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RUNNING HEAD: Nurses role in managing Diabetes Mellitus

Abstract

Nurses play an important role in promoting public health. Traditionally, the focus of health

promotion by nurses has been on disease prevention and changing the behavior of individuals with

respect to their health. However, their role as promoters of health is more complex, since they have

multi-disciplinary knowledge and experience of health promotion in their nursing

The role of nurses has included clinical nursing practices, consultation, follow-up treatment,

patient education and illness prevention. This has improved the availability of health-care services,

reduced symptoms of chronic diseases, increased cost-effectiveness and enhanced customers'

experiences of health-care services (Stromberg et al., 2003; Griffiths et al., 2007). In addition,

health promotion by nurses can lead to many positive health outcomes including adherence, quality

of life, patients' knowledge of their illness and self-management (Bosch-Capblanc et al.,

2009; Keleher et al., 2009). However, because of the broad field of health promotion, more

research is needed to examine the role of health promotion in nursing (Whitehead, 2011).

Introduction

Diabetes mellitus describes a metabolic disorder of multiple etiology characterized by chronic

hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from

defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long

term damage, dysfunction and failure of various organs. Diabetes mellitus may present with

characteristic symptoms such as thirst, polyuria, blurring of vision, and weight loss. In its most

severe forms, ketoacidosis or a nonketotic hyperosmolar state may develop and lead to stupor,

coma and, in absence of effective treatment, death. Often symptoms are not severe, or may be

absent, and consequently hyperglycemia sufficient to cause pathological and functional changes
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
may be present for a long time before the diagnosis is made. The longterm effects of diabetes

mellitus include progressive development of the specific complications of retinopathy with

potential blindness, nephropathy that may lead to renal failure, and/or neuropathy with risk of foot

ulcers, amputation, Charcot joints, and features of autonomic dysfunction, including sexual

dysfunction. People with diabetes are at increased risk of cardiovascular, peripheral vascular and

cerebrovascular disease. Several pathogenesis processes are involved in the development of

diabetes. These include processes which destroy the beta cells of the pancreas with consequent

insulin deficiency, and others that result in resistance to insulin action. The abnormalities of

carbohydrate, fat and protein metabolism are due to deficient action of insulin on target tissues

resulting from insensitivity or lack of insulin.(WHO,1999)

The incidence of diabetes is growing around the world. It is in the top ten leading causes of deaths.

Filipinos are not an exemption to this incidence as more and more Filipinos are affected by the

disease. In the Philippines, 4.1% of Filipinos have diabetes mellitus. In the present populations of

the Filipinos, approximately 2.5% million of them have diabetes excluding the undiagnosed one.

In fact, Another cause for alarm is that Filipinos diagnosed with diabetes are getting younger.

Children as young as 5-years old have been diagnosed with type 2 diabetes. With this trend, the

Philippines is expected to belong on the top 10 countries with the most people with diabetes 15

years from now (Philippine Diabetic Statistics,2012)

Review of Related Literature

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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
Primary healthcare providers who can attempt an alternative delivery of care based on health

promotion and disease prevention principles are in a unique position to intervene, motivate, and

ultimately influence the patients outcome through teaching and counseling as an adjunct to

pharmacological resources (Sinsell-Phillips, 2006). One alternative avenue of delivery of care is

that of health promotion. Health promotion behavior as a key entity in the concept of health care

delivery and intervention has received wide-spread attention as impacting the likelihood of

adherence to a diabetic regimen. With the recent trend toward public awareness of life styles, the

emphasis on health promotion and health behavior change techniques for wellness enhancement

has surfaced as an issue for all health care professionals (Palank, 2011).Determining what

interventions will best serve the client and be most effective in achieving the behaviors necessary

to successful management of diabetes provides a complex challenge for both providers and

patients. In diabetes care, daily attention to a myriad of factors is involved, making the issue of

patient education, knowledge, and skill levels a critical one. How patients learn self-management

through applying information, and how well they adapt it to their lives has not been well explained

(Price, 2013). According to Brown (2009) many investigators have examined the effectiveness of

various teaching programs, linking the results of those studies to the degree of diabetic control

experienced by the patients. The assumption has been that if the patient was in poor control, then

either the teaching was faulty or the patient had not practiced adherence to the regimen prescribed.

Few attempts have been made to determine whether diabetic patients actually learned the necessary

information when exposed to the available education strategies, or whether the patient was able to

transfer this knowledge to the home environment. Acceptable performance of recommended

therapy by the patient is thought to result from a thorough understanding of the disease and its

consequences, which in turn provides motivation for the patient to use the new knowledge (Scott,
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
2004). Consequently, adequate knowledge and accurate performance of self-care techniques

should result in metabolic control. Literature regarding what interventions are likely to result in

the higher likelihood of adherence to a prescribed regimen is limited.

Conceptual Framework

The conceptual framework of the study will be grounded from the idea of Nola Penders Health

promotion model .Nola Pender definition of health as a positive dynamic state rather than simply

the absence of disease. Health promotion is directed at increasing a patient's level of well-being.

It further describes the multidimensional nature of persons as they interact within their

environment to pursue health. The major concepts of the Health Promotion Model are individual

characteristics and experiences, prior behavior, and the frequency of the similar behavior in the

past Direct and indirect effects on the likelihood of engaging in health-promoting behaviors.

Personal factors are categorized as biological, psychological and socio-cultural. These factors are

predictive of a given behavior and shaped by the nature of the target behavior being considered.

Biological personal factors include variables such as age gender body mass index pubertal status,

aerobic capacity, strength, agility, or balance. Psychological personal factors include variables

such as self-esteem self-motivation personal competence perceived health status and definition of

health. Socio-cultural personal factors include variables such as race ethnicity, acculturation,

education and socioeconomic status. Perceived benefits of action are the anticipated positive

outcomes that will occur from health behavior. Perceived barriers to action are anticipated,

imagined, or real blocks and costs of understanding a given behavior. Perceived self-efficacy is

the judgment or personal capability to organize and execute a health-promoting behavior.

Perceived self-efficacy influences perceived barriers to action so higher efficacy result in lowered

perceptions of barriers to the performance of the behavior. Activity-related affect is defined as the
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
subjective positive or negative feeling that occurs based on the stimulus properties of the behavior

itself. They influence self-efficacy, which means the more positive the subjective feeling, the

greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive

affect. Interpersonal influences are cognition-concerning behaviors, beliefs, or attitudes of the

others. Interpersonal influences include: norms (expectations of significant others), social support

(instrumental and emotional encouragement) and modeling (vicarious learning through observing

others engaged in a particular behavior). Primary sources of interpersonal influences are families,

peers, and healthcare providers. Situational influences are personal perceptions and cognitions that

can facilitate or impede behavior. They include perceptions of options available, as well as demand

characteristics and aesthetic features of the environment in which given health promoting is

proposed to take place. Situational influences may have direct or indirect influences on health

behavior. Within the behavioral outcome, there is a commitment to a plan of action, which is the

concept of intention and identification of a planned strategy that leads to implementation of health

behavior. Competing demands are those alternative behaviors over which individuals have low

control because there are environmental contingencies such as work or family care responsibilities.

Competing preferences are alternative behavior over which individuals exert relatively high

control. Health-promoting behavior is the endpoint or action outcome directed toward attaining a

positive health outcome such as optimal well-being, personal fulfillment, and productive living

Behavior Specific conditions

And affect

Individual Perceived
Characteristics Behavioral
benefits of
Outcomes
And experiences action
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus

Perceived Immediate
barrier to competing
action demands (low
Prior related control) and
Behavior preferences (high
control)
Perceived
self-
efficacy

Activity related
affect
Personal factors Commitment Health
(Biological, to a plan promoting
Psychological, behavior
Socio cultural)

