European Diabetes Nursing最新文献

The increasing prevalence of diabetes among older people challenges nurses and nursing aides in providing high-quality evidence-based care in nursing homes and municipal home-based services. Deficiencies in treatment and follow-up care, as well as significant need for educating personnel, are emphasised. Organisational challenges related to transferring tasks from specialist to primary health care services imply an urgent need for enhanced professional competence.

We aim to describe the development, implementation and evaluation of an educational training programme for nurses and nursing aides in nursing homes and municipal home-based services.

Sixteen registered nurses and four nursing aides participated (women, aged 32–59 years). Three main principles were emphasised in the development of the programme: enhancing professional authority; improving communication within professions and levels of care; and reflections based on experience with patients and perceived challenges in clinical practice. To evaluate the programme a questionnaire was used including both quantitative and qualitative data.

Participants described enhanced competence in relation to: professional updating, exchange of experience, professional confidence, sharing knowledge and personal development. Further, the participants reported confidence related to evidence-based practice skills and knowledge, and providing high-quality nursing care.

In conclusion, the elements of this programme seem adequate for inclusion in a programme designed to promote enhanced professional competence for nurses and nursing aides caring for older people with diabetes, and might be supplemented with annual follow-up sessions as a part of the services offered by specialist health care services on a regular basis. Copyright © 2013 FEND. Published by John Wiley & Sons, Ltd.

Incretin therapy is a glucose-lowering therapy which has attracted great interest during recent years. It is based on the antidiabetic action of the incretin hormone glucagon-like peptide-1 (GLP-1), which involves both stimulation of insulin secretion and inhibition of glucagon secretion. This results in lowering of both fasting and postprandial glycaemia. Incretin therapy is either with GLP-1 receptor agonists or with inhibitors of dipeptidyl peptidase-4 (DPP-4), which is the enzyme which inactivates endogenous GLP-1. The GLP-1 receptor agonists are injected subcutaneously once or twice daily or once weekly. The DPP-4 inhibitors are oral tablets taken once or twice daily. Both therapies reduce HbA_1c without weight gain, and for GLP-1 receptor agonists with a weight reduction. Incretin therapy is safe with very few adverse events and an additional value of the therapy is a very low risk for hypoglycaemia. Incretin therapy is efficient both in monotherapy and in combination with metformin, sulphonylureas, thiazolidinediones and insulin. Its main indication is as add-on to metformin in patients who are insufficiently controlled on metformin alone, and an important indication is also in combination with insulin therapy. The experienced value of incretin therapy for patient care will most likely result in increased use of this therapy during the coming years. Copyright © 2013 FEND. Published by John Wiley & Sons, Ltd.

It has been well established that sub-optimal glycaemic control at conception and during early pregnancy is associated with increased fetal loss and congenital abnormalities in the infants of women with established diabetes. There is compelling evidence demonstrating that if these women improve their glycaemic control prior to and during early pregnancy, the rate of these abnormalities can be reduced.

We undertook a survey of women attending a general diabetes service – in which only half of the women of reproductive age reported receiving advice specific to pre-pregnancy care. Following this, a dedicated pre-pregnancy clinic was established.

Attendance at this clinic has resulted in women attending the maternity services at an earlier gestation and with better glycaemic control than those who did not attend for pre-pregnancy care. Despite the availability of this care, the number of women availing themselves of it remains less than half of those attending the maternity service.

The challenge now is how to inform all women of reproductive age with diabetes about the importance of obtaining this care, and how to encourage attendance for pre-pregnancy care. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd.

In our first editorial we would like to share our vision for the journal with you. However, first of all we pay tribute to the previous editors, Dr Gillian Hood and Professor Bert Vrijhoef; they have done an amazing job in improving the quality of the journal and its profile. They have worked extremely hard to attract papers that tackle important issues in diabetes and that inform the contribution of nurses in diabetes care. We very much hope to build on Gillian and Bert's legacy, and, in keeping with their approach, invite you to be part of the journal by engaging with the practices and ideas expressed in its contents. We encourage you to share your thinking with the diabetes nursing community through EDN. So, whether you agree or disagree with what you read, please write to us and give your views, and we will be pleased to consider correspondence for publication. Of course, we also encourage you to write and share projects or research that you have undertaken. We see EDN very much as a vehicle for improving clinical care, and really hope that you will share clinical innovations through the journal to maximise patient benefit. And, following the comment from Bert in the previous editorial, we will certainly have fun in achieving this ambition.

