Nursing strategies to facilitate self-management in persons living with diabetes mellitus type 2

Abstract

The growing pandemic of diabetes mellitus (DM) is continuing to spread around the world with developing countries being most vulnerable. Diabetes mellitus is the direct cause of 5 percent of deaths worldwide at present, with an expected increase of 50percent in the next 10 years. Diabetes mellitus was virtually unknown in Africa at the start of the 20th century but the incidence is expected to increase by 80 percent by 2025. South African estimates indicate that at present there are up to four million people living with DM in South Africa, with an expected rise of 25 percent by 2020. If DM is not adequately controlled, life-threatening complications ensue, resulting in financial, physical and emotional costs both for people living with the condition and for their families. There is also a great financial burden on the state, both directly due to the cost of providing health care and indirectly due to loss of productivity and a reduced tax base. Global initiatives against DM include the Diabetes Strategy for Africa compiled by the International Diabetes Federation and World Health Organization. There are several forms of DM with Type 2 being the most common with an estimated 95% of cases. Optimal glycaemic control is essential for the management of DM, potentially allowing the course of the disease to be slowed or halted. The previous medical model of management of chronic disease has changed to an empowerment approach where the person living with the condition is a partner in the management process. This is particularly true of DM where all aspects of life are affected by the condition. During Phase One of this study, a qualitative, exploratory, descriptive, contextual approach was utilized to explore and describe the experiences of persons living with DM and of diabetes nurse educators who assist them in Nelson Mandela Bay. During Phase Two, a conceptual framework was created and utilized to develop strategies which professional nurses may use in facilitating self-management by persons living with DM. Persons living with DM experience a definite initial experience on diagnosis of DM but gradually gain an acceptance and acknowledgment of their condition. They have definite views on the concept of self-management and experience both positive and negative factors influencing self-management. They also have definite ideas on how professional nurses may assist them in achieving self-management. These findings were confirmed ii by the experiences of the diabetes nurse educators who formed the second group of participants in this study. The ACE approach to self-management of DM consists of an Action Strategy, a Coordination Strategy and an Education Strategy. The ACE approach makes use of grand and functional strategies implemented on the macro (national), meso (provincial) and micro (local) levels to enable the professional nurse to assist persons living with DM to achieve self-management of their condition. Grand strategies need to be implemented on a macro or meso level to enable the professional nurse to function effectively on a micro level. Assisting the patient has to go beyond merely improving knowledge about the condition but has to include individual goal setting as well as problem solving skills and coping strategies as part of a therapeutic relationship between the professional nurse and the person living with DM. The level of personal responsibility achieved by persons living with DM is affected by the memes which they hold regarding their level of health and their ability to address any barriers to self-management which they may experience. Making use of the process of the therapeutic relationship, the professional nurse is able to positively influence the memes held by persons living with DM and assist them in achieving a greater level of personal responsibility. The therapeutic relationship is potentially influenced by all three of the strategies described above. This study provides insight into the experiences of persons living with DM and of the diabetes nurse educators who assist them in Nelson Mandela Bay. Recommendations regarding the implementation of a National Diabetes Policy on a macro level are made, as well as recommendations for nursing practice, education and research. The strategies which were evaluated by an Expert Panel provide a tool for the professional nurse to use while assisting persons living with DM by facilitating the growth of personal responsibility leading to self-management