Interpersonal
influences: Family,
peers, providers,
norms, support
models

Situational Influences:
options, demand
characteristics,
aesthetics

Health Promotion Model(Adopted from Pender,N.J.,Murdaugh,C.L.,Pearsons,M.A(2002)Health

Promotion In Nursing Practice(4th ed.)Upper Saddle River,NJ:Prentice Hall)
Discussion

What is the essence of Diabetes Nursing as an independent nursing specialization in advance

nursing practice?
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
The National Association of Clinical Nurse Specialists and the American Nurses Association agree

in defining specialization as a delimited or concentrated area of expert clinical practice with

focused knowledge and competencies. The specialty area may be broadly or narrowly defined; the

area may be well established or emerging. Typically, a CNS specialty is identified in terms of

population, such as gerontology or maternal child health; type of problem, such as wound or pain

care; setting, such as perioperative or emergency; type of care, such as rehabilitation or palliative

care; and disease/pathology, such as oncology, diabetes, and orthopedics. The impetus for

specialization arises from scientific and technological discoveries along with continuously

evolving health concerns in a society. Specialties are, therefore, adaptable.

As specialists, CNSs are clinical experts in the diagnosis and treatment of illness and the delivery

of evidence-based nursing interventions, possess advanced knowledge of the science of nursing

along with a specialty focus, and apply that knowledge to nursing assessments, diagnoses, and

interventions and to the design of innovations for clients with similar special needs. CNS is first

a generalist, who has the ability to understand and appreciate the complexity and compounding

nature of the multiple problems that a patient may experience. For example, a CNS with a specialty

in wound care would be able to understand the etiology and contributing factors influencing

wounds from multiple causes-for example, diabetes, vascular insufficiency, trauma-because the

CNS is first a generalist.

CNS specialization ensures that a portion of the profession has in-depth knowledge and advanced

competencies about emerging and narrow health concerns. Generalist preparation cannot

adequately address specialty competencies; thus a smaller group of advanced practice specialists,
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
CNSs, provide the knowledge and competencies to both deliver and direct care to clients and to

translate nursing's phenomena of concern into specialty interests.

State nurse practice acts grant nurses an independent and autonomous scope of practice that

differentiates the practice of registered nursing from the practice of other licensed health

professions, such as physician, physical therapist, and pharmacist.

As a diabetes nurse educator, how will you help improve the quality of life of persons with

diabetes?

Diabetes nurse educator provide information to patients with pre-diabetes and diabetes in

an effort to help patients make informed decisions about prevention and managing their

conditions .Working with patients to assess their needs and to develop a plan that

includes educational interventions and self-management support strategies appropriate for

the patient. Providing education that helps the patient accomplish self-management goals.

Working with patients to assess their needs and to develop a plan that includes

educational interventions and self-management support strategies appropriate for the

patient. Providing education that helps the patient accomplish self-management goals .

References:

1. Baisch M. J.Community Health: An Evolutionary Concept Analysis, Journal of

Advanced Nursing,2009, vol. 65 (pg. 2464-2476)
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RUNNING HEAD: Nurses role in managing Diabetes Mellitus
2. Beaudet N.,Richard L.,Gendron S.,Boisvert N:Advancing Population-Based Health
Promotion And Prevention Practice In Community-Health Nursing,Advances in Nursing
Science,2011, vol. 34 (pg. E1-E12)

3. Benson A.,Latter S;Implementing Health Promoting Nursing: The Integration Of

Interpersonal Skills And Health Promotion,Journal of Advanced
Nursing,1998 vol.27(pg.100-107)

4. NACNS. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, Pa:
National Association of Clinical Nurse Specialists; 2004.

5. American Nurses Association. Nursing: Scope and Standards of Practice. Washington,

DC: American Nurses Association; 2004

6. Peplau H. Specialization in professional nursing. Clin Nurse Spec. 1965/2003;17:3-9.

7. Lyon BL. The CNS regulatory quagmire: we need clarity about advanced nursing
practice. Clin Nurse Spec. 2004;18:9-13