Introduction: As per Oxford’s concise dictionary, 2014, Research is the systematic investigation and study of materials and sources in order to get facts and reach out new conclusions. Research in nursing is needed as it provides new insights into nursing care, one can understand the basic concepts in depth, there will be improved and developed methods of care. Moreover, research is essential in practice and evidence-based professions such as nursing. I have chosen type 1 diabetes mellitus in children as my research topic. My main aim behind choosing this topic is I have come across a child of age 3 who is suffering from type1 diabetes mellitus. I have seen his parent’s concern regarding the illness and its outcome. So I am keen to know how this disease affects the children and their parents mental status, how they are going to cope with the lifelong disease condition, etc. I have chosen four articles one qualitative, one quantitative and two mixed methods. I have selected the articles from various online sites like PubMed, NHS Evidence, Department of Health Publications, CINHAL, and The Cochrane Library.
Article one is a qualitative piece of research on Parents’ information and support needs when their child is diagnosed with type1 diabetes, 2014 The Authors Health Expectations published by John Wiley and sons ltd.
Research Design/ Methodology
Qualitative Research is “an interpretive naturalistic approach to the world. This means that qualitative researchers study things in their natural settings, attempting to make sense of or interpret phenomena in terms of the meanings people bring to them”(Denzin and Lincon 2005). It is a type of social science research that collects and works with non-numerical data and that seeks to interpret meaning from these data that help us understand social life through the study of targeted populations or places (Ashley Crossman 2017).
This research uses a qualitative approach to review the data regarding parents’ information and support needs when their child is diagnosed with type1 diabetes. This study was conducted in Scotland. With this study, we could find out how the parents could be supported in the future (David Rankin2014). The article uses an inductive and thematic approach. In four pediatric diabetes clinics in Scotland, semi-structured interviews were conducted with 54 parents of children with type1 diabetes. As per the parents’ flexibility to share their own understandings and experiences. This study used an emergent design, in which collection of data and analysis was done simultaneously that was informed by the principles of grounded theory research (Britten N, 1995). The research was reviewed with consideration of Critical Appraisal Skills Programme (CASP 2017) checklist. There are 10 questions, that are designed in such a way that it helps to think about the issues in article systematically.
40 interviews were performed in total that includes 26 solo interviews (24 with mothers and 2 fathers) and 14 joint interviews (involving with both parents). The interview was conducted between November 2012 and August 2013 which was face-to-face in parents’ homes. The data collection was done by David Rankin who has extensive experience in conducting interviews and knowledge regarding type 1 diabetes. The study’s advisory group included health professionals, policymakers, and parents of children with type 1 diabetes. Interviews lasted approximately 120 minutes that were digitally recorded and transcribed with the consents.
A thematic analysis was undertaken by two experienced researchers (David Rankin, Julia Lawton) who read each participant’s interview in full and also performed independent analyses. Participants’ accounts were cross-compared using the constant comparative method (Strauss A, Corbin J 1990) that identified issues and experiences which cut across different parents’ accounts.
Parents wanted more reassurance after their child diagnosis before receiving any complex information about diabetes management, that would be better psychologically and emotionally to absorb this information. (Rankin D, Harden J, Waugh N et al, (2014) Also highlighted their need for more emotional and practical support from health care professionals when diabetes regimens at home were first implemented, the flexibility of their availability from personal and domestic circumstances.
The study’s finding suggests that the professionals should consider the timings and provide support chronologically to ensure the parents’ informational and emotional needs are addressed when their child is diagnosed. Practical advice and further emotional support are provided that would take account of their day-to-day experiences of caring for their child.
Article two discusses a quantitative piece of research “Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation – the CASCADE study”
Research Design/ Methodology
As per Wikipedia Encyclopaedia, (2005) quantitative research is the numerical presentation and maneuvering of clarification to describe and explain the phenomena that those observations imitate. It is used in mainly in a multiplicity of natural and social sciences that involves physics, biology, psychology, sociology, and geology. According to Cohen (1980), “quantitative research is defined as a social study that employs empirical methods and empirical statements.”
