Fatigue in diabetes mellitus: testing a middle range theory of well-being derived from Neuman's theory of optimal client system stability and the Neuman Systems Model.

Abstract

The purpose of this study was to test a middle range theory of well-being in adults with diabetes mellitus derived from Neuman's Theory of Optimal Client System Stability and the Neuman Systems Model. The relationships among stress, well-being, and fatigue in adults living with diabetes mellitus were examined to test the theory that disruption in well-being in adults living with the stress of diabetes mellitus leads to greater fatigue.Data were collected from a convenience sample of 87 adults with Type 1 and Type 2 diabetes mellitus. Subjects completed a questionnaire packet that was designed to elicit demographic information, a measure of their stress related to living with diabetes mellitus, a measure of the physiological, psychological, sociocultural, developmental, and spiritual well-being, and a measure of their level of fatigue. Data were analyzed using bivariate correlation and hierarchical multiple regression.The findings of this study revealed initial support for the relationships proposed by the middle range theory of well-being. Stress scores ranged from 2-70 (possible 0-80) with a mean of 26.14, standard deviation of 18.21, and a median of 20 and supported that living with diabetes mellitus is a stressor. Stress was significantly correlated with all variables and in the anticipated direction and supported that stress of living with diabetes mellitus is disrupting to client well-being. Fatigue scores ranged from 9-63 (possible 9-63) with a mean of 38.83, standard deviation of 14.66, a median of 39.00, and a mode of 63 and supported that disrupting client well-being leads to energy depletion. Finally, stress and well-being accounted for 32% of the variance in fatigue scores and provided support for the proposed theory. Additionally, the psychological interacting variable of well-being best explained the functioning of the overall well-being in this sample.This study provides the initial testing of the Theory of Well-Being and establishes the groundwork for a program of research. Implications for nursing practice include nursing interventions directed at strengthening client well-being to reduce fatigue. Recommendations for research included further testing of the theory and instrument development.