Judy Ann Wollin

Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: A randomized controlled trial

BACKGROUND Type 2 diabetes is a serious and growing problem in Taiwan where it is the fifth leading cause of death, and health care costs are 4.3 times higher than for people without diabetes. OBJECTIVES The purpose of this study was to determine whether participation in a motivational interview for people with type 2 diabetes would improve their self-management, psychological and glycemic outcomes. DESIGN A randomized controlled trial to assess the effects of the motivational interviewing intervention. SETTINGS Participants were drawn from the diabetes outpatient clinic of a large teaching hospital in South Taiwan. PARTICIPANTS A sample of 250 type 2 diabetes people. METHODS Type 2 diabetes people were randomly allocated into either the motivational interview group or the usual care group from baseline to 3 months follow-up. The intervention was based on motivational interviewing which encompassed a variety of interviewing techniques, and reflected each persons readiness stage to change. The control group was provided with usual care by nursing staff. RESULTS A total of 250 type 2 diabetic participants were randomized. The retention rate in the intervention group was 83% (n=104). The motivational interview did improve participants significantly in self-management, self-efficacy, quality of life, and HbA1c among diabetes people with appropriate baseline value (<121.24, <174.57, <107.18, and >7.62, respectively) but not in depression, anxiety and stress (F=0.13, p=0.72) compared to the control group at 3 months follow-up. CONCLUSION The findings provided important evidence concerning the positive effect of motivational interventions in self-management, psychological and glycemic outcomes. This research provided evidence for future clinical practices in diabetes care.

Peer mentorship in clinical education: outcomes of a pilot programme for first year students

Identifying effective strategies for promoting learning in the clinical setting continues to pose challenges for nurse educators. The aim of the present paper is to examine the potential that peer mentorship may have in helping nursing students to improve clinical learning outcomes. An example of a peer mentorship programme for nursing students undertaking their first clinical practicum is described, and preliminary findings from an evaluation of this pilot programme are presented. The results suggest that peer mentorship may be of some benefit to students, particularly in relation to reducing anxiety and improving confidence with clinical practice experiences, and is therefore a strategy which is worthy of further investigation.

What people with newly diagnosed MS (and their families and friends) need to know

The aim of this retrospective study was to determine from people with multiple sclerosis (MS) and their families what information would assist a person with newly diagnosed MS — in which format, when, and from whom it should be delivered. Thirty-four Queensland, Australia, residents with MS and 18 family members and friends participated in the main study. Participants were self-selected for this purposive, statewide, cross-sectional study. Nine of the respondents answered open-ended questions in addition to the standard questionnaires, and seven respondents gave in-depth interviews. The respondents recommended that people with a recent MS diagnosis and their families be given a wide range of information reflective of their personal needs. The information should be provided in person (in both group and individual sessions). They preferred to receive the information from their physicians and the staff of the Multiple Sclerosis Society. Research aimed at cures and therapies, as well as counseling and support services, should be discussed early in the course of the disease. Because of the small sample size and retrospective design, additional studies with larger populations are suggested to confirm these results and their cross-cultural applicability.

The Multiple Sclerosis Work Difficulties Questionnaire

Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.

Nurse-Led Telephone Interventions for People with Cardiac Disease: A Review of the Research Literature

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

Mammograms and Pap smears for Australian deaf women.

This study aimed to assess baseline knowledge about mammograms and pap smears among Australian Deaf women, to investigate their participation in breast and cervical cancer screening services, and to explore, where relevant, their perceptions about their access to breast and cervical screening services. An interview schedule was developed, and a convenience sample of 13 Deaf women was interviewed face-to-face by the first researcher with an accredited Auslan interpreter. The Deaf womens knowledge about mammograms and Pap smears often was incomplete. However, most of the eligible women had undergone a mammogram and had been rescreened within the recommended time frame. Although most had received a Pap smear, some were not attending as recommended by the Cancer Council of Australia. This exploration into the experiences of Deaf women can prompt all nurses to consider the needs of particular minorities and the barriers they may face to participate fully in health services.

Illness and Demographic Correlates of Chronic Pain Among a Community-Based Sample of People With Multiple Sclerosis

OBJECTIVE To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS). DESIGN A cross-sectional survey and structured pain interview. SETTING Community. PARTICIPANTS People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques. RESULTS Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0+/-1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity. CONCLUSIONS Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.

Biopsychosocial correlates of adjustment to pain among people with multiple sclerosis.

ObjectivesThe objective of this study was to examine the extent to which pain-related beliefs and coping strategies predicted measures of adjustment to pain among people with multiple sclerosis (MS), over and above that accomplished by demographic and clinical variables. MethodsParticipants were a community-based sample of people with chronic MS-related pain (N=105) who completed postal surveys and standardized interviews that included measures of demographic and MS-related variables, typical pain intensity, psychologic functioning, pain interference, pain beliefs, and coping strategies. ResultsPain-specific beliefs and coping strategies were associated with and explained a significant proportion of the variance in adjustment to pain (24% to 34%) among people with MS, over and above that accomplished by demographic and disease-related variables and pain intensity. Compatible with previous studies, greater endorsement of pain constancy and catastrophizing were significant predictors of poorer adjustment, whereas perceived ability to decrease pain and increasing behavioral activities in response to pain were related to positive adaptation. DiscussionThese findings provide support for the premise that psychosocial factors remain central in disability-related pain and suggest the possibility that interventions targeting these variables would reduce the negative impact of pain among people with MS.

Caregiver Burden: Meeting the Needs of People who Support the Person with Multiple Sclerosis

Abstract Reliance on informal arrangements to support the person with multiple sclerosis (MS) is an increasingly common phenomenon. The focus of this Australian-based research is on the impact of the caregiver role, the identification of stressors that might prevent a continuation of the role, and the determination of resources needed by caregivers to continue in this role. Using surveys that were sent through the mail, the views of 34 people who care for an individual with MS were collected in order to identify the caregivers’ views on the impact of their role. The results indicate that caregivers provide between 2 and 10 hours daily of physical, emotional, financial, or informational support to the person with MS. The majority of people who provide support to individuals with MS are married to them; they provide care out of love; and they are overtaxed by day-to-day tasks with reduced physical, emotional, and financial resources. Caregivers requested practical support rather than information to reduce t...

Psychosocial Factors That Influence Quality of Life and Potential for Self-Management in Multiple Sclerosis

Optimizing quality of life (QOL) and self-management in people with multiple sclerosis (MS) is increasingly seen as a worthwhile goal. This study aimed to investigate factors that affect QOL in MS. A large national sample of Australians with MS (n = 1848) generated from the Australian Multiple Sclerosis Longitudinal Study completed a survey addressing disease duration and severity, self-efficacy, depression, perceived stress, social support, QOL, and self-management. We tested a model of self-help in which antecedent variables are influenced by mediating variables, which in turn affects outcome variables. In the current study, the antecedent variables were disease duration and disease severity; the mediating variables were self-efficacy, depression, perceived stress, and social support; and the outcome variables were QOL and self-management. We also tested the hypothesis that disease severity, depression, and perceived stress would correlate inversely with QOL and potential for self-management, whereas self-efficacy and perceived level of social support would correlate positively with QOL and potential for self-management. The results indicated that the antecedent variables did not correlate with the mediating variables, with one exception: a negative correlation was found between disease severity and social support. No correlations were found between social support and QOL or self-management. However, significant correlations were found between depression, self-efficacy, stress, and social support and QOL. No correlations were found between either the antecedent or the mediating variables and self-management. The results confirm previous findings of statistically significant correlations between psychosocial factors and QOL.