Thesis (M. Med. Sc.)-University of KwaZulu-Natal, 2006.

Nursing has its own unique contribution to make to diabetes care, but that impact is rarely quantified, measured or conceptualised. The thesis makes this contribution in the form of three published research projects and proposes an adaptation to Abbott’s conceptual framework on the division of expert labour. The first research project demonstrates the value of the hospital based diabetes specialist nurse using a randomised controlled trial; the second delineates the competences of different levels of nurses in diabetes care using a nominal group technique and the third project provides a baseline of the state of nursing in relation to the initiation of insulin therapy using a survey approach. Each project is followed by a personal reflection and discussion of the implications in the light of Abbott’s framework. Abbott’s thesis is that the development of professions is determined by a series of jurisdictional disputes rather than by a grand plan of the professions themselves. While this assertion does not always hold true in diabetes care the studies do concur with Abbott in other ways, particularly that the profession can be taken forward by taking responsibility for appropriate educational preparation, extending the boundaries of knowledge and the nursing role where appropriate. The discussion cautions against setting up professional edifices that become self-serving and stifle development, either by rigid enforcement of competences or by fossilising the nursing contribution to diabetes care. In terms of the care of the person with diabetes, nursing remains most effective within the umbrella of a multi-disciplinary team while demonstrating its own contribution. Nursing should show professionalism by continually striving for excellence, developing new knowledge and pushing role boundaries when it is in the best interests of the patient. The original contribution to knowledge is shown in the research projects’ contribution to the evolution of diabetes nursing in the United Kingdom and the proposal that Abbott’s framework be modified to put more emphasis on the task of work to achieve optimum patient outcomes than on the jostling of professions; acknowledging the growth in multi-disciplinary team-working and rise in the power of organisations at the expense of the power of individual professions since his work was first published.

This study was conducted to determine the level of knowledge and perceptions of Type Two Diabetes Mellitus (T2DM) among people in Rwamagana District. A quantitative descriptive design and a cluster multistage sampling technique were used in this study. Out of a sample of 355 people, 301 voluntary participated in the study and completed the anonymous questionnaires. The response rate was 85%. The questions in the questionnaire were designed to collect socio-demographic information of the participants, their knowledge of diabetes and their perceptions of diabetes. Analysis of findings revealed that the level of knowledge of diabetes was inadequate and low among participants. Very few participants were able to answer properly the questions aimed to explore their knowledge of the meaning, signs/symptoms, causes, risk factors, management and prevention of diabetes. In addition many participants answered that they had no knowledge about any of the aspects of diabetes explored in our questionnaire. The perceptions were also poor and inadequate, especially perceptions of diabetes management at the community level and of diabetes prevention. The perceived risk of developing diabetes was low and many participants felt that behaviour change was of no importance in the prevention of diabetes, since the majority reported that they were not planning any behaviour change in the future. The findings suggest that there is a need for education campaigns in Rwamagana district to raise public knowledge about all aspects of diabetes. There is a need also to train the community health workers of this district to enable them to offer proper advice at the community level about diabetes prevention and management. The findings from this study could be used to assist in the planning of diabetes prevention and management programs in Rwamagana district. / Thesis (M.N.)-University of KwaZulu-Natal, Howard College, 2010.

