The process and rationale for an online master's program in diabetes education and management.

PURPOSE: Although all certified diabetes educators have been required to have specific clinical training in a health discipline, graduate programs in diabetes education are relatively rare. The purpose of this article is to describe the development of a different approach to educating diabetes educators: an interdisciplinary graduate degree in diabetes education and management. In addition to preparing more diabetes educators, a graduate degree encourages existing diabetes educators to expand their area of expertise and their leadership skills. The article provides a discussion of the current trend toward interprofessional education and describes the challenges associated with mounting an online graduate program. CONCLUSIONS: Those who are engaged in or seeking a career in diabetes education are interested in a graduate degree in the specialty. Such a degree offers a route into diabetes education for those who are not currently in the field as well as a method for current diabetes educators to increase their expertise and their potential for leadership. The time has come to raise the professional standard for diabetes education by providing an academic preparation for diabetes educators.

Health-related quality of life, disease severity, and anticipated trajectory of diabetes.

PURPOSE: Adults hospitalized with diabetes are likely to have multiple comorbid conditions contributing to suboptimal health-related quality of life. The purpose of this study was to survey urban, very low-income, hospitalized adults with diabetes about disease severity, anticipated disease trajectory, and self-rated health-related quality of life. METHODS: Data were collected using the Brief Illness Perception Questionnaire, the 36-item Short Form Health Survey (SF-36), the comparative risk perception questionnaire, and glycosylated hemoglobin. Severity was defined by glycosylated hemoglobin level and current microvascular complications from diabetes. FINDINGS: Those with more severe disease who also anticipated the development of additional diabetes-related complications were likely to have suboptimal physical and mental functioning. The perception of diabetes as a health threat concurrent with having non-diabetes-related comorbid chronic conditions contributed uniquely to explaining scores in health-related quality of life. CONCLUSION: Hospitalized adults with diabetes represent a population affected by chronic disease demands that contribute to suboptimal physical and mental functioning. Suboptimal quality of life may contribute to severity of diabetes and to a perception of having a threatening disease trajectory. Hospitalization provides an opportunity for clinicians to intervene in mental and physical functioning by assessing for threatening illness perceptions and employing interventions to promote acceptance of functional limitations.

Hispanic acculturation, psychosocial functioning, and routine support for diabetes self-management.

PURPOSE: The purpose of this study was to describe the relationship between Spanish language-based acculturation, psychosocial coping with diabetes, and perceptions of social support obtainment for the daily management of diabetes. METHODS: Adults (N = 209) were surveyed by telephone about Hispanic ethnicity, depressed mood (PHQ-8), anxiety and worry over diabetes, social burden due to diabetes, diabetes control, and physical function (Diabetes-39), and Spanish language-based acculturation (n = 101, Hispanic only). RESULTS: Significant associations revealed a relationship between less language-based acculturation with other contextual factors (gender, family demands, disease severity), and depressed mood and social burden of disease. Acculturation alone explained little about psychosocial coping. Individuals with poor psychosocial coping were more likely to have routine daily help with diabetes self- management, with acculturation explaining little about who obtains help. CONCLUSIONS: Hispanic values such as placing a priority on providing help to friends and family likely have more to do with psychosocial coping with diabetes than does language preference or proficiency. Individuals with poor psychosocial functioning may benefit from external social support when family support is not present to help with the routine management of diabetes.

Generational differences and learning style preferences in nurses from a large metropolitan medical center.

Nursing educators face the challenge of presenting educational programs to meet the learning needs of four diverse generational groups of nurses. This cross-sectional survey examined if there is a relationship between staff nurses' generation and their learning styles. Results show that a combination of years in practice, time lapsed since last educational program ended, current school enrollment, degree earned, and generation influences preferred learning style. Implications for educators are discussed.

Afrocentric cultural values and beliefs: movement beyond the race and ethnicity proxy to understand views of diabetes.

