Type 1 diabetes self-management in hospital: a constructivist grounded theory

Author: Rebecca Munt

Munt, Rebecca, 2020 Type 1 diabetes self-management in hospital: a constructivist grounded theory, Flinders University, College of Nursing and Health Sciences

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Every day in Australia, nine people are newly diagnosed with type 1 diabetes (T1D), with prevalence of the chronic condition on the increase worldwide. T1D is an autoimmune disorder which destroys the ability of the pancreas' beta cells to produce insulin, leading to high plasma glucose levels. Currently, this chronic condition is unpreventable and incurable and requires those living with T1D to self-manage using blood glucose monitoring (BGM), insulin administration, dietary intake management and undertaking physical activity. This intricate and complex daily self-management routine also incorporates timing of all management tasks, decision-making and problem-solving around those tasks and implementing treatment in response to alterations of blood glucose levels (BGLs). Over time those living with T1D become known as expert self-managers. However, on admission to hospital people with T1D are often required to relinquish their self-management and their expertise related to their chronic condition is overlooked by health professionals.

Currently there is limited research on T1D self-management in hospital, therefore a constructivist grounded theory approach was used to explore the influence of hospitalisation on T1D self-management in Australia. A focus group and in-depth interviews were conducted with adults living with T1D to interpret and explain their meanings of self-management while in hospital and their subsequent actions. The generation and analysis of data were guided by Charmaz’s constructivist grounded theory methods which include line by line and focused coding and constant comparative analysis.

The application of the core tenets of grounded theory led to the construction of the substantive theory which explains T1D self-management in hospital from the perspective of the participants. The participants found their interactions with health professionals in hospital led the participants to recognise the risks they faced in relation to their T1D management and forced them to take action to prevent harm being caused to them. As a consequence of the health professionals’ actions in hospital, participants’ reliance on their everyday T1D self-management expertise was required. The overall substantive grounded theory constructed during this study was The Social Construction of Keeping Self Safe.

While there are some similarities to existing research, the findings of this study are unique as there has been no previous exploration of the experience of the person with T1D in hospital, nor generation of a theory to explain the phenomenon. Furthermore, with a current focus on safety and quality in health care in Australian hospitals, this study found participants with T1D felt unsafe while in hospital and as a consequence, they found themselves having to take responsibility for maintaining their safety, as they could not rely on being kept safe by the actions of health professionals in hospital. This grounded theory therefore enables an increased understanding of the requirements of people with T1D in hospital and identified areas for improvement, particularly in relation to the care provided by health professionals. The study makes recommendations in relation to suggested improvements for current practices in Australian hospitals such as the development of self-management policies, additional education requirements for health professionals and further research.

Therefore, my original contribution to knowledge was to generate a theory that explains T1D self-management in hospital. This thesis contributes to an enhanced understanding of the experience and meaning of self-management for the person living with T1D while in hospital.

Keywords: type 1 diabetes, self-management, hospital, persons perspective

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Professor Alison Hutton