Developing an understanding of brief intervention opportunities to support people in emergency care settings, in order to prevent subsequent severe hypoglycaemic events

Activity: Examination typesThesis Examination

Description

PhD Viva for King's College London
Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care
Abstract
Background: Severe hypoglycaemic events (SHE) are classified as a glucose level of 3.9mmol/L or lower, requiring assistance from another person to treat. These diabetic emergencies are correlated with lower general health, greater fear and anxiety, lower health-related quality-of-life, higher risk of long term complications (e.g. increased risk of cardiovascular events and dementia), mortality, reduced work productivity, and problems performing daily activities. Patient empowerment and structured patient education programs aiming at reducing SHEs and restoring hypoglycaemia awareness are highly recommended. However, there seems to be a gap between timely, person-centred interventions within the treatment pathway and a knowledge gap on how affected individuals and their family members experience managing SHEs in everyday life. A promising approach to bridging this and supporting daily self-management activities are brief interventions (BI). Therefore, the study's overall aim was to develop a better understanding of BI opportunities to prevent SHEs in people with diabetes.

Method: A data and methodological triangulation approach was chosen. A systematic review study (paper 1) identified BI's components and outcomes for people with diabetes in the first step. In a second step, an analysis of routinely collected data (paper 2) quantified and described the characteristics of individuals treated for SHEs in emergency care settings. And finally, a constructivist Grounded Theory study explored in twelve affected individuals and six spouses, patterns of social actions, interactions, and human behaviour while dealing with SHEs.


Results: Although there was an inconsistency in using the term BI in health care, reported core components of BI utilised for people with diabetes included assessment, advice-giving and assistance. Most affected by SHEs were men over 65 years of age, living in a relationship, and diagnosed with type 2 diabetes for more than ten years. Individuals treated by emergency medical services alone were significantly younger than those subsequently treated in the emergency department or requiring follow-up inpatient treatment. The emerged grounded theory, described the affected individuals' and their spouses' individual and shared experiences while managing SHEs. Four phases constituted a chronological trajectory while experiencing a disturbed rhythm of activities: falling out of rhythm, re-establishing identity, re-establishing routines, and experiencing (new) normality. These results combined led to three key findings providing novel insights and aspects in the care of people with SHEs and opportunities for BI; 1) SHEs led to a disrupted self, identity and normality in affected individuals, 2) SHEs were best managed when both, affected individuals and their spouses, were involved, and 3) BI offered in emergency services and in beyond care could prevent future SHEs.

Conclusion: The findings highlighted the disruptive and discontinuing nature of SHEs in the affected individuals' and their spouses' lives. During the encounter with emergency care services, there is an opportunity for BIs to initiate on-going support. Therefore, BIs need to be integrated into person-centred, clinical pathways in emergency care services. Further, essential on-going support throughout the mentioned trajectory calls for trusting relationships between healthcare professionals, affected individuals and spouses. Thereby, BI could complement structured patient education programs by supporting the couple's dyadic management.
Period14 Oct 202114 Jan 2022
Examination held at
  • King's College London
Degree of RecognitionInternational

Keywords

  • Severe hypoglycaemia
  • Brief intervention
  • Grounded theory