Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial.

People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

Effectiveness of nurse-led intervention on self-management, self-efficacy and blood glucose level among patients with Type 2 diabetes mellitus.

Background This study assesses the effectiveness of nurse-led intervention on self-management, self-efficacy, and blood glucose level among patients with Type 2 diabetes mellitus (DM) attending diabetic Out patient department (OPD) in Sri Ramachandra Hospital, Chennai. Methods In this study, the experimental group received nurse-led intervention on video-assisted teaching regarding nature of the disease condition including, diet, medication, hand and leg exercises, home care management, for 30 mins. Then a demonstration of hand and leg exercise was done followed by return demonstration done by the participants. The participants in the control group did not receive nurse-led intervention; they received only routine care. On the 15th day, when the patients came for the first follow-up, posttest was conducted for both the experimental and control groups. Results There was a statistically considerable difference noted in self-management (t=29.639; p<0.001), self-efficacy (t=28.293; p<0.001), FBS (t=2.415; p<0.05), and PPBS (t=2.102; p<0.05) in the posttest among patients with Type 2 DM in the experimental group. Conclusions The study concluded that the nurse-led intervention through video-assisted teaching is an effective method to recover self-management and self-efficacy as well as reduce the fasting blood sugar and postprandial blood sugar among patients with Type 2 DM.

Intervenções de enfermagem em pacientes com diabetes mellitus tipo 2 que aumentam seus comportamentos de autocuidado: revisão sistemática / Intervenciones de enfermería en pacientes con diabetes mellitus tipo 2 que aumentan sus conductas de autocuidado: revisión integrativa / Nursing interventions in patients with type 2 diabetes mellitus that increase their self-care behaviors: systematic review

Resumo O objetivo desta revisão foi identificar as intervenções de enfermagem para aumentar os comportamentos de autoatendimento em pacientes diagnosticados com diabetes mellitus tipo 2. É uma revisão integrativa, onde foi realizada uma pesquisa nas bases de dados SciELO, BVS, PubMed e WOS, entre Setembro e dezembro de 2017, utilizando os descritores; diabetes mellitus tipo 2 E autocuidado e cuidados de enfermagem, em espanhol, inglês e português. Inicialmente, foram identificadas 2.534 publicações e após a aplicação de; filtros, critérios de seleção e escala JADAD, a amostra selecionada foi de 10 artigos. Em cinco dos estudos, a intervenção teve resultados positivos em relação ao autocuidado, dos quais quatro utilizaram estratégias derivadas da psicologia, como; entrevista motivacional, teoria da mudança de comportamento e resolução de problemas. Conclui-se que os profissionais de Enfermagem devem aprofundar-se na área de psicologia e formar equipes de trabalho com esses profissionais, uma vez que pessoas com diabetes mellitus tipo 2 necessitam de uma mudança de comportamento a longo prazo. Portanto, intervenções a longo prazo também são necessárias para alcançar essas mudanças e aumentar a qualidade de vida desses pacientes.

Resumen El objetivo de esta revisión fue identificar intervenciones de Enfermería que aumenten las conductas de autocuidado en pacientes con diagnóstico de Diabetes mellitus tipo 2. Es una revisión integrativa donde se realizó una búsqueda en las bases de datos en SciELO, BVS, PUBMED y WOS, entre septiembre y diciembre del 2017, utilizando los descriptores; diabetes mellitus tipo 2 AND autocuidado AND atención de Enfermería, en idioma español, inglés y portugués. Inicialmente se identificaron 2.534 publicaciones y tras la aplicación de; filtros, criterios de selección y escala JADAD, la muestra seleccionada fue de 10 artículos. En cinco de los estudios la intervención tuvo resultados positivos con respecto al autocuidado, de las cuales cuatro utilizaban estrategias derivadas de la psicología como; entrevista motivacional, teoría del cambio de comportamiento y resolución de problemas. Se concluye que los profesionales de Enfermería deben profundizar en el área de la psicología y formar equipos de trabajo con estos profesionales, ya que las personas con diabetes mellitus tipo 2 necesitan un cambio de comportamiento a largo plazo. Por lo tanto, también se necesitan intervenciones de larga duración para lograr estos cambios y aumentar la calidad de vida de estos pacientes.

