In the Yawkey Athletic Center on Nov. 17, Margaret Grey declared that the innovations she has developed with her colleagues in the nursing industry over the past 10 years have the potential to truly transform population health.
As a part of the 11th Pinnacle Lecture Series, sponsored by the Connell School of Nursing, Grey was invited to speak to students, faculty, and the public about her discoveries in the self-management of chronic conditions.
Grey, the ninth dean of the Yale School of Nursing and an Annie Goodrich Professor of Nursing at the university, opened by explaining that she is currently on sabbatical. After holding positions at both the University of Pennsylvania and Columbia University, she began working at Yale in 1993 and became dean in 2005.
After providing some insight into her more recent career, Grey began to talk about how self-management has evolved over time, and what that means for clinical practice, research, and the larger issue of the population’s health.
“Self management is a cluster of daily behaviors that individuals perform to manage a chronic condition,” she said.
She went on to explain that, when working with children and families who are dealing with a chronic illness, nurses should come up with self-management constructs in which the patient is in control. Thus, she acknowledged the many benefits of a revised self- and family-management framework. In this new approach, there is an additional focus on the facilitators and barriers that come into play as an individual is making his or her daily decisions. These factors can stem from the patient’s lifestyle, health status, resources, environment, or health care system.
“So we all know that knowledge is fundamental to behavior change, but it’s not sufficient,” Grey said.
She discussed how an individual might know exactly how to take care of himself, but that these other barriers can impact whether he follows through with the necessary actions or not. She used a personal example to help the audience better understand the dynamic.
Like many people, Grey’s weight has fluctuated innumerable times over the course of her life. This may not seem to make sense, as she works with individuals who have Type 1 diabetes, and knows well what she needs to do to manage her weight. There are other factors in life, however, that crop up and prevent her from taking the needed steps to maintaining a constant, desireable weight.
After recognizing these facilitators and barriers, Grey explained the process of self-management itself, and the call to pay attention to an individual’s illness needs, activating resources, and adjusting to the new lifestyle. One of the most important and difficult, parts of this step is for a person to find meaning in their serious condition.
“How can you use this experience to be even better than you were before?” she asked. “That’s making meaning.”
Grey then transitioned to describing how these methods of self-management relate to her own research she has conducted with children diagnosed with Type 1 diabetes. The study that she discussed most thoroughly was a randomized trial that determined the effects of coping skills training intervention compared to general diabetes education. With this study, Grey came to the conclusion that group-based interventions may be beneficial for adolescents.
The problem she found with the type of coping skills training they conducted was that it was done in small groups, and therefore was not available on a large scale. In order to make such education more effective for adolescents, she decided they would need to create a medium that would be flexible enough for busy teenagers to utilize it when their varying schedules would allow it. This led to the development of TeenCope—the Internet-based coping skills training program.
“We developed this in a very patient-centered way,” Grey said.
With the help of her colleagues, she asked adolescents navigating their lives with diabetes what they see as attractive in a website. Essentially, they called for characters they could relate to, and more interactive features, rather than daunting, lengthy paragraphs for them to read.
Grey explained that with this project and all of her work, she has learned the importance of engaging people. In conclusion, she emphasized that nurses need to help patients focus on their illness needs, as well as figuring out how to live with a chronic illness.
After she finished her prepared lecture, Grey answered several questions from members of the audience. These included inquiries about the roles of school nurses in such studies, as individuals in attendance had personal connections to that specific career. Some of these women took the opportunity to share their experiences, insights, and questions on the matter. This ultimately led to Grey’s acknowledgment of the struggle to find a balance.
Grey asserted that the immense difficulty of finding and maintaining this equilibrium is just as hard for the parents of patients as it is for the children themselves.
“It’s a terrible responsibility,” Grey said. “We need to be sympathetic to parents because it’s not easy.”
Featured Image by Lucius Xuan / Heights Staff