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Nursing ; 49(6): 56-60, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124857


Nurses can make a difference by carefully considering the language they use to talk to or about patients with diabetes. This article discusses the importance of words and messages in healthcare, particularly in diabetes education.

Diabetes Mellitus/enfermagem , Linguagem , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto , Humanos
Enferm. glob ; 18(54): 533-547, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183493


Introducción: La Fibrosis Quística (FQ) es una enfermedad hereditaria recesiva que afecta a varios órganos, fundamentalmente de los aparatos respiratorio y digestivo. La Diabetes Relacionada con la Fibrosis Quística (DRFQ) es una de sus principales complicaciones.Objetivos: Estudiar las complicaciones específicas de los pacientes pediátricos que padecen DRFQ y cómo afectan a su calidad de vida. Comparar las tasas de mortalidad de los pacientes pediátricos con FQ y con DRFQ. Poner de manifiesto la importancia del personal de enfermería en el manejo de los pacientes pediátricos con DRFQ.Metodología: Se llevó a cabo una revisión bibliográfica sistemática. Se incluyeron estudios publicados, en inglés y castellano, durante los últimos 10 años, y que analizaban una muestra de población de entre 0 y 9 años con FQ y/o DRFQ.Resultados: Se utilizaron 4 bases de datos para la búsqueda sistemática. Se analizaron 10 artículos para la resolución de los objetivos.Conclusiones: Las complicaciones que provocan la DRFQ, y los cuidados que requieren afectan a la calidad de vida de los pacientes. La progresión del diagnóstico y los tratamientos ha hecho que mejore su calidad de vida y que la diferencia de mortalidad entre los pacientes con FQ y con DRFQ se reduzca. El personal enfermero que atiende a los niños con DRFQ es un recurso de información esencial para los pacientes y sus familias. Las enfermeras deben transmitir la importancia de la adhesión a los tratamientos para conseguir una mejor calidad de vida

Introduction: Cystic Fibrosis (CF) is a hereditary recessive disease that affects several organs, mainly within the respiratory and digestive systems. Cystic Fibrosis Related Diabetes (CFRD) is one of its main complications.Objectives: To study the specific complications of pediatric patients suffering from CFRD and how they affect a patient's quality of life. To compare the mortality rates of pediatric patients with CF and with CFRD. To highlight the importance of nurses in the management of pediatric patients with CFRD.Methodology: A systematic bibliographic review was conducted. We included studies, in English and Spanish, published over the last 10 years, which analysed a population aged between 0 and 9 years old with CF and/or CFRD.Results: Four databases were used for the systematic search. We analysed 10 articles to address the objectives.Conclusions: The complications caused by CFRD and the care that patients require affect the patient's quality of life. Progress both with diagnosis and with treatment has improved the quality of life of patients, and has contributed to reductions in the difference between the mortality rates of patients with CF and without CFRD. Nurses who care for children with CFRD are essential as an information resource for patients and their families. Nurses must convey the importance of therapeutic adherence to achieve a better quality of life

Humanos , Criança , Diabetes Mellitus/enfermagem , Fibrose Cística/enfermagem , Cuidados de Enfermagem/métodos , Diabetes Mellitus/epidemiologia , Fibrose Cística/complicações , Insuficiência Pancreática Exócrina/epidemiologia , Obstrução Intestinal/epidemiologia
Int J Nurs Stud ; 93: 119-128, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30908959


