Diabetes Australia Company - Essay Example

Lisa-Maree Cunningham No: s192312 NUR314 Foundations of Inquiry in Health Care Research Proposal Assignment: 3 Words: 2000-3000 Due 29th August 2009 Page: 1.0 Introduction................................................................................................................ 3 1.1 Research aim (via a hunch).......................................................................................... 3 1.2 Literature review.......................................................................................................... 3 1.3 Critique of relevance of research................................................................................. 1.4 Significance of the research........................................................................................ 1.5 Research question...................................................................................................... 2.0 Method...................................................................................................................................... 2.1 Research approach........................................................................................................ 2.2 Research design............................................................................................................ 2.3 Instrument for data collection...................................................................................... 2.4 Research participants.................................................................................................... 2.5 Data analysis.................................................................................................................. 2.6 Strategy for effective response rate.............................................................................. 3.0 Ethical consideration ............................................................................................................. 3.1 4.0 Limitations ............................................................................................................................... 4.1 5.0 Reference List ......................................................................................................................... 6.0 Appendices............................................................................................................................. 6.1 Survey Questionnaire............................................................................................... What factors influence a diabetic client to implement ‘effective’ foot care? Introduction 1.1 Research aim (via a hunch) Diabetes Australia continually strives to prevent and find a cure for diabetes. It provides information and education devised of evidenced-based research for the diabetic client in relation to hygiene and foot care. Complications associated with Diabetes Mellitus include neuropathy and impaired circulation to the feet causing impaired circulation to the lower extremities possibly resulting in lower leg amputation (www.diabetesaustralia.com). Diabetes Mellitus is an incurable chronic disease and is a debilitating health problem which is increasing worldwide. Extreme outcomes can leave the person disabled causing further strain on healthcare costs due to a high incidence of amputations requiring rehabilitation programs (Dunning, 2005) The purpose of this research proposal is to investigate the attitudes and experiences of the diabetic client and to establish which factors prevent effective foot care and compliance. Thus, enhancing the nurses’ understanding of the patients perceptions of the disease and what influences their lifestyles in order to meet compliance or non-compliance toward a holistically devised treatment plan as well as establishing client autonomy to implement effective foot care are the goals of this project(Greenwood, 2000). 1.2 Literature Review ‘Patients with diabetes are vulnerable to damage to their feet, and minor problems can deteriorate rapidly’ (Clapham, 1997, p. 851). The successful management of diabetes requires the adherence of a patient to a prescribed self-care plan. This often presents a challenge to health care professionals in order to ensure that the plan of care is implemented. The framework for this literature review is multilevel, moving from the global aspect of diabetic complications, to the more specific aspects of patient’s attitudes and experiences in relation to education and compliance, focusing on the foot care problems experienced by the diabetic client. As the topic of diabetes and lifestyle is reviewed, it is impossible to discuss the complications and implementation of foot care without including the major intervention of patient education. Gallichan (1997, p. 100) states, ‘Diabetic foot problems are usually preventable, through education, early intervention and treatment’. On review of the articles it appears that there is still a strong educational focus on the importance of adhering to adequate foot care guidelines. Johnson et al, (2005) suggest that whilst there are a variety of education programs available incorporating lifestyle adjustments, often they only feature foot care as a small component because there is so much information to comprehend in relation to the range of complications. Fishman et al (1996) and Popoola et al (2005) focus on teaching the diabetic general foot care guidelines together with the physical aspects related to prevention strategies concerning foot care. Gallichan (1997) emphasizes the fact that patients should be educated and encouraged to examine their feet for the early signs of common foot problems. Clapham (1997) supports this view and also believes that by educating both patients and health care staff, infections and amputations may be avoided. Popoola et al (2005) and Gallichan (1997) suggest that nurses have an important role to play in any practice setting; they can be instrumental in assessing, making recommendations, and educating the patient and significant others about foot disease as it relates to the condition of diabetes. Clapham (1997) suggests the importance of educational and interactive sessions with the diabetic patient by providing ‘an informal, non threatening