The role of diabetes specialist nurses in delivering diabetes consultations has been recognised for more than a decade, particularly since the publication of the Standards for Specialist Education and Practice by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) in 2001. However, evidence on how the consultation is delivered, together with patients’ experiences, is somewhat limited. This study examined diabetes specialist nurses’ and patients’ consultation experiences in primary care. It also investigated the process and outcome of these diabetes consultations. This research utilised a sequential mixed methods single approach design in which qualitative was followed by quantitative investigation. In the qualitative stage, 7 diabetes specialist nurses and 7 patients were interviewed separately, followed by observations of 7 nurse-patient consultations. The data from the interviews were analysed thematically, whereas the data from nurse patient consultations were examined though conversation analysis (CA). The investigation continued quantitatively, where the questionnaires were developed based on the qualitative findings and adaptation of the Consultation Quality Index (CQI-2). Following on from a pilot study, the questionnaires were sent to adult patients with diabetes (n=150) and 40 completed questionnaires were returned for statistical analysis. The qualitative and quantitative findings were then merged in a matrix diagram to reveal holistic findings on consultation experiences. The thematic analysis of patients’ interviews produced five themes which were: ‘I don’t like living with diabetes’, ‘Daily problems’, ‘Coping with my diabetes’, ‘How the nurses approach me’ and ‘My expectations toward the diabetes specialist nurses’ . In contrast, the themes from the nurses focused not only on the diabetes consultation but also care management issues: ‘Current problems’, ‘My expectations towards the patients’, ‘Consultation approaches’, ‘Personal development’ and ‘Team working’. Details on the sequence and scope of consultations were obtained from conversation analysis which highlighted the approaches commonly used by the diabetes specialist nurses. The statistical analysis showed associations between partnership and empathy (P=0.01), empathy and outcome (P= 0.005), information giving and consultation time (P= 0.05). The integration of qualitative and quantitative findings suggested ‘Consultation stages’ as a theme, and also four themes related to consultation experiences: ‘Day to day hurdle’, ‘Knowing each other’, ‘Shared expectations’and ‘Working together’. This study has identified the value and processes of the nurse-patient consultation in diabetes care from a nursing context. In general, the patients experienced their consultations with the DSNs positively. They highlighted key personal characteristics of the nurses. Similarly, the nurses considered their role in delivering consultation as crucial. Some challenges were evident including patients’ behaviours, the diabetes knowledge of other health care professionals and the lack of administrative support. The association between the nurses’ empathetical approaches and the patients’ outcomes needs further investigation.

<p>Individuals with diabetes and blindness meet problems in daily life that are related to both conditions. The aim was to study diabetes self-management, burden of diabetes, power, sense of coherence (SOC) and health among individuals with diabetes-related blindness. The aim was further to determine psychometric properties of a diabetes empowerment scale (DES) and to use it in the evaluation of an empowerment programme. The participants were 39 blind diabetic and non-diabetic individuals and 21 diabetic individuals with threat of blindness. A convenience sample of 195 diabetic patients completed DES and 9 blind diabetic individuals participated in the empowerment programme. Two reference groups from the Swed-qual population studies were also included. Data were collected by questionnaires, interviews and by scrutinizing medical records. Quantitative data were analyzed with parametric and non-parametric methods and qualitative data with content analysis. Blind diabetic individuals expressed more problems with self-management than did those with threat of blindness. In some health domains, blind diabetic individuals perceived significantly poorer health than did non-diabetic blind individuals. There were though individual differences in how blind individuals perceived their health as well as how burdensome they experienced their self-management. Individuals with power and strong SOC felt less burden and perceived better health when compared to those with weak SOC or non-power. The diabetes empowerment scale showed acceptable validity and reliability and was used, along with qualitative interviews, to evaluate the effect of the empowerment programme. Evaluation of the programme showed that the participants had improved knowledge and awareness of self-management. The programme seems suitable for blind individuals and creates an inspiring learning climate enhancing empowerment. It is concluded that blind individuals have problems in their diabetes self-management and perceive poor health but the experience of power is a factor of importance for health and an empowerment education programme may enhance power.</p>

Individuals with diabetes and blindness meet problems in daily life that are related to both conditions. The aim was to study diabetes self-management, burden of diabetes, power, sense of coherence (SOC) and health among individuals with diabetes-related blindness. The aim was further to determine psychometric properties of a diabetes empowerment scale (DES) and to use it in the evaluation of an empowerment programme. The participants were 39 blind diabetic and non-diabetic individuals and 21 diabetic individuals with threat of blindness. A convenience sample of 195 diabetic patients completed DES and 9 blind diabetic individuals participated in the empowerment programme. Two reference groups from the Swed-qual population studies were also included. Data were collected by questionnaires, interviews and by scrutinizing medical records. Quantitative data were analyzed with parametric and non-parametric methods and qualitative data with content analysis. Blind diabetic individuals expressed more problems with self-management than did those with threat of blindness. In some health domains, blind diabetic individuals perceived significantly poorer health than did non-diabetic blind individuals. There were though individual differences in how blind individuals perceived their health as well as how burdensome they experienced their self-management. Individuals with power and strong SOC felt less burden and perceived better health when compared to those with weak SOC or non-power. The diabetes empowerment scale showed acceptable validity and reliability and was used, along with qualitative interviews, to evaluate the effect of the empowerment programme. Evaluation of the programme showed that the participants had improved knowledge and awareness of self-management. The programme seems suitable for blind individuals and creates an inspiring learning climate enhancing empowerment. It is concluded that blind individuals have problems in their diabetes self-management and perceive poor health but the experience of power is a factor of importance for health and an empowerment education programme may enhance power.

