Diabetes Complication: the Nurse’s Role in Reducing Diabetic Complications

About 17 million people in America are currently suffering from diabetes. “A significant public health problem, diabetes is the seventh leading cause of death in the United States.” (Black, 2005, p.1244) Because diabetes can cause serious complications such as retinopathy, neuropathy, renal failure, and even death, nurses play a critical role in reducing diabetic complications through holistic care and education. Nurses can prevent diabetes complications in patients by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patients bimonthly to check upon patients’ compliance with diabetes control regimen. Through these interventions, nurses can greatly reduce diabetes complications in patients.
Diabetes mellitus is a “chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin.” (Kronmal, 2006, p.401) Diabetes mellitus can be divided into either type I or type II. Type I diabetes is characterized by absolute insulin deficiency caused by destruction of pancreatic beta cells. Patients with type II diabetes produce insulin, but their liver and peripheral tissues are resistant to the effects of insulin. As a result of defective insulin utilization, diabetes patients experience decreased glucose utilization, increased fat mobilization, and increased protein utilization. If untreated, diabetes mellitus can cause more serious complications such as coronary artery disease, hypertension, retinopathy, nephropathy, and neuropathy.
Diabetes is a disease that requires a tremendous change in a patient’s life style. Since patients have to live with diabetes for the rest of their lives, it is essential that they are educated early after the diagnosis on what they need to know to improve the quality of their life. The diabetes education nurse can set up a convenient time for the patient, choose a private room, and explain the pathology, clinical manifestations, and complications of diabetes. During this education session, it is important to emphasize to patients that they did not do anything wrong to cause the disease. Glycemic control is directly linked to the patient’s exercise level and dietary regimen, and thus it is easy for patients to think that they have earned the disease. According to the Diabetes Attitudes, Wishes, and Needs (DAWN) study “diabetes distress was common among patients, with 85.2% of them experiencing a feeling of shock, guilt, anger, anxiety, and depression at the time of the diagnosis” (Funnell, 2006, p.155). The study also stated that these psychological distresses lead to poor glycemic control in patients, so it is critical to educate patients and answer any questions they have, soon after the initial diagnosis.
Once the patient has accepted the diagnosis of diabetes, the nurse can coordinate a multi disciplinary approach to create a diabetes control regimen. The multidisciplinary team can consist of a nutritionist, physician, diabetes education nurse, and the patient. This team can decide on measures to keep patients’ glucose level as normal as possible, such as eating a balanced diet, exercising regularly, and administering daily medication. During the meetings, the nurse should act as a patient advocate and actively involve the patient in the decision making process. Since diabetes is a chronic condition, the control regimen “should be individualized to each patient’s goals, age, lifestyle, nutritional needs, activity level, and type of diabetes” (Davidson, 2003, p.2291) to produce optimal outcome. The nurse plays a critical role in creating this individualized regimen by assessing the patient’s needs and what they are willing to do.
Once the diabetes control regimen has been implemented, the nurse can increase patient’s compliance by calling them bimonthly to check their status. Asking a few simple questions such as the patient’s recent glucose levels, recent meals, or last time that the patient exercised, can give a nurse valuable clues about how the patient is doing. Patients also benefit from these phone calls by building a better care relationship with the providers. Patients can utilize this time to ask any additional questions that they came up with or simply express concerns. According to the research study performed by Taylor, et al, (2003) patients who have received the bimonthly calls from nurses “showed significant reduction in blood glucose level, total cholesterol level, and total LDL level.” (p.1063)
Diabetes is a complex disease that requires extensive change in the patient’s life style. Nurses can help the patients adjust to change in their lives by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patient bimonthly to check upon patient’s compliance with the diabetes control regimen. Nurses can help diabetes patients better than any other healthcare team members, since they spend most time with patients. Through careful observation and active listening, nurses can be more attuned to each patient’s beliefs and attitudes toward diabetes and can come up with individualized diabetes control regimens that can effectively reduce complications from diabetes.
Intervention #1
Nurses need to provide diabetes education to newly diagnosed patients.
Disadvantage #1
One problem with nurses providing education to diabetes patient is that nurses have to spend extra effort and time to learn about diabetes. Diabetes is a complex disease that impacts patient’s overall health status. As a result, nurses first have to become knowledgeable about different aspects of diabetes management before they can educate their patients. According to a study in Magson-Robert’s paper, only 38% of nurses responsible for diabetes education had “attended a diabetes study day within the past two years.” Nurses are not mandated to regularly update themselves in diabetes management, and this lack of continuing education can lead to nurses giving invalid or inappropriate advice to their patients.
Disadvantage #2
Some patients might not follow instructions given by the diabetes education nurses, due to the faulty perception that nurses don’t have the authority or knowledge to educate them. In his paper, Martin stated that “authorities seen as credible sources of information are particularly effective as agents of behavior change.” Conversely, patients’ compliance will decrease if the patient views nurses as having no authority. Thus, nurses need to be creative in devising a way to convey their expertise to the patients to increase patient’s compliance.
Intervention #2
Nurses need to call their patients bimonthly to check upon patient’s compliance with diabetes regimen.
Disadvantage #1
One problem that occurs with this intervention is that nurses are so short staffed that they don’t have time to call all their patients bimonthly. Nurses’ workload are heavy as it already is and added responsibility of telephone checks can lead to dissatisfaction of the nursing staffs. According to study done on 43,000 nurses only 34% of surveyed nurses believed that they had enough RNs to provide high-quality care in the facility where they work (Mees, 2008). If the nurses are already feeling like they don’t have enough staffs to provide high-quality care, they will not appreciate any added work, regardless of the benefits that it offers to their patients.
Disadvantage #2
Another barrier to this intervention is that the patient’s might not have adequate socioeconomic means to participate in the program, even if it is offered. For instance, according to Borsky’s research article, Asian Americans were less likely than whites to receive eye examinations, physiological testing, and self – care instructions. This can be attributed to the fact that Asian Americans have the highest rate of uninsurance (6%), compared with white (0.2%), reflecting different work pattern. This socioeconomic status of having no insurance had significant influence on health outcomes for Asian Americans since
diabetes is the fifth leading cause of death among Asians, and the prevalence of diabetes is higher among Asians compared to white population. References
Black, J.M., Hawks, J.H. (2005). Management of clients with Diabetes Mellitus. In Medica-Surgical Nursing (pp.1243-1287). Missouri: Elsevier
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Davidson, M.B. (August 2003). Effect of a nurse-directed diabetes care in a minority population. Diabetes Care, 26(8), 2281-2291. Retrieved from ProQuest Smart Search database on May 29, 2007. (384283331)
Funnell, M. M. (2006). The diabetes attitudes, wishes, and needs (DAWN) study. Clinical Diabetes, 24 (4), 154-156. Retrieved from ProQuest Smart Search database on May 23, 2007. (1166450571).
Kronmal, R.A., Barzilay, J.I., Smith, L.N, Psaty, B.M., Kuller, L.H., et al. (2006) Mortality in Pharmacologically Treated Older Adults with Diabetes: The Cardiovascular Health Study, 1989–2001. Public Library of Science Medicine 3(10), 400-404. Retrieved from PLoS Medicine database on April 30, 2007. (p.0030400)
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Taylor, C. B., Miller, N.H., Reilly, K.R., Greenwald, G, et al. (2003). Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Journal of Diabetes Care, 26 (4), 1058-1064. Retrieved from ProQuest Smart Search database on April 19, 2007. (324968961).