Nursing Management of a Chronic Illness: Diabetes

Over time, ineffective management of diabetes can lead to a number of health related problems such as damage to the heart, blood vessels, eyes, kidneys and nerves. Diabetes is a rapidly growing health epidemic. Insulin is a hormone that is produced to regular blood sugar levels. Diabetes is a chronic illness that can be caused by the pancreas producing an inadequate amount of insulin; this is referred to as type 1 diabetes. Type 1 diabetes is not preventable and the cause is not known. Type 2 diabetes is characterized by the body ineffectively using the insulin produced by the pancreas. This type of diabetes occurs in approximately 90% of the individuals living with diabetes. It is mainly caused by obesity and lack of physical exercise. Another type of diabetes is referred to as gestational diabetes; this is caused by hyperglycemia during pregnancy. The incidence of both type 1 and type 2 diabetes has made a dramatic increase in recent years. It is classified as one of the world’s leading causes of illness and premature death.

Powerlessness is referred to as the feelings expressed by an individual suffering from a chronic illness, it can occur at some point during their illness. There are numerous methods in which individuals with diabetes can control and be involved in their own healthcare. Nurses play a very important role in improving the health outcomes of individuals living with diabetes. Some strategies a nurse can implement to empower and facilitate self-management for patients and families or carers include: educating the client about correct administration of insulin and blood glucose monitoring, empowerment of the client in order for them to recognize and acknowledge the amount of control their have and require regarding their own health outcomes as well as assisting the client with the development of realistic and attainable healthcare goals.

The client is in complete control of their healthcare requirements. Previous research has highlighted the importance of the role of the nurse and how they can improve client compliance and ultimately improve the quality of life in individuals living with diabetes. This improvement is influenced by education and empowerment techniques implemented by the nurse that enable the client to effectively self-manage their chronic illness. Diabetes is a worldwide health epidemic, therefore it is critical that individuals involved in the care of a client with diabetes take the necessary action to educate and empower the client with diabetes. Recent statistics has highlighted the prevalence of diabetes. In 2013, approximately 347 million individuals worldwide lived with diabetes. It is predicted that by 2030, diabetes will be the seventh leading cause of death. Complications associated with diabetes includes kidney failure, cardiovascular disease, diabetic retinopathy and diabetic neuropathy. According to WHO, in 2004 it was estimated that 34 million individuals died as a result of the complications of diabetes such as hyperglycemia.

Poorly controlled diabetes contributes to other consequences other than the physical consequences. These include: the emotional impact on the individual and family or carer and the financial issues associated with living with a chronic illness. These consequences combine to result in the client with diabetes becoming less compliant and also experiencing a reduced quality of life. The negative consequence of living with diabetes exposes the client to the risks of lifelong financial and emotional issues. The nurse plays a diverse role in assisting their client with education regarding how to embrace their chronic illness with the aim to achieve the best possible quality of life. Introducing an explaining the medical interventions that are implemented in order to manage diabetes, such as insulin and blood glucose monitoring, encourages the creation of realistic and attainable goals as well as assisting the client to form what to self-manage and learn certain copying techniques in order to gain control over with health outcomes, avoiding the illness taking control are some strategies that allows the clients to make informed choice and changes to their healthcare in the future.

The first strategy the nurse can implement is assisting their client with developing realistic and attainable goals in regards to their longtime diabetes management. Encouraging the client to create health care goals will not always lead to the client attaining them. The nurse must understand and be aware of the various problems related to helping their client develop health care goals that are realistic, and especially attainable. The goals the client creates must be specific and based on physical outcomes (e.g. not drinking sweetened beverages), measureable (e.g. running for half an hour twice a week), action orientated (e.g. exercise). The goals must be both challenging but realistic so that the client is not discouraged by the over challenging goals or has no sense of accomplishment due to ease of attaining goal.

There are numerous barriers that are related to creating goals and may deter the client from achieving them. Knowledge deficit regarding the influence of lifestyle factors on diabetes management may cause clients to misunderstand the importance of setting health goals and prevent them from adhering to them. The client may also avoid changes to their health behavior goals due to emotional barriers such as lack of motivation. Another disadvantage the nurse may face when assisting their client with creating a goal is lack of finances and barriers in available resources. These barriers include lack of money and lack of social support systems. Clients may require assistance with planning ways to overcome difficulties to attaining health goals. These difficulties may include the inability to afford fresh fruit and vegetables to maintain a nutrient rich diet. It is important that strategies are in place for each barrier the nurse identifies in order to overcome them. This is due to some clients lacking the skills required to solve problems that may come in contact with when living with a chronic illness when consumed with other issues such as financial difficulties.

Another strategy the nurse can implement is educating the client on the correct administration of insulin and blood glucose monitoring. Many barriers can impair the client’s ability to self-manage their diabetes in an effective manner despite having been educated on medication administration and blood glucose monitoring. Clients may be resistant to following a insulin administration regimen due to factors such as fear of administrating an injection, being uncertain about the correct injection techniques and being afraid of having a hyperglycemia or hypoglycemic episode. These concerns are shared among individuals with diabetes in regards to monitoring their blood glucose levels. According to H, the clients that became tolerant of daily blood glucose monitoring remain unaware of how to correctly interpret the blood glucose levels and were unaware of how to change their food consumption and contribution to physical activity, let alone determine when insulin administration was required.

Current diabetes self-management education (DSME) is a short program that clients with diabetes complete and involves education regarding basic self-management skills. Further education and developments of these skills is required in order to allow patients to possess the adequate knowledge and the comfort required to effectively manage their illness for their lifetime. Another barrier related to educating the client on the correct administration of insulin and blood glucose monitoring involves lack of finances that are required to adequately maintain control of the client’s chronic illness. A client that has been diagnosed with diabetes will live with the illness for their entire life; therefore the financial impact on the client will be lifelong.

The financial impact of living with a chronic illness such as diabetes can contribute to emotional and financial difficulties that may have a negative effect on the client self-management efforts. Issues the client may face living with diabetes includes the inability to afford the supplies required to maintain specific health goals. This financial difficulty can be caused by lack of health insurance or low socio-economic status and has the potential to put the client at risk of having reduced compliance and poorer health outcomes. According to Stys (2007), client’s living with diabetes that have health insurance can afford prescription medications and therefore are involved in better health outcomes compared to client without health insurance. Also, many clients are able to self-manage their diabetes but are unable to due to financial difficulties.

The final strategy the nurse can implement is assisting the patient to develop copying techniques as well as empowering them to identify and acknowledge the control they have on their diabetes. Educating the client regarding ways to cope and empowering them to effectively self-manage their diabetes is an important role of the nurse. The client may experience stress as a result of the fear of the complications of diabetes, depression, tough medication and diet guidelines and the feeling of being overwhelmed is associated with the client being less likely to effectively self-manage their illness. Morbidity, mortality, limitation to function and reduced quality of life can been caused by emotional distress. The nurse must respond to stress experienced by their client quickly in order to adequate educate them on ways of coping with diabetes as well as encouraging the client to gain a reasonable understanding and acceptance of their illness. This is a requirement for patients living with diabetes and will result in the client feeling empowered and in control of their health.

Despite advances in the treatment of diabetes, clients with the chronic illness have less than optimal control and therefore suffer from preventable complications associated with it. There are numerous methods in which individuals with diabetes can control and be involved in their own healthcare. Previous research has highlighted the importance of the role of the nurse and how they can improve client compliance and ultimately improve the quality of life in individuals living with diabetes. This improvement is influenced by education and empowerment techniques implemented by the nurse that enable the client to effectively self-manage their chronic illness. Being aware of the strategies that are effective in assisting a client with a chronic illness as well as the barriers they may face is an important aspect in improving the health outcomes of individuals living with diabetes.

References

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Marrero, D, Ard, J, Delamater, A, Peragallo-Dittko, V, Mayer-Davis, E, Nwankwo, R, & Fisher, E 2013, ‘Twenty-first century behavioral medicine: A context for empowering clinicians and patients with diabetes’, Diabetes Care, 36, 2, pp.463-470.

Peyrot, M, & Rubin, R 2007, ‘Behavioral and psychosocial interventions in diabetes: A conceptual review’, Diabetes Care, 30, 10, pp.2433-2441.

Scambler, S, Newtown, P, & Asimakopoulou, K 2014, ‘The context of empowerment and self-care within the field of diabetes’, Health, 1, 16, pp.1-16.

Stys, A & Kulkarni, K 2007, Identification of self-care behaviors and adoption of lifestyle changes result in sustained glucose control and reduction of comorbidities in Type 2 diabetes’, Diabetes Spectrum, 20, 1, pp.55-59.

World Health Organization 2013, ‘Diabetes Program 2013’, retrieved May 5th, 2014, <http://www.who.int/diabetes/en/>

MADDISON ADAMS (211265503)