Introduction
The current healthcare development program focuses on the outpatient component of medical care, includes measures to improve hospital-replacing technologies, and suggests the importance of the institution of general practitioners and nursing staff. However, the essential role of nursing personnel as a human capital reserve in the healthcare system has until recently been underestimated. Thus, most industry-specific programs for providing assistance in various diseases contained exclusively diagnostic and treatment sections. At the same time, the organization of nursing, patients care, and their subsequent rehabilitation was not given due attention.
Unfortunately, in practical health care, until recently, it has rarely been possible to detect the effective use of qualified nursing personnel. Meanwhile, the typical problems of patients with diabetes are a significant decrease in the quality of life, a forced change in habits, interests, rhythm of life, etc. This requires enhanced care on the part of the nursing staff, which, in turn, necessitates effective nursing leadership and active participation of nurses decision-making for the prevention and management of diabetes.
Project Description
The project focused on two main elements: how nursing leadership is involved in policy development in diabetes management and what is the advantage of including nursing leadership in decision-making on diabetes management. Namely the intensive involvement of nurses with different levels of education, including having managerial skills, the organization of medical care can very well provide a number of measures aimed at improving the condition of patients with diabetes mellitus, the degree of compensation for the disease, and improving the quality of life for patients.
Raising and maintaining a healthy lifestyle among patients with diabetes is not an easy task. In order to successfully cope with it, a nurse, in addition to professional education and experience, needs training in the field of psychology and pedagogy, as well as additional time costs for “non-medical work,” which can vary greatly depending on the characteristics of the patient. The need for additional time to work with such patients should be considered by health managers. In addition, it is important to develop uniform standard algorithms for the provision of nursing care, which will ensure high quality services. Motivating patients, cultivating new healthy habits, and maintaining a healthy lifestyle is not an easy task that must be addressed primarily by the nursing staff.
Unfortunately, the healthcare system prefers to spend money on expensive equipment and new hospitals instead of investing in nursing personnel, training them and expanding their functions. Both on the part of health managers and on the part of doctors, there is a reluctance to delegate more authority to nurses. Meanwhile, the emphasis on nursing staff is the ‘command of the times’ and the World Health Organization.
In the WHO documents, the focus is on the issues of the new personnel policy, the redistribution of powers, the efficient use of available resources, the development of new approaches to the training of nurses, the formation of multidisciplinary teams, where the nurse has the opportunity to provide medical advice and management of patients with chronic diseases in remission, prescribing drugs and making research.
In recent years, the professional and educational level of nurses has grown significantly, both due to the introduction of a multi-level nursing education system, and due to natural professional selection (Sibandze & Scafide, 2018). Such potential can and should be used creatively, which resulted in the birth of the concept of expanding the functions of specialists with secondary medical education (Al-Hamdan, Dalky, & Al-Ramadneh, 2017). The nurse must think clinically and make professional decisions on patient care.
The leadership competencies of a nurse for participating in the development of diabetes management programs and appropriate decision-making can be summarized in six areas of competence: determining the direction, managing services and achieving results, leading people and teams, improving the level of nursing professionalism and ethics, communication and collaboration skills in teamwork, as well as independent leadership.
This involves the creation of a participatory culture in healthcare organizations. Numerous leadership studies have shown that participatory culture contributes significantly to organizational performance (Jenkins, 2019). Based on the primary and secondary studies, it is shown that the participation of nurses in the development and implementation of diabetes management programs can significantly improve the quality of care for patients with diabetes.
Project Rationale
Due to expanding nurses’ participation, the performance of healthcare facilities in care provided for diabetic patients. The participation of nurses in the development of policies and decision-making, and, therefore, in management, can be considered as the following advantages: a way of motivation; fuller use of the healthcare workers’ potential; a tool to reduce staff turnover; competitive advantage of healthcare facilities.
As the results of the project implementation showed, a number of positive effects for the medical institution that arise when nursing personnel are involved in managing the organization can be distinguished:
- The delegation of authority places responsibility on the nurse and allows her to feel true job satisfaction, to feel her significance.
- The involvement of nurses in decision-making will make it possible to make better decisions, since line workers may have information that is not available to the head of the unit (for example, about the specifics of the patient’s behavior, due to his social attitudes and cultural affiliation, etc.)
- Many experts believe that the participation of nursing staff in management, as well as the delegation of authority, can significantly increase productivity (Tobiano, Bucknall, Marshall, & Guinane, 2015).
