Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study.

BACKGROUND: Initiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach. OBJECTIVE: This study aimed to evaluate the clinical effectiveness and feasibility and the patients' and health care providers' experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment. METHODS: An observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16). RESULTS: Of 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] -17.13; P<.001) and T1 and T3 (MD -18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD -0.64; P=.002) and T1 and T3 (MD -0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team. CONCLUSIONS: This intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

Key word signing: Parents' experiences of an unaided form of augmentative and alternative communication (Lámh).

Parents' experiences of using Lámh, a key word signing approach used in Ireland, were captured through in-depth face-to-face interviews with parents of children with a range of intellectual disabilities. It emerged that Lámh provides child users with one of the rudiments of inclusion, that is, a means of engaging with others. A number of factors can potentially influence the engagement achieved, namely ongoing family commitment to the sustainment of Lámh, available communication partners, accessibility, appropriate Lámh training, speech and language therapy support and the existence of a Lámh signing environment external to the home. The child's family, education and community need to commit to Lámh in order to support a child user become an active member of their community.

Life with chronic obstructive pulmonary disease: striving for 'controlled co-existence'.

AIMS AND OBJECTIVES: To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. BACKGROUND: COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. DESIGN: Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. METHODS: Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. RESULTS: Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. CONCLUSION: The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. RELEVANCE TO CLINICAL PRACTICE: Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease.

Poetry as an engagement strategy: A novice teacher experience of its use within lectures.

It has been acknowledged the traditional lecture format is a familiar teaching methodology and that there is still much to be learnt from using this in class room based lectures. Whilst the first author was a postgraduate student undertaking a programme in Nurse Education at a University in the Republic of Ireland, poetry was used to challenge undergraduate nursing students' attitudes towards older persons in a large group format. The students were in Year 3 of a Bachelor of Nursing Science General and Intellectual Disability Programmes. Feedback was obtained from the students that comprised of three main themes; Aids Recall of Information; Enriched Learning Experiences, Challenges Attitudes to Person Centred Care. Thus, the paper aims to evaluate using poetry as an engaging teaching strategy within a lecture format for the first time as a novice teacher when drawing out nursing students' attitudes towards older persons with a focus on supporting them in embracing key care skills in the clinical setting. This paper should provide other student educationalists the opportunity to see the value of poetry as a teaching strategy and provide practical tips on its use within the classroom.

Promoting self awareness in undergraduate nursing students in relation to their health status and personal behaviours.

The purpose of this article is to report the experience of facilitating, delivering and evaluating a health assessment workshop as part of Assessing and Promoting Health module on the Bachelor of Nursing Science (BNSc) General and Intellectual Disability programme. This module is delivered to 65 nursing students (40 general and 25 intellectual disability) undertaking the first year of the four year programme. The aim of the workshop is to promote health awareness among these undergraduate students. The objectives are to provide students with time to self assess their health knowledge and lifestyle practices. From this students' current health behaviours are discussed in conjunction with recommendations from the Department of Health and Children (DOHC) (2005). Students are then provided with an opportunity to assess the stresses they perceive in their own lives and this is followed by a relaxation session guided by the facilitators. The teaching methods focus mostly on active student participation, demonstration and experience sharing.

Communication among nurses and adults with severe and profound intellectual disabilities: predicted and observed strategies.

This study explored communication strategies adopted by staff nurses in a residential centre in Ireland for persons with severe and profound intellectual disabilities. Interactions between staff nurses and service users were video recorded and analysed to determine the frequencies of verbal and non-verbal communication acts. Semi-structured and focus group interviews were carried out with the 10 participating staff nurses. Participants identified staff-related factors, the communicative environment, alternative methods of communication and choice as key elements in communicating with service users. No differences were observed in the frequency of verbal and non-verbal communicative acts. There was a discrepancy between what communicative acts the participants named as their preferred strategies and those observed when they interacted with service users. Most failed to adjust their language to meet service users' needs. The findings suggest that staff nurses do not always adopt optimal strategies in everyday interactions with individuals who use non-verbal communication. Continuing education in communication is recommended.