Date of Award

2014-05-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; Jane Georges, PhD, RN; Ruth Bush, PhD

Keywords

adolescents, adult care, care transitions, nursing, patients, Type 1 Diabetes

Abstract

Background: Care transitions, defined as hospital discharge or movement from one healthcare setting to another, are currently a major concern for healthcare providers and policy makers alike. These care transitions are occurring in the context of increasingly fragmented care and have been known to result in hospital readmissions, adverse events, and medication errors. The adolescents' transition between pediatric and the adult care system is not only fragmented but occurs at a time when they are most vulnerable and ill equipped for change. Objectives: The purpose of this research was to conduct a feasibility study to examine if the use of a diabetes transition program, SMILE (Self-Management In Living Everyday), improves glycemic control in adolescents with type I diabetes mellitus (TIDM). The aims of the study were to examine 1) pre and post scores in diabetes knowledge, diabetes distress, and glycemic among a sample of adolescents with TIDM participating in the SMILE program, 2) relationships between diabetes knowledge, diabetes distress, and glycemic control among a sample of adolescents with TIDM participating in the SMILE program, and 3) the feasibility and acceptability of an individualized transition program utilizing technology, health care advocates, and home education visits among a sample of adolescents with TIDM participating in the SMILE program. Methods: A descriptive, correlational, repeated measures design was used for this feasibility study. Both quantitative and qualitative data were collected from a purposive sample of 14 adolescents recruited from patients who received care in the endocrine clinic at a large academic children's hospital located in Southern California. Data were collected during the spring of 2012 and participants' total time in the program was three months. Study measures included The Diabetes Knowledge Test (Fitzgerald, et al., 1998), Diabetes Distress Scale (DDS17), (Polonsky et al., 2005), Hemoglobin Al c, Frequency of Self Monitored Blood Glucose Testing (SMBG), and selected demographics. Statistical analysis included descriptive and inferential statistics. Results: A statistically significant difference was found in the pre mean = 12.57 (SD = 1.61) and post mean = 10.97 (SD=1.62) intervention HbAlc, t (13) = 3.94, p =.002; the pre mean, M = 72.4 (SD = 5.2) and post mean 87.5 (SD = 3.8) diabetes knowledge scores t (13) = - 6.47, p < .001, and mean DDS pre-SMILE score was 2.6 (SD = 1.02) and the mean DDS post-SMILE was 2.0 (SD = 0.99), t (13) = 3.63, p = .003. Qualitative Findings: Adolescents, Parents, and Health Care Advocates were queried at the conclusion of the SMILE intervention. Qualitative content analysis was used to guide the interpretive description of the data (Sandelowski, 2000). Study participants and parents overwhelming gave positive feedback about the SMILE program. Conclusion and Implications for Nursing Science: Transition experiences are not one-dimensional but each transition is characterized by its uniqueness, complexities, and multiple dimensions. Training and education on transition care for both healthcare personnel and patients is the first essential step to ensure smooth and effective transition from pediatric to adult service. Clinicians, administrators, and researchers should focus future efforts on developing more comprehensive transition programs that take place over time and maximize the use of health care advocates as well as technology.

Document Type

Dissertation: Open Access

Department

Nursing

Included in

Nursing Commons

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