Moreover, creativity and innovation are the main advantages of healthcare organizations in which the participation of nurses in management is applied. Also, resistance to changes in organizations where nurses have the right to vote is lower, than where their opinions are not taken into account, which is quite logical (Tistad et al., 2016). The uniting of employees to solve common problems favorably affects the corporate spirit of the organization.
Personal/Professional Implications
Professionally, the implementation of project contributed to enhancing my knowledge on the role of nursing leadership in policy making, especially in the prevention and management of diabetes. I improved my competence in organizational behavior in the field of healthcare. Personally, I have learned more about competent management and prevention of diabetes, which is important for me as I consider myself being in at-risk group.
Project Goals
The project core objective implied determination of the nursing leadership role in the development of policies for diabetes prevention and management. The objective included the following goals:
- To determine whether nurses are included in the development of patient care policies for the prevention and management of diabetes.
- To reveal different ways in which nurses are incorporated into the decision-making circle of hospital management, with reference to diabetes management.
In the process of primary and secondary data collection and processing, both goals were successfully achieved. Moreover, the project implementation contributed to better understanding of the possibilities of participative management best practices in healthcare organization in terms of diabetes management.
Literature Review
Diabetes mellitus (DM) is one of the leading health problems. About 90% of all diabetes cases occur in type 2 diabetes (Zheng, Ley, & Hu, 2017). In 20-30% of patients with type 2 diabetes, diabetes-specific complications are also detected at the time of diabetes diagnosis (World Health Organization, 2016). Each year, the number of newly diagnosed cases is 6-10% in relation to the total number of patients, so the number of people suffering from this disease doubles every 10-15 years (World Health Organization, 2016).
In addition, type 2 diabetes is characterized by a long asymptomatic onset of the disease, late manifestation, and a high prevalence of cardiovascular disease already in the onset of the disease. Long-term chronic hyperglycemia in this category of patients contributes to early damage to the cardiovascular, nervous system, kidneys, and other organs and tissues (Lofty, Adeghate, Kalasz, & Singh, 2015). The prevention of acute or chronic hyperglycemia in patients with diabetes mellitus is necessary from the standpoint of the prevention of cardiovascular diseases. Moreover, a strong relationship has been established between poorly controlled diabetes and depression (Badescu et al., 2016).
To date, the psychological aspects of the treatment process, especially the internal picture of the disease in type 1 diabetes, the relationship and interdependence of its emotional, cognitive, and motivational sides remain poorly understood. It also applies to the dependence of the internal picture of the disease on gender, age, severity of the disease, level of social adaptation, and its impact on diabetes management effectiveness (Badescu et al., 2016). Accordingly, the development of comprehensive programs for the psychosocial rehabilitation of patients with diabetes on this basis, aimed at successfully managing their disease, and, as a result, improving their quality of life, is of great relevance.
While organizational communication is a top-down flow of information, participatory communication is a bottom-up flow of information (Altiok & Ustun, 2014). However, in hospitals, nurses are mainly involved only in the “top-down” communication process, following the doctor’s instructions, approved algorithm for diabetes management, not having the right to deviate from the set instructions and offer own vision of problems and their solutions (Altiok & Ustun, 2014). This negatively affects their psychological well-being and reduces their labor potential and degree of loyalty to the healthcare facility.
It should be noted that over the past twenty years, the goals of treating diabetes have changed dramatically. Until recently, the dominant goal of diabetes therapy was only to eliminate the symptoms of hyperglycemia, such as thirst, polyuria, weakness. Currently, effective management of diabetes is aimed at protecting pancreatic β-cells from depletion, creating an optimal glucose balance in the body, preventing and/or slowing the progression of both micro- and macrovascular complications of the disease, which lead to patient disability and early mortality (Ong & Ozanne, 2015).
Obviously, this increases the complexity of diabetes management and requires the development of appropriate advanced system programs. In turn, their development requires a wide evidence base and large amounts of data from clinical cases, which can be largely obtained through the practical experience of nurses in the field. Accordingly, the involvement of nurses in the development of programs and decision-making in the field of diabetes management at the present stage seems extremely appropriate.
Procedure
The collection of secondary data was carried out on the basis of the analysis of publications in specialized periodicals, as well as data from systematic reviews. Primary research was carried out using the questionnaire and round table discussions, which took three days. At the next stage, the processing of the results of the primary study was carried out: the survey data were processed using SPSS software, and the results of discussions at round tables using the grounded theory of Corbin and Straus. Thus, the mixed research method contributed to increasing the reliability and depth of the data. The sample size was 300 people for the survey and 50 people for the round table.
