Adolescents Having Type 1 Diabetes - Research Proposal Example

Research Proposal, Nursing The need to comprehend the factors that affect the rate of adherence to long terms treatment procedures by patens is imminent in the medical profession. This research proposal proposes a research that will be geared towards comparing two strategies used to motivate patients to adhere and comply to treatment, with an aim t see which is more effective when used on adolescents having type 1 diabetes. The study will seek to find out whether there are other factors that affect the same. Table of Contents Abstract 2 Chapter 1: Introduction 3 Research question 5 Hypothesis 5 Chapter 2; Literature review 5 Chapter 3: Methods 9 Sampling 9 Identifying the participants 10 Number of participants 11 Ethical Considerations 11 Instruments 12 Interviews 12 Questionnaires 12 Clinical observations 12 Chapter 4: Data Analysis 13 References 15 Chapter 1: Introduction One of the biggest problems with long terms medication is that the patient may not be willing to adhere or conform to the treatment. This hinders any improvement in the patient because for the treatment to be effective, the patient has to adhere to the letter with regard to medication. Adolescents are more likely to fail to adhere to medication. Yet, this medication process has a fundamental impact on their health outcomes. Nurses and other health professionals have to come up with strategies to make sure that these adolescents are motivated and encouraged to adhere to medication. There are two main ways in which this can be done. The first one is peer group education and the second one is nursing education and teaching. For adolescents who are suffering with type 1 diabetes, it is absolutely necessary for them to be able to adhere to treatment. This study seeks to know which of the two named methods of improving adherence to treatment is more useful over the other, or they are equally effective. This is important in that in the modern world, there are a lot of adolescents who are living with type 1 diabetes as compared to the past where diabetes was majorly suffered by much older people. The issue in this case is the fact that these adolescents are more likely to have negative attitudes towards the need to strictly adhere to the treatment process, especially because this to them looks like a never ending process that seems to interfere with their lives. Treatment for type 1 diabetes requires these adolescents to not only take medication on a regular basis but also interferes with their lifestyle with regard to what they can eat or drink. This is a big problem for this class of patients because they feel that the treatment process is a nuisance to them and especially when such treatment makes it harder for them to be able to go on with their social life. In this regard, it is very evident that the need for a way to motivate and encourage these adolescents to adhere to the medication for type 1 diabetes is eminent and cannot be avoided if better results are to be achieved. Nurses and medical practitioners however have to know which the better way to motivate these adolescents to adhere to medication and treatment procedures is. Peer group education and nursing education and teaching are the two main ways in which these adolescents can be motivated to improve treatment adherence for treatment for type 1 diabetes. The purpose of this study will be to identify which of the two methods is likely to be most suitable for the adolescents in order to make sure that nurses and medical practitioners can use the method that is most effective in delivering healthcare for such patients. Research question In adolescents with type 1 diabetes, will there be a difference in treatment adherence between those who take part in peer group education and those who receive nursing education and teaching. Hypothesis This study will operate under the hypothesis that the adolescents who are involved in peer group education for treatment of type I diabetes are more likely to have higher rates of adherence to treatment than those who receive nursing education and teaching. Chapter 2; Literature review There have been various studies that have been done with regard to the issue of treatment adherence in various diseases that require long term care. These studies have investigated a number of strategies for encouraging the patients to adhere more strictly to the treatment procedure. According to Carlsson (2014 ), it is necessary for patients to be motivated to use the various ways to be able to increase their compliance or adherence to treatment procedures with regard to treatment processes that take long time. At the same time, as Jimmy and Jose (2011) argues, it is providing support and motivation for patients who are involved in the kind of treatment where the nurse of doctor does not have total control of the treatment process is also a good way to make sure that the patient does not deviate from or ignore the instruction of the doctor or he nurse. George (2008) also argues that there is a need to make sure that the patient are motivated in order to make sure that they not only understand but also comply to the treatment procedures and requirements. Ugochukwu, Uys, and Karani (2013) also identified that nurses have a very big role in enhancing the adherence of patients to treatment procedures and that this can be improved by the use of such strategies as the peer group education and nursing education and teaching. They argue that since the nurse is the most reachable contact that the patient has, it is necessary for the nurse to go beyond just giving the doctor’s prescription to the patient and therefore look for way to help the patients to be able to adhere to the patient.Hartigan (2007) identified that peer group education is very useful in helping young patients to be able to adhere to the treatment process and instructions. She identified that the problem with adolescents and young adults is that they are highly affected by their peers. For instance, a young person is likely to fail to adhere to treatment requires due to peer pressure from the colleagues. For diabetes patients, the patient is likely to ignore the doctor’s instruction not to eat certain foods, or ignore the doctor’s instruction to each certain foods, because they want to fit in with their groups. This issue of peer pressure is an enemy to the issue of adherence among teenagers and adolescents. However, the same issue of peer influence can be used by nurses positively in order to help increase adherence of the adolescent patients to treatment requirements. Involving these patients in peer group education can be very important in helping them to be able to not only feel that they are not alone in their situation but cal also help them with low self esteem that may come with the need to use such treatment. According to McDonald et al (2002), having these patients participate in such peer group education and peer group support helps the patent, especially the adolescents to be able to overcome any stigma that may be associated with the treatment they are going on. In this regard, it is clear that where a patient has to take long treatment procedures, these patients always suffer not only from the disease that is being medically treated, but from physiological issues that come with the issue of having to be in treatment. This can heavily affect the way a patient is able or willing to adhere to the treatment procedures. It is crucial in such a case to ensure that the patient is supported in the best way possible and so peer support and peer education is necessary (Levy, 2000). In fact, peer group education in such an instance can be said to have at least two positive impacts on the patient. The first it is social support. When the patient is involved in such peer group education, the feel that they are not along in their predicament and that offers them social and psychological strength to be able to face their situation. Secondly, it becomes easier for the patient to be able to learn. According to learning theories, people are more likely to learn better and faster when they learn from their peers as opposed to when they have to learn from people who are superior to them. In this case, when a nurse gives the patients the instruction on how the medication is supposed to work, the patent are likely to be less interested and this has a negative impact on how the patient will be able to adhere to the standards. However, when the teaching and education about the disease, its impact and the necessity to adhere to treatment procedures are given by a peer, the students are more able to understand and to adhere to treatment procedures. This indicates that it is very necessary for peer group education to be used as a way to increase the adherence level for the students. The other strategy that can be considered for encouraging he patients (adolescents with type I diabetes in this case) to be able to adhere to treatment procedures is the use of nursing education and teaching to help the patients to understand how the treatment should work and the consequences of not adhering to the procedures. According to Jimmy and Jose (2011) nursing education and teaching play a very important role in increasing the patent adherence to the treatment process. At the same time, there is a need to make sure that this is used in a timely and in an effective way. How nursing education and teaching is used may not be effective for all types of patients. The patient’s demographics can be very vital in determining how effective it is going to be to motivate the patients to adhere to the treatment procedures. These demographics include the age, sex, economic and social class of the patient. In this case, when being used for adolescents, it may need some care to be taken to know whether it will be effective with this class of demographics. Nursing education and teaching is definitely different from the use of peer education in that in nursing education and teaching, the element of peer support is removed and the patient will feel that he or she is being patronized. The use of nursing education and teaching is important but ail lot be able to look into the issue of helping the patients to do away with the issue of self esteem and confidence. However, as George (2008) says, the importance of nursing education and teaching cannot be underestimated because it plays a big role in creating useful awareness by the patient and thus helping in improving the rate of adherence to the treatment procedure. In this regard, this is also another viable way to help the patient to adhere to the treatment. As Hartigan (2007), nurses have to know that such long and sometimes life-long treatments for patient can be devastating to the patient and therefore the patient may sometimes feel that they want to have a break. Motivating the patient to stay on course with treatment may take more than just words of encouragement and this is where nursing education and teaching come in. When the patient is involved in the nursing education and teaching, they are better able to understand the need for them to adhere to and follow strictly the treatment requirements. This is more important especially with regard to treat that takes more than just medication and goes to the issue of the kind of foods that a patient takes, or is not supposed to take. This is the case with the diabetes type one where the patient will not only be needed to take some medication but is stopped to be very careful with regard to the types of food they must or must eat. For the patient to be able to adhere to the treatment requirements, they may need extensive training on diet and nutrition so that they can know how to make the right choices. This then becomes a very important aspect of the treatment mode and it can be argued that nursing education and teaching has a fundamental impact on patient adherence to the treatment because the patients needs this training and information in order for them to know why they are being asked do certain things. For adolescents for instance, they may not be able to fully comprehend why they are being asked to refrain from certain types of food in relation to their diabetes type one. Without the property information given to such young patient with regard to how failing o observe the dietary requirement given by the nurse, they may have the tendency to think ha the dietary recent are not very important and therefore ignore them. However if the patients are helped with nursing education and teaching, they are more able to make more informed decisions and therefore their possibility of adhering to treatment procedures. Chapter 3: Methods To carry out the study, a quantitative approach will be used in order to gather the data that will be utilized for analysis. Sampling A random probabilistic sampling method will be used to get the participants who will represent the larger population. This will aid in ensuring that the participants are as much a representation of the larger population as possible. The advantage with this study is that it is not a study of the whole population but a section of the population; that is, adolescent with diabetes type one. Instead of sampling in the general population, the sampling will be done in healthcare centers where information about such participants will be easily accessible. A number of hospitals will be used in order to try and distribute the probability as much as possible. The need to distribute the sample across more than one hospital is that there may be other factors that may affect the effectiveness of each of the two methods being investigated. As stated in the introduction of this research proposal, the research being proposed will be investigating where there is a difference in the effectiveness of two strategies for motivating he patients to adhere to the treatment procedure for the diabetes type one. These two methods include the peer group education and nursing education and teaching. Identifying the participants Participants will be reached and told about the study with an aim to invite them to participate the study. Those who will be interested will be shortlisted to anticipate in the study. Scone most of these patients under investigation are adolescents which mean that they are minors, it will be necessary for their parent’s permission to be acquired before involving them into the study. As a result, the parents will also be informed about the study and what it intends to achieve. In the process of informing the parent and the patients, necessary measures will be taken in order to make sure that they are as informed as possible but without at the same time giving too much information that can interfere with the results of the study. For instance, the patients will not be told that they are being compared in order to see who is more capable of adhering to the treatment procedures. This will guarantee the integrity of the data and will help in making sure that the results of the study can be said to be valid. Once all the permission have been taken, further sampling will be done in order to remove an eliminate those who are more likely to provide relevant data. For instance the participants who will be chosen will be those who are just beginning their treatment as opposed to those who have been in treatment for a long time. Of course, those who are involved in these two months of motivation will not be considered because this will not offer a very good chance for comparison. Once the final cohort has been indentified, they will be observed for three calendar months while monitoring their progress as well as their adherence in the treatment process. Number of participants The number of participants for each group will be kept at around 20-30 participants in order to make sure that even if some of the participants drop out during the time of the study, there will be enough data for the analysis. Ethical Considerations There are a number of ethical considerations that will need to be considered in order to ensure that the study is done within the ethical requirements. The ethical requirements are with regard to doctor-patient confidentiality. Every doctor has a liability to make sure that he does not reveal the patient’s information. In this regard, extra measure will be taken to make sure that this is not broken and that there is a need to make sure that the patient’s information is well protected. The other ethical issue that will be taken into consideration is how this is likely to affect the patients treatment. Even as the study is being taken, it is necessary to make sure that the study will not interfere in a bad way with the treatment of the patients. The study must go on without interfering with the treatment of the patients. It is also important to make sure that the study is done in a very careful way in order to ensure that the results are valid and reliable. The study will inform some important decisions in the future with regard to the method of motivation that is going to be used to motivate the patient to adhere to the treatment procedure strictly. If the study is done in the wrong way and the results give wrong information about which meth dos more effective to achieve this, it is going to be a loss to the cause. Instruments The study will use a