This paper reviews some popular models of patient-centred care and acknowledges work that has questioned the measurement and effectiveness of patient-centredness in practice. In an attempt to enhance testing the concept practically, we propose a practical hierarchy of patient-centredness that we hope will aid the practical application of patient-centred care in clinical practice. The proposed hierarchy is illustrated through a practical example and the various stages inherent in it are described.
M Graue PhD, RN, MM Iversen PhD, RN, ÁK Sigurdardottir PhD, RN, V Zoffmann PhD, MPH, RN, B Smide PhD, RN, J Leksell PhD, RN
New knowledge from research studies is important as a foundation for high-quality care in practice as well as crucial to further stimulate research in the future.
The aims of this study were to determine the total number of peer-reviewed articles on diabetes research reported by nurses in four Nordic countries (Denmark, Iceland, Norway and Sweden) from 1979–2009, and to identify the time periods in which they had been published, different study designs and the number of publications related to nurse authors.
We performed an electronic search for potentially relevant scientific articles between 1 January 1979 and 31 December 2009 using the MEDLINE, Medline in process, EMBASE, CINAHL, PsycINFO and Cochrane databases. The studies focused either on the diabetes population or on diabetes health care professionals.
We included 164 scientific articles; 132 resulting from electronic search and 32 from manual search. They were published in 63 different scientific journals, with 52 (32%) published in nursing journals and typically by authors with university degrees. Only one in four authors had published five or more articles. The majority of the studies originated from a single country, with 23 (14%) including co-authors from another country.
Health care workers employed in nursing homes need sufficient diabetes knowledge to make adequate decisions in order to optimise diabetes management and minimise complications which may arise from poor diabetes control.
The aim of this study was to determine levels of diabetes knowledge among health care workers when presented with a case description regarding an older person. Ten health care workers were asked to read a paper copy of the case description, reflect upon it and express their understanding of the case in question.
The main results were summarised in two categories: namely, diabetes knowledge in relation to the presented case description and general diabetes knowledge. Some of the respondents considered the symptoms to be related to hyperglycaemia, while others were uncertain. Health care workers' general diabetes knowledge varied.
In this issue of European Diabetes Nursing we have two papers reporting on the care of older people in care homes (Hausken and Graue; Smide and Nygren). Over a quarter of residents in care homes have diabetes, 1 a number that will increase as life expectancy rises. Older people with diabetes in care homes often have multiple co-morbidities, are frail and are very vulnerable. They have a high risk of avoidable hospital admission, acute complications and hypoglycaemia. Not only are these hazardous events dangerous to the older person, they can be distressing, disruptive and erode that most valuable of commodities in older age: quality of life. The evidence suggests, however, that many older people in care homes experience poor clinical care. There is often a lack of consideration for: the nutri tional needs of the older person; the need to tackle polypharmacy; the importance of preventing hypo glycaemia; the management of inter-current illness; and the need to minimise diabetes symptoms such as polyuria. Older people with diabetes in care homes may also experience problems with pain, fatigue and urinary incontinence. There is often increased mental frailty in care home residents, with high levels of cognitive impairment and dementia. This mental frailty may impede the person’s capacity to self-manage their diabetes, leading to changes in the level of external support they receive with their care. In some instances, older people may be restricted in undertaking their own self-management with the routines of the institu tion becoming dominant over their own needs. This may create problems in the timing of medications like insulin, in blood glucose monitoring or in mealtimes. Older people have a highly elevated risk of foot complications. Foot complications affect over 20% of older people. Therefore, preventing foot problems is of vital importance in this population. The key to solving these problems and improving the quality of life experienced by older people with diabetes in care homes is to ensure that those who are responsible for supporting them have the necessary skills to manage their diabetes effectively. Skills that should include: recognising diabetes symptoms; being aware of the selfmanagement needs of each patient; and the ability to develop and deliver an individualised care plan that will minimise risk, reduce symptoms and promote quality of life. Skills for minimising risk and preventing problems such as hypoglycaemia, foot ulcers and poly-pharmacy are essential. These skills are required at all levels of personnel: those involved in supporting the daily living needs of the person, nursing staff, the catering and nutri tional staff, and the managers of the care home. Patients also require regular access to health professionals with expertise in diabetes to help construct the care plan in conjunction with the older person and their carers. Diabetes specialist nurses can make an important contribution here, both by facilitating integrate
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{"title":"Reflections on ‘Tackling type 2 diabetes and coexisting conditions’","authors":"","doi":"10.1002/edn.223","DOIUrl":"https://doi.org/10.1002/edn.223","url":null,"abstract":"","PeriodicalId":100496,"journal":{"name":"European Diabetes Nursing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/edn.223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"109174498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fatemah M Alsaleh BPharm, MSc, PhD, Felicity J Smith BPharm, MA, PhD, FRPharmS, Rebecca Thompson RSCN, BSc, MSc, Kevin MG Taylor BPharm, PhD, MRPharmS
This study aimed to determine the views and experiences of parents and children regarding the training and services they had received at a London teaching hospital, when the child commenced insulin pump therapy; and to inform future services.
Face-to-face semi-structured interviews were conducted with children/young people (n=34) aged 5–17 years, using pump therapy, and their parents (n=38). Interviews were audio-recorded, transcribed verbatim and analysed using established qualitative analytical procedures.
Parents and children/young people had their own concerns on starting pump therapy: constant attachment of the child to an insulin pump and the cannula-insertion procedure respectively, being the greatest concerns. The hospital-based diabetes team supported families to overcome such issues. They provided families with 24-hour telephone contact, contacted schools and nurseries, ran a two-day Pump School at the start of pump therapy and provided ongoing services to ease patients' transition from insulin injections to pumps. The programme and services provided were generally perceived positively by children and parents. However, some limitations were reported and suggestions for improvement were made.
Dr Michelle Spence BSc, PhD, Professor Roy Harper BSc, MB BCh, BAO, MD, FRCP, Professor David R McCance BSc, MB, BCh, MD, FRCP, Professor Fiona A Alderdice BSc, PhD, Dr Michelle C McKinley BSc, PhD, Clare Hughes, Dr Valerie A Holmes RN, BSc, PhD, For the Women with Diabetes Project Team
The purpose of this article is to describe the design, development and process evaluation of a preconception counselling resource (a DVD) for women with pre-gestational diabetes.
DVD design and development centred on two key stakeholders (‘DVD user group’ and ‘professional advisory group’) working alongside a professional multimedia company. The DVD user group provided feedback on preferred DVD style, and informed modifications and improvements. The professional advisory group prepared the script, and ensured content and face validity. Evaluation of the DVD's acceptability and usefulness was assessed among women with diabetes via a postal questionnaire.
Development phase: the resulting DVD is a 45-minute programme with three parts, featuring eight women with diabetes sharing their views and experiences, alongside an evidence-based commentary. The programme focuses on the importance of preventing an unplanned pregnancy (highlighting contraception) and on essential planning advice.
Evaluation phase: 97 women (89 with type 1 and 8 with type 2 diabetes) evaluated the DVD using a rating scale of 0–10. Mean (SD) scores were: 9.1 (1.3) for quality; 9.0 (1.4) for content; 8.8 (1.5) for interest; 8.7 (1.8) for usefulness; 7.8 (2.2) for knowledge acquisition; and 8.0 (2.1) for knowledge confirmation.
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