Nursing Interventions In The Management Of Diabetes
Describe your methodological design.
I propose to conduct a primarily quantitative study that will measure a number of CDC certified diabetes nurses educators and .evaluate success of tailor patient, self-managed diabetes goals (eg: A1C, blood pressure, cholesterol, weight, amount of physical activity using International Physical Activity Questionnaire (IPAQ) (Tabak et al. 403-06) in primary care setting. Nurses or medical staff feedback concerning the feasibility of translation to will be optional to eliminate burden; if a substantial amount of data is collected it will be analyzed. Since this form of data collection is unknown, it does not truly meet the criteria of mixed-method design(Creswell). I intend to execute a randomized control trial (RCT), which is considered to be a "gold standard” in clinical research (Suresh, Thomas and Suresh 287).Nurses will be trained in the CDC Diabetes Prevention Program (DPP) and execute the computer-based ‘diabetes self-management’ protocol to those identified as high risk for or have formal diagnosis of type 2 diabetes) (Tabak et al. 403-06). Among these patients, those randomized to the intervention will receive education on self-management techniques and will set a personalized goal to assist in self-management of diabetes
Indicate how the approach would best fit the overall research design for the desired objective.
Researchers concluded diabetes self-management education shows to encourage behavior change, consistent with previous literature supporting improvement in health outcomes as a result of an intervention promoting self-efficacy skills(Tabak et al. 403-06). This proposal will test the efficacy of self-management DPP program improve patient-tailored outcome goals. For example, achievement of self-management diabetes goal such increased physical activity, weight loss, AC1. It will also evaluate the feasibility of training nurses in DPP. The intervention vs control approach will determine if program is effective and worth replacing standard care.
Describe the specific methods of data collection you would use.
I aim to collect data to monitor the effectiveness of the online DPP program. De-identified patient data will be used to obtain clinical measures that relate to the patient goal stated and inputted into existing patient database at baseline. Outcomes such as A1C, blood pressure, cholesterol, weight, amount of physical activity using International Physical Activity Questionnaire (IPAQ) will be collected by research staff, if possible so to decrease potential for bias as the nurses are the ones executing the intervention. Fidelity of the training protocol/whether the provider is delivering diabetes education will also be assessed using feedback notes entered in the database.
Explain how you would analyze your results.
In brief, the analysis will draw conclusions that the DPP program was effective in improving patient-tailored goals, such as lowered blood pressure, a decline in A1C, and a hemoglobin A1C concentration. Group comparisons between DPP group and standard of care will determine if DPP participants have improved health outcomes more than control group. All data collected would be stored in an SPSS database, those who fail to complete any follow data would not be included in the analyses. The tests chosen will determine if the outcomes of patients are better for those who received the intervention. Baseline differences between the control and were examined using independent t tests or chi-squared tests, as appropriate. ANOVA will assess differences in either AC1, weight, or physical activity between baseline and follow-up at 6 and 12 months in these continuous variables in the full sample(Bush 94-102). All statistical tests will use a p-value of .05, and will be two-tailed.
Provide background and a rationale for methodologies
Well designed RCTs enable the researcher to evaluate the effect of the interventions, rather than being mediating by other factors (Bush 94-102). A randomized control trial eliminates bias by having the equal probability of being chosen to receive the treatment (Bush 94-102). Researchers will randomly assign participants to the group who receives the behavioral or clinical intervention and the group who does not (LoBiondo-Wood and Haber 43, 91-120). Considering the strength of this design as it pertains to evaluating interventions, the study certainly aligns with the features of the research design to achieve the objective of examining the efficacy of a diabetes management intervention lead by nurses to improve patient-tailored outcomes(LoBiondo-Wood and Haber 43, 91-120; Suresh, Thomas and Suresh).
Provide a justification for subject selection and sampling procedure.
Since diabetes is a major problem that affects a large population (American Diabetes)I think the best setting to recruit the sample of participants would be primary care offices so that rapport is previously established and likelihood of outcome data collection will be higher because they are more likely to see a primary care physician than a specialist. I would target those at risk or diagnosed with type 2 diabetes and is mentioned in their medical chart. The criteria of a high-quality RCT include a sample size larger than 40 subjects (LoBiondo-Wood and Haber 43, 91-120). Therefore, I think a target sample size of 80 subjects is sufficient to test main effects and interaction for design, accounting for control vs. Intervention comparisons.
Describe potential limitations; control for potential confounding variables and errors methodology outweighs the risk of these problems cropping
Limitations include feasibility of nurses having the time to be trained, and to the ability to have the high fidelity of the DPP protocol as assessment for such will be an added task to already overworked nursing staff. Regarding mediating factors, conduct screening quiz to make sure that they are not receiving another similar treatment to the intervention and that they do not have any conditions that would not allow me to contextualize my findings with other studies. This will help prevent confounding variables such as medication use or program participation that may impact patient outcomes particular to diabetes self-management. The only risk I see is that those in the intervention group may have access to more tools to improve health compared to standard of care. Therefore once the study is complete and effectiveness is determined those enrolled who received only standard of attention would then also receive DPP intervention.
References:
American Diabetes, Association. "Diagnosis and Classification of Diabetes Mellitus." Diabetes Care 37.Supplement 1 (2014): S81-S90. Print.
Bush, H.M. Biostatistics: An Applied Introduction for the Public Health Practitioner. Cengage Learning, 2011. Print.
Creswell, John W. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage publications, 2013. Print.
LoBiondo-Wood, G., and J. Haber. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences, 2014. Print.
Suresh, Karthik, Sanjeev V Thomas, and Geetha Suresh. "Design, Data Analysis and Sampling Techniques for Clinical Research." Annals of Indian Academy of Neurology 14.4 (2011): 287. Print.
Tabak, Rachel G., et al. "A Review of Diabetes Prevention Program Translations: Use of Cultural Adaptation and Implementation Research." Translational Behavioral Medicine 5.4 (2015): 401-14. Print.
Breland, J. Y., Yeh, V. M., & Yu, J. (2013). Adherence to evidence-based guidelines among diabetes self-management apps. Translational behavioral medicine, 3(3), 277-286.
Tricco, A. C., Ivers, N. M., Grimshaw, J. M., Moher, D., Turner, L., Galipeau, J., & Tonelli, M. (2012). Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. The Lancet, 379(9833), 2252-2261.
