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
Intervention:
Three experienced registered nurses were trained in case
management and motivational interviewing. Techniques for
learning MI included role plays, lectures, videoconferencing, journal
article reviews, attending a conference, and mock interviews with
standardized patients. They were provided continuous feedback
from experts based on live performance, feedback from audio and
videotapes, and regular analysis of taped visits to assure fidelity.
Using an evidenced based protocol for glucose, cholesterol, blood
pressure, and depression management, the nurses work in
collaboration with PCPs to provide care to patients with diabetes.
Outcome measures include: clinical parameters, quality of life, self
care behavior, depression, treatment satisfaction, provider
satisfaction, emotional distress, and cost effectiveness.
Clients are initially seen at 2, 4, and 6 weeks, then typically at a
minimum of every 3-6 months, although the schedule is tailored to
individual preference as needed. Patients are in the intervention for
three years.
In addition to the standard assessment, content of initial interview
includes a status report on lab values and intake survey results,
nursing assessment of medications, exploration of the patient’s
goals, and evaluation of current satisfaction with diabetes health.
Deliberate attempts to establish rapport through a non-judgmental
approach, understanding other aspects of patient’s life, and active
listening are used. Typical intake visits last one hour, with
subsequent visits varying between 15 minutes to one hour.
Subsequent visits are based on results of intake visit, but use MI to
identify ‘the agenda’ which, if any, self care behaviors the patient
would like to change, and how health can be improved or
maintained. The nurse-patient relationship is enhanced by the use
of MI, which helps identify aspects of the care plan amenable to
behavior change, and establish goals for change and a plan to
achieve them. The nurse case managers are integrated into the
primary care clinic setting and have a continuous relationship with
study participants through providing both direct clinical
interventions and collaborating with other members of the health
care team.
Patients randomized to NCM continue to see their PCP at regularly
scheduled visits and also meet individually with a nurse case
manager as detailed below. Patients randomized to the usual care
group remain solely under the treatment of their PCP. Each nurse
has a patient caseload of approximately 140 to permit incorporation
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