Evidence Based Practice for Type 2 Diabetes in the United States
I. Introduction
Type 2 Diabetes is a prevalent chronic disease. It is currently the fastest growing disease in the world (Franz & Splett,2007).The health burden of diabetes as it currently stands is that the prevalence of Type 2 Diabetes is high among people aged above 25 (Narayan , et al., 2009). This segment of the demography is highly productive and dependable for the growth of the global economy (Narayan, et al., 2009). For every one person diagnosed with Type 2 Diabetes, there is one other person who goes undiagnosed.
Pacific Islanders, Native Hawaiians, Asian Americans, Native Americans, Latinos, and African Americans are mostly affected by type 2 Diabetes in America. According to the American diabetes fact sheets of 2012, the total number of people affected by the disease in America is 25.8 million (American Diabetes Association, 2012), which is about 8.3% of the entire American population. In this figure, people aged above 65 are the ones most affected, as they constitute 26.9 percent (ADA, 2012). The new cases registered were almost 2 million people and most of them were 20 years or older. More disappointing figures indicated that more than 35 percent of American aged between 20 and 65 were at the pre-diabetic stage based on the measure of fasting glucose (ADA, 2012).
Hence, there is need for evidence based practice for type 2 diabetes, in the United States, in order to devise ways to improve the quality of care provided to diabetes patients (Keith & Harvey, 2008). This is because, although, diabetes is one of the leading diseases causing deaths, in America, there exists several barriers relating to management and care for the patients who have the disease, or those who at a risk of acquiring the disease (ADA, 2008). Sackett et al. (2000) defines evidence based practice in nursing is the incorporation of current best research evidence with patient care values and clinical expertise.
The issue of type II diabetes is significant in my nursing practice, as I often encounter patients with hypertension, hyperlipidemia and hyperglycemia. Since these patients are at an increased risk of acquiring Type 2 Diabetes, this study will be of immense significance to me, in my nursing practice, as I will learn how to manage this condition, as well as, barriers that I may encounter while trying to manage the condition. Also, the research will be significant for nursing practice, in general, because it will consider the nursing barriers to management of type 2 diabetes, among them being lack of knowledge among nurses, which leads to mismanagement. Literature Review
The literature materials reviewed in this section are retrieved from the internet and online databases including Ebsco and Emerald Insight. In this study, I used only articles that were published in the last 10-14 years, in order to obtain the latest knowledge. The concept map was used to develop a search strategy. Concept maps show relationships between ideas and concepts (for more information see Appendix 1). They, also, allow for a simplified way of visualizing how ideas fit into certain concepts. The strategy was to look for other research studies conducted that are similar to this proposed research and critically review them to the extent of their quality and strength of the evidence they produce. The main key word used for the search strategy is ‘evidence based practice for Type 2 Diabetes’. The other key words related to the research question included ‘management of type 2 diabetes’, and the ‘nursing barriers in caring for the diabetes patients’. Due to the enormous amount of information available on the internet, my search criteria involved limitations. These were, I only considered articles written in English. The second limit was supposed to ensure that the sources were current.
Barriers to effective management of care
According to the American diabetes Association, prevention of certain diabetes related complications is possible. But the problem is that, health systems, care providers, and the patients may act as a barrier to effective implementation of the best practices that are based on evidence (ADA, 2008). Diabetes and the complications related to the disease may easily be controlled and managed through evidence based best practice (Chiasson & Rabasa-Lhoret, 2004). For instance, further development of diabetes may be delayed or completely prevented through controlling the risk factors involved. The common risk factors that need to be controlled include hypertension, hyperlipidemia, and hyperglycemia (ADA, 2008). The American Diabetes Association has several publications and literature materials that relate to diabetes in general. These materials provide quality research findings conducted over the years. The research materials are however only focused in the United States of America. These findings are the ones most relied upon by the federal government when it comes to providing statistical data on the diabetes situation within the country and within individual states.
