THE LIVED EXPERIENCE OF BECOMING A DIABETIC: A PHENOMENOLOGICAL STUDY

231 Pages·2012·1.13 MB·English

by  Hazel Hunley

The Pennsylvania State University
The Graduate School
School of Nursing

THE LIVED EXPERIENCE OF BECOMING A DIABETIC:
A PHENOMENOLOGICAL STUDY

A Dissertation in
Nursing
by
Marianne T. Adam

© 2012 Marianne T. Adam

Submitted in Partial Fulfillment
of the Requirements
for the Degree of

Doctor of Philosophy

August 2012
The dissertation of Marianne T. Adam was reviewed and approved* by the following:

Carol A. Smith
Associate Professor
School of Nursing
Dissertation Advisor
Chair of Committee

Judith E. Hupcey
Associate Dean for Graduate Education
School of Nursing

Robert A. Gabbay
Professor of Medicine and Endocrinology
Penn State Hershey College of Medicine

Edward W. Taylor
Professor of Adult Education

*Signatures are on file in the Graduate School
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ABSTRACT
Type 2 diabetes mellitus is a chronic disease that affects an estimated 25.8 million
persons or 8.3% of the U.S. population, who are at high risk for major health
complications (CDC, 2011; NDIC, 2012). Control of the disease depends largely on the
diabetic’s adoption of self-care and health management strategies designed to control
serum glucose levels. Diabetes Self-Management Education (DSME) is one process
recommended to facilitate health behavior change and usually an expectation for the
person recently diagnosed. However, outcomes of the formalized DSME programs are
inconsistent and the overall process of self-care learning in the context of a recent
diagnosis of diabetes is poorly understood.
The purpose of this phenomenological study was to enhance the understanding of
the initial lived experience of becoming a diabetic. The focus was on the individual’s
engagement with learning new self-care activities and initiating changes in self-care
commonly recommended in order to control serum glucose and generally manage the
disease progression. The focus of the study was not on how learning occurs or is
accomplished as a process but rather on uncovering the key elements and the context of
the actual experience itself to gain information not previously explored.
Using an interpretive phenomenological method of inquiry (van Manen, 1990),
this study investigated the lived experience of becoming a diabetic in 10 adults recently
diagnosed with type 2 (often referred to as ‘adult onset’) diabetes. The participants (8
females and 2 males) ranged in age from 39 to 77. Most (9) had been diagnosed within 1
to 1.5 years of this study. Analysis of the data obtained from open-ended interviews
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revealed three themes of the lived experience of becoming a diabetic: (a) hearing the
news (diagnosis), (b) sorting it out, and (c) moving on. Although these themes framed the
experience for all of the participants, they were not in a fixed order. Improved
understanding of the experience of becoming a diabetic and responses to the disease, as
revealed in this study, provides new insight into how to best support patients in similar
situations. Implications for nursing practice, education, and research are also identified.
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TABLE OF CONTENTS
List of Tables .........................................................................................................................x
Acknowledgements ................................................................................................................xi
Chapter 1: Introduction ..........................................................................................................1
Background ......................................................................................................................3
Statement of the Problem .................................................................................................7
Research Questions ..........................................................................................................7
Purpose of the Study ........................................................................................................8
Theoretical Perspective ....................................................................................................8
Significance of the Study .................................................................................................9
Assumptions .....................................................................................................................10
Limitations of the Study...................................................................................................10
Conceptual Terms ............................................................................................................11
Chapter Summary ............................................................................................................12
Chapter 2: Review of the Literature .......................................................................................14
Phenomenology................................................................................................................14
The Preparatory Phase ...............................................................................................15
The German Phase .....................................................................................................16
Husserl .................................................................................................................17
Heidegger .............................................................................................................19
The French Phase .......................................................................................................21
Parallel Development .................................................................................................22
Phenomenological Research and Nursing .................................................................22
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Hermeneutic Phenomenology ....................................................................................23
Adult Learning .................................................................................................................25
Learner-Driven Versus Teacher-Driven Activities ....................................................27
Informal Learning ......................................................................................................31
The Health Belief Model .................................................................................................34
Learning in the Context of Illness ....................................................................................35
Learning and Chronic Illness .....................................................................................36
Learning in the Context of Diabetes ..........................................................................41
Rationale for Using Hermeneutic (Interpretative) Phenomenology ................................51
Chapter Summary ............................................................................................................52
Chapter 3: Research Design and Method...............................................................................55
Participant Sampling ........................................................................................................56
Recruitment ......................................................................................................................59
Data Collection ................................................................................................................59
Data Management ............................................................................................................61
Data Analysis ...................................................................................................................61
Human Subjects Protection ..............................................................................................67
Conclusion .......................................................................................................................68
Chapter 4: Study Results and Analysis ..................................................................................70
The Study Participants .....................................................................................................70
Participant #1: Pam ....................................................................................................72
Participant #2: Sally ...................................................................................................72
Participant #3: Lenny ................................................................................................73
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Participant #4: Debbie................................................................................................73
Participant #5: Martin ................................................................................................74
Participant #6: Karen .................................................................................................74
Participant #7: Diane .................................................................................................75
Participant #8: Jane....................................................................................................75
Participant #9: Cathy..................................................................................................76
Participant #10: Carol ................................................................................................76
Identification of Themes ..................................................................................................77
Analysis of the Themes ....................................................................................................79
Hearing the News .......................................................................................................80
Hearing the News: Blocking the Message ...........................................................80
Hearing the News: Reflecting on the Past ...........................................................83
Hearing the News: Fear of “Knowing” ................................................................86
Existential Themes When Hearing the News ............................................................90
Sorting It Out .............................................................................................................92
Sorting It Out: Knowing by Comparison to Others .............................................92
Sorting It Out: Working to Understand and Stay Aware .....................................100
Sorting It Out: Recognizing Support Options ......................................................109
Existential Themes When Sorting It Out ...................................................................118
Moving On .................................................................................................................119
Moving On: Movement Toward a New Reality ..................................................120
Moving On: Choosing Action Versus Inaction ...................................................127
Moving On: Achieving a New Level of Awareness ............................................137
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Existential Themes When Moving On .......................................................................145
Summary of the Findings ...........................................................................................147
Self-Care When Becoming a Diabetic .................................................................147
Medication Management ...............................................................................148
Dietary Management ......................................................................................148
Glucometry ....................................................................................................150
Exercise ..........................................................................................................150
Participants’ View of Complications .............................................................150
Existential Themes When Becoming a Diabetic .......................................................151
Individual Meanings When Becoming a Diabetic .....................................................152
Shared Meaning of the Lived Experience of Becoming a Diabetic...........................155
Conclusion .......................................................................................................................156
Chapter 5: Discussion ............................................................................................................159
Hearing the News .............................................................................................................160
Sorting it Out....................................................................................................................164
Moving On .......................................................................................................................177
Becoming a Diabetic and Learning Principles.................................................................184
Implications for Nursing Practice and Education ............................................................187
Recommendations for Further Research ..........................................................................190
Limitations of the Study...................................................................................................191
Strengths of the Study ......................................................................................................192
Conclusion .......................................................................................................................194
References ..............................................................................................................................196
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Appendix A: Recruitment Materials ......................................................................................209
Appendix B: Interview Guide ................................................................................................213
Appendix C: IRB Approval ...................................................................................................215
Appendix D: Informed Consent .............................................................................................217
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LIST OF TABLES
Table 4.1. Summary of the Study Participants’ Demographics .........................................71
Table 4.2. Summary of the Primary Themes and Thematic Elements ..............................79

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