OBJECTIVES: To determine the clinical effectiveness (glycemic control, other biological measures, cost-effectiveness and patient satisfaction) of primary care nurse-led interventions for diabetes. DESIGN: A systematic review following methods described for complex interventions and using PRISMA guidelines for reporting was undertaken. Nurse-led care for diabetes can be regarded as a complex intervention requiring the measurement of more than one outcome and for this reason we chose a range of outcomes clinical (symptoms), patient-centred (experiences) and organisational (cost-effectiveness). DATA SOURCES: An extensive literature search using MEDLINE (PubMed) EMBASE, and CINAHL was conducted. REVIEW METHODS: Primary studies with adults in primary care with both quantitative (comparison with physician-led care and cost-effectiveness) and qualitative (patient experiences of nurse-led care) methodologies from 2003 until June 2018. All studies were appraised using the Cochrane Collaboration's tool for assessing risk of bias. The appraisal involved evaluation of the degree of risk of bias in selection, performance, detection, attrition and reporting. Because of the complexity of multiple outcomes (quantitative and qualitative) a narrative synthesis was undertaken. RESULTS: The search generated 18 published studies that met our eligibility criteria. Three randomized controlled trials and one historical control trial found statistically significant differences in glycemic levels in favour of the nurse-led interventions. Two cluster randomized trials, two randomized pragmatic trials and two randomized controlled trials found no differences between groups. The three open-label studies found statistically significant improvements in HbA1c levels. The audit identified that more patients had lower HbA1c levels after the initiation of a nurse-led intervention. Three randomized controlled trials found significant improvements in biological outcomes and one did not. The four studies measuring cost-effectiveness found the nurse-led intervention was associated with less costs. Four studies examined patient satisfaction with nurse-led care and found this was very good. CONCLUSION: This review which incorporated a broad range of studies to capture the complexity of nurse-led interventions has identified that there is evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care.

Diabetes Mellitus/enfermagem , Modelos de Enfermagem , Glicemia/análise , Análise Custo-Benefício , Diabetes Mellitus/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Satisfação do Paciente
Nursing ; 49(3): 49-54, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30801408


Implementing lifestyle changes can be a substantial challenge for patients with diabetes. This article offers nursing strategies to help patients set and meet glycemic goals and manage their own therapy.

Diabetes Mellitus/enfermagem , Relações Enfermeiro-Paciente , Glicemia/análise , Metas , Humanos , Estilo de Vida , Autocuidado/psicologia
Br J Nurs ; 28(2): 110-115, 2019 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-30673318


New ways of measuring blood glucose bring hope of easing the burden of diabetes management for patients living with the conditions. The smart tattoo is an innovation that represents a nascent nanotechnology, which is designed to be implanted within the skin to provide continuous and reliable glucose detection for individuals diagnosed with diabetes. The potential benefits of the smart tattoo are compelling not only due to the potential of these nanodevices to prevent diabetic complications and decrease the related social costs, but also due to ease of use and relative user comfort. However, despite the advantages of the smart tattoo, it is important that health professionals, in embracing nanotechnology, understand the ethical implications of using these innovative devices.

Automonitorização da Glicemia/métodos , Diabetes Mellitus/prevenção & controle , Nanotecnologia , Automonitorização da Glicemia/tendências , Diabetes Mellitus/enfermagem , Educação em Enfermagem , Previsões , Humanos , Nanotecnologia/ética
J Gerontol Nurs ; 45(2): 35-41, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690652


Some researchers attribute the excess rates of diabetes complications among African American older adults compared to other racial/ethnic subgroups to low diabetes knowledge. Diabetes knowledge measures have a biomedical orientation, including knowledge of glycemic control and using diet and exercise to control blood sugar. Measures do not assess informal knowledge that patients obtain outside of the clinical environment. The distinction between formal and informal knowledge is meaningful for cultural groups such as African American individuals who have historically transferred knowledge about maintaining their health "through the grapevine." A qualitative approach was used to understand participants' informal diabetes knowledge. Three major themes identified addressed the threat that participants perceived when diagnosed, the social construction of diabetes knowledge through their lived and observed experiences, and the limited role that clinicians played in participants' diabetes knowledge acquisition. Findings reveal ways nurses can individualize the diabetes education they provide to African American older adults based on their experiential understanding. [Journal of Gerontological Nursing, 45(2), 35-41.].

