Putting the Pieces Together: An Exploration of Diabetes Ketoacidosis Readmissions
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ORIGINAL PAPER
Putting the Pieces Together: An Exploration of Diabetes Ketoacidosis Readmissions Thompson H. Forbes III1 · Jennifer Hodgson2 · Julian Crespo3 · Eunicia Jones4 · Sandra Hardee5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The purpose of this study was to develop a grounded theory from the patient and support person perspective on how biopsychosocial and spiritual factors influence DKA hospital readmissions. This grounded theory study sampled participants from one Southeastern US academic medical center who had been admitted with DKA. Semi-structured interviews were conducted over a 10-month period from 2016 to 2017. Participants were interviewed until thematic saturation was reached. Participants included 13 patients and 6 support persons, majority Black, African Americans. Analysis led to the overarching theme of Putting the Pieces Together. This consists of the subthemes of contextual life factors and action strategies that participants attributed to their cycle of readmissions for DKA. Results are not generalizable to all patients who experience DKA but are a reflection of the experiences of a predominately non-Hispanic Black/African American subset of the larger population. This study supports the need for equal importance to be placed on addressing the patient’s availability of a support system that promotes patient agency, supports their cultural beliefs, and respects the contextual factors that influence diabetes management and may break or maintain the readmission cycle. Healthcare systems must develop processes that ensure community and family support systems are available to patients and understand the importance of their role in disease management. Keywords Diabetes · Diabetes ketoacidosis · Qualitative · Grounded theory · Hospital readmissions Thompson H. Forbes and Jennifer Hodgson are co-first authors. * Thompson H. Forbes III [email protected] Jennifer Hodgson [email protected] Julian Crespo [email protected] Eunicia Jones [email protected] Sandra Hardee [email protected] 1
Department of Nursing Science, East Carolina University, 2134 Health Sciences Building, Greenville, NC 27858, USA
2
Department of Human Development & Family Science, East Carolina University, 114 Redditt House, Greenville, NC 27858, USA
3
Medical Family Therapy Doctoral Student, East Carolina University, Greenville, NC, USA
4
Pathways to Life Inc., 150 Arlington Blvd., Greenville, NC 27858, USA
5
Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27858, USA
Introduction According to the Centers for Disease Control (2020), 13% or 34.1 million of all U.S. adults have diabetes. Despite medical advancements, incidence of type 2 diabetes in the United States has remained stable between 2002 and 2015 among non-Hispanic white adults; whereas it has increased for all other race/ethnic groups, especially non-Hispanic Black adults (CDC 2020). Hospitalization for diabetic ketoacidosis (DKA), one of the most serious but avoidable compl
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