This article uses quantitative approach. Its main objective is to incorporate psychological approaches to improve long-term glycaemic control, quality of life and psychosocial functioning in a diverse group of young people by providing a clinical-based structured educational group programme (Deborah Christie, Rebecca Thompson 2014). The design of this study was a pragmatic, cluster randomised control trial with an integral process and economic evaluation. The study was conducted in 28 pediatric diabetes services across London, south-east England, and the Midlands. Altogether 362 children aged 8-16 yrs with type 1 diabetes were recruited for this study. The research was reviewed with the help of Evaluation Tool for Quantitative Research Studies (Prof Andrew long, 2002). There were 51 questions to evaluate the authenticity of the article and whether the research has the data systematically arranged.
The research was carried out in 28 pediatric diabetes services. The sample size was depended on the clinic size, age (pediatric or adolescent) and specialization units like district general hospital clinic or teaching hospital/tertiary clinic. There were 14 teams that included forty-three health-care practitioners. Total 362 children of age group 8-16 years with type1 diabetes (T1D) were selected for the study. (Nansel TR, Iannotti RJ, Simons-Morton BG, Cox 2007) Also, the selection of children was based on criteria that they should be diagnosed as T1D for less than 12 months, with a mean 12 –month HbA1c level of less than equal to 8.5%. There was one day workshop on two days that taught intervention delivery. A detailed manual and resources were provided to the participants. The pediatric diabetes specialist nurse with another team member conducted four group education sessions.
The goal of the primary analysis was to compare and treat HbA1c values of the two groups of patients at 12 months and at 24 months, to allow clustering in the clinic at that level analysis of covariance is used with a random method. With the help of baseline and follow-up questionnaires, psychological conclusion methods were imitated so that it would allow people to assemble. As the majority of the psychological result processes were highly twisted, 95% confidence intervals (CIs) for these methods were approximated using 2000 bootstrap samples. For dual outcomes, logistic deterioration was used to estimate the consequences of the intervention. Over again, random consequences were incorporated at the clinic level were permitted for clustering and baseline values were accustomed to, where available. The subgroup analyses based on age 8-16 years, sex, initial HbA1c elevated or low values (more than 10.4 vs less than equal to 10.4 mmol/l) and socioeconomic eminence were carried out (as precise by the several deprivation scores) , and result sizes and 95% CIs approximate from models that incorporated an communication term.
The prime conclusion was to control hyperglycemia, each and every individual’s venous HbA1c readings were assessed and was compared then measured at baseline between 12-24 months. Secondary results were ultimately related with the management of diabetes, that included hypoglycemic episodes ( low sugar level), admissions in hospital, course of therapy for diabetes, knowledge, skills and responsibilities involved in managing diabetes, intervention observance, utilising facilities of clinics, emotional and behavioural adjustment, quality of life of an individual generally and with diabetes. Primary and secondary analyses were intention-to-treat comparisons of outcomes at 12 and 24 months, using analysis of covariance with a random effect for the clinic. Prespecified subgroup analyses based on age, gender, initial HbA1c value and socioeconomic status were estimated from models that included an interaction term. The economic analysis compared long-term costs and predicted quality-adjusted-life-years (QALYs).
A high-quality, difficult, pragmatic trial of structured education can be fruitfully conducted next to standard care in NHS diabetes clinics. Pragmatic components of a NICE- complaint structured learning programme can be effectively delivered subsequently a moderately brief two-day training while pediatric health-care professionals advantage from guidance in behavior transform skills. The study provides invaluable information on barriers and opportunities regarding future, similar interventions. A low dropout rate and good attendance for the group that attended the intervention suggests there might be superior uptake if accessible to young people with lower HbA1c. Testing whether this move towards can be more victorious and vigorous ongoing supervisory constituent should be an object of further research.