Afro-Americanos , Diabetes Mellitus/enfermagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto
Worldviews Evid Based Nurs ; 16(1): 60-69, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30609254


BACKGROUND AND AIMS: Accumulation of real-world evidence from practice-based perinatal nurse home visits to pregnant women with diabetes prompted this translational perinatal health disparities research. Given the global diabetes epidemic, this academic-community partnered research team is studying the utilization, processes, and outcomes of this understudied model of perinatal nurse home visiting that provide home-based enhanced diabetes care to pregnant women. Because the nursing records provide the rich source of data for the study, our aim is to provide an in-depth description of the Philadelphia Pregnancy and Diabetes Home Visiting (PPD-HV) research database developed from data in the longitudinal nursing records. METHODS: This descriptive study uses retrospective data abstracted from paper-based perinatal nurse home visiting clinical records to create the PPD-HV, a HIPAA compliant, secure REDCap electronic research database. The sample includes 248 urban, pregnant women with diabetes who received a total of 1,644 home visits during the year 2012. The setting was Philadelphia, a large metropolitan city in the northeastern part of the United States. The PPD-HV database followed the information fields of the paper-based clinical nursing forms, which were originally designed by following the Omaha System to guide documenting the nursing process used in caring for patients in their homes. RESULTS: Using REDCap, the PPD-HV research database is robust with 239 variables and captures longitudinal clinical nursing data. Among the pregnant women with diabetes receiving nurse home visits, the mean age was 30.7 years, most were single, and had given birth to other children. LINKING EVIDENCE TO ACTION: Real-world clinical nursing practice data provide a rich source of research data to advance understandings about this model of enhanced diabetes care and the pregnant women with diabetes receiving the care. Considering the global epidemic of diabetes, this is a perinatal nurse home visiting model to replicate and evaluate.

Bases de Dados Factuais/normas , Diabetes Mellitus/enfermagem , Prática Clínica Baseada em Evidências/métodos , Serviços de Assistência Domiciliar/tendências , Enfermagem Neonatal/normas , Adulto , Bases de Dados Factuais/tendências , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Enfermagem Neonatal/métodos , Philadelphia , Gravidez , Estudos Retrospectivos
J Biol Regul Homeost Agents ; 32(6): 1507-1513, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30574757


The aim of this study was to probe the influence of continuous nursing intervention on recovery of diabetic patients. From October 2016 to June 2017, 80 diabetic patients who received treatment in our hospital were selected and randomly divided into an intervention group and a control group. The intervention group received continuous nursing care including indirect follow-up, health education and home visit. The self-care ability and blood sugar of the two groups were compared three months later. The score of self-care ability in the intervention group was 89.64±1.64 and that in control group was 72.68±2.47, and a significant difference was observed (P less than 0.001). The fasting blood glucose level in the intervention group was 6.62±0.86 MMOL/L, and the 2-hour post-meal blood glucose level was 8.47±1.32 MMOL/L, which were both lower than those in the control group. Continuous nursing can help monitor the recovery of patients after discharge. It is helpful to improve the self-care ability of patients, control blood sugar level, and promote recovery. It is worth wide promotion.

Diabetes Mellitus/enfermagem , Glicemia/análise , Humanos
J. Health NPEPS ; 3(2): 634-648, Julho-Dezembro. 2018.
Artigo em Espanhol | LILACS | ID: biblio-981440


Objetivo: describir el desarrollo de una teoría de rango medio que contribuya en el abordaje de las perspectivas tanto del individuo como de los integrantes de la familia considerando las relaciones e interacciones que surgen en la dinámica de la vida diaria al experimentar una situación de cronicidad. Método: la teoría fue desarrollada deductivamente del modelo de la organización sistémica, un modelo empleado en la investigación y en la disciplina de enfermería para el abordaje del sistema familiar e individual. Los vínculos entre los conceptos de la teoría se desarrollan bajo los niveles de abstracción planteados por Smith y Liehr. Resultados: el desarrollo de la teoría procesos familiares e individuales y descontrol glucémico en adultos con diabetes mellitus 2 sirve para construir la ciencia de enfermería mediante la integración de la teoría de enfermería existente y el conocimiento empírico. Conclusión: esta teoría ayuda a comprender de mejor forma como se percibe y otorga el apoyo al interior de la familia y la influencia con el automanejo del integrante con diabetes mellitus 2 reflejado en el control glucémico.(AU)

Objective: to describe the development of a mid-range theory that contributes to the approach of the perspectives of both the individual and the members of the family considering the relationships and interactions that arise in the dynamics of daily life when experiencing a situation of chronicity. Method: the theory was developed deductively from the model of the systemic organization, a model used in research and in the discipline of nursing for the approach of the family and individual system. The links between the concepts of the theory are developed under the levels of abstraction proposed by Smith and Liehr. Results: the development of the theory: Family and Individual Processes and Glycemic Decontrol in adults with diabetes mellitus 2 serves to build nursing science through the integration of existing nursing theory and empirical knowledge. Conclusion: this theory helps to better understand how it is perceived and gives support to the interior of the family and the influence with the self-management of the member with diabetes mellitus 2 reflected in glycemic control.(AU)

Objetivo: descrever o desenvolvimento de uma teoria de médio alcance que contribua para abordagem das perspectivas tanto do indivíduo quanto dos membros da familia, considerando as relações e interações que surgem na dinâmica da vida diária ao experimentar uma situação de cronicidade. Método: teoria desenvolvida dedutivamente a partir do modelo de organização sistêmica, um modelo usado na investigação e disciplina de enfermagem para abordar a família e sistema individual. As ligações entre os conceitos da teoria são desenvolvidas sob os níveis de abstração levantados por Smith e Liehr. Resultados: o desenvolvimento da teoria processos familiares e individuais, e descontrole glicémico em adultos com diabetes mellitus 2 serve para construir a ciência de enfermagem mediante a integração da teoría de enfermagem existente e o conhecimento empírico. Conclusão: esta teoria ajuda a compreender de melhor forma como se percebe e fornece o apoio no interior da familia e a influência com o automanejo do integrante com diabetes mellitus 2 refletido no controle glicémico.(AU)

Automonitorização da Glicemia , Diabetes Mellitus/enfermagem , Diabetes Mellitus/psicologia , Relações Familiares
Br J Community Nurs ; 23(10): 510-513, 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30290725


An increasing number of people require insulin to manage their diabetes, many of them in supported environments such as residential care homes. Community nursing teams are likely to have a growing caseload of care home residents who require diabetes care, including insulin injections, and many unregistered practitioners are being asked to take on this role. If community nurse leads, matrons, frailty teams and pharmacy teams work together to provide training to staff in care homes (particularly unregistered practitioners), diabetes care can be improved. This has to be suitable for groups and for people with different levels of understanding, and supported by written resources. Courses are interactive to engage and motivate all learners, and methods of teaching include group work, visual teaching aids and games. Self-assessment around competencies, using a competency framework, not only demonstrates the development of staff but also highlights key areas of diabetes care.

Pessoal Técnico de Saúde/educação , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/enfermagem , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Instituições Residenciais , Idoso , Enfermagem em Saúde Comunitária , Redução de Custos , Humanos , Segurança do Paciente , Instituições Residenciais/economia , Instituições Residenciais/normas , Reino Unido , Carga de Trabalho
Enferm. glob ; 17(52): 512-524, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173993


