This essay will examine and critique the research paper “Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences” (Graves et al., 2016) using the ‘PROMPT’ criteria (The Open university, 2017a). Type two diabetes mellitus (T2DM) is a chronic condition caused by either insulin insufficiency, insulin resistance, or often a combination of both of these factors (NHS Choices, cited in The Nursing Times 2009a). The incidence of T2DM can be increased by certain risk factors such as being overweight or obese, increasing age, genetic risk factors, and ethnic origin (NHS Choices, cited in The Nursing Times 2009a). T2DM requires long term management from the individual with the disease in partnership with their healthcare team, this is commonly carried out in primary care (Lloyd et al, 2007) and consists of a combination of patient education, lifestyle changes, physical health monitoring and medication (NICE, 2017).
The information in “Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences” is presented in a readable format which is word processed and formatted in a way that makes it typical of an academical article (University of Leicester, 2009). The paper makes use of subheadings throughout which makes it easier for the reader to follow and understand the information and its flow (The Open University, 2017b). The article does not contain any unnecessary designs, pictures or animations that could potentially distract the reader from the information contained within it, and makes the article appear more professional (The Open University, 2017b). The author also avoids language that is unnecessarily over complicated which further adds to the readability of the material, whilst using medical terminology which should be understood by the target audience (The Open University, 2017b). The article was published in Primary Care Diabetes Europe, a journal which publishes original research articles and high-quality reviews in the fields of diabetes education, clinical care, health services, nutrition, psychological research and epidemiology where it is relevant to diabetes in primary care (Primary Care Diabetes Europe, n.d.). The journal has in excess of 2400 members and over 1100 electronic library holdings, and has been publishing since 2006 (Primary Care Diabetes Europe, n.d.), which may suggest it is a reliable source.
The relevance aspect of The PROMPT criteria investigates whether the information in the article meets the needs of the researcher to reach a conclusion on the research question (The Open University, 2017c). It is addressed in the research paper that there is a shortage of mental health providers available with the appropriate training to deliver psychological therapies to individuals with T2DM, and that primary care nurses are increasingly expected to deliver such interventions (Graves et al., 2016), although the efficacy of these interventions is questionable (Chew et al., 2017). The author of the paper does not discuss the efficacy of the interventions examined in the study, as it is believed that they may influence the results of the nurses’ opinions of their delivery of the psychological interventions and could present as a bias (Graves et al., 2016). Although the aim of the study was to assess the nurses’ experiences of delivering the psychological intervention, it is arguable that perhaps a quantitative study may have been more appropriate to fully assess the effects of the interventions that were being delivered, otherwise the intervention itself may not have been appropriate. The psychological intervention sounds like something that would be useful to apply to my practice to assist patients to self-manage chronic conditions, however, as it required a vast amount of training from a clinical psychologist, it may not be easily transferrable to other areas of practice (Graves et al., 2016).
The objectivity aspect of the PROMPT criteria questions what the motivation for carrying out the research was, and whether there was any bias or gains to be made by the author or funding organisation (The Open University, 2017d). Within the paper there is a section regarding conflicts of interest, and states that the authors have none to declare (Graves et al., 2016). However, it is important to recognise that this does not include the nurses who have participated in the study, and if they have any potential conflicts of interest. These might include the likes of their own personal beliefs regarding the efficacy of psychological interventions for T2DM. The results of the quantitative research were not revealed until after the completion of the study to reduce potential bias from the researchers and nurses (Graves et al., 2016). It is stated in the article that all of the researchers involved in the study work in Diabetes Research groups in King’s College, London (Graves et.al, 2016). This in itself may create subconscious bias of wanting the study to be effective. Secondary to this, two of the researchers work specifically in The Department of Psychological Medicine and Diabetes Research Group (Graves et al., 2016) and it could be questioned that psychological interventions delivered by adult nurses may either reduce the work load of phycologists, or take away from their status of being specialist practitioners; which may also be considered a bias. The author of the material does avoid emotive language in the study, something which shows that they have been objective by not trying to trigger an emotional response from the reader (The Open University, 2017d).
