European Diabetes Nursing最新文献

Many organisations avoid disease-based labels such as ‘diabetic’ or ‘epileptic’ as they are believed to be detrimental to a patient's beliefs about their condition and may generate stigma.

The aim of this study was to examine the impact of the term ‘a diabetic’ compared with the term ‘a person with diabetes’ on the beliefs of participants who either did or did not have the condition.

The study used an experimental design and was in two parts, with study cohorts derived from Diabetes UK websites and the University of Surrey website. Part 1 evaluated the impact of the two terms – ‘a diabetic’ and ‘a person with diabetes’ – on participants who had diabetes, in relation to their beliefs about the condition, using the Revised Illness Perception Questionnaire. Part 2 measured the impact of these two terms on participants without diabetes in relation to their positive and negative stereotypes of the condition.

Data were gathered for 92 participants with diabetes (Part 1) and for 99 participants without diabetes (Part 2). The results showed no significant differences between the term ‘a diabetic’ compared with the term ‘a person with diabetes’ on either the beliefs of people with diabetes or the stereotypical attitudes of people without diabetes.

In conclusion, the results suggest that the two terms are not as different as has been sometimes assumed.

Diabetes mellitus is a common chronic disease. According to previous research, family has an important role in the management of diabetes among children and adolescents.

The aim of this study was to describe how adult people with type 1 diabetes experience everyday life in their families.

The Straussian grounded theory method was used to analyse data collected by interviewing 19 people with type 1 diabetes.

On the basis of the data, eight concepts describing different views on everyday living with diabetes were generated: managing hypoglycaemia; balancing self-management needs; performing daily routines in the family; living with changing feelings; diabetes being invisibly present; protecting the family's well-being; the family members variously contributing to the self-management; and learning to live with diabetes in the family.

In conclusion, everyday life in families includes many different issues and family members are involved in the self-management of diabetes in many ways. In the interests of developing family-centred education and care, it is important to understand how adult people with type 1 diabetes experience everyday life within their families. Eur Diabetes Nursing 2013; 10(3): 86–90

However, the jurisdiction and meaning of patient centredness are complex. A patient centred approach has multiple meanings ranging from an individualisation of therapies to approaches that seek to engage patients in identifying their own treatment goals. In this issue of the journal we have a collection of papers that encourage us to reflect on the concept of patient centred care. Two central themes within the papers are identity and relationships.

In the paper by Ogden and Parkes, we are asked to consider whether the labels which patients are given have a stigmatising effect that may be detrimental to their engagement with their diabetes and its management. While the data did not show strong differences between labels (i.e. a ‘diabetic’ or a ‘person with diabetes’), it does make us consider how an individual might identify with their disease. Some patients will refer to themselves as a ‘diabetic’, others as ‘a person with diabetes’ or even as a partner in their disease management. The fundamental point is that in a patient centred model it should be about allowing the patient to find and express their own identity, rather than it being imposed by the health professional. Sometimes this identity may reflect a negative sense of self and patients may need help in reconstructing an identity during their experience with the disease. Hence, understanding identity and the effect of labels in health care interactions may be an interesting area for further research and inquiry. In the spirit of patient centredness, perhaps we should allow patients to choose their own labels; it is then the job of the health professional to understand and work with that choice.

The papers by Rintala and Simmons encourage us to think about the impact of different types of relationships in diabetes care. These studies highlight the importance of relationships, both informal in the context of family life and formal through organised peer based interventions. In recognising the power of these relationships, perhaps we need to expand our construction of patient centredness to include these important personal and social networks. Therefore, a patient centred approach is not patient centric: it is about understanding the person in the context of their social world and the network of relations that may either enable or inhibit their ability to adapt to life with diabetes.

Peer interactions are also important and Simmons' report indicates that there is scope to expand organised programmes of peer support. While there is still much to be understood as to how best to develop and resource such programmes, it would seem that these are generally valued by patients. We must also recognise that there is an informal peer system already, with many patients interacting through a variety of media. As with family interactions, these can be either enabling or inhibitory.

Finally, in the report from Mehica we are reminded that the patient centred model is not unive

There is growing evidence that the physical and mental health of people with, or at risk of, diabetes can benefit from support from a person with diabetes: known as diabetes peer support. Peer support involves the social and emotional help that supplements the assistance provided by health professionals and others in the life of the person with diabetes. By sharing, discussing, finding and facilitating the ways that can improve diabetes and overcome barriers to care and self-care, metabolic control and wellbeing can improve. Linking peer support to clinical care is thought to strengthen its effectiveness. Peer support complements diabetes education and facilitates implementation of the knowledge gained.

