Paired Glucose Testing With Telehealth Support to Empower Type 2 Diabetes Patients

Jacob Molyneux, senior editor

bloodglucosetestingType 2 diabetes is challenging for those trying to meet blood glucose target ranges, often requiring one or more daily medications, increases in exercise, changes in eating habits, and self-monitoring of glucose level. Those who are willing and able to learn about factors affecting their glucose level and to make small daily efforts in one or more areas have the potential to radically improve their sense of control over their diabetes.

This month’s Diabetes Under Control column, “Better Type 2 Diabetes Self-Management Using Paired Testing and Remote Monitoring” (free until April 1), presents a successful story of patient engagement in diabetes self-management. It describes the case of a participant in a clinical trial who, with clinician support, incorporated paired glucose testing (self-testing before and after meals) and telehealth (remote patient monitoring, or RPM).

The article is easy to follow and gives a series of biweekly updates on the patient’s progress. Before the study starts, she’s not very engaged in self-management. For example, she’s only testing her own glucose level three to four times a month. To get a sense of how much more empowered she’s come to feel by week 12 of the protocol, consider this brief excerpt: […]

2016-11-21T13:03:02-05:00February 13th, 2015|digital health, Nursing, patient engagement, Patients|4 Comments
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A Little Levity to Ease the Family Caregiver’s Burden

Illustration by Hana Cisarova for AJN/All right reserved. Illustration by Hana Cisarova for AJN/All right reserved.

According to the CDC, almost 21% of households in the U.S. are affected by family caregiving responsibilities. The pressures and costs of this unpaid labor of love have been well documented.

This month’s Reflections essay, “Swabbing Tubby,” is written from the family caregiver perspective rather than that of a nurse. It’s about the wife and two adult daughters of an ailing older man as they are coached in one of the skills they will need to care for him at home.

It’s a tough situation, but one in this case leavened by the ability of these three women to laugh a little at the more absurd aspects of their predicament. Here’s the beginning:

In retrospect, I can’t help feeling sorry for the earnest young woman who tried so hard to show my mother, my sister, and myself how to hook up our brand-new, at-home, IV feeding device. She was all of 25, with the freshly scrubbed look of a young schoolgirl. Her youthful perkiness was no match for the trio of exhausted, crabby women who faced her across the empty hospital bed. Dad was down in X-ray having yet another CT scan, and the three of us were awaiting instructions […]

2016-11-21T13:03:06-05:00February 2nd, 2015|patient engagement, patient experience, Patients|1 Comment
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Cassandra’s Refusal of Chemo: Nurse Ethicist Ponders Ethics of Forcing Treatment

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scalesThe case of Cassandra, a 17-year-old female in Connecticut being compelled by the court to undergo chemotherapy for Hodgkin’s lymphoma, has aroused interest in the media and among bioethicists, who have offered mixed conclusions. (Here’s a recent update on Cassandra’s legal status.) For example, Ruth Macklin concludes that the actions taken to force the treatment were not justified, while Arthur Caplan concludes that compelling her to have the chemo is justified. Both are scholars of the highest order.

I agree with Caplan that she should be given the chemotherapy, but my purpose here is to illustrate that perspective plays an often unacknowledged role in ethical analysis. When feelings and personal perspective go unacknowledged, the analysis loses credibility and depth.

The principles in conflict in this the case are straightforward for ethicists: respect for autonomy versus beneficence.

As a society, we value control over personal choice, that is, autonomy, which would mean honoring Cassandra’s decision to forgo the chemo. The chief justification for overriding a patient’s autonomy is that the patient lacks decision-making capacity because she is a minor.

However, we also value doing what is best […]

2016-11-21T13:03:09-05:00January 21st, 2015|Ethics, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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Long-Term Complications After Congenital Heart Defect Repair

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Even those of us who don’t work in peds or cardiology are familiar with the amazing surgeries done to repair congenital heart defects (CHDs). After surgery, kids with CHDs are literally transformed, their glowing good health a reminder that medical miracles really can happen.

Sometimes, though, health problems develop many years after CHD surgery. These can be consequences of the original defect itself, or of the specific type of repair that was employed.

In this month’s CE feature, “Long-Term Outcomes after Repair of Congenital Heart Defects (part 1),” Marion McRae, an NP in the Guerin Family Congenital Heart Program at Cedars-Sinai Medical Center, Los Angeles, discusses the anatomy, physiology, and repair options related to six common CHDs: bicuspid aortic valve, atrial septal defect, ventricular septal defect, atrioventricular septal defect, coarctation of the aorta, and pulmonic stenosis. One of the types of congenital heart defects covered in the article is shown in the illustration.

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2016-11-21T13:03:10-05:00January 19th, 2015|Nursing, Patients|2 Comments
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Calling All Nurses to Address Health Disparities

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.

The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing. The author with nursing students at the Rhode Island Nurses Institute Middle College, the first charter school in the country for high school students who want to major in nursing.

The research on health disparities is stark and continues to increase. The Centers for Disease Control and Prevention’s Health Disparities and Inequalities Report–2013 found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.

But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way—lives that are often very different than our own.

I understand that it is human nature to be more comfortable with the familiar, but this is not what we are called to in nursing. More than […]

2016-11-21T13:03:11-05:00January 16th, 2015|career, Nursing, nursing perspective, Patients|3 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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