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Biomedical subjects

Robin Whittemore

Publications and source records attributed to Robin Whittemore.

17 recordsLinked to original sources
PubMed2006

Behavioral interventions for diabetes self-management.

This article synthesizes the research on behavioral interventions aimed at diabetes self-management, describes current trends in diabetes self-management, and proposes future directions for diabetes self-management care and research. Interventions that are multifaceted, tailored to the individual, and provided six months or longer demonstrate modest effects in improving diabetes-related outcomes. Improving access to behavioral interventions, maintaining the effects of behavioral interventions, and addressing the more complex social and environmental factors that contribute to behavior change are current challenges in diabetes self-management that warrant further attention and research.

Behavior Therapy↗
PubMed2005

The integrative review: updated methodology.

AIM: The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process. BACKGROUND: Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated. DISCUSSION: A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review. CONCLUSION: An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

Data Collection↗
PubMed2005

Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes.

AIMS: To examine factors associated with metabolic control, self-management (diet and exercise behaviour), and psychosocial adjustment (diabetes-related distress) in women with type 2 diabetes. DESIGN: Cross-sectional design using baseline data of women with type 2 diabetes enrolled to participate in a pilot study of a nurse coaching intervention (n = 53). ETHICAL ISSUES: Appropriate ethical review and approval was completed. Informed consent from participants was obtained. OUTCOME MEASURES: Physiological measures included body mass index and glycosylated haemoglobin (HbA1c). Self-management measures included the Dietary Subscale of the Summary of Diabetes Self-Care Activities Questionnaire and a modified Paffenbarger Physical Activity Questionnaire. Psychosocial measures included the Problem Areas in Diabetes Survey (diabetes-related distress), the Diabetes Questionnaire, the Diabetes Self-Management Assessment Tool Support and Confidence Subscale, and the Social Functioning Scale. Descriptive, bivariate, and multivariate analyses were completed. RESULTS: The most consistent predictor of metabolic control, dietary self-management, and diabetes-related distress was support and confidence in living with diabetes. Additionally, women had difficulty meeting optimal goals for exercise, yet reported higher levels of other physical activity. LIMITATIONS: This study was an exploratory analysis with a homogeneous sample of women with type 2 diabetes enrolled in an intervention study and measurements included multiple self-report instruments. CONCLUSIONS: Interventions to increase women's perceived self-confidence and support may contribute to positive health outcomes in women with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE: Assessment of social support and self-confidence in diabetes self-management in women with type 2 diabetes may assist in determining individualized goals and strategies. Enhanced social support and self-confidence in diabetes self-management may subsequently improve metabolic control, self-management and psychosocial adjustment to diabetes.

Adaptation, Psychological↗
PubMed2005

Analysis of integration in nursing science and practice.

PURPOSE: To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care. DESIGN: An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical. METHODS: Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health. FINDINGS: A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance. CONCLUSIONS: Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Activities of Daily Living↗
PubMed2004

Applying the social ecological theory to type 2 diabetes prevention and management.

Obesity and Type 2 diabetes have become major public health problems in the United States. Community health nurses, with expertise in preventive health care, have the potential to play a vital role in addressing these significant health issues. The purposes of this article are to identify current challenges related to obesity and Type 2 diabetes and to present the social ecological theory as a framework for the expansion of the reach of diabetes prevention and management that is relevant to community health nurses.

Community Health Nursing↗
PubMed2003

Promoting lifestyle change in the prevention and management of type 2 diabetes.

PURPOSE: To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices. DATA SOURCES: Selected scientific literature and the Internet. CONCLUSIONS: There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals. IMPLICATIONS FOR PRACTICE: APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow-up.

Activities of Daily Living↗
PubMed2002

Depression in type 1 diabetes in children: natural history and correlates.

The combination of diabetes and depression in children and adolescents is largely unstudied. The purpose of this article is to review the literature on the natural history and correlates of comorbid diabetes and depression in children and adolescents. Children with diabetes have a two-fold greater prevalence of depression, and adolescents up to three-fold greater, than youth without diabetes. Correlates of depression and diabetes include gender, poorer metabolic control, and family behaviors. Very little is known about treatment in these youth, and more studies are indicated.

Adolescent↗
PubMed2002

Correlates of depressive symptoms in adolescents with type 1 diabetes.

