Delegation of insulin administration: a survey of community nursing teams in England.

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

Interprofessional collaboration to improve care for patients with diabetes.

BACKGROUND: The COVID-19 pandemic resulted in decreased access to routine diabetes care in rural areas and adversely affected self-management of diabetes. METHODS: This article describes a descriptive pretest-posttest study conducted to assess efficacy in managing hemoglobin A1C (A1C) among patients with type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring (CGM) system for 1 year. RESULTS: A total of 14 participants completed the Diabetes Mellitus Self-Efficacy Scale survey. Of those 14, 11 used CGM for 1 year; of the 11 who maintained CGM use, A1C levels improved in 9. CONCLUSIONS: Results indicate that CGM combined with medication management positively impacts self-efficacy in managing A1C levels among patients with T2DM. Interdisciplinary collaboration optimizes patient outcomes.

Impacto del confinamiento domiciliario por COVID-19 en población con diabetes tipo 2 de una zona rural / Impact of home confinement due to COVID-19 in the population with Type 2 diabetes of a rural area

Objetivo: determinar el impacto del confinamiento domiciliario por la pandemia de COVID-19 sobre el control de la hemoglobina glicosilada (Hb1Ac) y el riesgo cardiovascular de personas diabéticas residentes en una zona rural de Cataluña, así como su autopercepción del control de la enfermedad.Método: estudio descriptivo longitudinal retrospectivo con personas diagnosticadas de DM2 usuarias de los servicios de Atención Primaria del Institut Català de la Salut, en el área rural del Ripollés (Cataluña, España). Se recogieron datos de la historia clínica sobre: Hb1Ac, riesgo cardiovascular (según la ecuación Framingham-REGICOR), edad, sexo, tabaquismo, tensión arterial, peso, índice de masa corporal y variables bioquímicas; tanto antes como después del confinamiento y se compararon. Además, se les administró un cuestionario ad hoc sobre salud autopercibida.Resultados: participaron N= 233 personas con una edad media de 69,8 (DE: 10) años, mayoritariamente hombres (56,2%) y no fumadores (90,3%). El 46,3% tenía un buen control de Hb1Ac preconfinamiento que aumentó al 48,1% (p= 0,555). No se detectaron diferencias significativas entre el promedio de HbA1c antes (7,26; DE: 1,17) y después (7,28; DE:1,23) del confinamiento. La mayoría de los participantes tenía un riesgo cardiovascular medio (51,4%) o alto (25,7%) y aumentó 0,11 puntos posconfinamiento (p= 0,307). El 18% de los encuestados (N= 42) percibió un empeoramiento del control de la DM2 tras el confinamiento, principalmente debido al sedentarismo (42,8%) y a cambios en la dieta (21,4%).Conclusiones: el confinamiento no generó impacto en los niveles de Hb1Ac en el riesgo cardiovascular, ni en la autopercepción del manejo de la DM2 de los pacientes con diabetes de un área rural.(AU)

Objective: to determine the impact of home confinement due to the COVID-19 pandemic on the control of glycosylated hemoglobin (Hb1Ac) and cardiovascular risk in diabetic persons living in a rural area of Catalonia, as well as their self-perception of disease controlMethod: a descriptive longitudinal retrospective study with persons diagnosed with T2D and users of the Primary Care services of the Institut Català de la Salut, in the rural area of Ripollés (Catalonia, Spain). Data were collected from clinical records about: Hb1Ac, cardiovascular risk (according to the Framingham-REGICOR equation), age, gender, smoking, blood pressure, weight, body mass index and biochemical variables, both before and after lockdown; and they were compared. Besides, an ad hoc questionnaire on self-perceived health was administered.Results: the study included N= 233 persons with a mean age of 69.8 (SD: 10) years, mostly male (56.2%) and non-smoking (90.3%). Of these, 46.3% had good control of their Hb1Ac before the confinement, which increased to 48.1% (p= 0.555). No significant differences were detected between the average HbA1c before (7.26; SD: 1.17) and after the confinement (7.28; SD:1.23). The majority of participants had medium (51.4%) or high cardiovascular risk (25.7%), and this increased by 0.11 points post-confinement (p= 0.307). There was a perception of worsening in their T2D after the confinement by 18% of participants (N= 42), mainly due to sedentarism (42.8%) and changes in their diet (21.4%).Conclusions: lockdown did not generate any impact on Hb1Ac levels in cardiovascular risk, or in the self-perception of T2D management of patients with diabetes in a rural area.(AU)

