Lakeidre Davis NURS 4318 Nurse as a Research Consumer 6/29/2013

Nursing Care of Diabetic Adolescents

PROBLEM STATEMENT
Diabetes is a growing problem for the adolescents in United States. Nursing care needs to be current with upcoming diabetic treatments, patient teaching, and psychosocial needs of the adolescent to improve the outcomes of the adolescent patient.

INTRODUCTION
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. 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. (Faulker,2010) The adolescent with diabetes is at risk for the complications of diabetes, which can be exacerbated by his or her drive for independence and peer acceptance (Ivey, Wright, and Dashiff, 2009)

LITERATURE REVIEW: KNOWN

Constant metabolic control of the diabetes management is associated with decreased long term complication such as kidney/heart disease(Bachman and Hsueh,2008) Metabolic control is influenced by proper self- care behaviors; these self care behaviors are related to how adolescents perceive themselves from social and emotional standpoint(Greene, Mandelco, Roper, Marshall, and Dyches, 2010). Responsibilities with monitoring blood glucose levels and managing diet/exercise can cause conflict between the adolescent their need to seek independence (Ivey,Wright, and Dashiff, 2009). As the care for diabetes evolves, school nurses feel intimidated about new treatments such insulin pumps and creating individual plans for glucose management (Bachman and Hsueh, 2008). Communication patterns between the parents and diabetic adolescents has influence on the adolescents ability to manage their care and establish positive health behaviors(Ivey,Wright, and Dashiff,2009).

LITERATURE REVIEW: UNKNOWN

If alternative methods such as online continuing education will improve nurses ability and confidence about diabetic children in a school setting. (Bachman and Hsueh,2008) Communication and interaction styles with diabetic teenagers and their parents. (Ivey, Wright, and Dashiff, 2009) If there is a relationship between metabolic control, self-care behaviors, and parental styles. (Greene, Mandelco, Roper, Marshall, and Dyches, 2010) If there is a relationship with perceived quality of life and cardiovascular fitness among diabetic adolescents (Faulker,2010).

Article Title Author(s) Year/ Purpose 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), 307-316. The purpose of this study was to explore the relationships between CV fitness (i.e., VO2peak), as well as selfreported physical activity, with generic or healthrelated QoL (HRQoL), glycemic control, and lipid profile in adolescents with type 1 or type 2 DM.

Conceptual Framework Literature Review * Exploration concerning the relationship between the quality of life and cardiovascular fitness in diabetic adolescents has not been investigated. * Teenagers with Type I DM that perceived a better quality of life generally have better glycemic control (HgBAc1 levels) * Studies indicate teenagers that participate in exercise generally have improved CV fitness and glycemic control. *The concept of (Qol) can be loosely defined with biological and individual factors (such CV fitness, physical activity, diet,)

Research Design Sampling Instruments Correlational A larger, cross-sectional descriptive investigation addressing CV risks in adolescents with either type 1 or type 2 DM. *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. Cannot have developmental disability or delay, and be within 2 years of age appropriate school level. Total of 151 adolescents participated

Data collection & Statistics

SUMMARY OF REVIEW
Clinical Interpretations & Clinical Applications *Adolescents with Type I DM are more likely to be physical active and have better glycemic control and perceive a higher QoL. *No clear associations or relationships for Type II DM regarding QoL and physical fitness. No clear indications on why Type II DM adolescent have a lack of physical activity compared Type I adolescent. *Nurse should promote and encourage physical activity among Type I and Type II to maximize QoL and metabolic control. Strengths -Findings supported by previous research *The only study to explore possible associations among the objective measure of physical fitness or the subjective measure of self-reported physical activity expenditure with either biological or QoL outcomes in adolescents with diabetes . Weaknesses *Small representation of Type II DM adolescent * Poor representation of minorities to small sample size.

*Data was collected over a period of few weeks and the morning of the test. Weeks prior to test, Tanner test was given for physical maturity. Adolescents were asked to fast for at least 10 hrs. Exercise portion was given 1 hr. after they were given a light breakfast. One the day of testing, BMI, interviews, and questionnaires were conducted. 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 type 2 DM. *Pearson correlation coefficients were used to examine associations between CV fitness and physical activity expenditure with the outcome variables of

Article Title Author(s) Year/ Purpose 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), 326336. 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.

Conceptual Framework Literature Review Research Design

Data collection & Statistics

SUMMARY OF REVIEW
Clinical Interpretations & Clinical Applications *No significant relationships were found among A1C values, self-care behaviors, and length of time since diagnosis, gender, and the age of participating adolescents. *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

Sampling
*Concepts are metabolic control, self- control, and parenting. *Researchers imply that there is relationship between metabolic control, self- control, and parents. Proper metabolic control is defined a hemoglobin A1C below 8 percent. Self control behaviors are defined as physical activity, proper dietary restrictions, proper insulin dosages, and frequent blood glucose monitoring. *Parenting- there are different types of parenting, during the times of adolescence, parenting style I s a great influences adherence to self -control behavior and metabolic control. * Retrospective, correctional design. * Recruited through a Western state diabetic summer camp, clinic, or use through use of snowball sampling- total of 29 participants. *Participants last 4 HbgA1C levels were used. *Diabetic Self- Care instrument was 12 question, Likert- scale type format involving self-care *Parenting Practices Report was questionnaire involving items of parenting styles. *Descriptive statistics were calculated for all study variables (i.e., metabolic control; self-care behaviors; and authoritarian, authoritative, and permissive parenting).