Abstract The objective of this review was to identify nursing interventions that increase self-care behaviors in patients diagnosed with type 2 Diabetes mellitus. It is an integrative review where a search was made in the databases in SciELO, VHL, PUBMED and WOS, among September and December 2017, using the descriptors; diabetes mellitus type 2 AND self-care AND nursing care, in Spanish, English and Portuguese. Initially, 2,534 publications were identified and after the application of; filters, selection criteria and JADAD scale, the sample selected was 10 articles. In five of the studies the intervention had positive results with respect to self-care, of which four used strategies derived from psychology such as; motivational interview, theory of behavior change and problem solving. It is concluded that nursing professionals must deepen in the area of psychology and formwork teams with these professionals, since people with diabetes mellitus type 2 need a change in behavior in the long term. Therefore, long-term interventions are also needed to achieve these changes and increase the quality of life of these patients.

Stepping outside the consultation room. On nurse-patient relationships and nursing responsibilities during a type 2 diabetes walking project.

AIMS: To examine the care practices of nurses during the organization of 20 weeks of walking sessions for people with type 2 diabetes and to reflect on implications for nurse-patient relationships and nursing responsibilities in the provision of physical activity (PA) care. DESIGN: Qualitative, ethnographic study. METHODS: Almost 70 hr of field work was completed by participant observations and informal conversations with nurses and participating patients of two different walking groups (April-October 2016). Analysis of field notes followed an inductive holistic-content approach, using both within-case and across-case analysis. RESULTS: The analysis revealed four main themes related to the nurses' care practices: (a) organizational efforts; (b) combining group and individual care; (c) stepping in- and outside the patient mode; and (d) implications back inside the consultation room. Underlying these themes was a process of relational development, both with and among patients. CONCLUSION: Stepping outside the consultation room seems to offer more space for patients' lifeworld narratives and contribute to more continuous and person-centred care. However, it also raises new questions about the provision of PA care and nursing responsibilities in this. IMPACT: Current nursing repertoires for PA counselling in type 2 diabetes care are insufficient and might be extended by organizing walking sessions for patients. Related nursing care practices impacted relationships both with and among participating patients. These have consequences for boundaries of both nursing responsibilities and care provision.

When peers count: The effects on integrated type II diabetes care of communication within general practitioner-only subgroups in interprofessional primary care teams.

BACKGROUND: Primary care teams (hereafter referred to as primary care units [PCUs]) composed of general practitioners (GPs), nurses, and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases. PURPOSES: The aim of the study was to assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect. METHODOLOGY/APPROACH: We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, that is, within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care. FINDINGS: We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs' capacity to work collaboratively in integrated type II diabetes care. PRACTICE IMPLICATIONS: The article suggests that, when creating interprofessional primary care teams, managers might be able to steer teams toward a better performance by encouraging communication among peers of the same profession.

Design and implementation of an Omaha System-based integrated nursing management model for patients with newly-diagnosed diabetes.

AIMS: The aim of the present paper was to establish and implement an integrated nursing management model for patients with newly-diagnosed type 2 diabetes mellitus (T2DM) based on the Omaha System and to explore its impact on blood glucose levels, quality of life, and diabetes knowledge in these patients. METHODS: A non-randomized concurrent controlled trial was designed and the study was conducted in a hospital on the east coast of China between September 2013 and November 2015. We screened for patients with newly-diagnosed T2DM in 12 clinics of 3 comprehensive hospitals. A total of 367 patients with newly-diagnosed T2DM were assigned into two groups. In the intervention group, patients received routine outpatient care plus integrated nursing management; in the control group, only routine outpatient care was given. Changes in blood glucose levels, quality of life, and diabetes knowledge in both groups before the intervention and 6 months after the intervention were observed and compared. RESULTS: At the 6months, blood glucose levels, quality of life, and diabetes knowledge in the intervention group were significantly superior to those in the control group (all P<0.01). CONCLUSIONS: The integrated nursing management model was able to improve patients' glucose levels, quality of life, and diabetes knowledge.

