Yasuko Shimizu

Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study

AIM The aim of this study was to assess the effectiveness of a preventative foot care nursing programme for diabetic patients. BACKGROUND Foot complications are common in diabetic patients and prevention of such complications requires foot care. However, there is little information on the effectiveness of foot care nursing on the incidence and recurrence of diabetic foot. METHODS We developed a diabetic foot care programme based on the International Working Group on the Diabetic Foot. We studied 88 patients who attended our foot care programme for 2 years, and collected data from April 2005 to March 2009. Patients were divided into four groups according to the risk classification, and received foot care. We evaluated the incidence of foot ulceration or recurrence and non-ulcerated foot condition. Characteristics of the patients were analysed using the paired t-test and McNemars test, and changes in severity of tinea pedis and grade of callus were analysed using Wilcoxons signed rank sum test. RESULTS The programme reduced the severity score of tinea pedis (P < 0·001) and improved callus grade (P < 0·001). All these were evaluated by Wilcoxons signed rank sum test. None of the patients of risk-group-3 (history of foot ulceration) showed recurrence of callus-related foot ulcers. Six high-risk patients developed foot ulceration during the programme because of minor injury, but the ulcers healed without development of gangrene. CONCLUSION A nurse-based foot care programme is effective in preventing diabetic foot in diabetic patients.

Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer.

PURPOSE The relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer. METHODS AND SAMPLE Path analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite. RESULTS At 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R2=0.48, p<0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R2=0.52, p<0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R2=0.62, p<0.001). CONCLUSIONS The results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy.

A PROGRAMME TO ENCOURAGE PARTICIPATION OF HAEMODIALYSIS PATIENTS IN AN EXERCISE REGIMEN

Recent research has reinforced the idea that haemodialysis (HD) patients should exercise to maintain their physical functioning and improve their quality of life. Some effective exercise programmes are available for HD patients. However, these programmes are not always completed by the patients who enrol in them, and therefore, these patients do not maintain long-term physical activity. In this study, a support programme based on the concepts of self-monitoring, verbal reinforcement and motivation was developed to encourage continued participation of HD patients in an exercise regimen. Intervention group participants were provided a support programme in addition to the exercise programme, whereas nonintervention group participants were only provided the exercise programme. The two groups were compared for 12 weeks. The intervention group participants showed a significantly higher rate of continuation of independent exercise than the nonintervention group participants.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

Purpose: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). Methods: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. Results: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach’s alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. Conclusion: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.

Involvement of Recipient Transplant Coordinators in Transplant Outpatient Clinics in Japan: Current Status and Transplant Physician's Thoughts on Follow-Up Clinics.

Context: Transplant recipients require long-term immunosuppressive therapy, so continued medical follow-up is necessary for long-term survival. Objective: To investigate the current role of recipient transplant coordinators (RTCs) in the outpatient care of organ transplant recipients in Japan. Methods: We sent a questionnaire survey to doctors in transplant facilities affiliated with the Japan Society for Transplantation probing attitudes on the role of RTCs in outpatient clinics. The questionnaire assessed responses using an ordinal scale of 5 ranks. Results: In total, 139 responses were obtained from 233 transplant facilities. Respondents were divided into 2 groups, doctors currently working with RTCs (group A) and doctors not currently working with RTCs (group B). Differences in response rates between groups were analyzed using the Mann-Whitney U test. The overall attendance rate of RTCs in outpatient clinics was only 45%. Of all items on transplant outpatient clinics, group A exhibited a significantly higher response rate of “strongly agree” for “The involvement of an RTC in outpatient work can be expected to help prevent complications in transplant patients” (P < .01) and “The involvement of an RTC in outpatient work can be expected to help prevent or reduce drug-related side effects in transplant patients” (P < .01). Those with the highest rate of “strongly agree” were “It is necessary for RTCs to provide outpatient follow-up for transplant patients alongside doctors” (82.1% vs 67.3%, P < .07). Conclusion: We suggest that Japanese RTCs must participate more frequently in posttransplant outpatient care.

A mixed methods study to examine the difficulties experienced and coping behaviours used by people with Type 2 diabetes of working age in Japan

Objective: The aim of this study was to investigate measures to support people of working age with Type 2 diabetes by clarifying their coping behaviours. Research methods: Mixed research methods were adopted. The questionnaires investigated PAID, SDSCA, and biomedical test data. After the questionnaires were completed, a qualitative survey in which the participants were asked to discuss any difficulties and corresponding coping measures was conducted. Results: The participants were 100 individuals (77 men). The following three aspects of difficulties felt in coordinating work and diabetes management were revealed: ‘Difficulty readjusting living hours’, ‘The presence of stress inhibiting a treatment lifestyle’, and ‘Conflict between maintaining interpersonal relationships and implementing treatment behaviors’. Among the factors associated with coping behaviours, a significant difference was seen in the presence or absence of coping measures for ‘Difficulty readjusting living hours’ and body mass index. Conclusions: When assessing patients, it is best to perform assessments from the three perspectives described in the present study.

