umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Illness integration, self-management and patient-centred support in type 2 diabetes
Umeå University, Faculty of Medicine, Department of Nursing.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Integration av sjukdom, sjukdomshantering och patientcentrerad support vid typ 2 diabetes (Swedish)
Abstract [en]

Background: Type 2 diabetes is a serious disease that is increasing globally. The focus of diabetes care has been to prevent diabetes related complications and thereby reduce mortality. An older population, the disease progression and decreased ability to perform self-management activities increases the risk for complications. Group education and patient-centred care are recommended to improve self-management through increased patient empowerment. Despite these recommendations, professionals have been reluctant to adopt these methods referring to lack of knowledge, time and tools to deliver patient-centred care in diabetes. Focusing on the patient’s illness integration process has in the literature been suggested to improve self-management and metabolic balance.

Aim: The overall aim of the thesis was to describe the experiences of illness integration, self-management and support in type 2 diabetes and to evaluate the metabolic effects of a nurse-led patient-centred model for self-management support.

Methods: The study setting was primary health care in Västerbotten County, Sweden. In total, 21 diabetes nurses (Study I) and 257 patients (Studies II-IV) participated in the four studies (Study II, n=44; Study III, n= 18; Study IV, n= 195). Data consisted of focus group interviews (Study I), individual semi-structured interviews (Studies II-III) and laboratory measurements (Study IV). Methods for analyses were qualitative content analysis (Studies I-III) and statistics (Study IV).

Results: Study I revealed that diabetes nurses found the ideal diabetes care complex to achieve. Conflicting paradigms, power relations and departmentalisation of work were described. Study II describes a process whereby illness integration and self-management in type 2 diabetes develop simultaneously. When a turning-point occurs, people view self-management as both necessary and feasible. In study III, turning points in self-management are illuminated. Turning-point transitions include existential and emotional aspects that increase inner motivation and power for lifestyle change. Study IV evaluates the effects of a nurse-led intervention in which haemoglobin A1c (HbA1c) was significantly decreased at 12 months’ follow-up. Group intervention and individual intervention were both effective compared to traditional diabetes care.

Conclusions: There is a potential for improvement of type 2 diabetes care. Increased patient-centredness is important to support patients towards illness integration and self-management. Focusing on the patients’ illness experiences, including the existential and emotional aspects of having and managing type 2 diabetes, in counselling can lead to improved self-management and glycaemic control. Patients’ experiences of illness are central to their inner motives for change, and patient-centred self-management support and patient education preferably emanate from this perspective.

Abstract [sv]

Bakgrund: Typ 2 diabetes är en allvarlig sjukdom som ökar globalt. Fokus i diabetesvården har varit att förebygga diabetesrelaterade komplikationer och därmed minska dödligheten. En åldrande befolkning, progression av sjukdomen samt en begränsad förmåga att utföra egenvårdsaktiviteter ökar risken för komplikationer. Grupputbildning och patientcentrerad vård rekommenderas för att förbättra egenvården genom ökad empowerment. Trots dessa rekommendationer har läkare och sjuksköterskor rapporterats vara tveksamma till dessa metoder och hänvisat till bristande kunskap, tidsbrist och avsaknad av verktyg. Att fokusera på patienters sjukdomsintegrationsprocess har i litteraturen föreslagits förbättra såväl egenvård som metabol balans.

Syfte: Avhandlingens övergripande syfte var att beskriva erfarenheter av sjukdomsintegration, sjukdomshantering och support vid typ 2 diabetes samt att utvärdera effekter av en sjuksköterskeledd patientcentrerad modell för egenvårdssupport.

Metod: Studierna genomfördes inom primärvården i Västerbottens läns landsting. Totalt deltog 21 diabetessjuksköterskor (Studie I) och 257 patienter (Studie II-IV), i de fyra studierna (Studie II, n=44; Studie III, n= 18; Studie IV, n= 195). Data bestod av fokusgruppsintervjuer (Studie I), individuella halvstrukturerade intervjuer (Studie II-III) och laboratoriemätningar (Studie IV). Analysmetoderna var kvalitativ innehållsanalys (Studie I-III) och statistik (Studie IV).

Resultat: Studie I visade att en ideal diabetesvård är svår att uppnå enligt diabetessjuksköterskorna. Paradigmkrockar, maktrelationer och splittrade arbetsuppgifter beskrevs. Studie II beskriver en modell där sjukdomsintegration och sjukdomshantering utvecklas samtidigt. När en ”turning point” nåddes såg patienterna sjukdomshanteringen som både nödvändig och möjlig att genomföra. I studie III belystes ”turning points” och som omfattar både existentiella och emotionella aspekter som kan öka inre motivation och egenkraft att utföra livsstilsförändringar. Studie IV utvärderade 12-månaderseffekterna av en sjuksköterskeledd intervention och HbA1c sänktes signifikant. Gruppintervention och individuell intervention visades vara effektiva metoder i jämförelse med traditionell diabetesvård.

Slutsatser: Det finns en förbättringspotential inom diabetesvården och ökad patientcentrering är viktig för att stödja patienter att integrera sjukdom och egenvård i livet. Att i diabetesvården fokusera på patienters sjukdomsupplevelser inklusive de existentiella och emotionella aspekterna av att leva med och hantera en sjukdom kan innebära förbättrad sjukdomshantering och metabol balans. Patienters sjukdomsupplevelser är centrala för deras inre motiv till förändring och patientcentrerad egenvårdssupport och patientutbildning bör utgå från detta perspektiv.

