Cynthia Frying Corbett

Background: Complex, interconnected issues challenge the United States health care system and the patients and families it serves. System fragmentation, limited resources, rigid disciplinary boundaries, institutional culture, ineffective communication, and uncertainty surrounding health policy legislation are contributing to suboptimal care delivery and patient outcomes. Methods: These problems are too complex to be solved by a single discipline. Interdisciplinary research affords the opportunity to examine and solve some of these problems from a more integrative perspective using innovative and rigorous methodological designs. Results: In this paper, we explore lessons learned from exemplars funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative. Discussion: The discussion is framed using an adaptation of the Interdisciplinary Research Model to evaluate improvements in individual health outcomes, health systems, and health policy. Barriers and facilitators to designing, conducting, and translating interdisciplinary research are discussed. Implications for health system and policy changes, including the need to provide funding mechanisms to implement interdisciplinary processes in both research and clinical practice, are provided.

Purpose: The purpose of this research was to compare and contrast perceived symptoms of type 2 diabetes mellitus and self-management strategies between Russian-speaking Slavic immigrant American women and non-Hispanic, nonimmigrant White American women. Methods: The qualitative–descriptive study design was conducted with a convenience sample of Slavic immigrant women 50 years of age and older with type 2 diabetes (n = 10), and non-Hispanic, nonimmigrant White American women 50 years of age and older with type 2 diabetes (n = 10). Results: Slavic immigrants reported more global holistic symptoms of diabetes, whereas nonimmigrants reported more specific physiological somatic symptoms. The nonimmigrant women used more complex diabetes self-management techniques compared with the Slavic group. A lack of education and awareness of hypoglycemia may contribute to less medication adherence in Slavic immigrants and may prevent them from being motivated to participate in diabetes self-management. Discussion and Conclusions: Health care providers caring for Slavic immigrant women with diabetes need to be aware that these women may fail to recognize the symptoms of hypoglycemia and seldom acknowledge depression, although depressive symptoms are often present. Culturally congruent health care will increase adherence and improve health outcomes for Slavic immigrant women.

Purpose Painful diabetic neuropathy (PDN) has a significant impact on patients’ quality of life, affecting sleep, mood, mobility, ability to work, interpersonal relationships, overall self-worth, and independence. The purpose of this article is to provide diabetes educators with current and essential tools for PDN assessment and management. Methods Medline and CINAHL database searches identified publications on the assessment and treatment of PDN. Identified research was evaluated, and information pertinent to diabetes educators was summarized. Results Recent advancements in assessment of neuropathic pain include identifying characteristics that distinguish between neuropathic and nonneuropathic pain. In the absence of treatment, research demonstrates that nerve damage may progress while pain diminishes. Many disease-modifying and symptom-management treatment options are available. Conclusion Good glycemic control is the first priority for both prevention and management of PDN. However, even with good glycemic control, up to 20% of patients will develop PDN. PDN recognition and assessment are critical to optimize management. Although several treatment modalities are available, few patients obtain complete pain relief. Recent advances in understanding the mechanisms underlying neuropathic pain should lead to better treatment and patient outcomes. Combination therapy, including nonpharmacologic modalities, may be required. Research evaluating the efficacy of combination therapy is needed.

PURPOSE the purpose of this study was to test the effectiveness of an educational intervention to improve patients' foot care knowledge, self-efficacy, and self-care practices. METHODS A prospective, randomized, single center, 2-group design was used with a convenience sample of 40 home care patients from a Medicare-certified home health agency. Baseline measures of foot care knowledge, self-efficacy, and reported self-care practices were obtained at study entry and 6 weeks later to control for foot care interventions provided during routine home care services. After obtaining the 6-week baseline measures, patients who were randomized to the intervention group received individualized education about proper foot care. All patients were interviewed a third time 3 months after study entry to determine the effectiveness of the intervention. RESULTS The educational intervention improved patients' knowledge, confidence, and reported foot care behaviors. CONCLUSIONS A brief, individualized educational intervention about standard foot care topics improved patients' foot care knowledge and self-efficacy as well as reported self-care practices. Incorporating such interventions into routine home care services may enhance the quality of care and decrease the incidence of lower-extremity complications.

The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time. Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients. Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home. The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment. Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.

This article describes the experiences of the home care agency-university partnership, identifies cooperative activities and resultant clinical and cost outcomes, and cites future collaborative plans. The authors also outline home care agency and university characteristics that contribute to successful partnerships and tips for initiating such relationships.

Part I of this two-part research article that describes diabetes knowledge pre- and post-home care instruction was reported in last month's issue of Home Healthcare Nurse. As indicated, foundational knowledge is a necessary prerequisite to effective diabetes management. This article reports on patients' self-efficacy for diabetes management before and after home care and demonstrates that boosting a person's judgment of his or her ability to perform specific diabetes activities is an important next step toward improving self-care.

Diabetes knowledge of adults who require insulin is examined in this two-part article. Part I reports on the study findings related to diabetes education and compares documented educational nursing interventions with post-home care knowledge outcomes. Part II, which will appear next month, reports on patients' self-efficacy for diabetes management before and after home care. Strategies for improving patient outcomes are presented.