The management of health in terms of prevention and control is an ever growing concern for health care professionals. A well planned care is necessary in order to obtain significant benefits. However, with the type of disorder and complexity involved, the management could vary. A well planned strategy initiated at the very beginning state of the disease may have better implications. Nursing strategies have become important constituents of today’s health care. From various perspectives, this area is progressing into a sophisticated care delivery options that could be available for patients at various settings. To better execute this specific care a framework may be necessary. The disease that best fits in this category and which requires care delivery from various facets of prevention and control is the chronic disease. The task of managing chronic disease is one of the most serious issues in the modem health care system (“Facing type 2 diabetes,” 2010).This could be due to the fact that the sufferers of chronic disease frequently need a spectrum of medications, repeated visits to doctor, health regulation and admission in the hospitals (“Facing type 2 diabetes,” 2010).Hence, the classical example in this context is Diabetes. In countries like United States it is the most commonly occurring chronic disease and is believed to affect nearly over 20 million individuals(“Facing type 2 diabetes,” 2010).It causes considerable morbidity and mortality and brings forward huge pressure to healthcare system of United States(“Facing type 2 diabetes,” 2010).Prevalence of this disorder is greatly enhanced by the risk factors which is nothing but the obesity(“Facing type 2 diabetes,” 2010).Nearly 20% of individuals living in United States have obesity (“Facing type 2 diabetes,” 2010).
To better overcome the rising diabetes prevalence, several agreements and reforms were developed to standardize the management and control of Diabetes (“Facing type 2 diabetes,” 2010).However, certain issues have transformed into a burden and are interfering with this policy. This threshold could be alleviated by a way of thorough changes in the healthcare system (“Facing type 2 diabetes,” 2010).It is important to note that certain prevention strategies have a potential to offer reliable approaches to the management and control of chronic diseases. These are incorporated at primary, secondary and tertiary levels. Primary prevention recognizes and prevents diabetes in the high risk individuals. This strategy influences by minimizing the care requirement of diabetes and necessary therapy to be provided to diabetes associated adverse health consequences. Type 2 diabetes better fits for primary prevention as type 1 has no evident prevention measures thoroughly undertaken yet. Here, physical activity and weight regulation which are important for the alleviation of type 2 diabetes are achieved through variations in the life style. Thus primary prevention may emphasize on the hygiene of general population or individuals. In th e nursing context, several concepts or theories and models have been described with regard to prevention. For instance, Levels of Prevention Model developed by Leavell and Clark in 1975, has made a significant impact on ambulatory care and health practice globally (“Models of prevention”, 2011).
This concept may indicate that the disease history in occurs in a sequence of set of numbers with the health at one cornet and the severe form of disease at the other corner. It defines the connection between the three modes of preventive strategies that could be exploited to facilitate health and cease the progression of the disease at various junctions along the sequence of the set of numbers.
Therefore the objective is to control the healthy condition and alleviate the disease occurrence. To determine this, there is need to develop awareness about the chronic illness carried by diabetes among older men and women with the literature support(Gallant, Spitze & Grove, 2010). This is nothing but the self care behavior. This ensures knowledge on social influences, enhances social relationships so as to gain maximum benefits through the interventions (Gallant et al., 2010)
. Since diabetes prevalence is tightly liked with the lifestyle changes, this nursing model could help in the easy management. Diet regimen and lifestyle habits provide key information on diabetes vulnerability. Similarly, culture and gender responsibilities may pose a risky task for the self care of chronic illness especially with regard to diet(Gallant et al., 2010). Families belonging to various ethnic groups may provide vital information with their diet and life style habits (Gallant et al., 2010) For instance, studies conducted on various ethnic groups to determine the impact of social interaction and family ties on self care have revealed that older Latino adults, were considered as as the primary support group and have potential in assisting the management of chronic illness and supplying encouragement and the strength gathered (Gallant et al., 2010). In addition, the concept of coordinated care is another option being provided in the primary healthcare settings (Ehrlich Carolyn, Kendall Elizabeth, Muenchberger Heidi & Armstrong Kylie, 2009). It ensures the supply of supportive, responsive and systematic, care to individuals who require chronic care (Ehrlich Carolyn et al., 2009).
This type of care is dependant on interactions, partnerships, sharing of knowledge and assistance for self management (Ehrlich Carolyn et al., 2009).