Objetivo: Determinar la prevalencia de los conocimientos y la actitud de las personas con diabetes mellitus tipo 2 en relación con la enfermedad y los factores asociados. Métodos: Investigación en los domicilios con 398 personas con diabetes mellitus tipo 2 inscritas en Atención Primaria. Se aplicaron tres cuestionarios: uno para el levantamiento de datos sociodemográficos y clínicos; el conocimiento de la diabetes Cuestionario (DKN-A) y la actitud de la diabetes Cuestionario (ATT-19). Para el análisis de datos, se utilizaron las pruebas bivariados y de regresión logística múltiple. Resultados: Más de la mitad de los sujetos (55,8%) tenía poco conocimiento sobre la enfermedad y la mayoría (92,2%), dificultad para resolverlos. Se verificó asociación entre el conocimiento acerca de la enfermedad con ocho o más años de estudio, cintura normal de la cadera, verificación de la glucosa en sangre regularmente, y relación inversa con el tiempo de diagnóstico <10 años. La actitud positiva hacia la enfermedad se asoció con edad entre 50 y 60 años y, a la inversa, con episodios de hiperglucemia. Conclusión: La baja prevalencia de conocimientos y actitudes positivas a la enfermedad. En cuanto a los factores asociados, cabe señalar que la mayoría de los destacados en este estudio no son modificables, lo que refuerza la importancia de que las actividades de promoción de la salud se centraron en gran medida en los grupos con estos factores

Objetivo: Verificar a prevalência do conhecimento e atitude de pessoas com diabetes mellitus tipo 2 em relação à doença e os fatores associados. Métodos: Inquérito domiciliar realizado com 398 pessoas com diabetes mellitus tipo 2 cadastradas na Atenção Primária. Foram aplicados três questionários: um para levantamento de dados sóciodemográficos e clínicos; o Diabetes Knowledge Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Para análise dos dados, utilizou-se testes bivariados e regressão logística múltipla. Resultados: Mais da metade dos indivíduos (55,8%) apresentou conhecimento insatisfatório sobre a doença e a maioria (92,2%), dificuldade para o seu enfrentamento. Verificou-se associação entre conhecimento sobre a doença com oito ou mais anos de estudo, relação cintura quadril normal, verificação da glicemia capilar regular e, relação inversa com o tempo de diagnóstico <10 anos. A atitude positiva frente a doença apresentou associação com idade entre 50 a 60 anos e, de modo inverso, com episódios de hiperglicemia. Conclusão: A prevalência de conhecimento e atitudes positivas frente à doença foi considerada reduzida. Quanto aos fatores associados, salienta-se que a maioria daqueles evidenciados nesse estudo não são passíveis de modificação, reforçando a importância das atividades de promoção da saúde focadas sobremaneira nos grupos que apresentam estes fatores

Objective: To verify the prevalence of knowledge and attitude of people with diabetes mellitus type 2 in relation to the disease and associated factors. Methods: A household survey of 398 people with diabetes mellitus type 2 enrolled in Primary Care. Three questionnaires were applied: one for sociodemographic and clinical data collection; the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). For data analysis, bivariate tests and multiple logistic regression were used. Results: More than half of the individuals (55.8%) presented unsatisfactory knowledge about the disease and the majority (92.2%) had difficulty in coping with it. There was an association between knowledge about the disease with eight or more years of study, normal waist hip ratio, regular capillary blood glucose check, and inverse relationship with time of diagnosis <10 years. The positive attitude towards the disease presented an association with age between 50 and 60 years and, conversely, with episodes of hyperglycemia. Conclusion: The prevalence of knowledge and positive attitudes towards the disease was considered low. As for the associated factors, most of those evidenced in this study are not subject to modification, reinforcing the importance of health promotion activities that are especially focused on the groups that present these factors

Humanos , Insulina/uso terapêutico , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Atenção Primária à Saúde , Promoção da Saúde/métodos , Diabetes Mellitus/enfermagem , Diabetes Mellitus Tipo 2/enfermagem , Estudos Transversais
Rev. pesqui. cuid. fundam. (Online) ; 10(4): 919-925, out.-dez. 2018. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-915523