There are a range of different ways in which peer support can be provided. Peer support might arise from a casual discussion with another person with diabetes or within a more structured programme. The degree of training can vary from life with diabetes in the casual encounter, to group leadership, to paraprofessional training including motivational interviewing and a range of educational and management skills. The media for delivery varies from face-to-face, telephone and online approaches.

At a time of a growing diabetes epidemic, peer support could well be a key strategy in supporting those with and at risk of diabetes, reducing downstream demands on health services while improving quality of life. If this turns out to be the case, every neighbourhood, village and clinic should have one or more peer coaches to support diabetes prevention and diabetes management.

This paper was presented as the 2013 Janet Kinson Lecture at the 2013 Diabetes UK Annual Professional Conference held in Manchester

Diabetic foot ulcer is a serious threat to the extremities and to the individual's survival. The most common risk factors for amputation are deep infection, plantar ulcer and gangrene.

The aim of this study was to measure inpatients' perception of health care quality, and to identify the health care needs of people with diabetes and infected foot ulcers during the preoperative and postoperative periods.

The study design was empirical with a quantitative approach. The short form of the Quality of care from the Patient's Perspective (Mini QPP) was used.

The results are described in four categories related to the Mini QPP model: medical technology; physical-technical conditions; identity-oriented approach; and socio-cultural atmosphere. The study participants (n=30) expressed a need for continuous information, a secure and comfortable physical environment, shared decision making, and better quality of pain management.

More research about how to improve information, the environment, shared decision making, and pain control would be desirable.Eur Diabetes Nursing 2013; 10(3): 91–95

Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described.

The objective of this study was to explore RNs' professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus.

Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years' experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8).

The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off-loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs' formal education was some years back and they relied mostly on experience-based knowledge.

It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Copyright © 2013 FEND. Published by John Wiley & Sons, Ltd.

The question as to how to screen diabetes risk in a multi-ethnic population is not easy to answer. There are a number of diagnostic procedures and risk score tools which may help identify people with increased risk. Some of the risk factors for diabetes have a clear ethnic component, thus the risk stratification is different in Caucasian, Asian and Latin American populations. However, we can expect that the pathophysiology for diabetes development consisting of insulin resistance and progressive beta-cell failure is very similar in its pathomechanistic background between ethnic groups, although the speed and progressive destruction may have ethnic and varying genetic components. In this environment, we have to find clinically applicable approaches to identify those with increased diabetes risk which have to be easy to understand, transparent and replicable for diabetes risk detection. The International Diabetes Federation recently started the PREDICT-2 study to develop a global diabetes risk score.

In this article, we discuss some of the strategies to identify diabetes risk and give some ideas about ethnic variation. Copyright © 2013 FEND. Published by John Wiley & Sons, Ltd.

However, all actions need to be measured and targeted to the needs of the patient, such that they will do no harm and will enhance the patient's wellbeing. Ensuring that we provide the right care or intervention at the right time requires knowledge. Knowledge that is transparent and based on enduring principles or theories. Such knowledge is found through research, research into what patients need and how best to meet those needs. Research is not an isolated endeavour nor is it a luxury: it should in every sense define the meaning of what the diabetes nurse thinks and does. If diabetes nursing is to flourish as a specialism, then we need a vibrant and active research community.

In this edition of European Diabetes Nursing we have an important piece of work by Graue and colleagues. Their paper presents a review of published research undertaken in the Nordic countries (Denmark, Iceland, Norway and Sweden) from 1979 to 2009. The results are quite encouraging in that they show a marked increase in the number of peer-reviewed submissions over three decades. This increase is particularly marked since 2000 and it shows that Sweden is leading the way in terms of output.

However, while this is a very encouraging trend, there is little room for complacency here. The majority of these studies are descriptive or are related to the development of measures; there are very few studies that are orientated to developing interventions that tackle specific patient needs.

These findings are similar to a previous review of nursing research, which highlighted the need to develop more clinically orientated research with strong theoretical underpinning and focused on important patient-centred problems.1 While diabetes research is rightly a multidisciplinary endeavour, there are many areas where nurses can and should be taking the lead. These areas include: psychological distress and adjustment; self-management support; and dealing with diabetes complications and symptoms – to name a few. Indeed, in this edition of the journal we have important topics such as wound care in older people and patient centredness.

There are, of course, many challenges in developing programmers of integrated research. These include funding opportunities and, more fundamentally, the need to have a research-prepared workforce. Hence, the green shoots that are evident in the Nordic region of Europe need to be carefully cultivated and seeded elsewhere. We need a variety of species in the range of research flora that we produce from scented flowers (novel ideas) to sturdy trees (clinical trials). In order for this to happen we need fertile soil and strong roots.

To this end, we need to develop strong pre- and post-doctoral training programmes. We also need to share our work and to foster greater international collaboration and propose integrated research programmes of scale to funders.

FEND has begun this process by investing in research