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By: Kimberly C. Murray, nursing student at University of Toledo

INTRODUCTION

The rise of patients with diabetes mellitus is growing both nationally and globally, and with that rise there needs to be a higher level of education and instruction on how to properly monitor blood glucose levels. That education needs to be individualized to the patient. For proper control of diabetes, it is essential for patients to actively participate in their own management such as appropriate diet, physical activity, blood glucose monitoring and adherence to medication (Eman et al. 2015, p. 5). A key component of diabetes management is self-monitoring of blood glucose, which is proven to improve glycemic outcomes in patients with diabetes (Charity et al. 2015, p. 2). The health and well-being of a patient with diabetes depends greatly on their knowledge of the disease and how they manage it; good management can only be obtained if there is proper informed education at the time of diagnosis.

BENEFITS

Research shows that intensive, individualized diabetes education can greatly decrease hypoglycemic events in patients with diabetes type 2 (Yong et al. 2015, p.7). Group education is appropriate for some cases, such as a bi-monthly or quarterly sessions to answer any questions and go over the basics once again, as well as having a group of other people that are battling the same disease and may have any tips or ideas others could try in means of diet or activity. Studies show that improvement in glycemic control was highest in the first 6 months after diagnosis and decreased in subsequent months, as shown in figure 2, factors associated with poor adherence to self-monitoring of blood glucose (Charity et al. 2015, p. 4-5). This study showed that as education decreases and reinforcement is ignored, the rate of glycemic control significantly declines. Once the rate of glycemic control declines, it will continue to decline and the patient will begin having complications which will include more care, more time, and more money. I feel that the more confidant a patient is concerning their disease and management of that disease, the more likely said patient will be to effectively control that disease and live a healthy, modified life, versus living with the disease as a burden on their family members and themselves. The benefits of increased education cannot be stressed enough.

CONCERNS

With the rise of diabetes, there should have been a rise of education; however, globally, there was an estimated 387 million people living with diabetes mellitus (about half of them undiagnosed) and 4.9 million deaths in 2014 with nearly half of all deaths occurring in people aged less than 60 years globally (Charity et al. 2015, p. 2). The research shows that even though education is part of the discharge, it does not mean that the patient has fully understood or grasped the kinds of lifestyle modifications that are necessary in order to live a healthy life. Increased education at the time of diagnosis is vital to a patient’s ability to succeed in their management of care. This education must be provided by a certified educator who has received professional training or by a multidisciplinary care team (Yong et al. 2015, p.2). Nurses and dieticians are part of that multidisciplinary care team and much of the weight of education lies on the nurse as they are the ones that do most of the discharging and patient care. Training for the multidisciplinary care team should be mandated and scheduled regularly in order to ensure nursing competency regarding diabetes and how it should be managed. Health care is an ever changing world and we, as nurses, must keep ourselves informed of these changes to better the welfare of our patients and their families.

SUGGESTED CHANGES

Diabetes education for the nurses is vital in forming solid knowledge that will equip them to be able to properly educate their patients. Poor education not only reflects in poor health for the patient but also leads to serious complications and early death imposing a large economic burden on the individual and healthcare systems (Eman et al. 2015, p.5). Millions of dollars could be saved every year if each diabetic patient was properly educated regarding proper nutrition, warning signs of hypoglycemia and hyperglycemia, what to do in both instances, the importance of exercise and the importance of glucose monitoring. This would reduce excess costs for emergency department care and care needed for complications concerning uncontrolled diabetes. A lot of the complications that diabetics face could be prevented easily. There is a large amount in the community of diabetics that simply do not care about their nutrition or health and are unwilling to make any sort of lifestyle change, those people aside, there is no excuse for the overwhelming amount of complications that some diabetics endure due to lack of knowledge. A patient with uncontrolled diabetes deals with physical ailments; people with uncontrolled type 1 diabetes often feel ill, experience cognitive dysfunction, have difficulty maintaining their weight at a desired level, and experience fluctuating moods (Vanstone et al. 2015, p. 21).

Individualized practical care should be implemented in the hospital and healthcare offices. A patient should never receive brochures and then told to call if they have any questions. Private session’s should be set up for patients so they feel comfortable enough to open up and ask questions that they may not feel comfortable asking in a group. Diabetes is a completely life-altering illness and it requires a lot of thought process and considerations. Research mentioned throughout this article shows that proper education will greatly affect the outcome of the patient and determine how well managed their diabetes is. If a patient knows the warning signs of hypoglycemia/hyperglycemia and how to react, it will help them maintain a relatively normal blood glucose throughout their day. For example, eating 15 grams of carbohydrates, waiting, then taking blood sugar again, if blood sugar is still too low, eat 30 grams carbohydrates and then take blood sugar again is something very easy and simple for a diabetic experiencing hypoglycemia could do to reverse their blood sugar. Examples like this would be best shared in a private, individualized meeting where the patient can explain their daily routine and the action plan will compliment that routine. For instance, a diabetic that is constantly on the go and in the car should pack some non-perishable snacks in their car such as crackers, oranges, or glucose tablets so they are readily available at a moment’s notice. Studies show that hypoglycemic episodes were significantly decreased in patients with intensive individualized reinforcement compared with those with structured diabetes group education only (Charity et al. 2015 p.7).

MY NURSING PRACTICE

After doing research and seeing the positive impact that diabetes education is to a patient’s well-being and overall health, I am determined to become an informed and knowledgeable educator regarding diabetes. I have many family members, including my dad, that has uncontrolled type 2 diabetes. Granted, some of them are part of the community I mentioned above that do not want to make any sort of lifestyle change; however, there are some that I do not believe were properly educated at the time of diagnosis and discharge, like my dad. I want to be the stop sign before a patient leaves the hospital that will be able to teach, instruct, and reinforce what the doctor has already told them. Do they understand what the doctor explained to them? I need to evaluate and see if they understand what this disease is and how to manage it and what the medications that they will be administering every day will do to help their body. The patient should not just be aware of all the bad things that can happen concerning diabetes; but they should be empowered by knowing and understanding what this disease is and how their medication and lifestyle changes will improve it. I believe my job as a nurse is to make sure my patients do not leave the building until they are fully confident in the lifestyle modifications and glucose monitoring that must be done in order for them to maintain healthy lives. I will do my best to educate not only my patients, but my fellow peers, including the establishment I work for by causing diabetes education awareness. The nurse is a caretaker, a good listener, a facilitator of healing, a preventer of illness and infection, a patient advocate, an educator and so much more. I want nurses all over the globe to be educated themselves and empowered to educate others.

 

REFERENCES

Charity, K. W., Kumar, A. M., Hinderaker, S. G., Chinnakali, P., Pastakia, S. D., & Kamano, J. (2015, November 18). Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Retrieved January 24, 2016, from http://www.diabetesresearchclinicalpractice.com/article/S0168-8227(15)00463-5/pdf

Eman, E. M., Alghamdi, M. A., & Al-Daghri, N. M. (2015, October 15). Intensified glucose self-monitoring with education in Saudi DM patients. Retrieved January 24, 2016, from http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC4694478&blobtype=pdf

Vanstone, M., Rewegan, A., Brundisini, F., Dejean, D., & Giacomini, M. (2015, September 1). Patient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis. Retrieved January 24, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664939/pdf/ohtas-15-1.pdf

Yong, Y., Shin, K. M., Lee, K. M., Cho, J. Y., Ko, S. H., Yoon, M. H., . . . Ahn, Y. B. (2014, July 29). Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes. Retrieved January 24, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411547/pdf/dmj-39-154.pdf