 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 91 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1560
Keyword [en]
Type 2 diabetes, illness integration, turning points, self-management, patient-centredness, diabetes care, primary health care, intervention, randomised controlled study
National Category
Family Medicine
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-67847ISBN: 978-91-7459-576-5 (print)OAI: oai:DiVA.org:umu-67847DiVA: diva2:615238
Public defence
2013-05-03, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-12 Created: 2013-04-04 Last updated: 2013-04-12Bibliographically approved
List of papers
1. Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives
Open this publication in new window or tab >>Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives
2012 (English)In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 2Article in journal (Refereed) Published
Abstract [en]

Background: Since diabetes specialty nurses are the professionals who spend the most time with patients living with diabetes, they probably have the greatest influence on the quality of diabetes care. Therefore, their personal perceptions about what constitutes “good care” in type 2 diabetes care are important to explore.

Aim: The aim of this study was to describe conditions for “good care” in type 2-diabetes as perceived by diabetes specialty nurses.

Method: Twenty-one experienced diabetes specialty nurses participated in three focus group interviews. Data were analyzed using qualitative content analysis.

Findings: The findings are presented in four themes describing diabetes specialty nurses’ perspectives on ideal versus real conditions for type 2 diabetes care: 1) Diabetes counseling built on empowerment versus governance; 2) Diabetes management built on comprehensive versus biomedical views; 3) Diabetes organization built on nurse-led versus physician-led care; and 4) Diabetes policies built on quality versus equality.

Conclusion: The ideal diabetes care is perceived as complex to achieve. Conflicting paradigms, power relations, and departmentalization of work are influencing the potential to deliver ideal diabetes care and to increase satisfaction among diabetes specialty nurses and patients. The diabetes specialty nurses described themselves as the “hub” of diabetes care, and they perceived conflicts between ideal versus real conditions in type 2 diabetes care. Patient centredness is not a real condition in diabetes care.

Keyword
Diabetes nursing, health care organization, nurse-physician collaboration, patient empowerment, patient centered care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-67943 (URN)
Available from: 2013-04-11 Created: 2013-04-09 Last updated: 2017-12-06Bibliographically approved
2. A model of integration of illness and self-management in type 2 diabetes
Open this publication in new window or tab >>A model of integration of illness and self-management in type 2 diabetes
2011 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 1, 41-51 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To describe the process of illness integration and self-management among people with type 2 diabetes.

Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.

Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.

Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.

Conclusion. Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.

Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keyword
chronic illness, nursing research, patients’ experience, qualitative study, self-management, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-41257 (URN)10.1111/j.1752-9824.2010.01078.x (DOI)
Available from: 2011-03-22 Created: 2011-03-22 Last updated: 2017-12-11Bibliographically approved
3. Turning points in self-management of type 2 diabetes
Open this publication in new window or tab >>Turning points in self-management of type 2 diabetes
2012 (English)In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, 46-50 p.Article in journal (Refereed) Published
Abstract [en]

A turning point is described in the literature as a powerful emotional experience or insight leading to a fundamental change in a person’s life, and requires a new way of managing the illness. However, turning points are not sufficiently described in the literature, particularly not with respect to diabetes.

The aim of this study was to throw light on turning points in self-management asdescribed by people with type 2 diabetes.

Eighteen participants diagnosed with type 2 diabetes within the previous two years, and who received treatment in primary health care, were invited to participate. Semi-structured interviews were analysed using qualitative content analysis.

The findings demonstrated that the turning point in self-management among individuals living with type 2 diabetes included four themes: being in a life and death struggle, being at a crossroads with no return, being the one who decides, and being the one who can change the outcome.

Turning point transitions include existential and emotional aspects that can increase inner motivation and power for changed behaviour. Turning points are possible to identify, and self-management could be facilitated if more attention is paid to the emotional and existential aspects of having an illness.

Place, publisher, year, edition, pages
John Wiley & Sons, 2012
Keyword
type 2 diabetes, turning point, self-management, illness integration, patient centredness
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-55195 (URN)10.1002/edn.205 (DOI)
Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2017-12-07Bibliographically approved
4. Diabetes control by patient-centred self-management support: a randomised controlled trial
Open this publication in new window or tab >>Diabetes control by patient-centred self-management support: a randomised controlled trial
Show others...
(English)Article in journal (Refereed) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-67842 (URN)
Available from: 2013-04-04 Created: 2013-04-04 Last updated: 2013-04-12Bibliographically approved

Open Access in DiVA

Kappan(749 kB)2105 downloads
File information
File name FULLTEXT02.pdfFile size 749 kBChecksum SHA-512
76cd6f35ee1bf6276e23916c5367aa76e6969aee149644f002b76260180afb4e5063a745e4aa70991472b6181c6a3cca559b5ce012e419b125ef818fde395c82
Type fulltextMimetype application/pdf
Spikblad(24 kB)181 downloads
File information
File name FULLTEXT03.pdfFile size 24 kBChecksum SHA-512
d114850031e1ca05cd316fbd1d60a8a9cfd097bcaa967daf00ce6b25e035cb096b035af4add7d8d7a9435807e72259e1b6a81c51a275364ccdc1b18459e9666f
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Jutterström, Lena
By organisation
Department of Nursing
Family Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 2286 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1684 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf