Nurses' Barriers to Teaching Type 2 Diabetes Self-Management
This paper presents a critical appraisal of literature examining nurses' perceptions of barriers to self-management of type 2 diabetes (T2D). Grounded in the principles of patient-centered care, the review explores why nurses struggle to teach patients effective self-management strategies. Drawing on five peer-reviewed studies identified through Google Scholar, the paper synthesizes findings related to psychosocial, cultural, communicative, and educational obstacles. Key themes include the need for continuing nurse education, the importance of individualized patient assessment, communication deficits, and the role of patient support systems. The paper concludes with recommendations for further mixed-methods research and highlights ethical considerations relevant to this area of nursing practice.
- Introduction and Background: Patient-centered care and T2D self-management rationale
- Research Question and Key Terms: Nurses' views on barriers to T2D self-management
- Literature Search Method: Google Scholar database search strategy described
- Critical Appraisal of Literature: Five studies on nurse-perceived T2D barriers evaluated
- Conclusions and Recommendations: Synthesis of findings and future research directions
- References and Appendix: Citations and literature search summary data
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The paper anchors its analysis in a clearly stated research question, which gives the critical appraisal a focused purpose and allows each reviewed study to be evaluated for its relevance to that specific question.
- Each study in the critical appraisal section is not only summarized but also assessed for its methodological strength and usefulness, demonstrating genuine evaluative thinking rather than mere description.
- The conclusion synthesizes findings across all five studies into four numbered, actionable takeaways, making the paper's practical implications easy to follow and apply.
Key academic technique demonstrated
This paper demonstrates critical appraisal as a formal academic method — each source is evaluated not just for what it found but for how credibly and convincingly it found it. The author explicitly notes methodological features such as triangulation of data sources, research design quality, and corroboration across studies, modeling how to move beyond summary toward evaluative analysis of evidence.
Structure breakdown
The paper follows a structured literature review format: an introduction establishing the clinical rationale, a clearly defined research question with defined terms, a transparent account of the search methodology, a study-by-study critical appraisal section, and a conclusions section that synthesizes findings and proposes directions for future research. This logical, stepped organization is well-suited to literature review and critical appraisal assignments in nursing and health sciences programs.
Introduction and Background
The basis of self-management is rooted in patient-centered care. The idea behind it is that patients will feel empowered to take ownership of their 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 the 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 may feel as though he or she has no part in the process of care. The patient will not take ownership of the care process and will instead take a passive approach to self-care, relying solely on 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 simply going to the healthcare 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 engage the patient in caring for his or her own health to such an extent that the patient becomes empowered to do more, know more, and be healthier overall. 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 a measure of 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 enable nurses to achieve the goal of teaching self-management of T2D, so that patients may reach a level of empowerment in taking 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 the case can be the first step in helping nurses overcome the challenges they face in teaching self-management of T2D.
Research Question and Key Terms
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 obstacles in collaborating with patients to train them in self-management. By understanding what nurses view as the main challenges, solutions to those struggles can then be developed. Unless the specific problem and pain points are identified, there is no way to provide relief or overcome the obstacle.
For the purposes of this critical appraisal, certain terms are defined as follows:
Self-management: the management of one's own care; the taking of responsibility and accountability for one's own health and well-being.
Barriers: obstacles to care that can take virtually any form — social barriers, personal barriers, identity barriers, knowledge barriers, support barriers, emotional barriers, and so on.
Patient-centered care: care that is oriented specifically to and uniquely designed to meet the needs of the individual patient.
In the next section, a discussion of the literature search method is provided. Following that is the critical appraisal of relevant literature on the topic of nurses' views of barriers to self-management of T2D. The paper concludes with a conclusions 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, as well as books and conference papers. The following keyword 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, is provided in the 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 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), healthcare providers view the barriers to the self-care of type 2 diabetes to be "psychosocial, socioeconomic, physical, environmental and cultural factors" (p. 4). Nurses also noted that patient attitudes toward 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, meaning that neither party is on the same page when communication breaks down. This study was very helpful in highlighting what nurses view as barriers to self-management because it focused specifically on challenges that nurses perceived and experienced. Those challenges were explored through interviews and survey methodology, allowing for a triangulation of data sources that gave 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 that of Nagelkerk, Reick, and Meengs (2006), in which the researchers noted that perceived barriers to T2D self-management included a lack of understanding about the care process on the patients' part, and a feeling among patients that their providers were not giving them enough support to effectively engage in self-management. Nurses who recognized these barriers felt that patients challenged by them needed more time, consideration, support, and education. Nurses believed patients could benefit from a boost in their health literacy on this matter. This study's findings were convincing and helped to show how much consideration patients actually need from nurses in order to reach a level where they can genuinely care for themselves.
Bos-Touwen et al. (2015) showed that nurses' view of patient barriers to self-management of T2D depended primarily on the type of patient being treated. Since every patient is unique, their study indicated that nurses have unique experiences with each individual patient when it comes to facing obstacles to self-management. Moreover, nurses held that identifying obstacles largely depended on the patient's own self-assessment: "Patient assessment was the key driver of tailoring, which was performed in various ways, and influenced how and the extent to which care was individualized" (Bos-Touwen et al., 2015, p. 282). This indicates that nurses need to have considerable discussion with patients before addressing challenges to self-care for the patient's diabetes, in order to better understand where the patient is likely to struggle and what the patient perceives as potential issues. This study was especially helpful in pointing out how important it is for every nurse to approach each patient as unique and to identify the patient's particular needs so that the patient can be sufficiently supported to engage in self-care.
The study by Sen (2005) showed that nurses require continuing education in order to be better prepared to identify obstacles in the self-management of T2D for patients. Sen (2005) revealed that nurses need additional training in assessment skills, knowledge, attitudes and values, and in identifying barriers to self-care. What the study revealed primarily is that nurses have not received effective training in addressing the management barriers that patients face in treating their T2D. This study was effective in illustrating how important it is for nurses to keep receiving training and not to assume that, once they have obtained their nursing certificate or degree, their education is finished. Continuing education is the foundation of quality care, and nurses will not be able to engage in collaborative care unless they are well-grounded in training on how to teach patients self-management — as this study convincingly shows.
Mulder, Lokhorst, Rutten, and van Woerkum (2015) show that nurses' perception of barriers to effective self-management of T2D is related to communication issues, corroborating the findings of Pun et al. (2009). Mulder et al. (2015) noted especially that "important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach" (p. 1100). When nurses fail to engage patients in the right manner, patients become locked out of the self-management process, feeling incapable of taking ownership of their own healthcare. Nurses are aware of effectively "freezing out" the patient in these instances but lack the communication skills needed to bring the patient back into the conversation so that the patient feels supported, empowered, and activated. Mulder et al. (2015) suggest that nurses must have a grounded approach in patient-centered care to be able to overcome this obstacle. This study's findings are convincing as they are corroborated by all the other studies examined here, and the conclusions are based on sound methodology and research design as described within the study.
Create your account
Always verify citation format against your institution’s current style guide requirements.