06 Oct STUDENT GUIDELINES FOR PEER REVIEWPeer Review Rubr
STUDENT GUIDELINES FOR PEER REVIEWPeer Review Rubric (for the reviewer)(1= Not at all or not very, 2= Somewhat, 3= Pretty much, but not totally, 4= Very) FOCUS: How clear is purpose? How consistent is attention to audience? 1 2 3 4ORGANIZATION: How easy is writing to follow between sentences and paragraphs? 1 2 3 4SUPPORT/ELABORATION OF IDEAS: How well are ideas developed? 1 2 3 4STYLE: How noticeable is a personal voice? Are sentences mature and varied? 1 2 3 4CONVENTIONS: How accurate is spelling, grammar, and punctuation? 1 2 3 4APPLICABLE: Sources cited correctly? Always or Not always (Circle one.)Overall Score: ______Strengths: Areas of improvement: Student reviewed: ______________________________________Student reviewing: ______________________________________Date: _____________A major public health problem is the diabetes epidemic among Hispanics in the United States (Beard et al, 2009). Hispanics in the USA are a fast-growing minority group and are disproportionately impacted by and influenced by the illness. This happens at a rate that is twice that of the general population. Between 1993 and 2005, the incidence of diabetes among Hispanics has almost doubled . Over ten percent of people of Hispanic descent are diagnosed with diabetes. The mortality rate and incidence of diabetes among Hispanics is between two and four times greater than their non-Hispanic white counterparts. Even with elevated mortality, they also have elevated levels of disability due to elevated levels of diabetes and other chronic conditions. In the United States, Hispanics are more likely to have poorly regulated blood sugar compared to the general population and die from long-term problems of diabetes. It is expected that by 2050, the diabetic prevalence among hispanics will increase 149% (Heuman, School, & Wilkinson, 2013).Self-care behaviour such as: healthy eating, exercise, foot care, and home glucose monitoring, is widely documented as being critical to the control of the disease and maintaining positive results for people with diabetes (Heuman et al, 2013). Research, however, has shown that self care behavior is more common than its non-Hispanic white counterparts for Hispanics with type 2 diabetes. Although the causal web of diabetes related determinants are not well understood, studies have shown that social demographics, health status, and cultural variables affect these behaviors in people with type 2 diabetes.Diabetes Education (DSME) is described to improve the knowledge and skills required for self-care of diabetes (Powers et al, 2016). DSME includes a regular commitment to healthy eating, physical activity, tracking of blood glucose, taking medication, primary care visits, fixing problems and coping processes. All of these duties can be difficult to accomplish and involve important lifestyle adaptations. Various such behaviours, which may affect people regimes, happen in social environments among families, colleagues, medical practitioners, or a society. Support for diabetes self-management relates to the assistance required to implement and maintain the abilities and conduct of communication required for the continuing management of diabetes. Diabetes patients with greater social support had higher physical and eating conditions than their counterparts who received fewer social support.According to recent qualitative population studies, people with type 2 diabetes with powerful social networks have a reduced level of stress, mortality, and increased levels of diabetic control (McEwen et al, 2017). Furthermore, social support, including training, encouragement, and access of funds have been seen by the doctors, patients and nurses as significant in maintaining control.Family support and social relationships are critical in improving diabetic management in Hispanics (McEwen et al., 2017). Engaging family in DSME and promoting family support may be a pivotal factor in creating an effective program. The development of an efficient prevention strategy requires understanding both family and social-cultural variables that contribute to the effective management of diabetes.Synthesis of LiteratureTo create an efficient DSME for Hispanics, one must plunge carefully into all the recent studies on this subject. Research on the Hispanic’s understanding of diabetes, cultural factors, familial and community support, barriers to healthcare, and willingness to control the disease are key pieces of information that must be gathered and summarized. Understanding all the variables in creating an effective program as well as gaining introspect on the Hispanic population’s perceptions of diabetes are pivotal in the process. Through this synthesis of research, the question can be asked, “ What are the recommendations for developing a FNP managed culturally and family centered intensive DM education program (I) within a primary care setting for Hispanic patients (P) with the goal of maintaining reduced blood glucose levels?”Scholarly media such as peer reviewed research articles were searched on CINAHL, Academic Search Premier, and Wilson Omnifile Mega. Search terms such as: Hispanic/Latino/Mexican diabetes education, diabetes perception, family support, culturally tailored programs, and diabetic barriers were all terms utilized to gain total perspective on the issue. The goal was to