Strengths -Findings supported by previous research -Determined parenting styles are strong influence on metabolic control and selfcare behaviors Weaknesses *Small representation of Type II DM adolescent * Poor representation of minorities to small sample size.

SUMMARY OF REVIEW
Article Title Author(s) Year 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. 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. Conceptual Framework Literature Review * Previous research involving diabetes education and training among school nurses indicated that more training is need regarding children with insulin pumps and current information was needed for school nurse to make curriculum for children with diabetes. *Based on the Rogers theory diffusion of innovation- that online diabetes CE will be equal to or better at current (face to face CE workshops), allow for nurses to use with ease, and improve ability to take care of children with diabetes Research Design Sampling Instruments *Quasi-experimental * 19 nurses in the state of Missouri that were not able to the face-toface continuing education workshops. Then to ensure quality, then number of nurses were reduced down to 10. Data collection & Statistics Clinical Interpretations & Clinical Applications *School nurse may find this as an effective, alternative method for current diabetes CE * Further information regarding meal planning and insulin pumps should be implemented in the future *Nurses using online CE require current computers skills, but many nurses still prefer traditional methods of CE Strengths *Suggests the online diabetes education can improve nursing ability to care for diabetic school children Weakness *Small sample size, no random selection *No parametric statistics *No testing for reliability and validity *Unable to determine if nurses are truly prefer online education rather face to face to education *Collected over two periods January and June over a two and three period *Descriptive statistics were calculated for all study dependent variables ( objectives met and effectiveness of each lesson) using a Likert type scale *Descriptive statistics were also used to describe the overall evaluation using a Likert type scale *Open ended questions were used acknowledge suggestion and effectiveness of the course.

SUMMARY OF REVIEW
Article Title Author(s) Year /Problem Statement 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), 10-18. Conceptual Framework Literature Review Research Design Sampling Instruments * Qualitative content longitudinal analysis. * Twenty- eight families in the longitudinal study were recruited from an endocrinology clinic from the southeastern part of U.S. *Further exclusion and inclusion criteria was used: 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. 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. Data collection & Statistics Clinical Interpretations & Clinical Applications *Nurses need to beware that the communication patterns by Type I DM may require intervention and teaching to foster a positive, working relationship with the adolescent and parent. *Fear and anxiety among parent created anxiety and fear in the adolescents *Nurse need to be able to teach parents how to cope with their own fears. *Positive relationships between the family will allow the adolescents to be independent and responsible Strengths *Supported previous studies of existing problems and conflict Weaknesses *Small sample *No data regarding the subjects metabolic control (HbgAC1) to draw more conclusions *Overrepresentation of the AfricanAmerican families, creating biased findings * Previous research suggesting that parental involvement influence with adolescents with diabetes. * Fear was strongly associated with parents of Type I DM and influenced adolescent control and confidence. * Few studies in the past The purpose of this study have observed the unique was to describe the interactions between ways that parents and adolescents and parents 11- to 15-year-old teens with diabetes. communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management. *Observed interaction (audiorecorded, participated interviews and questionnaires. *Audio and transcripts were reviewed on multiple occasion to insure accuracy and prevent bias *Data was processed and recorded using analysis template and repeated until no further data was collected *Themes such as fear, frustration, discounting, normalizing, and trust were found.

ROGERS THEORY OF DIFFUSION OF INNOVATIONS

NURSING IMPLICATIONS
Alternative methods (online education) may prove to effective to provide current education and training on school nurses unable to attend face- to face education. However, nurses will require basic computer and internet skills in order to fully experience online education. (Bachman and Hsueh,2008) Online education may not be for everyone and more information regarding meal planning and different types of insulin will be required in future continuing education classes. (Bachman and Hsueh, 2008)

Nurses should be advocates for positive communication between the parent and diabetic adolescent and intervene whenever negative, nonproductive communication is present during clinical visits. (Ivey, Wright, and Dashiff, 2009)

NURSING IMPLICATIONS (CONTINUED)

Nurses should also advocates for parents (especially mothers) to ensure proper resources and support are present. This will result increased knowledge, action, and care from the parents. (Greene, Mandelco, Roper, Marshall, and Dyches, 2010) Adolescents with Type I DM are more likely to be physical active and have better glycemic control and perceive a higher QoL (Faulker,2010). 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 (Faulkner, 2010).

NURSING INTERVENTIONS
Encourage parents to express their fears and anxieties about caring for diabetic adolescents. (Ivey, Wright, and Dashiff, 2010) Assess parental styles and interaction with their children. If possible, providing teaching and suggestions for authoritative parenting. (Greene, Mandelco, Roper, Marshall, and Dyches, 2010) Encourage positive interactions between the parent and adolescent to minimize conflict and prevent long- term complications. (Greene, Mandelco, Roper, Marshall, and Dyches, 2010)

Promote and provide teaching for healthy behaviors such cardiovascular exercise to promote well being and quality of life. (Faulker,2010)

SUMMARY
Nurse must implement nursing interventions aimed at maintaining adolescents self-esteem and confidence to manage diabetes independently. Also, nurses must acknowledge that parents and their parenting style are one the key factors influencing good metabolic control for diabetic adolescents. Further studies should include larger, diverse population of (type1/type 2 DM) adolescents studying more complex variables such as quality of life and available supporting resources. Further research should test the effectiveness of parental education strategies and explore in-depth definition of metabolic control.

REFERENCES
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. 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. 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), 10-18. 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.