A UK wide survey of insulin initiation in children with type 1 diabetes and nurses' perceptions of associated decision-making

Lesley Lowes, Ruth Davis, Vivien Coates, Joan McDowell, Florence Brown, Paul Dromgoole, Eileen Turner, Kathryn Thompson

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3 Citations (Scopus)

Abstract

Aim and objectives. The aim of this study was to examine insulin initiation practice across the UK in relation to children with newly diagnosed type 1 diabetes. Objectives of this study were to explore practices surrounding insulin initiation in children and nurses' perceptions of associated decision-making.Background. There are comparative studies of insulin treatments and regimens for children but few that describe the insulin initiation process or associated decision-making. The literature suggests a heavy workload for nurses working in practice and insufficient resources for home initiation of insulin.Design. A survey design.Method. A questionnaire regarding insulin initiation was distributed to 247 diabetes specialist nurses working with children from all four UK countries.Results. One hundred and twelve responses (45%). Only 37 (33%) started clinically well, newly diagnosed children on insulin at home, but most would do so with adequate resources. The most common insulin regimen at diagnosis was twice daily injections, with 86% (n = 96) using re-usable pens to deliver the insulin. As expected, no one commenced children on pump therapy at diagnosis. Analogue insulin was seen as the drug of choice by over a quarter of the nurses (29%, n = 32). Doctors appeared to be the main decision-makers, supplemented by other members of the paediatric diabetes multi-disciplinary team and decision-making aids.Conclusion. Approaches to treatment at onset of type 1 diabetes in children remain relatively traditional. Nurses expressed a desire to stabilise clinically well children at home but were restricted by lack of resources. Decision-making in most domains was largely medically dominated.Relevance to clinical practice. The study provides an insight into current insulin initiation practice in childhood diabetes and offers a useful comparator as practices change in the light of advances in treatment (medication and equipment), changes in professional roles (e.g. independent prescribing) and policy shifts (the move away from hospitals and resource constraints).
LanguageEnglish
Pages1287-1294
JournalJournal of Clinical Nursing
Volume18
Issue number9
DOIs
Publication statusPublished - Sep 2008

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Type 1 Diabetes Mellitus
Decision Making
Nurses
Insulin
Surveys and Questionnaires
Professional Role
Decision Support Techniques
Therapeutics
Workload
Pediatrics
Equipment and Supplies
Injections

Cite this

Lowes, Lesley ; Davis, Ruth ; Coates, Vivien ; McDowell, Joan ; Brown, Florence ; Dromgoole, Paul ; Turner, Eileen ; Thompson, Kathryn. / A UK wide survey of insulin initiation in children with type 1 diabetes and nurses' perceptions of associated decision-making. In: Journal of Clinical Nursing. 2008 ; Vol. 18, No. 9. pp. 1287-1294.
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abstract = "Aim and objectives. The aim of this study was to examine insulin initiation practice across the UK in relation to children with newly diagnosed type 1 diabetes. Objectives of this study were to explore practices surrounding insulin initiation in children and nurses' perceptions of associated decision-making.Background. There are comparative studies of insulin treatments and regimens for children but few that describe the insulin initiation process or associated decision-making. The literature suggests a heavy workload for nurses working in practice and insufficient resources for home initiation of insulin.Design. A survey design.Method. A questionnaire regarding insulin initiation was distributed to 247 diabetes specialist nurses working with children from all four UK countries.Results. One hundred and twelve responses (45{\%}). Only 37 (33{\%}) started clinically well, newly diagnosed children on insulin at home, but most would do so with adequate resources. The most common insulin regimen at diagnosis was twice daily injections, with 86{\%} (n = 96) using re-usable pens to deliver the insulin. As expected, no one commenced children on pump therapy at diagnosis. Analogue insulin was seen as the drug of choice by over a quarter of the nurses (29{\%}, n = 32). Doctors appeared to be the main decision-makers, supplemented by other members of the paediatric diabetes multi-disciplinary team and decision-making aids.Conclusion. Approaches to treatment at onset of type 1 diabetes in children remain relatively traditional. Nurses expressed a desire to stabilise clinically well children at home but were restricted by lack of resources. Decision-making in most domains was largely medically dominated.Relevance to clinical practice. The study provides an insight into current insulin initiation practice in childhood diabetes and offers a useful comparator as practices change in the light of advances in treatment (medication and equipment), changes in professional roles (e.g. independent prescribing) and policy shifts (the move away from hospitals and resource constraints).",
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A UK wide survey of insulin initiation in children with type 1 diabetes and nurses' perceptions of associated decision-making. / Lowes, Lesley; Davis, Ruth; Coates, Vivien; McDowell, Joan; Brown, Florence; Dromgoole, Paul; Turner, Eileen; Thompson, Kathryn.

