the purpose of this study was to systematically evaluate the content, integrity, and efficacy of a nurse coaching intervention provided after diabetes education that focused on dietary and exercise lifestyle change in persons with type 2 diabetes.
METHODS
A multimethod design incorporated an interpretive approach to examine the content and integrity of the intervention and a multiple-baseline, single-subject method to determine the preliminary efficacy of the intervention.
RESULTS
The primary strategies of the nurse coaching intervention consisted of facilitating lifestyle change through educational reinforcement, psychosocial support, and motivational guidance. Aggregate quantitative outcomes revealed a modest increase in health-promoting behaviors and a decrease in fasting blood glucose, indicating a trend toward physiologic adaptation. Participants demonstrated a significant increase in integration reflective of psychosocial adaptation.
CONCLUSIONS
Providing individualized nursing care after diabetes education may improve health outcomes and the quality of life of persons newly diagnosed with type 2 diabetes. This multimethod design is a cost-effective approach for preliminary evaluation of complex and/or novel interventions.
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References
1.
1. National Diabetes Information Clearinghouse. Diabetes statistics. 1998. Available at: www.niddk.nih.gov/health/diabetes/pubs/dmstats. Accessed July 2001.
2.
2. Turner R, Cull C, Holman R. United Kingdom Prospective Diabetes Study 17: A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulindependent diabetes mellitus. Ann Intern Med. 1996;124: 136-145.
3.
3. UKPDS Study Group. Intensive blood glucose control with sulphonylureas or insulin compared to conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837-853.
4.
4. Gilmer TP, O'Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care. 1997; 20:1847-1853.
5.
5. Brown SA. Effects of educational interventions in diabetes care: a meta-analysis of findings. Nursing Res. 1988;37: 223-230.
6.
6. Brown SA. Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited. Patient Educ Counsel. 1990;16: 189-215.
7.
7. Clement S. Diabetes selfmanagement education. Diabetes Care. 1995;18:1204-1214.
8.
8. American Diabetes Association. National standards for diabetes self-management education programs and American Diabetes Association review criteria. Diabetes Care. 1997;20(suppl 1):S67-S70.
9.
9. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: PrenticeHill; 1986.
10.
10. Rosenstock IM. Understanding and enhancing patient compliance with diabetic regimens. Diabetes Care. 1985;8: 610-616.
11.
11. Glasgow RE, Osteen VL. Evaluating diabetes education: are we measuring the most important outcomes. Diabetes Care. 1992;18:1423-1432.
12.
12. Anders CL. Evaluating the effectiveness of a diabetes education program. Diabetes Spectrum. 1993;6:314-319.
13.
13. Funnell MM, Haas LB. National standards for diabetes self-management education programs. Diabetes Care. 1995; 18:100-116.
15. Elford RW, Yeo M, Jennett PA, Sawa RJ. A practical approach to lifestyle change counseling in primary care. Patient Educ Counsel. 1994;24: 175-183.
16.
16. Pollock SE. Adaptation to chronic illness: a program of research for testing nursing theory. Nurs Sci Q. 1993;6:86-92.
17.
17. Roy SC, Andrews HA. The Roy Adaptation Model. Norwalk, Conn: Appleton & Lange; 1991.
18.
18. Roy SC, Andrews HA. The Roy Adaptation Model. Norwalk, Conn: Appleton and Lange; 1999.
19.
19. Roy SC. Future of the Roy Model: challenge to redefine adaptation. Nurs Sci Q. 1997; 10:42-48.
20.
20. Fleury JD. Empowering potential: a theory of wellness motivation. Nurs Res. 1991;40: 286-291.
21.
21. Hernandez C. The development and testing of an instrument to measure integration in adults with diabetes mellitus. Can J Nurs Res. 1995;28: 18-26.
22.
22. Medich CJ, Stuart E, Chase SK. Healing through integration: promoting wellness in cardiac rehabilitation. J Cardiovasc Nurs. 1997;11: 66-79.
23.
23. Price MJ. An experiential model of learning diabetes selfmanagement. Qualitative Health Res. 1993;3:29-54.
24.
24. Hernandez C. Integration: the experience of living with insulin-dependent diabetes. Can J Nurs Res. 1996;28:37-56.
25.
25. Smith DE, Heckemeyer CM, Kratt PP, Mason DA. Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. Diabetes Care. 1997; 20:52-54.
