The effect evaluation of continuous nursing intervention in patients with type 2 diabetic retinopathy.

INTRODUCTION: To evaluate the application effect of continuous nursing intervention in type 2 diabetic retinopathy (DR). METHODS: Patients with type 2 DR were selected and divided into intervention group and control group by random. The control group received routine nursing intervention, and the intervention group received continuous nursing intervention on the basis of the control group. The clinical effects of the two groups were compared. RESULTS: After 1 and 2 years of intervention, the intervention group compared to the control group. The rate of visual acuity decrease was significantly lower (p < 0.05). Fasting blood glucose, 2 h postprandial blood glucose, and glycosylated hemoglobin were significantly lower (p < 0.05). The self-management ability and satisfaction were significantly higher, and the readmission rate was significantly lower (p < 0.05). CONCLUSION: The continuous nursing intervention model has a good clinical effect on the visual acuity of patients with type 2 DR.

Influence of continuous 4C nursing on quality of life and self-care ability of patients with diabetes retinopathy: An observational study.

This study aims to investigate the impact of continuous 4C nursing on patients with diabetes retinopathy (DR) and its influence on self-care ability. A total of 100 DR patients admitted to our hospital from October 2020 to October 2022 were randomly divided into a control group and an observation group, with 50 cases in each group. The control group received routine care, while the observation group received continuous 4C care. The nursing effects of both groups were compared. After nursing, the observation group showed a lower self-rating anxiety scale score and a higher self-care ability scale score compared to the control group (P < .05). The SQQL-VI scores for all social activities were also higher in the observation group (P < .05). Additionally, the observation group had lower levels of fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin than the control group (P < .05). Moreover, the observation group had higher visual acuity and lower intraocular pressure than the control group (P < .05). The visual impairment rate was lower and the overall compliance rate was higher in the observation group compared to the control group (P < .05). After nursing, both groups showed improvements in symptoms, visual function, physical function, psychological and social activity scores, visual acuity, and patient satisfaction scores. The observation group showed greater improvements compared to the control group (P < .05). The application of continuous 4C nursing in DR patients has shown positive effects, including improved patient compliance and satisfaction, enhanced patient quality of life and visual acuity. These findings suggest that continuous 4C nursing should be widely promoted and applied in clinical practice.

Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives.

BACKGROUND: The aim of the present study was to assess the performance of three primary care-led initiatives providing structured care to patients with Type 2 diabetes in Ireland, a country with minimal incentives to promote the quality of care. METHODS: Data, from three primary care initiatives, were available for 3010 adult patients with Type 2 diabetes. Results were benchmarked against the national guidelines for the management of Type 2 diabetes in the community and results from the National Diabetes Audit (NDA) for England (2008/2009) and the Scottish Diabetes Survey (2009). RESULTS: The recording of clinical processes of care was similar to results in the UK however the recording of lifestyle factors was markedly lower. Recording of HbA1c, blood pressure and lipids exceeded 85%. Recording of retinopathy screening (71%) was also comparable to England (77%) and Scotland (90%). Only 63% of patients had smoking status recorded compared to 99% in Scotland while 70% had BMI recorded compared to 89% in England. A similar proportion of patients in this initiative and the UK achieved clinical targets. Thirty-five percent of patients achieved a target HbA1c of < 6.5% (< 48 mmol/mol) compared to 25% in England. Applying the NICE target for blood pressure (≤ 140/80 mmHg), 54% of patients reached this target comparable to 60% in England. Slightly less patients were categorised as obese (> 30 kg/m²) in Ireland (50%, n = 1060) compared to Scotland (54%). CONCLUSIONS: This study has demonstrated what can be achieved by proactive and interested health professionals in the absence of national infrastructure to support high quality diabetes care. The quality of primary care-led diabetes management in the three initiatives studied appears broadly consistent with results from the UK with the exception of recording lifestyle factors. The challenge facing health systems is to establish quality assurance a responsibility for all health care professionals rather than the subject of special interest for a few.

Diabetes mellitus in the Tamil Nadu State-Noncommunicable diseases nurse model in diabetic retinopathy screening.