atmosphere to encourage questions and the airing of any fears or anxieties’ (Clapham, 1997, p. 852). This view taken by Clapham (1997) is the basis for the research planned, in which regular communication with the patient will determine what influences them to implement good foot care. Gallichan (1997) reinforces this by suggesting that nursing intervention and interaction together with education of the person with diabetes may increase independence and also assist to prevent long term complications of the diabetic condition. On review of the literature available it remains obvious that the education of the patient remains a vital component of patient care, it is also demonstrated that it does influence the implementation of foot care for the diabetic individual. Another important issue to consider when reviewing the implementation of foot care is the topic of compliance, what influences the diabetic client to compliance or non-compliance of their treatment regime. Johnson et al., (2005) state, ‘although diabetic patients are aware of the risk factors for foot ulcers, they do not consider themselves to be at risk’. If patients tend to deny the existence of this serious complication, they often have disastrous results, consequently presenting the nurse with a challenge as to how to provide proper education (Clapham 1997). Throughout the literature it can be seen that patient attitude and perception has a serious effect on the compliance of a patient to a treatment plan, hence the development of the research question to further understand the patient experiences. Another important issue to consider when reviewing compliance is the decision of who is ultimately responsible for the individuals care. Clapham (1997) believes that personal responsibility for the implementation of foot care should be emphasized to all patients. Patients should be encouraged to recognise that they play a vital role in providing their own foot care and that the responsibility for their feet falls on to them themselves. If a review of psychosocial aspects and barriers combined with these issues was conducted and addressed at the commencement of patient education, this may influence and increase the compliance of the diabetic individual. Weigner (2006) believes that the identification of factors influencing self-care behaviours is an essential theme in compliance and the patient education for the diabetic patient. The personal perception of the diabetic client also appears to influence the implementation of foot care. Dunning and Martin (1998) and Weinger (2006) found that beliefs and attitudes together with perception and feelings of an individual, combine to present complex issues, which can have a major influence on the way individuals respond to and manage their condition. Although these important issues are mentioned in the literature they are not a comprehensive review of the perceptions of a diabetic client. This research approach aims to explore the attitudes and experiences of the diabetic client in relation to foot care and compliance from an Australian perspective. Clapham (1997) suggests that diabetic foot care is expensive in terms of health resources and also financial and social costs to patients. There are many important elements to consider together with the fact that actions and the omissions of nurses can have a significant impact on the quality of life of people with diabetes (Gallichan 1997). As the issue of diabetic complications is reviewed it would appear that a reduction in complications may result in improved quality of life for diabetic individuals and also savings to the health budget within Australia. If throughout a chronic illness the diabetic individual implements foot care, this may result in the prevention or reduction of long-term diabetic complications. 1.3 Critique of relevance of research Diabetic clients face a serious risk of foot disease which could lead to amputation (www.diadetesaustralia.com). The information and education available to these clients may not be effectively implemented by the person due to numerous reasons being investigated by this research. Jarvis (2008, p. 547) recommends that ‘health care providers should not only remember to examine the feet for common foot problems but also be prepared to explain and demonstrate what ‘good’ foot care really means’. Therefore this study will be conducted in a qualitative manner as suggested by Burns and Grove (1997) as this approach ‘appears to be a more effective method of investigating emotional responses rather than the quantitative method’ which according to Nieswiadomy (1993) has a focus on a group or population and not on the individual. Interviewing the client using a qualitative approach provides a more precise understanding of the client’s views, feelings and perceptions regarding how to implement effective foot care (Burns and Grove, 1997). This can be established by firstly ascertaining the client’s initial understanding of foot care and demonstrating effective foot care as recommended by Jarvis (2008), enhancing the knowledge of the client. 1.4 Significance of the research Evidence purport there is still a relatively high incidence of foot amputation in existence despite reports that effective foot care can prevent amputations (Gallichan 1997). The management of diabetic clients and effective foot care appears to be commonly neglected causing disabling consequences that could be prevented if the factors influencing effective foot care were established (Rith-Najarian, 1999). Therefore the significance of this research topic is to investigate the issues influencing effective foot care for the diabetic client in our communities, establishing an insight from the client’s point of view, providing reasons why there remains a high incidence of diabetic foot problems and amputations in an educated health care system. This will be conducted using a qualitative research approach as described by Oiler Boyd (1993) ‘in naturalistic settings and involves close, often sustained contact between the researcher and research participant’. 