93f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-04T12:44:24Z No. of bitstreams: 1 Olivia%20Almeida.pdf: 986220 bytes, checksum: 9a6cb323a6ec4e11aae4744cdf8cda54 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-09T16:21:03Z (GMT) No. of bitstreams: 1 Olivia%20Almeida.pdf: 986220 bytes, checksum: 9a6cb323a6ec4e11aae4744cdf8cda54 (MD5) / Made available in DSpace on 2013-04-09T16:21:03Z (GMT). No. of bitstreams: 1 Olivia%20Almeida.pdf: 986220 bytes, checksum: 9a6cb323a6ec4e11aae4744cdf8cda54 (MD5) Previous issue date: 2009 / Este é um estudo que teve por objetivo compreender os significados de ser diabéticos tipo 2. O estudo exploratório­descritivo, com abordagem qualitativa foi realizado em um ambulatório de diabetes, privado, na cidade de Salvador­BA, no período de Janeiro a Julho de 2008, com 15 pacientes que tinham diabetes tipo 2 há mais de 1 ano e concordaram em participar do estudo. Utilizou como instrumento de coleta de dados um roteiro para entrevista semi­estruturada e análise documental, cujos dados foram analisados com base na Análise Temática de Conteúdo. Os resultados revelaram que Ser diabético significa conviver com o incômodo, o desconforto e a dor das injeções de insulina e das lancetas; com o medo das complicações; com restrição alimentar, em especial, aos doces; com esperança da cura, ou ao menos do controle glicêmico. Constatou­se, também, que as pessoas que tiveram apoio de familiares e/ou profissionais de saúde possuíam um significado mais positivo em relação à doença. Deste modo, o significado de se cuidar implica reconhecer­se portador de limitação importante, determinada pela doença crônica. A enfermeira deve buscar conhecer estes significados para poder criar estratégias que ajudem o paciente a lidar melhor com a doença, obter controle metabólico adequado e uma melhor qualidade de vida. / Salvador

Thesis submitted in fulfillment of the requirements for the degree Master of Technology: Nursing In the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology 2014 / Diabetes is one of the major non-communicable diseases in South Africa (SA) and in 2008, 6.4 percent of the South African population was reported by Frost and Sullivan to have diabetes (Business Wire, 2008). Furthermore, the prevalence of diabetes in South Africans between the ages of 20 and 70 had been predicted to rise from 3.4% to 3.9% by the year 2025 (Rheeder, 2006:20). There is no clear assessment of the amount of nursing care Occupational Health Nursing Practitioners (OHNPs) provide to diabetic employees in SA. From working experience of the researcher, employees with diabetes were absent from work more often due to poor glucose control than other workers with chronic health conditions. The increasing levels of absenteeism had financial impact on the diabetic employees, other workers, and industry. Therefore, OHNPs working in industries and organizations must have the appropriate knowledge to ensure that workers with diabetes are screened, monitored, and managed effectively in the workplace. The aim of the study is to assess the knowledge and practices of OHNPs in managing diabetes in workplaces in SA. The objectives of the study are firstly, to explore the extent of knowledge and practices of OHNPs regarding screening for diabetes in the workplace; secondly, to describe knowledge and practices of OHNPs regarding monitoring of diabetes in the workplace; and thirdly, to examine the knowledge and practices of OHNPs in management of diabetes in the workplace. Quantitative survey design was selected to focus the study and inform on the data collection tool. The population was all the OHNPs that were members of the South African Society of Occupational Health Nurse Practitioners (SASOHN) and registered on the SASOHN database. SASOHN Executive Office granted permission for use of the database. Ethical approval for the study was obtained from the University Research and Ethics Committee. The sample included all the members of SASOHN that had access to emails. The researcher developed an electronic self-administered questionnaire based on the 2009 American Diabetic Association position statement. The questionnaire contained both closed and open-ended questions which were grouped under specific sections. The questionnaire was emailed to participants accompanied by an invitation to participate and an informed consent form. Results: due to the complexity of industries and factories that OHNPs are employed in, the organisations were divided into eight categories. About 45% of respondents rated their knowledge of diabetes management as either good or average, 55% rated their knowledge of screening as good, 44% rated their knowledge of diabetes management as good and only 7% as very good. Only 51% of OHNPs routinely screened workers for diabetes. The majority of the OHNPs indicated that the Fasting Blood Glucose (FBG) was the diagnostic test they used to diagnose diabetes, which is the preferred test. Between 73 -85% of OHNPs indicated that each of the suggested five aspects of immediate care were performed after diagnosis Conclusions: OHNPs consider their knowledge on different aspects of diabetes to be average to good, however, lack of knowledge on types of diabetes, and some gaps identified regarding the tests for screening and diagnosis of diabetes, are cause for concern. Most OHNPs that participated in the study use different approaches to conduct diabetes awareness initiatives to promote health amongst their employees. There is a gap in OHNPs’ practice of screening for diabetes as well as in their knowledge. The lack of knowledge of the OHNPs that used the Oral Glucose Tolerance Test (OGTT) or other tests is cause for concern. Amongst most respondents the five aspects of care necessary after diagnosis of DM were performed. Recommendations: firstly, a strategy should be developed to encourage males to specialise in occupational health nursing. Secondly, a vigorous marketing strategy must be promoted to inform career guidance teachers on how to attract new applicants to the nursing profession and to promote nursing as a career of choice. Thirdly, the number of nurses trained in occupational health nursing and practising as OHNPs should be determined to assess professional developmental needs. Fourthly, additional research ought to be conducted to determine OHNPs’ actual knowledge of crucial aspects of diabetes and diabetes management. A standard/guideline could be developed to ensure that OHNPs have points of reference, and continuous training and professional development programmes on screening and diagnosing of diabetes should be established. There must be an investigation into constraints that OHNPs are faced with when implementing health promotion in the workplace as well as to determine the impact of such health promotion initiatives on the employees. OHNPs should be informed about the immediate care that needs to be performed on diagnosis of diabetes to improve their knowledge base and to motivate them to change their practice to provide a solid basis for continuity of care and management of newly diagnosed clients. Suggestions for further research: research on the effect of screening programmes in the occupational health setting to diagnose diabetics and the follow up care that is given. More research is required on how much monitoring and supervision is being conducted by OHNPs in the workplace.

