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NURS 4318 Literature Research Assignment

Davis, Lakeidre 1

Topic: Nursing Care among Adolescents with Diabetes

Bachman, J., & Hsueh, K. (2008). Evaluation of online education about diabetes management in the school setting. Journal Of School Nursing (Allen Press Publishing Services Inc.), 24(3), 151-157. doi:http://dx.doi.org/10.1177/1059840533445566 Quasi-experimental Abstract Background. There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if objectives of the program were met, if participants believed the education provided would enhance their ability to manage children with diabetes, and participants opinions about the online delivery method. Purpose. The purpose of this study was to develop and evaluate an online CE program to educate school nurses in how to manage care for children with diabetes in school using the current practice principles outlined in Diabetes Management in the School

Setting: A Resource Guide for School Nurses.

Sample/Setting. The study chose 19 nurses in the state of Missouri that were not able to the face-to- face continuing education workshops. Then to ensure quality, then number of nurses were reduced down to 10. These nurse were then given access to Blackboard learning system to participate in the course. Design/Methods. DescriptiveCourse participants used the revised Diabetes Management in the School Setting: A Resource Guide for School Nurses, viewed online Power-Point presentations (including written speaker notes), had access to external Internet links via Blackboard, asked questions of faculty and other course participants via three discussion boards, and posted written answers to discussion questions on discussion boards. The online program consisted of three lessons. Lesson 1 was an overview of diabetes in children and an update on diabetes management in the school setting. Lesson 2 covered managing students with insulin pumps. Lesson 3 discussed the role of the school nurse in managing children with diabetes. Each lesson had a discussion board. Three faculty teams with expertise on each lesson guided discussions and answered questions.

NURS 4318 Literature Research Assignment

Davis, Lakeidre 2

Discussion/Conclusion. A majority of school nurses responded that the objectives for the course were met. A majority rated the class as excellent for value and usefulness and stated that the information would improve their ability to manage students with diabetes. Some of the school nurses appreciate the convenience of the online education, whereas others stated it did not fit their learning style and they learned better in a classroom setting. Implications for Nursing. With the increasing prevalence of children with diabetes in schools, an important finding of this study is that online CE with current practices on care and pump technology may enhance school nurses ability to manage children with diabetes in their schools. This method allows for CE for school nurses who find it difficult to attend face-to-face workshops. The online method saves travel time and expenses; however, computer skills and access to computers are needed. Faulkner, M. (2010). Cardiovascular Fitness and Quality of Life in Adolescents With Type 1 or Type 2 Diabetes. Journal For Specialists In Pediatric Nursing, 15(4), 307316. doi:http://dx.doi.org/10.1111/j.1744-6155.2010.00254.x Quantitative/Correlational Article Study Background/Introduction: Current therapeutic regimens for adolescents with diabetes, regardless of the type, are based on self-management of pharmacological interventions with insulin and/or oral agents, medical nutritional therapy, and regular exercise to maintain glycemic control, preserve quality of life (QoL), and minimize future complications (American Diabetes Association, 2010). Although adolescents face many developmental and emotional challenges for managing their DM, the American Diabetes Association (2010) presently recommends that glycosylated hemoglobin (A1C) values be maintained below 7.5% to improve long-term health outcomes. A major focus of pediatric multidisciplinary DM care is the attainment of optimal glycemic control (A1C) while ensuring high QoL (Ingerski, Laffel, Drotar, Repaske, & Hood, 2010). Glycemic control reflects the physiological outcome of DM management, whereas QoL represents the psychological perspective of treatment outcomes for individuals with DM. Purpose. The purpose of this study was to explore the relationships between CV fitness (i.e., VO2peak), as well as self-reported physical activity, with generic or healthrelated QoL (HRQoL), glycemic control, and lipid profile in adolescents with type 1 or type 2 DM. Design/ Methods. Cross-sectional, descriptive. Graded ergometry testing for fitness, fasting assays for lipids, glycosylated hemoglobin (A1C), and self-reported PA and QoL instruments were completed with 151 adolescents. Sample/Setting. Adolescents between 13 and 18 years of age with a primary diagnosis of either type 1 or type 2 DM who were receiving routine care at a large, university-based, metropolitan pediatric DM center in the Midwest were eligible to participate. Adolescents were required to have a diagnosis of DM for at least 1 year.
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NURS 4318 Literature Research Assignment

