Patricia E. McDonald

Testing a conceptual framework for diabetes self-care management.

Diabetes is a major source of morbidity, mortality, and economic expense in the United States. The majority of researchers and clinicians believe that diabetes is a self-care management disease, and that patients should be reliable, capable, and sufficiently responsible to take care of themselves. However, individuals with diabetes may or may not have diabetes knowledge, social support, self-care agency (an individual’s capability to perform self-care actions), and self-efficacy (an individual’s beliefs in his or her capability to perform self-care actions) that would help them to engage in diabetes self-care management. Therefore, this study examined the relationship among those factors using a cross-sectional model testing design. A convenient sample of 141 insulin-requiring individuals with either diabetes type 1 or type 2, 21 years old and over, was recruited from an outpatient diabetes care center located in a Southeast region of the United States. Simple linear regression, multiple standard regression, and multiple hierarchical regression were used to analyze the data. Individuals with greater diabetes knowledge had greater self-care agency and self-efficacy. Those with a higher score in social support had greater self-care agency and better diabetes self-care management, and those with greater self-efficacy had better diabetes self-care management. In addition, self-care agency mediated the effects of diabetes knowledge on self-efficacy and the effects of social support on diabetes self-care management. Self-efficacy mediated the effects of self-care agency on diabetes self-care management. Furthermore, the linear combination of diabetes knowledge, social support, self-care agency, and self-efficacy, taken together, positively affected diabetes self-care management. Enhancing an individual’s diabetes knowledge, social support, self-care agency, and self-efficacy may be a strategy which can promote better engagement in diabetes self-care.

Effects of Teaching Resourcefulness and Acceptance on Affect, Behavior, and Cognition of Chronically Ill Elders

This clinical trial examined changes in affect, behavior, and cognition in 176 chronically ill elders who were randomly assigned to Resourcefulness Training (RT), Acceptance Training (AT), or Diversional Activities (DA). The RT group improved on affect (t(1,42) = 4.91; p < .001) and cognition (t(1,42) = 2.03; p < .05) and these effects lasted 12 weeks. The AT group improved on affect (t(1,36) = 3.08; p < .01), but this improvement did not persist. The RT and AT groups both showed positive behavior changes after six weeks. There were no changes in the DA group. The findings suggest that teaching elders resourcefulness and acceptance of chronic conditions may promote healthy functioning and improve their quality of life.

Self-reported health-promoting behaviors of black and white caregivers.

The purpose of this study was to describe the behaviors that caregivers report carrying out to maintain their own health, and to compare the health-promoting behaviors of Black and White caregivers. Although many studies have examined health-promoting behaviors, few have examined health promotion among caregivers. Reported studies of caregivers’ health-promoting behaviors have not compared cultural groups. The sample for this study was selected by random digit dialing, and included 136 Black and 257 White caregivers of frail elders. Content analysis of respondents’ answers to the open-ended question, “In general, what do you do to stay healthy?” was used to address the research questions. Most caregivers reported specific behaviors they engaged in for the purpose of staying healthy. Although most of their behaviors addressed physical health, caregivers also mentioned behaviors that contribute to mental and spiritual health. Both differences and similarities were found in Black and White caregivers’ self-reported health behaviors, which have important implications for nursing practice and research in the future.

The effect of age, gender, risk level and glycosylated hemoglobin in predicting foot amputation in HMO patients with diabetes.

Purpose To determine if age, gender, risk level and glucosylated hemoglobin could predict foot amputations in HMO patients with diabetes. Data Sources A retrospective chart review of a non‐random sample of 27 patients with amputation and 110 randomly selected patients without amputation during the same time period. Chi‐square, t‐tests and logistic regression were used to analyze the data. Conclusions There was no significant difference between the group with amputation and those without amputation in age or gender. However, there was a significant difference between the two groups in the risk stratification (p=.005) and glycosylated hemoglobin levels (p=.058). Implications for Practice Nurse practitioners can effectively screen for amputation risk factors and closely monitor glycosylated hemoglobin levels of diabetic patients to reduce the incidence of vascular complications and related lower extremity amputation.

Aging and Immigration: Who Are the Elderly?

Much U.S. research in aging and the social sciences of health compares beliefs, conditions, or behaviors of “racial” groups. In immigration studies, social identity is most often delineated by virtue of foreign origin with respect to a host country. Thus, nationality is often the marker of difference. The present article joins two generally separate streams of research, gerontologic and immigration research in the United States. The paper considers data from several studies of seniors in Cleveland, Ohio in the 1990s; the “Black and White Caregivers” and the “Use of Services of Black and White Elderly”. These are considered not in terms of their original research goals, but rather in terms of a reflective examination of assumptions regarding the identity of the elders and caregivers that framed the two studies. The results show that “racial” terms conceal, not reveal, the actual ethnic and therefore, cultural, affiliations of the seniors. We suggest that because “racial” classification is an impediment to, rather than a facilitator of, cultural comparisons, such terms should not be used to compare, predict or explain beliefs or behaviors. The revelation of distinct, highly varied ethnic groups within asserted homogeneous “racial” groups has implications for immigration studies. These are discussed in the final section as relates to psychiatric and social issues.

Psychometric Properties of a Measure of Acceptance of Long-Standing Health Problems

Acceptance of chronic illness is important for health promotion and for improving the quality of life of elders with chronic conditions. Thus, a reliable and valid measure of acceptance is needed for this population. Currently available measures of acceptance do not focus specifically on accepting chronic conditions. This study of 176 elders with chronic conditions examined the psychometric properties of an adapted measure of acceptance—the Ideas About Long-Standing Health Problems (IALHP) questionnaire. Although the findings provided beginning evidence for internal reliability and construct validity to support its potential usefulness in elders, further scale development is recommended.

An Evaluation of Patient Comfort During Acute Psychiatric Hospitalization.

PURPOSE To assess the difference in the level of comfort between psychiatric inpatients who received a warmed blanket and psychiatric inpatients who did not receive a warmed blanket. DESIGN AND METHODS A descriptive pilot study from a convenience sample of 37 psychiatric patients aged 18-59. Subjects level of comfort was measured with Kolcabas verbal rating scale (VRS). FINDINGS Independent t-tests showed that the VRS mean score was lower in the control group (6.81) than the experimental group (7.29). PRACTICE IMPLICATIONS Comfort is central to nursing and there has been little research regarding the effects of warm topical applications in the psychiatric hospital setting. Warmed blankets are not routinely offered to patients in the psychiatric setting. The use of warmed blankets may increase patient comfort.

Characteristics of smokers with type 2 diabetes

AIM The purpose of this secondary analysis was to identify the characteristics of smokers with type 2 diabetes, enrolled in a smoking cessation program. BACKGROUND The health consequences of smoking are particularly severe for individuals with diabetes who smoke. METHODS The characteristics of 227 smokers with type 2 diabetes were analyzed to determine which traits were more likely to be associated with quit success. RESULTS Results of the data analysis indicate that smokers with type 2 diabetes were more likely to be abstinent 30 days and 6 months after the quit date if they attended a majority of the program classes and support groups; and used cessation medications. Expressing concerns about the expense of cigarettes was also associated with quit success at 6 months. CONCLUSIONS Although studies have examined compliance with other diabetes care recommendations, few have evaluated the characteristics of individuals with diabetes who smoke.