European Diabetes Nursing最新文献

Evaluation is an essential component of structured diabetes education with most established programmes showing positive effects at group level. However, evaluation of post-educational intervention outcomes is dependent on the participant completing the programme. There is, currently, little research into the psychological or demographic attributes of non-attendees for post-educational intervention evaluation.

This study aimed to use the evaluation of a structured diabetes education programme in order to explore the characteristics of participants and determine if any association existed between personal characteristics and benefits of attendance and/or non-attendance for post-programme evaluation.

Using a convenience sample of people, a pre-post research design was employed to identify the psychological characteristics of people who benefit from and those who fail to complete an educational intervention programme for type 2 diabetes. The sample consisted of valid responses from 392 (98%, n=401) participants attending the Community Orientated Diabetes Education (CODE) programme, a structured diabetes education programme delivered to people with type 2 diabetes in the Republic of Ireland. The programme is based on an empowering philosophy with the main outcome measurement being diabetes-related empowerment, quality of life (QOL), knowledge, weight and biomedical markers.

In all, 237 (60%) completed the post-programme evaluation and demonstrated positive outcomes in empowerment, QOL and knowledge at group level but these were not sustained at individual level. However, over one-third of participants did not attend for post-evaluation and these were more likely to be younger and report poorer QOL.

The findings indicate the need to evaluate change at an individual level and to target younger people to retain their attendance for the full educational intervention. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

The role of the diabetes specialist nurse (DSN) has evolved since its inception over 70 years ago. Now, 1363 DSNs work in the UK, in various health care settings. The need to work within a culture of evidence-based practice and clinical and cost effectiveness, along with a perceived lack of evidence within diabetes specialist nursing, has prompted investigation into the role and efficacy of UK-based DSNs.

This review discusses the workforce demographics of DSNs employed in the UK, the evolving specialist nurse role and the clinical and cost effectiveness of specialist nursing. The DSNs' roles and workforce issues were assessed using existing surveys and reports. Clinical and cost effectiveness of DSNs were explored using a systematic literature review. This article is based on the Janet Kinson Lecture given at the 2010 Diabetes UK Annual Professional Conference in Liverpool, which gave an overview of specialist nursing, current literature supporting DSN practice and insights into challenges facing the profession in the current NHS culture of efficiency savings. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

Strategies for timely recognition and adequate treatment of mental disorder in diabetes are urgently needed. The aims of this study are to develop and evaluate an intervention for anxiety disorder and major depressive disorder (depression) in patients with type 2 diabetes (T2DM) by diabetes nurses (DNs) in primary care that requires minimal effort of all caregivers involved.

In this pilot, an open clinical study with pre-post test, seven trained DNs screened their patients. Patients screen-positive for anxiety disorder or depression underwent a standardised interview (MINI) by a researcher for validation. Patients fulfilling DSM-IV-TR criteria for anxiety disorder or depression were offered a self-help intervention supported and monitored by the DN in one-to-one guidance. Follow-up assessment was at six months.

Of 311 eligible patients, 111 consented to screening. Fifty-five patients were screened positive; 26 screen-positives were confirmed. Of the latter, 16 started and 15 completed the guided self-help intervention. Anxiety symptoms dropped 3.2 points (p=0.011), depressive symptoms 5.7 points (p=0.007), and somatic symptom severity 2.9 points (p=0.041) on the Patient Health Questionnaire. Diabetes-related negative emotions (PAID-NL) dropped 3.8 points (p=0.048). General functioning (EuroQol) improved by 14 points (p=0.007), and emotional role-functioning (SF-36) showed 33.4 points improvement (p=0.010). To conclude, trained DNs succeeded in screening and guiding a self-help intervention; mental and somatic symptoms, general functioning, and quality of life improved significantly.

This pilot strongly indicates that DNs can perform screening and one-to-one guidance regarding a self-help intervention for anxiety disorder and depression, playing an important role in the early detection and follow up of co-morbid mental disorders complicating diabetes. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

The ability to self-manage one's diabetes is challenged by the limited availability of clinic-based resources. This paper seeks to describe and determine the impact of Diabetes Hamilton (DH), a novel, voluntary, community-based programme in Hamilton, Ontario, that aims to facilitate self-management behaviours by supplementing existing resources.

DH registrants who completed a baseline questionnaire from February 2000 to March 2007 were included in the cross-sectional survey (n=3161). A total of 2994 individuals were also included in the trend analysis, examining the impact of DH on self-management behaviours.

