European Diabetes Nursing最新文献

End of life care is a subject that many patients or health care professionals would prefer not to talk about. People with diabetes have a unique set of care needs during the last year, months and days of life, but until now there has been little guidance on their specific clinical requirements. Approximately half a million people die in England each year and around 75 000 of them will have diabetes. European statistics demonstrate important variations in mortality and the burden of disease related to diabetes with age standardised death rates per 100 000 ranging from 4.0 (Greece) to 17.9 (Portugal), and with higher levels ranging from 36.1 (Israel) to 46.8 (Armenia). It is important that health care professionals are equipped with the knowledge, skills and clear guidance in order to support patients, relatives and carers during what is often a difficult time for all.

This article gives a robust definition of the term ‘end of life’, discusses the demise of more generic United Kingdom guidance on the care of the dying, and presents a consensus approach to quality care for people who are nearing the end of their life. These recommendations were commissioned by Diabetes UK, developed by a multidisciplinary group of heath care professionals and endorsed by key diabetes organisations. The recommendations given can easily be adopted for use in other countries, and the documents and tools are freely available to all.

The aim of counselling is to optimise diabetic patients' self-care by increasing knowledge, skills and self-awareness. Patients' resources during counselling have been supported by highlighting health-promoting aspects.

The aim of this study was to describe diabetes patients' perceptions of their coping resources and experiences of counselling by nurses. The ultimate aim was to understand how health-promoting aspects are realised in counselling according to diabetes patients.

We used a descriptive qualitative approach with thematic individual interviews conducted in December 2011 and January 2012. The data were analysed by inductive content analysis.

Study participants comprised 15 adults with type 2 diabetes. Participants considered their coping resources to be an accepting attitude towards the disease, adherence to self-care, knowledge of the disease and supportive relationships. In addition, activities and support by the nurse were mentioned. Participants reported that the content of counselling focused mainly on medication. The form of counselling was individual in a person-centred way.

It can be concluded from the study that resources that have a positive impact on diabetes patients' self-care must be emphasised in counselling guidance. Nurses have the professional responsibility for counselling but also the right to have more knowledge. Nurses giving advice to diabetes patients should receive education based on the healthpromoting aspects in order to assist them in providing comprehensive guidance. The findings of the study can be used to develop comprehensive health promotion in nursing.

Diabetes specialist nurses are ideally placed to identify patients with monogenic diabetes but may lack knowledge of the key features and fail to recognise potential cases. Once the diagnosis of diabetes has been made this may not be revisited and may be assumed to be correct. However, increasing knowledge and awareness of monogenic diabetes will allow health care professionals to question the diagnosis of their patients where appropriate and lead to greater recognition and correct treatment of monogenic diabetes.

Maturity onset diabetes of the young (MODY) is typically detected in individuals diagnosed with diabetes before the age of 25 years who also have a parent with diabetes. They are non-insulin dependent but are often mistaken to have type 1 diabetes and are insulin treated. Patients meeting these criteria should be considered for further investigation to ensure their diagnosis is correct. Neonatal diabetes can also be caused by a single genetic change, and patients diagnosed with diabetes within the first six months of life should be referred for genetic testing whatever their current age.

This paper highlights three useful means of aiding differential diagnosis: urinary C-peptide creatinine ratio (UCPCR), pancreatic autoantibodies, and use of the online MODY probability calculator. Case studies are used to illustrate the key diagnostic features of MODY and indicate how awareness of family history and other features raised suspicion of an alternative cause of diabetes in these families. Treatment change following a positive molecular genetic diagnosis is also described.

These drivers are particularly important in the context of vulnerability. We have seen that it was the most vulnerable patients, the older frail patients and those with multiple comorbidities that were most affected by the universal pursuit of aggressive treatment targets. It is the vulnerable that require much more sensitive management with the need to balance different needs and risks. And we often find vulnerability in the patients who struggle to adapt to life with diabetes – those that may not engage well with diabetes care. In this edition of the journal we have some exemplar innovations that address many of these issues.

In the report from Shepherd, we hear about the important issue of patients with maturity onset diabetes of the young (MODY) and the role diabetes nurses can play in identifying these patients and ensuring appropriate care. These patients are vulnerable as they can receive inappropriate treatment that can be detrimental to their well-being. The report contains methods for identifying these patients and individually tailored treatments that will help ensure better care outcomes.

Another important vulnerable group of patients with diabetes are patients at the end of life. James's report highlights the need for a sensitive and, again, individualised approach to care management for these patients. At the end of life the challenge is to promote comfort and quality of life. The report gives diabetes nurses a framework to help them consider the needs of patients, relatives and carers through this difficult and vulnerable period during the different stages in end of life care. Again, we see that individualisation is important and that diabetes nurses should be taking a lead in maximising the quality of life in these patients and in symptom alleviation.

Young infants are by definition vulnerable. Having to manage a complex health problem like diabetes with a demanding technology such as an insulin pump can be very difficult for families. These families can feel vulnerable; this vulnerability is captured in the report from Forsner et al., which highlights the needs of parents and infants with diabetes in relation to pump therapy.

We also have a report from Halkoaho et al. identifying the difficulties patients face in living with type 2 diabetes. The report illustrates that patients value a supportive approach with strong relational care and that, when health professionals promote their own agenda focusing on medications and lifestyle change, this can be alienating. This is, again, vulnerability: it is the vulnerability of the patient's interest in their diabetes and the belief that they can do things that will make a difference to their own health.

Vulnerability is also an important global issue. We include in this edition a report from the recent World Diabetes Congress in Melbourne at the end of last year. As you will read from Gill Hood's account, there are many significant internatio

Diabetes during infancy is uncommon and continuous subcutaneous insulin infusion (CSII) is the recommended treatment with such young children. However, this form of treatment has not been investigated previously from the perspective of the parents.

The aim of this study was to determine parents' experiences of caring for a child less than two years old who had diabetes mellitus and was being treated with CSII therapy.

Three pairs of parents were interviewed twice to elucidate their views on the initial period and on daily living. Data were submitted to qualitative content analysis and resulted in seven categories and one theme, the latter being: ‘The diabetes disease was threatening our baby's life, but then the insulin pump came as a rescuing, though challenging, angel’. Parents initially felt life had been turned upside down, but later they felt in control nearly all the time.

It was concluded that parents of infants with diabetes are in great need of support in order to manage the disease and CSII technology. The fear of losing control and the lack of relief lead to social isolation. Educating someone close to the family could be a valuable intervention.