On these grounds diabetes could be prevented by the incorporating changes with regard to diet and lifestyle behavior. This is due to the fact that lifestyle associated evaluative strategies and approaches for the primary prevention of diabetes could become effective through psychosocial, learning based and activity therapeutic factors when implemented(Korczak, Dietl &, Steinhauser,2011). Through programme to programme, the endurance of prevention intervention of diabetes may be only possible (Korczak et al., 2011).This could furnish information on the outcome parameters, lifestyle associated interventions, their expenditure and the influence of any social or socio-economic factors on the utility of the services and efficacy (Korczak et al., 2011). Next, the other of prevention is Secondary prevention. This entails the prior recognition and alleviation of disease complications, thus finally minimizing the requirement for therapy. The accomplishment done during the initial stages of diabetes is considered more significant as far as quality of life is concerned and is inexpensive provided this approach could lessen hospitalization. With the available evidence it was described secondary prevention has potential for the regulation of blood glucose levels is easier and could dramatically minimize the chances of acquiring disease characteristics and retardation of diabetes progression. Similarly, the control of elevated blood lipid levels and high blood pressure was also emphasized in this mode of prevention. In the nursing context, according to levels of prevention model, devised by Leavell and Clark, secondary prevention could be further highlighted as the approach that is more costlier and low in efficacy than the primary prevention as an incomplete utility in the disease transmission. As such there is a further need to explore the secondary prevention strategies in the area of diabetes. This complex metabolic disorder has multiple risk contributing factors.
It is widely believed by the researchers that for a reliable treatment the actions in the forms of health care services require feasibility and coordination(Bookbinder & McHugh, 2010).This is with reference to early prevention and strategies that enable good hygiene and lessen acute illness (Bookbinder & McHugh, 2010).Here, nursing interventions could play pivotal role in accomplishing these outcomes. Nurses could offer their service through palliative care as it has the best advantage to impact the practice, public policy, scholarship, and future research implications to enhance the health care of population and societies(Bookbinder & McHugh, 2010). Controlling diabetes development and its consequences is well associated with the screening of vulnerable individuals, early diagnosis and the immediate therapeutic approaches (Levich, 2011).Nurses are considered as the primary healthcare team members. They could get acquainted with the patients and utilize their skills training to develop awareness and encourage patients with diabetes with regard to the insulin use and methods of conquering treatment objectives practically (Levich, 2011). They serve as worth fitting candidates to bridge the gap and enhance the reliability in diabetes associated health care by serving patients with the beginning of insulin therapy and self- regulation of glycemic levels (Levich, 2011).Palliative care nurses could prevent diabetes by collaborating with Palliative care doctors, diabetes nurse educators and endocrinologists(Quinn, Hudson & Dunning, 2006). This was revealed when a study was carried out by employing two groups of patients with a structured questionnaire (Quinn et al., 2006). The study demonstrated that nurses employed several practices and blood glucose testing approaches to monitor blood glucose dependant on their previous practice exposure but not on evidence based methods (Quinn et al., 2006). So, this practice has near future implications provided there is perfect interaction between palliative care nurses and
diabetes and the requirement to streamline the reforms of clinical management (Quinn et al., 2006). With this palliative nurse care strategy secondary prevention of diabetes is feasible. As it was cited in Bookbinder & McHugh (2010), the palliative care constitutes the complete care of patients actively whose disease does not correspond to therapy intended for curing especially when the pain, symptom, social and spiritual, social and psychological difficulties are important. The professionals practicing palliative care facilitate the clear achievement of goals and other responsibilities set for the recipient care (Nakazawa et al., 2010). Hence diabetes could prevented at the earliest by enhancing adequate assistance to the patients family and care providers and improving the quality of life by solving the problems related physical, psychosocial, and cultural needs (Nakazawa et al., 2010). Since diabetes needs modulation in the life style and diet regimen, addressing the problems on these standards may help in the earlier diagnosis (Nakazawa et al., 2010). To better execute this strategy, determination of palliative care knowledge is essential. Specially devised instruments could help to evaluate the nurse’s awareness on palliative care (Nakazawa et al., 2010). Educational programmes incorporated through questionnaires have made significant impact on the psychometric methods like intraclass correlation coefficients and item response theory. This instrument was developed for other conditions not relevant to diabetes like gastrointestinal problems, ‘psychiatric problems”psychiatric problems’ and pain (Nakazawa et al., 2010). However, in an evidence based format it could ensure the evaluation of broad aspects of palliative care knowledge by the support of nurses. Hence, the assessment of knowledge through educational programmes on diabetes management may facilitate the control of the altered physiological conditions like blood glucose levels and insulin.