Teleconsulta de enfermagem à pessoa idosa com diabetes e cuidadores informais para promoção do cuidado-de-si / Nursing teleconsultation to elderly people with diabetes and informal caregivers to promote self-care

Atualmente o envelhecimento da população e consequentemente o aumento da prevalência das doenças crónicas tornam-se numa das transformações sociais e de saúde mais significativas do século XXI. A identificação desta problemática leva à necessidade de identificar novas respostas. Perante este cenário agravado pela pandemia por Sars-Cov-2, importa destacar a necessidade da gestão das doenças crónicas, nomeadamente a Diabetes Mellitus Tipo2 (DM2). As evidências científicas têm realçado que o uso a teleconsulta pode ser eficaz no tratamento e melhoria dos resultados clínicos em pessoas idosas com DM2, nomeadamente através da telemonitorização. Neste sentido, o cuidado de enfermagem através da teleconsulta por telefone pode ajudar a promover condições que permitam à pessoa idosa promover o Cuidado-de-Si própria, de acordo com o seu projeto de vida, mas também ao familiar cuidador assegurar o Cuidado do Outro em situação de dependência parcial ou total, de acordo com o modelo de parceria de Gomes (2021). No âmbito da pandemia por SARS-Cov-2, surgiu a necessidade de reestruturar e implementar a teleconsulta de enfermagem direcionada à população idosa com Diabetes Mellitus Tipo2 (DM2) incluindo os familiares cuidadores na USFX utilizando a metodologia de projeto. Desta forma, elaborámos um projeto de estágio que pretendeu dar continuidade a um já iniciado anteriormente pelas mestrandas que estagiaram anteriormente nesta unidade (Oliveira, A. & Moniz, S., 2021). O projeto que desenvolvemos teve como objetivo desenvolver competências de enfermeiro especialista e mestre na prestação de cuidados de enfermagem à pessoa idosa com DM2 e familiares cuidadores através da teleconsulta de enfermagem e simultaneamente contribuir para a capacitação dos profissionais de enfermagem de uma USF no desenvolvimento de competências para a implementação da mesma. Como resultado das atividades desenvolvidas, salientamos a realização de uma revisão scoping que nos permitiu mapear a evidência da temática em estudo, a realização de um planeamento estruturado para teleconsulta de enfermagem à pessoa idosa com DM2 e a implementação e avaliação do mesmo com a realização de um estudo qualitativo com a metodologia de estudo de caso múltiplos, que permitiu perceber a capacitação das pessoas idosas para o Cuidado-de-Si com a implantação desta intervenção. Desta forma podemos concluir que os maiores ganhos da teleconsulta de enfermagem são a possibilidade de prestar cuidados de maior proximidade, vigilância e resposta adequada e atempada perante situações complexas/urgentes como é o caso da DM2.

Nowadays, the aging of the general population, and consequently, the increase in the prevalence of chronic diseases, became one of the most significant social transformations of the XXI century. The existence of this problem created a need for new answers and new solutions. Given this scenario, aggravated by the pandemic of Sars-Cov-2, it's important to highlight the need to manage chronic diseases, namely, Type 2 Diabetes Mellitus (DM2). The scientific evidence has emphasized the effectiveness of the teleconsultation concept in the treatment, and improvement of clinical results in elderly people affected with DM2, namely through a process of telemonitorization. In this sense, nursing care through teleconsultation by phone can help promote certain conditions that allow the elderly person to adopt a Self-Care regime, according to their life project, but also for the family caregiver to ensure the Care of the Other in a situation of partial or total dependence, according to the partnership model by Gomes (2021). In the context of the SARS-Cov-2 pandemic, the need arose to restructure and implement a nursing teleconsultation, aimed at the elderly population with Type 2 Diabetes Mellitus (DM2), including family caregivers at USFX, using the project methodology. In this way, we created an internship project that intended to continue the one already started by the master's students who had previously been interns in this Health Care Unit (Oliveira, A. & Moniz, S., 2021). The project we prepared, was aimed at the development of specialist and master nursing skills in the clinical care of elderly people with DM2, and family caregivers, through a nursing teleconsultation and simultaneously contributing to the training of nursing professionals in a USF in the development of skills for its implementation. As a result of the activities developed, we emphasize, the elaboration of a scoping review that allowed us to map the evidence of the subject under study, the creation of structured planning for a nursing teleconsultation for the elderly person with DM2, and the implementation and evaluation of the patient with the realization of a qualitative study, using the methodology of multiple case studies, which made it possible to perceive the capacity of elderly people for Self-Care with the implementation of this intervention. In this way, we can conclude that the greatest gains from nursing teleconsultation are the possibility of providing closer care, surveillance, and adequate and timely response to complex/urgent situations such as DM2.