Objetivo: Identificar a prevalência de fatores de risco para o desenvolvimento de pé diabético. Métodos: Estudo descritivo, com abordagem quantitativa, realizado junto a 71 indivíduos com diabetes mellitus tipo 2 cadastrados em uma Unidade de Saúde da região noroeste do Paraná. Os dados foram coletados por meio de entrevista e exame clínico dos pés e analisados por meio de estatística descritiva. Resultados: Os fatores de risco mais prevalentes para o desenvolvimento de pé diabético foram: pele ressecada (78,9%), utilização de calçados inadequados diariamente (70,4%), rachadura nos pés (60,6%) e presença de calosidade (56,3%). A prevalência do pé de risco para ulceração foi de 35,2%, predominando alterações grau 2 (33,8%). Conclusão: O exame clínico dos pés deve fazer parte da consulta de Enfermagem ao indivíduo com diabetes, para que seja possível a identificação precoce de fatores de risco e posterior planejamento de ações de cuidado

Objective: To identify the prevalence of risk factors for the development of diabetic foot. Methods: A descriptive study, with a quantitative approach, carried out among 71 individuals with type 2 diabetes mellitus enrolled in a Health Unit in the northwestern region of Paraná. Data were collected through interviews and clinical examination of the feet and analyzed using descriptive statistics. Results: The most prevalent risk factors for diabetic foot development were: dry skin (78.9%), inadequate footwear daily use (70.4%), foot crack (60.6%) and presence of Callosity (56.3%). The prevalence of foot ulceration risk was 35.2%, with grade 2 abnormalities predominating (33.8%). Conclusion: Clinical examination of the feet should be part of the nursing visit to the individual with diabetes, so that early identification of risk factors and subsequent planning of care actions may be possible

Objetivo: Identificar la prevalencia de factores de riesgo para el desarrollo de pie diabético. Métodos: Se realizó un estudio descriptivo con um enfoque cuantitativo, realizado con 71 sujetos con diabetes tipo 2 inscritos en una Unidad de Salud de la región noroeste de Paraná. Los datos fueron recolectados a través de entrevistas y el examen clínico del pie y se analizaron mediante estadística descriptiva. Resultados: Los factores de riesgo para el desarrollo de pie diabético más prevalentes fueron: piel seca (78,9%), el uso de zapatos inadecuados al día (70,4%), pies (60,6%) y la presencia de grietas callosidades (56,3%). La prevalencia de riesgo de ulceración del pie fue del 35,2%, predominantemente de grado 2 cambios (33,8%). Conclusión: El examen clínico de los pies debe ser parte de la consulta de enfermería a la persona con diabetes para que la identificación temprana de los factores de riesgo y la posterior planificación de las acciones de atención posibles

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pé Diabético/complicações , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Diabetes Mellitus/enfermagem , Fatores de Risco
Ostomy Wound Manage ; 64(9): 39-46, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30256750


Management of diabetes-related foot ulcers often involves debridement of devitalized tissue, but evidence regarding the most effective debridement method is limited. PURPOSE: A systematic review was conducted to determine the effectiveness of nonsurgical sharp debridement (NSSD) versus low-frequency ultrasonic debridement (LFUD) for diabetes-related foot ulceration in adults. METHOD: Published studies (earliest date available to April 2017) comparing healing outcomes of LFUD- and NSSD-treated foot ulcers in adults were considered. The quality of publications that met inclusion criteria were assessed using the PEDro scale, and a meta-analysis was undertaken to compare percentage healed and percentage of ulcer size reduction. RESULTS: Of the 259 publications identified, 4 met the inclusion criteria but 2 of the 4 did not contain sufficient patient outcomes details for meta-analysis, leaving a sample size of 173 patients. Outcome data for the 2 studies included percentage of ulcers healed between the 2 debridement methods. This difference was not significant (RR = 0.92; 95% CI = 0.76-1.11). The risk of bias for both studies was low. CONCLUSION: No difference in healing outcomes between NSSD and LFUD debridement of diabetic foot ulcers was found. Well-designed, controlled clinical studies are needed to address the current paucity of studies examining the efficacy and comparative effectiveness of debridement methods.

Desbridamento/normas , Pé Diabético/cirurgia , Ultrassom/normas , Adulto , Desbridamento/métodos , Diabetes Mellitus/enfermagem , Humanos , Cicatrização/fisiologia
Prim Care Diabetes ; 12(6): 491-500, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30145189


AIMS: To describe trends from 2006-8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. METHODS: A total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006-8. RESULTS: A 73% response rate was attained in 2016. Compared with nurses in 2006-8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006-8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. CONCLUSIONS: Major demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006-8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.