This could also improve the psychological well being of diabetic patients making them socially and psychosocially fit in the environment (Nakazawa et al., 2010).
Next, tertiary prevention according to the nursing contest focuses on the strategies developed to minimize or confine aberrations and disabilities, lessen the ailments resulting due to deviations from normal hygiene and to facilitate the individuals conformity to irreparable health conditions. This could also entail prior recognition and cure of diabetic complications like diabetic nephropathy, retinopathy, peripheral vascular and cardiovascular disease. By employing an open clinical algorithm, nurses could devise a protocol to minimize cardiovascular risks (Woodward, Wallymahmed, Wilding & Gill 2006). With this blood pressure levels will be regulated and cardiovascular risk factors could be reduced (Woodward et al., 2006).This was revealed when a study was undertaken in type 2 diabetic patients who were receiving antihypertensive drugs (Woodward et al., 2006). Nurse led clinics have proven to become good referral centers for these patients. This could be due to the fact that a proper cut off could be set for measuring BP levels and checking the efficacy of aspirin and statin therapy followed by lifestyle related suggestions (Woodward et al., 2006). Apart from lessen cardiovascular risk, treatment modalities will be regulated to minimize antihypertensive medication, antiplatelet therapy and lipid-lowering therapy (Woodward et al., 2006).Diabetic patients will be largely benefitted from this protocol-driven, nurse-led clinic. Hence, prevention of diabetes could be significantly made feasible with nurse led referral centers and successful protocol implementation. Further, Diabetic retinopathy could be prevented by collaboration between nurses and ophthalmologists (Kirkwood, Coster & Essex, 2006). Nurse led diabetic retinopathy screening clinic offer the reliable tertiary prevention strategy through a well defined methodology (Kirkwood et al., 2006).
This is an important nursing intervention for experimental approaches involving a 3-month trial period as it determines the best mutual understanding of retinopathy grading between a nurse practitioner and an ophthalmologist(Kirkwood et al., 2006).This ensures precise identification of complications related to diabetic retinopathy with considerable sensitivity and specificity (Kirkwood et al., 2006). Nurse practitioners could thus finally convert a severe form of diabetic retinopathy into a less advanced one (Kirkwood et al., 2006). Nurses could easily detect visual deformity signs which helps them to enable changes in the environment to reduce trauma like making rooms well lit and floors free of clutter (Whiteside, Wallhagen & Pettengill, 2006). This strategy helps in correcting vision defects encountered during diabetic retinopathy (Whiteside et al., 2006). This will also help nurses to manage other forms of vision impairments frequent in old age like glaucoma, cataracts and age-related macular degeneration (Whiteside et al., 2006). An intervention known as Diabetes Eye Nurse Project has emerged to provide optimum care to diabetic retinopathy patients. This is considered to be a joint collaboration between the ophthalmology and diabetes departments (Khan et al., 2010).
This project was believed to minimize the gaps existing between these two departments and provide a perfect nexus. It has a significant lessening effect on serum lipid and HbA 1c levels in study conducted on 100 individuals with diabetic eye disease, thus leading to small risk in the disease development and other micro- and macrovascular conditions (Khan et al., 2010). This project has screened nearly 350 individuals and sought high-risk individuals with diabetes who are living with risk factors uncured (Khan et al., 2010). This project could be considered as the good innovative service strategy for the tertiary prevention of diabetes as it has multidisciplinary options for management of diabetes (Khan et al., 2010).
Nurses could manage the tertiary prevention strategy by performing telephonic intervention to improve the conditions(Fischer, Mackenzie , McCullen , Everhart & Estacio, 2008). This was made feasible by developing algorithms for diabetes care that emphasizes on nephropathy and also glycemic control, lipid management, blood pressure, cigarette smoking and obesity (Fischer et al., 2008). In addition, the motivational interviewing techniques were used by nurses such that self-management of patients will be promoted (Fischer et al., 2008). Here, not only renal dysfunction will be improved but also lipid levels and medication adherence will be regulated (Fischer et al., 2008).