PURPOSE: The purpose of this study was to estimate the benefit of using a cultural characteristics scale to help diabetes educators understand how African Americans cope with diabetes. Illness representations are influenced by culture. Race and ethnicity as a proxy for culture provides an incomplete understanding of the mechanism by which cultural values influence representations of diabetes. METHODS: A descriptive correlational design was employed by recruiting hospitalized adults with type 2 diabetes at 3 metropolitan northeast coast sites. The TRIOS Afrocentric cultural characteristics measure and the Illness perception Questionnaire were administered by paper-and-pencil to a diverse sample. Black race and African American ethnicity was used as a proxy for culture and compared to levels of agreement on an Afrocentric cultural scale to determine the relative ability to explain variance in illness representations of diabetes. CONCLUSION: The TRIOS measure adapted to diabetes care explained variance in illness representations of diabetes, while African American ethnicity/black race was not able to explain variance in illness representations. Clinicians would benefit from considering the degree to which a patient identifies with particular cultural characteristics when tailoring interventions to manipulate illness representations that are not concordant with biomedical representations.

Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression.

PURPOSE: The purpose of this study was to implement a continuous quality improvement project aimed at improving primary care provider recognition of depression. MATERIALS AND METHODS: A randomized, blinded, pre- and post-test design was implemented with 92 adults attending an academic internal medicine clinic. Subjects were assigned to an intervention where healthcare technicians (HCT) trained in the fundamentals of diabetes education delivered brief probing questions about self-care behavior and tailored talking points to encourage patients to talk to their primary care physician about their emotional health. The control group received a sham intervention that included only information on standards of diabetes care. Measures included both a paper-and-pencil screening of depression and the Primary Healthcare Questionnaire-8 (PHQ-8). Outcomes were evaluated for antidepressant and/or counseling treatment modalities once the possibility of depression was identified. RESULTS: Both the control and intervention groups improved from pre-test to 3-month post-test scores on the PHQ-8 in clinically significant ways, but continued to have moderate to severe depression symptoms. There was a significant likelihood of receiving antidepressant therapy and/or counseling in those who scored high on the PHQ-8. CONCLUSION: HCT can be trained to talk to patients about emotional health issues during routine primary care visits. Depression screening measures can be administered as part of the triage routine at the start of a primary care visit, along with tasks such as vital signs. Answering a screening measure can help create awareness of symptoms and feelings that can prompt discussion during the patient-provider encounter that can result in the diagnosis and treatment of depression.

Self-regulation theory and the multigenerational legacy of diabetes.

The purpose of this study was to lend further support to the practice-based theory multigenerational legacies of diabetes (MGLDM). The hypothesis that perceptions of diabetes differ depending upon self-reported family history of diabetes was tested. Surveys assessing illness representation were administered by mail to adults with type 2 diabetes who attended diabetes education programs in a Northern Metropolitan East Coast location. Perceptions of diabetes were significantly different between those who remember a family member having diabetes and those who do not. Components of the commonsense model that differ in this sample were personal control, treatment control, emotional representations, and illness coherence (understanding), which were associated with dietary and monitoring adherence. Exploring commonsense models of diabetes during education sessions may help identify perceptions that may be shaped by the experiences of family members.

The evaluation and management of childhood type 2 diabetes mellitus.

Diabetes in children is increasing in prevalence with obesity-associated insulin resistance being a major contributing factor. This report contains a comprehensive review of treatment paradigms regarding the management of diabetes in children. The information provided was collected from an extensive literature review on type 2 diabetes, and children and/or adolescents with diabetes and/or obesity treatment. There is a wide array of contributing factors to the development of diabetes and consequences that indicate the need to tailor treatment plans with reducing obesity as a primary outcome. Lipocentric treatment paradigms offer opportunity to reduce the impact of obesity.

Evaluation and management of apparent life-threatening events in infants.

