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American Psychological Association 5Th Edition NURSING DIAGNOSES IN THE CARE OF HOSPITALIZED PATIENTS WITH TYPE 2 DIABETES MELLITUS: PATTERN ANALYSIS AND CORRELATES OF HEALTH DISPARITIES Kennedy O. Onori A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Nursing. Chapel Hill 2013 Approved by: _ Edward J. Halloran, PhD, RN, FAAN Lorna H. Harris, PhD, RN, FAAN Allison A. Vorderstrasse, DNSc, RN Shielda G. Rodgers, PhD, RN Jamie L. Crandell, PhD © 2013 Kennedy O. Onori ALL RIGHTS RESERVED ii ABSTRACT KENNEDY O. ONORI: Nursing Diagnoses in the Care of the Hospitalized Patient with Type 2 Diabetes Mellitus: Pattern Analysis and Correlates of Health Disparities (Under the direction of Edward J. Halloran, RN, PhD, FAAN) This study examined the human needs of 445 adults admitted to hospital with the primary medical diagnosis of Type 2 Diabetes Mellitus [ICD-9CM 250.0-9] and compared the pattern of nursing diagnoses (human needs) with those of 5321 patients having Type 2 DM but admitted to hospital for other reasons and with the 78,480 inpatients with no DM. Length of hospital stay, intensive care unit use and discharge dispositions were examined, controlling for race, poverty, marital status and age, to determine if the nursing diagnosis variables were distinctive for any of the three patient groups. A subset of 14 nursing diagnoses was identified from the literature on the care of Type 2 DM to determine how they varied among the three groups. The 61 nursing diagnoses were also fitted in regression models to explain variances in patient length of stay and to explore patient diabetes status. A multinomial logistic (logit) regression model that included the predictor variables of patient age, race, marital status, socioeconomic position (insurance type), and sex was used to predict patient discharge disposition. This study was a secondary analysis of data collected over a three-year period by nurses in the daily assessment and care of their hospitalized patients. Donabedian’s structure, process, and outcome model of quality of care provided the conceptual framework for this study. The statistical software SAS (9.3) was used for the analysis. Nursing diagnosis use pattern did not consistently distinguish patients with type 2 diabetes mellitus from other patients. Patient information gathered by nurses in the provision of care to their patients is qualitative in nature -with holistic perspective independent of International Classification of Diseases codes. Nursing diagnosis was related to patient length of iii stay. The number of different nursing diagnoses was the most important predictor of patient length of stay in a model that included patient age, sex, marital status and socioeconomic position. Patient race, age, and socioeconomic position were predictive of patient discharge disposition (discharge to own home, discharge to home with home health services, discharge to nursing homes, or discharge to other healthcare facility) but not substantially related to patient length of stay. This methodological study has helped address two related questions in the negative; when the disease is known are the needs of the patient known and when the needs of the patient are known, is the disease known? Keywords: Nursing diagnoses, nursing care, medical diagnoses, chronic diseases, chronic illnesses iv DEDICATION To my wife, Karen and my daughter Kenna, you are the center of my universe. Thank you for your support and patience. v ACKNOWLEDGMENTS I am forever grateful to Dr. Edward J. Halloran, my advisor, mentor and committee chair, and without whom this would not have been possible. He believed in me, challenged me, and above all supported me when I thought I could not go on. His words of encouragement and firm handshakes were always reassuring and became welcome parting gifts at the end of each of our discussion sessions. Dr. Halloran’s generosity with his time and resource is inestimable. Many thanks for giving me access to the Nurse-Patient Summary data set, explaining new concepts, and exposing me to the very important work of Virginia Henderson. Many thanks also to the other members of my dissertation committee, Dr. Lorna Harris, Dr. Shielda Rodgers, Dr. Allison Vorderstrasse, and Dr. Jamie Crandell for their time, thoughtful comments, edits, and above all fresh ideas. Thank you for believing in me enough to want to do this. And last but not the least, thank you Karen and Kenna for respectively settling for a part- time spouse and a part-time dad during this last five years. vi TABLE OF CONTENTS LIST OF TABLES ...................................................................................................................................... x LIST OF FIGURES .................................................................................................................................. xii ABBREVIATIONS .................................................................................................................................. xiii CHAPTER 1 ................................................................................................................................................ 1 INTRODUCTION ....................................................................................................................................... 1 Statement of the Problem .......................................................................................................................... 3 Purpose of the Study ................................................................................................................................. 5 Research Questions ............................................................................................................................... 6 Theoretical Framework ............................................................................................................................. 6 Study Model Overview ............................................................................................................................. 8 International Classification of Diseases (ICD) and Diagnosis-related group (DRG) ......................... 10 Nursing Data ....................................................................................................................................... 12 CHAPTER 2 .............................................................................................................................................. 15 REVIEW OF THE LITERATURE......................................................................................................... 15 Overview ............................................................................................................................................. 15 Nursing Diagnosis ................................................................................................................................... 15 Validity of Nursing Diagnosis ............................................................................................................ 19 Medical Diagnosis of Diabetes ............................................................................................................... 22 Definition ............................................................................................................................................ 24 Diagnosing Diabetes Mellitus ............................................................................................................. 26 Patient Factors Affecting Health Outcomes ........................................................................................... 30 Age ...................................................................................................................................................... 30 Marital Status and Family/Social Support .......................................................................................... 31 Sex ...................................................................................................................................................... 33 Race/Ethnicity ..................................................................................................................................... 34 Education ............................................................................................................................................ 38 Payer Type/Socioeconomic Position .................................................................................................. 39 vii CHAPTER 3 .............................................................................................................................................. 42 METHODOLOGY ................................................................................................................................... 42 Overview ............................................................................................................................................. 42 Research Questions ............................................................................................................................. 42 Type of Data ....................................................................................................................................... 46 Design ................................................................................................................................................. 47 Sample................................................................................................................................................
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