Relação interpessoal no cuidado de enfermagem a pessoas com diabetes tipo 2 / Interpersonal relationships in the nursing care of people with type 2 diabetes / Relación interpersonal en el cuidado de enfermería a personas con diabetes tipo 2

Objetivo: analisar a efetividade da relação interpessoal no cuidado de enfermagem e sua relação com as práticas de autocuidado geral e com os pés em pessoas com diabetes tipo 2. Método: estudo transversal, analítico, realizado em um Hospital Universitário, com 150 pessoas com diabetes tipo 2 que responderam ao Questionário relação interpessoal no cuidado de enfermagem, questionário de atividades de autocuidado com diabetes e questionário da avaliação da adesão ao autocuidado com os pés. Resultados: os resultados mostraram que a efetividade da relação interpessoal no cuidado variou de moderada a alta. Os escores do questionário mostraram significância comorbidades nefropatia, acidente vascular encefálico, aderir à dieta e receber orientações sobre cuidados som os pés. Conclusão: a relação interpessoal no cuidado efetiva pode fortalecer a criação de vínculos, a confiança e verbalização de sentimentos, contribuindo para melhoria na educação em diabetes e para adesão de comportamentos de autocuidado.

Objectives: to analyze the effectiveness of the interpersonal relationship in nursing care and its relationship with general self- care and foot care in people with type 2 diabetes. Method: this cross-sectional, analytical study was conducted at a University Hospital with 150 people with type 2 diabetes who answered the Interpersonal Relationship in Nursing Care Questionnaire, a questionnaire on self-care activities with diabetes, and a questionnaire to assess adherence to feet self-care. Results: the results showed that the effectiveness of the interpersonal relationship in care ranged from moderate to high. The questionnaire scores were significant with nephropathy comorbidities, cerebrovascular accident, diet adherence, and receiving foot care guidance. Conclusion: interpersonal relationships in effective care can strengthen bonding, trust, and verbalization of feelings, improving diabetes education and adherence to self-care behaviors.

Objetivos:analizar la efectividad de la relación interpersonal en el cuidado de enfermería y su relación con las prácticas generales de autocuidado y con los pies en personas con diabetes tipo 2. Método: estudio transversal, analítico, realizado en un Hospital Universitario, con 150 personas con diabetes tipo 2 que respondieron el Cuestionario de Relación Interpersonal en el Cuidado de Enfermería, cuestionario sobre actividades de autocuidado con diabetes y cuestionario para la evaluación de adherencia al autocuidado con los pies. Resultados:los resultados mostraron que la efectividad de la relación interpersonal en el cuidado varió de moderada a alta. Los puntajes del cuestionario mostraron significación con las comorbilidades de la nefropatía, el accidente cerebrovascular, la adherencia a la dieta y recibir orientación sobre el cuidado de los pies. Conclusión:la relación interpersonal en el cuidado efectivo puede fortalecer la creación del vínculo, la confianza y la verbalización de los sentimientos, contribuyendo para una mejoría en la educación en diabetes y la adherencia a las conductas de autocuidado.

Practice nurses' communication with people living with type 2 diabetes: A scoping review.

OBJECTIVE: To identify the key characteristics of practice nurses' communication with people living with Type 2 Diabetes (T2D) where lifestyle activities are discussed. METHODS: A scoping review of the peer-reviewed literature was conducted. Reflexive thematic analysis was used to identify key themes that emerged. The PRISMA-ScR checklist was followed. RESULTS: 25 studies were retained in the final review. Nurses who were committed to engaging in lifestyle discussions created supportive environments and built rapport to enable change conversations. However, this was present in just 20% of the studies. In most studies, (60%) nurses continued to use traditional health education communication styles, had little understanding of behaviour change theories, lacked skills in behaviour change counselling and were reluctant to engage in behaviour change discussions with people with T2D . CONCLUSIONS: Nurses require a deeper understanding of behavioural change theories and skills in behavioural counselling. PRACTICE IMPLICATIONS: Practice nurses have a unique opportunity to facilitate T2D remission by engaging in evidence-based behaviour change communication. A behaviour change training intervention is needed that recognises the environment of practice nurse consultations. It needs to be pragmatic and fully consider the enablers and barriers to addressing behaviour change in both the nurse and the person with T2D.

Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial.

People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

The role of nursing care in the type 2 diabetes treatment associated with chronic liver diseases.

OBJECTIVE: Diabetes is the fifth leading cause of death in the People's Republic of China. The aim of the article is to compare the effects of nursing care on the laboratory findings and ultrasound results of diabetic patients with chronic liver diseases (CLD) who were treated with antiglycemic drugs. METHODS: Diabetic were patients treated with metformin hydrochloride in combination with gliclazide, pioglitazone hydrochloride, sitagliptin, exenatide or liraglutide. Non-alcoholic fatty liver disease (NAFLD) was evaluated by abdominal ultrasound, and fibrosis stages were evaluated at baseline and 8 months. All the patients were equally divided into two groups depending on the therapeutic approach. RESULTS: The first group of patients additionally received nursing care, and the second group adhered to the prescribed therapy on their own. In total 90 patients, or 55.6%, had NAFLD at baseline, and its course was dependent upon changes in the weight (P = 0.009) and waist circumference (P = 0.012). The proportions of patients who demonstrated an ultrasonographic improvement in the control group were: 24 (56.8%) with gliclazide, 15 (41.3%) with pioglitazone hydrochloride, 28 (66.1%) with sitagliptin, 16 (79%) with exenatide and 15 (66.7%) with liraglutide (P = 0.2). For the group that received nursing care an ultrasonographic improvement was in: 29 (68.16%) with gliclazide, 18 (49.56%) with pioglitazone hydrochloride, 33 (79.32%) with sitagliptin, 19 (94.8%) with exenatide and 21 80.04% with liraglutide (P = 0.2). CONCLUSIONS: Outcomes from the type 2 diabetes treatment paralleling of CLD were presented. Treatment of type 2 diabetes with pioglitazone hydrochloride, gliclazide, sitagliptin, liraglutide and exenatide was proven effective.

Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2 / Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2 / Risk of unstable glycemia in elderly people with type 2 diabetes mellitus

Objetivo: avaliar os fatores de risco do diagnóstico de enfermagem Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2. Método: estudo transversal realizado com 152 pessoas idosas atendidas na atenção primária de agosto a outubro de 2021. Na consulta de enfermagem, avaliaram-se dados clínicos, perda de sensibilidade protetora plantar e checklist com fatores de risco do Risco de glicemia instável da NANDA. Empregaram-se análise descritiva e testes de associação. Resultados: 46,7% apresentaram HbA1c ≥ 7,0 e maior prevalência dos fatores de risco: Conhecimento insuficiente sobre o controle da doença (p<0,001); Conhecimento insuficiente sobre os fatores modificáveis (p<0,001); Controle insuficiente do diabetes (p<0,001); Falta de adesão ao plano de controle do diabetes (p=0,002); e Monitorização inadequada da glicemia (p<0,001). Conclusão: os fatores de risco foram relacionados ao conhecimento insuficiente e à falta de manejo com a doença, ressaltando a importância do enfermeiro no planejamento de cuidados adequado.

Objective: to assess the risk factors of the nursing diagnosis Risk of unstable glycemia in elderly people with type 2 diabetes mellitus. Method: cross-sectional study carried out with 152 elderly people assisted in primary care from August to October 2021. In the nursing consultation, clinical data, loss of plantar protective sensitivity and a checklist with risk factors of unstable NANDA glycemia risk were evaluated. Descriptive analysis and association tests were used. Results: 46.7% had HbA1c ≥ 7.0 and higher prevalence of risk factors: Insufficient knowledge about disease control (p<0.001); Insufficient knowledge about modifiable factors (p<0.001); Insufficient control of diabetes (p<0.001); Lack of adherence to the diabetes control plan (p=0.002); and Inadequate blood glucose monitoring (p<0.001). Conclusion: risk factors were related to insufficient knowledge and lack of management with the disease, emphasizing the importance of nurses in the planning of appropriate care.

