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NURS2000 Behavioural Responses To Chronic Illness

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Question:

Please select one of the following articles (You will find these in your reading list under Assessments):

Dao, S., Spooner, C., Lo, W., & Harris, M. (2019). Factors influencing self-management in patients with type 2 diabetes in general practice: A qualitative study. Australian Journal of Primary Health, 25(2), 176-184. https://doi.org/10.1071/PY18095 

Luckett, T., Agar, M., DiGiacomo, M., Ferguson, C., Lam, L., & Phillips, J. (2019). Health status of people who have provided informal care or support to an adult with chronic disease in the last 5 years: Results from a population based cross sectional survey in South Australia. Australian Health Review, 43(4), 408-414. https://doi.org/10.1071/AH17289

Assessment Requirements

The purpose of this critical review is to demonstrate an understanding of your chosen article in terms of its; relevance to you as a student RN/Paramedic, research robustness, reference to psychosocial issues (both stated and potential), and how these impact the health and wellbeing of families, contribution to the interdisciplinary approach, and finally its meaningfulness to your own clinical practice.

In order to achieve this, you will need to consider the strengths and weaknesses within the article in relation to each of these areas so that you can present a fair and reasoned critique.
Your succinct introduction should outline the purpose of your paper and:

  1. identify the aim of the article,

  2. include a brief summary of the research setting, sample, and findings

  3. conclude your introduction with a general statement about the review (e.g., “The article contributes to best practice….” or “The value of this article is its contribution to the professional knowledge of nursing/paramedic students by….”). Please use your own statement. The position you take should be justified in the body of your critical review.

  4. Your critical review will identify the study design (including research methods used by the authors) and critically analyse the design in relation to strengths and limitations of the chosen research methodology and the aims of the study.

  5. Consider how this article can assist healthcare providers to consider psychosocial factors that are associated with the chronic disease(s) AND identify what psychosocial issues this article either does or could draw attention to. Your critical review will also identify and explain how these psychosocial factors impact individuals and/or families and their responses to the chronic illness.

  6. Your critical review will then include your understanding of the interdisciplinary approach and follow with an explanation in terms of strengths and limitations how the article can contribute to the interdisciplinary approach and knowledge to achieve best practice management of chronic illness. It is important here that you demonstrate an understanding of what the interdisciplinary approach is.

  7. Your critical review will explain how the article would be applied to your own clinical practice as a Student RN/Paramedic. For example, explain how the insights gained from the article would specifically improve your current approach to working with people with chronic illness or reduce barriers associated with seeking information about their needs. Please use your own ideas.
 

Answer:

Self-management of type 2 diabetes has been considered as a challenge that precedes the onset of complications. Hence, in a bid to identify factors that could facilitate adoption of effective self-management strategies, Dao, Spooner, Lo, and Harris (2019) carried out an exploratory study that aimed to unearth these factors. The researchers used a qualitative study approach to engage participants in semi-structured interviews. The participants included patients with type 2 diabetes, as well as general practitioners and nurses attending to them. The study focused on a low socioeconomic zone of Australia, New South Wales, and Sydney. Using thematic analysis, the researchers showed that factors influencing self-management fell in 4 categories in reference to the socio-ecological model: individual level, interpersonal level, organizational level, and community level. The article contributes to professional health practice by giving insight into the factors of priority that should be considered when designing best programs that incorporate feasible and effective activities to attain the targeted behavior of self-management in attaining good prognosis.

The authors have adequately justifies the use of the qualitative approach by indicating that previous qualitative researches have not used a social-ecological model that seems to be a novel framework first used in Canada. The researchers have justified their choice of the research setting but confuses the reader because the abstract and the methodology section are not congruent in this context. The researchers fail to link the low socioeconomic area traversing three geographical regions with the focus on South Western Sydney. The research methodology, however, refuses the principles of existing research methods as the aim is to reorient thinking (St. Pierre, 2018). Thereby, develops a new mode of inquiry without benchmarks, and which poses as a challenge for the critique. The current qualitative approach does not fall in either of the realms described by Williams, Boylan, and Nunan (2018). The methodology is very confusing because the role of the intervention in this case is not well-defined. The typical case would be to test he efficacy of the intervention, but in this case, the researchers’ reflectivity has had a significant influence on the methodology. As a result, reflectivity has greatly introduced bias because by introducing the intervention, the researchers altered the real setting which should be the ideal research setting for qualitative research (Hammarberg, Kirkman, & de Lacey, 2016). Nonetheless, the principles of qualitative research form basis for the review, as discussed by Gadoud, Taylor, and Hussain (2013).

The article does not adhere to the sampling principles of qualitative research where the participants are recruited until there is no new information can be obtained. The selection of participants during pre- and post-intervention periods has not been articulately defined. Also, there is no explanation of variance in the selection of study participants. Again, the data collection process is missing some elements in reference to adjustments of research questions to fit the research aims as the interviews progressed as well as how confidentiality was maintained. While the researchers seemed to focus on the low socioeconomic domain, the converse seems to be case because they target individuals with some elements typical of a high socioeconomic context, such as internet access. Nonetheless, the article helps to unearth some of the pertinent factors that healthcare professionals should not ignore when advocating for self-management of chronic illnesses. The presentation of the findings enhances their credibility as the authors compare their findings with those of researchers and justify emerging discrepancies, like in the case of motivation where providers’ views were contrary to patients’ views.  

