How do adults with cystic fibrosis cope following a diagnosis of diabetes?

The official published version of the article can be obtained from the link below.Aim. This paper is a report of a study examining the experience of adults with cystic fibrosis in adapting to the diagnosis of diabetes, a second chronic illness. Background. Diabetes is a common complication of cystic fibrosis; the onset signifies the development of a second chronic illness. Both cystic fibrosis and diabetes are complex conditions, which require daily treatment schedules as part of their management. However, it is unclear how people already living with cystic fibrosis respond to the diagnosis of diabetes. Method. A qualitative method was chosen to obtain an ‘insider’ experience of adjusting to a second chronic illness. Semi-structured interviews were conducted in 2004 with 22 adults with cystic fibrosis-related diabetes. The data were analysed using interpretative phenomenological analysis. Findings. Four recurring themes were identified: emotional response to diagnosis of diabetes, looking for an understanding, learning to live with diabetes, and limiting the impact of diagnosis. Having cystic fibrosis appeared helpful in limiting the impact of the diagnosis of diabetes. Juggling conflicting dietary demands of cystic fibrosis and diabetes coupled with the lack of practical professional advice available was seen as one of the biggest challenges in adapting to diabetes. Conclusion. Healthcare professionals need increased awareness of diabetes amongst adults with cystic fibrosis and provide adequate support and structured evidence-based education throughout the course of the illness, particularly in relation to diet. Nevertheless, patients’ familiarity with regular daily routines and problem-solving attitudes, already developed in the context of cystic fibrosis, may be drawn on to limit the impact of diabetes

Exploring diabetes management of low-income, Type 2 diabetics using a communication perspective

Indiana University-Purdue University Indianapolis (IUPUI)In this exploratory, qualitative study, the author examined the lived experiences of low-income type 2 diabetics around managing their diabetes. Semi-structured, individual interviews were conducted with volunteer participants from a Midwest student outreach clinic (N=14; 8 men, 6 women). Interviews were first analyzed using LUUUUTT model from the Coordinated Management of Meaning (CMM) theory for gaps between stories lived and stories told. Findings suggest that the lived experience of the majority of the participants had low social support and heightened stress around managing their diabetes. Using the Communication Complex framework, the patterns of interactions around these two tensions were analyzed to make suggestions for change

Improving Adherence for Children with Diabetes

This chapter provides critical information on diabetes in children. Ideas for improving adherence to the child’s medical regimen are reviewed. In addition, factors that may hinder adherence are presented. Ideas for clinicians are presented in a case study

The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics

The purpose of this phenomenological study was to investigate the meaning of diabetes, as perceived and experienced by rural, homebound, 65-year and older, diabetics requiring insulin. The sixty-five year and older persons are disproportionately affected by diabetes. They are more likely than younger diabetics to have co-morbidities, disabilities and difficulty preventing diabetic complications. Guidelines for diabetes management and treatment developed by the American Diabetes Association are not specifically targeted for the 65-year and older population. Phenomenological research was used to examine and describe the understanding of diabetes from perspectives of older diabetics. A purposive sample of participants was recruited from Senior Agencies referrals in a Southern State, following University of Tennessee Institutional Review Board approval. Participants were 65 years of age or older, female, required insulin, homebound, lived alone, lucid, English speaking, and willing to participate. Unstructured, audiotaped, face-to-face interviews were conducted individually in each person’s home. Thomas and Polio’s (2002) phenomenological method, which begins with bracketing, was used for collecting and analyzing the qualitative data in this study. Data was reviewed by the researcher and selected transcripts were read aloud to members of an interpretive, interdisciplinary, phenomenology research group at The University of Tennessee, Knoxville, to determine emerging themes described by the participants. The group assisted the researcher in identifying thematic structures from the data. This phenomenological study revealed that diabetes had forever changed lives. Four figural themes emerged; the predominant theme was “you just go on.” Remaining themes were: “your body will let you know: if you miss it you’ll wind up in a coma;” I thought I was fine, but I wasn’t;” and “only way out is to die.” Participants seemed pleased to have the opportunity to describe their experiences to a professional health care provider. Their perceptions and experiences of living with diabetes led to introspection and existential questioning. The participant’s experiences were unique in quality and meaning. Based on the outcome of this study, this population requires a different approach to diabetes self-management. Understanding an older person’s perceptions and experiences with diabetes may provide a foundation for considering new diabetic protocols. Nursing interventions could include diabetes regimens planned with consideration of the context of the person’s life, which could be more efficacious than conventional regimens

