Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
influences the ability to self-manage, psychological difficulties can in
turn impact negatively on glycemic control.
As with other chronic illnesses, self management of exercise, diet,
medication adherence, monitoring, routine follow up care, and other
health promoting behaviors can prevent complications and enhance
wellbeing. In one study of patients with diabetes, this regimen
would require an extra two hours each day to carry out. In addition
to time constraints, patients may not make life style changes
because of denial, clinician communication style, lack of confidence
or belief in importance, financial or transportation problems,
availability of health care providers, and/or cultural belief systems.
Due to lack of time or communication skills, many Primary Care
Providers (PCPs) fail to fully explore whether patients follow through
on their recommendations, or to determine whether barriers to self
management can be modified or not. Consequently, patient
adherence rates are low, and in the U.S., mean HbA1c levels have
not changed in the last decade. Currently, only 7% of patients are
at goal for A1c, LDL, and BP levels.
When polled, diabetes educators said the greatest challenges to
improving outcomes were better techniques to address behavior
change. Strategies traditionally used by health care providers to
encourage behavior change include “scare tactics,” advice-giving,
badgering, and other highly directive approaches. In contrast,
interventions that include patient empowerment, education,
psychosocial understanding, and more recently, brief behavior
change counseling approaches such as Motivational Interviewing
(MI) are more effective.
Our study uses MI and nursing case management (NCM) to promote
behavior change in patients with Type 2 Diabetes Mellitus. NCM is a
cost effective practice model that improves patient outcomes
through education, support, and care coordination. Nurses are
optimal case managers because they spend more time with patients
and have a professional background that enhances this method of
patient care. NCM has been used with success in several chronic
diseases, but cost-effectiveness and long-term sustainability of this
approach in diabetes management has not been rigorously tested.
MI is a patient-centered counseling approach that actively engages
patients and draws on their underlying motivation for change. MI
specifically stresses the importance of understanding each patient's
unique perspectives and priorities when developing a treatment
plan, and uses reflective listening, therapeutic communication, and
rapport-building skills to empower the patient to make behavior
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