According to Nagelkerk, Reick, and Meengs (2006) barriers to effective management care were found to be associated with lack of sufficient knowledge. Many of the respondents in the study lacked the information they required to effectively manage patients’ conditions. Lack of understanding of the care plan and frustrations were also found to be barriers to the care of patients with Diabetes. The article also emphasises on some of the effective strategies found. One of them is the development of positive and collaborative relationships with other health professionals.
Nurses' association with other medical professionals
Research by Ohman-Strickland et al. ( 2008) and Aubert et al. (2006) reveal thatthe control of diabetes can be improved if nurses work in association with other health care professionals. Ohman-Strickland, et al. ( 2008) revealed that nurses performed better in taking care of diabetes patients than doctors and Physician assistants in the context of family practice. Even though the doctor was found to be essential in the diagnosis and decision making, the nurse was found to be the better caretaker for the diabetes patient. Similarly, Aubert et al. (2006) conducted a different research study, which compared the control of diabetes in patients receiving self - care and patients receiving nursing care. This journal article was retrieved from the American College of Physicians online database and presents quality literature material that is relevant to this research. The design used to conduct this study was randomized control trials. This design was based on the nature of the study. This research was carried out in primary health care clinics. A total of 121 patients with Type 2 Diabetes and 17 patients with Type 1 diabetes were used as the participants in this research (Aubert, et al., 2006). The intervention procedure was to place some patients in nursing care while others left to proceed with the ongoing care provided by their physicians. However, all patients continued with the ongoing physicians care (Aubert, et al., 2006). After 12 months, measurements were done on the hemoglobin value for blood sugar. Patients who were placed under nursing care while still going through their primary from their physicians the measurement of hemoglobin in their blood was found to have decreased compared to the other patients that were not placed in nursing care (Aubert, et al., 2006). From this research article by (Aubert, et al., 2006), it is clear that nurses have a significant role to play in control and management of Type 2 Diabetes. Thus, the control of diabetes can be improved if nurses work in association with other health care professionals.
Knowledge of evidence based best practices
In their research study, Zgibor and Songer (2008) found out that even though nurses and other medical professionals may have the knowledge of evidence based best practices sometimes they may fail to adhere to proper established guidelines. These guidelines are aimed at management and controlling of the risk factors involved in the development of Type 2 Diabetes (Zgibor&Songer, 2008). This literature material demonstrated quality and reliable content based on how the research was done. The material was retrieved from the American Diabetes Association journal .The authors are credible researchers within the field of medicine and they have conducted numerous research studies. In this particular article, the authors were determining barriers to proper care for diabetes patients. They found out that some of the barriers were patient based while others were practitioner based. According to Zgibor and Songer (2008) it is not only the health care service providers to blame, but also the patients themselves. Some of the patients have the knowledge for proper ways of managing the disease however they fail to adhere to the established guidelines (Chang & Daly, 2007). It may not be prudent to only identify where the problem is and lay blame to both healthcare service providers and the patients, but there is a need to further investigate the issue in order to come up with a solution for the problem (ADA, 2008).
Zgibor and Songer (2008) also state that the evidence based best practices must be focused on preventive healthcare since this is the most fundamental thing to preventing development of diabetes and its complication in Americans. Within the US, the American Diabetes Association is the body that is charged with formulation of the guidelines aimed at providing evidence based best practices (The DCCT Research Group, 2005). Sometimes it is perceived that patients may fail to seek care because the providers including nurses and physicians may actually fail to provide preventive services. At the same time this failure by providers to give preventive services is largely associated to non adherence by patients to the recommendations of treatment (ADA, 2008).
Studies that investigate the problems of management of healthcare for patients with Type 2 Diabetes are focused on the system to be having factors that contribute to the poor level of care (Skaer&Sclar, 2009). For instance, the lack of health insurance plans for most Americans is seen as a factor that contributes to poor management of care for diabetes patients. In addition there is an obvious difference in patterns in terms of practice by the different practitioners. This pattern difference is also among the healthcare system factors that are largely blamed for poor management of Type 2 Diabetes in the United States (Skaer&Sclar, 2009). Socio-Economic Socio Economic Barriers
As mentioned earlier, patients have also been blamed for the problem related to proper management of diabetes in the US. In order for patients to be able to support prevention of further development of diabetes, they must have the ease of access to good care. In addition, they also have to be able to pay for the services and have access to education and training for self -care of diabetes. Basically, on the side of the patients, social economic status may be the biggest barrier to the effective implementation of evidence based best practices (Connolly & Kesson, 2006). Besides, Blackwell et al. (2009) reveals that in the US, patients belonging to lower social economic status are not likely to have access to doctors frequently. This implies that they are likely not to receive proper care that they need to prevent further development of diabetes. Hence, social economic status is a factor that contributes to non utilization of preventive services (Blackwell et al., 2009; Connolly & Kesson, 2006).