26.
26. Estey AL, Tan MH, Mann K. Follow-up intervention: its effect in compliance behavior to a diabetes regimen. Diabetes Educ. 1990;16:291-295.
27.
27. Miles MB, Huberman AM. Qualitative Data Analysis. Thousand Oaks, Calif: Sage Publications; 1994.
28.
28. Kratochwill TR, Levin JR. Single-Case Research Design and Analysis. Hillsdale, NJ: Lawrence Erlbaum Associates; 1992.
29.
29. Barlow DH, Hersen M. Single Case Experimental Designs: Strategies for Studying Behavior Change. New York: Pergamon Press; 1984.
30.
30. Chan JC, Wong RY, Cheung CK, et al. Accuracy, precision and user-acceptability of self blood glucose monitoring machines. Diabetes Res Clin Pract. 1997;36:91-104.
31.
31. Kilpatrick ES, McLeod MJ, Rumley AG, Small M. A ward comparison between the One Touch II and Glucometer II blood glucose meters. Diabetes Med. 1994;11:214-217.
32.
32. Toobert DJ, Glasgow RE. Assessing diabetes self-management: the Summary of the Diabetes Self-Care Activities Questionnaire. In: Bradley C, ed. Handbook of Psychology and Diabetes. Australia: Harwook Academic Press; 1994:351-375.
33.
33. Glasgow RE, Toobert DJ, Mitchell DL, Donnelly JE, Calder D. Nutrition education and social learning interventions for type II diabetes. Diabetes Care. 1989;12:150-152.
34.
34. Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly RD. Improving self-care among older patients with type II diabetes: the 'Sixty Something' Study. Patient Educ Counsel. 1992;19:61-74.
35.
35. Ainsworth BE, Leon AS, Richardson MT, Jacobs DR, Paffenbarger RS. Accuracy of the College Alumnus Physical Activity Questionnaire. J Clin Epidemiol. 1993;46: 1403-1411.
36.
36. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM. Tests of glycemia in diabetes. Diabetes Care. 1995;18:896-909.
37.
37. Redmon EM, Bell-Farrow AD, Wang ZQ, McBride DG, Cefalu WT. Clinical validation of a new rapid fingerstick test for glycated proteins (fructosamine). Paper presented at: American Diabetes Association 57th Scientific Session; 1997; Boston, Mass.
38.
38. Lincoln YS, Guba EG. Naturalistic Inquiry. Beverly Hills, Calif: Sage Publications; 1985.
39.
39. Tawney J, Gast D. SingleSubject Research in Special Education. Columbus, Ohio: Merrill; 1986.
40.
40. Ottenbacher KJ. Evaluating Clinical Change: Strategies for Occupational and Physical Therapists. Baltimore, Md: Williams & Wilkins; 1986.
41.
41. Jones P. Single-case statistical analysis: statistical tools. 2000. Available at: www.unlv.Edu/Colleges/Education/EP/scsa.tool. Accessed January 2000.
42.
42. Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press; 1991.
43.
43. Whittemore R, Chase SA, Mandle CL, Roy C. Lifestyle change in type 2 diabetes: a process model. Nurs Res. In press.
44.
44. Whittemore R. A Coaching Intervention to Integrate Lifestyle Change in Adults With Non-Insulin-Dependent Diabetes Mellitus.[dissertation] Chestnut Hill, Mass: Boston College School of Nursing; 2000.
45.
45. Paterson BL, Sloan J. A phenomenological study of the decision-making experience of individuals with long-standing diabetes. Can J Diabetes Care. 1994;18:10-19.
46.
46. Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, Calif: Addison Wesley; 1984.
47.
47. Combs A, Gonzalez D. Helping Relationships: Basic Concepts for the Helping Professions. Boston, Mass: Allyn & Bacon; 1994.
48.
48. Beeney U, Bakry AA, Dunn SM. Patient psychological and information needs when the diagnosis is diabetes. Patient Educ Counsel. 1996;29: 109-116.
49.
49. Wikblad KF. Patient perspectives of diabetes care and education. J Adv Nurs. 1991; 16:837-844.
50.
50. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102-1114.
51.
51. Franklin RD, Allison DB, Gorman BS. Design and analysis of single-case research. Mahwah, NJ: Lawrence Erlbaum Associates; 1997.
