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NURS 3600 Nursing Research Literature Review Matrix
Name: Kimberly Small
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Eckert-Norton, M. (2011). Journeying with the familiar but unknown through the labyrinth of care: Patterns of self-care decision making in women of African descent with type 2 diabetes
2011 Qualitative,Descriptive
The study was conducted using a hermeneutic-dialectic approach consistent with theprotocol described in Newman's (1994) publication, Health as Expanding Consciousness
The purpose of this study was to describe patterns of self-care decision-making in womenOf African descent with type 2 diabetes
The study also explored how nursing practice
16 recruits
15 met all inclusion and exclusion criteria
13 completed
2 interviews
African descent
Diagnosis of type 2 diabetes
Low-income or uninsured
Urban dwelling
Recruited by word of mouth and fliers
Narrative inquiry
Each interviewed as least twice
Upon reflection, all of the life patterns identified reveal a capacity to move forward under arduous situations
Having met manychallenges in their lives, the participants describe frustration and confusion in interactions withhealth care providers
Participants
I found it interesting that all of the participants demonstrated the ability to handle the complexity of daily life, yet struggled with the self-management skills needed when living with type 2 diabetes
Authenticrelationships between nurses and clients emerged from the narratives as central to the process oftransformation
living in urban America (Doctoral dissertation) Retrieved from http://search.proquest.com/docview/904570011?accountid=27045
Thisapproachembodies an action research method based on the forming of authentic relationships betweennurse and participants, and guided by a unitary-transformative paradigm
can assist participants to find personal meaning in their patterns of self-care decision-making.
stated that in this clinic setting nurses aremost available through diabetes education classes
Frustration and confusion can be countered by authentic nurse-client relationships
This study supported the theory that nursing education can improve patient outcomes for patients with T2DM
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Edelman, D. P., Dolor, R. J., Coffman, C. J., Pereira, K. C., & Granger, B. B. (2015).
2015 Quantitative,Comparative
Patient-level randomized controlled trial
To assess the effectiveness of nurse behavioral management of DM and HTN in
A1c or HTN Nurse telephone case management including DM- and HTN- focused behavioral
377 enrolled
193 were randomized to intervent
Adults
Diagnosis of both type 2 diabetes and HTN
Receiving care at
Patients received a call from a nurse once every 2 months over 2 years, for a total of 12
Expressing model estimated differences as (intervention – control), at 24 months, intervention patients had
Although telephone conversations give nurses an opportunity to interact with patients and relay information, they do not promote a nurse
Nurse-led behavioral management of diabetes and hypertension in community practices: A randomized trial. Journal of General Internal Medicine, 30(5), 626-633. doi:10.1007/s11606-014-3154-9
community practices among patients with both diseases
content
OR
Nurse telephone case management involving non-interactive information regarding health issues unrelated to DM and HTN
ion
184 to control
55% female
50 % white
one of nine community fee-for-service practices
Required to have inadequately controlled DM but could have well controlled HTN
calls
SBP and A1c were measured at 6, 12, and 24 months; 24 months was the primary time point
similar A1c [diff = 0.1 %, 95 % CI (−0.3, 0.5), p = 0.51] and SBP [diff = −0.9 mmH g, 95% CI (−5.4, 3.5), p = 0.68] values compared to control patients
In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP.
Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary
–patient relationship that is established in face-to-face interaction that was seen other studies in this review
Would the results have been different if the frequency of the calls had been more frequent? 2 months may be too long between phone calls
For me, this study provides reason for nurses to consider the format in which they present the information to the patient and its effectiveness toward better patient outcomes
care settings.AUTHOR,
TITLE, JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Azar, K. M. J., Chung, S., Wang, E. J., Zhao, B., Linde, R. B., Lederer, J., & Palaniappan, L. P. (2015). Impact of education on weight in newly diagnosed type 2 diabetes: Every little bit helps. PLoS One, 10(6), doi:10.1371/journal.pone.0129
2015 Quantitative,Experimental
A difference-in-differences approach was used to estimate pre-post weight change associated with treatment
Difference-in-differences estimates were drawn from multivariate models where the coefficients
To investigate the effectiveness of counseling/education in a real practice setting among individuals with newly diagnosed type 2 diabetes
Body weight
Formal behavioral lifestyle counseling/education only
Diabetes medication prescription only
Both counseling/education and prescription of medication
Monitoring only
(Monitoring only is not a lack of diabetes care, but rather
1,314
599(45.6%) pts received counseling/education with (26.2%) and without (19.4%) medication
298(22.7%) pts received a prescription for medicati
Participants were extracted from the EHRs in a large multi-specialty, mixed-payer, outpatient, group practice organization in northern California
Age 35-74
Newly diagnosed with T2DM between January 1, 2007 and June 30, 2010
Required weight measurement during the observation period
Participation in counseling/education was identified if a patient participated in individual counseling with a registered dietitian or nutritionist or a group-based class focused on behavioral lifestyle modification, weight management, and/or type 2 diabetes
Average weight loss associated with counseling/education only (no medication) was 6.3 lbs
Weight loss associated with medication prescription only (no counseling/education) was 3.5 lbs
Weight loss among those who received both counseling/education and medication prescription was 8.1 lbs
Even a small dose of formal behavioral lifestyle counseling and/or education (i.e., attending one session) offered at outpatient clinics can be beneficial and promote modest weight loss
It was interesting to me that this study had a larger sample size than some of the other studies and results were still similar
This sample has common characteristics to the patients that I would regularly care
348 for main treatment indicators represent pre-post weight change associated with each treatment.