As the results of the initial study showed, the survey data to a large extent corresponded to the categories identified in the process of applying a grounded theory for analysis. Comparison of these data with the data of the secondary study also showed a high degree of compliance. It was found that, despite the complexity and systemic nature of diabetes management, the involvement of nurses in developing diabetes management programs is low. Often, they are not considered as full-fledged participants in the strategic and tactical planning process, but rather simply as support staff, which significantly reduces their motivation.
Outcomes
The results of a study of the socio-psychological aspects of diabetes management make it possible to implement a comprehensive treatment and rehabilitation approach in helping patients. Thanks to the use of mixed research methods, new information has been obtained on the personal, psycho-emotional, and psychosocial characteristics, characteristics, features of the internal picture of the disease of patients with diabetes. At the same time, on a significant sample size for the primary study, a significant level of barriers to the participation of nurses in the development of diabetes management and decision-making programs was revealed.
In this regard, it should be noted the need to solve the following tasks:
- Identify the causes and dynamics of the resistance to nursing participation, evaluate the attitude of employees to organizational transformations;
- Based on best organizational practices, develop nursing participatory programs in developing policies and decision-making in diabetes management
- To propose the use of indicators characterizing the attitude of employees to changes: the level of perception of changes, the degree of awareness, understanding of the essence and desirability of changes, satisfaction with the motivation for participation, willingness and ability to transform;
- To form a model of human resource management ‑ nursing staff ‑ under the conditions of change, which allows for the phased implementation of the transformation and provide effective feedback;
- Develop theoretical and methodological approaches to the formation of effective human resource management strategies in the face of change.
When seeking to participate in the implementation of the change, initiators should listen to the opinions of the employees involved in this process, and subsequently use their advice. Various means of training and business games, where participants’ ideas are used in modeling the progress of changes, can serve as means of involving employees in reforms.
In our opinion, this will help to create a field of strong culture with such characteristics as the presence of a unifying corporate philosophy and mission, employee participation in management, a sense of satisfaction and belonging, and improve the quality of diabetes management. The potential of nurses with secondary and higher education in the management of patients with diabetes mellitus is not sufficiently integrated into the healthcare system.
This is explained by the imperfection of the regulatory framework governing the powers and competencies of doctors and nurses. However, given the permissible level of autonomy of medical institutions, it seems necessary to take appropriate measures at the level of individual healthcare facilities, which in the future will allow developing a sufficient information base for the adoption of policies for the participation of nurses in strategic diabetes management at the community, state, and even at the federal level.
References
Al-Hamdan, Z., Dalky, H., & Al-Ramadneh, K. (2017). Nurses’ professional commitment and its effect on patient safety. Global Journal of Health Science, 10(1), 111-131.
Altiok, H. O., & Ustun, N. (2014). The professional socialization theory: Social skills in nursing students. Hamburg, Germany: LAP LAMBERT Academic Publishing.
Badescu, A., Tataru, C., Kobylinska, L., Georgescu, E., Zahiu, D., Zagrean, A., & Zagrean, L. (2016). The association between diabetes mellitus and depression. Journal of Medicine and Life, 9(2), 120-125.
Jenkins, H. (2019). Participatory culture: Interviews. Cambridge, UK: Polity.
Lofty, M., Adeghate, J., Kalasz, H., & Singh, J. (2015). Chronic complications of diabetes mellitus: A mini review. Current Diabetes Reviews, 13(1), 88-99.
Ong, T. P., & Ozanne, S. E. (2015). Developmental programming of type 2 diabetes: Early nutrition and epigenetic mechanisms. Current Opinion in Clinical Nutrition & Metabolic Care, 18, 354-360.
Sibandze, B. T., & Scafide, K. N. (2018). Among nurses, how does education level impact professional values? A systematic review. International Nursing Review, 65(1), 65-77.
Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C.B., Tomson, G. … Eldh, A.C. (2016). Developing leadership in managers to facilitate the implementation of national guideline recommendations: A process evaluation of feasibility and usefulness. IJHPM, 5(8), 477-486.
Tobiano, G., Bucknall, T., Marshall, A. P., & Guinane, J. L. (2015). Nurses’ views of patient participation in nursing care. Journal of Advanced Nursing, 71(12), 32-44.
World Health Organization. (2016). Global report on diabetes. Geneva, Switzerland: WHO.
Zheng, Y., Ley, S., & Hu, F. (2017). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88-98.