Abstract Background: Tis study investigated the efectiveness of using patient participation goal attainment scaling in a telenursing system for self-management behavior in two Japanese type 2 diabetic patients. Methods: Te intervention consisted of using goal attainment scaling to set goals, and eforts toward realizing these goals were made using a telenursing system that included on-demand webcam conversations, e-mail and phone calls. Over the intervention period of 6 months, the patients performed daily self-monitoring and the nurse provided telenursing support according to the patients’ needs and nursing care requirements. Results: Both patients had improved self-management behavior and a positive opinion of the telenursing system and goal attainment scaling. Conclusion: Incorporating goal attainment scaling into a telenursing system for type 2 diabetic patients was efective in continuing self-management behavior, suggesting that it is efective in providing continued home nursing care in diabetic patients. The Effects of Telenursing with Goal Attainment Scaling in Diabetic Patients: A Case Report Publication History: Received: December 21, 2014 Accepted: February 16, 2015 Published: February 18, 2015 Keywords: Goal attainment scaling, Self care, Telenursing, Type 2 diabetic patients Case Report Open Access Introduction Diabetes care Globally, the number of adults afected by diabetes is increasing and expected to reach 439 million (7.7% of the global population) by 2030 [1]. Of all diagnosed cases of adult diabetes, type 2 diabetes accounts for about 90-95% [2]. Te goal of treatment for type 2 diabetes is to prevent the development and progression of complications through better glycemic control and implementation of regular outpatient visits accompanied by diet, exercise, and drug therapy [3]. To date, efective behavioral interventions have been developed for diabetic patients [4, 5], such as “mutual goal setting” and daily “self- monitoring” (observing and recording one’s own behavior) [6,7]. Mutual goal setting and goal attainment scaling Mutual goal setting is an efective nursing intervention in patients with chronic diseases [8,9], and involves patients and nurses collaborating to set patient goals and reaching a mutual agreement about these goals as treatment intervention [10]. Goal attainment scaling (GAS) is one way of putting this intervention into practical use [11]. GAS involves discussion between the patient and nurse to maintain and recover health in the future, thereby establishing agreement for mutual goal attainment. A Goal Attainment Follow-up Guide (GAFG) is used in this process and includes realistic and practical goals (3 to 5 levels) based on mutual understanding between the patient and nurse, goal weighting, and setting dates to assess the degree of goal attainment. Based on this agreement, the nurse implements a specifc intervention plan towards mutual goal attainment. Te goal attainment score is used to quantitatively evaluate the degree of mutual goal attainment. Tese efects can be calculated by a formula, namely, the goal attainment score. Te goal attainment score is calculated using formula (1) below [12], where “wi” is the weight assigned to the ith goal and “xi” is the attainment level (between -2 and +2) of the ith goal. * Corresponding Author: Dr. Kaori Higano, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura, Ibaraki 300-0051, Japan, Tel: +81-29-883-6019, Fax: +81-29-826-6776; E-mail: k-higano@tius.ac.jp Citation: Higano K, Shibayama T, Ichikawa M, Motomura M, Shimano H, et al. (2015) The Effects of Telenursing with Goal Attainment Scaling in Diabetic Patients: A Case Report. Int J Nurs Clin Pract 2: 117. doi: http://dx.doi. org/10.15344/2394-4978/2015/117 Copyright: © 2015 Higano et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. International Journal of Nursing & Clinical Practices Kaori Higano 1* , Taiga Shibayama 2 , Masao Ichikawa 2 , Miwa Motomura 3 , Hitoshi Shimano 2 , Yasushi Kawakami 2 , Kayuri Furuya 2 and Takayasu Kawaguchi 2 1 Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura, Ibaraki 300-0051, Japan 2 Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan 3 Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami, Ibaraki 300-0394, Japan Int J Nurs Clin Pract IJNCP, an open access journal ISSN: 2394-4978 Volume 2. 2015. 117 Higano et al., Int J Nurs Clin Pract 2015, 2: 117 http://dx.doi.org/10.15344/2394-4978/2015/117 10Σwixi Goal Attainment Score = 50 + (1) [0.7wi 2 +0.3(Σwi) 2 ] 1/2 GAS involves comparing the goal attainment scores when the goals are set to when they are evaluated. A score exceeding 50 means that the expected level of goal attainment has been either reached or surpassed [11]. A P value can be used to refect the estimated average interrelation of the goal attainment score. Kiresuk and Sherman [11] argued that a P value of 0.30 can be safely used as a constant in formula (1). On the other hand, MacKay, Somerville, and Lundie [13] reasoned that the P value could not be presumed based on intuition, but rather should be computed retrospectively on a case-by-case basis by adjusting it to achieve a desired range of scores. GAS has been validated in a study evaluating the efects of drug therapy [14], and is used not only in the assessment of individual goal achievement in therapeutic processes, but also in comparative studies of relative success in achieving goals, making it suitable for evaluation projects [15,16]. Telenursing Recently, there has been interest in telenursing as a new healthcare service to support home care patients [17,18,19]. Telenursing refers to the use of telecommunications and information technology to provide nursing care at a distance, which may help solve increasing shortages of nurses, reduce both travel distance and time, and keep patients out of the hospital [18]. Research has shown that the use of telenursing increases patient