Introduction/Background The basis of self-management is rooted in patient-centered care. The idea behind it is that the patient will feel empowered to take ownership of his or her care process. Patient collaboration helps to get to the heart of patient-centered care, as Chiaramonte et al. (2018) note. Patient-centered care is about putting the patient’s needs first and foremost in care providing process. It means that the patient is likely to have questions, cultural inputs, unique needs and ideas about what care means to him or her. By collaborating with the patient to develop a unique and personalized care approach, the nurse can empower the patient and make the patient feel that he or she is truly part of the decision making process. Otherwise, the patient can feel disenfranchised and can feel as though he or she has not part in the process of care. The patient will not take ownership of the care process and instead will take a passive approach to self-care and rely solely on the medical professionals.

One of the main incentives of collaborative and patient-centered care is that it allows the patient to be more involved in taking ownership of his or her own health: rather than just going to the health care provider and asking to be “fixed,” the nurse and the patient work together to develop a plan that touches on everything from treatment to lifestyle rearrangement. The aim is to get the patient involved in taking care of his or her own health in such a way and to such an extent that the patient becomes empowered to do more, know more, and be healthier all the way around. Increasing the patient’s health literacy through collaboration is one of the best ways to ensure that this goal is reached on a patient to patient basis year round.

The degree to which nurses are able to collaborate with patients to teach self-management of treatment can be seen as the degree to which patient-centered care, and quality care by extension, is provided. For patients with type 2 diabetes (T2D), it is important that they exercise self-management so that they can take ownership of their bodies and the treatment process and thereby lead a healthier life (Powers et al., 2017). Understanding the barriers that nurses face in teaching or promoting self-management of T2D can help to improve patient collaboration and the enable nurses to achieve the goal of teaching self-management of T2D to patients that they may reach that level of empowerment as patients who take ownership of their care. Currently, nurses struggle to teach self-management of T2D to patients (Majeed?Ariss, Jackson, Knapp & Cheater, 2015). Knowing why this is so can be the first step in helping nurses to overcome the challenges they face in teaching self-management of T2D.

Research Question

The research question for this study is: What are nurses’ views of barriers to self-management of T2D?

The purpose of this question is to find out what nurses see as the main obstacle in collaborating with patients to train them in self-management. The idea is that by understanding what nurses see as the main challenges, solutions to their struggles can then be developed. Unless one knows what the problem or the pain points are, there is no way to provide relief or overcome the obstacle.

Terms

For the purposes of this critical appraisal certain terms are defined as follows:

Self-management: the management of one’s care by oneself; the taking of responsibility and accountability for one’s...

Following that is the critical appraisal of relevant literature on the topic of nurses’ views of barriers to self-management of T2D. At the end is the conclusion and recommendations section.
Literature Search Method

This literature review of all English language literature on nurses’ perceptions of barriers to self-management of T2D was undertaken by searching for publications on the subject via Google Scholar. Google Scholar has been found to be a helpful method of searching various databases to find relevant peer-reviewed literature on many subjects (Jasco, 2005; Beel, Gipp & Wilde, 2010; Schultz, 2007). Databases included in the Google Scholar searches were Medline, The British Nursing Index and other health related databases and journals, books, and papers from conferences. The following key word searches were used: “diabetes self management,” “t2d self-management,” “obstacles t2d self-care,” and “nurses perspective t2d self-management”: The last electronic search was undertaken on February 1, 2019. A summary of the results of the literature search, including a record of what was found and what was selected for critical appraisal should are provided as an appendix.

Critical Appraisal of Literature

The literature pertaining to this subject is very robust with several studies having been conducted within the past 15 years that help to provide deep insight into nurses’ perceptions of barriers to care for self-management of T2D. The following studies were evaluated for this critical appraisal.

According to Pun, Coates and Benzie (2009), health care providers view the barriers to the self-care of type 2 diabetes (T2D) to be “psychosocial, socioeconomic, physical, environmental and cultural factors” (p. 4). Nurses also noted that patient attitudes towards diabetes were often a barrier to self-care as was the complexity of the management process (Pun et al., 2009). If the patient lacked a support system, this too served as a barrier, according to the study. Other factors included poor communication, as providers and patients placed different degrees of importance on different barriers to self-care—so neither is on the same page when communication breaks down. This study was very helpful in highlight what nurses view as barriers to self-management as it focused specifically on challenges that nurses perceived and experienced. Those challenges were related to the researchers using interviews and survey methodology to allow for a triangulation of data sources, giving the study a great deal of credibility and trustworthiness. This was the most helpful study for answering the research question posed above.

Another helpful study was the one by Nagelkerk, Reick and Meengs (2006), in which the researchers noted that perceived barriers to T2D self-management were a lack of understanding about the process of care on the patients’ part, and a feeling on the part of patients that their providers were not giving them enough support for them…