Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes

Effectiveness of a low-intensity nurse-led lifestyle intervention on glycaemic control in individuals with prediabetes: The PREDIPHONE randomized controlled clinical trial

BACKGROUND

Lifestyle changes can effectively prevent diabetes onset in individuals with prediabetes. Although nurse-led interventions have proven to be cost-effective and feasible in the management of diabetes and hypertension in primary care, low-intensity lifestyle interventions for people with prediabetes led by nurses remain poorly evaluated.

OBJECTIVE

To assess whether a low-intensity nurse-led telephone lifestyle intervention is effective in reducing fasting plasma glucose levels in individuals with prediabetes.

DESIGN

A two-arm, parallel, randomized controlled clinical.

SETTINGS

Five Primary Care Centres in the Balearic Islands, Spain.

PARTICIPANTS

A total of 206 participants were enrolled, 103 in each group.

METHODS

Consenting participants aged 25-75 years, with fasting plasma glucose levels of 100-125 mg/dL, and body mass index ≥27 and < 40 kg/m2 were randomly assigned (1:1) to either a 9-month nurse-led telephone lifestyle intervention (intervention) or short text messages with general lifestyle advice (control). Research staff and the statistician were masked to group allocation. The primary outcome was fasting plasma glucose at 9-month follow-up, analyzed per protocol and by intention-to-treat.

RESULTS

Among the 206 participants (103 in each group), 189 (91·8 %; n = 91 in the intervention group, n = 98 in the control group) completed the 4-month follow-up and 181 (87·9 %; n = 87 in the intervention group, n = 94 in the control group) completed the 9-month follow-up. Among the 206 randomized participants, 52.9 % were women, 73.8 % were obese, and 69.4 % were of Spanish nationality. Differences in fasting plasma glucose between groups at 9-months were not statistically significant (Intervention group n = 85 mean 103·4 mg/dL [SD 9·6] vs Control group n = 91 mean 104·8 mg/dL [SD 9·7]; adjusted mean difference 1·1 mg/dL [95 % CI -1·6 to 3·8]; p-value = 0·43). Difference in waist circumference at 9 months were statistically significant (Intervention group n = 85 mean 100.6 cm [SD 10.2] vs Control group n = 91 mean 104.0 cm [SD 10.2]; adjusted mean difference 1.9 cm [95 % CI 0.6 to 3.3]; p-value <0.01). At 9-month follow-up, diet quality improved in the intervention group (intervention group n = 86 mean 8.4 points [SD 2.0] vs control group n = 93 mean 7.5 points [SD 2.1], adjusted mean difference - 1.3 points [95 CI -1.7 to -0.7]; p-value <0.01). Likewise, sedentary behavior presented statistically significant differences at 9-month follow-up (intervention group n = 86 mean 5.4 H/d [SD 1.8] vs control group n = 93 mean 6.3 H/d [SD 1.9], adjusted mean difference 1.0 H/d [95 CI 0.5 to 1.4]; p-value <0.01).

CONCLUSIONS

These results do not support the effectiveness of a low-intensity nurse-led telephone lifestyle intervention in reducing fasting plasma glucose in individuals with prediabetes, although changes in diet quality and sedentary behavior were observed.

REGISTRATION

https://clinicaltrials.gov/study/NCT04735640?term=prediphone&rank=1NCT04735640. Registered 03/02/2021, first recruitment 13/04/2021.

TWEETABLE ABSTRACT

A nurse-led phone intervention had no significant benefits on glucose levels in patients with prediabetes. @GlobalHealth_rg.

Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus

AIM

The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (T2DM) on dietary and physical activity recommendations in a Spanish region.

METHODS

A two-arm pragmatic randomized pilot trial was developed. The intervention consisted of a 6-month period with three components: face-to-face counseling, a phone call, and specially designed written guidelines focusing on dietary and physical activity recommendations The primary outcome was changes in dietary and physical activity recommendations. The secondary outcome, the impact of the intervention on HbA1c levels, body mass index, and the frequency of consultations to primary care.

RESULTS

n=208 patients were recruited. Individuals in the intervention experienced a significative improvement in adherence to dietary recommendations (+0.52; p-value<0.001), physical activity (+0.79; p-value<0.001), and a decrease in HbA1c levels (0.11 %; p-value=0.04).

CONCLUSION

The 6-month intervention, designed for T2DM patients and based on the BCW model, has demonstrated effectiveness in improving adherence to healthy dietary and physical activity recommendations, as well as reducing HbA1c levels.

Nursing consultation and diabetes: an educational and transformative process for primary health care

OBJECTIVE

METHOD

convergent care research carried out with 12 nurses. Participant observation, semi-structured individual interviews and convergence groups were used to collect data, which were treated by participatory analysis, with an interpretative approach.

RESULTS

the promotion of self-care, the bond between professionals and users, and the support for lifestyle changes for people with diabetes were aligned with the proposed Care Model. On the other hand, attitudes, values and knowledge that weaken care were identified as divergent. The theoretical and practical deepening of the care model, diabetes, dealing with work overload, and the implementation of a guide and a protocol for the development of the nursing consultation were points of convergence for improving the quality of the consultation. It was also observed that nurses' autonomy was strengthened, critical thinking was awakened, and the search for improvement and redefinition of the relationship with the user was sought.