The method aspect of the PROMPT criteria examines the method which was used to complete the study, and questions if it was effective and appropriate (The Open University, 2019e). The study was of a small-scale, it aimed to recruit 23 nurses, but 7 ignored repeated invitations to interview resulting in a study sample of 16 nurses (Graves et al., 2016). To put this into perspective there were 15,528 full-time equivalent practice nurses in the UK in March 2017 (Nuffield Trust, 2018). The study was completed in 5 South London general practice surgeries (Graves et al., 2016); it is important to highlight that the ethnic diversity in London is not typical of the rest of the UK having the highest proportion of BME groups representing 40.2% of the population in the 2011 census (Office for national Statistics, 2018). This is of importance as members of certain BME groups are more likely to develop T2DM and at a younger age than those of white ethnic origin (NICE, 2011). This questions the transferability of the research to the rest of the UK. The majority of the BME members who were involved in the study were allocated to the intervention arm of the research (Graves et. al., 2016), although this does not reveal the numbers, just a percentage, which would question the demographics of the study.
The study also contains a table explaining the sample characteristics, it shows that some of the nurses in the control group had previous training at various levels to deliver psychological therapies (Graves et al., 2016), so it is reasonable to question if they already deliver an element to this in their consultations.
The data was obtained by conducting semi-structured interviews at the end of the study in the nurses’ place of work (Graves et al., 2016). This may have made the nurses feel more comfortable to discuss the study as it was an environment they knew, but conversely this may have made the nurses feel under pressure if there were still clinics running or they were interrupted, but the study does not disclose this information. The topic guide was developed using the supervision sessions during the study (Graves et al., 2016), but it may have been more appropriate to develop this before the commencement of the study in line with the study aims. The topic guide also highlights that nurses in the control group were questioned regarding their opinion of training other practice nurses in the intervention, and how confident they felt delivering the intervention (Graves et al., 2016); however, these questions were not relevant as the nurses were not trained in the intervention.
The consideration of provenance in the PROMPT criteria aims to consider the origin of information, investigating whether the author and their organisation are one that is regarded as trustworthy and whether they reference any other sources that are of importance (The Open University, 2017f). The authors of the research paper form part of King’s College, London (Graves et al., 2016). King’s College, London is a renowned organisation which carry out extensive research into diabetes (King’s College London, n.d.) and is regarded as a reputable source. This may however raise the question as to would a good research outcome be desirable to them? The study was funded by The National Institute for Health Research (NIHR), who receive their funding from The Department of Health (National Institute for Health Research, n.d.). This suggests that they are less likely to have a vested interest in the outcome of the study, but also highlights that the researching organisation is of a high standard as NIHR aim to deliver world-class research (National Institute for Health Research, n.d.).
Whilst researching the references of the study, some other the references made for interesting reading, however, not all of the information was accessible from the references provided, which may question were the information was sourced.
The final aspect of the PROMPT criteria is timeliness, which questions when the information was produced and whether it is still up-to-date (The Open University, 2017g). The study was published in 2016, and although medical research is continually developing, it is still be regarded as up-to-date. A literature search of The Open University Library did not find further, recent research into nurses’ experiences of delivering psychological interventions to support the self-management of diabetes.
This essay has critically evaluated “Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences” (Graves et al., 2016) using the PROMPT criteria which was designed to evaluate the quality of information (The Open University, 2017a). It has explored both positive and negative aspects of the paper to decide how it could be implemented into practice. Working on an acute respiratory unit, there are aspects of the psychological intervention that I may be able to deliver to patients to empower them to take responsibility for managing their own condition, such as asthma or chronic obstructive pulmonary disease (COPD), and create a sense of ownership for their illness. However, the nurses’ who implemented in intervention required extensive training and support from a specialist (Graves et al., 2016) which may suggest that this would be difficult to fully undertake without the support of my employing organisation, and this may be an expensive intervention to deliver.