Davis, Lakeidre 3

Analysis. All data were analyzed using SPSS Version 16.0 (SPSS,Inc., Chicago, IL, USA).Descriptive statistics were used for demographic data and t-tests were used to detect differences in clinical data between adolescents with type 1 versus type2 DM. Pearson correlation coefficients were used to examine associations between CV fitness and physical activity expenditure with the outcome variables of A1C, lipids, DM-related or generic QoL for the total sample, and for each subgroup, those with type 1 or type 2 DM. Results. In terms of DM-related or generic QoL, adolescents did not differ significantly depending on their type of DM. Only the global measure of health perception was lower for those with type 2 (3.10 _ 0.72 vs. 2.58 0.84, t = 3.50, degrees of freedom = 61.0, p = .001). Although the total sample had significant associations between CV fitness and lower LDL-c, triglycerides, and average A1C, those with type 1 DM specifically, but not type 2 DM, exhibited significant lowering of total cholesterol, LDL-c, triglycerides, and both recent and average A1C values. No significant associations between physical activity expenditure with lipids and A1C were found (see Table 3).Tables 4 and 5 present the significant associations between CV fitness and physical activity expenditure with DM-related and generic QoL. The total sample and specifically those with type 1 revealed more positive perceptions of personal health and athletic competence when adolescents were more physically fit. Implications for Nursing. Nurses practicing in primary care clinics, schools, pediatric endocrine clinics, and hospitals are key advocates for identifying strategies for motivating teens with either type 1 or type 2 DM to be more physically active and for adding exercise into treatment regimes for optimal metabolic and QoL outcomes. Ivey, J. B., Wright, A., & Dashiff, C. J. (2009). Finding the balance: adolescents with type one diabetes and their parents. Journal of Pediatric Health Care, 23(1), 1018. Retrieved from http://dx.doi.org.manowar.tamucc.edu/10.1016/j.pedhc.2007.12.008 Qualitative Study Abstract Background: The adolescent with type 1 diabetes is at risk for the complications of diabetes, which can be exacerbated by his or her drive for independence and peer acceptance (Silverstein et al., 2005, p. 190). Adolescents may be less vigilant with selfmanagement, fail to recognize and treat hypoglycemia, and may resent close parental supervision (Silverstein et al.). Although usual parent-adolescent conflicts are similar for families of adolescents with type 1 diabetes (Viikinsalo, Crawford, Kimbrel, Long, & Dashiff, 2005), communication about disease management can bring additional and unique sources of friction or conflicts that can influence such an adolescents metabolic control (Anderson et al., 2002).

NURS 4318 Literature Research Assignment

Davis, Lakeidre 4

Purpose: The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management. Sample: All families in the longitudinal study were recruited from an endocrinology clinic in a childrens hospital in the southeastern United States. To be eligible for the study, the adolescent must have been between the ages of 11 and 15 years at the time of enrollment in the longitudinal study; have had type 1 diabetes for at least one year; and have had no psychological problems learning disabilities or other chronic illnesses. In addition, the family was required to have been living together as a unit for at least 1 year (i.e., not divorced, widowed, or separated within the previous year), and neither of the parents could have been in a learning- disabled class in high school. Method: A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents. Results: Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication. Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management. J Pediatr Health Care. (2009) 23, 10-18. Discussion: In conclusion, communication processes are important in adolescent diabetes management. Communication processes include the ways in which nurses and other clinicians utilize opportunities to model effective communication about diabetes management and work directly with parents and adolescents to improve communication about diabetes management.

Greene, M. S., Mandelco, B., Roper, S. O., Marshall, E. S., & Dyches, T. (2010). Metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes: A correlational study. The Diabetes Educator, 36(2), 326-336. DOI: 10.1177/0145721710361270 Correlational Study Abstract ** Background: Diabetes is one of the most common chronic diseases in childhood and adolescence in the United States and currently affects roughly 210,000 people under the age of 20 years.1 In fact, approximately 1 in every 400 to 500 children and adolescents is thought to have diabetes, and every year, more than 13,000 young people are newly diagnosed with the disease. Research has documented the importance of tight metabolic control in preventing long-term complications of diabetes.
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NURS 4318 Literature Research Assignment

Davis, Lakeidre 5

Even though many factors contribute to improved metabolic control, few are as effective as successful self-care behaviors. Many factors enhance a young persons diabetes related self-care behaviors, including family cohesion and adaptability, social support, personal coping, positive self -perceptions, and a good attitude toward illness.

Purpose. The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. Design and Method. Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. Sample: Participants lived in a western state and were initially contacted during registration at diabetes summer camps, at a Diabetes Management Clinic, or through snowball sampling. Inclusion criteria for the study required participants to be between 10 to 18 years old, have been diagnosed with diabetes for at least 2 years, and have at least one parent willing to take part in the research. Procedures: Families were visited in their homes by trained research assistants who explained the nature of the study. Consent was obtained from parents, and assent was obtained from adolescents. Parents and adolescents completed self-report measures. Participants received a $20 gift card for participating in the research study. Results. No significant relationships were found among A1C values, self-care behaviors, and length of time since diagnosis, gender, and the age of participating adolescents. However, authoritative mothering was associated with lower A1C values and higher scores on overall self-care; permissive parenting in both parents was related to poorer metabolic outcomes in 1-tailed correlations (Table 3).Consistent with outcomes suggesting authoritative parenting is more common in families from higher socioeconomic classes, the current sample of parents rated themselves higher on authoritative parenting and lower on authoritarian and permissive parenting. Interestingly, the correlations in this study varied by parent gender; authoritative mothering was the strongest predictor of better metabolic control and overall diabetes self-care. Because mothers in this study spent less time working outside the home (almost 18 hours/week) than fathers (more than 40 hours/week), they may have had more influence than fathers. Practice Implications. Results of this study show parenting style is related to metabolic control and self-care behaviors in adolescents with diabetes. Because
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NURS 4318 Literature Research Assignment

Davis, Lakeidre 6

mothers authoritative parenting style had the strongest association with metabolic control and overall self-care behaviors, the bulk of parenting interventions for families with diabetes must include mothers. It would also be useful to assess parenting practices most frequently used by parents and, if necessary, teach them to use authoritative parenting as a part of their parenting repertoire. Despite the absence of strong correlations between authoritative fathering and improved metabolic control in this study, preliminary research from other studies suggests many possible benefits from working with fathers of young people with chronic illnesses like diabetes.

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