Nurse-led psychological interventions to improve diabetes control: assessing competencies

OBJECTIVE: To assess whether medical nurses can deliver motivational enhancement therapy (MET) and cognitive behavioural therapy (CBT) to a competent level and whether treatment fidelity is maintained.

METHODS: Training consisted of classroom teaching, written materials, a training caseload, and audio-visual feedback. We used the Motivational Interviewing Treatment Integrity (MITI), the Revised 12-item Cognitive Therapy Scale (CTS-R), and components of the Motivational Interviewing Skill Code (MISC) to assess competency and treatment fidelity. Two independent clinical psychologists who were blind to the allocation rated a random selection of 40 sessions.

RESULTS: Six nurses were trained in both interventions. For the MET the mean (SD) scores for empathy and spirit on the MITI scale were 5.1 (0.7) and 4.6 (1.0) respectively and for CBT the total mean (SD) CTS-R score was 52.1 (7.5), which was acceptable competency in both treatments. The two interventions were distinguishable.

CONCLUSION: Results suggest that nurses can be trained to deliver diabetes-specific MET and CBT competently and maintain treatment fidelity.

PRACTICE IMPLICATIONS: Findings of this study provide preliminary evidence to suggest that nurse-led psychological interventions could be incorporated into the traditional diabetes setting.