insulin resistance improvement in metabolic regulation. This case report describes a 59-year-old diabetic woman with severe insulin resistance due to obesity. Discussion focuses on the types of insulin resistance, appropriate treatment, and benefits from U-500 insulin therapy.

Incorporating Peplau’s Theory of Interpersonal Relations to Promote Holistic Communication Between Older Adults and Nursing Students

With the increased life expectancy, older adults will interact with multiple health care providers to manage acute and chronic conditions. These interactions include nursing students who use various health care settings to meet the clinical practicum requirements of their programs. Nursing faculty are charged with facilitating students’ learning throughout the program from basic human needs, to holistic communication, to advanced medical surgical concepts. Despite educating students on holistic communication, there remains a lack of a reliable framework to undertake the task of teaching holistic communication skills. Nursing students preparing to function as licensed practitioners need to develop appropriate knowledge to holistically care for older adults. The purpose of this article is to examine Hildegard Peplau’s interpersonal relations theory as a framework to assist nursing students to understand holistic communication skills during their encounters with older adults. Peplau’s theory provides nursing a useful set of three interlocking and oftentimes overlapping working phases for nurses’ interaction with patients in the form of the nurse–patient relationship. Nursing education could adopt the three phases of Peplau’s interpersonal relations theory to educate students on holistically communicating with older adults.

Psychometric Properties of the Spanish Version of the Diabetes Self-management Assessment Report Tool

PURPOSE The purpose of this study is to evaluate the psychometric properties of a Spanish-language version of the Diabetes Self-management Assessment Report Tool (D-SMART) for Hispanics with type 2 diabetes. METHODS Participants were 174 Hispanics from the Worcester Family Health Center diagnosed with type 2 diabetes. Reliability testing was conducted to determine the internal consistency and stability of the newly revised Spanish-language version of the D-SMART. RESULTS Psychometric findings support the reliability of the newly translated Spanish-language version of the D-SMART. CONCLUSIONS The newly revised Spanish-language version of the D-SMART provides educators with a culturally relevant measure of diabetes self-management along with a better understanding about how Hispanics perceive their diabetes and self-management practices.