Psychological Skills Training to Support Diabetes Self-management | Article Critique

Prepare a critique of one research paper selected from your programme pathway.

Graves, H., Garrett, C., Amiel, S. A., Ismail, K. and Winkley, K. (2016) ‘Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences’, Primary Care Diabetes, vol. 10, no. 5, pp. 376–82.

Research plays a vital role in nursing practice and helps address the key areas in need of development which will improve and enhance patient wellbeing as a result. (Moule and Hek, 2011), cited within (The Open University, 2018a) define research as a process that is organised with the intention of gathering information to problem solving and answering questions with the aim of gaining new knowledge about healthcare. The role of the nurse has progressed significantly through the years with the main goal of being an advocate to patients and thus providing the best quality of care through evidence-based research. The Nursing and Midwifery Council reinforces this by claiming that nurses must make sure that any information or advice given is evidence-based, including information relating to using any health and care products or services. (NMC, 2015) This can be clearly seen in clinical practice through new and up to date information in examples such as wound care and risk assessments.

The aim of this essay is to critique a research paper that I have chosen called, Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences’, (Graves, et al 2016). This will be achieved by using the ‘PROMPT criteria’ which was developed by The Open University and offers a systematic approach to evaluate research (The Open University, 2018b). I will also use the ’critical reading framework’ from Horsley et al, (1983) cited within the Open University, (2018c), During my district nursing clinical placement i was able to shadow the diabetic nurse specialist and one of her greatest concerns was her client’s poor self-management of the condition. This was the reason for choosing this research paper. I hope to gain more knowledge about type 2 diabetes and read other nurses experiences on the management of this condition.

The presentation of this research paper is very clearly defined by the researchers. The title is written in larger font and the length is within recommended standards. According to (Meehan, 1999) the title should be between 10 and 15 words long and should clearly identify the purpose of the study. This captures the reader’s attention as to the fact that it is a qualitative assessment of nurse’s experiences that is being carried out.  The abstract is well laid out and gives the reader a brief description of the overall research study in clearly identifiable headings. The academic text had some areas that were difficult to understand at first. It became clear after a few more attempts at reading and getting familiar with the terminology used. The text is grammatically correct and has avoided any use of jargon. (Polit and Beck, 2006) state that writing style should be written in such a way that it ‘attracts the reader to continue to read further.

The relevance of this paper is very evident as diabetes is a growing health problem and according to the (World Health Organisation, 2016) an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. It has contributed to 1.5 million deaths in 2012 alone. The research carried out is part of a wider study called the D-6 study. The nature of this study isn’t very clear and could very well cause confusion with the reader. The study was carried out in five of South London’s Bourgh’s, none of which were clearly identified within the study. This is important as some Bourgh’s in South London are very deprived and have a higher ethnic population than others. Deprivation is strongly associated with higher risk of developing Type 2 diabetes.  It is also more common amongst South Asian and Black African Caribbean communities, and 300.000 who live in these Bourgh’s are diagnosed with the condition (DOH 2003). The paper also highlights the need for mental health providers with specialist diabetes knowledge (Graves, et al 2016).  Diabetes UK (2019) recognises that those affected by diabetes are twice as likely to be affected by depression and anxiety related conditions. The cost of treatment for Diabetes and related complications to the NHS is more than £14 billion putting extreme pressure on resources. A recent report by Robertson et al. (2017) cited in (The Open University, 2018d) highlighted how the financial pressures on the NHS are having a direct effect on patient care.

The objectives were clearly set out which were to evidence the efficacy of psychological skills training that nurses are expected to learn so they can support patients’ self-management. (Graves et al, 2016). This was part of a wider Diabetes -6 study which was a randomised control trial. The study is not explained very well and uses phrases like “usual diabetes care” (Graves et al, 2016). Which are not clear for some readers who know very little about what diabetes care is. It also states the nurses were trained in 6 psychological skills but it fails to identify what these actual skills are. The results of the trial were not known at the time of data collection or analysis, which demonstrates less bias in nurse or researcher reporting (Graves et al, 2016). The study was approved by the King’s College Ethics Committee and was funded by a grant for applied research from the NIHR (Graves et al, 2016).

In relation to the number of participants, who took part in the D-6 study the sample size is considered small as there were only 23 nurses. (Coughan et al, 2007). Suggests small samples are more likely to be at risk of being overly representative of small subgroups within a target population. It didn’t specify the nurses background are if they had any previous experience of training which could affect results. The researchers could be viewed as having a naturalistic view to research as they seek to understand their participants’ perspectives through the use of in-depth interviews. (The Open University, 2018e).  (Burns & Grove, 2006) also describe qualitative research as focusing on the human experience through systematic and interactive approaches.  The component skills were drawn from motivational interviews and cognitive behavioural therapy to enable collaborative working between patient and client. This could be open to misinterpretation due to cultural differences and language barriers especially in the diverse society of the South London Borough’s. Primary research was undertaken through Semi structured interviews which were carried out with each individual nurse.  The key questions had been developed prior to the interview which gives an element of structure whilst still probing the answers for more information. Face to face interviews also allows the interviewer to read body language and other nonverbal communication. (Dearnley, 2005) found that the open nature of the questions encouraged depth and vitality, which helped new concepts to emerge. This increased the validity of the study, by assisting them in collecting rich data for analysis. A disadvantage of semi structured interview’s is that the interviewer may lack experience in carrying out interviews. It can also be easy to navigate from the role of interviewer and start presenting their own ideas which could lead to bias and data collection harder to analyse. It states the interviews were audio recorded which helps its validity as it is based upon exact records.

This study was approved by the King’s College Hospital in London (Graves et al, 2016c). It was published in the journal of Primary care diabetes. The names of all five authors are clearly identified on the front page and the online version of the journal allows you to view their profession and qualifications. All five authors involved in this study are very highly qualified in the field of diabetes research and have written other research papers in which many have been published. This adds to the credibility of the article as the reader is assured that the author must have the appropriate clinical and educational credentials for this current research study.

This article was published in 2016 which is clearly documented on the front page. It is a recent article as it has the red cross mark on the front also which indicates the article being current. Nurses need to be aware of new up to date research related to their field of practice in order to carry out effective nursing care. It is evident nurses play a key role in improving the health outcomes of individuals living with diabetes. Nurses empowering people to become partners in their own care. But the conclusion highlights the need for further training and support for primary care nurses in order to facilitate psychological therapies in the future.  Diabetes is a growing problem with more people being affected each year. The findings of this study have reinforced the need for more education and training for nurses. But it has also highlighted the fact that the problem with poor self-management and compliance could be the result of social, economic and financial factors which will require a multi-disciplinary approach to dealing with them.

In conclusion

This essay highlighted the importance research has on nursing practice. Which ensures quality nursing care through effective evidence-based practice guidelines. The PROMPT criteria helped identify the quality of the research papers which ensures they are up to date and reliable. It has also made me aware of the use of bias and helped me to reflect on whether I could be bias in my own writing. Research enables nursing practice to keep up with a fast  moving world in which health care practices must make  continuous  improvements to meet changing demands, patient expectations and requirements (Eastabrooks, 1998).


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