The multivariate models incorporated propensity score adjustment.
“active monitoring” as patients in this group made follow-up visits addressing diabetes)
on alone
417(31.7%) pts were only monitored
41% female
Average age 54
49.7% non-Hispanic white
36.8% Asian
Among those who participated in any counseling/education, the number of sessions attended within 12 months of diagnosis ranged from 1 to 11, but most received 2 sessions
No significant weight change was observed in the monitoring only group
Pts lost more weight as the frequency of counseling/education increased, but the relationship is not linear
This study made me curious if newly diagnosed patients are more receptive to counseling/ education
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Ozgul, E. (2015). An individualized education programme with empower
2015 Qualitative,Descriptive
Case study
Empowerment approach was used in
Explore the effectivene
ss of an empowerment based
approach in a health
education
1 42 year oldwoman with type 2 diabetes
Graduated from a primary school
Married with
Patient was randomly selected from a group ofindividuals receiving medical
At the beginning, it wasfound that she felt herself near to constrained, weak,dependent, worthless, tense
Patient empowerment is an effectiveapproach to developing educational interventionsincluding the
ment approach: A case study. International Journal of Caring Sciences, 8(2), 451-457. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/1685874188?accountid=27045
thisindividualized health education program
program of a patient
with type 2 diabetes in
order to assist
nurses who are
working in this area to
providemore
effective diabetes
health education and care
two childrenHer husband is an unemployed cook
lives in a small town and worksat a textile factory
Economic problems due to low income
Sedentary lifestyle, during the day she wassitting and sewing at work
After long working hours,she became tired, came home, ate meal and thenslept
She has health insurance
treatment and care ininpatient clinic of Endocrinology
Attitude Measurement Scale was used
A Diabetes KnowledgeTest was used at the beginning and again at the end in order to evaluate herdiabetes knowledge
The health educator nurse toldher not to blame herself and
and unsafe
Her diabetes knowledge increased and she began togive decisions about her diabetes management
Her wrong beliefs changed and she adhered theinsulin therapyShe expressed the beneficial effectsof insulin therapy
She could test her blood glucose, make insulininjection, interpret the results and be aware of whatwas going on
She also knew the effects of diet and
psychosocial aspects of living with type 2diabetes
Health educators need to takepsychosocial factors into account and start where thepatient is
Due to the complex nature of T2DM management, small steps toward change and frequent education sessions lead to the desired patient outcome
Her mother, father and aunt also have diabetes, but theyare not taking any medicine and not continued on aregular diabetes control program They did notknow much about diabetes and give it no importance
She was diagnosed 10 years ago but she didn’tgive importance to diabetes
She feels guiltyabout past years
She does not smoke or drinkAlcohol
to look to the future
The health education sessions’ contents and timeswere planned according to patient’s needs andpreferences with the common decisions of the healtheducator and the patient
exercise onblood glucose control
After 3 months, she stated that shewas feeling lighter and this made her happy
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Rothschild, S. K., Martin, M. A., Swider, S. M., Lynas, C. M., & Janssen, I. (2014). Mexican American trial of community health workers: A randomized controlled trial of a community health worker intervention for Mexican
2014 Quantitative,Comparative
Single-blinded, randomized controlled study
Whether community health workers (CHWs) could improve glycemic control among Mexican Americans with diabetes
Glycemic control among Mexican Americans with diabetes
Community Health Worker Intervention, delivering self-management training through 36 home visits over 2 years
OR
Bilingual control newsletter delivering the same information on the same schedule
144 Mexican Americans
Live in metropolitan Chicago
Diagnosed with T2DM
18 years or older
Being treated with at least 1 oral hypoglycemic agent
Required to have health insurance or to receive primary care through a free clinic or public facility at the
Recruitment strategies for the study consisted of direct mailings, outreach at community events and churches, partnerships with primary care clinics, and direct outreach by the CHWs themselves
Participants were randomized and followed for 2 years
Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 = -Δ0.55; P = .021) and year 2 ( = -Δ0.69; P = .005)
No effect on blood pressure control, glucose self-monitoring, or adherence to medications or diet was observed
Intervention participants
In my original question, I did not specify WHO was providing the education, only that education was being provided
The Community Health Workers in this study were not nurses, but received more than 100 hours of training on diabetes, behavioral self-management support, and home visiting
Because CHWs share culture, language, and knowledge of the community, they effectively engaged
Americans with type 2 diabetes mellitus. American Journal of Public Health, 104(8), 1540-1548. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/1549549165?accountid=27045
time of enrollment Participants
were told that the study was comparing 2 forms of diabetes education and were blinded to the study hypothesis
Research assistants blinded to participants' group assignments collected outcome data at 12 and 24 months after randomization
increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years
minority populations
This study supports the theory that patient education can improve patient outcomes in patients with T2DM
In my opinion, nurses are more prepared to educate these patients, but I also appreciate the positive effect that the CHW’s had the patients in the study. Some effect is better than none.
