Exploratory study: How does the spirituality of a group of British people with Type 2 Diabetes impact their coping and self-management of their condition?
I am currently undertaking a part-time Doctorate of Clinical Practice (DClinP) whilst working as an advanced nurse practitioner in primary care. A doctorate rather than PhD was chosen, as this enabled me to not only conduct original research, but have a clinical focus, develop leadership qualities, clinical effectiveness, consider new pathways, and develop myself professionally. The research scholarship contributed to the third year of my DClinP, where I was writing a literature review, developing a research proposal and going through an NHS ethics application.
I work as an advanced nurse practitioner within primary care in Hampshire. I work in the duty clinic alongside GPs, conducting telephone triage, and seeing patients for urgent same-day appointments. I work autonomously, prescribe medications, and also manage chronic disease. In run diabetes clinics, and have a special interest in type 2 diabetes – I am interested in factors that may influence how patients cope with the demands of the self-management of their condition. Patients may only be seen bi-annually for diabetes appointments, yet are expected to cope alone with the difficulties of this condition on a daily basis. Careful attention must be paid to diet and exercise, if they are to reduce the risk of complications associated with type 2 diabetes. Diabetes has both macrovascular and microvascular impact, with people at risk of heart attacks, stroke, kidney disease, blindness, nerve damage and depression (National Institute of Health and Clinical Excellence, 2014).
In the clinics I run, some patients with type 2 diabetes have revealed that their spiritual beliefs impact upon their self-management behaviours of diet and exercise; the extent to which they engage (or not) with treatment and their fears of disease progression. As a result I sought to discover what was known about how patients’ spirituality can influence the day to day management of type 2 diabetes. In conducting a literature review, I found 37 papers, with the vast majority coming from the USA and focused on Christian African Americans. Although there were a few papers from the rest of the world, it was clear there was a paucity of research in this area outside the USA. In addition, there was only 1 paper from the UK (Meetoo and Meetoo, 2005) that made a brief reference to spirituality. As a result, I was keen to research this area to discover if British patients’ spirituality influences their approach to diet and exercise. I sought to do a doctorate to research this, alongside developing myself clinically, and am now researching how the spirituality of patients with type 2 diabetes influences their approach to the self-management of their condition.
My literature review led to the refining of my research question: ‘How does the spirituality of a group of British people with type 2 diabetes impact their coping and self-management of their condition?’ It was also clear to produce in-depth data about spirituality, diet and exercise, and coping mechanisms, that qualitative interviews would be most appropriate. After reviewing different qualitative methods, the biographical-narrative-interpretive method (BNIM) was selected. This method utilises minimal questioning by the researcher, and encourages the participant to fully tell their story about a given area, yielding rich and detailed narratives (Chamberlayne et al., 2002; Wengraf, 2004, 2005, 2006; Rosenthal, 2010). As a result of the scholarship I was able to pay my university fees for the third year, as well as attend a one week training course of the BNIM. The training was thorough, and also gave opportunity to meet other researchers wanting to conduct in-depth interviews.
Alongside BNIM qualitative interviews, other data including serum hba1c (blood glucose), weight, age and date of diagnosis will also be collected to contextualise the interviews. Thematic analysis will be used to examine the data for emergent patterns/themes which will then be reviewed and discussed with my supervisors, with reference to relevant literature. I have started interviewing participants, and have been very moved by some of the narratives, which have been very personal. So far, people who have chosen to participate have all been Christian, and themes so far are: ‘God helps those who help themselves’, ‘God directed me to take my medication’ and ‘God abandoned me, so I must manage alone’. I am hoping to recruit some participants will either be agnostic, other religions, or atheist but have yet to fully recruit.
In producing qualitative research regarding how the spirituality of patients with type 2 diabetes impacts their self-management behaviours, I will be adding to the knowledge base for diabetes health professionals to better understand our patients’ lives and needs. This new knowledge should help clinicians to consider other aspects of a patient’s life that may influence how they manage their condition. Spirituality is not an area that clinicians usually discuss with patients. If we can understand the lives of our patients, then we will be better able to see their condition from their perspective. If we are able to understand the patient’s beliefs, we can make joint care plans that are more meaningful, engage the patient in their care further, and hopefully reduce potential complications of diabetes, such as stroke and amputations.
Achievements during the scholarship
During my scholarship period, I produced a research proposal and published my Literature Review. I have passed through my Research Ethics application and am now starting data collection.
I published two papers (Duke 2015; Duke & Wigley 2016) and one review (Duke 2016); and gave a Presentation regarding the Literature Review at a local Diabetes Nurses Conference, focusing on implications for clinical practice.
In addition, I was involved in the development of nursing capabilities and planning of a community outreach programme for a rural health clinic in Uganda. This culminated in a visit to Uganda, where I also taught first aid principles in a secondary school.
In addition to my clinical and doctoral work, I wanted to develop my analytical skills. In 2015 I was also appointed to the Appeal Board of the Prescription Medicines Code of Practice Authority. The Authority was established by The Association of the British Pharmaceutical Industry (ABPI) to operate the ABPI Code of Practice for the Pharmaceutical Industry, independently of the ABPI. As a member of the Appeal Board, I am involved with analyses of complex breaches of the Code and the placement of sanctions where appropriate. As the only nurse on the board, I am able to bring a different perspective. Being a member of the Appeal Board has developed my analytical skills, ability to work at committee level, and to understand the complex relationship between the NHS and pharmaceutical companies.
Acknowledgements
I am deeply grateful to the Florence Nightingale Foundation, through the generosity of The Band Trust Research Scholarship 2015-16, for their financial support that enabled me to continue with my doctoral studies. I would also like to thank my supervisors Professor Emeritus Andree Le May and Dr Wendy Wigley, the University of Southampton, and my research participants, and my husband for his support.