Rural and Urban Environment
Rural and urban setting is also another factor that can prevent patients from access to quality healthcare aimed at early detection and controlling of the complications related to diabetes (Connolly & Kesson, 2006). This is mainly because of the diverse perception between urban patients and rural patients. Besides, Lasala (2000) reveals that most health centres in rural do not have adequate nursing personnel. This is because rural areas do not provide opportunities for better payment, similar to urban areas. Hence, a nurse who are positionedto work in rural areas tend to be attracted to urban areas due to better renumeration, creating deficiences in rural health care settings.
Non adherence to Medication
Basically members from some communities may have poorer perceptions in regards to treatment and management of diabetes, leading to non adherence to medication. Management of diabetes would require proper dieting and maintaining a certain lifestyle that reduces the risks of advancement of the illness (Saaddine, et al., 2009). Dieting and lifestyle can be done alone or in other cases combined with oral therapy (Cameron, et al., 2009). Proper care for the Type 2 Diabetes patients requires that additional attention be given in order to manage body weight, blood pressure, lipids (Cameron, et al., 2009). This helps to reduce the risks associated with long term complications (Steinman & Landefeld, 2008). Thus, the failure of patients to cooperate in treating and managing diabetes may pose a chief barrier to treatment, since nurses alone cannot achieve this without cooperation from patients.
A study set in Cameroon found that nurses have significant potential to improve access to diabetes care in rural areas where physicians are often unavailable (Kengne, et al., 2009).
The Purpose of Study
It has been identified that knowledge of research findings in nursing care of diabetes patients, is necessary for efficient management of the disease. Mismanagement of the disease has been observed at various occasions. While this is not entirely the fault of the nurses, it is important to identify the nursing barriers to management of type II diabetes.
Research Question
The study will be conducted in the United States of America. It intends to answer the question “What are the nurses perceptions of barriers to management of type II diabetes?”
Research Design and Methodology
Qualitative research is a form of scientific research that tries to comprehend a certain research topic from the viewpoint of the people it engrosses (Denzin, 2000) .According to Pope (2000), qualitative research employs semi-structured techniques like observation and in-depth interviews. Conversely, Nkwi et al. (2000) explains that qualitative research employs a preset group of procedures to respond to questions. A key strength of qualitative analysis is that use of open-ended questions and probes, which gives respondents a chance to answer questions using their own words. Another merit of qualitative design is that it uses more flexible tools and an iterative technique of obtaining and classifying answers to questions. On the other hand, qualitative analysis has several shortcomings. First, it may be difficult to compare responses, due to its nature of flexibility and use of open-ended questions. Second, qualitative analysis may be subject to bias, since the researcher uses his own judgments to categorize data. In this study, we decided to use qualitative research design because the study is supposed to gather information regarding nursing barriers to care for diabetes patients. It will therefore mostly depend on the opinions of the respondents.
Survey is a method of data collection method that uses questionnaires or interviews to obtain data (Research Methods Knowledge Base, 2006). Questionnaires are instruments that consist of preset questions, and they can be filled by respondents using paper and pen. Conversely, interviews become completed by the interviewer depending on the answers of respondents. The key difference between interviews and questionnaires is that interviews involve personal contact whereas questionnaires do not. While conducting personal interviews, the interviewer maintains direct contact with the respondent. Different from mail surveys, the interviewer may probe or structure questions depending on the context of the interview.