Objetivo: evaluar los factores de riesgo del diagnóstico de enfermería Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2. Método: estudio transversal realizado con 152 ancianos atendidos en la atención primaria de agosto a octubre de 2021. En la enfermería consulta, se evaluaron datos clínicos, pérdida de sensibilidad protectora plantar y se utilizó la lista de verificación con factores de riesgo de NANDA Riesgo para glucemia inestable. Se utilizaron análisis descriptivos y pruebas de asociación. Resultados: 46,7% tenían HbA1c ≥ 7,0 y mayor prevalencia de factores de riesgo: Insuficiente conocimiento sobre control de la enfermedad (p<0,001); Conocimiento insuficiente sobre factores modificables (p<0,001); control insuficiente de la diabetes (p<0,001); Falta de adherencia al plan de control de la diabetes (p=0,002); y Monitoreo inadecuado de glucemia en sangre (p<0.001). Conclusión: los factores de riesgo se relacionaron con el conocimiento insuficiente y la falta de administración de la enfermedad, destacando la importancia de los enfermeros en la planificación de la atención adecuada.

Eficacia de una intervención de enfermería de soporte social al adulto para el autocontrol de la diabetes mellitus tipo 2 / Efficacy of a social support nursing intervention for adults for the self-management of type 2 diabetes mellitus

Objetivo: Determinar la eficacia de una intervención de enfermería de soporte social al adulto para el autocontrol de la diabetes mellitus tipo 2. Método: Ensayo Clínico Aleatorizado de tipo paralelo en una muestra de 94 sujetos, 47 sujetos asignados al grupo de intervención y 47 sujetos asignados al grupo control, que recibió la atención convencional. Los desenlaces primarios fueron el autocontrol y el soporte social, evaluados en tres momentos (pre - post y seguimiento al mes de finalizada la intervención) con las etiquetas de resultados de enfermería Autocontrol: diabetes (1619) y Soporte social (1504). La intervención de enfermería de soporte social fue diseñada con base en la Teoría de Autocontrol Individual y Familiar, y en evidencia científica; posteriormente validada por consenso de expertos. Resultados: El efecto de la intervención para el resultado Autocontrol: diabetes, mostró una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Para el resultado Soporte Social, también hubo una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Conclusiones: se pudo comprobar que la intervención de enfermería de soporte social en el adulto es más eficaz para el autocontrol de la diabetes mellitus tipo 2 que la atención convencional. De esta manera, se hace necesario considerar la implementación de esta intervención en la práctica de enfermería.

Objective: To determine the effectiveness of a social support intervention for adults for the self-management of type 2 diabetes mellitus. Method: Randomized clinical trial of parallel type in a sample of 94 subjects, 47 subjects assigned to the intervention group and 47 subjects assigned to the control group, who received conventional care. The primary outcomes were self-management and social support, evaluated in three moments (pre-post and follow-up one month after the end of the intervention) with the nursing result labels Self-management: diabetes (1619) and Social support (1504). The social support intervention was designed based on the Individual and Family Self-management Theory, and on scientific evidence; subsequently validated by expert consensus. Results: The effect of the intervention for the outcome Self-management: diabetes, showed a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. For the Social Support outcome, there was also a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. Conclusions: it was found that social support intervention in adults is more effective for self-management of type 2 diabetes mellitus than conventional care. Thus, it is necessary to consider the implementation of this intervention in nursing practice.

Characterizing shared and distinct symptom clusters in common chronic conditions through natural language processing of nursing notes.

Data-driven characterization of symptom clusters in chronic conditions is essential for shared cluster detection and physiological mechanism discovery. This study aims to computationally describe symptom documentation from electronic nursing notes and compare symptom clusters among patients diagnosed with four chronic conditions-chronic obstructive pulmonary disease (COPD), heart failure, type 2 diabetes mellitus, and cancer. Nursing notes (N = 504,395; 133,977 patients) were obtained for the 2016 calendar year from a single medical center. We used NimbleMiner, a natural language processing application, to identify the presence of 56 symptoms. We calculated symptom documentation prevalence by note and patient for the corpus. Then, we visually compared documentation for a subset of patients (N = 22,657) diagnosed with COPD (n = 3339), heart failure (n = 6587), diabetes (n = 12,139), and cancer (n = 7269) and conducted multiple correspondence analysis and hierarchical clustering to discover underlying groups of patients who have similar symptom profiles (i.e., symptom clusters) for each condition. As expected, pain was the most frequently documented symptom. All conditions had a group of patients characterized by no symptoms. Shared clusters included cardiovascular symptoms for heart failure and diabetes; pain and other symptoms for COPD, diabetes, and cancer; and a newly-identified cognitive and neurological symptom cluster for heart failure, diabetes, and cancer. Cancer (gastrointestinal symptoms and fatigue) and COPD (mental health symptoms) each contained a unique cluster. In summary, we report both shared and distinct, as well as established and novel, symptom clusters across chronic conditions. Findings support the use of electronic health record-derived notes and NLP methods to study symptoms and symptom clusters to advance symptom science.

