Patients have unwritten duties: experiences of patients with type 1 diabetes in health care

The interplay between patients and healthcare professionals in a cross-sectoral setting in connection with the treatment and care of patients with diabetic foot ulcers: a realistic evaluation

BACKGROUND

Diabetes-related lower extremity complications such as diabetic foot ulcer (DFU) are a global disability burden. Treatment and care for patients with DFU call for a multisectoral approach that incorporates interdisciplinary care pathways. We aimed to explore the interplay between patients with DFU and healthcare professionals in cross-sectoral settings that address treatment and care and to determine "what works, for whom, and under what circumstances".

METHOD

The study was designed as a realistic evaluation. The data were generated from September 2022 to March 2023 and drew upon approximately 60 h of participant observation of 14 patients during the treatment and care of DFUs in their homes (primary care) and/or at outpatient clinics (wound specialist clinics in a hospital setting) in a Danish cross-sectoral setting. The Standards for Reporting Qualitative Research (SRQR) were applied in this study.

RESULTS

We identified three illuminating themes that described the interplay between patients with DFU and related healthcare professionals representing both primary and secondary health care systems: (1) humour is a relationship-enhancing element between nurses and patients; (2) support from patients' coping strategies promotes patient-centeredness and collaboration; and (3) patients and professionals occupy unnegotiated identity roles.

CONCLUSION

Our study led to a refined programme theory developed through the realistic evaluation process that allows us to propose an answer to the problem of "what works, for whom, and under what circumstances". The interplay between patients with DFU and healthcare professionals in a cross-sectoral setting for treatment and care is characterised by the use of humour as a relation-enhancing element and by improving support for patient coping strategies, which encourages healthcare professionals to promote health literacy. Future research should examine strategies for negotiating identity roles between patients with DFU and healthcare professionals to enhance collaboration, patient health literacy, and health promotion in cross-sectoral healthcare settings.

Type 1 Diabetes Management and Health Care Experiences Across Rural Nebraska

INTRODUCTION

This study aimed to explore the unique health care needs of rural Nebraska families with a child with type 1 diabetes mellitus (T1DM).

METHOD

Using a phenomenological approach, the researchers conducted four focus groups across Nebraska. The focus groups gathered input from children, caregivers, and health care providers (n = 23). The researchers coded data and generated themes. Member checking, researcher triangulation, reflexivity, a thick description of the process, and an audit trail established trustworthiness.

RESULTS

Four themes emerged: dramatic family and lifestyle changes following diagnosis, lack of access to specialized care resulting in complications, isolation improved health management resourcefulness, and technology improved health management and flexibility.

DISCUSSION

Lifestyle changes persist after a child's diagnosis with T1DM. Rural families reported unpredictable health status of their child, reduced health care services, and limited information access. Conversely, limited specialty health care access, resources, and community support led to creative self-education, advocacy, and health care management strategies. Diabetes technology offered opportunities for improved provider-patient communication and continuous glucose monitoring.

Survey on the Necessity, Sensibility, and Timing of Psycho-Oncological Counseling and the Willingness to Discuss Various Topics During the Inpatient Stay in the Case of Breast Cancer

After the diagnosis of cancer patients require a lot of information because the disease affects all aspects of life. Some important issues regarding optimal counseling remain to be determined. This includes the time-related relevance of various topics and questions regarding who and when to consult on the topics. We analyzed the answers of 155 women with non-metastatic breast cancer undergoing primary surgery, primary chemotherapy, and having completed adjuvant treatment regarding the above-mentioned issues. We found that counseling must consider the treatment situation. Breast cancer patients in the follow-up phase reported that they preferred being counseled by female consultants. Our results largely support a counseling concept which puts the breast care nurse at the center of interest rather than psychologists and social service workers. A breast care nurse centered counseling system for women with non-metastatic breast cancer appears to meet patients' needs best.

Developing a scale: Adolescents' health choices related rights, duties and responsibilities

BACKGROUND

Adolescents' health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties, and responsibilities, have been disregarded and scale is required to measure these.

OBJECTIVE

To describe the development of a scale that measures adolescents' rights, duties, and responsibilities in relation to health choices and document the preliminary scale testing.

RESEARCH DESIGN

A multi-phase development method was used to construct the Health Rights Duties and Responsibilities (HealthRDR) scale. The concepts and content were defined through document analysis, a systematic literature review, and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses, and researchers. We calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15-16 years. Descriptive statistics, Cronbach's alpha correlation, and statistics for the item-analysis were calculated.

ETHICAL CONSIDERATIONS

Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study.

FINDINGS

The Health Rights Duties and Responsibilities scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties, and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. Cronbach's alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were health choices (0.93), rights (0.97), responsibilities (0.99), and duties (0.98).

DISCUSSION

The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale.

CONCLUSION

The Health Rights Duties and Responsibilities scale defines and understands adolescents' rights, duties, and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed.

Living with type 1 diabetes as experienced by young adults

AIM

Describe young adults` (19-30 years) experiences of living with Type 1 Diabetes (T1D).

BACKGROUND

Young adulthood is characterized by adaption to adult roles, gradual separation from parental support and leaving the parental home. Living with T1D in young adulthood raises challenges and concerns.

DESIGN

This study has a qualitative design.

METHODS

Semistructured interviews with 12 young adults living with T1D for 3-14 years, analysed with qualitative content analysis.

RESULTS

The analysis revealed contradictory ways of handling the illness, as is illuminated in two main categories (a) and five subcategories (b). Handling the situation and dealing with different opinions (a), (b) managing daily life, emotional roller coaster and general attitudes, own views and apprehensions, ignorance and lack of motivation. Most participants were motivated, had knowledge and were in control of their long-term illness. Planning and structure were an essential part of their daily life. The participants were anxious about losing control of their bodies, the situation, die or be a burden to other people.

The cardiac patients' perceptions of their responsibilities in adherence to care: a qualitative interview study

AIMS AND OBJECTIVES

To describe cardiac patients' perceptions of their responsibilities in adherence to care.

BACKGROUND

The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study.

DESIGN

A qualitative, hermeneutic inquiry.

METHODS

We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis.

RESULTS

Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system.

CONCLUSION

Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research.

Adolescents’ health choices related rights, duties and responsibilities: An integrative review

Background:

Although the link between adolescents’ health choices in relation to rights, duties and responsibilities is acknowledged, little is studied in this subject.

Aim:

To identify, describe and synthesize previous studies on adolescents’ health choices in relation to rights, duties and responsibilities.

Ethical considerations:

Ethical approval is not needed as it is an integrative review of published literature.

Method:

The integrative review was used to review and synthesize current knowledge. Electronic and manual searches from 2009 to March 2014 were used to systematically identify earlier studies.

Results:

The review identified 13 studies. Adolescents’ health choices were linked to unsuccessfully exercised rights, arising from questioned autonomy and freedom, and their duties were hardly mentioned.

Conclusion:

Research into adolescents’ health choices in relation to their rights, duties and responsibilities is still methodologically fragmented. In future, more research is needed to support adolescents’ health promotion initiatives and increase their involvement opportunities.