References;
Chew, B., Vos, R., Metzendorf, M., Scholten, R., Rutten, G. (2017) ‘Psychological interventions for diabetes‐related distress in adults with type 2 diabetes mellitus’, Cochrane Database of Systematic Reviews, vol.9, no.9, pp. N/A [Online]. Available at URL: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011469.pub2/full (Accessed 23rd January 2019).
Graves, H., Garrett, C., Amiel, S., Ismail, K., Winkley, K. (2016) ‘Psychological skills training to support diabetes self-management: Qualitative assessment of nurses’ experiences’, Primary Care Diabetes Europe, vol.10, no.5, pp.376-382 [Online]. Available at URL: https://www-sciencedirect-com.libezproxy.open.ac.uk/science/article/pii/S1751991816000279 (Accessed 16th January 2019).
King’s College London (n.d.) Department of Diabetes; Research [Online]. Available at URL: https://www.kcl.ac.uk/lsm/Schools/life-course-sciences/departments/diabetes/index.aspx (Accessed 25th January 2019).
Lloyd, C., Gill, P., Stone, M. (2007) ‘Psychological Care in a National Health Service: Challenges for People with Diabetes’, Current Diabetes Reports, vol.13, no.6, pp.894-899 [Online]. Available at URL: https://link-springer-com.libezproxy.open.ac.uk/article/10.1007/s11892-013-0416-6 (Accessed 20th January 2019).
National Institute for Health Research (n.d.) Who we are [Online]. Available at URL: https://www.nihr.ac.uk/about-us/our-purpose/ (Accessed 24th January 2019).
NHS Choices (2009a) The Nursing Times, Diabetes, type 2 [Online]. Available at URL: https://www.nursingtimes.net/diabetes-type-2/1998966.article (Accessed 20th January 2019).
NICE (2011) National Institute for Health and Care Excellence, Type 2 diabetes prevention: population and community-level interventions (PH35), 2 Public health need and practice [Online]. Available at URL: https://www.nice.org.uk/guidance/ph35/chapter/2-public-health-need-and-practice (Accessed 25th January 2019).
NICE (2017) National Institute for Health and Care Excellence, Type 2 Diabetes in Adults; Management (NG28) [Online]. Available at URL: https://www.nice.org.uk/guidance/ng28/chapter/Key-priorities-for-implementation (Accessed 21st January 2019).
Nuffield Trust (2018) The NHS workforce in numbers [Online]. Available at URL: https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#2-what-is-the-overall-shortfall-in-clinical-staff-in-the-nhs (Accessed 23rd January 2019).
Office for National Statistics (2018) Regional ethnic diversity [Online]. Available at URL: https://www.ethnicity-facts-figures.service.gov.uk/british-population/national-and-regional-populations/regional-ethnic-diversity/latest (Accessed 24th January 2019).
Primary Care Diabetes Europe (n.d.) Primary Care Diabetes Europe Journal [Online]. Available at URL: https://www.pcdeurope.org/journal/ (Accessed 17th January 2019).
The Open University (2017a) ‘The PROMPT Criteria’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=2 (Accessed 18th January 2019).
The Open University (2017b) ‘The PROMPT Criteria; Presentation’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=3 (Accessed 18th January 2019).
The Open University (2017c) ‘The PROMPT Criteria; Relevance’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=4 (Accessed 18th January 2019).
The Open University (2017d) ‘The PROMPT Criteria; Objectivity’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=5 (Accessed 18th January 2019).
The Open University (2017e) ‘The PROMPT Criteria; Method’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=6 (Accessed 18th January 2019).
The Open University (2017f) ‘The PROMPT Criteria; Provenance’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=7 (Accessed 18th January 2019).
The Open University (2017g) ‘The PROMPT Criteria; Timeliness’, KYN237 Critically Evaluate information, online interactions and online tools; Evaluating the quality of information [Online]. Available at URL: https://learn1.open.ac.uk/mod/oucontent/view.php?id=2614§ion=8 (Accessed 18th January 2019).
University of Leicester (2009) Writing Reports [Online]. Available at URL: https://www2.le.ac.uk/offices/ld/resources/writing/writing-resources/reports (Accessed 21st January 2019).