PURPOSE: To determine correlates of depression in adolescents with type 1 diabetes. METHODS: Data on 117 adolescents participating in a longitudinal study (72 F, 45 M; 95 W; age = 14.3 +/- 2.0 yr; duration = 6.3 +/- 3.7) were collected with the Children's Depression Inventory (CDI), Diabetes Family Behavior Scale (DFBS), Family Adaptability and Cohesion Scale (FACES), and chart review at study entry and 2-year follow-up. RESULTS: Fifteen per cent of adolescents in this sample demonstrated depressive symptoms (CDI > 13) at study entry and 10% at 2 yr follow-up. Adolescents aged 14.1-16 yr and those with diabetes > 10 yr demonstrated the highest rates. When demographic/clinical variables were controlled, the DFBS warmth-caring subscale (p = 0.001) and the FACES adaptability subscale (p = 0.005), but not DFBS guidance-control (p = 0.635), contributed significantly to the explained variance in depressive symptoms (R(2) = 0.27) at study entry. At 2 yr follow-up, study entry CDI scores were the only significant predictor of depressive symptoms (R(2) = 0.40). By 2 yr, adolescents with depressive symptoms had significantly higher HbA1c than those without (p = 0.03). CONCLUSION: The prevalence of depressive symptoms in adolescents with type 1 diabetes coupled with the potential impact of depressive symptoms on metabolic control suggest the need for early diagnosis and treatment. Greater attention to psychosocial outcomes of youth, family functioning, and the potential burden of diabetes over time to youth/families is indicated.

Journal Article↗
PubMed2002

The systematic development of nursing interventions.

PURPOSE: To propose guidelines for systematic and progressive testing of nursing interventions. ORGANIZING FRAMEWORK: The National Institutes of Health has indicated four phases of clinical trials to guide research on treatments and interventions in the health sciences. Several important issues specific to nursing interventions need further clarification to enhance the interpretation of nursing clinical trials: (a) linking problem identification and nursing interventions, (b) articulating the content of interventions, (c) determining the strength and timing of interventions, (d) differentiating between efficacy and effectiveness research, and (e) incorporating multiple perspectives in intervention development. CONCLUSIONS: Systematic and progressive nursing intervention programs of research are needed to address these issues and to enhance the science and practice of nursing.

Clinical Trials as Topic↗
PubMed2002

Adapting to diabetes mellitus: a theory synthesis.

One priority in nursing research is the development of middle-range theories that are applicable to nursing practice. The purpose of this article is to describe the development of a middle-range theory, adapting to diabetes mellitus, through theory and concept synthesis. The adaptation to chronic illness model explicates the conceptual relationships of the Roy adaptation model in a theory specific to chronic illness. Several concepts in the diabetes literature, self-management, integration, and health-within-illness were synthesized with the theory through examination of empirical evidence. This method of theory development increases the specificity of the existing theory and informs the application to nursing practice.

Adaptation, Psychological↗
PubMedDate not supplied

Self-report of depressed mood and depression in women with type 2 diabetes.

The purpose of this cross-sectional analysis (N = 53) was to (a) describe the self-reported prevalence of depressed mood and depression in women with type 2 diabetes; (b) to describe the antidepressive agents and dosages prescribed for depression treatment in women with type 2 diabetes; and (c) to examine differences in diabetes-related health outcomes (physiologic, psychosocial, and health functioning variables) with respect to depressed mood. Forty-four percent of women in this sample reported a depressed mood and 34% of the sample reported a history of depression. The majority of women with a history of depression were taking an antidepressive agent at the time of assessment (94%). Most women were treated with selective serotonin reuptake inhibitors (SSRIs). Women with depressed mood demonstrated poorer psychosocial adjustment and health functioning compared to women without a depressed mood; however, no differences in physiological outcomes were demonstrated. Only 18% of the participants were currently being treated with psychotherapy in conjunction with medication. Further research on this understudied population is indicated.

Adult↗
PubMedDate not supplied

Lifestyle change in type 2 diabetes a process model.

BACKGROUND: Integration is an emerging concept in the study of self-management and chronic illness, yet this process and how it occurs is not well understood. OBJECTIVES: This investigation, part of a triangulated study, focused on the experience of integrating type 2 diabetes treatment recommendations into an existing lifestyle while participating in a nurse-coaching intervention. METHOD: An interpretive method elicited data from nurse-coaching sessions (4), field notes, and an interview in 9 women with type 2 diabetes. The process of data reduction and analysis (Miles & Huberman, 1994) was used to interpret data. RESULTS: The core process of integrating lifestyle change in type 2 diabetes was multifaceted and complex. Challenges to the process of integrating lifestyle change included reconciling emotions, composing a structure, striving for satisfaction, exploring self and conflicts, discovering balance, and developing a new cadence to life. These challenges required acknowledgment in order for participants to progress toward integration. DISCUSSION: Balance was an integral component to the experience of integration, between structure and flexibility, fear and hope, conflict and acceptance, diabetes and life. Conceptualizations identified with this investigation extend understanding of theories of integration and lifestyle change and invite the development and testing of nursing interventions.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Combining evidence in nursing research: methods and implications.

