How Do People With Type 2 Diabeyes and Practice Nurses Understand and Manage Decision-Making Involving Risks Associated With This Condition?

This thesis explores how patients and practice nurses negotiate and manage decisionmaking involving risks associated with type 2 diabetes. The location of the study was general practice as this reflects the significant shift of diabetes management for people with type 2 diabetes over the last decade.
Purpose of the study
To improve understanding of what is effective when communicating about risks to people with diabetes and how people with diabetes use information on risk to make decisions about how they manage their diabetes.
Overview of study design
A qualitative approach, based on case studies involving a patient with diabetes and a practice nurse who was their main diabetes care provider, was undertaken in three local general practices. Grounded theory methodology was used to investigate the perspectives of healthcare professionals and patients managing risk of diabetes complications.
Data collection involved audio recording or observing a consultation between a person with diabetes and their practice nurse, followed by individual interviews with each. The follow-up interviews were lightly structured around a topic list, which was adapted to pick up issues identified from the consultation. Subsequent interviews were informed by theoretical sampling consistent with the grounded theory method. Data was analysed through cycles of data collection, coding and constant comparative analysis with the development of categories and the final core category: ‘Responding according to risk perception’.
Findings
What this study contributes to understanding risk communication and how risk is managed:
 Patients live with uncertainty which impacts on their behaviour and how they manage risk
 Diabetes creates a social risk for patients which has to be managed in their daily lives
 Practice nurses balance the tensions of formal and informal risk management in order to meet professional and organisational requirements as well as the expectations of patients
 Effective risk communication may be enhanced by the quality of the nurse-patient relationship, the use of visual metaphors and anecdotes involving ‘similar’ others