APRN practice patterns in primary care.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
Margaret Grey
Publications and source records attributed to Margaret Grey.
Depression in type 1 diabetes in children: natural history and correlates.
The combination of diabetes and depression in children and adolescents is largely unstudied. The purpose of this article is to review the literature on the natural history and correlates of comorbid diabetes and depression in children and adolescents. Children with diabetes have a two-fold greater prevalence of depression, and adolescents up to three-fold greater, than youth without diabetes. Correlates of depression and diabetes include gender, poorer metabolic control, and family behaviors. Very little is known about treatment in these youth, and more studies are indicated.
Adolescent↗
The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis.
AIM: An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND: Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS: Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS: The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS: It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.
Adolescent↗
The systematic development of nursing interventions.
PURPOSE: To propose guidelines for systematic and progressive testing of nursing interventions. ORGANIZING FRAMEWORK: The National Institutes of Health has indicated four phases of clinical trials to guide research on treatments and interventions in the health sciences. Several important issues specific to nursing interventions need further clarification to enhance the interpretation of nursing clinical trials: (a) linking problem identification and nursing interventions, (b) articulating the content of interventions, (c) determining the strength and timing of interventions, (d) differentiating between efficacy and effectiveness research, and (e) incorporating multiple perspectives in intervention development. CONCLUSIONS: Systematic and progressive nursing intervention programs of research are needed to address these issues and to enhance the science and practice of nursing.
Clinical Trials as Topic↗
Fighting childhood obesity with university-community partnerships.
This article describes how two Robert Wood Johnson (RWJ) Executive Nurse Fellows used their leadership competencies to inspire and lead change within the community to fight the growing problem of childhood obesity. A model of University-Community partnership is proposed which incorporated the core leadership competencies of the RWJ program--interpersonal and communication effectiveness; risk-taking and creativity; self-knowledge; skills in creating change; and, strategic vision. Leadership lessons learned are provided for nurses interested in leading efforts to improve the health status of communities.
Child↗
Establishing a practice-based research network of advanced practice registered nurses in southern New England.
BACKGROUND: Biomedical research focuses on highly controlled clinical trials in academic health centers, where the emphasis is on disease treatment and rehabilitation. The results, therefore, are not readily applicable to patient populations that primary care clinicians encounter in their community practices, where the focus is on health promotion and disease prevention. Although the number of practice-based research networks (PBRNs) is growing in primary care, these networks are governed by the physicians who created them and address research questions reflective of physicians' practices and perspectives. Other primary care clinicians, such as advanced practice registered nurses (APRNs), who routinely provide care for underserved and minority populations lack a forum for studying their practice problems and processes. A PBRN of APRNs in primary care provides a means for this research. SUMMARY: The Advanced Practice Registered Nurses' Research Network in southern New England is the first PBRN established for APRNs. This article describes the development of the network.
Evidence-Based Medicine↗
Maternal management behaviors for young children with type 1 diabetes.
PURPOSE: To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children. STUDY DESIGN AND METHODS: A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings. RESULTS: The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population. CLINICAL IMPLICATIONS: Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.
Adaptation, Psychological↗
Mothers' experiences raising young children with type 1 diabetes.
ISSUES AND PURPOSE: To examine the day-to-day experiences of mothers raising children 4 years of age and younger with type 1 diabetes. DESIGN AND METHODS: The descriptive design compared mothers of children with (n = 25) and without diabetes (n = 25). Mother-child observations were completed for children with diabetes. RESULTS: Mothers of children with diabetes are very skilled in reading their children's behavioral cues. Mothers' concerns included the fear of hypoglycemia and seizure activity, access to daycare centers, and babysitting services capable of caring for their children's condition. These responses significantly differed from the control group mothers. PRACTICE IMPLICATIONS: Nurses can affirm that hypoglycemia-related fears are normal and help mothers identify community resources that might ease the burden of care required, especially during the early postdiagnosis period.
Activities of Daily Living↗
Depression in adolescents with diabetes.
TOPIC: Prevalence and interventions for depression in youth with type 1 diabetes. PURPOSE: To explore the co-morbidity of youth with diabetes and psychiatric conditions, and evaluate the relationship of youth with co-morbid depression and diabetes on glycemic control, quality of life, family support, behavioral problems, attributional style, and self-esteem. SOURCES: Relevant literature in both child and adolescent populations of psychiatry, psychology, and nursing. CONCLUSIONS: Youth with type 1 diabetes have significantly higher rates of depression over the general population. Seratonin reuptake inhibitors, cognitive behavioral treatment, interpersonal therapy, improving family communication and problem-solving skills, and diabetes education hold promise as treatment that can decrease depression in youth with diabetes. Advanced practice nurses are positioned to provide these interventions and treatments.
Adolescent↗