view the evidence from research through multiple dimensions. The evidence sought was: were familial based interventions superior to nonfamilial based programs?, were programs that were more culturally tailored more effective than those that were not?, Hispanic perceptions and attitudes towards diabetes, and the effects of lower socioeconomic status in Hispanic DSME. It is felt that by viewing the evidence from these perspectives that the best recommendations can be ascertained to create a well rounded DSME program for hispanics.The first body of literature sought was to find evidence that questioned the efficacy of family involved and culturally tailored programs on Hispanics. Four research articles by the Diabetes Educator and Health Psychology investigated the effect of family and culture on DSME programs. Salto et al. (2011) developed a culturally centered DSME program by holding the program times on Sundays and evenings to accommodate work schedules, as well as delivering the instruction in Spanish by Hispanic professionals. Smaller portion sizes as well as discussing healthier food alternatives with Hispanic food groups was the main focus. After the three month program, a significant change in glycated hemoglobin (HbA1c) was found, even though there was no weight loss in all participants. Two other studies by McEwen et al. (2012), and Vincent et al. (2017) also published studies with two similar programs. They both tailored their programs to suite their Hispanic sample. Vincent et al. (2017) tailored their program by providing cooking demonstrations using traditional Hispanic foods and ingredients and offering their program materials in both English and Spanish. McEwen et al. (2012) tailored their program that included a promotora that conducted social support sessions, home visits, and telephone calls. Furthermore, the program integrated the whole family as part of the intervention. Both studies resulted in an increase in self efficacy for supporting healthy habits, general well being, dietary adherence, and diabetic control.In contrast, Mier et al. (2012) examined 238 Hispanics and and found that 73% of their sample never received DSME. They found that old age, male, and higher education correlated to a healthier eating plan. Furthermore, exposure to DSME was significantly related to meeting physical activity requirements and healthy glucose recommendations. This study postulated that DSME programs should be family oriented and should be held in large groups where Hispanics congregate.Ramal et al. (2018) did an experimental study that tested two Hispanic groups with a high fiber low fat diet. One group had psychological support at multiple points throughout the six month intervention while the other only had the initial five week DSME intervention taught in Spanish. The support included involving family with a Hispanic nutritional instructor in excises preparing and cooking and modifying ethic foods to be high in fiber and low in fat. The results yielded much favorable outcomes for the intervention group that included the support. They had lower levels of fat consumption, decreased hip circumference, and decreased HbA1c levels.August and Sorkin (2011) interviewed 1361 adults in which 54.5% were Hispanic. Their research found that spouses provided the greatest source of support and control for 40% of Hispanics. Also, children were rated the next highest source of support for Hispanics. It was found that high levels of support was positively associated with healthy dietary behavior. Additionally, those with lower levels of support have lower levels of glycemic control.In addition to studies that have reviewed the effects of involving family and culture modification on DSME programs, there has been research performed on the Hispanic population’s perception of diabetes. It is equally important to know the views of the population as well as the factors that influence DSME in order to create an effective program. Four articles were referenced to gain insight of the perceptions of Hispanics on diabetes as well as the barriers in effectively controlling the disease. Many of these research articles asked open ended questions to Hispanic adults with diabetes and catalogued the themes among the answers. This promoted an educational discussion as well as insight on how to overcome some of the obstacles that Hispanics face with diabetes.Lynch et al. (2012) summarized that Hispanics understands all the concepts behind managing diabetes, but their actions do not reflect the current guidelines and recommendations. The Hispanics interviewed in this study understood that medication use, diet, weight loss, and exercise are all important in managing their diabetes, but they lacked the critical understanding of how to properly exercise, prepare healthy meals, and understand the importance of medication adherence. Furthermore, many of the Hispanics believed that stress was the underlying cause of their diabetes. This same theme has been found in research done by Coronado et al in 2004. Both of these studies found that Hispanics believe that stressful life events triggered their diabetes. Extreme emotions of fright, anger, joy, or sadness are potential causes believed by both samples in both studies. Both studies also mention the use of traditional therapies, such as the use of cactus, aloe vera, and tree spinach. Hispanics