1.5 Research question According to Polit & Beck (2006, p 127) ‘a research question states the specific query the researcher wants to answer to address the research problem’. This research study asks “What factors influence a diabetic client to implement ‘effective’ foot care?” Method 2.1 Research approach – qualitative. The most effective way to measure human emotions and narrative information in conversations with the client is by using a qualitative approach. Polit and Beck (2006, p37) explains that ‘in qualitative studies, researchers collect primarily qualitative data, which are narrative descriptions. Narrative information can be obtained by having conversations with participants, by making notes about how participants behave in naturalistic settings, or by obtaining narrative records, such as diaries’. This will establish a research design in the format of a client survey to be conducted as a one-on-one interview between researcher and participant. A structured Interview survey containing qualitative data is enclosed in Appendices A. 2.2 Research design Polit & Hungler (1997, p.18) suggest that ‘qualitative researchers often conduct a study to examine phenomenon about which little is known’. The survey to be carried out in this instance resembles the phenomenon that little is known about factors influencing the diabetic client implementing effective foot care. Hence the high incidence of amputations acknowledge by Gallichan (1997). This research design is a one on one interview exploring the attitudes and experiences of the diabetic client in an area where there appears to be minimal information. Schneider et al (2003, pp. 140-1) describes ‘the advantage of using a qualitative approach is that the phenomenon may be studied holistically and contextually. There is a focus on human experience, and it is possible to develop a rich description and deep understanding of the phenomenon under investigation’. This appears to be the appropriate approach, as the broad focus of this study and the findings are influenced by the researcher’s values and perceptions. This approach assumes that subjectivity is essential to enable understanding of human experience (Burns & Grove 1993). Therefore a qualitative method can be justified in this research as the most appropriate attempting to obtain valuable information from the client’s experiences. 2.3 Instrument for data collection Data collection will be carried out as part of a qualitative research survey. The survey will be conducted as a one-on-one structured interview recorded using an audio tape. Schneider et al., (2003, p. 180) suggest that ‘one of the characteristics of qualitative research is that it involves a close relationship between the researcher and participant’. The interviews will be conducted over a time period established by each individual client’s needs. One-on-one interviews are private and an ideal setting for the discussion of an emotional topic. A group interview might discourage participants to share information or allow little chance to speak if the group exists of outspoken participants; this can make the survey both ineffective and unreliable. Therefore one-on-one interviews are ideal as this method enables the researcher to really listen and watch both verbal and non-verbal responses the participant may express. This allows the researcher to gather more in depth data as a result, ‘recognising the existence of multiple realities’, as recognised by Schneider, (2003, p. 179) 2.4 Research participants When selecting research participants Stringer & Ganet (2004 p 199) explains ‘often it is not possible to work with all individuals in a context because of constraints of time or resources. It is sometimes necessary to focus attention on a smaller number of people to explore their experience in depth and to reveal with clarity the elements and features of experience that have a significant impact on events’. The participants selected for this study will be people diagnosed with Diabetes Mellitus, as these participants currently experience the phenomenon being studied and their ability to articulate their experience is appropriate. Sourcing the participants could be obtained through doctor’s that have diabetic patients or specialists in diabetic care that are willing to participate and encourage their specifically selected patient’s to participate in the research. The age of participants targeted for the survey would be over the legal age of 18, so they are able to make a choice t whether to participate or not. Schneider (2005, p.197) confirms ‘the richness of the data collected is more important than the number of participants in the study’. 2.5 Data analysis ‘The purpose of data analysis is to sift through the accumulated data to identify the information that is most pertinent to the issue on which the study has focused’ Stringer & Genat (2004, p 194). The research tool for the study of the diabetic client will focus on emotional factors and concentrates on compliance and non-compliance to autonomy of self-care. Data analysis reveals how people make sense of their experience and utilises these understandings to enact positive change in their lives. ‘The focus of interpretive research on meanings people give to themselves and their life experiences requires researchers to capture the voices, emotions, and actions of those studied in order to acquire an empathetic understanding of another’s life experience’ as suggested by Stringer & Genat (2004, p 195). Therefore the research survey enclosed in (Appendices A) needs to be focused toward the diabetic client as a one-on-one interview to get the best result of data collection to be analysed. The nurse will need to be respectful and empathetic towards the client’s disclosure of private and sensitive information. 2.6 Strategy for effective response rate According to the National Health and Medical Research Council (NHMRC) 2007, qualitative research data is a commonly used approach in the format of interviews. ‘Interviews involve researchers talking to one or more participants, where the categories of response are focused but not necessarily pre-determined’. This research study will involve a one-on-one interview ensuring that the participant is able to engage with an in depth structured interview, recorded by audio tape ensuring to collect individual data that can be compared to other interviews of similar context. The NHMRC, 2007, states that ‘these records are research data in themselves, but may also be transcribed’. Schneider et al, (2003, p.189) explains ‘Qualitative researchers do not claim generalisation, the findings from qualitative research can inform nursing practice by the contribution of new insights about the phenomenon that concern them. Awareness of these insights can heighten the nurse’s sensitivity and understanding of the patient’s experiences of such phenomena, enhancing empathy’. The environment and targeted participants must be appropriate and carefully chosen and the research procedure free from prejudice with ethical consideration implemented in order to receive an effective response rate. 3.0 Ethical Consideration Ethical consideration needs to be implemented from the commencement of any research study and carried out throughout the course of the procedure. The objective is to ensure the participant is protected from any unethical implications that could affect the participant’s state of being. According to the NHMRC (2007), ‘researchers are to assess for risks their participants might suffer from prior to commencing research’. Failure to comply with ethical standards will represent scientific misconduct. Therefore it is imperative that the participant is informed of the research procedures, gives consent in writing, and is a willing participant to carry out the required steps to conduct the research study (Taylor et al, 2006). 4.0 Limitations Diabetes Mellitus is a chronic health care problem is ongoing and long term in duration. This can have disastrous effects for the client as the care needs to be continuous and over a lifetime. The client may become non- compliant toward the treatment due to these factors and a lack of patient education and autonomy of self-care impeded by expensive costs. Therefore the healthcare team needs to focus on the best treatment plan meeting the client’s individual circumstances also taking into consideration the environment and economic climate the individual resides in. The healthcare team also needs to consider chronic wound care and provide assistance through community health care services to provide patient education and cost effective treatment to prevent deterioration of an already serious foot disease. (www.diabetesaustralia.com.au) Throughout this research proposal the information gathered about the factors influencing a diabetic client to implement effective foot care were investigated focusing on the patient education and compliance. Gallighan (1997) stipulates that ‘the amputation rates are still too high’ regardless of the information and education available. Therefore it is important that we address this issue and research the topic in more detail. A review of the literature indicates that although there is a diverse range of information on diabetes available, the issue of what factors influence the diabetic client to implement foot care is not detailed from the perspective that this research approach has identified. The focus of this research is designed bring the diabetic client to the foreground, and involves listening to their attitudes and opinions and illuminates their experience, this type of research will collaborate with the existing information available to provide a holistic approach to patient care. 5.0 References: Australian Government: National Health and Medical Research Council, ‘National Statement on Ethical Conduct in Human Research(2007), Guidelines, 2007’, @http://www.nhmrc.gov.au/publications/ethics/2007_human/contents.htm, (sourced 25th August 2009) Australian Government: National Health and Medical Research Council, ‘National Statement on Ethical Conduct in Human Research (2007), Chapter 3.1 Qualitative Methods, @http://www.nhmrc.gov.au/guidelines/index.htm, (sourced 25th August 2009) Burns, N. & Grove, S, K. 1993, The Practice of Nursing Research: Conduct, Critique and Utilisation, 2nd Edition, W.B Saunders Company, Philadelphia. Clapham, L. 1997, ‘Preventing foot problems in patients with diabetes’, Professional Nurse, vol. 12, no. 12, pp. 851-3. Dunning, T. 2005, ‘Assessment and Management of Patients with Diabetes Mellitus’, in M. Farrell, (2005 Edition), Smelter & Bare’s Textbook of Medical-Surgical Nursing, Lippincott Williams & Wilkins Pty Ltd, Broadway Fishman, T, D. Freeline, A, D. & Kahn, D. 1996, ‘Putting the best foot forward’, Nursing, vol. 26, no. 1, pp. 58-60. Gallichan, M. 1997, Promoting Health in the Older People with Diabetes’, Professional Nurse, vol. 13, no. 2, pp. 96-100. Greenwood, J (2000), Nursing Theory in Australia, Prentice Hall, Frenchs Forest, Chapter 8. http://www.diabetesaustralia.com Johnson, M, Newton, P, Jiwa, M & Goyder, E. 2005, ‘Meeting the educational needs of people at risk of diabetes-related amputation: a vignette study with patients and professionals’, Health Expectations, vol. 8, pp. 324-33. Nieswiadomy, R, M. 1993, Qualitative Research Designs’, Foundations of Nursing Research, Appleton & Lange, Connecticut, pp. 149-65. Oiler Boyd, (1993), in Schneider, Z, Elliot, D, Lobiondo-Wood, G & Haber, J (2003) Nursing Research: Methods, Critical Appraisal & Utilisation, Mosby, Sydney, Chapter 9 Polit & Beck Polit, D, F. & Hungler, B, P. 1997, ‘Sources of Knowledge’, Essentials of Nursing Research Methods, Appraisal and Utilisation, 4th Edition, Lippincott, Pennsylvania, (pp. 10-11) Popoola, m, Jenkins, L. & Griffin, O. 2005, ‘Caring for the Foot Mobile: Holistic Foot and Nail Management’, Holistic Nursing Practice, vol. 19, no. 5, pp. 222-7. Rith-Najarian, S 1999, ‘A Program of Foot Care to Reduce Diabetes Related Amputations’, American Family Physician, vol.59, no. 2, pp 449-50 Schneider, Z, Elliot, D, LoBiondo-Wood, G & Haber, J (2003) Nursing Research: Methods, Critical Appraisal & Utilisation, Mosby, Sydney, Chapter 9 Schneider, Z, Elliot, D, LoBiondo-Wood, G & Haber, J 2005, Nursing Research: Methods, Critical Appraisal & Uilisation, 2nd Edition, Mosby, Sydney Stringer and Ganet Taylor, B, Kermode, S. & Roberts, K. 2006, Research in Nursing and Health Care: Evidence for Practice, 3rd Edition, CENGAGE Learning, Victoria, Australia. Weinger, K. 2006, ‘Keeping up with the elderly: implications for diabetes education’, Diabetes Spectrum, vol. 19, no. 4, p. 194. Read More