The purpose of this scholarly project is to examine the effects of motivational interviewing (MI), on T2DM patient adherence to A1c testing.
The overarching research question for this scholarly project is as follows: In adult patients (18 years and older) with T2DM located in a southern Mississippi outpatient setting, what are the effects (if any) of motivational interviewing on patients’ adherence to recommended A1c testing?
Diabetes mellitus (DM) is worldwide epidemic and is the leading cause of poor health, physical disabilities and premature death. Globally, 422 million people were diagnosed with diabetes in 2014, and over 1.5 million people died from diabetes-related complications (World Health Organization, 2016). In the United States (U.S.), diabetes was the cause of over 74.9 thousand deaths and 1.85 million disability years lived in 2013. The widespread presence rate of type 2 diabetes (T2DM) in the U.S. is estimated to reach 44 million by 2034. Presently, nearly 25.8 million adults and children have diabetes, with T2DM being more prevalent in Latinos, African Americans, Asian Americans, Native Americans, other Pacific Islanders and Native Hawaiians (World Health Organization, 2016).
Table of Contents
Theory of Prevention as Intervention and Neuman’s Systems Model
Author
Purpose
Relevant Major Assumptions
Major Concepts
Theoretical Framework: The Adherence-to-Awareness Model
Rationale for Selecting the Theory of Prevention as Intervention and NSM
Rationale for Selecting the Adherence-to-Awareness Model
Objectives and Topics
This scholarly project aims to investigate the impact of motivational interviewing on the adherence of patients with type 2 diabetes (T2DM) to recommended A1c testing in a rural outpatient setting, utilizing established nursing and compliance models to improve clinical outcomes.
- Application of Neuman’s Systems Model in diabetes management.
- Examination of the Adherence-to-Awareness model for clinical guidelines.
- Evaluation of barriers to physician adherence to American Diabetes Association (ADA) standards.
- Strategies for improving glycemic control through patient and provider education.
- Analysis of the relationship between clinical inertia and provider self-efficacy.
Excerpt from the Book
Theoretical Framework: The Adherence-to-Awareness Model
Pathman et al. (1996) first utilized non-adherence to national principles for childhood immunizations as a model to formulate a conceptual framework to deal with non-adherence to recommended guidelines. In the adherence-to-awareness model, Pathman et al. described the sequential, cognitive along with behavioral phases required to accomplish physician observance to guidelines as awareness, adoption and adherence. With regards to awareness, physicians are compelled to understand the existence of the guidelines, making the dissemination process of the guidelines very fundamental. Agreement requires health practitioners to agree with the accuracy and dependability of the provided guidelines. Failure to agree with the recommended guidelines leads to the freezing of the treatment process.
Even though physicians may be pressured to adopt the guidelines as a result of peer pressure and possible malpractice litigations, Pathman speculates that most physicians develop the tendency of using guidelines in their treatment plans because they are aware of it and agree with the importance of using the recommended standards in promoting and maintaining patients’ wellbeing. Pathmam et al. further appreciates that adoption and adherence are rampant in evidence-based practice, particularly because of the increases scrutiny from the health regulatory organizations and insurance providers. However, Pathman et al. proposes that physicians are engaged in voluntary compliance of the appropriate guidelines in the provision of care, mainly because they are aware the importance of such conduct in the health care practice.
The adherence-to-awareness model was further developed by Cabana et al. (1999), improving its scope to produce multi-directional flow which emulates the cognitive conflict that lead to barriers manifested as physician non-adherence to required standards. Specific concepts expanded by Cabana et al. (1999) includes lack of knowledge such as lack of awareness and familiarity; attitudes regarding appropriate standards such as lack of agreement, self-efficacy, and outcome expectancy as well as inertia of traditional practice; while the final notion is the behavior which is characterized by external barriers.
Summary of Chapters
Theory of Prevention as Intervention and Neuman’s Systems Model: Introduces the holistic, system-centered approach to nursing care that focuses on patient stability through primary, secondary, and tertiary interventions.
Author: Details the professional background of Betty Neuman and the evolution of her Systems Model within nursing education and practice.
Purpose: Defines the core objective of applying the NSM to restore patient stability and prevent disease progression.
Relevant Major Assumptions: Outlines the foundational principles of the NSM, including the patient as a dynamic system with lines of defense against stressors.
Major Concepts: Explores key components such as environmental variables, open systems, and the categorization of stressors that impact patient wellness.
Theoretical Framework: The Adherence-to-Awareness Model: Discusses the progression from physician awareness to guideline adoption and the barriers that contribute to clinical non-adherence.
Rationale for Selecting the Theory of Prevention as Intervention and NSM: Explains the utility of the NSM in improving quality of life for diabetic patients by strengthening their resistance to stressors.
Rationale for Selecting the Adherence-to-Awareness Model: Justifies the use of this framework to address the low compliance rates among healthcare providers regarding ADA A1c testing guidelines.
Keywords
Type 2 diabetes, A1c testing, Neuman’s Systems Model, Adherence-to-Awareness Model, motivational interviewing, clinical inertia, nursing interventions, patient stability, healthcare guidelines, glycemic control, rural primary care, provider adherence, health stressors, diabetes management, evidence-based practice.
Frequently Asked Questions
What is the primary focus of this project?
The project focuses on improving adherence to American Diabetes Association (ADA) guidelines regarding the frequency of A1c testing for adult patients with Type 2 diabetes in a rural outpatient setting.
What is the overarching research question?
The study asks how motivational interviewing affects patient adherence to recommended A1c testing protocols among adults over 18 in a southern Mississippi clinic.
What theoretical models are used?
The research primarily utilizes Neuman’s Systems Model (NSM) and the Adherence-to-Awareness model developed by Pathman et al. and refined by Cabana et al.
What is "clinical inertia"?
Clinical inertia is defined as the inability or unwillingness of healthcare providers to intensify treatment for patients who are not achieving therapeutic glycemic goals, often linked to provider attitudes and self-efficacy.
Why is the Adherence-to-Awareness model relevant here?
It provides a framework to understand why healthcare providers may fail to follow clinical guidelines, specifically examining the stages of awareness, agreement, adoption, and adherence.
What are the key themes of the research?
Key themes include the impact of diabetes as a worldwide epidemic, the importance of clinical guideline compliance, the role of nurses in preventative care, and the management of diabetic stressors.
How does Neuman's model define health?
Neuman defines health as a degree of system stability, existing on a continuum ranging from optimal wellness to illness, influenced by a person's interaction with internal and external stressors.
What role do the "lines of defense" play in the NSM?
They represent protective mechanisms that surround and protect the patient's normal stability against potential stressors, which can be strengthened through nursing interventions.
How does this study suggest improving adherence?
By using the Adherence-to-Awareness framework to develop nurse practitioner knowledge and education, the project seeks to move providers from mere awareness to the consistent adoption of ADA standards.
- Quote paper
- Leonard Kahungu (Author), 2017, A rural Primary Care Provider Adherence to the ADA Guideline for Frequency of A1c Testing, Munich, GRIN Verlag, https://www.grin.com/document/368352