A key strength of interviews is that they are usually simple for the respondent, particularly when the aim of the interview is to find impressions and opinions. Also, interviews are flexible and private. Furthermore, the interviewer has the capacity to judge the quality of response during interviews (The Health Communication Unit, 2006). However, interviews may utilize lots of time and resources (The Health Communication Unit, 2006). Besides, the interviewer contributes to other tools of measurement and interviewers must be well trained, in order to be in a position to deal with any contingency. Other advantages and disadvantages of survey methods can be seen in appendix 2. In this research, we will use interviews. This is because the topic of our research is supposed to gather information regarding nursing barriers to care for diabetes patients. It will therefore mostly depend on the opinions of the respondents. Besides, we need to judge the reactions of respondents, in order to obtain accurate data. Also, considering that interviews are flexible, we will be able to obtain the exact feelings of the respondents regarding the question of research, without restrictions. We did not find questionnaires appropriate for this study, since they limit the answers that respondents can give.
There exist three types of interviews including structured, semi-structured and unstructured interviews. Structured interviews follow strict rules, such as, reading the questions exactly how they appear on the protocol. They are most appropriate for quantitative data, since they gather information that is very specific. Conversely, unstructured interviews do not require any rules or procedures. The whole data collection process resembles a conversation, as there are no formulated questions, but only topic for discussion. Unstructured questions are mostly used for case studies. Lastly, semi structured interviews are more flexible than structured interviews. Semi structured questions, also, follow questions as they appear on protocol. However, the researcher may be quite flexible to ask for additional information or clarifications. Hence, semi structured interviews are the most appropriate to use in qualitative analysis, as they are the best to use when seeking for personal opinions.
Methods of data collection
Burns and Grove (2007) suggest that interview is often the choice for data collection in qualitative study. In this study, interviews will be used as a method of data collection, since the study seeks to obtain opinions of respondents regarding nursing barriers to management of type II diabetes. The data collection process will be guided by the question of research (Cengage Learning, 2005). Data collection will begin only after the aims and objectives of research have been explained to all the participants and people directly involved. Ethical considerations have to be emphasized before the process of data collection. A list of questions has been formulated that the interviewees are supposed to answer. These questions are derived from the research question, thus have a specified theme. These questions will comprise of open -ended statements using words such as 'how' 'what' or 'why'. Questions will be posed sequentially so that participants will feel comfortable even when more in depth question are used(Polit and Beck,2008). The interviews will be carried out in a non- standardized approach, face- to- face, and individually, using English as the language of communication.
Before the interview, a pilot test will be conducted. This pilot test is important to test the hypothesis and identify whether the results to be collected will be accurate. The study will then follow a simple process of collecting data. First, all the respondents will be identified through non probability and purposive sampling technique. The researcher will contact selected respondents, personally, and organize the most appropriate time to interview each one of them, depending with their work schedules and availability. The interview will be face-face, and each respondent will have the opportunity to ask for any clarification before starting to participate in the interview. The interviewer will be expected to take the minimum time possible with each respondent. The interviewer will record all the information that the interviewee gives, according to the semi-structured questions.
The interview questions will contain a simple language and ask only necessary questions in order to make it easier for the respondents to respond. The interviewer will then analyze all the gathered information after conducting the interview and store the data in a locked room, for ethical reasons. The questions of the interview will be aimed at retrieving information about nursing barriers to management of type II diabetes. For instance, the questions will focus on whether lack of knowledge, non adherence to medication, nurses’ association with other medical professionals, knowledge of evidence based training, rural to the urban environment and social economic barriers contribute to nursing barriers to management of type II diabetes.
Sampling
For qualitative research design, the best sampling method is non probability and purposive. In this technique, the researcher selects units, depending on his own judgment (Groves, 2010). This is because the sampled population is expected to provide the research with the richest possible data to answer the question under study (Newhouse, et al., 2011). One key benefit of purposive sampling is that it presents a wide range of sampling techniques. Conversely, this method is prone to bias by the researcher. However, we shall use this method because this study will require use of multiple phases, and only purposive sampling techniques provide room for this.