I also appreciated that the control group did not go without any education. This allowed these participants to still potentially benefit from the study
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Soner Cander, O. G. (2014). The impact of patient education on anthropometric, lipidemic, and glycemic parameters among patients with poorly controlled type II diabetes mellitus: A 3-month prospective single-center
2014 Quantitative,correlational
Prospective observational single-center study
This study evaluated the impact of patient education on adherence to a diabetes care plan (e.g., anthropometric, lipidemic,and glycemic parameters) among adults with type II diabetes mellitus without adequate glycemic
Adherence to a diabetes care plan as evidenced by Anthropometric,lipidemic, and glycemic parameters among ambulatoryadults with type II diabetes mellitus
Education on regularself-monitoring of blood glucose, standard diabeticdiet, and exercise
61 Ambulatory adults
Diagnosis of T2DM between 1 and 20years
Mean age: 53.6 ± 8.2 years
70.5% female29.5% male
Age 35 - 65
HbA1c levels of 7.5 to 10
Data on participants was collected for each individualduring the baseline visit at study enrollment
All participants were reevaluated 3 months after initialtraining to assess changes in each study parameter
Eachparticipant
A 5.1% HbA1c decrement was shown at 3 months
Decrease inbody weight and fat percentage(p < .001 for each)
Increase in uric acid levels (p = .002)
No differencewas observed in total cholesterol and triglyceridelevels
Decrease in nighttime (2300) capillary bloodglucose levels
This study was interesting to me because part of its theory was that helping employees manage their T2DM helps to maintain a healthy workforce, and avoid the health and economic burdens
Study findings indicatedthat education about adherence to diabetic care plansshould include regular self-monitoring of blood glucose,standard diabetic diet, and routine exercise
Turkish study. Workplace Health & Safety, 62(12)500-507. doi:10.3928/21650799-20140826-02
control took part in diabetes-related education in a 30- to 45-minute one-on-one instructionby a training team that included an endocrinologyspecialist, a diabetes nurse, a licensed dietician and a sports physician
I also found it interesting that the education in this study reinforced the importance of closeand frequent self-monitoring of blood glucose in maintaining achieved glycemic control
I also appreciated the inclusion of specialists in addition to the nurse in this study
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Walker, E. A., Stevens, K. A., & Persaud, S. P. (2010). Promoting
2010 Quantitative
Quasi-experimental pre-test/post-test
Increase knowledge and self-management of diabetes
Knowledge and self-management of diabetes among
Educational intervention
OR
No
195
145 participants in the
African American
Adult
40 years of age
Participants were assigned to intervention and comparison
Significantly increased knowledge among intervention group
I thought it was interesting that the researchers in this study used a Healthy People 2010 objective as
diabetes self-management among African Americans: An educational intervention. Journal of Health Care for the Poor and Underserved, 21(3), 169-186. Retrieved from http://search.proquest.com.libproxy.dixie.edu/docview/747083882?accountid=27045
comparison group design
among African American adults 40 years of age and older diagnosed with type II diabetes
African American adults 40 years of age and older diagnosed with type II diabetes
educational intervention
intervention group
50 in the comparison group
old and olderDiagnosed with type 2 diabetes
Residents of Prince George's County, Maryland
groups by self-selection
Three two- hour educational sessions were provided to participants in the intervention group
The educational intervention was developed by the researchers in collaboration with two Certified Diabetes Educators, one a registered
participants between the pre- and post-test
Findings for HbA1c values, body mass index, and weight were not significant
one basis for the study
An interesting side finding if the study was that patients responded well to interactive learning activities, including games like Jeopardy, and these games were an effective way to reinforce information
Although the participants demonstrated an increase in knowledge, what really needs to happen is that the knowledge is applied and then evidenced through improvements in factors such as HbA1c and weight. I do not think that phone call follow up
nurse and the other a dietitian
Teaching strategies included discussion, games, and demonstrations. Patient navigators provided follow-up by phone at scheduled intervals