believed that these traditional therapies can be used as a cure for their diabetes, but fail to mention it to their doctors because they might disapprove of their methods. Interestingly enough, although both sample groups ,mentioned that exercise was important for diabetes control, they were unsure about the meaning of exercise. Some of the sample mentioned that mild activity, such as everyday movement while doing daily activities or working as sufficient exercise.Two studies by Martinez et al. (2012) and Heuman et al. (2012) also explored the barriers that Hispanics faced in managing their diabetes. Heuman et al. found that there is a lack of support from the community. Some of the parents within the sample felt powerless to help their children be healthy, especially if it was just them looking out for their children’s welfare. They felt that more support from teachers, coaches, and local leaders is necessary to properly educate their children on the risks of diabetes. One member from the sample mentioned that it would be great if there were community activities that would focus on exercise and healthy eating. Furthermore, both studies found the emerging theme that the children from both sample groups prefer American fast foods over tradidional healthier dishes. One adult from Heuman’s research mentioned that it is difficult to manage what her children eat, especially when she is away from home all day working. Many of the caregivers mentioned that they would rather have their kids eat something unhealthy rather than not have them eat at all. One mother mentioned that if she does not prepare something that her child likes, typically something unhealthy, he would go to school without eating.These two studies also referenced the barriers associated with healthy eating. Martinez et al. (2012) found from their sample study that many Hispanics found it difficult to adhere to healthy dietary practices because of strenuous work hours and fear of losing employment. The long hours away from home at work also created high attrition rates from the studies posted previously. Much of the programs researched with high attrition rates referenced lack of transportation or long work hours. Lack of funds, as well as lack of proper transportation are factors that prevent Hispanics from purchasing healthier foods (Heuman et al., 2013). First generation immigrants were more likely to prepare their own food with fresh fruits and vegetables whereas more acculturated Hispanics are more likely to consume more processed foods devoid of fruits and vegetables. Strenuous manual labor, lack of sidewalks and exercise facilities are some barriers that Martinez et al. (2012) found in their research. Many of the participants reported fatigue prevented them from exercising outside work hours. Furthermore, the lack of sidewalks and exercise facilities were common barriers from this cohort. Lastly, all four of the previous research groups mentioned that there is a lack of health programs and information in Spanish. Matinez et al. (2012) found in their study that 30% reported never receiving DSME education and 44% reported not receiving education in the last five years. Their discussion mentioned that a lack of understanding in English could be one reason for the high percentages.The biggest gap across this body of literature is creating and following a program that encompasses Hispanics from multiple geographic locations. Many of the research referenced above limited their study to small geographic regions, such as cities, counties, or Mexico/US border towns. Research needs to be done on multiple Hispanic populations across the US to get a broader view of the issue. Furthermore, of all the programs researched, no one program was longer than six months. These studies were unable to check for adherence of the program objectives long term. Although significant changes in body fat percentage, HbA1c, and dietary adherence were found at three and six months periods, many of the studies were unable to show results past those time frames. Long term studies that show favorable outcomes over 1 year would be beneficial for DSME research.The research reviewed suggests that Hispanics with diabetes perceive diabetes self management primarily in terms of exercise, diet, and medication adherence as effective self management behaviors. Further examination of the research suggests that Hispanic’s definitions of those terms widely differed from evidence based recommendations. Explanation of what a proper diet and exercise is paramount as an advanced practice provider. Additionally, proper understanding of the disease needs to be communicated to the population. Some of the research has suggested that some Hispanics believed that extreme emotions can cause the disease. Proper education on the physiology of the education should be provided. Furthermore, in order to affect long term outcomes, the healthcare team must actively and consistently collaborate with the patient and family members during clinical encounters. Involving family in the plan of care and being open to herbal remedies instill trust in the Hispanic population. The health care structures in which advanced practice nursing is a part in must demonstrate a commitment to quality, culturally tailored, and family based DSME as an important to diabetes care.
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