Diabetes Mellitus/enfermagem , Mão de Obra em Saúde/tendências , Enfermeiras Especialistas/tendências , Recursos Humanos de Enfermagem/tendências , Padrões de Prática em Enfermagem/tendências , Enfermagem de Atenção Primária/tendências , Adulto , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Educação em Enfermagem/tendências , Feminino , Pesquisas sobre Serviços de Saúde , Mão de Obra em Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Enfermeiras Especialistas/educação , Enfermeiras Especialistas/organização & administração , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/organização & administração , Equipe de Assistência ao Paciente/tendências , Fatores de Tempo
Diabet Med ; 35(8): 1027-1036, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30152589


This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: or Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area.

Glicemia/metabolismo , Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Nutrição Enteral/normas , Hospitalização , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Complicações do Diabetes/sangue , Complicações do Diabetes/enfermagem , Diabetes Mellitus/sangue , Diabetes Mellitus/enfermagem , Nutrição Enteral/métodos , Nutrição Enteral/enfermagem , Humanos , Pacientes Internados , Monitorização Fisiológica/enfermagem , Monitorização Fisiológica/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Reino Unido
Br J Community Nurs ; 23(9): 426-434, 2018 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-30156898


This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach.

Enfermagem em Saúde Comunitária , Diabetes Mellitus/enfermagem , Enfermeiras Especialistas , Papel do Profissional de Enfermagem , Humanos , Educação de Pacientes como Assunto , Competência Profissional , Escócia , Autocuidado
Int J Nurs Stud ; 86: 139-150, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30007585


BACKGROUND: Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES: To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS: The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS: Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS: Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.

Diabetes Mellitus/enfermagem , Gerenciamento Clínico , Educação em Saúde/normas , Hipercolesterolemia/enfermagem , Hipertensão/enfermagem , Doença Crônica , Educação em Saúde/organização & administração , Humanos , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde
Nurs Leadersh (Tor Ont) ; 31(1): 42-49, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29927382


Newfoundland and Labrador (NL) has the highest prevalence of diabetes in Canada. In 2011, Eastern Health (EH) selected diabetes as its chronic disease management focus in response to national statistics on the disease. In 2012, EH partnered with Saint Elizabeth (SE) to offer a free e-learning module on diabetes management to its healthcare providers. In this paper, the Engage Others domain of the LEADS in a Caring Environment Framework is used to describe the EH-SE partnership for this e-learning including strategies used to engage nursing and allied health staff.

Pessoal Técnico de Saúde/educação , Instrução por Computador , Diabetes Mellitus/enfermagem , Avaliação Educacional/métodos , Recursos Humanos de Enfermagem no Hospital/educação , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Canadá , Feminino , Humanos , Colaboração Intersetorial , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Reprodutibilidade dos Testes
Rev Bras Enferm ; 71(3): 1092-1098, 2018 May.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29924160


OBJECTIVE: To verify the effectiveness of nursing interventions based on the Imogene King's Theory of Goal Attainment, on improving care for people with diabetes and adherence to treatment. METHOD: Quasi-experimental, longitudinal, randomized, simple study in a Primary Health Care Unit, in the city of Fortaleza, Ceará state, Brazil. The sample consisted of 60 people with diabetes, divided into intervention and control groups, whose collection occurred from February to August 2013. RESULTS: In the intervention group, a significant adherence of the patients to the goals defined in the study was found. In the control, there was improvement in some aspects of the treatment. CONCLUSION: With these results, it was possible to conclude the feasibility of using Theory of Goal Attainment in the positive aspects for adherence to diabetes treatment and improvement of quality of life.

Diabetes Mellitus/enfermagem , Cuidados de Enfermagem/métodos , Teoria de Enfermagem , Edulcorantes/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade