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
Cost effectives is determined form the perspective of the provider,
payor, and society within the US healthcare system. Evaluation of
costs and cost-effectiveness of the intervention is through the
record of outpatient and inpatient health care utilization by the
patients, including the cost of medications. Additional data is
collected through surveys to evaluate societal costs.
Summary of key findings:
Preliminary analyses reveal that study participants have more
diabetes-related psychological distress, lower adherence to most
self care behaviors, lower satisfaction with treatment, and more
depression than generally reported in the literature.. They are,
therefore, a group at risk for poor outcomes.
Results of our focus group analysis reveals the intervention has
empowered many study participants to make lifestyle changes
related to nutrition and exercise. Some dramatic improvements
have been documented in patients’ emotional acceptance of
disease, stress levels around specific self care behaviors such as
monitoring, improved coping with chronic illness, and taking a more
active role in self management. Some measurable changes
observed include weight loss, lab values normalizing due to
medication or lifestyle change, more trust and better rapport with
PCPs, honesty and sharing confidences with the study nurses, and
describing the nurses as their advocates. Not surprisingly,
depression and stress management are two issues that often need
addressed.
Among the underserved group, patients were more open about use
of alternative therapies to manage diabetes and co-morbidities.
Despite more geographic transitions, Hispanic participants
continued with the study at a rate equal to non-Hispanic patients.
The nurses note that PCPs generally overestimate adherence,
whereas providing empathy and being nonjudgmental facilitates
accurate reporting of self care behavior by patients. They also
describe MI as a technique which allows “natural nursing tendencies
toward empathy” to be made manifest. Barriers to care such as
provider availability, transportation access, suspicion, and mistrust
have been removed as part of the intervention. Although clinical
inertia is considered a common problem in diabetes medical care,
the nurses’ experience is that patients often did not make
prescribed behavior changes because they were not ready, or for
easily remedied reasons unknown to the physician. MI is a strategy
that the nurses find effective in helping them to facilitate a patient’s
acceptance of PCP recommendations, such as taking a new
medication, monitoring on a regular basis, and/or taking insulin.
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