Cehic, A & Meijer, S. Gruppundervisning för individer med diabetes typ 2. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2009.Syftet med denna litteraturstudie var att undersöka om det finns stöd i vetenskaplig litteratur för att gruppundervisning för individer med typ 2-diabetes stimulerar till livsstilsförändringar. Författarna ville även belysa vilka faktorer i undervisningen som är viktiga. Litteraturstudien är genomförd efter modell av Friberg (2006). Tio kvantitativa artiklar ligger till grund för resultatet. Detta visar på starkt stöd för att gruppundervisning stimulerar typ 2-diabetiker till livsstilsförändringar. Viktiga faktorer i undervisningen var att den som ledde undervisningen hade förtrogenhetskunskap om diabetes, att undervisningen byggde på empowerment och/eller problembaserat lärande och stimulerade till aktiv medverkan av gruppdeltagarna, samt att utbildningen hade långtidsuppföljningar. Ingen skillnad sågs mellan undervisning som leddes av olika yrkeskategorier. Ytterligare forskning med fler studier med långtidsuppföljning samt kvalitativa studier av individernas egna upplevelser är önskvärda. / Cehic, A & Meijer, S. Group education for individuals with type 2 diabetes. A literature review. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2009.The aim of this review was to examine if there is support in scientific literature that group education for individuals with type 2 diabetes encourages lifestyle changes. The authors also wished to describe what factors in group education are important. A model of Friberg (2006) was used as method for the review. The result, based on 10 quantitative articles, shows strong support for group education encouraging type 2 diabetics to make lifestyle changes. Important factors in education were familiarity of diabetes in the educators and education based on empowerment and/or problem based learning. Also was long term follow-up of the education groups important. No differences were seen in the results between groups led by different professions. Further research, more long-term studies and qualitative studies of how patients experience group education, is required.

The purpose of the study was to evaluate the health education for clients diagnosed with diabetes mellitus by nurses working in the diabetes clinic of the specific hospital. The quantitative descriptive cross sectional design used two questionnaires to collect data from all 20 nurses working in the diabetes clinic and from a convenient sample of 132 clients diagnosed with diabetes mellitus, making use of the health services at the diabetes clinic of the hospital. Data was analysed by a computer program, statistical package for social science (SPSS). Measures were taken to ensure acceptable ethical practice, validity and reliability of the study. Findings revealed the absence of official documents to guide the health education and other factors, such as not knowing the learning needs of the clients, not utilising teaching methods optimally. Recommendations address the development of standard procedures, lesson plans, recording of health education sessions and education skills development for the nurses. / Health Studies / M. A. (Nursing Science)