With the growing scope of the diabetes problem, questions arise as to how nurses could assist patients with diabetes in maintaining an adequate level of health and wellbeing. The PICOT question developed for this work is “Does nurse-provided telephone support in elderly diabetic patients improve consistency in maintaining glucose levels for the first three months following diagnosis?” The significance of the question to nursing practice can hardly be overstated. On the one hand, nurses seek innovative approaches to diabetes care. On the other hand, elderly patients cannot always monitor their health and control their blood glucose levels. Telephone calls exemplify a promising intervention that could support elderly community members with newly diagnosed diabetes in meeting the goals of health promotion and disease prevention.
The current state of research provides rich evidence to inform the development of community nursing interventions for elderly populations with diabetes. Most researchers focus their efforts on analyzing the efficacy of nurse telephone calls to patients with diabetes, while others seek to maintain effective nurse-patient relationships through automated calls or SMS. A number of randomized controlled trials were conducted to evaluate the effects of nurse telephone support on the quality and outcomes of diabetic care provided by nurses. Unfortunately, the target population in these studies does not always match the population criteria specified in the PICOT question. Still, most researchers agree that nurse telephone calls could enhance the quality of patient decisions and improve their blood glucose controls (Farmer et al., 2005; Kim & Oh, 2003; Kim, 2007; Piette et al., 2000a; Piette et al., 2000b).
All researchers note that providing patients with regular reminders (nurse telephone calls, automated calls, or SMS) is relatively effective in reducing respondents’ blood glucose levels (Farmer et al., 2005; Kim & Oh, 2003; Kim, 2007; Piette et al., 2000). Still, it is nurse telephone calls that have proved to be particularly effective in managing diabetes care. Nurses called their patients to remind them of the necessity to check their blood glucose levels and provide emotional reassurance (Kim & Oh, 2003). They answered patients’ questions and reminded them about medication (Kim & Oh, 2003). Automated calls were provided to promote self-care and educate patients with diabetes about glucose monitoring and medication adherence (Piette et al., 2000a). Despite small sample sizes and inconsistencies in randomization, such results shape a favorable ground for implementing the proposed interventions in practice.
The discussed evidence-based practice contributes to better outcomes in several ways. First, nurses use telephone calls to deliver personalized care and support in outpatient settings. As a result, patients with diabetes do not forget to monitor their blood levels and adhere to the prescribed medication regimens, thus reducing the risks of elevated blood glucose. Second, patients who receive nurse phone calls engage in a greater variety of self-care activities, which minimize the risks of physical and emotional complications due to diabetes. According to Piette et al. (2000a), nurse phone calls motivate patients to conduct regular foot inspection and weight monitoring. Such patients spend fewer days in bed and face lower risks of depression due to illness (Piette et al., 2000b). Finally, nurse telephone calls represent a low-cost method of managing health and illness in diabetic patients. With the growing pressure to contain healthcare costs, such approaches facilitate the incorporation of quality diabetic care into patients’ routines (Kim & Oh, 2003). Without such interventions, more patients will fail to maintain an adequate level of blood glucose. Consequently, the risks of developing health complications will increase, coupled with the growing costs of diabetes care.
The strategy for disseminating the evidence-based practice will be based on the diffusion of innovations theory by Rogers. It is a rational approach to translating evidence into nursing practice. It enables nurses to overcome barriers to adopting novel clinical behaviors (Sanson-Fisher, 2004). The proposed evidence-based strategy will be disseminated based on a thorough analysis of its strengths and weaknesses. Nurses in the hospital facility will learn about the relative advantage of nurse phone calls, their simplicity and compatibility with the current nursing values and beliefs, as well as observability of their results or patient outcomes (Sanson-Fisher, 2004). The importance of the evidence-based practice will be communicated during face-to-face meetings with colleagues, so that they have an opportunity to ask questions, raise concerns, and express their fears. Actually, the importance of face-to-face communication in disseminating evidence-based nursing practices has been widely acknowledged (Sanson-Fisher, 2004). It is with the help of face-to-face communication that concerns and opposition to change will also be addressed.
The only thing to note is that the transition from disseminating information to implementing the evidence-based practice will also require changes in the social context. According to Sanson-Fisher (2004), only nursing facilities with a culture of creativity and a relatively flat organizational structure have the potential to implement evidence-based practices quickly and at minimal costs. The existing systems may need to be modified to incorporate the proposed novelties and turn them into a routine practice. Regular feedback will be provided to monitor the progress of the intervention at the individual and organizational levels.
In conclusion, several randomized controlled trials were organized to test the efficacy of nurse phone calls in managing diabetes care. The results confirm that the discussed intervention improves patient outcomes. Nurses call their patients to remind them of the necessity to monitor blood glucose levels, adhere to medication and dietary regiments, and engage in a variety of self-care activities, such as foot inspection. The evidence-based practice can be successfully disseminated and implemented on the basis of Rogers’ diffusion of innovations model.