On that note it is a pleasure to introduce the current issue of the journal in which there are some very timely papers. Two of these express an important and often neglected interest in the impact that significant relationships have on people with diabetes. Wennick and Huus present an absorbing account of how diabetes impacts on the siblings of children with type 1 diabetes; and Costa and colleagues explore the impact of diabetes on partners. In a further paper relating to prevention of problems in diabetes, Abu-Qamar gives some interesting insights regarding the benefits of foot screening in determining risk for ulceration. In keeping with the journal's commitment to developing and exploring clinical management in diabetes, we also have a very informative overview from Rita Forde on the development of pre-pregnancy care.

We very much look forward to engaging with you all through EDN. Together we can ensure that the journal will develop further as an essential reference for nurses in diabetes.

Although previous studies have stressed that having a brother or sister with a chronic condition may affect the healthy sibling, few have specifically focused on healthy siblings of children with type 1 diabetes.

Hence, this study aimed to illuminate what it is like to be a brother or sister of a child newly diagnosed with type 1 diabetes.

Individual interviews were conducted with seven siblings aged 10–17 years (median=12) from six different families. Each interview was analysed using content analysis.

Three different categories emerged – Living differently, Being concerned and Participating in caring for the affected child – indicating that, for the healthy sibling, the illness entails a transformed everyday life including worry about the affected child and the need to help in the home.

In conclusion, the paediatric health care service may need to develop new strategies to meet the siblings' desired level of knowledge in educational team sessions related to diabetes. As the sibling relationship is probably the longest one that an affected child will experience in her/his lifetime, it is worth investing in it to promote this long-term support resource. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd.

In Portugal, diabetes affects 11.7% of the population, of whom about 90% have type 2 diabetes. Patients and their partners are affected and the latter have a direct impact on patients' adaptation to diabetes. A large proportion of patients, at diagnosis, have to readjust their daily routines in order to integrate self-care behaviours related to diabetes.

The goal of this study was to analyse the relationship among partner support, social-cognitive variables about self-monitoring of blood glucose (SMBG) (intentions, attitudes, subjective norms, perceived behaviour control, action planning and coping planning), adherence and glycaemic control in type 2 diabetes patients, diagnosed in the past 12 months.

A total of 179 people with diabetes participated in the study. The instruments used were: Multidimensional Diabetes Questionnaire; Revised Summary of Diabetes Self-Care Activities Scale; and Planned Behavior Questionnaire – Self-Monitoring of Blood Glucose. Glycaemic control was assessed by HbA_1c.

The perception of positive support from partners and intention to perform SMBG predicted adherence to SMBG. Furthermore, positive support mediated the relationship between intention and adherence to SMBG. Positive and negative partner support were positively associated with intention, action and coping planning and adherence to SMBG. Good metabolic control was negatively associated with negative support.

The results show the importance of partners' support and social-cognitive variables, regarding self-monitoring of blood glucose, on patients' adherence. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd.

Despite the alarming prevalence of diabetes in Jordan, there is insufficient information on foot manifestations of diabetes. Periodic screening is recommended for the prevention of diabetes-related foot complications so that foot changes can be identified in the initial stages and appropriate treatment provided in a timely manner.

The purpose of the current study was two-fold: first, to report the findings of an opportunistic foot screening survey for 1072 people with diabetes recruited from nine health care facilities in Jordan; and, second, to identify whether or not they undergo periodic screening.

Descriptive statistics were used to analyse data collected by trained research assistants using an ethically approved standardised protocol covering three main aspects of foot examination (dermatological inspection, and vascular and neurological assessment) with demographic data plus information on diabetic foot care. The protocol also guided the research assistant to appraise height, weight, blood pressure and blood glucose levels.

The study participants were almost equally distributed in terms of gender (males: 50.9%). More than half of participants were aged between 41 and 60 years; 58.1% of the study population had diabetes of more than five years' duration, and most of them had type 2 diabetes. Poor protective sensation was found in the feet of one-fifth of the study population, and a similar proportion was documented for foot deformities. The participants were sorted into four categories of risk for foot ulceration, ranging from risk category 0 to risk category 3. A quarter of the study population were located within risk category 3, and nearly 66% were classified into risk category 0.

In conclusion, Jordanians with diabetes possess several risk factors for diabetic foot ulceration. These risk factors coexist with a lack of adherence to periodic foot screening. Efforts should be made to incorporate periodic foot screening within the context of routine care provided to individuals with diabetes. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd.