Introduction
The number of Americans diagnosed with diabetes is approximately 20 million ( Eberhart et al, 2004). The number continues to rise as the population ages and the prevalence of obesity increases. Consequently there is great urgency in the need for diabetes education and self care among patients. The article by Seley and Weinger, improving diabetes self management attempts to address the possible barriers to patient education and the role of the nurse in assisting the patient to manage diabetes. This article includes the input of various nurses who participate in a symposium on how to promote diabetes self management.
Main Text
Diabetes mellitus is a condition in which the body’s production or use of insulin is impaired. It is characterized by deranged metabolism and hyperglycaemia – characteristic symptoms include polyyuria, polydipsia, blurred vision and high blood sugars. There are generally two main forms of diabetes mellitus. Type 1 diabetes and type 2 diabetes. Type 1 diabetes occurs as a result of inadequate insulin and may be caused by autoimmune destruction of the beta cells of the pancreas.
Type 2 diabetes has its aetiology in insulin resistance on target tissues. Due to this, an abnormally high amount of insulin is required by the cells and when the beta cells cannot meet this demand, diabetes develops. Type 1 insulin is treated using insulin (injected). Dietary and lifestyle modifications re also part of the management. Type two usually does not require insulin injections and is managed by a combination of dietary treatment, oral hypoglycaemic agents and lifestyle adjustment (WHO, 1999).
Self management of diabetes is very important since diabetes can lead to various complications. Among these are acute complications for example diabetic ketoacidosis and hypoglycaemia. Long term complications are increase risk of cardiovascular disease, retinopathies, nephropathies, neuropathies, micro vascular damage which may lead to importance and poor healing of wounds. Diabetic foot is a common and serious complication among diabetic patients who get wound of the feet. Poor healing of the wound leads to gangrene which more often than not makes amputation a requirement.
In the developed countries, diabetes is a significant cause of blindness among non-elderly adults, it is the major cause of non-traumatic amputation and nephropathy secondary to diabetes is the most prevalent illness requiring renal dialysis in the United States (Mailloux, 2007). To prevent these complications, patients are asked to follow a meal plan, exercise on a regular basis and to take medication. While new treatments may help to avoid complications, self care is made more complex, and it becomes even more complicated when the patient has comorbidities.
The article provides patient teaching instructions by authoring how attitudes and approaches to patient education as far as diabetes self management can be improved. The article begins by pointing out that most health care system stakeholders do not value patient education enough. The article then goes on to suggest that research proves the need for patient education should be collected. Routine reimbursement to nurses and diabetic educators is an outcome that could be measured to indicate that has been recognition of the value of patient education (Seley and Weinger, 2007). The article emphasizes the need for clearly defined desired outcomes of self management education. This will serve as evaluation measures for the quality and effectiveness of the patient teaching.
The article also points out that a nurse teacher ought to have adequate flexibility to accommodate patient’s differences, such as literacy and cultural background. The teach back method is endorsed as an effective and useful tool which would require evaluation as well as the use of support groups during the patient education process. The diabetes education workforce as presented by the article needs expansion. The article presents a number of strategies that can be used to achieve this (Seley and Weinger, 2007). Among these are competencies, credentialing and the continued education for nurses and diabetic educators working with nurses. A method suggested in the article to teach nurses how to be self management educators is postgraduate mentoring programs (Seley and Weinger, 2007)..
Benefits that can be gained from reading this article include an increased awareness of the barriers that keep patients from successfully managing their diabetes. The article also provides some insight into the working relationship between the nurses and community health workers with reference to diabetic patients and management of their conditions. Being aware of the challenges that patients face in adhering to their treatment regimens is important since from that premises, the nurse can assist the patient to comply as much as possible with the regime.
Further, the article identifies several strategies to help patients overcome these barriers. Among these are helping the patient to navigate the healthcare system. The article suggested use of the chronic care model as a means of being successful at self managing diabetes. The article has also contributed to my appreciation of importance of research in the nursing curriculum and in the providing evidence-based nursing. Consequently, I have identified gaps in research as a result of reading the article and realizing that is limited research on the relationship between great clinical education and better outcome for patients as well as the role of no cure healthcare professionals in giving patient education.
The information obtained from the article can be incorporated in various ways in my nursing practice. To begin with, I will have a more proactive and educative role when managing diabetic patients, when teaching I will employ the teach back method to find out how effective it is in helping the patient to understand management of their condition.
The information learnt from the article can also be incorporated into nursing practice by linking patients who have been recently diagnosed with diabetes to self management education programs. This will make it easier for the patients to go through the health systems.
Eliciting patients’ fears, concern, worries and needs is also practical approaches that could be incorporated into patient teaching. This is an especially good approach when the patient has comorbidities and doing so helps to prioritize the needs of the patient leading to optimum use of time and effectively addressing the patient’s problems.
Utilization of computers to track patients and as a tool of patient education are also strategies that can be easily incorporated into nursing practice especially in hospitals whose the policy altars. Support groups can also be adequately used to give a sense of comfort and solidarity for patients. I would employ this strategy with an aim of addressing the psychosocial issues associated with diabetes and especially when working in a situation where the clients are from similar backgrounds.
Conclusion
The information generated on research by the article can be incorporated into nursing practice when I join a journal club that would provide the opportunity to be involved in research work and to practice skills of evaluation to enhance evidence based care nursing. Another benefit of reading this article is the fact that it has opened my eyes to possible ways in which my professionalism can be enhanced. This is because the article mentions postgraduate mentoring programs that I would benefit not only the nurse but also patient. In addition, by mentioning some of the research gaps in diabetes patient care management, the article has helped to provide several research problems that could be pursued in my final year of study.
References
Eberhart, MS; Ogden C, Engelgau M, Cadwell B, Hedley AA, Saydah SH (2004). Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes — United States, 1988–1994 and 1999–2002 Morbidity and Mortality Weekly Report 53 (45): 1066-1068.
Seley J and Weinger K 2007 American Journal of Nursing.
– Supplement: State of the Science on Diabetes Self Management: Strategies for Nursing. Pages 6 – 11 Volume 107 Number 6.
Mailloux L, 2007 Up-To-Date Dialysis in diabetic nephropathy. Web.
World Health Organisation, 1999 Department of Noncommunicable Disease Surveillance Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Web.