title: Decision-making: initiating insulin therapy for adults with diabetes.
abstract: OBJECTIVE
  This paper is a report of a study to describe nurses' perceptions of decision-making and the evidence base for the initiation of insulin therapy.
  
  
  BACKGROUND
  Several theoretical perspectives and professional's attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions.
  
  
  METHODS
  A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37.7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent.
  
  
  RESULTS
  People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses' identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated.
  
  
  CONCLUSIONS
  Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy.
authors.affiliation: Division of Nursing & Health Care, University of Glasgow, UK. j.r.mcdowell@clinmed.gla.ac.uk
authors.forename: Joan R S
authors.initials: JR
authors.lastname: McDowell
authors.forename: Vivien
authors.initials: V
authors.lastname: Coates
authors.forename: Ruth
authors.initials: R
authors.lastname: Davis
authors.forename: Florence
authors.initials: F
authors.lastname: Brown
authors.forename: Paul
authors.initials: P
authors.lastname: Dromgoole
authors.forename: Lesley
authors.initials: L
authors.lastname: Lowes
authors.forename: Eileen V
authors.initials: EV
authors.lastname: Turner
authors.forename: Kate
authors.initials: K
authors.lastname: Thompson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000451:nursing; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D024802:Nurse's Role / Q000523:psychology*; D009730:Nursing Assessment / Q000379:methods*; D010358:Patient Participation; D017009:Professional Autonomy; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin