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Problem SolvingA CommentaryFrom the Lovelace Medical Group, Albuquerque, New Mexico. Correspondence to Donna Tomky, MSN, RN, C-NP, CDE, Lovelace Medical Group, 1327 Carmino Ecuestre NW, Albuquerque, NM 87107 (dtomky{at}xmission.com). The problem-solving systematic review has highlighted some interesting findings, and one of these is that problem-solving behavior is a multidimensional concept. Although multiple definitions have been reported in the literature, there is commonality in all definitions by describing problem solving as comprising both a logical and systematic approach for applying skills and knowledge as well as experiential learning. Also, problem solving applied to diabetes is further complicated by the need to consider problem-solving behaviors within a specific context: food management, medication taking, monitoring, and so forth. The problem-solving systematic review concluded that there are few studies that actually included a measure of general problem solving as part of any educational or treatment intervention. Studies that did measure problem solving commonly used eliciting verbal responses from participants about vignettes of hypothetical problem situations. Other assessment tools (inventory scales, assessment tests) were used in a few studies, but none were ready for direct practice use or to be used as tools on which treatment decisions could be based. When problem solving was applied to a specific area of self-management—insulin taking, carbohydrate counting, portion size, and ingredient calculations—the evidence was more strongly associated with problem solving's being a necessary and robust factor. There is some evidence that associates poor problem-solving ability with poor glycemic outcomes, but exactly how this association works is not well understood or well studied. Other metabolic parameters commonly associated with diabetes related to problem solving such as lowering lipids or blood pressure are scantily reported, and more research is needed to correlate the associated metabolic comorbidities with diabetes and problem-solving behaviors such as adjusting food, physical activity, or implementing coping strategies while monitoring blood pressure and weight. Problem-solving evidence for application to practice at this time is not as firm as most clinicians would require. This lack of evidence points to the need for additional research that specifically looks to measure the influence of problem-solving behaviors on process and health status outcomes. To make confident correlations between improved glycemic control and problem solving, further research is needed to better understand the relationship of problem-solving behaviors to all other AADE7TM diabetes self-management behaviors. Further research is also needed to understand how to most effectively incorporate problem solving as a specific curricular component in DSME interventions. More evidence is needed on how diabetes educators can best facilitate and increase understanding of problem-solving behaviors related to diabetes self-management, in particular, how to translate models of decision making and action choices in situations involving hyperglycemia or hypoglycemia and sick days. As Dr Hill-Briggs revealed, there is a limited amount of evidence for specific recommendations for systematic integration of problem-solving training methods into diabetes self-management education (DSME). One reported approach used by diabetes educators to quantify problem-solving abilities is numeracy research. This provides a method to evaluate how patients interpret self-monitoring data to make decisions about accurate insulin doses. Other uses involve evaluating the use of carbohydrate-to-insulin calculations, portion size, or ingredient calculations. Evidence strongly supports continued assessment of these instruments and research to identify appropriate measures in everyday practice. The area of problem solving also raises the question regarding the best approach to training diabetes educators/health professionals in assessing, teaching, and evaluating this high-level skill. More research is indicated for evaluating the best methods of training diabetes educators for incorporation into the medical or education session. Measuring the effectiveness of health professional training and resulting patient education and clinical outcomes is needed. Perhaps researching current perceptions and understanding of problem-solving behaviors in the diabetes educator population is warranted. The problem-solving systematic review supports the importance of problem solving but also reveals how little is known about how to teach this skill and link it appropriately to areas of diabetes management outcomes. Some questions that remain unanswered include the following: What interventions, methodology, resources, and time are most effective in facilitating problem-solving behaviors in different populations? Is it more effective to deliver problem-solving education through individual counseling or group classes? Is problem solving a stand-alone behavior, or must it be incorporated throughout the entire DSME experience, as well as with other self-care behaviors? The evidence reveals that more research is needed involving DSME for developing approaches in addressing problem-solving training throughout the diabetes continuum.
The Diabetes Educator, Vol. 33, No. 6,
1051-1052 (2007) This article has been cited by other articles:
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