Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Do Practice Nurses Have the Knowledge to Provide Diabetes Self-Management Education?

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Do Practice Nurses Have the Knowledge to Provide Diabetes Self-Management Education?

Article excerpt

Diabetes is a chronic disease which is currently in pandemic proportions. It is predicted that in developed countries by 2030 there will be 82 million people over 64 years of age with diabetes (Wild, Roglic, Green, Silree, & King, 2004). In Australia, the prevalence has been confirmed in the 1999-2000 Aus-Diab study as 7.4% in the adult population (Cameron et al., 2003), whilst a follow-up study in 2004-2005 indicated that 275 people were newly diagnosed with diabetes every day (Barr et al., 2005).

The disease is associated with significant mor- bidity and mortality, accounting for 8% of all deaths in Australia (Australian Institute of Health and Welfare [AIHW], 2005). By 2003, diabetes accounted for 5.5% of the total health-care bur- den (AIHW, 2008) and by 2006, the Melbourne based International Diabetes Institute (IDI) esti- mated diabetes cost the community $3 billion annually (IDI, 2005). The DiabCo$t study found that costs escalated linearly as the incidence of chronic complications rose (Colaguiri, Colaguiri, Conway, Grainger, & Davey, 2003). Not surpris- ingly, in 1996, diabetes became and has remained one of the top health priorities targetted by the Australian Government (Department of Health and Ageing, 2006). It is imperative that health- care services can respond to improve health outcomes.

The chronic care model (Harris, Kidd, & Snowdon, 2008) is proposed to address poor health outcomes and represents a radical paradig- matic shift in the provision of health care. Abbott (2007), a former Australian Minister for Health, articulated the need to manage chronic dis- ease in the community rather than the hospital. Accordingly, the Liberal Government expanded Medicare to support the Enhanced Primary Care (EPC) programme. The EPC programme sup- ports the development of general practice man- agement plans between patients and their general practitioners, team care arrangements permitting consultations with allied health professionals and the Practice Incentive Programme, which sup- ports annual cycles of care for patients and remu- neration for General Practices involved in these cycles of care (Abbott, 2007; Harris & Zwar, 2007; Medicare Australia, 2005).

Given the Medicare Benefit Schedule changes it is increasingly likely that PNs are or will have a greater role in diabetes care. Hence, it is important that the scope of practice of PNs is evidence based. In order to provide diabetes self-management edu- cation (DSME), PNs require knowledge of diabe- tes and its management, together with teaching and counselling skills. However, PNs have seldom had any specific training in DSME (Drass, Muir- Nash, Boykin, Turek, & Baker, 1989). As Peters et al. attest 'the delivery of a first class service of diabetes depends partly on the views, practices and attitudes of those health-care professionals who provide hands-on care for patients' (Peters, Hutchinson, McIntosh, MacKinnon, & Jones, 2000, p. 844). In response, a study was conducted to determine the diabetes-specific knowledge base of practice nurses employed in a regional rural area on the Mid North Coast of New South Wales. The particular objectives of the study were to:

1. Determine practice nurses' knowledge of dia- betes care and management.

2. Identify variables which mediate practice nurses' diabetes related knowledge.

Literature review

A diagnosis of diabetes requires extensive lifestyle modifications and the application of skills to gain glycaemic control. The American Association of Diabetes Educators (AADE, 2008) identified seven self-care behaviours: Healthy eating, being active, monitoring, taking medication, prob- lem solving, reducing risks and healthy coping, which have since been endorsed by the Australian Diabetes Educators Association (ADEA, 2008). These behaviours are all considered funda- mental to successful self-management and pro- vide a framework to guide DSME programmes (AADE, 2008). …

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