The study has picked two settings: one in the rural and one urban community. Selected respondents will be provided information regarding the intention of the study, and their roles. Besides, they will be expected to sign consent forms, ahead of participating in the study. If respondents refuse to give consent, they will be replaced by others through the same selection process.
The two diabetes care units will be selected from different districts in order to remove any form of bias (Sikand, et al., 2000). Specifically one unit shall be located in an urban center and be receiving patients mostly from urban centers. The second unit shall be located in the rural or semi urban area. This will also help the research team identify any relative significance in the urban or rural lifestyle with the development of type 2 diabetes (Creswell, et al., 2007). Before the study begins, all the identified individuals will be informed of the study and their consent will be requested. Consent is important to ensure that the information collected is voluntary. The study will only commence, when all the staff selected have given consent.
Respondents will be constituted of health care professionals. Therefore identifying them will involve visiting hospitals and talking to the staff. The staff will be selected randomly but they have to be associated with Type 2 Diabetes patient care.
A sample of 30 respondents will be drawn from each of the diabetes care units to take part in this research. This is a large sample to work with and the reason for picking a large sample is for the purpose of accuracy. Big samples are assumed to lead to more accurate data collected based on the research questions. Smaller samples cannot be used for making firm conclusion on a topic under investigation (Cengage Learning, 2005). In terms of age, the participants are expected to be above 18 years. This is because of the ethical issues involved with age. It is easier to get informed consent from participants who are technically considered adults (Cengage Learning, 2005).
Data analysis
Streubert-Speziale and Carpenter(2007) state that qualitative data analysis entails significant levels of reading, intuiting, analyzing and reporting. The collected data will be analyzed through several steps. First, the interviewer will examine the questions and responses, in order to identify consistencies and differences among responses. Second, data shall be categorized. This will involve reading the collected data for several times, in order to identify rational categories.Computer Assisted qualitative data analysis software (CAQDAS)will be used in this research. The program that will be used is Nvivo8 which helpto find patterns in dat and can also assist in classifying, sorting and arranging thousands of pieces of information(Polit and Beck ,2008; QSR International.com, 2010) Also, abbreviations of symbols will be placed next to ideas and themes that are found in the data (Cengage Learning, 2005). Third, these categories will be closely examined for identification of connections that exist among categories. Lastly, interpretation shall be made using themes and connections.Percentages and averages will be used in making interpretations.
According to Taylor-Powel and Renner (2003), a systematic approach is essential for analyzing qualitative data. This approach involves five key processes including examining data, focusing on analysis, categorizing, identifying patterns and interpreting data. Conversely, Seidel (1998) uses a three phase model to explain the process of qualitative data analysis. The three phases include noticing, collecting, and thinking concerning exciting things (Seidel, 1998). He views the three phases as interrelated and equates the procedure to solving a puzzle. Seidel (1998) further explains that noticing things that are exciting and giving them codes according to themes divides the data into parts.Applied codes then assist in categorizing the data.
While identifying data patterns, we will focus on the theme of the study, which is nursing barriers to treatment of Diabetes Type 2. Similarities and differences among views of respondents will be examined. We will count the number of times different barriers reappear and try to establish connections between themes.
Ethical issues involved
One of the issues of research ethics involved in this study is voluntary participation (Shaw, et al., 2009; Chanson, et al., 2010). It is not expected that the participants will be coerced to take part in research (Shaw, et al., 2009; Chanson, et al., 2010). The selected sample population has to be engaged in the implications of the research to their personal lives and to everyone who is in one way or another affected by diabetes (Shaw, et al., 2009; Chanson, et al., 2010). This is before they are given the opportunity to make the decision to participate in the research study. This research will not rely on any participant under captivity (Shaw, et al., 2009; Chanson, et al., 2010). The participants will choose on their own whether they want to be counted in or not despite the location of the selected healthcare unit (Shaw, et al., 2009; Chanson, et al., 2010).