Article three discusses the mixed piece of research “an exploratory study of positive and incongruent communication in young children with type 1 Diabetes and their mothers, 2012 By V.Chisholm and C.Kelnar.
Research design / methodology
“Mixed method research is the type of research or team of researchers combines fundamentals of qualitative and quantitative approaches (use of a qualitative view, points data group, analysis, assumption techniques)for the purpose of breadth and depth of understanding and corroboration” as per American public university system.
Mixed method research is more precise in that it includes the mixing of qualitative and quantitative data, methods, methodologies, and /or paradigms in a research study or set of related studies .one could disagree that mixed methods research is a special case of multimethod research.
According to Grey and Kanner (2000) Interview is a most convenient method to collect data and to get a result in a proper manner. An interview is a verbal discussion between two people with the objectives of collecting appropriate information for the purpose of to do research. In this study, Sample was children and mothers for this study. The method was adherence interview, maternal evaluation of child adjustment and combined problem-solving activity.
Participants were 23 children (aged 6 to 8 years) and mothers, presence Scottish diabetes clinic. Parental occupation was classified according to National Statistics Socio-economic Classification (NS-SEC2010) procedure with 52% in social class I and II, 26% in classes III, IV and V and 22% in classes 6,7and 8; 87% of mothers were in stable relationships. They approach all families with small children with TID 8 years and younger who were registered at the health center.
The interview was conducted three 20 min for 24 hours recall by telephone more than 2 weeks with mothers. Mothers described what kids ate and section sizes using familiar household measures to estimate portion size.
The impact of demographic variables that is age, age at diagnosis .type 1 duration social class and sex of children’s non milk extrinsic sugar consumption, glycosylated hemoglobin levels and the psychological variables, the research was performed and the analyses of variance and chi-squared analyses as appropriate. Pearson assessed other relationships by product moment correlations. Kurtosis and skewness distribution were assessed prior to analysis. Square root transformation had to be applied to one variable, incongruent maternal communications as it was not normally distributed, and all analyses were conducted on the transformed data.
Variables against the psychological and type 1 diabetes-related variables had no significant differences and so it was not treated as a potential stun. Since the power was low so we cannot say that there was no relation between these demographics and psychological and type 1 related outcomes in the population.
Results converged to form a theoretically and empirically consistent pattern in that behavioral indices of poorer communication in both mother and child again and again correlated with poorer child adjustment outcomes. This study shows that specific features of dyadic, child and maternal communication could be targeted in developmentally sensitive interventions to promote positive communication in the home management of type 1 diabetes care for young children.
Article four is a second mixed research article on “An ongoing struggle: a mixed-method systematic review of interventions, barriers, and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in an educational setting.
The study was performed in a mixed-method systematic review to establish intervention success and blend child/parent/professional view barricades and facilitators to achieving the most favorable diabetes self-care and management for children and a juvenile group of age 3-25 years in educational settings. The design was well-versed by mixed-method synthesis methods widened by the Evidence for Policy and Practice Information (EPPI) center (Thomas J 2004, Oliver S 2005). As per (EPOC Resources for review authors) the study pursued Cochrane Effective Practice and Organisation of Care Guidance on the addition of more different quantitative study designs to resolve the effects of interventions as our primary scoping review has acknowledged few randomized controlled trials.
The investigate scheme is recapitulated within a customized Setting, Population/People/Perspective, Intervention/Issue of Interest, Comparison, Evaluation (SPICE) (Booth A, Brice A, 2003). The search requisites incorporated medical subject headings (MeSH) and ‘free text’ conditions blended and were adapted according to the exacting database. A solitary search was used for both stages of the reassess with no methodological limits. CINAHL, MEDLINE, Scopus, British Nursing Index, Cochrane Library, EMBASE, PsychINFO and Web of Science were the databases through which the studies were investigated.
