Nursing is a job where various skills and tools are necessary to be learned and applied for providing proper health care and decision making. Although most activities are practical, having a theoretical basis and continuously obtaining new knowledge is crucial to work with excellence. Consequently, exploring scientific works and conducting research to make evidence-based decisions go beyond the educational process and are utilized by nurses in their daily practice. A nursing professional must easily identify study design, sampling, statistical analysis, data collection strategies to help them develop the ability to make proper conclusions (Spooner et al., 2018). A randomized trial, “Effects of coping skills training in school-age children with type 1 diabetes,” conducted by Grey et al., is an interesting example to explore the research design and tools (Grey et al., 2009). This paper aims to overview the selected study, discuss its strengths and weaknesses, propose changes to improve its quality, and mention the implications for nursing practice.
Type 1 diabetes (T1D) is one of the severest chronic illnesses developed in early childhood, thus numerous studies were conducted to gather information about the disease’s influence on individuals’ lives. The research “Effects of coping skills training in school-age children with type 1 diabetes,” published by Grey et al. in 2009, explored how to deal with such conditions. The scientists tested three hypotheses: participants who received coping skills training would have better metabolic control and diabetes self-efficacy (Grey et al., 2009). Besides, they claimed that age, sex, socioeconomic status, and treatment modality would moderate the intervention effect, while changes in coping, self-efficacy and family functioning will mediate it (Grey et al., 2009). The study intended to provide a preventive intervention before the adolescence period when metabolic control worsens and challenges for parents occur (Grey et al., 2009). The results did not submit the first hypothesis and suggested that group coping skills training intervention is beneficial for school-aged children with T1D.
The study was designed as a randomized trial with the two-group experimental intervention: one group received the coping skills training (CST), and another had group education (GE). The 100 subjects aged 8-12 years with T1D participated in the research, and the data was collected at 1, 3, 6, and 12 months post-randomization (Grey et al., 2009). Researchers used Fisher’s Exact test for categorical variables and t-test for continuous variables to submit the average similarity of groups’ characteristics. The CST and GE interventions differed by design as the former addressed the self-regulation and decision-making approaches while the latter provided general information about insulin regimen, nutrition, and daily activities. As a result, Grey et al. (2009) claim that “no significant correlations were observed between changes in self-efficacy, upset related to coping, or family guidance/control and any of the outcome variables” (p. 414). The CST had no expected results, yet both interventions had beneficial psychosocial outcomes for children.
Strengths of The Study
The randomized trial is a profound approach to retrieve a massive volume of data about the participants and analyze the outcomes based on the interventions. The comparativeness is the primary strength of the selected study: children of the same age group with T1D received different types of disease management education, and baseline measurements helped evaluate their efficiency. It is crucial to emphasize that sampling was applied to select subjects with a maximum similarity in their demographic and socioeconomic status, and randomization eliminated the selection biases (Grey et al., 2009). Consequently, comparing CST to GE was objective, and various analysis factors applied solely to the interventions’ outcomes.
Another strength of the study is the measurement strategies applied for the collected data analysis. The information about children’s metabolic control, depressive symptoms, QOL, coping, self-efficacy, and family functioning required evaluation for further comparison and intervention efficacy statement (Grey et al., 2009). The scientists utilized profound, internationally approved standards for their measurements, making the research outcomes reliable and evidence-based. For instance, Grey et al. (2009) claim that “self-efficacy was measured by the Self-Efficacy for Diabetes Scale, which evaluates self-perceptions held by children about their personal competence for successfully managing their T1D” (p. 410). Comprehensive measurements containing multiple items and variables to retrieve are necessary for a quantitative study’s validity and value for further research (Rutberg & Bouikidis, 2018). The evaluated information, filled in a database, provides a foundation to explore how school-aged children cope with T1D.
Moreover, scientists created and applied the concept of children’s individual cope strategies of dealing with T1D, and establishing such a framework for the intervention research strengthens the study. Grey et al. (2009) state that “adaptation is the degree to which an individual adjusts both physiologically and psychosocially to the stress of living with a long-term illness.” (p. 407). Providing explanations of terms utilized and constructing data retrieve and analysis around specific frameworks is a strength of the study’s design because it helps the scientists make the results more precise and considerable.
Weaknesses of the Study
The research about school-age children with T1D coping skills has three weaknesses that influence its validity and practical outcomes. Firstly, the study’s sampling is narrow and small in quantity because only 100 subjects were selected to take part in the randomized trial. Participants were from the upper socioeconomic status families with the life conditions for better disease control, and most of them received insulin pumps, a practice that is not common for managing T1D in children (Grey et al., 2009). Lacking sampling diversity and quantity doubts the actual efficiency of CST and GE intervention for individuals aged 8-12 years because ones with other backgrounds or treatment methods might show different results.
Secondly, the weakness of the given study is the low differentiation between interventions as CST and GE can only be distinguished by the general approach for educating about T1D management. The coping training was individual, while the group sessions involved more people, and it could influence how children perceived the given information because in the first case, participants had no role models of their peers who are good at self-management (Grey et al., 2009). The quantitative study results depend on the range of contrasting practices used for the intervention. Testing mediators and moderators could be more precise if CST and GE had more dissimilarities (Gray et al., 2021). Lack of differentiation between interventions eliminates the probability for significant predictors of outcomes to be retrieved in the adjusted analyses.
Lastly, the weakness of the research is related to the lack of theoretical basis and discussion of similar studies conducted before or with other subjects. Although the article includes explaining the demand in developing coping skills in children before they become adolescents and mentions the general disease management practices, it lacks the literature review (Grey et al., 2009). Providing references to similar scientific works, research that explored the coping skills for individuals with T1D, and books or articles that share treatment and clinical support practices is crucial to validate the results (Spooner et al., 2018). The use of other studies’ conclusions and analysis of the selected interventions’ actuality is essential to clarify if they can be considered evidence for nursing decision-making.
Proposal of Changes to Improve The Study’s Quality
The strategies of analyzing researches, identifying their methodology, sampling, design, outcomes, and validation are essential to be learned by future professionals. Proposing the changes to improve the selected study’s quality based on its strengths and weaknesses is beneficial for nursing education and further clinical practice (Spooner et al., 2018). Indeed, there are several details to address in the research about children with T1D coping skills training to increase the results’ validity. For instance, sampling can be expanded to include the control group with no particular interventions. Although searching for participants might take more time, the outcomes would provide specific evidence for CST and GE’s influence on children’s coping with T1D. Furthermore, forming a control group in the quantitative research is necessary to identify what variables depended on the intervention’s existence and exclude the unnecessary measurements (Gray et al., 2021). The selected study has not made any particular conclusions about the coping skills training, yet including a control group that had no intervention could help the scientists discover the impact of CST.
Moreover, the research included three hypotheses as the scientists aimed to retrieve the factors to consider mediators and moderators and submit that CST profoundly impacts school-age children’s T1D control and self-management. The change to improve the study’s quality is to implement a null hypothesis stating that the interventions do not influence participants’ coping skills. The approach of including the “no difference” statement sets a direction for a quantitative study by forcing the data collection and analysis processes to search for distinguishes in groups’ results (Gray et al., 2021). Exercising this type of research design could help the scientists revise the measurements they took and use other points of view for assessing their interventions’ outcomes.
Lastly, the study’s quality would be improved if the data collected in post-randomization and trials period longer than the included 12 months. For instance, the follow-up on the participants’ conditions, coping, and family environment could provide more supportive evidence for the study results once they enter the adolescence stage. Increasing the volume of data collected about the subjects on different time sets is beneficial for analyzing and submitting the intervention efficacy (Rutberg & Bouikidis, 2018). Furthermore, additional follow-ups could be conducted if a patient switched their treatment modality as it would admit or deny the correlation between the variables of disease management and insulin pumping.
Study’s Implications for Nursing Practice
The study about the effects of coping skills training in school-age children with T1D has strengths and weaknesses, its design and methodology could be improved, yet its outcomes are valid for nursing practice. The participants showed beneficial outcomes of both CST and GE, submitted the importance of a prosperous family environment and revealed the impact of insulin pumping on disease control. Dowling (2021) states that “suboptimal management can lead to serious health consequences, including damage to various organs and body systems” (p. 1). Consequently, the development of solid management practices and helpful habits must begin in the pre-adolescence period because children are more adjustable to behavioral changes. The study’s evidence suggests that nursing professionals must educate the patients and their parents in an understandable and effective manner to help them deal with chronic disease.
Besides, the research explored and submitted the importance of group-based psycho-educational interventions for school-aged participants with T1D and their parents. Grey et al. (2009) state that “children participating in both programs demonstrated improvements on important psychosocial outcomes, particularly in self-efficacy, coping, depressive symptoms, worry, and impact of diabetes on QOL” (p. 416). The outcome for nursing practice is based on the fact that disease management practices are better learned in groups, therefore clinical visits of T1D patients could be merged into educational sessions.
The selected work’s design, methodology, sampling, and testing also have implications for nursing practice as the research was conducted with a small number of subjects and limited by one healthcare facility. The internal study can include statistical data from patients’ medical records, and data analysis can be checked with Fisher’s Exact test and t-tests (Spooner et al., 2018). Addressing the ethical side of using personal records is critical in such a case, therefore a nurse might need to discuss the idea of research with senior colleagues and patients.
Going beyond the scientific information presented in a study and exploring the research design, methodology, data collection, and analysis is a profound approach for nursing professionals’ work improvement. The demand for integrating evidence-based practice encourages developing a process of critical evaluation of gathered information and continuously obtaining new knowledge about medicine and healthcare. The analyzed study provides helpful recommendations for dealing with T1D management and patient education and shows how important it is to select a proper sampling, hypotheses, and research methodology.
Dowling, L. (2021). Effective management of type 1 diabetes in children and young people. Nursing Children and Young People, 33(3).
Gray, J.R., Grove, S.K., & Sutherland, S. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Saunders Elsevier.
Grey, M., Whittemore, R., Jaser, S., Ambrosino, J., Lindemann, E., Liberti, L., Northrup, V., & Dziura, J. (2009). Effects of coping skills training in school‐age children with type 1 diabetes. Research in Nursing & Health, 32(4), 405-418.
Rutberg, S., & Bouikidis, C. D. (2018). Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-213.
Spooner, A. J., Aitken, L. M., & Chaboyer, W. (2018). Implementation of an evidence‐based practice nursing handover tool in intensive care using the knowledge‐to‐action framework. Worldviews on Evidence‐Based Nursing, 15(2), 88-96.