A nurse-led, community-based self management program for people living with type 2 diabetes in Western Ethiopia: A feasibility and pilot study protocol.

AIM: To develop and examine the preliminary effects of a nurse-led, community-based diabetes self management education and support program on clinical outcomes, self care behaviours, quality of life and family support through a pilot randomized controlled trial among adults living with type 2 diabetes in Western Ethiopia. METHODS: A two-arm parallel-group pilot randomized controlled trial involving participant-caregiver dyads will be conducted. A total of 76 dyads will be recruited, with 38 dyads randomly allocated to the intervention arm receiving six sessions of the diabetes self management education and support program supported by an educational handbook, flier and video on top of the usual care; the control arm will continue to receive the usual care. The intervention will be guided by social cognitive theory and related international guidelines for diabetes management, addressing misconceptions, using culturally tailored foods and involving family members in the intervention. Participants will be recruited at Nekemte Specialized Hospital over 2 months. Nurses will deliver the intervention in the community in Nekemte, western Ethiopia. Diabetes self​ care behaviour, quality of life, family support, glycosylated haemoglobin, body mass index, blood pressure and lipid profiles will be assessed. Descriptive statistics will summarize the sociodemographic variables of the dyads; people living with diabetes' clinical outcomes, self care behaviours, quality of life and the level of family support; family caregivers' behaviours; and the acceptability level. Cohen's d will be computed to estimate the effect size. TRIAL REGISTRATION: The Chinese Clinical Trial Registry prospectively registered the trial, and the registration number was ChiCTR2000040292.

Documented diabetes care among older people receiving home care services: a cross-sectional study.

BACKGROUND: Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services. METHODS: A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis. RESULTS: A total of 92 home care records from older home-dwelling persons with diabetes, aged 66-99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals. CONCLUSIONS: The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.

Pathways of diabetes distress, decisional balance, self-efficacy and resilience to quality of life in insulin-treated patients with type 2 diabetes: A 9-month prospective study.

AIMS AND OBJECTIVES: To construct a path model addressing influences of diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin-treated patients with type 2 diabetes (T2DM). BACKGROUND: Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin-treated T2DM patients. DESIGN: A 9-month prospective design was employed in this study. METHODS: Self-reported questionnaires were used to collect data from 185 insulin-treated T2DM patients. At baseline, diabetes distress and self-efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE. RESULTS: Low baseline diabetes distress and high 9-month decisional balance of injecting insulin directly associated with high 9-month QoL. High baseline self-efficacy of injecting insulin and high 9-month resilience directly associated with high 9-month decisional balance of insulin injection and indirectly associated with high 9-month QoL. High baseline diabetes distress directly and indirectly associated with poor 9-month QoL. CONCLUSIONS: Diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin-treated T2DM patients. RELEVANCE TO CLINICAL PRACTICE: Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin-treated patients. Improving self-efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients.

A Nurse Practitioner-Led Multidisciplinary Diabetes Clinic for Adult Patients Discharged From Hospital.

OBJECTIVES: In this study, we evaluated the feasibility of a nurse practitioner-led outpatient clinic (NPC) to facilitate the safe transition of patients with diabetes receiving insulin therapy between hospital and the community. METHODS: An NPC was set up to manage patients who had diabetes education in hospital and who were discharged on insulin. In addition to patient demographics and admission diagnosis, days seen postdischarge, duration of follow up, diabetes interventions and discharge care plan were recorded. For quality improvement, patients were asked to complete a questionnaire at the time of discharge from the NPC. RESULTS: Within a 12-month period, 71 patients with diabetes attended the NPC 3 to 21 days after discharge and they were followed for 1 to 98 days. Thirteen patients required management of hypoglycemia and 56 patients had adjustment of medications to basal/prandial insulin or switched to oral antihyperglycemic agents. Fifty-four patients were returned to the care of their family physicians and 18 patients required a referral to a diabetes specialist. A postclinic questionnaire indicated that the clinic enabled patients to improve management of their diabetes. However, communication of the diabetes management plan to the family physician was an identified concern. CONCLUSIONS: An NPC clinic can provide timely management and is a viable option to ensure safe transition of patients with diabetes from hospital back to their family physicians.

The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.

AIM: To describe diabetes nurses' perspectives on the impact of the COVID-19 pandemic on people with diabetes and diabetes services across Europe. METHODS: An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. RESULTS: Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID-19 pandemic had impacted 'a lot' on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased 'a lot': anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty-seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self-management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID-19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. CONCLUSION: The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID-19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.

Diagnósticos de enfermagem em pacientes diabéticos: revisão integrativa / Nursing diagnoses in diabetic patients: an integrative review / Diagnósticos de enfermería en pacientes diabéticos: revisión integradora

Objetivo: identificar os diagnósticos de enfermagem segundo a taxonomia NANDA Internacional, Inc. evidenciados em pacientes com diabetes mellitus. Método: trata-se de uma revisão integrativa da literatura realizada no mês de maio de 2020, nas bases CINAHL, Scopus, PUBMED, LILACS, BDEnf e Biblioteca Eletrônica Científica Online SciELO. Foram selecionados artigos científicos que abordavam diagnósticos de enfermagem em pacientes adultos com diabetes mellitus tipo 1 e 2, no recorte temporal de 2004 a 2020. Resultados: selecionados 21 artigos, sendo a maioria brasileiros, do tipo descritivo e transversal. Encontrou-se 60 diferentes diagnósticos de enfermagem, destes, 43 eram com foco no problema, 15 de risco e dois de promoção da saúde. Conclusão: os domínios predominantes foram: Promoção da Saúde, Nutrição, Eliminação e Troca, Atividade/repouso, Enfrentamento/Tolerância ao Estresse e Segurança/proteção. As evidências de diagnósticos de enfermagem norteiam o cuidado de enfermagem, subsidiam o raciocínio clínico e científico dos profissionais potencializando, assim, a sistematização da assistência.

Objective: to identify nursing diagnoses in patients with diabetes mellitus, by the NANDA International, Inc. taxonomy. Method: this integrative review was conducted in May 2020 in the CINAHL, Scopus, PUBMED, LILACS, BDENF and Scientific Electronic Library Online (SciELO) databases, resulting in a selection of scientific articles on nursing diagnoses in adult patients with type 1 and 2 diabetes mellitus, published between 2004 and 2020. Results: most of the 21 articles selected were Brazilian, descriptive and cross-sectional. Sixty different nursing diagnoses were identified, of which 43 focused on the problem, 15 on the risk, and two on health promotion. Conclusion: the predominant areas were Health Promotion, Nutrition, Elimination and Exchange, Activity/Rest, Coping and Stress Tolerance, and Safety/Protection. Evidence from nursing diagnoses in diabetic patients guides nursing care and informs health personnel's clinical and scientific reasoning, thus making for more systematic care.

Objetivo: identificar los diagnósticos de enfermería, según la taxonomía de la NANDA International, Inc., evidenciados en pacientes con diabetes mellitus. Método: revisión integradora, celebrada en el mes de mayo de 2020, en las bases de datos CINAHL, Scopus, PUBMED, LILACS, BDENF y Scientific Electronic Library Online SciELO. Se seleccionaron los artículos científicos que abordan diagnósticos de enfermería en pacientes adultos con diabetes mellitus tipo 1 y 2, en el recorte temporal de 2004 a 2020. Resultados: se seleccionaron 21 artículos, siendo la mayoría brasileña, descriptiva y transversal. Se encontraron 60 diferentes diagnósticos de enfermería; de éstos, 43 se centraron en el problema, 15 en el riesgo y dos en la promoción de la salud. Conclusión: las áreas predominantes fueron: Promoción de la Salud, Nutrición, Eliminación e Intercambio, Actividad/descanso, Enfrentamiento y Tolerancia al Estrés y Seguridad/protección. Las evidencias de diagnósticos de enfermería en pacientes diabéticos guían la atención de enfermería, subsidian el razonamiento clínico y científico de los profesionales y, por lo tanto, potencian la sistematización de la asistencia.

