Diabetes Patient Education example essay topic

DIABETES EDUCATION. Section- 1 Diabetes-mellitus is caused by a raised blood-glucose concentration due to either insufficient insulin or the presence of factors that oppose its action (Watkins, 1998). According to WHO (1999) diabetes-mellitus describes a metabolic disorder of multiple aetiology characterized by chronic heperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects inn insulin secretion, insulin action or both. There are two types of diabetes, insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). IDDM usually presents in young people and accounts for 15% of diagnosed cases. It is treated with insulin injections.

NIDDM accounts for 85% of diagnosed cases and it is treated with diet, oral hypoglycemic agents or insulin, depending on the level of blood glucose control. This study will be focussed on type-2 diabetes because it accounts for 85% of all cases and the writer have tended mostly to patients with type 2 diabetes. The study aim to gain the knowledge of factors that affect education and compliance through experiential knowledge, although personal and subjective, its defined by Bernard (1987) as "a process in which a particular experience is, on reflection, translated into concepts which in turn become guidelines for future experiences. The phenomenon of experimental learning considered by Kolbs (1984) as offering a model of learning and adaptation will be used to analyse my practice placement experience and in order to provide structure, direction and to remain focussed and avoid aimless and potentially confusing discussion CASE-STUDY As a nursing student I have had my placement in various area of care including the hospital and in the community... I have met with patients with diabetic whose legs and arms have been amputated, who are admitted for diabetic emergencies and for reasons other than diabetic, all these patients self-manage their diabetic at home. This arose my interest and it raised this question within me on how and whether this patients were educated, also if the patient are really complying with the recommended treatment.

I therefore I decided to have my elective placement in a diabetic centre of a local hospital. The diabetic centres operate in team from a purpose built facility, where two diabetes specialist nurses (Dns) worked full-time. The team, which is pioneered by the senior DSN, the consultant and the podiatrist, offer various education sessions and assessment clinics. Education were offered to patients with diabetic either individually or in group which includes how to monitor and maintain blood sugar level, administration of insulin or other medication and life rules with regard to nutrition and physical exercise. (are examples of activities, which the patient needs to plan and do everyday) These are the restrictions to personal freedom involve in striving for normoglycaemia.

(HOPE, 2000). (in order to follow complex set of behavioural actions to care for themselves on a daily basis such as following a meal plan and engaging in appropriate physical activity, these knowledge and skills are to be integrated into the patient's daily routine. Educating the patient with diabetes was a new experience for (me) the writer, so (I) she immediately became a novice, this formulate the first-stage of the Kolbs (1984) learning cycle. Benner (1984) states that the analysis of present-state enables a planned change process to occur to reach a future state. The value of the students own experience and interpretations is of great worth in the process of gaining knowledge Through my observation (in accordance with... ) that despite the education being given some patients are not complying-they have either increased in weight, could not keep up with the planned diet or are not taking their medication as prescribed and have been admitted to hospital for diabetic emergencies. This is in accordance with various literatures who have also found that... (However) the report by the Audit Commission (2000) identified gaps in current service provision.

The Commission found severe deficits in understanding about diabetes among patients and lack of evidence-based practice. Reflecting back on the different types of education given in the centre, it made me wonder if benefit reflected the amount of information given or the approach used to educate the patient? The method in which education was given depends on how the patients was booked for the education, the patients who have had their diabetic for some time but needed to go on insulin, newly diagnosed patients who needed to know about the appropriate diet or general care of the foot and eye may be booked for group teaching, whereas, those who are not achieving the appropriate blood-glucose level, those who are not coping with the recommended treatment, or newly diagnosed who need to know how to self-manage their diabetic. REASONS FOR CHOICE OF TOPIC (DIABETES MELLITUS AND EDUCATION) THE IMPORTANCE OF DIABETES MELLITUS AND EDUCATION Diabetes-mellitus officially affects 3% of people in England and Wales (Audit Commission, 2000) However, its prevalence is thought to be higher than current rates of diagnosis suggest and an estimated 2 million people in the United Kingdom (UK) is said to have the disease (HSG, 1997). The overall prevalence of clinically diagnosed diabetes in the UK is around 3% with prevalence in some minority ethnic groups being up to five times higher (Department of Health, 2001 and William and Farrar, 2002). Morbidity, mortality and the use of healthcare resources are much higher in people with diabetes because of the potentially disabling and life-threatening secondary complications.

