Thesis (M.A.)--Indiana University, 2009. / Title from screen (viewed on February 1, 2010). Department of English, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Ulla M. Connor, Frank M. Smith, Honnor Orlando. Includes vitae. Includes bibliographical references (leaves 138-139).

Bakgrund: Diabetes typ 2 är en av de vanligaste folksjukdomarna och orsakas av både arv och miljö. Sjukdomen medför en risk för att drabbas av komplikationer, bland annat hjärt- och kärlsjukdom och nedsatt perifer cirkulation. För att undvika detta har en persons levnadsvanor en stor betydelse, detta genom fysisk aktivitet och hälsosam kost. Genom att förändra sin livsstil kan upp emot 80% av fallen förebyggas. Syfte: Litteraturöversiktens syfte var att beskriva upplevelsen av livsstilsförändringar hos personer med diabetes mellitus typ 2. Metod: En litteraturöversikt baserad på sexton vetenskapliga artiklar med kvalitativ ansats. Artiklarna har granskats och analyserats utifrån Fribergs femstegsmodell. Resultat: Upplevelsen av livsstilsförändringar påverkades av olika faktorer. Utifrån motivation och upplevda begränsningar diskuterades vardagliga saker så som fysisk aktivitet, utövande av religion, att dela en familjemåltid och upplevt stöd från både omgivning och sjukvård. Slutsats: Livsstilsförändringarna som personer med diabetes typ 2 gjorde upplevdes som en begränsning i vardagen. Att få diagnosen diabetes typ 2 leder till att en transitionsprocess kan påbörjas och möjliggör för att finna ett välmående i sin sjukdom. / Background: Diabetes type 2 is one of the most common diseases and it is caused by both  heredity and environment. The disease entails a risk of various complications, for instance cardiovascular diseases and reduced peripheral circulation. To avoid these complications, a person’s lifestyle has a big importance. Making a lifestyle change can prevent 80% of these cases. Aim: To describe the experience of making lifestyle changes amongst people with type 2 diabetes. Methods: A qualitative literature review based on sixteen studies. These studies has been processed and analyzed by the five steps of Friberg. Findings: The experiences of making lifestyle changes were affected by several factors. Everyday things such as physical activity, practice religion, share a family meal, support from family and health care was discussed from motivation and perceived limitations. Conclusion: Lifestyle changes made by people with type 2 diabetes were experienced as a limitation in the everyday life. To be diagnosed with type 2 diabetes enables a possibility to begin a process of transition, which can help these people to find a well being in their disease.

Bakgrund:Diabetes typ 2 är en livslång sjukdom där egenvård har en stor betydelse för att undvika komplikationer. Sjuksköterskan har en betydande roll i egenvården och sjuksköterskan ska ha förmågan att vägleda samt ge stöd. Därför är det viktigt att sjuksköterskan får en djupare förståelse av upplevelsen av egenvård vid diabetes typ 2. Syfte:Syftet var att beskriva upplevelser av egenvård hos individer med diabetes typ 2. Metod:En litteraturöversikt baserad på nio vetenskapliga artiklar varav åtta kvalitativa samt en kvantitativ. Artiklarna har hämtats från databaserna CINAHL, Pub Med samt SWE pub. Resultat:I resultatet framkommer tre huvudteman. Temat ”Upplevelsen av egenvård vid nydiagnostiserad diabetes typ 2” beskriver individens upplevelse av att få diagnosen diabetes typ 2. I temat ”Att integrera sjukdom och egenvård i vardagen” beskrivs hur individen integrerar sjukdom samt egenvård i sitt liv. I det tredje temat ”Vårdgivarens inflytande på egenvården” berörs sjukvårdspersonalens betydelse för egenvård. Två subteman har även tillkommit ”Upplevelser av socialt stöd i egenvården” som tillhör temat ”Upplevelsen av egenvård vid nydiagnostiserad diabetes typ 2” samt ”Vändpunkter i upplevelsen av egenvård” som tillhör temat ”Att integrera sjukdom och egenvård i vardagen”. Diskussion:Under metoddiskussionen diskuteras litteraturöversiktens styrkor samt svagheter. De flesta artiklarna är utförda i Norden vilket kan ses som en styrka, att författaren skrivit ensam och själv fått bestämma utformningen av arbetet är ytterligare en styrka. Samtidigt var det en svaghet att skriva ensam då författaren saknat någon att diskutera med. Resultatdiskussionen utgår ifrån den teoretiska utgångspunkten Orems egenvårdsteori. / Background:Diabetes type 2 is a lifelong disease in which self-care is of great importance to avoid complications. The nurse has a significant role in the individuals ' self-care and will be there to guide and be able to provide support. Therefore it is important that the nurse gets a deeper understanding of the experience of self-care in diabetes type 2.  