Tamil Nadu is one of the states in India, where the diabetic retinopathy (DR) project was implemented in the Tirunelveli District. Aravind Eye Hospital, Tirunelveli was the mentoring institution and ophthalmology department of Tirunelveli Medical College and Hospital (TVMCH) was the implementing partner. The objective of the project was to develop a district level model for building capacity at the government health system for effective screening, diagnosis and management (primary to tertiary) of diabetic retinopathy. The DR screening, counseling, referral and follow-up tasks were included in the scope of Non- Communicable Disease (NCD) nurses at the respective Community Health Centres and Primary Health Centres using the tele-medicine platform. During the project period (December 2016 to June 2019), 8,574 people with diabetes were registered at the 18 CHCs/PHCs. 6,462 (75.4% of those registered) were screened by NCD staff. The government has agreed to scale up services in 3 more districts.

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples.

Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.

[The instruction of the patient educational method in clinical nursing training: the actual condition of a student guidance case about diabetic's nursing using the diabetes retinopathy model].

We taught fourth-year students in a university about patient education using the diabetes retinopathy model in adult nursing practice. We analyzed teacher's student guidance plans and the guidance process using a clinical training education analysis form from the viewpoint of qualitative interpretation. We evaluated the degree of achievement of the students' goal for practice and the training subject. Consequently, the teacher developed training guidance as a class.

A nurse-led approach to diabetic retinal screening.

Diabetic retinopathy is the leading cause of blindness in people under the age of 60 in industrialised countries (NICE, 2002). This article discusses a nurse-led approach to diabetic retinal screening currently being undertaken at the Western Eye Hospital, London.

Lighting a lamp for persons who are visually challenged.

This paper is an outgrowth of an investigation to (1) identify persons with diabetes mellitus who manifest varying degrees of self-destructive behavior, (2) compile a list of dangerously negative self-management practices observed in the person who is visually challenged, (3) outline a comprehensive diabetes skills update designed to restore self-esteem, and (4) suggest to the rehabilitation worker and the diabetes educator ways to enhance instruction. The paper lists behaviors that may cause deadly harm to persons visually challenged by diabetes mellitus, requiring careful observation by the diabetes educator. A case report shows that numerous teaching opportunities arise from analyzing self-care skills that are lost due to vision pathology.

Diabetic retinopathy.

The risk of blindness is 25 times greater in diabetics than nondiabetics. Medical, laser, and surgical interventions have the potential to enhance greatly the prognosis of maintaining useful vision throughout life. Patient education is paramount to improve comprehension of the condition, recommended treatment modalities, and compliance with prescribed regimens. Nursing assessments and interventions related to anxiety, discomfort, ineffective coping mechanisms, and immobility add a quality link in the multidisciplinary approach surrounding the delivery of care to patients with diabetic retinopathies.

Keeping good vision with diabetic retinopathy: a nursing responsibility.

African Americans are nearly twice as likely to have diabetes mellitus than White Americans (Padonu, 1994). Diabetic retinopathy affects approximately 11 million Americans, which means that statistically, almost two-thirds of them are Black. It is the leading cause of blindness in persons age 20-74, and accounts for over 5,000 new cases annually (Smith, 1992). Blindness is 25 times more common in diabetics than in nondiabetics (Harris, 1987). The prevalence of diabetic retinopathy increases with the duration of the diabetes. Many studies of patients with type 1 diabetes diagnosed under the age of 30 have reported a direct relationship between prevalence and severity (AAO, 1989).

Diabetic retinopathy: protecting the vision of people with diabetes.

The aim of this article is to provide an update on the effects, causes and treatment of diabetic retinopathy and to discuss practical ways in which community nurses can help protect people with diabetes from losing their vision and support them if they do.

Proposed criteria for referring diabetic retinopathy.

Diabetic retinopathy is a leading preventable cause of blindness in the United States. The primary care nurse practitioner is often confronted with the decision of whether to refer a person with diabetes to an ophthalmologist. Because ophthalmoscopy may be technically difficult with a particular patient, current recommendations are to refer all diabetics. Unfortunately, many studies reveal that this approach is not working. This article defines criteria for the nurse practitioner to determine who is most in need of referral. The tested criteria have a sensitivity of 77 percent and a specificity of 81 percent when compared with ophthalmoscopy. The criteria are based on the results of ophthalmoscopy, duration of diabetes, status of glycemic control, status of achilles tendon reflex, status of serum creatinine, amount of alcohol consumption and the presence of hypertension. Using the criteria is feasible in a clinic or hospital setting. Use of this tool may improve appropriate ophthalmological referral of persons with diabetes.