Half of DH registrants are female (51.2%), with a mean BMI of 30.8 (SD 7.5), a mean age of 61.6 years (SD 14.6) and a mean age of 48.6 years at diagnosis (SD 16.7). A third of registrants reported insulin use (33.4%) and >90% reported having had an annual blood pressure and cholesterol test respectively. Trend analysis of behaviours showed an increase in cholesterol screening ( p<0.00), diabetes provider visits ( p<0.00), and medication use for glycaemic control and vascular protection ( p<0.02).

Although DH reaches motivated, well-educated individuals in the community, some diabetes self-management behaviours improved. Strategies to engage greater public participation across various demographics (e.g. ethnicity, education, age) are ongoing. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

This article describes the results of an intervention study considering patient education on retinopathy, aiming to increase knowledge of retinopathy, self-care and self-efficacy.

Fifty patients were randomised to either an education programme or standard follow up in the clinical setting. The patients were followed for two years. Parameters were measured at baseline, and after one and two years. Twelve patients were interviewed after one year using semi-structured focus group interviews. The analyses were grounded in the framework of Steinar Kvale and an approach based on Aaron Antonovsky′s ‘sense of coherence’.

Several themes emerged. The main themes in both groups were fear, knowledge and acceptance, but there was a difference in the way in which these themes were described. The intervention group could describe how they used the knowledge in their everyday life. In contrast, the control group indicated knowledge about retinopathy but appeared not to use this knowledge in everyday life. Furthermore, the intervention group regarded prevention of retinopathy as a responsibility shared between themselves and the health professionals in relation to self-care skills, whereas the control group appeared not to take responsibility. The only theme described identically in both groups was ‘anxiety’ at the time of diagnosis. The quantitative data did not show any significant effect of the patient education.

We conclude that education made a difference to the way in which the patients experienced retinopathy. The intervention group showed ‘sense of coherence’ by expressing comprehensibility, manageability, and meaningfulness. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

I have been heartened by those nurses from the Emirates who have identified and determined their own educational needs to facilitate self-care in their patients. Similarly, the papers submitted for this issue of EDN reflect the changing perspectives of diabetes nurses and their ability to rise to the challenges of the diabetes pandemic.

The nurses from Dubai reflected on their need to be proficient in their work and have professional competencies defined as part of a developed career structure. This development is happening in many countries and Hill's paper on the progress of the UK Diabetes Competency Framework shows the way forward for all levels of diabetes nursing which could be adapted in many European countries. Similarly, nurses everywhere now recognise the need for skills in counselling and motivational interviewing and Hunt's overview on the latter is a great introduction to this subject.

Diabetes nurses also need to be proactive in terms of screening and education. We have two papers here which demonstrate how nurses can successfully use self-help guidance strategies for people with diabetes who have emotional disorders (Meeuwissen), and also for those with diabetic retinopathy (Rothmann). Finally, Sherifali describes a community-based programme which builds upon existing structures to facilitate self-management behaviours.

Diabetes nurses in Europe and beyond – such as the group I met in Dubai – are focused upon the professional direction needed to face the growing diabetes epidemic. We might not yet be able to change the direction of this global diabetes scourge, but we can certainly adapt our professional competencies, knowledge and skills to contribute to the best possible outcome for all people with diabetes.

Our new Professor in Diabetes Nursing, Angus Forbes, appointed last year, organised and delivered the first module of the 2011 FEND ENDCUP programme in London in early July. There were 18 participants from all over Europe and the second phase, the research module, will take place next year.

The European Coalition in Diabetes continues its advocacy for a European recommendation for diabetes and is working collaboratively, with support from the European Diabetes Working Groups (MEPs).

The United Nations (UN) established an informal civil society meeting in June in preparation for the UN high level summit in New York in September. FEND sent representation to this meeting, Professor Angus Forbes and Kristin de Backer. The meeting was of interest to us, although we remain concerned that the zero draft outcomes document lacks focus and specificity. Furthermore, while FEND recognises the importance of tobacco control and appropriate food labelling, there is a real need to recognise that in considering the specific diseases that are recommended in the Non-communicable Diseases Summit Meeting, it is essential to address the infrastructure required, to ensure that health care systems and the competencies of health professionals are monitored constantly.

This is a very important period for diabetes and professionals working within the specialty. FEND will continue to strive on your behalf to promote the role of nursing and we look forward to hearing your thoughts and views at our forthcoming conference.

Have a great summer and I look forward to seeing some of you in Lisbon.