Closely related is the issue of informed consent (Shaw, et al., 2009; Chanson, et al., 2010). The participants of the research will be informed before consenting to participate (Shaw, et al., 2009; Chanson, et al., 2010). In this case, the participants have to be apprised of the risks involved in the study (Shaw, et al., 2009; Chanson, et al., 2010). They will be informed of every detailed procedure and step that needs to be taken in order to complete the study (Shaw, et al., 2009; Chanson, et al., 2010). In order to ensure that the study is protected as well as the respondents, they will be required to sign a consent form that will detail every aspect of their participation. To protect the staff selected, signed consent will be acquired from the hospital’s administrator.
Ethical guidelines for medical and related research require that participants are not placed in situations where they are at a risk of harm (Shaw, et al., 2009; Chanson, et al., 2010). All procedures to be followed in this research will not involve such risky situations with the potential of harming the participants (Shaw, et al., 2009; Chanson, et al., 2010).
The other ethical issue is the issue of confidentiality (Shaw, et al., 2009; Chanson, et al., 2010). The participants will be assured of maximum confidentiality (National Academy of Sciences, 2009). Information provided by the participants will be treated with confidentiality. No information will be used for any other purpose apart from what it was intended for. No one will be able to have access to any identifying information (Shaw, et al., 2009; Chanson, et al., 2010).
Confidentiality is quite similar to anonymity although the latter is stricter. This implies that all the participants have to remain anonymous throughout the entire research study (National Academy of Sciences, 2009). This is the same principle and standard that will be upheld in this study. Since only important details required for this study deal with diabetes and the issues and complications related to the disease, there will be no need to focus on identifying information (Shaw, et al., 2009; Chanson, et al., 2010).
II. Reporting and dissemination
The results of this study will be of use particularly to the stakeholders and audiences within the medical field. The results are expected to make a contribution to the field and increase the database of evidence based research relating to Type 2 Diabetes. The results are also expected to further influence decision making in management of diabetes within America and the world at large. Reporting for each of the stakeholders will happen differently. The results will be posted online in research databases. This is a good platform where other scholars can be able to access the final report from any part of the world. The general audience for this study includes university students and faculty members. For this audience, the report will be detailed enough. It will not only focus on the results of the study, but also the research methodology, and procedure of data collection.
Implication to practice
Most of the results expected are to be based on the above critical analysis of empirical evidence. There are also additional variables that will be analyzed to identify their association and correlation. All this information will be of relevance to practice in the medical field particularly care and management of diabetes in America. Several other agencies will benefit from the findings of this research. This also includes the two care units in which the study will be conducted, hospitals, community health centers in the US and other parts of the world. For community health centers, they specifically deal with provision of health education and information. Through the findings in research, this function by community health centers and medical practitioners in general can be improved.
The findings will be of use to the general American public and any other individual of interest in the findings. It is expected that the study will further prove the risk factors for developing Type 2 Diabetes. As a result this should be able to influence the behaviors of individual Americans when it comes to eating habits, and sedentary lifestyle. At least people should be able to take care of their own health and ensure that they minimizeas much as possible any risk involved in the development of health conditions.
Since this research specifically deals with nurses, the findings will be relevant to professional nurses. Evidence based research in nursing is useful in improving the quality of healthcare provided to patients (Johantgen & Newhouse, 2011). Nurses play a central role in providing healthcare to patients (LoBiondo-Wood & Haber, 2006). The quality of care needs to be emphasized so that people can experience good health (Edwards, 2008), (LoBiondo-Wood & Haber, 2006). The ultimate goal of evidence based practice in nursing is to have a cost efficient care of the highest quality possible (Bryant, et al., 2007). The process of evidence based practice is found on integration of several research studies that are valid, important and applicable (Association of Advanced Nursing Practice Educators, 2006). The findings of this research will be appreciated by allowing them to influence decision making and implementation of best practice within the field of nursing (Canadian Nurses Association, 2009).
The finding of the research will be no different from similar studies conducted in the past. Most of these past studies have been discussed in the literature review section of this paper.
Reference List
ADA. (2012). Standards of Medical Care in diabetes-2012. Daibetes care, 35(1), 1-49.
American Diabetes Association. (2008). Evidence-based nutrition principles and recommendations for thetreatment and prevention of diabetes and related complications. Washington: Diabetes Care.
