Development of a preliminary diabetes dietary satisfaction and outcomes measure for patients with type 2 diabetes.

Adopting dietary lifestyle changes for diabetes management is often difficult for patients; yet the health-related quality of life (HRQOL) outcomes of dietary management for the patient are not extensively developed in the HRQOL assessments now widely used in diabetes research. This study developed a preliminary instrument, the diabetes dietary satisfaction and outcomes measure, to assess outcomes of individuals' experiences in following a meal plan for the treatment of type 2 diabetes. A theoretical framework and preliminary focus group data guided the design of a 47-item questionnaire, administered to 239 patients with type 2 diabetes. Medical file data was obtained on 180 of these patients. Fifty-four percent of respondents were women, with mean age of 64 +/- 12 years and diabetes duration of 10 +/- 8 years. Scores for the satisfaction and other outcome measures discriminated between patient groups by age, gender, medication use, depression diagnosis, meal plan status, and employment status. Significant correlations also occurred with diet adherence, number of co-morbidities, and glycemic control as measured by glycolated hemoglobin (HbA1c). Future research with additional patient samples is needed to refine the measure for use in diabetes education programs.

A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise.

Diet and exercise are the cornerstones of treatment for persons with type 2 diabetes mellitus, yet patients find these areas of self-management to be the most difficult. Considerable research has indicated that barriers to diet and exercise are critical influences determining adherence to diet and exercise plans. Standards of practice require educators to assess patient barriers to self-management. However, little research has investigated whether patients and educators perceive these barriers similarly. This project's objectives were to compare and contrast patients' and educators' perspectives of patient barriers to following a meal or exercise plan, and to identify differences in patients' perceived barriers as related to patient characteristics. Patients with type 2 diabetes mellitus (n = 97) from three eastern Washington area hospitals and diabetes educators (n = 143) from the Washington Association of Diabetes Educators (WADE) were recruited for a mail survey. From the patient survey, the proportion of patients on meal plan (52%) or exercise plan (26%) was low. Certain barriers were prominent for both patients and educators relative to diet (difficulty maintaining a diet away from home, liking foods not in the meal plan) and exercise (not a high priority, weather). However, multivariate analyses indicated that patients and educators view barriers differently. Similarities and differences between educators and patients in response to barriers are discussed relative to enhancing diabetes counseling and education, and overall communication between educators and patients.

Barriers to nutrition care for nursing home residents.

The prevalence of protein-calorie malnutrition (PCM) in nursing home residents has reached 85% in some nursing homes and is linked to increased mortality among residents. Separate survey questionnaires were developed and administered to 99 nursing assistants and 44 nurses (35 RNs, 9 LPNs) from five eastern Washington nursing homes. The purpose was to assess nurse (RN, LPN) and nursing assistant perceived beliefs and views related to nutritional needs of nursing home residents that have a potential impact on PCM of residents. Experienced nursing assistants did not view the nurse as an active participant during mealtime. Specific barriers such as a lack of time and training, too many residents, working short staffed, poor food quality, and a lack of nurse-nursing-assistant teamwork may contribute to residents not getting enough food to eat. An education program addressing staff relationships and nutrition training of nursing assistants could improve the ability of nursing staff to ensure residents' food intake and improve the quality of life for residents in nursing homes.

Nutrition knowledge of nurses in long-term care facilities.

BACKGROUND: The purpose of this study was to determine knowledge-based nutrition competencies of nurses and describe needed nutrition education relative to reducing protein-calorie malnutrition (PCM) in nursing home residents. METHOD: A sample of 44 nurses (35 RNs, 9 LPNs) from five eastern Washington nursing homes completed a 50-item questionnaire that measured nutrition knowledge based on Benner's Novice to Expert Model. RESULTS: Nurses scored an average 65% +/- 11% on the nutrition examination. CONCLUSION: An educational program addressing the identified deficient areas could improve the ability of nursing staff to assess and monitor resident food intake, thereby reducing the prevalence of PCM of residents in nursing homes.

Comparing nutrition knowledge exam scores with reported nutrition topics of interest among nursing home nurses.

Nursing home nurses (licensed practice nurses and registered nurses) were assessed to determine nutrition training issues that have a potential impact or influence on protein-calorie malnutrition of residents. The results of a 50-item nutrition knowledge exam are reported and compared with what nurses report they are interested in knowing about nutrition. Nurses in nursing homes were found to lack sufficient nutrition knowledge to meet dietary needs of elderly residents.

Nursing assistants' perceptions of barriers to nutrition care for residents in long-term care facilities.

The purpose of this study was to assess nursing assistants' perceptions of barriers to feeding nursing home residents. A 38-item questionnaire was developed from data obtained during four different focus groups. Results suggest that workload and supervision constraints, poor nurse-nursing assistant interactions, inadequate food quality and quantity, and staff educational needs may all negatively influence resident food intake.

Diabetes educators' perspectives on barriers for patients and educators in diabetes education.

PURPOSE: This study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education. METHODS: A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N = 143). RESULTS: Most respondents were registered nurses (61%) or registered dietitians (27%); 74% were certified diabetes educators. The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services. CONCLUSIONS: Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.