Studies were integrated if they determined on children and adolescent with type 1 diabetes within an educational setting and integrated those 3-16 years in preschool or recognized education and those 16-25 years in post-compulsory education. In accumulation, studies counting or focusing on parents, peers, educational setting staff and health specialized that are connected to this age group were included. Limitations were not functional in conditions of research design or methods. Unpublished records were not required from authors. All studies published in the preceding 15 years were included (January 1996- July 2011) that were accomplished in any country and was printed in English in a peer-reviewed scientific journal. A 15-year window was selected confine reasonably modern context. Studies were expelled if there was no before and after process and if the study did not directly testimony the views of children and young people, parents, peers, professionals
Three kinds of syntheses were executed. Initially for stream 1 (intervention studies) meta-analysis was unfortunate due to the varied nature of the studies in relation to meta-analysis was unfortunate due to the varied nature of the studies in relation to populations, intrusions, and results. (Centre for Reviews and Dissemination: 2009) As a substitute, the results from the studies were accounted in a description synopsis within and across studies. Secondly, for the stream two study Ritchie and Spencer’s thematic skeleton synthesis for non-intervention studies (Ritchie J and Spencer L, 1994). Every single study included in stream 2 were then uploaded into the software Atlas Ti and an a priori index coding framework based on the theoretical structure and concerns of attention mapped against review questions and purposes were applied to the studies. Thirdly, an ultimate overarching synthesis of interventions and non-intervention studies was conducted. For this final synthesis, a matrix was made that mapped most excellent practice guidance against the age-related obstacles and catalysts recognized by kids and adolescents, parents, school employees and school health experts and age-related interventions and outcomes in stream 1.
The study is predominantly paying attention to see the amount to which interventions were successful and addressed the obstacles known by the children, parents and tutors/ health professionals, and built upon the facilitators to provide an optimal care and management of children and young people with type 1 diabetes in educational settings. The study also acknowledged breach in facts, considered the toughness of the synthesis by making an interpretation about the quality of included particulars, and looked particularly at the age and context of child contributors in interventions compared with child participants in studies of attitudes and experience.
There were 55 view studies and 11 interventions were included. The study mainly focused was matched with school diabetes guiding principle. Meta-analysis was not at all possible. Interventions were mainly related to specific contents with a high risk of prejudice. The studies were of the moderate quality with common exchangeable findings.
The school nurse and the health plans were very effective in various types. For individual case management telemedicine were effectual. Educational interventions were to enlarge the knowledge and boost the confidence level both in children as well as the school staff which had a significant short-term possession but for a longer time, it has to be followed up. As per children, parents, and staff, they struggled with the organization, composition, education, and attitude as school barriers. Individual health plan aspects were implemented as per the school guidelines. Even the children started recognizing & appreciating the staffs those were trained and confident enough to shore up diabetes management.
In this research the university students were deficient. Thus self-management was much easier for the children who juggled with diabetes management accompanied with a lifestyle such as adopting the strategies to manage alcohol consumption.
This mixed method systematic review is the first to integrate intervention effectiveness with views of children, parents, professionals against the diabetes guidelines in school. The management of diabetes would be improved by implementing and regularly auditing on the impact. There is a huge gap in the knowledge of what is working but the evidence is limited. As per the research, the telemedicine is effectual in children in specific contexts, between the health care providers and the school nurse. But not all the education system employs onsite nurses. More innovations and sustainable solutions are required. An all-inclusive standard of living approaches for university students permits further development and assessment.
Personal learning points from this study:
Quantitative, Qualitative and mixed are three different research methodologies. These are basically different in their approaches and their aspires are to demonstrate different results. The findings have important implications for service development. With the help of these findings, we can conclude that type 1 diabetes is common in young children with the long term and short term complications. There is also a number of environmental factors that are associated with the development of type 1 diabetes in children. The study has highlighted a need for more consideration towards parents as well as children’s psychology. Health professionals should also consider ways to provide practical support to parents to help them integrate diabetes management into their families’ normal lifestyle.
In future, research may find a way to halt the development of type 1 diabetes, but till date, no interventions have successfully preventing type 1 diabetes in children.