Aim: The aim of this study was to describe the experience of self-care in adults with diabetes type 2. Method:A literature review based on nine studies. The articles were sought in CINAHL, Pub Med and SWE pub. Results:The results are presented in three themes. The theme ”Experiences of self-care in newly diagnosed diabetes type 2" describes how it is experienced to get the diagnosis diabetes type 2.  ”Integrating illness and self-care in everyday life” describes how the individual integrate disease and self-care in their lives.  The theme ”The caregivers influence on self-care” describes the nurses role in the individuals self-care.  Two subthemes have also resided ”Experiences of social support in self-care” and ”Turning points in the experience of self-care”. Discussions:Under the method discussion it was discussed about the strengths and weaknesses in the literature review. The result discussion has Dorothea Orems theory of self-care as a basis.

Background: African American (AA) women have a disproportionately higher prevalence of Type 2 Diabetes Mellitus (T2DM) and its related complications than Hispanics and non-Hispanic white women. Cultural practices, stigmatization, discrimination, socio-economic status, historical experiences and geographical locations have all been proposed as factors that influence the prevalence of T2DM in AA women. However, no study has explored how AA women with T2DM perceive their risk of developing diabetes complications, and how their risk perceptions impact their diabetes self -management. Purpose: The purpose of this study was to describe the perceptions that AA women diagnosed with T2DM have of their risks of developing DM complications, how their perceived risk of diabetes complications influences their DM self-management, and how the socio-cultural and economic contexts in which DM management occurs influences AA women's DM self-management behaviors. Method: A qualitative descriptive study was used to provide a comprehensive description of the perception of risk for developing diabetes complications among AA women with T2DM. A purposive sample of 10 AA women with T2DM was selected for the study. Findings: Findings revealed that the risk perception for developing DM complications influenced DM self-management among AA women with T2DM. Sociocultural and economic factors were also found to influence DM self-management among AA women with T2DM. Conclusion: This study revealed numerous factors that were associated with development of diabetes complications among AA with T2DM. However, risk perception stood out to be associated with all the factors.

Bakgrund:Diabetes typ 2 är ett globalt, växande folkhälsoproblem och i Sverige beräknas drygt 300 000 personer lida av sjukdomen. Livsstilsfaktorer såsom matvanor, brist på motion och stress är bidragande orsaker till uppkomst av sjukdomen. Livsstilsförändringar är en av de viktigaste åtgärderna för att få kontroll på blodsockret och därmed minska riskerna för kärlkomplikationer. Att förändra sin livsstil är komplicerat och sjuksköterskans roll är bland annat att stödja patienter till att förändra den. För att kunna förstå hur sjuksköterskan kan ge adekvat stöd är det viktigt att först få en förståelse för patienternas upplevelser. Syfte: Syftet är att beskriva upplevelser relaterat till livsstilsförändringar hos patienter med diabetes typ 2. Vilka hinder och möjligheter upplever patienterna i att förändra sin livsstil? Metod: Studien är en systematisk litteraturstudie baserad på 14 kvalitativa artiklar publicerade mellan åren 2001-2011. Databaser som använts är CINAHL, PubMed, SwePub och Medline. Även manuell sökning har genomförts. Dataanalysen influerades av Graneheim & Lundmans (2004) beskrivning av innehållsanalys. Resultat: Två huvudkategorier identifierades; upplevelser av diagnosen - en personlig bas som inverkar på förmågan att förändra sin livsstil samt kampen att förändra sin livsstil - hinder och möjligheter. Fyra subkategorier identifierades i den första kategorin och dessa handlar om diagnosen inverkan på patienternas förmåga att ändra sin livsstil. I den andra huvudkategorin klarlades sju subkategorier som beskriver vilka hinder och möjligheter patienterna upplevde i sin kamp att förändra sin livsstil. Diskussion: Resultaten diskuterades utifrån Katie Erikssons teorier om lidande och hälsa. Resultaten visade att patienterna upplevde olika grad av lidande vilket påverkade möjligheterna till livsstilsförändringar. / Background:Diabetes type 2 is a global, growing health problem. Lifestyle patterns as food habits, lack of exercise and stress are some of the reasons for developing the illness. Lifestyle changes are important means to get control of the blood sugar and to avoid vascular complications. To change living habits is complicated and the role of the nurse is to support patients in doing so. To better understand how the nurse could give adequate support it is important to get an understanding of the patients’ experiences.   