Association of Advanced Nursing Practice Educators. (2006, May 23). Advance nursing practice defined. Retrieved from AANPE: http://www.aanpe.com/adavancednursingpractice/tabid/721/default.aspx. May 26,2012
Aubert, R. E., Herman, W. H., Waters, J., & Moore, W. (2006). Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization. ACP journal, 129(8), 605-612.
Blackwell, D.L., Martinez, M.E., Gentleman, J.F., Sanmartin, C. and Berthelot, J.M. (2009).socioeconomic status and utilization of health care services in Canada and the United States. Medical Care, 47(11), 1136-1146.
Bryant, L. D., Dicenso, A., Brownie, G. &Pinelli, J., 2007. Advanced practicing nurses roles: development, implementation and evaluation. Journal of Advanced Nursing, 45(8), pp. 519-526.
Burns N. & Grove S.K. (eds) (2007) Understanding Nursing Research, 4thedn. Saunders
Elsevier: MA
Canadian Nurses Association, 2009. Canadian nurses practitioners: core competencies framework. Ottawa: Canadian Nurses Association.
Cameron, A., Welborn, T., & Zimmet, P. (2009). Overweight and obesity in Australiathe 1999-2000 Australian Diabetes, Obesity and Lifestyle Study. MJA, 178(9):427-432.
Cengage Learning. (2005). Nonprobability Sampling Strategies. Retrieved May 2, 2012, from cengage.com: http://www.wadsworth.com/psychology_d/templates/student_resources/workshops/res_methd/sampling/sampling_29.html
Chang, E., & Daly, J. (2007). Relationships among work place stressor, coping methods. demographic characteristics and health in Australian nurses. Journal of proffesional nursing 22(1), 345(7), 30-38.
Chanson, H., Mavinic, D., & Abbott, S. (2010). Publication Ethical Standards: Guidelines and Procedures. AIAA Jl, 45(8), 1794- 9.
Chiasson, J.-L., & Rabasa-Lhoret, R. (2004). Prevention of Type 2 Diabetes; Insulin Resistance and Beta-Cell Function. Diabetes vol. 53, 34-38.
Connolly, V., & Kesson, C. (2006). Socioeconomic status and clustering of cardiovascular disease risk factors in diabetic patients. Daibetes Care, 1(19), 419-22.
Creswell, J. W., Fetters, M. D., & Ivankova, N. V. (2007). Designing A Mixed Methods Study In Primary Care. Annals of Family medicine, 2(1), 7-12.
Denzin N.K. & Lincoln, Y.S. (2000).Handbook of qualitative research. London: Sage Publications.
Edwards, S. D. (2008). What is philosophy of nursing? Journal of Advanced Nursing, 25(7), 1089-1093.
Ereaut G. (2010) What is qualitative research. http://www.qrsinternational.com/products_nvivo.aspx Retrieved June 26 2012.
Franz, M. &Splett, P., 2007. Cost effectiveness of medical nutrition therapy provided by dietitians in the management of non insulin-dependent diabetes mellitus. J Am Diet Assoc, 95(9), pp. 1018-1024.
Groves, R. (2010). Survey methodology (2nd ed.). Belmont: Duxbury Press.
Johantgen, M., & Newhouse, R. (2011). Advanced Practice Nurse Outcomes: 1990-2008: A Systematic Review. Nursing Economic, 29(5), 123-129.
Juturu, V., & Daly, A. (2007). Diabetes risk factors and chromium intake in moderately obese subjects with type 2 diabetes mellitus. Nutrition & Food Science, 36(6), 390-399.
Keith, P., & Harvey, J. (2008). Network structure and attitudes toward collaboration in a community partnership for diabetes control on the US-Mexican border. Journal of Health Organization and Management, 19(6), 504-518.
Kengne, A. P., Fezeu, L., Sobngwi, E., Awah, P. K., Terence J. Aspray, N. C.-C., Unwin, N. C., et al. (2009). Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon. Primary Care Diabetes Vol. 3 Issue 3, 181-188.
Lasala, K.B. (2000). nursing workforce issues in rural and urban settings: looking at the difference in recruitment, retention and distribution. OnlineJournal of Rural Nursing and Health Care, 1, 1-17.