Nurse-led management of i.v. fluorescein angiography.

Fluorescein angiography is undertaken to investigate the state of the circulation in diabetic eye disease, the commonest manifestation of which is diabetic retinopathy. Senior ophthalmic nurses, equipped with the appropriate skills and level of confidence, are now undertaking the procedure. In the eye centre at the Central Middlesex Hospital, a proactive nurse-led approach to the management of patients undergoing fluorescein angiography has had a significant impact on the outcomes of the procedure, and resulted in positive patient feedback.

The nurse's role in helping patients cope with sight loss.

Patients with sight loss often have additional nursing and care needs. Nursing staff should be familiar with the common causes of sight loss and their treatment. To help patients come to terms with the distress of losing their eyesight, nursing staff should be aware of the implications of sight loss for patients and, where appropriate, refer them to the relevant support worker, such as an eye clinic liaison officer.

Identifying and managing the complications of diabetes.

Diabetic complications are common, costly and have a major impact on length and quality of life. There is good evidence that they can be delayed or even prevented in type 1 and type 2 diabetes by achievement of normoglycaemia, control of other risk factors, regular review and early treatment. This article discusses the type of damage that can occur in both type 1 and type 2 diabetes, which patients are particularly vulnerable and why, the costs of diabetic complications, how they can be prevented, the nursing implications of caring for patients who already have damage and helping to prevent it in others.

Coordination skills during vitrectomy in treatment of proliferative diabetic retinopathy.

PURPOSE: To discuss effective nursing and coordination skills for vitrectomy in the treatment of diabetic retinopathy. METHODS: Fifty patients (51 eyes) with diabetic retinopathy required vitrectomy were enrolled in this study. Individual nursing service was delivered by strengthening preoperative preparation, providing psychological nursing, and intraoperative observation of the severity of diseases by circulating nurses; meticulous nursing was given postoperatively. RESULTS: All 50 patients underwent surgery successfully. Intraoperatively, patients had stable physical signs. Five patients had postoperative visual acuity < 0.05, 14 with 0.05 to 0.1, 20 with 0.1 to 0.3 and 16 with > 0.3. No complicated infection was seen. CONCLUSION: For patients diagnosed with proliferative diabetic retinopathy requiring vitrectomy, full preparations should be made and psychological nursing should be delivered preoperatively, the severity of diseases and clinical reactions should be closely observed intraoperatively, and proper processing and nursing measures should be taken postoperatively, which collectively enhance surgical success rate, decrease surgical complications, and attain favorable treatment efficacy.

[Retinography and tonometry in primary care: techniques incorporated into routine nursing practice]. / Retinografía y tonometría en atención primaria: técnicas incorporadas a la práctica habitual de enfermería.

OBJECTIVES: To determine the frequency of eye fundus examinations during the study period compared to the previous year. To find out the prevalence of diabetic retinopathy and the level of agreement between the primary care doctor and the ophthalmologist in the interpration of retinographies performed. To determine the relationship of the different variables with the prevalence of retinopathy. To describe the problems detected in the handling of the digital retinograph. And finally to determine the prevalence of increased intraocular pressure (IOP) in diabetic patients. METHODS: In the wellness area S. Gormaz Esteban (Soria, Spain) we performed a descriptive observational study on patients with diabetes. The nurse conducted a visual screening that included retinography and tonometry. RESULTS: There was moderate agreement in interpretation of retinographs. The coverage of diabetes who have undergone eye screening has increased to 50% (133). Some degree of retinopathy was seen in 38% (44) of the patients studied and the quality of images obtained in 67% (88) was good. The type of diabetes and treatment, the presence of dyslipidemia and nephropathy and years of evolution and elevated glycated haemoglobin are statistically significant variables. The mean IOP was 14.66 mmHg, and 5% (6) had levels >21 mmHg. CONCLUSIONS: The implementation of comprehensive eye screening for diabetic patients should be consolidated as an intervention in primary care and referring only patients with specialized referral criteria, doubtful cases and technical failures.