Apparent life-threatening events (ALTEs) are frightening to caregivers and clinicians alike. This article provides a comprehensive review of the causes, management, and consequences of ALTEs. The information provided was collected from an extensive literature review using the search terms ALTE, sudden infant death syndrome, and apnea. There is a wide array of contributing factors to ALTE syndrome and sequalae for both infants and caregivers of infants experiencing an ALTE.

Perceived risk of amputation, emotions, and foot self-care among adults with type 2 diabetes.

PURPOSE: The purpose of this study was to determine the influence of having a family member who experienced an amputation on one's own perceived risk and fear of experiencing a diabetes-related amputation. METHODS: This was a descriptive cross-sectional study using paper-and-pencil surveys by mail. Adults with type 2 diabetes and a family history of diabetes attending a self-management education program in the Metropolitan New York/New Jersey area were recruited. Measures were completed about risk perception and fear of amputation, emotional representations of diabetes from the Illness Perception Questionnaire, and the foot self-care behavior component of the Summary of Diabetes Self-care Activities Survey. The authors estimated the variability in foot self-care that was accounted for by risk perception and fearful memories. RESULTS: In those who remembered a family member needing an amputation, high perceived risk and fear was associated with less routine foot self-care. For those without family history of amputation, fear was positively associated with foot self-care. CONCLUSIONS: Motivation for foot self-care behavior may be driven by risk perception and emotional responses. The ways in which risk perception and fear influence motivation for preventive foot self-care behavior are influenced by whether one's family member was affected by an amputation. Probing about the influence of the patient's legacy of diabetes may be helpful when customizing education plans.

Multigenerational timeline and understanding of diabetes and self-care.

Testing the practice-theory multigenerational legacies of diabetes, effects of a family member's perceptions of the time line and understanding of diabetes on participants' perceptions of their own diabetes and effect of their own perceptions on self-care were examined. Using a cross-sectional descriptive design, 123 participants completed study instruments by mail. Memories of a family member's perception of the time line (r = .25, p = .01 ) and understanding of diabetes (r = .32, p = .01) were related; participants' own perceptions of time line (beta = -.24) and understanding (beta = .10) accounted for significant variance in dietary adherence, with time line contributing unique variance (R2 = .06, F = 3.3, p = .04). The perceptions were not associated with other self-care behaviors. Findings illuminate effects of time line and understanding of diabetes in patients with family history of diabetes.

Legacy of diabetes and self-care behavior.

The effect of multigenerational legacies of diabetes on health beliefs and behaviors was explored. Diabetic participants (N = 123) with family histories of diabetes responded to survey questions about their own diabetes self-care behavior, illness representation (including consequences and controllability of diabetes), recollection of a family member's illness representation and complications, and perceived social consequences of diabetes. Recollections about family members' disease controllability (r = .21, p < .05) and social consequences (r = -.19, p < .05) and participants' own perceptions of controllability were significantly related. Significant associations were also found between perceptions of controllability and general and social consequences with medication adherence (beta =-.33, beta = -36, and beta = -.43, respectively, all p<.05). Findings suggest that explorations of patients' recollections of a family member's experiences with diabetes can affect their illness perceptions and behavior.

The context of a legacy of diabetes: correlates of self-care behavior.

PURPOSE: The purpose of this study is to develop a means to assess recollections of a family member's diabetes self-care behavior and to assess the relationships to a participant's own self-care behavior. Assessing recollections of a family member's self-care behavior may provide insight into what patients learn from family members with diabetes. METHODS: Volunteers with diabetes were recruited from 2 centers in the metropolitan New York/New Jersey area (N = 104) to complete a new pencil-and-paper survey called the Family Summary of Diabetes Self-care Activities Survey, adapted from the widely used, valid and reliable Summary of Diabetes Self-care Activities Survey to assess their recollections about a family member's diabetes self-care behavior. The measure was used to examine the relationships between recollections of a family member's self-care behavior and the participant's own self-care behavior. RESULTS: There was a significant positive association between recollections about family members' dietary behavior with participants' own dietary behavior, indicating that more dietary adherence of the family member is associated with more dietary adherence by the individual. No significant associations were found between the other self-care behaviors (physical activity, glucose monitoring, pill and insulin adherence). CONCLUSION: The relationship of recollections about the self-care of family members to individuals' own self-care provides some empirical support for the concept of multigenerational legacies of diabetes.