CONCLUSION

the nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

BACKGROUND

(1) The Nursing Consultation for people with DM by nurses consisted of elements that are similar to and different from the MACC. (2) Elements that align with the MACC: as establishing a bond with users, accountability, longitudinal care, and the social and family approach. (3) Elements diverged from the assumptions of MACC: a limited understanding of the care model, the professional attitude of blaming the user and the weaknesses in the application of the nursing process. (4) The nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

Nurses' Role in Obesity Management in Adults in Primary Healthcare Settings Worldwide: A Scoping Review

Obesity is a chronic, prevalent, and complex health condition that adversely impairs physical and mental health. The World Health Organization calls for integrating obesity care into existing chronic disease management programs within primary healthcare services. This scoping review aimed to examine registered nurses' roles in the primary healthcare management of individuals with obesity. A scoping review was conducted using the Johanna Briggs Institute methodology framework. Thematic analysis was used to identify and categorize nurses' roles in primary healthcare obesity management of adults. Of 1142 documents included in this review, 15 papers met the inclusion criteria. Thematic analysis yielded the following six themes representing nurses' major roles: patient-centred care, patient assessments, therapeutic interventions, care management, patient education, and professional development. This review identified that the literature on nurses' roles primarily described their focus on lifestyle interventions (mainly nutrition and physical activity), anthropometric measurements, health planning, goal setting, supportive care, monitoring progress, and arranging follow-up. The Discussion highlights the importance of determining RN knowledge gaps and biases. More research is required to determine the need for additional RN pre-and or post-education related to obesity as a complex chronic disease.

Nursing Recommendations for Symptom-Specific Self-care of Low Anterior Resection Syndrome: A Systematic, Scoping Review of the Literature

BACKGROUND

Low anterior resection syndrome (LARS) is a result of removing part or most of the rectum as a treatment for rectal cancer that negatively impacts quality of life. There is a lack of standardized nursing symptom-specific self-care recommendations for patients suffering from LARS.

OBJECTIVE

The aim of this study was to map the existing research regarding nursing guidelines and symptom-specific recommendations for LARS self-care.

METHODS

A systematic scoping review using 4 comprehensive databases (ProQuest, EMBASE, PubMed, and Web of Science) was completed using the PRISMA Extension for Scoping Reviews guidelines. Applying specified search terms, relevant articles were extracted using criteria and entered into an Excel database.

RESULTS

Three publications met the study inclusion criteria: 1 randomized controlled pilot study; 1 nonrandomized, retrospective pilot study; and 1 retrospective, comparative, cross-sectional study. No professional nursing guidelines were found, but 3 nurse-led management programs were reviewed. Publications provided self-care nursing recommendations for all LARS symptoms except for repeated painful stools/tenesmus, soiling, or discrimination disorders/flatulence. Combination of nursing self-care recommendations included dietary/lifestyle modifications, fiber supplements/bulking agents, antidiarrheal and laxative over-the-counter medications, and pelvic floor muscle exercises.

CONCLUSIONS

When mapping the literature, there appears to be nurse-led management programs and recommendations for self-care for patients with LARS for almost all symptoms. Yet, there are no standardized recommendations.

IMPLICATIONS FOR PRACTICE

Professional nursing practice guidelines for all symptoms are lacking. Nursing recommendations for self-care of LARS exist and need to be expanded and standardized to include all symptoms. Further research regarding comprehensive nursing self-care recommendations and management is warranted.

Nurses' adoption of diabetes clinical practice guidelines in primary care and the impacts on patient outcomes and safety: An integrative review

BACKGROUND

Complications related to diabetes mellitus impose substantial health and economic burdens to individuals and society. While clinical practice guidelines improve diabetes management in primary care settings, the variability in adherence to these guidelines persist. Hence, there is a need to comprehensively review existing evidence regarding factors influencing nurses' adherence to implementation of clinical practice guidelines to improve clinical care and patient safety.

OBJECTIVE

This integrative review seeks to investigate nurses' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes.

METHODS

A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311).

RESULTS

The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care.

CONCLUSION

Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes.

TWEETABLE ABSTRACT

In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.

Nurse-led clinics in primary health care: A scoping review of contemporary definitions, implementation enablers and barriers and their health impact

AIMS

To define nurse-led clinics in primary health care, identify barriers and enablers that influence their successful implementation, and understand what impact they have on patient and population health outcomes.

BACKGROUND

Nurse-led clinics definitions remain inconsistent. There is limited understanding regarding what enablers and barriers impact successful nurse-led clinic implementation and their impact on patient health care.

DESIGN

Scoping review using narrative synthesis.

METHODS

PubMed, MEDLINE, Web of Science, Scopus, CINAHL and PsycINFO were searched to identify nurse-led clinic definitions and models of care between 2000 and 2023. Screening and selection of studies were based on eligibility criteria and methodological quality assessment. Narrative synthesis enabled to communicate the phenomena of interest and follows the PRISMA for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS

Among the 36 identified studies, key principles of what constitutes nurse-led clinics were articulated providing a robust definition. Nurse-led clinics are, in most cases, commensurate with standard care, however, they provide more time with patients leading to greater satisfaction. Enablers highlight nurse-led clinic success is achieved through champions, partners, systems, and clear processes, while barriers encompass key risk points and sustainability considerations.

CONCLUSION

The review highlights several fundamental elements are central to nurse-led clinic success and are highly recommended when developing interventional nurse-led strategies. Nurse-led clinics within primary health care seek to address health care through community driven, health professional and policy supported strategies. Overall, a robust and contemporary definition of nurse-led care and the clinics in which they operate is provided.

RELEVANCE TO CLINICAL PRACTICE

The comprehensive definition, clear mediators of success and the health impact of nurse-led clinics provide a clear framework to effectively build greater capacity among nursing services within primary health care. This, in addition, highlights the need for good health care policy to ensure sustainability.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial

BACKGROUND

The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control.

AIM

To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels.

METHODS

We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test.

RESULTS

One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater.

CONCLUSION

The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.