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 […]

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 […]

2016-11-21T13:03:09-05:00January 21st, 2015|Ethics, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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Long-Distance Coaching

Patrice Gopo is a writer living in North Carolina.

The author Patrice Gopo

Moments ago I’d been crouching on my bed, but now I lay wrapped in a thick duvet. My panting began to slow to a normal cadence. Then a sharp rush. My midsection hardened, followed by intense cramping. With a swift motion, I moved from lying on the bed back to all fours.

“Find your point and focus.”

I heard my mother’s words through the speakers of the computer. My eyes locked on where the edge of the metal curtain rod met the white wall.

Around me, voices and images drifted away.

Before I gave birth to my first child, I didn’t know that between a tightening abdomen and waves of pain, Skype conversations were possible.

While I appreciated that technology could bring someone distant close, my mother wasn’t supposed to be a face on the computer. She was meant to be by my side and not in a living room 10,000 miles away. But my daughter had decided to slide down the birth canal 12 days before expected.

My mother describes herself as a practical person. “I’m a nurse. It’s in the job description,” she often says. When pregnant with her own firstborn—my older sister—her contractions began in the midst of an overnight shift in the labor and delivery unit. She completed the night’s job […]

2016-11-21T13:03:15-05:00January 9th, 2015|Nursing, nursing perspective, patient engagement, Patients|2 Comments
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New CE for Nurses: Understanding the Origins of the Obesity Epidemic

By Gaulsstin/via Wikimedia Commons By Gaulsstin/via Wikimedia Commons

One of our two December feature CE articles, “The Obesity Epidemic, Part 1: Understanding the Origins,” is about a pervasive and complex issue that nurses see the health consequences of in every practice setting:

. . . more than 35% of adults and 16% of children ages two to 18 are obese. Obesity disproportionately affects racial and ethnic minorities as well as people at lower income and educational levels, though it is prevalent among men and women in every segment of society. Obese children and adults are at risk for type 2 diabetes, cardiovascular disease, musculoskeletal dysfunction, and certain types of cancer. The Centers for Medicare and Medicaid Services estimates the annual national health care expenditure on obesity to be about $147 billion, with per capita spending on obese people averaging $1,429 more than spending on individuals of normal weight.

Knowledge about this epidemic continues to evolve. This article is part 1 of a two-part series and provides readers a concise overview of current theories about the pathophysiologic, psychological, and social factors that influence weight control. As the overview points out, ” [t]o contribute to obesity’s treatment and prevention, nurses must be conversant in a wide range of theoretical and clinical perspectives on the problem.” […]

2016-11-21T13:03:22-05:00December 10th, 2014|nursing perspective, patient engagement, Patients|0 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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