Article critique

The Role of the Nurse in Diabetes Management Outcomes in Primary Care

Kieonna Stewart

Indiana Wesleyan University

GNUR- 501: Evidence Based Communication

Sandra Horton

January 13, 2020

The Role of the Nurse in Diabetes Management Outcomes in Primary Care

The role of the nurse in diabetes management outcomes in primary care is my area of expertise. This literature critique will discuss articles related to best methods in diabetes care management in primary care settings. The critique will explore the issue being researched, strengths, and weaknesses of the articles, the author's bias, and if the articles can be applied to theory, practice, or both. The critique will also discuss if the articles fit the needs of the nursing expertise paper.

Article One

“Integrated Care: Evaluation of Patient Satisfaction with Education Provided by the Diabetes Specialist Nurse” was published in the Journal of Diabetes Nursing in 2018. The article was written by Newell and published in volume 41, issue 2 on pages 1-5. The author stated nurse-led clinics in primary care have great potential in supporting patients in diabetes management. The study aimed to assess if the education provided by the nurse affected the patients' understanding of the disease process and lifestyle changes needed.

The method used to collect data was patient surveys given at the end of the 45-minute education sessions with the diabetes nurse. The surveys were enclosed in an envelope to keep confidentiality. Each session was patient-specific with emphasis on self- management skills. The population consisted of 50 randomly selected patients who were diagnosed with type 2 diabetes. The study was conducted over three months.

One strength of the study was the response rate of the sample population. One weakness of the study is the survey was given after the education session with no follow-up survey. The author cannot conclude if the sessions had a long-term effect on the patient’s lifestyle/behavioral change. The survey was self- reported, which may be biased. The article could be applied to practice. Ensuring personalized educational sessions met the needs of the patients to improve diabetes management outcomes. The article fits the needs of my nursing expertise paper because demonstrates the positive impact of nurse led clinics and self-management of patients with diabetes.

Article Two

“Patients’ Readiness to Receive Psychosocial Care During Nurse-Led Routine Diabetes Consultations in Primary Care: A Mixed Methods Study” was published in the International Journal of Nursing Studies in 2016. The article was written by van Dijk-de Vries, van Bokhoven, de Jong, Metsemakers, Verhaak, van der Weijden, and van Eijk and published in volume 63 on pages 58-64. The authors articulated patients with diabetes suffer from emotional and social effects of the disease daily such as depression. The symptoms have an impact on outcomes of diabetes. The scope of the article is to assess the patient’s willingness or readiness to discuss the psychosocial problems they may have experienced with a nurse during routine diabetes consultation.  

The method used to collect data was an in-depth interview followed by a questionnaire. The strengths of the article were the mixed-method design, which was qualitative data collection followed by a quantitative data collection. In the study, there was selection bias. Patients responded to the first set of questions; it then determined if they were selected for the next phase of questions. One limitation of the study is the validity and accuracy of the quantitative phase. The authors stated results should be interpreted with caution. Even though the findings show patients are satisfied with nurse-led care as regards to diabetes care, they do not feel the need to talk about psychosocial problems. The article could be applied to practice if there was an education component explaining the roles of each healthcare worker to the patient. The article does not fit the needs of my clinical expertise paper due to the limitations of the study.

Article Three

“Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care” was written by Krall, Durdock, Johnson, Koshinsky, Thearle, Siminerio. It was published in 2016 in the Clinical Diabetes in volume 35 on pages 100-105. The authors stated previous studies are reporting the barriers to diabetes care, but there is a lack of solutions. The issue being discussed is the lack of education on resources available for advanced therapies for diabetic patients in primary care.

The method was divided into three phases. Phase one studied patient and staff perception of diabetes therapy intensification; Phase two, developed an educational program and presented it to the primary care staff. Phase three, the diabetes educator, was present in the primary care practices for one year to support the delivery of advanced therapy. One strength of the study is the length of time conducted for the study. The diabetes nurse educator stayed in the primary care practices for one year. One limitation of the study is the use of convenience sampling, which can create bias. The article can be applied to practice because it shows the outcomes of the team-based approach with the diabetes educator. The article does fit the needs of my clinical expertise paper because it shows the positive use of diabetes educators in primary care by providers.

Article Four

“Improving Diabetes Control in the Community: A Nurse Managed Intervention Model in a Multidisciplinary Clinic” was written by Ginzburg, Hoffman, and Azuri. It was published in 2017 in the Australian Journal of Advanced Nursing in volume 35, issue 2 on pages 23-30. The aim of the study was to assess the effectiveness of diabetes care management led by a nurse.

The study was completed by randomly selecting diabetic patients who met the criteria of high glycated hemoglobin (A1C), blood pressure, and cholesterol levels in a primary care setting. The patients were then referred to the diabetes nurse for management.

One of the strengths in methodology included the data collected from the central medical database. The results were measurable from baseline, intervention, and follow up period. Also, a weakness is the study was retrospective. It relied on others to input the data — the limitation of the study convenience sampling, which can create bias. The article can be applied to practice because it shows an improvement in outcomes with the nurse as the facilitator. The article also fits the needs of the expertise paper; it associates improved diabetic outcomes with the nurse.

Article Five

“Psychological Skills Training to Support Diabetes Self-Management: Qualitative Assessment of Nurses’ Experiences” was written by Graves, Garrett, Amiel, Ismail, and Winkley. It was published in 2016 in the Primary Care Diabetes in volume 10 on pages 376-382. The aim of the study was to explore the primary care nurses’ experiences of psychological skills in training as part of the Diabetes-6 study.

The method of data collection was interviews with the nurses about their experiences of psychological intervention with diabetic patients. The strength of the article was the results of the randomized control study was not known upon data collection. The chances of bias were significantly low. A weakness or limitation of the study was nurses not reporting mistakes due to fear. The article can be applied to practice if nurses are