Aim:Our aim is to describe experiences related to lifestyle changes among patients with type 2 diabetes. What barriers and opportunities do the patients experience in changing their lifestyle? Method:The study is a systematic literature review based on 14 qualitative articles published between the years 2001-2011. Databases used are CINAHL, PubMed, SwePub and Medline. The data analysis is influenced by Graneheim & Lundmans (2004) description of content analysis. Result:Two categories were identified; experiences of the diagnosis – a personal basis that influences the ability to change one’s lifestyle and the struggle to change one’s lifestyle – barriers and possibilities. Four subcategories were identified in the first category which illuminates the diagnosis influence on the patients’ ability to change their habits. Seven subcategories were found in the second category which describes barriers and possibilities for lifestyle changes. Discussion:The results were discussed using the theories of suffering and health of Katie Eriksson. The result shows that patients experienced different grades of suffering which had an impact on the lifestyle changes.

Innan insulinets upptäckt 1920 behandlades diabetespatienter med lågkolhydratkost. Enligt tidigare forskning om lågkolhydratkost framkom bra resultat gällande det minskade insulin behovet och förbättrade HbA1c värden. Omvårdsteoretikern Dorothea Orems omvårdnadsmodell innebär att en människa utför handlingar för sin egen skull för att upprätthålla hälsa. Människor med diabetes typ 2 har stort ansvar gällande egenvårdsaktiviteter för att öka välbefinnande och hälsa. Syftet med studien var att beskriva erfarenheter av egenvård hos människor med diabetes typ 2 som äter LCHF-kost. Studien hade en kvalitativ ansats med en beskrivande design. Undersökningsgruppen bestod av bloggande vuxna kvinnor med diabetes typ 2 som äter LCHF-kost som egenvård av sin sjukdom. Det insamlade materialet i studien analyserades i en latent kvalitativ innehållsanalys som resulterade i ett tema och två kategorier. Huvudresultatet i föreliggande studie visar att individerna bakom bloggarna kände stöd från sjuksköterskan gällande kostomläggningen. Den positiva attityden hade stärkt bloggarna i sin förändring mot bättre hälsa. Trots förbättrad hälsa och stabilare blodsocker märkte bloggarna en dålig attityd från läkarna. Slutsats: sjukvårdens uppfattning av LCHF-kost är att den ses som en kortvarig ”diet” inte som en kostbehandling. Studien visar hur patienterna påverkas positivt av LCHF, hur de förbättrat hälsan och utvecklat en bättre egenvård. Tack vare sjuksköterskornas stöd av patienternas val av egenvård förbättrades hälsan hos dessa människor, utan detta stöd finns risk att deras känsla av egenansvar minskar. / Before insulin's discovery in 1920 diabetic patients were treated with low carbohydrate diets. According to previous research about low carbohydrate diets good results regarding the reduced insulin need and improved HbA1c values was shown.Dorothea Orem’s nursing model means that a person performs acts in its own interests to maintain health. People with type2 diabetes have large responsibility regarding self-care activities to improve well-being and health. The aim of the study was to describe the experiences of self-care in people with type 2 diabetes who eat LCHF-diet. The study has a qualitative approach with a descriptive design. The blogs consists of adult women with type 2 diabetes who eat LCHF-diet to self-management their disease. The materials in the study were analyzed by a latent qualitative content analysis that resulted in a theme and two categories. The main results concluded that bloggers felt support from the nurse regarding dietary change. The positive attitude has strengthened the bloggers towards better health, despite improved health and stable blood sugar they get bad attitudes from the doctors. Conclusion: the healthcare’s idea of LCHF is that it is seen as a short-term "diet” not a dietary treatment. The study shows how patients are affected positively by LCHF, how they improved health and developed a better self-care. Thanks to the nurses support of patient’s choice of self-care improves the health of these people, without this support there is a risk that their sense of responsibility is reduced.

Bakgrund: Diabetes typ 2 är ett globalt växande hälsoproblem och antalet diagnostiserade fortsätter att öka. Sjukdomen kräver ett stort engagemang från personen på grund av de nya livsstilsförändringarna. Egenvården är därför en betydelsefull del för att kunna hantera sjukdomen. Förutsättningen för en fungerande egenvård är att personen är välinformerad samt upplever stöd från sin familj och omgivning. Hälso- och sjukvården har en betydelsefull roll i att informera, motivera och stödja personen i livsstilsförändringarna. Syfte: Var att beskriva personers upplevelse av egenvårdsmöjligheter vid diabetes typ 2. Metod: En litteraturstudie baserad på 14 kvalitativa vetenskapliga artiklar som analyserades utifrån Fribergs femstegsmodell. Ordet personer syftar på personer med diabetes typ 2. Resultat: Egenvårdshanteringen upplevdes som svår. Mat- och samhällskulturen sågs som ett hinder för att genomföra livsstilsförändringarna på grund av rädslan att hamna i utanförskap.  Stöd söktes från familj, religion eller samhället för att kunna hantera sjukdomen. Slutsats: Personen med diabetes typ 2 bär ansvaret att genomföra livsstilsförändringar. Motivationsfaktorer behövs för att personen ska kunna genomföra förändringarna.

Trata-se de um estudo qualitativo, que teve como objetivo compreender as mudanças de vida das pessoas aposentadas com diabete tipo 2. Primeiramente se caracteriza a população com diabetes tipo 2 da Clínica Hospital ISSSTE Celaya - México, onde extraiu-se uma amostra de 56 pacientes do quais 39,28% estão entre 60 e 69 anos de idade, 53,6% pertencem ao sexo feminino, 69,6% são casados, 35,7% são do lar, 41% têm nível básico de estudos, 92,8% vivem com algum familiar, 28,57% têm entre 1 e 5 anos de diagnóstico, 87,7% comparecem à consulta pelo menos uma vez ao mês, 60,7% foram em mais de uma ocasião, 39,3% ignoram as causas de hospitalização, 66,1% têm patologia associada, 98,2% fazem tratamento medicamentoso. A seguir se aplica uma entrevista semiestruturada com dez pacientes com diabetes tipo 2 e por meio da Análise de Conteúdo Modalidade Temática, chegou-se a quatro grandes temas: 1) vida dedicada ao trabalho; 2) insegurança em relação ao diabetes tipo 2; 3) alternativas depois da aposentadoria e 4) plano terapêutico para o controle do diabete tipo 2. O resultados evidenciaram que grande parte dos sujeitos tiveram uma vida dedicada ao trabalho, que gerou satisfação e insatisfação. Antes da aposentadoria relatam que não tiveram tempo para o cuidado com o controle metabólico do diabetes, priorizaram o trabalho, o cuidado dos filhos e do lar, além de que havia uma dupla jornada de trabalho que nem sempre era dividida com seus companheiros e filhos; mesmo reconhecendo que o diabetes tem um componente genético, isto não foi suficiente para que houvesse mudanças no estilo de vida, e consideram que os aspectos emocionais interferem no controle metabólico do diabetes; identificou-se que poucos sujeitos buscaram alternativas para o ocupação do tempo livre na aposentadoria, como participação em grupos comunitários ou no desenvolvimento de habilidades pessoais; foi possível apreender que além do tratamento convencional para o controle do diabetes, os sujeitos incorporam também as práticas não convencionais como o uso de plantas medicinais, como o Nopal, amplamente difundido e reconhecido na sociedade mexicana; além disso reconhecem que existe dificuldades para as mudanças no padrão alimentar, concorrendo para isso uma história alimentar com grandes quantidades de calorias e pela difusão de outras culturas alimentares na atualidade; não existe, no plano terapêutico, a prática das atividades físicas. Nas considerações finais reconhece-se que o México tem, no seu Plano Nacional de Saúde, referenciais teóricos mais amplos como o da atenção primária à saúde e da promoção da saúde, mas ao apresentar uma organização dos serviços de proteção social e de saúde organizados por Institutos de Seguridade Social. Estes detém autonomia para a incorporação e adequação da macro política no âmbito local, e que reflete na forma de atenção à saúde, dispensada para a população