 


As noted earlier, the study adopts a unique study design because it introduces an intervention that alters the natural setting and affects its dependability (Ryan, Coughlan, & Cronin, 2007). The study participants consisted of a highly diversified group and the results merely give insight of factors that health providers should consider when dealing with individuals from culturally diverse backgrounds. The confirmability of the results to individuals in a low socioeconomic setting is not absolute because the intervention might have altered participant’s views and responses. Hence, the overall goodness of the study is lacking because the researchers fail to adequately justify their methodological sequence in reference to use of intervention and focus on the internet.

The article presents information on psychosocial factors which are important determinants of self-managing chronic conditions (Vilhena et al., 2014). The study is useful in helping healthcare providers to understand how they can help their patients to make use of available resources to aid in self-management of their condition. The study included patients with internet access, but despite the fact that they had access to technology, which is believed to increase healthcare access, they were not literate about its use. Also, they did not know which resources were credible and which were not. Therefore, with this information, the healthcare providers can devise ways of developing educational materials that they could post on their websites to help their patients get the right and correct information. Also, in view of their literacy levels, enhancing organizational websites so that they can get the information they need from here would provide more useful and satisfying. The study helped the healthcare providers to gain information on the areas that that needed improvement, such as content areas for information development. An understanding of cultural values and initiatives individuals engage in to understand ways of effectively managing their condition shows the willingness and craving for help. Even though some cultures still believe in big feasts like in the targeted population, selective eating to avoid overindulgence should be a guiding principle. Thereby, the information from this study can help to gain insight that can be integrated into existing models, structures, and policies to enhance the relevance of the interventions to motivate adoption of effective self-management strategies for type 2 diabetes.

Using organizational websites to engage patients would help them to deal with emerging challenges through discussion forums. For example, during instances when patients stated that the weather limited engagement in physical activity, a discussion forum would help brainstorm ideas through which individuals would deal with the challenge. However, such a strategy would require the concerted effort of different healthcare providers to address the different dimensions of health that should be considered during the self-management of type 2 diabetes. The article indicates that the responsibility of promoting self-management among patients with type 2 diabetes is not the sole responsibility of the nurse and general practitioners because developing a highly interactive organizational website would require the input of technical and administrative units. Also, the patients are pertinent stakeholders as their needs, preferences, and interests are meant to guide healthcare providers when designing and implementing interventions.

The article helps me as a student registered nurse to be open-minded when dealing with patients because there is no standard approach to effectively managing type 2 diabetes in view of the fact that the patients have different predispositions and routines. For example, in the case of time constriction, it would not make sense to develop elaborate schedules that were not in alignment with the schedules of the patients. Nonetheless, by understanding the patient’s schedules first, I can suggest ways of maintaining a healthy lifestyle without compromising attainment of positive health outcomes and a patient’s schedule. I have also realized the importance of working with an array of healthcare providers because individuals have different health and personal needs that require a multidisciplinary approach to solve them. Thereby, I should ensure to have great teamwork and interpersonal skills through which I can extract relevant and useful information from patients and involve the right healthcare providers in promoting self-management strategies for chronic illnesses.

The article aimed to reveal factors that influence self-management of type 2 diabetes as it is an important management strategy in preventing and delaying onset of complications. Using a socioeconomic model, the study was meant to give insight into the different factors under individuals, interpersonal, community, and organizational levels that inhibit the attainment of effective self-management practices. However, the study is affected by selection and performance bias because it does not focus on participants in their natural setting. The researchers should have been articulate about the investigation of an internet-based intervention because it focused on individuals with internet access. The robustness of the study is not guaranteed because the researcher’s reflectivity has greatly influenced the research process. The study is affected by sampling and selection bias because there is no objective inclusion/exclusion criteria to allow transferability of results. However, the findings cannot be ignored as they advocate for the essence of understanding patient’s needs as a basis in the development of a multifaceted intervention approach.

 

References

Dao, S., Spooner, C., Lo, W., & Harris, M. (2019). Factors influencing self-management in patients with type 2 diabetes in general practice: A qualitative study. Australian Journal of Primary Health, 25(2), 176-184. https://doi.org/10.1071/PY18095.

Gadoud, A., Taylor, P., & Hussain, J. (2013). How to appraise a qualitative study. British Journal of Hospital Medicine, 74(5), 271-4. Doi: 10.12968/hmed.2013.74.5.271.

Hammarberg, K., Kirkman, M., & de Lacey, S. (2016) Qualitative research methods: when to use them and how to judge them, Human Reproduction, 31(3), 498–501. https://doi.org/10.1093/humrep/dev334.

Ryan, F., Coughlan, M., & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 2: Qualitative research. British Journal of Nursing, 16(12), 738-744. https://doi.org/10.12968/bjon.2007.16.12.23726.

St. Pierre, E. A. (2019). Post Qualitative Inquiry in an Ontology of Immanence. Qualitative Inquiry, 25(1), 3–16. https://doi.org/10.1177/1077800418772634.

Vilhena, E., Pais-Ribeiro, J., Silva, I., Pedro, L., Meneses, R. F., Cardosos, H., ...Medonç.  (2014). Psychosocial factors as predictors of quality of life in chronic Portuguese patients. Health Qual Life Outcomes, 12(3). https://doi.org/10.1186/1477-7525-12-3.

Williams, V., Boylan, A., & Nunan, D. (2018). Critical Appraisal of Qualitative Research: Necessity, Partialities and the Issue of Bias. BMJ. https://dx.doi.org/10.1136/bmjebm- 2018-111132.

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