Browsing by Author "Stewart, Maria Lynn"

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Educating registered nurses to perform monofilament exams on type 2 diabetics to detect peripheral neuropathy
(Montana State University - Bozeman, College of Nursing, 2013) Stewart, Maria Lynn; Chairperson, Graduate Committee: Karen Zulkowski
Diabetic Peripheral Neuropathy (PN), a serious complication of diabetes, affects nearly 50% of diabetics. Complications of PN are pain, foot wounds, infection, and amputation of the lower extremity. These complications cost the healthcare system billions of dollars annually. Assessing for loss of sensation in the feet is an American Diabetes Association (ADA) standard of care. This exam is vital in preventing further complications and is done with a simple tool called the monofilament wire. Currently registered nurses are not educated in school or on the job on how to use this simple tool; therefore it is unknown how effective registered nurses could be at detecting PN. This study aimed to determine if registered nurses could be educated on the use of a monofilament tool and perform these exams accurately and obtain reliable results. Five registered nurses in an outpatient diabetes clinic were educated on how to perform a monofilament exam using recommendations by the ADA. The nurses performed practice exams on each other while being observed by the author. After successfully completing the education process they performed the exam on patients. The nurses performed 15 monofilament exams. A negative result indicates sensation in the feet is in tact. A positive indicates loss of sensation. The patient's primary care provider verified all 15 results obtained. The nurses' results were congruent 100% of the time when compared to the provider's. Of the 15 exams, 53% were positive and 47% were negative The results of this study indicate that nurses can be educated on how to perform the monofilament exam accurately, based on the verification of results by the primary care provider. Although a small sample size, the results show that the nurses picked up 53% of cases of loss of sensation, which will increase patient awareness and provide opportunity for education on foot health and how to prevent foot wounds and infections. Allowing the nurse to participate in this simple exam, as part of their assessment on diabetic patients, will increase the number of cases of PN detected, decrease costs to the healthcare system, and increase patient quality of life.
Group Diabetes Self-Management Education (DSME) for adolescents with type 1 diabetes to improve knowledge and understanding of self-management skills
(Montana State University - Bozeman, College of Nursing, 2018) Stewart, Maria Lynn; Chairperson, Graduate Committee: Jennifer Sofie
Those with type 1 diabetes mellitus (T1DM) are required to perform many self-care activities, such as monitoring blood glucose and taking insulin, every day to prevent long term complications associated with the disease, such as retinopathy, neuropathy, nephropathy and heart disease (American Diabetes Association, ADA). Knowledge of the self-management skills required to care for diabetes is known as Diabetes Self-Management Education (DSME). Adolescents with T1DM struggle with management of their disease for many reasons, and most often it is the family who receives the education at diagnosis. This leaves the adolescent vulnerable to a gap in understanding their disease process and proper management skills. Implementation of group DSME that is led by a diabetes specialist is showing promise in the adult setting and has implications for youth with T1DM as well (Raymond, et al, 2015). Surveys assessing knowledge and confidence in management of T1DM were given before and after a group DSME class were given to nine participants. Results of the post surveys show that there was an increase in both knowledge and confidence after the class among all participants. These results suggest that there is a benefit to group, adolescent specific DSME classes.