Melissa Scollan-Koliopoulos

Perceived risk of amputation, emotions, and foot self-care among adults with type 2 diabetes.

Purpose The purpose of this study was to determine the influence of having a family member who experienced an amputation on one’s own perceived risk and fear of experiencing a diabetes-related amputation. Methods This was a descriptive cross-sectional study using paper-and-pencil surveys by mail. Adults with type 2 diabetes and a family history of diabetes attending a self-management education program in the Metropolitan New York/ New Jersey area were recruited. Measures were completed about risk perception and fear of amputation, emotional representations of diabetes from the Illness Perception Questionnaire, and the foot self-care behavior component of the Summary of Diabetes Self-care Activities Survey. The authors estimated the variability in foot self-care that was accounted for by risk perception and fearful memories. Results In those who remembered a family member needing an amputation, high perceived risk and fear was associated with less routine foot self-care. For those without family history of amputation, fear was positively associated with foot self-care. Conclusions Motivation for foot self-care behavior may be driven by risk perception and emotional responses. The ways in which risk perception and fear influence motivation for preventive foot self-care behavior are influenced by whether one’s family member was affected by an amputation. Probing about the influence of the patient’s legacy of diabetes may be helpful when customizing education plans.

The First Diabetes Educator Is the Family: Using Illness Representation to Recognize a Multigenerational Legacy of Diabetes

Purpose: This article proposes a framework for understanding multigenerational legacies of diabetes, which will assist with designing educational interventions for individuals with a known family history of type 2 diabetes. Background/Rationale: Diabetes is a chronic illness that has an associated hereditary predisposition. Family members at risk in subsequent generations may be influenced by the prior generations experiences. Multigenerational legacies and stories shape a familys health beliefs and response to illness and transmit patterns of adaptation across generations. Method: A review of the literature from 1984 to 2004 was conducted to identify evidence of legacies of chronic illness. Outcome: Family-systems-illness-disability Model and Theory of Illness Representation were used to guide the development of a framework of multigenerational legacies of diabetes. Interpretation/Conclusion: A framework for understanding the influence of illness representation on multigenerational legacy of type 2 diabetes is presented. Implications for Nursing Practice: Clinicians are in need of a useful framework that can provide direction as they attempt to understand the effect of a family history of diabetes on the health behavior of the next generation of family members with diabetes. This framework could serve to guide them as they probe for information relevant to the influence of recollections about the family members experience with diabetes on an individuals health behavior.

Gestational diabetes management: guidelines to a healthy pregnancy.

estational diabetes mellitus is not uncommon, affecting 7% of pregnant women annually (200,000 cases are diagnosed each year). Gestational diabetes is defined as any degree of glucose intolerance with onset or initial recognition during pregnancy. It can have negative effects on the development and health of the fetus, including metabolic abnormalities, such as hypoglycemia, and injuries during birth, such as damage to the shoulders caused by macrosomia (abnormally large body). There are noticeable long-term effects of the intrauterine environment in the offspring of women with gestational diabetes. While insulin has been the accepted treatment for gestational diabetes when diet and exercise are not effective at controlling blood glucose, attention is now being given to the safety and effectiveness of oral agents. There are various treatments available for the mother and modalities for the prevention of type 2 diabetes in children born to mothers with gestational diabetes.

Generational differences and learning style preferences in nurses from a large metropolitan medical center.

Nursing educators face the challenge of presenting educational programs to meet the learning needs of four diverse generational groups of nurses. This cross-sectional survey examined if there is a relationship between staff nurses’ generation and their learning styles. Results show that a combination of years in practice, time lapsed since last educational program ended, current school enrollment, degree earned, and generation influences preferred learning style. Implications for educators are discussed.

Health-Related Quality of Life, Disease Severity, and Anticipated Trajectory of Diabetes

Purpose Adults hospitalized with diabetes are likely to have multiple comorbid conditions contributing to suboptimal health-related quality of life. The purpose of this study was to survey urban, very low-income, hospitalized adults with diabetes about disease severity, anticipated disease trajectory, and self-rated health-related quality of life. Methods Data were collected using the Brief Illness Perception Questionnaire, the 36-item Short Form Health Survey (SF-36), the comparative risk perception questionnaire, and glycosylated hemoglobin. Severity was defined by glycosylated hemoglobin level and current microvascular complications from diabetes. Findings Those with more severe disease who also anticipated the development of additional diabetes-related complications were likely to have suboptimal physical and mental functioning. The perception of diabetes as a health threat concurrent with having non-diabetes-related comorbid chronic conditions contributed uniquely to explaining scores in health-related quality of life. Conclusion Hospitalized adults with diabetes represent a population affected by chronic disease demands that contribute to suboptimal physical and mental functioning. Suboptimal quality of life may contribute to severity of diabetes and to a perception of having a threatening disease trajectory. Hospitalization provides an opportunity for clinicians to intervene in mental and physical functioning by assessing for threatening illness perceptions and employing interventions to promote acceptance of functional limitations.

Self-regulation Theory and the Multigenerational Legacy of Diabetes

The purpose of this study was to lend further support to the practice-based theory multigenerational legacies of diabetes (MGLDM). The hypothesis that perceptions of diabetes differ depending upon self-reported family history of diabetes was tested. Surveys assessing illness representation were administered by mail to adults with type 2 diabetes who attended diabetes education programs in a Northern Metropolitan East Coast location. Perceptions of diabetes were significantly different between those who remember a family member having diabetes and those who do not. Components of the commonsense model that differ in this sample were personal control, treatment control, emotional representations, and illness coherence (understanding), which were associated with dietary and monitoring adherence. Exploring commonsense models of diabetes during education sessions may help identify perceptions that may be shaped by the experiences of family members.

Managing stress response to control hypertension in type 2 diabetes

The purpose of this article is to help clinicians understand how biological, psychological, and sociological stress responses synergistically influence blood pressure in individuals with type 2 diabetes mellitus.

The process and rationale for an online master's program in diabetes education and management.

Purpose Although all certified diabetes educators have been required to have specific clinical training in a health discipline, graduate programs in diabetes education are relatively rare. The purpose of this article is to describe the development of a different approach to educating diabetes educators: an interdisciplinary graduate degree in diabetes education and management. In addition to preparing more diabetes educators, a graduate degree encourages existing diabetes educators to expand their area of expertise and their leadership skills. The article provides a discussion of the current trend toward interprofessional education and describes the challenges associated with mounting an online graduate program. Conclusions Those who are engaged in or seeking a career in diabetes education are interested in a graduate degree in the specialty. Such a degree offers a route into diabetes education for those who are not currently in the field as well as a method for current diabetes educators to increase their expertise and their potential for leadership. The time has come to raise the professional standard for diabetes education by providing an academic preparation for diabetes educators.

Hispanic acculturation, psychosocial functioning, and routine support for diabetes self-management.

Purpose The purpose of this study was to describe the relationship between Spanish language-based acculturation, psychosocial coping with diabetes, and perceptions of social support obtainment for the daily management of diabetes. Methods Adults (N = 209) were surveyed by telephone about Hispanic ethnicity, depressed mood (PHQ-8), anxiety and worry over diabetes, social burden due to diabetes, diabetes control, and physical function (Diabetes-39), and Spanish language-based acculturation (n = 101, Hispanic only). Results Significant associations revealed a relationship between less language-based acculturation with other contextual factors (gender, family demands, disease severity), and depressed mood and social burden of disease. Acculturation alone explained little about psychosocial coping. Individuals with poor psychosocial coping were more likely to have routine daily help with diabetes self- management, with acculturation explaining little about who obtains help. Conclusions Hispanic values such as placing a priority on providing help to friends and family likely have more to do with psychosocial coping with diabetes than does language preference or proficiency. Individuals with poor psychosocial functioning may benefit from external social support when family support is not present to help with the routine management of diabetes.

Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression.

Purpose: The purpose of this study was to implement a continuous quality improvement project aimed at improving primary care provider recognition of depression. Materials and Methods: A randomized, blinded, pre- and post-test design was implemented with 92 adults attending an academic internal medicine clinic. Subjects were assigned to an intervention where healthcare technicians (HCT) trained in the fundamentals of diabetes education delivered brief probing questions about self-care behavior and tailored talking points to encourage patients to talk to their primary care physician about their emotional health. The control group received a sham intervention that included only information on standards of diabetes care. Measures included both a paper-and-pencil screening of depression and the Primary Healthcare Questionnaire-8 (PHQ-8). Outcomes were evaluated for antidepressant and/or counseling treatment modalities once the possibility of depression was identified. Results: Both the control and intervention groups improved from pre-test to 3-month post-test scores on the PHQ-8 in clinically significant ways, but continued to have moderate to severe depression symptoms. There was a significant likelihood of receiving antidepressant therapy and/or counseling in those who scored high on the PHQ-8. Conclusion: HCT can be trained to talk to patients about emotional health issues during routine primary care visits. Depression screening measures can be administered as part of the triage routine at the start of a primary care visit, along with tasks such as vital signs. Answering a screening measure can help create awareness of symptoms and feelings that can prompt discussion during the patient–provider encounter that can result in the diagnosis and treatment of depression.