In: Journal of Clinical Nursing, Vol. 18, No. 9, 09.2008, p. 1287-1294.

Research output: Contribution to journalArticle

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AU - Davis, Ruth

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AU - Dromgoole, Paul

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AU - Thompson, Kathryn

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N2 - Aim and objectives. The aim of this study was to examine insulin initiation practice across the UK in relation to children with newly diagnosed type 1 diabetes. Objectives of this study were to explore practices surrounding insulin initiation in children and nurses' perceptions of associated decision-making.Background. There are comparative studies of insulin treatments and regimens for children but few that describe the insulin initiation process or associated decision-making. The literature suggests a heavy workload for nurses working in practice and insufficient resources for home initiation of insulin.Design. A survey design.Method. A questionnaire regarding insulin initiation was distributed to 247 diabetes specialist nurses working with children from all four UK countries.Results. One hundred and twelve responses (45%). Only 37 (33%) started clinically well, newly diagnosed children on insulin at home, but most would do so with adequate resources. The most common insulin regimen at diagnosis was twice daily injections, with 86% (n = 96) using re-usable pens to deliver the insulin. As expected, no one commenced children on pump therapy at diagnosis. Analogue insulin was seen as the drug of choice by over a quarter of the nurses (29%, n = 32). Doctors appeared to be the main decision-makers, supplemented by other members of the paediatric diabetes multi-disciplinary team and decision-making aids.Conclusion. Approaches to treatment at onset of type 1 diabetes in children remain relatively traditional. Nurses expressed a desire to stabilise clinically well children at home but were restricted by lack of resources. Decision-making in most domains was largely medically dominated.Relevance to clinical practice. The study provides an insight into current insulin initiation practice in childhood diabetes and offers a useful comparator as practices change in the light of advances in treatment (medication and equipment), changes in professional roles (e.g. independent prescribing) and policy shifts (the move away from hospitals and resource constraints).

AB - Aim and objectives. The aim of this study was to examine insulin initiation practice across the UK in relation to children with newly diagnosed type 1 diabetes. Objectives of this study were to explore practices surrounding insulin initiation in children and nurses' perceptions of associated decision-making.Background. There are comparative studies of insulin treatments and regimens for children but few that describe the insulin initiation process or associated decision-making. The literature suggests a heavy workload for nurses working in practice and insufficient resources for home initiation of insulin.Design. A survey design.Method. A questionnaire regarding insulin initiation was distributed to 247 diabetes specialist nurses working with children from all four UK countries.Results. One hundred and twelve responses (45%). Only 37 (33%) started clinically well, newly diagnosed children on insulin at home, but most would do so with adequate resources. The most common insulin regimen at diagnosis was twice daily injections, with 86% (n = 96) using re-usable pens to deliver the insulin. As expected, no one commenced children on pump therapy at diagnosis. Analogue insulin was seen as the drug of choice by over a quarter of the nurses (29%, n = 32). Doctors appeared to be the main decision-makers, supplemented by other members of the paediatric diabetes multi-disciplinary team and decision-making aids.Conclusion. Approaches to treatment at onset of type 1 diabetes in children remain relatively traditional. Nurses expressed a desire to stabilise clinically well children at home but were restricted by lack of resources. Decision-making in most domains was largely medically dominated.Relevance to clinical practice. The study provides an insight into current insulin initiation practice in childhood diabetes and offers a useful comparator as practices change in the light of advances in treatment (medication and equipment), changes in professional roles (e.g. independent prescribing) and policy shifts (the move away from hospitals and resource constraints).

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