OR Diabetes is a major cause of mortality and morbidity due to its complications (Lam et al 1995). THE PROGRESSION OF VASCULAR COMPLICATIONS IN HIGH-RISK PATIENTS WITH TYPE-2 DIABETES-MELLITUS The risk of development or progression of complication increases progressively as the glycosylated haemoglobin value increases above the non-diabetic range (Barton, 2000). A person with type-2 diabetes is 2-4 times more likely to suffer from heart disease, stroke and peripheral vascular disease than someone without diabetes. Patient with diabetes- mellitus have a shorter life expectancy than those without diabetes (Gu, Cowie and Harris, 1998), a higher incidence of cardiac, cerebrovascular and peripheral vascular disease and in addition, carry the burden of microvascular complications such as retinopathy, nephropathy and neuropathy. Microvascular and microvascular complications are largely irreversible (Howard et al., 1998).

The decline in cardiovascular, mortality seen in the general population during the last three decades is said to have bypassed those with diabetes (Burke et al., 1999). The cost of these complications has been estimated at 5% of the NHS budget (2) Blood sugar control, administration of insulin or other medication and life rules with regard to nutrition and physical exercise are examples of activities, which the patient needs to plan and do everyday (HOPE, 2000). These are the restrictions to personal freedom involve in striving for normoglycaemia. Patients indicate that they consider this daily regimen of self-care activities more difficulty than the diagnosis of mellitus itself. The frustration caused by these restrictions is illustrated in a study (Brown, Brown and Sharma et al.

2000), which demonstrated the perceived disadvantages effects that diabetes has on the quality of life. 292 patients whose age ranged from 21-85 were studied and it was concluded that the average diabetic was willing to trade away 12% of his or her remaining life in return for a diabetic-free health state (Brown et al. 2000). SECTION-1's SUMMARY Therefore psychological and social factors involved in patient compliance will be discussed with reference to the literature findings indicating varying degree of agreement between researchers. Concepts and theories influencing patients' education and compliance will be explored utilising appropriate literature and research. Suggestions will be made for health-care professionals to promote patient compliance with therapeutic regimens based on the recognition of the psychological and social factors involved.

1 b Carroll et al reported gaps in the knowledge of patients and health-professionals relating to treatment and other aspect of management. (TO INSERT NURSES KNOWLEDGE) (The results of the Diabetes Control and Complications Trial (DCCT) study indicated that the maintenance of near normal blood-glucose levels could prevent or slow the development of the complications of type-1 diabetes (DCCT, 1994). These developments contributed to a shift of emphasis from the medical management of the disease to the ways in which individuals care for themselves, in collaboration with health care providers). (Importance) Rubin et al. (1998) in a retrospective analysis of short-term baseline and follow up clinical, economic, and member and provider satisfaction data from around 7000 people with diabetes showed that implementation of a comprehensive health-care management programme for people with diabetes can lead to substantial improvements in costs and clinical outcome in the short-term. It has been repeatedly shown that intensive therapeutic regimens aimed at lowering blood-pressure levels, lowering low-density lipoprotein cholesterol and maintaining adequate blood sugar control are effective in reducing diabetic complications and cardiovascular morbidity (UKPDS, 1998; Sawicki, 1995).

Diabetes and its complications currently account for almost 10% iof all health service spending in the UK. (The resources invested in improved health-surveillance, identifying people with diabetes earlier and encouraging them to comply with best practice should be more than balanced by the cost-savings from prevented complications, and these patients' enhanced well-being and ability to work. (importance) Intensive therapy to improve the control of blood pressure or control of hyperglycemia is more costly than routine care, but there are significant reductions in direct health-care costs and considerable benefit in the longer term (Gray et al. (UKPDS) 2000). By the time type- 2 diabetes is diagnosed in an individual they may already have complications from their diabetes that have insidiously occurred in direct response to high blood-glucose levels over the preceding years. (thus there is potential here for... education). Diabetes-mellitus is a chronic disease requiring lifelong medical treatment and lifestyle adjustment by the patient (Naga sawa et al. 1992).

Compliance has the largest effect on metabolic control (Brown and Hedges, 1994), yet poor glycemic control and non-compliance prevent the realization of potential benefits from therapy and produce inestimable costs in both human and economic terms (Hinn en, 1993). Section-2 (EDUCATION- method, and importance) (after def, method then importance) Education has long been considered one of the cornerstones of improved diabetes management for both patients and health professionals (Joslin, 1939) and self-management is the cornerstone of diabetes management (Ruggiero et al. 1997). The current trend in helping people to achieve self-management of their diabetes is to empower them with the information they request in order to make informed choices. Enabling empowerment is analogous to parenting in order to arrive at maturity, the child has to be cared for, encouraged and nurtured to achieve independence and for this time is needed.

The diabetes UK (2000) emphasizes the patients right to good information throughout their management and care, and their right to be involved in decision making about their management. Discussion with the patient should cover the implication of diabetes as well as ongoing education about their diabetes and its control (and the beneficial effects of exercise... ) People with diabetes have to deal with a complex package of tasks in order to treat and regulate their disease, and especially to prevent complications. Blood sugar control, administration of insulin or other medication and life rules with regard to nutrition and physical exercise are examples of activities, which the patient needs to plan and do everyday (HOPE, 2000). 2000). The responsibility for the daily management of diabetes rests with the person who has it, then, good education and support are essential for enabling optimum metabolic control and health-enhancing lifestyles.

It is increasingly recognised that patients may benefit if they are able to play an informed and active role in the management of their diabetes (Courtier, 1997). However, the recent review of diabetes services in England and Wales by the Audit Commission showed variations in the quality of information and healthcare for people with diabetes (AC, 2000). The NHS plan highlights the importance of patient empowerment and patient central care (DoH, 2000). IMPORTANCE OF EDUCATION The importance of good patient education was in the conclusion of systematic review: 'the key to care lies first in the patient education: the patient needs to know and understand the full situation about his or her disease and to be empowered to receive the maximum amount of care possible... The disease is frightening, restricting and irritating... ' What has to be achieved is a working partnership between patient and carers'.

Empowerment should be a central goal for both patients and professionals (Greenhalgh, 1994). Integrated care pathway map expected care, improve implementation of guidelines facilitate critical evaluation of care and improve communication within multidisciplinary teams. The importance of patient education is shown in a prospective study (O'Brien and Hardy, 2000) of the impact of formal integrated care pathway-driven education programme on HbA 1 c, which compared patients' knowledge and well-being at week 0 and 6, and HbA 1 c at week 0 and 12. There were highly significant improvement in diabetic knowledge, diabetes well-being and HbA 1 c compared to the baseline, indicating the importance of education. There is evidence that diabetes patient education has effect on improving patients' knowledge (UKPDS, 1998). However, intervention intended primarily to achieve an improvement in patient self-care behaviour are few (10) In a study (Van den A rend, 2000) which compared the effectiveness of protocol ized support programme; an educational programme for poorly controlled patients and an educational programme combined with clinicians' consultancy with regards with clinicians' consultancy with regards to patients' knowledge on diabetes; diabetes related self-care behaviour and disease perception.

The result indicated that not only the programmes with an educational component but also programmes focussing merely on the structure of care resulted in improved patient knowledge and self-care behaviour. The researchers claimed improving disease knowledge result in an increase in self-care behaviour. It could be argued that the voluntary inclusion of the patients resulted in a selection of, motivated participants which is essential to studies in which patients has to be an active participants. However, this method gives the best estimates of what to find when implementing such a programme in everyday clinical practice.

Husband and Chegwidden (2002) described group programme that was developed to provide patients with basic education required for understanding and living with diabetes. The patients knowledge was assessed before and after the programme, it was found that improved knowledge, reassurance and peer group discussion helped patients to put their perceived restrictions into perspective, thereby improving overall quality of life. Participants seemed able to make more informed decision about their level of risk, their perception about the effect of diabetes on them is said to have changed. It was also suggested that apart from improved knowledge, the patient might have been motivated to use their enhanced knowledge to improve their diabetes control. Nonetheless, whether these patients retain this perception or motivation in the longer term is questionable and may need to be re-evaluated. In contrast, I noticed at the follow up clinic there was a gap between what some of the patients were taught to do and what they were actually doing.

This could be Knowledge-action-gap as found by Chan and Molassiotis (1999) that patients could not apply what they had learnt to the real situation and could not synthesis e the knowledge, indicating that knowledge is no guarantee of behaviour change in diabetic patients. Providing knowledge is only one step in the process of facilitating participation and compliance. It is essential to understand the individuals' belief and attitude, motives, demands and priorities in order to understand his / her compliance behaviour. (ADD 14 b) Health-professionals are in an educative as well as supportive role. Good quality communication can deepen the understanding the patient has of the disease, not only in general terms but more specifically and personally for them. Lo (1999) indicated that the quality of rapport patients with their health professional is crucial to the success of patients adhering to their health regimens.

This is in line with the results from other researchers (Brannon and Feist, 1992; DiMatteo, 1998) who demonstrated that positive feelings, appointment keeping and a perception that one's physician is warm, caring and communicating have been associated with medication adherence (DiMatteo, 1998). In opposition, lower levels of adherence has been related to actions that anger patients resulting in dissatisfaction such as requiring people to wait for a long-time (Linn et al. 1982). However, the better the patients' relationship with the treating health-professionals and the more opportunity there is for discussion, the more likely it is that their fears or mistaken beliefs about treatment can be expressed and defused or corrected (Carroll et al., 2000). Patients' perceptions of risk differed significantly from those of physicians, in that they relied more on personal experience and health beliefs, whereas clinicians used clinical measures and judgement. Brown et al. investigated the beliefs of patient with type-2 diabetes with regards to cardiovascular risk-reducing behaviour and medication, and it has implications for improving patient education.

The non-clinical dimension to health in diabetes was highlighted, by the St. Vincent.