Term Paper on "Diabetes Self-Care"

Term Paper 13 pages (3676 words) Sources: 13 Style: APA

[EXCERPT] . . . .

Diabetes Self-Care

This research study conducts an extensive review of relevant academic literature including professional nursing journals in a qualitative review in order to determine the factors that exist in relation to barriers and challenges of specific groups of patients in self-care management of diabetes mellitus. Findings in this study include race/ethnicity differences in self-care management as well as psychological, social, and family predictors of the probability of self-care management of diabetes success for patients.

DIABETES SELF-CARE

The objective of this research is to examine diabetes self-care with an emphasis on evidence-based clinical management and education which addresses the patient and nurse practitioner's concerns related to this problem and specifically appropriate nurse practitioner clinical management including non-pharmacologic treatment, pharmacotherapy, patient education, patient and family psychological aspects, and criteria for referral and community resources. Diabetes Mellitus has "reached nearly epidemic proportions in the United States. The American Diabetes Association (ADA) reports 20.8 million men, women and children in the United States are diabetic." (Twedell, 2007) it is critically important that the nurse practitioner understand the needed support and education of diabetes patients in self-care management of this disease.

METHOD

The method of research employed in this study is one of a qualitative nature conducted through an extensive review of relevant and academic literature in this subject area.

BACKGROUND

Diabetes mellitus is a chronic systemic disease (Scemons, 2007). Diabetes mellitus has been divided into four clinical classes by the American Diabetes Association (ADA) which are the four as follows: (1) Type 1 diabetes is an autoimmune disease possibly triggered by genetic and environmental factors. it's caused by the destruction of pancreatic beta cells that produce insulin. Totally insulin-deficient, the patient needs exogenous insulin to survive; (2) Type 2 diabetes, accounting for 90% to 95% of all diabetes in the United States, involves a decreased ability to use the insulin produced in the pancreas. The beta cells maintain some function but become progressively desensitized to blood glucose levels. Decreased insulin sensitivity in the liver and peripheral tissues adds to the problem; (3) Gestadomd diabetes develops during pregnancy; and (4) Other types have various specific causes, such as genetic defects in beta cell function or insulin action, pancreatic disease, or adverse drug reactions. (Scemons, 2007) Research has shown that the maintenance of blood glucose levels "within specific ranges significantly reduces comorbidities and secondary complications of diabetes and improves quality of life." (Scemons, 2007)

REVIEW of RELEVANT THEORETICAL LITERATURE

The work of Karen Davies entitled: "What is Effective Intervention? - Using Theories of Health Promotion" states the fact that the "increased prevalence of chronic disease offers nurses the challenge of how to help individuals make lifestyle changes and manage their conditions. (Whittemore, 2000; as cited in Davies, 2006) Interventions through means of education is one method of proffering the needed support in this initiative. Identification of a "curriculum to increase client knowledge would be insufficient without including skills and self-care strategies to deal with the complexities of managing a chronic condition." (Davies, 2006) Davies relates that "Government initiatives, such as the 'Choosing Health' white paper (Department of Health (DH), 2005) and 'Making a Difference' (DH, 1999), acknowledge the contribution that nurses need to play in the success of health promotion, by emphasizing and encouraging lifestyle choices and self-care." (Davies, 2006) Nurse practitioners can draw upon theories from health promotion in making the provision of "a structural theoretical framework where concepts can be applied and evaluated. These models and theoretical perspectives draw upon a variety of disciplines such as psychology, sociology, genetics and politics." (Davies, 2006) Davies states that "the diversity of theories, models and approaches can offer nursing a wide knowledge base, which can assist in describing and explaining behavior related to individuals." (2006) However, relates Davies, "using such a broad ideological base to evaluate interventions can increase complexity and confusion in application. One of the current debates is the need for a strong and consensual theoretical base as health promotion questions its ideological basis. (Bunton and MacDonald, 2002; as cited in Davies, 2006) Davies relates that the work of Naidoo and Wills (2001) relates that "government targets and diabetes standards place a high emphasis on individual behavior change. If overemphasized there is a potential for victim blaming, particularly if socioeconomic determinants of health such as income, literacy, and health service delivery are ignored." (Davies, 2006) it is important to identify factors that help with understanding changes in behavior. "Health promotion theory for individual behavior change draws upon health psychology by using social cognition models." (Davies, 2006) One model in itself cannot explain "the content and complexity ob behavior change" (Davies, 2006) however it is possible through use of several models as it may potentially provide a partial explanation. Self-efficacy is one aspect of the "health belief model" and as well the "theory of planned behavior has been used to promote health-related behaviors..." And can be utilized in measurement of "pre- and post-intervention by questionnaire to evaluate self-belief and confidence in ability to perform skills such as managing carbohydrate counting." (Davies, 2006) Furthermore, self-efficacy "takes into consideration the broader social and environmental context of the behavior, reflecting the individual's perceived ability to carry out behaviors." (Hollaway and Watson, 2002; as cited in Davies, 2006) While there is a debate regarding whether social and cognitive models can effectively make identification of the elements of health behavior relevant to nursing it is suggested in the evidence that these models may be used as a meaning of gaining understanding of health behavior "to some of its component parts, such as locus of control, self-esteem and efficacy" (Davies, 2006) in assisting with planning and facilitation of intervention. It is important that the client-centered goals are realistic in assisting the patient with gaining confidence and motivation for management of their condition. In diabetes management initiative, there is existing evidence "that intensive glucose management, can prevent microvascular complications, such as retinopathy and nephropathy. (Diabetes Control and Complications Trial (DCCT), 1993; United Kingdom Prospective Diabetes Study Group (UKPDS), 1998; as cited in Davies, 2006) Because of this "glucose control and biomedical outcomes remain a measure of success and an important focus within diabetes management." (Davies, 2006) Davies states that "evidence suggests that setting collaborative, attainable goals will foster success, engagement and further improvements." (Wolpert and Anderson, 2001; as cited in Davies, 2006) Davies related that the "common theme emerging is the need to understand the individual's concept of health, so that there can be a focus on factors that can promote and maintain improved self-care." (Wolpert and Anderson, 2001; as cited in Davies, 2006) Davies relates that measures of health are both 'objective' and 'subjective'. The following chart provides a list of each of these areas of measures of health.

MEASURES of HEALTH

____OBJECTIVE____SUBJECTIVE

Health status Physical well-being, functional ability,

Health behavior indicators health status

Environmental Indicators Psychological well-being

Socio-economic indicators Social well-being

Quality of life

SOURCE: DAVIES (2006)

LITERATURE REVIEW

The work of Gregg et al. entitled: "Improving Diabetes Self-Management Through Acceptance, Mindfulness and Values: A Randomized Controlled Trial" states that "self-management of Type 2 diabetes requires attention to diet, physical activity, blood glucose monitoring and consistent administration of diabetes medication and/or insulin. Good self-management is related to lower glycated hemoglobin levels which reflects a decreased likelihood of developing diabetes-related complications of as much as 37%." (2007) Education of diabetes patients relating to "nutrition, physical activity, blood glucose self-monitoring, and medication and insulin administration are essential components of diabetes treatment" (Gregg, et al., 2007) however, education alone does not lead to self-management of an adequate nature. It has been shown that adherence to regimen is reduced by patient distress. Cognitive behavior therapy and other psychologically focused interventions have shown mixed results in self-management of diabetes. Gregg et al. states that: "Consistent with CBT assumptions, in many of these studies researchers attempted to teach patients to control diabetes-related thoughts and feelings in order to reduce or eliminate distress. However, eliminating distress may not be a realistic strategy with this population. Each time patients with diabetes monitor blood glucose, look at an item of food, or notice an ache or pain, a psychological connection may be made to the very real and inherently distressing possible results of their disease. Self-management behaviors may thus evoke thoughts of the illness and reactions to its dangers, which could itself be distressing if a patient believes that distress, fear, worry, and other negative diabetes-related emotions and cognitions must be stopped, altered, or reduced. Teaching acceptance and mindfulness skills may provide a more realistic alternative." (Gregg, et al., 2007) Gregg et al. reports that the study conducted was for the purpose of seeking to apply an acceptance approach to coping with diabetes. Acceptance and commitment therapy (ACT: Hayes, Stosahl, & Wilson, 1999) teacher individuals to accept their feelings, to 'defuse' or disengage from the content of their thoughts by focusing more mindfully on the process of thinking itself, and to link all of this to goal-based action. In short, ACT attempts to teach individuals to experience their thoughts… READ MORE

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