is enough. Other studies have supported face-to-face interactions with individualized discussion resulted in better patient outcomes
I think of the patients I care for at the hospital who may not have any opportunity for follow up or support after discharge
AUTHOR, TITLE,
JOURNAL
YEAR METHOD & DESIGN
STUDY PURPOSE
VARIABLES(Omit if a qualitative study)
SUBJECTS RESULTS COMMENTS*
Dependent Independent Number Characteristics Sample Method
Morrison, F., Shubina, M., & Turchin, A. (2012). Lifestyle counseling
2012 Quantitative
Retrospective cohort study
To determine whether lifestyle counseling is associated with time
A1C, blood pressure, and LDL cholesterol levels in patients with diabetes
Average counseling rate and time
30,897 Documented diagnosis of diabetes or HgA1C >= 7.0%
Pts seen by physicians affiliated with
Lifestyle counseling instances were defined as distinct days when a PCP provided
Lifestyle counseling in the primary care setting is strongly associated with faster achievement of A1C, blood
I chose this study because it focused on long-term effects of education for patients with type diabetes
The other studies I
in routine care and long-term glucose, blood pressure, and cholesterol control in patients with diabetes. Diabetes Care. 35(2), 334-341. doi:10.2337/dcll-1635
to A1C, blood pressure, and LDL cholesterol control in patients with diabetes
the Brigham and Women’s Hospital and Massachusetts General Hospital for at least 2 years between January 2000 and January 2010
At least 18 years old
diet, exercise, or weight counseling.Documentation of lifestyle counseling was computationally abstracted from notes.
pressure, and LDL cholesterol control
In all treatment categories, time to treatment target rose progressively at the less frequent rates of lifestyle counseling
As counseling rates decreased, the proportion of patients who never reached treatment targets rose steadily
read demonstrated positive results over considerably short periods of time. The real truth is if patients can maintain self-management over a long period of time, they are likely to have better quality of life and healthier outcomes
I realize the education was provided by physicians and not nurses, but the content is the same and it was interesting to see that the outcome was similar
*Include under Comments anything that may be of interest to you in the article, would be helpful in considering whether contributes to answering your clinical question, or to application of the research findings to your practice; e.g. “Small sample size, no race info.” “Subjects very unlike my patients.” “Innovative intervention, not sure if my manager would go for it.”
Now that you have summarized the articles you obtained, please answer the following questions:
1. Does the evidence answer your clinical question? YES
2. If the evidence answered your clinical question, what is the answer?
Based on studies I reviewed the answer is that patients who receive any amount of diabetic education experience a remission of their diabetes.If I was to clarify my question, remission could mean any of the following:
Decreased HgA1c, Blood Pressure, Cholesterol levels, Weight, and Body Mass Index -or-Increased Patient Self-Management, Patient Self-Efficacy, and Patient Outcomes
The studies I reviewed supported each of these. I could however narrow down my question and be able to a literature review on just one of them.
3. If the evidence did not answer your clinical question, what are your next steps?
Although my question was answered, I am going to respond to this question by saying that not only could I clarify my definition of remission; I could narrow in on some other aspects of my question and refine my research.
For example: Who provides the education? The studies I read included nurses, physicians, specialists, and specifically trained coaches. I could do a study on which
of these is the most effective. What type of information should be included? The studies I read referred to not only management of physiological variables, but psychological,
cultural and emotional aspects as well. What format of teaching is most effective? The studies I read favored face-to-face teaching because it helps to develop an instructor-patient
relationship. I wonder about written, visual, and auditory; is one more effective than another? There are all different types of learners and patients are more likely to retain information when it is in a format they respond to.
When should the education start and how frequent should the information be reinforced? How long should the education continue? Is there an advantage between individual versus group instruction?
This assignment was very interesting and opened my eyes to the value of nursing research. There is so much to be learned about how to best support patients with type 2 diabetes.