The How-To for Type 2: An Overview of Diagnosis and Management of Type 2 Diabetes Mellitus.

This article presents an overview of type 2 diabetes diagnosis and management. A brief discussion of epidemiology, including incidence, prevalence, and etiology, provides the basis for the importance of the discussion. The review then proceeds to outline diagnostic criteria and follow-up monitoring guidelines. Recommendations for evidence-based lifestyle measures and current pharmacologic options are addressed. A priority on individualized, holistic care with patient-specified goals and the management of comorbidities is emphasized.

The Patient-Centered Medical Home Model and Diabetes Outcomes: An Integrative Literature Review.

The purpose of this integrative review was to synthesize the existing evidence on diabetes care within a Patient-Centered Medical Home (PCMH) model to evaluate its effectiveness on quality outcomes. Literature published in English between 2005 and 2015 was searched using thefollowing keywords: PCMH and diabetes, comprehensive care, care coordination, patient-centered care, quality and safety, and accessible care. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Cochrane Review, Academic Premier (EBSCO), and Psych INFO. The search yielded 96 articles; 11 were selectedfor review. The effects of the PCMH model on diabetes outcomes varied. The heterogeneity of the research designs, practice settings, and quality outcomes limited the generalizability of the findings. The evidence related to diabetes type 2 quality outcomes in a PCMH model is limited yet encouraging. However, future studies should consider longitudinal designs, where outcomes can be observed over a period of time.

A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes.

AIMS: To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS: The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS: Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS: Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).

Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary.

Faith community nursing scope of practice: extending access to healthcare.

The role of the Faith Community Nurse (FCN) is a multifaceted wholistic practice focused on individuals, families, and the faith and broader communities. The FCN is skilled in professional nursing and spiritual care, supporting health through attention to spiritual, physical, mental, and social health. FCNs can help meet the growing need for healthcare, especially for the uninsured, poor, and homeless. The contribution of FCNs on, primary prevention, health maintenance, and management of chronic disease deserves attention to help broaden understanding of the scope of FCN practice.

Application of a theoretical framework to foster a cardiac-diabetes self-management programme.

AIM: This paper analyses and illustrates the application of Bandura's self-efficacy construct to an innovative self-management programme for patients with both type 2 diabetes and coronary heart disease. BACKGROUND: Using theory as a framework for any health intervention provides a solid and valid foundation for aspects of planning and delivering such an intervention; however, it is reported that many health behaviour intervention programmes are not based upon theory and are consequently limited in their applicability to different populations. The cardiac-diabetes self-management programme has been specifically developed for patients with dual conditions with the strategies for delivering the programme based upon Bandura's self-efficacy theory. This patient group is at greater risk of negative health outcomes than that with a single chronic condition and therefore requires appropriate intervention programmes with solid theoretical foundations that can address the complexity of care required. SOURCES OF EVIDENCE: The cardiac-diabetes self-management programme has been developed incorporating theory, evidence and practical strategies. DISCUSSION: This paper provides explicit knowledge of the theoretical basis and components of a cardiac-diabetes self-management programme. Such detail enhances the ability to replicate or adopt the intervention in similar or differing populations and/or cultural contexts as it provides in-depth understanding of each element within the intervention. CONCLUSION: Knowledge of the concepts alone is not sufficient to deliver a successful health programme. Supporting patients to master skills of self-care is essential in order for patients to successfully manage two complex, chronic illnesses. IMPLICATIONS FOR NURSING PRACTICE OR HEALTH POLICY: Valuable information has been provided to close the theory-practice gap for more consistent health outcomes, engaging with patients for promoting holistic care within organizational and cultural contexts.

Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.

AIMS: To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. METHODS: This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA(1c) concentration at 12 months. Secondary end points included serum lipids and blood pressure. RESULTS: The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA(1c) target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c) concentration, blood pressure and LDL cholesterol. CONCLUSIONS: A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.

Psychological resistance to insulin therapy in adults with type 2 diabetes: mixed-method systematic review.

AIM: This paper is a report of a review that aimed to describe the phenomenon of psychological resistance to insulin therapy from the perspective of adults with type 2 diabetes mellitus. BACKGROUND: Although the benefits of insulin for people with diabetes who are poorly controlled by oral agents have been established, delay in transition to insulin treatment is common. An understanding of the barriers to insulin from the client's viewpoint provides information to facilitate appropriate and effective care. DATA SOURCES: Searches were carried out between 1999 and 2009 using computerized databases, three in English language and one in Chinese. REVIEW METHODS: Review design was a mixed-method systematic review, and data abstraction and synthesis were undertaken by thematic synthesis. Reviewed articles were restricted to adults with type 2 diabetes and published in English or Chinese. RESULTS: Sixteen articles were included. For adults with type 2 diabetes, psychological resistance to insulin therapy could be explained by five themes. Three themes were categorized as cognitive appraisal, including 'people do not see the necessity for insulin and actively seek ways to control blood sugars without insulin', 'people have a holistic view of the consequences of insulin' and 'people see insulin therapy as less feasible'. Two themes were categorized as emotional reactions: 'people see insulin as a source of fear/anxiety', and 'the necessity to start insulin therapy has a very negative connotation for them and is associated with dysfunctional emotions'. CONCLUSION: Psychological resistance to insulin therapy can result from a range of personal viewpoints involving cognitive appraisal and/or emotional reactions.

Integrating nurse-directed diabetes management into a primary care setting.

OBJECTIVE: To compare outcome measures of nurse-directed diabetes management for 9 to 12 months between a nonintegrated model (patients removed from the primary care clinic and followed up in a separate diabetes clinic with supervision by an endocrinologist) and an integrated model (nurse placed in the primary care clinic with supervision by primary care physicians). STUDY DESIGN: Observational. METHODS: A nurse trained to follow approved detailed treatment algorithms (glycemia and dyslipidemia algorithms for both models plus a hypertension algorithm for the integrated model) was given prescription authority. RESULTS: A total of 367 patients were randomly selected from a primary care clinic for the nonintegrated model, and 178 patients were referred to the nurse by primary care physicians for the subsequent integrated model. Ultimately, one quarter of patients in the nonintegrated model were using insulin (mostly bedtime insulin only), while three quarters of patients in the integrated model were using insulin (mostly intensified regimens). The initial mean (SD) glycosylated hemoglobin (A1C) levels fell from 8.9% (2.6%) to 7.0% (1.2%) of total hemoglobin in the nonintegrated model and from 11.1% (2.3%) to 7.2% (0.9%) of total hemoglobin in the integrated model (to convert A1C level to proportion of total hemoglobin, multiply by 0.01). Taking initial values into account, the final A1C levels were not statistically different (P = .61). In the nonintegrated and integrated models, respectively, 60% and 49% met the American Diabetes Association (ADA) A1C goal, and 82% and 96% met the low-density lipoprotein cholesterol (LDLC) goal. In the integrated model, 90% met the blood pressure (BP) goal, and 47% met all 3 goals (ADA A1C, LDL-C, and BP). CONCLUSION: An integrated model of diabetes care is generalizable and should be considered by policy makers to improve diabetes outcomes, especially among underserved minority populations.

Addressing low-density lipoprotein (LDL) in Mexican Americans with diabetes in the NHANES (1999-2000 and 2001-2002).

The National Health and Nutrition Examination Survey (1999-2000 and 2001-2002) was utilized to examine and compare low-density lipoprotein levels in Mexican Americans with diabetes.