Groundbreaking research by Yale School of Nursing Dean Margaret Grey and her colleagues was recently honored as being among the top ten most influential nursing studies in the 22-year history of the National Institute of Nursing Research, according to “Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies,” a publication issued by the NINR last month.
Grey and her team conceptualized and confirmed the long-term effectiveness of a novel behavioral intervention, called Coping Skills Training, for teenagers with Type I diabetes — a disease affecting over 200,000 youth nationally that influences how the body processes sugar.
The study was the first of its kind to statistically show that a cognitive-behavior therapy could be an effective intervention, introducing the importance of a “new approach to diabetes care” which couples both medical and behavioral strategies, Grey said.
“Before this, no one thought that a cognitive-behavioral therapy could affect long-term treatment outcomes, such as the metabolic control of the disease, as much as could the medical part of it, such as the insulin delivery,” she said. “No one had shown that teenagers need to learn the life skills to make the right coping decisions.”
Managing the disease as a child or adolescent can be difficult, Grey said, especially given that proper care for Diabetes I requires frequent, self-administered insulin injections and blood sugar level tests. Poor management of the disease can compound its effects and lead to conditions such as high blood pressure, poor blood circulation, kidney damage and blindness, she said.
But the CST trains teenagers in the areas of communication, healthy decision making and conflict resolution, in addition to the basic level of diabetes management, which equips them with a set of “life skills” to make better decisions on how to cope, she said.
Patricia Grady, director of the NINR, said Grey’s study embodies the idea that nursing research often focuses on areas, such as clinical and behavioral research, that other medical professionals may not, considering that much of medical research is oriented towards drug development.
In Grey’s study, the intervention group was enrolled in the CST program for six weeks, with weekly 60- to 90-minute intervention sessions, followed by monthly training visits. An assessment of the two groups a year later found that the intervention group had secured many benefits over the control group, including higher metabolic control, reduced blood-sugar levels and lower depression rates.
Depression can often be a side effect of diabetes that makes it more difficult for the child in question to cope effectively with the disease, which makes the CST’s ability to combat this one of its most useful features, Gail D’Eramo Melkus, diabetes nurse practitioner and researcher at YSN, said.
“Depressive mood is common is all people with diabetes, and particularly in children, as they try to view themselves as normal and try to make normal developmental strides,” she said. “CST comes at a very small cost, considering this.”
The CST also addresses peer pressure — another stressful component of coping with the disease as an adolescent or child — by engaging children in role-playing scenarios that mimic difficult social situations they face in their daily lives, Melkus said.
Attesting to the program’s applicability to the clinical care of diabetes, over 100 practices have requested Grey’s CST manual to date, to incorporate the training into their existing clinical strategies, according to the NINR publication. Clinical-care protocols on managing Diabetes I have also begun to stress behavioral care in addition to disease management through drug administration, the publication said.
“Nursing is about helping people out with the hand they’ve been dealt,” Grey said. “People who have children with chronic illnesses have been dealt with a very bad hand. And so what we do is try to develop ways that help them manage very difficult situations better.”