usuária. Mesmo incorporando parte da política de promoção da saúde, por meio da formação dos clubes de diabéticos, ainda não é considerado a focalização na família e o seu entorno social. Nesse sentido, percebe-se que as pessoas com diabetes tipo 2, não tem um seguimento regular na assistência, assim como no autogerenciamento do seu controle metabólico, fato, evidenciado pelo grande número de consultas e internações hospitalares durante o período de um ano. Também faz parte de nossas reflexões o fato as dificuldades para a adoção de mudanças no estilo de vida parecem estar relacionadas ao aparecimento e a confirmação do diabetes tipo 2 na fase adulta, onde os costumes, crenças e valores já estão incorporados no cotidiano, por isso qualquer mudança parece ser mais penosa para estas pessoas. / This qualitative study aimed to understand life changes of retired people with diabetes type 2. First, the population with diabetes type 2 from the Clinic Hospital ISSSTE Celaya, México was characterize, from which a sample of 56 patients where extracted, 39.28% are between 60 and 69 years old, 53.6% female, 69.6% married, 35.7% housewives, 41% primary schooling, 92.8% live with relatives, 28.57% has one to five years of diagnosis, 87.7% attend consultation at least one a month, 60.7% attended more than one occasion, 39.3% ignored hospitalization causes, 66.1% has associated pathology, 98.2% is under medicament treatment. A semi-structured interview was applied to ten patients with diabetes type 2. Four main themes emerged through Content Analysis Thematic Modality: 1) life dedicated to work; 2) insecurity regarding the diabetes type 2; 3) alternatives after retirement and 4) therapeutic plan for the control of diabetes type 2. The results evidenced that a great portion of them had a life dedicated to work, which caused both satisfaction and dissatisfaction. They reported that before retiring they had no time for keeping the diabetes metabolic control, prioritized work, children and family, besides double work journey which was not always divided with their partners and children: the recognition that diabetes has a genetic component was not sufficient for changes in the life style and they consider that emotional aspects interfere in the metabolic control of diabetes; a few subjects sought alternatives for occupying their free time after retirement, such as the participation in communitarian groups or in the development of personal abilities. It was possible to infer that besides the conventional treatment for the diabetes control, subjects also incorporated non-conventional practices such as the use of medicinal plants, as Nopal, largely disseminated and known by the Mexican society. They also recognize there are difficulties in changing eating habits, which are coupled with a history of great quantity of calories ingested and to other cultural eating habits currently disseminated, no therapeutic plan or practice of physical activities. It is acknowledged, in the final considerations, that the Mexican National Health Plan follows ample theoretical references such as those of primary health care and health promotion. However, its organization of services for social protection and health are performed by Social Security Institutes. These institutes have autonomy to incorporate and adequate the macro policy in the local sphere which is reflected in the form of health care delivered to the user population. Even incorporating part of the health promotion policy through the creation of diabetic clubs, the family focus and its social environment have not being considered. In this sense, it is perceived that people with diabetes type 2 do not have a regular follow-up in the assistance or self manage their metabolic control, which is evidenced by the great number of consultations and hospitalizations during a one-year period. The difficulties in adopting changes in their life styles seem to be related to the appearance and confirmation of diabetes type 2 in adult age, when habits, beliefs and values are incorporated in routine; thus, any change seems to be more difficulty for them.

Background: Type 2 diabetes mellitus (T2DM) is a major health concern among Navajo Indians. Native Americans and Alaskan Natives (NA/AN) currently have the highest rates of T2DM in the United States (Indian Health Service, 2016). The rate of diabetes on the Navajo Indian reservation is 22% (Partnersinhealth.org, 2009). Major health concerns for patients with T2DM include cardiovascular complications. Treatment is essential to prevent high-risk complications such as, cardiovascular disease (CVD). Purpose: The purpose of this quality improvement project was to implement a clinical decision support tool (CDST) to increase primary care provider awareness of current American Diabetes Association (ADA) statin therapy guidelines. The first objective was to increase the prescription rates of statin medications by 10%. The second objective of this project was to increase the performance target rate by 10%. Setting: This project was implemented at the Gallup Indian Medical Center (GIMC) Family Medicine Clinic. GIMC is located in Gallup, New Mexico. Participants: Participants included primary care providers, six Medical Doctors, two Nurse Practitioners, and one Physician Assistant. Methods: An evidence based clinical support decision tool (CDST) was generated the ADA statin therapy guidelines. Participants were educated on these practice guidelines and the CDST. The CDST was implemented into the electronic health record (EHR) over a four-week period. The provider used the CDST as a point-of-care guide when prescribing statin therapy to those with T2DM. Results: There was a 0.5% increase in the GPRA performance rating at GIMC as well as a 10% increase in prescribed statin therapy medications. There were 253 newly prescribed statin medications during data collection. Conclusion: While this project did not result in significant improvement of statin therapy GPRA performance ratings, a new EHR tool that providers can use to improve patient care was implemented. One outcome was met, there was a 10% increase in statin medication prescriptions. Further studies and future PDSA cycles will be required for testing the effectiveness of CDSTs.

Bakgrund: Diabetes är en folksjukdom som ökar i världen. Behandlingen för diabetes kan vara både medicinsk och livsstilsförändringar, till exempel som fysisk aktivitet och en hälsosammare kost. Kosten har en stor betydelse när det kommer till behandlingen av diabetes.  Syfte: Syftet var att beskriva personers upplevelser av rekommenderad kosthållning vid diabetes typ 2.   Metod: Metoden är en litteraturöversikt med ett systematiskt urval av artiklar från två databaser Pubmed och Cinahl Complete. Sökorden som användes vid databassökningarna är diabetes mellitus, type-2, diet, attitude, experience och management. Valda artiklar är från åren 2017–2020. Samtliga resultatartiklar använder sig utav en kvalitativ metod. Vid analys av metoden tillämpades Fribergs metodanalys och som teoretisk utgångpunkt tillämpades Roys teoretiska perspektiv.  Resultat: Resultatet visade att familjen hade stor påverkan på hur och vad som åts. Att ha familjen som stöd har visat vara en stor betydelse för familjemedlemmen som har en diabetessjukdom. I många kulturer som är studerade har familjen värnats väldigt högt. Det har även varit skillnader på kosten runt om i världen, en del har ätit friterad kost trots att det inte är en diabetisk diet. Kostnaden har även spelat en stor roll över vilka tillgångar som har funnits.  Slutsats: Patienters erfarenheter av kosten vid diabetes typ 2 visar att kostråd bör baseras på olika teman. Dessa teman är kultur, kunskap, familj och ekonomi. De olika temana har betydelse för hur individerna hanterar sin diabetessjukdom utifrån deras kosthållning. / Background: Diabetes is a common disease globally where there is a constant increase around the world. The treatment of diabetes can be both medical and lifestyle changes, for example physical activity and a healthier diet. Diet is of great importance when it comes to treating diabetes.  Aim: The aim of this literature review was to describe individuals’ experiences of recommended diet when diagnosed with diabetes type 2.   Method: The method is a literature review with a systematic selection of articles from two databases Pubmed and Cinahl Complete. The keywords used in the database searches were diabetes mellitus, type 2, diet, attitude, experience, and management. Selected articles are from the years 2017-2020. All articles had a qualitative design. When analyzing the method Friberg's method analysis is applied, and the choice of theoretical starting point is applied to Roy's theoretical perspective.  Results: This review shows that the family had a significant impact of what was eaten. Support from the family was of importance with diagnosed with diabetes. There has also had been a noticeable difference with the nutrition around the world, some people ate fried foods even though it is not perceived as a diet for people with diabetes. The financial aspect played a big part of which assets you got.  Conclusion: Individuals experiences of diet in diabetes type 2 have shown that dietary advice should be based on different themes. These themes are culture, knowledge, family, and economics. The different themes show how patients manage their diabetes disease based on their diet.