This approach of diabetes nurse care has further drawn the attention of investigators which led to maintain the consistency in the motivational interviewing techniques.
A study conducted on 700 type 2 diabetic patients involved the role of primary care nurse to provide care for patients in one group of intervention (Jansink et al., 2009). These nurses were also trained in an approach where motivational interviewing was considered as the main factor. Other factors of this approach are facilitating the diabetes protocols get aligned to local circumstances, life style assistance with the help of a social maps, motivational interviewing by supportive and educational tools for its regulation(Jansink et al., 2009). Measurements focused during the strategy operation involved blood pressure and lipids, glycosylated hemoglobin, patients’ willingness to change, and health-related quality of life (Jansink et al., 2009). This will improve the diabetic conditions from all corners. The treatment strategies intended for curing diabetes need effective monitoring by the nurse care professionals. Since tertiary prevention is involved in the lessening of diabetes complications, nurses need to streamline the approaches already in existence and strive for their effective implementation.
Nurse led approaches like projects, telephonic motivations, interviewing have emerged to provide early remedy. Tertiary prevention strategies focused on diabetes may need to identify and implement certain models of care for early diagnosis. Out come measures relevant to nurse oriented diabetes management have proven to be effective fro integrated model and a nonintegrated model (Davidson,Blanco-Castellanos & Duran, 2010). Here with the help of endocrinologists diabetic patients will be followed up to determine basic parameters like low-density lipoprotein cholesterol (LDLC) and blood pressure levels(Davidson et al., 2010). This approach has significant lessening effect on the diabetes outcomes as their improvement is concerned. In addition this strategy is described to work better if applied for minority populations (Davidson et al., 2010). Hence, policy makers should come forward to exploit the integrated models for the betterment of diabetes patients by attempting to enhance the quality of life. This would show positive impact on the disabilities and complications, low severity and disease development. Prevention strategies may rely on nurse’s awareness and their overall perception of diabetes. This requires skill and intelligence of nurses. Responsibilities
Demand educating patients with precise and recent information such that standards will be maintained regarding the disease and their complications. A deficiency among nurses will promote insufficient health care precautions (Chan and Zang, 2007).
To overcome this negative consequence on the health outcome of diabetic patients a strategy of tailor made educational programmes have been framed and applied to enable the patients receive leaning needs (Chan and Zang, 2007).Here most important the factors like the demographic data of Nurses, perceived and actual diabetes mellitus awareness, and competence play important role (Chan and Zang, 2007). As such it may facilitate to establish the connection with the diabetes prevention strategies.
This places nurse education and efficiency a central component in the management. Expertise and nurse education should be recognized when such educational programmes are designed (Chan and Zang, 2007). Prevention measures adopted often rely on decision making. This could be because individuals with diabetes are not sure of the impact their decision is leaving on their life(Mc Dowell et al., 2009). Hence the role of nurse is important in recognizing various responsibilities for individuals in various care settings(Mc Dowell et al., 2009). This involves many theoretical and professional guidelines to assist in decision-making such that approaches like insulin therapy will be commenced (Mc Dowell et al., 2009). To enable diabetic individuals become more active partners nurses encouragement is necessary provided there is also additional support from clinical guidelines in decision-making (Mc Dowell et al., 2009).
For example , nurses have made a debut in influencing the insulin initiation in children with type 11 diabetes. They have stabilized children better, brought tremendous change in the treatment in terms of equipment an medication changes in policy and professional roles (Lowes and Davis, 2009). However, this approach has few limitations with deficiency in resources availability (Lowes and Davis, 2009). Hence much investigation may be suggestive for this approach. Referral centers offer a reliable platform for executing all nursing models on the diabetic prevention measures.
Nurses of primary care have brought a variation in care from internists to primary care, thus playing vital role in diabetes care(VanDijk et al., 2010).When introduced in GP-practice they induce changes in shifts from hospital to primary care (VanDijk et al., 2010).
Prevention strategies may be better streamlined with supplementary prescribing approaches (Carey & Courtenay, 2008).. This could involve supplying medications to diabetic patients independently This could mean that nurses are equivalent to doctors when this task of prescription is concerned (Carey & Courtenay, 2008).
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