LoBiondo-Wood, G., & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis: Mosby Elsevier.
Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing, 151-158.
Narayan, K., Boyle, J., & Thompson, T. (2009). Lifetime risk for diabetes mellitus in the United States. JAMA, 290(14), 1884-90.
National Academy of Sciences. (2009). On Being a Scientist. Washington, DC: The national academies press.
Newhouse, R., Hutt, J., White, K. M., Johantgen, M., & Bass, E. (2011). Advanced Practice Nurse Outcomes: 1990-2008: A Systematic Review. Nursing Economic, 29 (5): 123-129.
Nkwi, P., Nyamongo, I. and Ryan, G. (2001) Field research into social issues: methodological guidelines. Washington, DC: UNESCO.
Ohman-Strickland, P. A., Orzano, J., Hudson, S. V., Solberg, L. I., DiCiccio-Bloom, B., O’Malley, D., et al. (2008). Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician’s Assistants. Annals Family Medicine Vol. 6 No.1, 14-22.
Polit D.F. & Beck C.T, (eds) (2008) Nursing Research-Generating and Assessing Evidence
for Nursing Practice, 8thedn. Lippincott Williams& Wilkins: Philadelphia
Pope, C, and Mays, N. (2000).Qualitative research in health care. London: BMJ Books.
Research Methods Knowledge Base (2006). Survey research. Retrieved from http://www.socialresearchmethods.net/kb/survey.php June 27,2012
Saaddine, J., Cadwell, B., & Gregg, G. (2009). Best Practice Guidelines for the maangement of type 2 diabetes. Annals of Internal Medicine, 144(7), 465-74.
Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000). Evidence-based medicine: How to practice and teach EBM. 2nd ed. Edinburgh & New York: Churchill Livingstone.
Shaw, S., Petchey, R., Chapman, J., & Abbott, S. (2009). A double-edged sword? Health research and research governance in UK primary care. Social Science & Medicine, 68: 912-918.
Seidel, J. (1998).Qualitative data analyisis: the ethnograph v5 manual, appendix E.
Retrieved from http://www.qualisresearch.com/ June 27,2012
Sikand, G., Kashyap, M., & Wong, N. H. (2000). Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidaemia and a history of niacin noncompliance. J Am Diet Assoc , 100(2):218-224 .
Skaer, T., & Sclar, D. (2009). Trends in the prescribing of oral agents for the management of type 2 diabetes mellitus in the United States, 2000-2011: does type of insurance influence access to innovation? The Diabetes Educator, 32(6), 940-53.
Steinman, M., & Landefeld, C. (2008). Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA, 289(6), 719-25.
Streubert-Speziale H.J. & Carpenter D.R., (eds) (2007) Qualitative Research in Nursing:
Advancing the Humanistic Imperative 3rd edition, Lippincott Williams and Wilkins,
Philadelphia.
TaylorPowell, E. & Renner, M. (2003).Analyzing qualitative data. Wisconsin: University of Wisconsin
The DCCT Research Group. (2005). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 1(329), 977-86.
The Health Communication Unit (2006).Advantages and disadvantages of survey methods.Retrieved from June 27,2012www.thcu.ca/infoandresources/publications/surveytable.pdf
Zgibor, J. C. &Songer, T. J., 2008. External Barriers to Diabetes Care: Addressing Personal and Health Systems Issues. Diabetes spectrum, 14(1), pp. 23-28.
Appendix 1
Concept Map
Steps in Developing a Concept Map
1. Come up with a general idea of want you want to research (in this case, Type 2 Diabetes).
2. Suggest concepts or ideas that are related to the topic Type 2 Diabetes, and include them in the map.
3. Add other ideas that have some relationship with those ideas created in no.2, on the map
4. Go on brainstorming until you write all ideas that come into your mind, on the map.
5. Eventually, you will have mapped all your ideas and you may pick those that are essential for the project, depending on the scope.
Appendix 2
Advantages and Disadvantages of Survey Methods (The Health Communication Unit, 2006).