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

PREDICTORS OF READINESS TO INITIATE INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES WHEN ORAL MEDICATIONS FAIL TO CONTROL HYPERGLYCEMIA

Type 2 diabetes (T2DM) has reached epidemic levels worldwide during the past two decades. It affects nearly 26 million adults in the U.S. Advances in both the treatments for T2DM and guidelines for its optimal management are extensive. Despite these advances, barely half of type 2 diabetics achieve recommended glycemic targets. Specific Aims: The specific aims were to: Describe the available research on clinical inertia and interventions that have been implemented to reduce it. Analyze various behavioral theories that explain and predict self-care practices in diabetes in order to develop a conceptual model on which to base an investigation of predictors of readiness to initiate insulin therapy in type 2 diabetics. Determine predictors of readiness to initiate insulin therapy in patients with T2DM when oral medications fail to control hyperglycemia using the conceptual model based on Self-Determination Theory (SDT) as a framework. Results: A review of research articles published from 1990 to 2010 concluded that clinical inertia of primary care providers treating T2DM resulted in a majority of patients experiencing unnecessary chronic uncontrolled hyperglycemia. Behavioral theories were analyzed for their ability to predict self-care behaviors in type 2 diabetics. A conceptual model was developed based on the major constructs of SDT in order to guide the design of study to investigate predictors of readiness to begin insulin therapy in T2DM. Finally, a descriptive, correlational study was performed to determine readiness to initiate insulin therapy in patients with T2DM when oral medications fail to control hyperglycemia. Results of the study revealed that participants who had a friend or family using insulin were 5.5 times more likely to rate their readiness to initiate insulin as high than those who had neither (p=.020). In addition, those with greater negative beliefs and attitudes toward insulin therapy were more likely to rate their readiness to initiate insulin as low (p=.012). A majority (58%) of participants rated their readiness to begin insulin therapy as immediate if it would give them better control over their hyperglycemia. The study also confirmed findings from previous studies that clinical inertia was present in this setting

School Nurses Bloom Where They are Planted

Abstract School nurses are an integral part of our education system. They play a critical role in the overall wellbeing and health of school-aged children across the country. The provide daily care for a wide range of health needs and utilize a vast array of nursing skills, planning skills, and homemade gumption based on their medical knowledge and experience. School nurses follow federal, state and district statutes, as well as adopt core values and ethical codes of their profession. Evidence based research affirms the value of a school nurse to the education process, through results regarding improved attendance, immunization compliance, management of chronic health conditions, emergency preparedness, and cost effectiveness. Also covered in this paper is an overview of the history, statistics, myths, staffing concerns, challenges, and collaborative partnerships of the school nurse. Keywords:school nurse, chronic health conditions, accommodation, collaboratio

Children and young people’s experiences and perceptions of self-management of type 1 diabetes: A qualitative meta-synthesis

The aim of this review was to conduct a meta-synthesis of the experiences and perceptions of self-management of type 1 diabetes of children and young people living with type 1 diabetes (CYPDs). Six databases were systematically searched for studies with qualitative findings relevant to CYPDs’ (aged 8–18 years) experiences of self-management. A thematic synthesis approach was used to combine articles and identify analytical themes. Forty articles met the inclusion criteria. Two analytical themes important to CYPDs’ experiences and perceptions of self-management were identified: (1) negotiating independence and (2) feeling in control. The synthesis contributes to knowledge on contextual factors underpinning self-management and what facilitates or impedes transition towards autonomous self-management for CYPDs