Conhecimento e Atitude: perfil de pessoas com diabetes em diálise / Knowledge and attitude: profile of diabetics in dialysis / Conocimiento y actitud: perfil de personas con diabetes en diálisis

Objetivo: identificar o conhecimento e o enfrentamento do diabetes junto a pessoas com diabetes em diálise. Método: estudo transversal, realizado com pacientes com diabetes tipo 2. Os instrumentos utilizados foram o Diabetes Knowledge Scale Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Resultados: participaram 71 pacientes, com idade média de 61,81±14,93 anos. A retinopatia diabética foi a complicação prevalente (81,69%); hipertensão arterial sistêmica foi a comorbidade (83,09%). A glicemia em jejum apresentou mediana de 152 (124-228,5) mg/dl e a hemoglobina glicada de 7,5 (6,42-8,27) mg/dl. O DKN-A apresentou escore médio de 7,84±2,55 pontos; seu item com maior número de acertos foi a conduta em caso de hipoglicemia; enquanto o com menor número de acertos foi em relação à cetonúria e substituições alimentares. O instrumento ATT-19 obteve média de 50,26±11,7 pontos. Conclusão: pessoas com diabetes, em diálise, apresentam conhecimento deficiente em relação ao diabetes, assim como baixo enfrentamento da doença.

Objective: to identify knowledge of, and coping with, diabetes mellitus among diabetics undergoing dialysis. Method: in this cross-sectional study of patients with type 2 diabetes, the instruments used were the Diabetes Knowledge Scale Questionnaire (DKN-A) and Diabetes Attitude Questionnaire (ATT-19). Results: mean age of the 71 participants was 61.81 ± 14.93 years. The most prevalent complication was diabetic retinopathy (81.69%), and the most prevalent comorbidity was systemic arterial hypertension (83.09%). Median fasting glycemia and glycated hemoglobin were 152 (124-228.5) mg/dl and 7,5 (6,42-8,27) mg/dl, respectively. Average DKN-A score was 7.84 ± 2.55; the highest success rate was on how to respond to hypoglycemia; the lowest was about ketones in urine and substitute foods. Mean ATT-19 score was 50.26 ± 11.7. Conclusion: the diabetics in dialysis showed deficient knowledge of diabetes and had negative attitudes to the disease.

Objetivo: identificar el conocimiento y el afrontamiento de la diabetes mellitus entre los diabéticos en diálisis. Método: en este estudio transversal de pacientes con diabetes tipo 2, los instrumentos utilizados fueron el Diabetes Knowledge Scale Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Resultados: la edad media de los 71 participantes fue de 61,81 ± 14,93 años. La complicación más prevalente fue la retinopatía diabética (81,69%) y la comorbilidad más prevalente fue la hipertensión arterial sistémica (83,09%). La mediana de la glucemia en ayunas y la hemoglobina glucosilada fueron 152 (124- 228,5) mg / dl y 7,5 (6,42-8,27) mg / dl, respectivamente. La puntuación promedio de DKN-A fue de 7,84 ± 2,55; la tasa de éxito más alta fue sobre cómo responder a la hipoglucemia; el más bajo fue sobre las cetonas en la orina y los alimentos sustitutos. La puntuación media de ATT-19 fue 50,26 ± 11,7. Conclusión: los diabéticos en diálisis mostraban un conocimiento deficiente de la diabetes y actitudes negativas hacia la enfermedad.

Effectiveness of nurse-led intervention on self-management, self-efficacy and blood glucose level among patients with Type 2 diabetes mellitus.

Background This study assesses the effectiveness of nurse-led intervention on self-management, self-efficacy, and blood glucose level among patients with Type 2 diabetes mellitus (DM) attending diabetic Out patient department (OPD) in Sri Ramachandra Hospital, Chennai. Methods In this study, the experimental group received nurse-led intervention on video-assisted teaching regarding nature of the disease condition including, diet, medication, hand and leg exercises, home care management, for 30 mins. Then a demonstration of hand and leg exercise was done followed by return demonstration done by the participants. The participants in the control group did not receive nurse-led intervention; they received only routine care. On the 15th day, when the patients came for the first follow-up, posttest was conducted for both the experimental and control groups. Results There was a statistically considerable difference noted in self-management (t=29.639; p<0.001), self-efficacy (t=28.293; p<0.001), FBS (t=2.415; p<0.05), and PPBS (t=2.102; p<0.05) in the posttest among patients with Type 2 DM in the experimental group. Conclusions The study concluded that the nurse-led intervention through video-assisted teaching is an effective method to recover self-management and self-efficacy as well as reduce the fasting blood sugar and postprandial blood sugar among patients with Type 2 DM.