The first diabetes educator is the family: using illness representation to recognize a multigenerational legacy of diabetes.

PURPOSE: This article proposes a framework for understanding multigenerational legacies of diabetes, which will assist with designing educational interventions for individuals with a known family history of type 2 diabetes. BACKGROUND/RATIONALE: Diabetes is a chronic illness that has an associated hereditary predisposition. Family members at risk in subsequent generations may be influenced by the prior generation's experiences. Multigenerational legacies and stories shape a family's health beliefs and response to illness and transmit patterns of adaptation across generations. METHOD: A review of the literature from 1984 to 2004 was conducted to identify evidence of legacies of chronic illness. OUTCOME: Family-systems-illness-disability Model and Theory of Illness Representation were used to guide the development of a framework of multigenerational legacies of diabetes. INTERPRETATION/CONCLUSION: A framework for understanding the influence of illness representation on multigenerational legacy of type 2 diabetes is presented. IMPLICATIONS FOR NURSING PRACTICE: Clinicians are in need of a useful framework that can provide direction as they attempt to understand the effect of a family history of diabetes on the health behavior of the next generation of family members with diabetes. This framework could serve to guide them as they probe for information relevant to the influence of recollections about the family member's experience with diabetes on an individual's health behavior.

Managing stress response to control hypertension in type 2 diabetes.

The purpose of this article is to help clinicians understand how biological, psychological, and sociological stress responses synergistically influence blood pressure in individuals with type 2 diabetes mellitus.

Theory-guided intervention for preventing diabetes-related amputations in African Americans.

A disproportionate number of individuals of African American descent undergo lower extremity amputations because of complications from diabetes mellitus (American Diabetes Association 2001). It is estimated that up to 85% of lower extremity amputations can be prevented through programs for preventing and treating foot ulcers, preventing reoccurrence of ulcers, and educating patients about proper foot care (American Diabetes Association 2001). The primary purpose of this article is to describe a church-based educational intervention that was developed to assist individuals of African American descent in the prevention of lower extremity amputations resulting from diabetes. The intervention was designed with the Health Belief Model as the framework. The secondary purpose of this article is to demonstrate the feasibility of using the Roy Adaptation Model as a framework for the same intervention. A comparison of the two frameworks is intended to support the use of the Roy Adaptation Model as a useful guide in the development of community-based nursing interventions. The current nursing literature (based on a search in CINHAL 1995-2003 and MEDLINE 1995-2003) exhibits an abundance of use of health behavior theories not authored by nurses that are used to guide interventions. The comparison of a health promotion model such as the Health Belief Model and a nursing theory is essential to address the relative lack of presence of the use of nursing theories in the realm of health-promoting interventions by nurses.

Consideration for legacies about diabetes and self-care for the family with a multigenerational occurrence of type 2 diabetes.

Type 2 diabetes mellitus is a familial disorder that is fast becoming epidemic in the USA. It is possible that nurses will care for entire families with diabetes in the near future. In multiple studies, family functioning, a family systems variable, has been correlated with self-management and glycemic outcomes. Most persons with diabetes live with family members who might facilitate or inhibit self-management tasks or skills. Multiple afflictions of family members with diabetes can further complicate matters relating to diabetes self-management. Diabetes collectively affects over 16 million people in the USA, incurring healthcare costs in excess of 92 billion dollars annually. Individuals engage in self-management behavior for diabetes care in the context of their family's environment. It is imperative that nurses consider factors that might inhibit or facilitate self-management efforts by individuals with type 2 diabetes mellitus. Assessment of family determinants of adaptation to diabetes with appropriate interventions can improve clinical outcomes, subsequently preventing complications.