Development and Psychometric Testing of the Diabetes Caregiver Activity and Support Scale.

Purpose The purpose of this study was to develop and psychometrically test the Diabetes Caregiver Activity and Support Scale (D-CASS), a measure of how difficult or easy caregiver activity and supportive behaviors are for family caregivers of persons with type 2 diabetes (T2DM). Methods Internal consistency reliability, test-retest reliability, criterion-related validity, and construct validity were examined in 101 family caregivers of persons with T2DM. Participants were recruited using study brochures distributed at a large hospital in the Midwest and at statewide American Indian Pow Wows. Additionally, study brochures were available via a link on Facebook. Data collection occurred by telephone, face-to-face, or through Facebook using measures with evidence of reliability and validity. Family caregivers were predominately female (82.2%), spouses (50.2%), and American Indian (17%), African American (24%), or white (55%). Data were analyzed using descriptive statistics and psychometric analyses. Results The psychometric analyses resulted in an 11-item D-CASS with evidence of internal consistency reliability (alpha = .82) and test-retest reliability. Evidence of construct validity was obtained using 3 hierarchical multiple regressions guided by a conceptual model. Factor analysis supported the unidimensionality of the D-CASS. Conclusion The 11-item D-CASS is a brief and easy to administer instrument that has evidence of reliability and validity in family caregivers of persons with T2DM.

Needs and Concerns of Family Caregivers of American Indians, African Americans, and Caucasians With Type 2 Diabetes.

Although type 2 diabetes is a chronic illness affecting the entire family, scant literature exists in this area. This study's purpose was to identify needs of family caregivers of persons with type 2 diabetes across cultures. Using a semi-structured interview guide with open-ended questions, a convenience sample of 33 family caregivers of American Indians (n = 14), African Americans (n = 11), and Caucasians (n = 8) with type 2 diabetes were interviewed by telephone. Qualitative content analysis was conducted based on five pre-determined categories derived from an existing conceptual model. Results were similar across groups and provided support for the conceptual model with themes emerging within the five pre-determined categories: (a) information about type 2 diabetes, (b) managing emotions and behaviors, (c) physical care, (d) instrumental care, and (e) personal responses to caregiving. No additional themes emerged. Although small and exploratory, findings provide information that may be useful to the future development of culturally based interventions.

A retrospective cohort study of a nurse-driven computerized insulin infusion program versus a paper-based protocol in critically ill patients.

BACKGROUND: There is variability in the extent of outcome achievement between computerized insulin infusion programs (CIIPs) and paper-based protocols (PBPs). This reported variability may be improved by intensive CIIP training prior to implementation. The objective was to evaluate the impact of a CIIP following intensive nurse training versus a PBP in a critical care setting. METHODS: A retrospective cohort study was performed on patients admitted to a mixed intensive care unit comparing glucose control between the CIIP following intensive training and a PBP. Consecutive patients on each protocol were assessed to obtain glucose concentrations and outcomes. The primary measure was the percentage of blood glucose values within target range (90-130 mg/dL). Patient glucose values were pooled and assessed using the χ(2) test for independence. RESULTS: In total, 61 patients with 5,495 glucose tests were included in the PBP group, and 51 patients with 5,645 glucose tests in the CIIP group. A greater percentage of glucose tests was within target range in the CIIP group (68.4% vs. 36.5%, P<0.001). In the CIIP group, time-to-target (median [interquartile range] 5 [3-8] h vs. 7 [4-20] h, P=0.02) and severe hypoglycemic events were reduced (26 vs. 6, P<0.0001). CONCLUSIONS: The nurse-driven CIIP led to a higher percentage of glucose values within target range, faster achievement of target glucose values, and a reduction in the number of severe hypoglycemic events. This improved outcome achievement compared with previous reports may be associated with intensive user training.