BACKGROUND: The knowledge explosion in health care coupled with recent evidence-based practice initiatives has increased both the need for and the production of reviews of past research. The proliferation of such reviews has contributed to inconsistency in methods and terminology. Differing methods for integrative reviews, systematic reviews, meta-analyses, and qualitative reviews have been proposed, yet are not clearly differentiated in published reports. Although there are common features to these methods, each method has a distinct purpose, sampling frame, definition, and type of analysis. APPROACH: The literature on research review methods was analyzed and synthesized. Specific attention was directed toward the issues specific to combining primary nursing research studies. RESULTS: The defining characteristics of different research review methods, the common stages of all research reviews, and criteria for evaluating quality are described. DISCUSSION: Greater clarity regarding research review methods has the potential to enhance methodological rigor and subsequently the applicability of findings of all review methods to practice and policy.

Humans↗
PubMedDate not supplied

Research environments that promote integrity.

BACKGROUND: The body of empirical knowledge about research integrity and the factors that promote research integrity in nursing research environments remains small. OBJECTIVE: To propose an internal control model as an innovative framework for the design and structure of nursing research environments that promote integrity. METHODS: An internal control model is adapted to illustrate its use for conceptualizing and designing research environments that promote integrity. RESULTS: The internal control model integrates both the organizational elements necessary to promote research integrity and the processes needed to assess research environments. The model provides five interrelated process components within which any number of research integrity variables and processes may be used and studied: internal control environment, risk assessment, internal control activities, monitoring, and information and communication. DISCUSSION: The components of the proposed research integrity internal control model proposed comprise an integrated conceptualization of the processes that provide reasonable assurance that research integrity will be promoted within the nursing research environment. Schools of nursing can use the model to design, implement, and evaluate systems that promote research integrity. The model process components need further exploration to substantiate the use of the model in nursing research environments.

Communication↗
PubMedDate not supplied

Quality of life in school-aged children with type 1 diabetes on intensive treatment and their parents.

PURPOSE: The purpose of this study was to examine the child, parent, and family factors associated with quality of life and metabolic control in school-aged children with type 1 diabetes on intensive treatment. METHODS: A cross-sectional analysis was performed of child, parent, and family psychosocial variables with child quality of life and metabolic control. RESULTS: Families of school-aged children were able to intensively manage type 1 diabetes, achieve good metabolic control (< 7.5%), experience good quality of life, and cope well with the demands of treatment. However, increased depressive symptoms were reported in children (8%) and a parent (29%). CONCLUSIONS: Most school-aged children and families in this sample coped well with the demands of intensive treatment. However, intensive psychosocial support may also be indicated because managing a complex chronic illness is stressful and potentially difficult for some families.

Adaptation, Psychological↗
PubMedDate not supplied

A nurse-coaching intervention for women with type 2 diabetes.

PURPOSE: The purpose of this pilot study was to determine the efficacy of a 6-month nurse-coaching intervention that was provided after diabetes education for women with type 2 diabetes. METHODS: In this pilot study, 53 women were randomized to the nurse-coaching intervention or a standard care control condition. The nurse-coaching intervention consisted of 5 individualized sessions and 2 follow-up phone calls over 6 months. The nurse-coaching sessions included educational, behavioral, and affective strategies. Data were collected on physiologic adaptation (hemoglobin A1c [A1C] and body mass index [BMI]), self-management (dietary and exercise), psychosocial adaptation (diabetes-related distress and integration), and treatment satisfaction at baseline, 3 months, and 6 months. RESULTS: Women in the treatment group demonstrated better diet self-management, less diabetes-related distress, better integration, and more satisfaction with care, and had trends of better exercise self-management and BMI. The A1C levels improved in both groups at 3 months, yet the difference between the groups was not significant. Attendance at nurse-coaching sessions was 96%. CONCLUSIONS: This nurse-coaching intervention demonstrates promise as a means of improving self-management and psychosocial outcomes in women with type 2 diabetes.

Diabetes Mellitus, Type 2↗