Introduction: Diabetic foot self-management intervention programs have been proven to positively influence individuals' behaviors in preventing diabetic foot ulcers. Using digital technologies to deliver programs can facilitate compliance with diabetes self-management programs. However, few studies have focused on the effects of such digital programs on improving the self-efficacy and behaviors of older adults with type 2 diabetes in the community. Aim: To evaluate the effects of a digital foot self-management program on self-efficacy, self-care behavior, and Hemoglobin A1c levels. Design: A single-blinded, randomized controlled trial was conducted. Methods: The intervention program comprised a 4-week digital foot care program with one face-to-face education session, phone calls once weekly, and LINE messages (social media) three times per research nurse and a follow-up of three months. Patients in the control group received routine care. Results: A total of 100 participants (n = 50 in the control and n = 50 in the intervention groups) completed the study with a mean age of 67.55 (SD = 11.17). The results showed significant improvements in self-efficacy (F = 2187.24, p < 0.01) and self-care behavior (F = 614.71, p < 0.01) in foot care between the groups. The Hemoglobin A1c levels showed a 0.41% reduction over time in the experimental group (t = -3.759; p < 0.01), whereas the control group showed a 0.06% reduction (t = -0.797, p > 0.05). Conclusion: The newly developed digital foot self-management program was effective in community-dwelling older adult patients with type 2 diabetes.
BACKGROUND: There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective. OBJECTIVE: To identify the experience of being an advanced practice nurse working in Australian acute care settings. INCLUSION CRITERIA: Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography. SEARCH STRATEGY: A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011. METHODOLOGICAL QUALITY: Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument. DATA EXTRACTION: Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool. DATA SYNTHESIS: Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument. RESULTS: Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings. CONCLUSIONS: The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people. IMPLICATIONS FOR PRACTICE: A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety. IMPLICATIONS FOR RESEARCH: If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.
AIM: This study aimed to gain in-depth understanding of the actual hospital and home experience of patients with diabetes and a critical cardiac event to assist in developing a pertinent diabetes self-management programme. BACKGROUND: Type 2 diabetes can lead to cardiac complications requiring critical nursing care. Patients with diabetes and a history of cardiac disease are at greater risk of a further cardiac event. Greater self-efficacy or confidence in regulating diabetes and reducing the risk of a further cardiac event can be achieved through self-management programmes. However, the start of such a programme within the critical care environment presents challenges to critical care staff. It is important to understand patients' experiences and needs to improve quality of care. DESIGN: An interpretive approach comprising open-ended interviews was used to collect data from patients with type 2 diabetes experiencing a cardiac event who had a coronary care unit admission in 2002-2003. FINDINGS: The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self-confidence and confidence in health professionals. Patients indicated that greater self-confidence and confidence in health professionals would help their ability to manage their daily lives. CONCLUSION: This paper provides in-depth understanding of the perspectives of patients with type 2 diabetes who have also been hospitalized for a critical cardiac event. This study concluded that further research is needed to fully explore whether enhancing self-confidence for these patients will lead to improved diabetes management, reduced negative feelings and more positive health outcomes. RELEVANCE TO CLINICAL PRACTICE: The themes identified in this study provide direction and strategies for nursing staff to improve patients' confidence levels and reduce their feelings of hopelessness and fatigue.
Diabetes Mellitus, Type 2 , Self Care , Coronary Care Units , Heart Diseases , Humans , Self Efficacy