Qualitative study on nursing processes to support blood glucose pattern management in Japan

A structured approach to self-monitoring of blood glucose and blood glucose pattern management (BGPM) is crucial in diabetes management. However, nursing processes for supporting BGPM among people with diabetes has not been studied. Here we described the process used by nurses certified in diabetes nursing in Japan to support BGPM among people with diabetes. Eleven nurses certified in diabetes nursing in Japan, with actual experience in supporting BGPM. We conducted semi-structured interviews with participants using an interview guide. The interview content was recorded on an IC recorder after obtaining consent. Qualitative analyses of data were conducted by qualitative synthesis. Based on the interviews with the 11 participants, 8 themes regarding the process of supporting BGPM were identified. These themes were as follows: ‘underlying supportive environment: a place where you can state what has been on your mind’, ‘sharing goals: exploring the person’s interest and finding clues’, ‘collaboration: finding patterns and devising measures’, ‘collaboration: considering effective and less burdensome blood glucose measurement and recording methods’, ‘leading to the next step: a long-range step-by-step perspective’, ‘support of active learning: utilising experiences and fostering independent thinking’, ‘mutual confidence: reward their efforts and trust their potential’ and ‘team approach: multilateral care’. Thereafter, the eight themes were schematised and the process of supporting BGPM was determined. Thus, we clarified the process of supporting BGPM and provided suggestions on how to utilise BGPM in ordinary nursing.

Structural model of self‐care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self‐Care Agency and body self‐awareness

Aim The aim of this study was to examine a causal model of self‐care agency by exploring the relationship between the structure of “body self‐awareness” and the structure of the Instrument of Diabetes Self‐Care Agency (IDSCA). Methods The participants were 353 patients with diabetes. The internal consistency of the six items for body self‐awareness was examined by calculating the factor structure using principal factor analysis and Cronbachs alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. Results With regard to the factor structure, the factor loading of these five items was 0.511–0.743 (α = 0.739). In the path analysis, “body self‐awareness” was influenced by the “ability to acquire knowledge” and had a direct effect (0.33) on the “motivation to self‐manage”, while “motivation to self‐manage” had an effect (−0.32) on the “ability to self‐manage”. The Goodness‐of‐Fit Index was 0.974. Conclusion “Body self‐awareness” plays a part in the self‐care operation process and serves as an intermediary factor to enable the performance of self‐care operations by making the most use of self‐care agency. Moreover, striking a proper balance between self‐management that is focused on the treatment of diabetes and a persons ability for self‐management of diabetes was found to be important.

Classification of Support Needs for Elderly Outpatients with Diabetes Who Live Alone.

OBJECTIVES To investigate the support needs of elderly patients with diabetes and to classify elderly patients with diabetes living alone on the basis of support needs. METHODS Support needs were derived from a literature review of relevant journals and interviews of outpatients as well as expert nurses in the field of diabetes to prepare a 45-item questionnaire. Each item was analyzed on a 4-point Likert scale. The study included 634 elderly patients with diabetes who were recruited from 3 hospitals in Japan. Exploratory factor analysis was performed to determine the underlying structure of support needs, followed by hierarchical cluster analysis to clarify the characteristics of patients living alone (n=104) who had common support needs. RESULTS Exploratory factor analysis suggested a 5-factor solution with 23 items: (1) hope for class and gatherings, (2) hope for personal advice including emergency response, (3) supportlessness and hopelessness, (4) barriers to food preparation, (5) hope of safe medical therapy. The hierarchical cluster analysis of subjects yielded 7 clusters, including a no special-support needs group, a collective support group, a self-care support group, a personal-support focus group, a life-support group, a food-preparation support group and a healthcare-environment support group. CONCLUSIONS The support needs of elderly patients with diabetes who live alone can be divided into 2 categories: life and self-care support. Implementation of these categories in outpatient-management programs in which contact time with patients is limited is important in the overall management of elderly patients with diabetes who are living alone.

A study of pattern management performed by nurses certified in diabetes nursing in Japan and clarification of the related factors

Introduction: To reveal the actual conditions of blood glucose pattern management (BGPM) performed by nurses certified in diabetes nursing (DCNs) in Japan and clarification of the related factors. DCNs are the specialists for people with diabetes and are certified by the Japanese Nursing Association (JNA). BGPM refers to a method aimed at improving blood glucose control by ascertaining changes (patterns) in blood glucose levels and conducting a systematic and multi-dimensional analysis of the factors contributing to these patterns. Method: Subjects were DCNs (n = 303) whose names and affiliations were publicly available on the JNA website in November 2011. The study was conducted through a postal questionnaire, involving items about how they were conducting guidance, the details of the BGPM (i.e. method and target) and the state of their overview of facilities, from January 2012 to February 2012. Result: The questionnaire was returned by 148 respondents. Regarding the statement ‘Looking with the people with diabetes for patterns in their blood glucose levels brings unexpected discoveries’, 140 (95.2%) selected ‘Agree’ or ‘Somewhat agree’. The respondents’ coefficient analyses showed a significant correlation between ‘I am very good at finding changes (patterns) in blood glucose or HbA1c levels’ and ‘The doctors at our facility are cooperative when it comes to BGPM’. Conclusion: In this study, most of the DCNs performed BGPM for people with diabetes and recognized that performing BGPM has been useful for most people with diabetes. In addition, building a good relationship between doctors and nurses is suggested for performing BGPM effectively.