number of instrument to complete the study and for data gathering. These will be as follows; Interviews Interviews will be carried out with the participants in order to identify crucial information about how the patients are dealing with the disease. The biggest problems here will be the fact that most of the patients, due to fear, may tell incorrect information. This would badly affect the validity of the study. Questionnaires Questionnaires will also be used to collect the quantitative data that will be used for the study. This will be necessary in mankind sure that there is enough data for the study. Questionnaires will be designed before the actual study starts. Pilot questionnaires will be designed and tested by just a few participants in order to detect any problems that may arise with the questioners. Clinical observations Clinical observation will be the most reliable source of data for the study. These clinical observations will provide quantitative data about how the patients are progressing with regard to the disease of which they are being treated. As a result, the study will focus very much in this data and use it for analysis. As far as the other methods of data collection are also good ones, clinical observation will also be very necessary for this study. However, here is the point where ethical issues must be considered, especially with regard to the issue of doctor-patient confidentiality. Even as the clinical observations are used as part of the data for this stud, it will be necessary for extra caution to be taken in order to ensure that the privacy of the patient has not been violated. This will necessary to make sure that the patient is protected. To achieve this, the participants along with their guardians will be informed about it and be clearly and explicitly informed about the precaution that will be taken to make sure that there are no violations of personal private information. Additionally, they will be informed that they have the right to decline to be involved in the study, or they can chose how much they want to be involved in the study. Chapter 4: Data Analysis The collected data will be analyzed for various types of trends in the data. To begin with, the data will be compared between those using peer group education and those who receive nursing education and teaching in order to identify which had the highest propensity to treatment adherence. This test will provide a simple yes/no answer as to whether one is better than the other and which one is the better one. Further statistical analysis will be carried out on the data to make sure that other trends are observed and this will be necessary to make sure that the data is valid. After the first analysis, the data will be tested further for more trends such as whether there are differences between the different patients in different hospitals. This will be necessary to ensure that any discrepancy on the data can be detected. More tests will also be done n the data to reveal more trends. For instance, the data will also be tested to see if there are any differences between the two genders, that is; male and female. This can be very important because the results can show that males or females are between off with one or other of the two. While the general results can indicate that one of the methods being investigated is more effective in motivating patient adherence to treatment, further analysis can indicate that when one gender is considered at a time, the results are different. In this case, the age issue will be considered as one of the data analysis requirements. At the same time, age will also be considered. Because the study will be looking into adolescents, it is necessary to note that adolescents can be anyone between the age of 12 to about 19. In this case, this is a very large age range and it is possible that the way the younger adolescents are affected by each of these methods is different. This will therefore be tested in order to have a clearer and broader picture of the data so collected. All these tests will be analyzed in order to come up with a final analysis in order to know which of the two methods being investigated is better than the other in terms on motivating the adolescents diabetes type 1 patients to be more adherent in their treatment processes. This will make it easier for the study to have a better and more authoritative conclusion with regard to the issues being investigated. It will also be a better way to understand whether there are other factors apart from the strategy of motivating the patients to adhere to the treatment used, that affect the rate of adherence to treatment among this patients. References Carlsson, M. e. (2014 ). Nurses’ Roles and Experiences with Enhancing Adherence to Tuberculosis Treatment among Patients in Burundi: A Qualitative Study. Tuberculosis Research and Treatment, 9 , pp. 78-87. George, L. (2008). Self-determination and compliance in directly observed therapy of tuberculosis treatment in the Kingdom of Lesotho. Social Work in Health Care, 46, 4 , pp. 81–99. Hartigan, K. (2007). Patient Education: The Cornerstone of Successful Oral Chemotherapy Treatment. Clinical Journal of Ontology, 7, 6 , pp. 21-24. Jimmy, B., & Jose, J. (2011). Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal, 26, 3: 155–159. , pp. 155–159. . Levy. M.L, & al, A. J. (2000). A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. . Respiratoty Medicine, 94 , pp. 900-908. McDonald, P. e. (2002). Interventions to Enhance Patient Adherence to Medication Prescriptions. The Journal of American Medical Association, 288, 22 , pp. 2879. Ugochukwu, C., Uys, L., & Karani, A. (2013). Roles of nurses in Sub-Saharan African region. International Journal of Nursing and Midwifery, 5 , pp. 117–131. Read More