A critical of the on the nursing management of type 2 adult diabetec patients - Literature review Example

?A Critical Review of the Literature on the Nursing Management of Type 2 Adult Diabetic Patients Diabetes is a fast-growing disease especially in the UK. This research paper will aim to review the literature on the use of nursing interventions to improve compliance. It is argued that for the better management of diabetes and for the eradication of non-compliance behaviour, effective nursing intervention can be resourceful. A literature review was therefore conducted on the compliance of patients with diabetes type 2 and the role of nursing interventions in improving compliance. The databases searched were CINAHL, British Nursing Index, ASSIA and The Cochrane Library. The results showed three main themes which have been discussed in the paper. The themes have been analyzed in the context of the research topic and implications for clinical practice have been highlighted. The studies are both qualitative as well as quantitative and have used several study designs such as randomized control trials, reviews, systematic literature review and correlational studies. The nursing-led interventions have not been studied taking a large sample and the study designs are at times not very reliable. This necessitates more researches to be done to reinforce the results of the previous studies. On a general note, the studies have suggested that nursing interventions aimed at providing more education, awareness and advice to the patients have positive effects on encouraging self-care and increasing compliance to control regimes. More researches need to be done on larger samples so that the results can be generalized to the entire population. The study helps to identify that implications for health care professionals from various departments exist; interprofessional team work from nurses, general practitioners, volunteers and social workers can collectively be focused on the better implementation of interventions and empowering diabetic patients. Keywords: “compliance”, “diabetes type 2”, “nursing interventions” 1. Introduction Diabetes is taken from the Greek verb diabainein, meaning to stand with the legs open as one does in urination. Diabetes is a fast-growing disease and is characteristic of polyruria. There are two main types of diabetes i.e. diabetes mellitus and diabetes insipidus. Diabetes mellitus is related to the hyperglycemia or intolerance to glucose in contrast to diabetes insipidus which occurs because of the lack of production of anti-diuretic hormone. Type 2 diabetes is a subclass of diabetes mellitus with typical symptoms of hyperglycemia due to insulin resistance and/or insulin deficiency (King & Brucker 2009). It is noted that obesity and diabetes type 2 have a strong correlation. According to Joslin and Kahn (2005) obesity worsens the insulin resistance and patients with diabetes type 2 develop an increased risk for a range of diseases such as macrovascular and microvascular problems. This paper aims to highlight nursing management practices with respect to the care of patients with type 2 diabetes. Nursing management entails the “use of personnel, supplies, equipment, clinical knowledge, and skills to give nursing care to clients within varying environments” (Roussel & Swansburg 2006). Nursing management brings together a number of principles such as planning, effective use of time, decision-making, formulation of goals, organization, leadership and working as knowledge workers. Type 2 diabetes is the most common form of diabetes and patients typically have a large store of abdominal fat (Plotnick & Henderson 1998). Diabetes is growing rapidly in the UK with more than 2.6 million people diagnosed with the condition in 2009. It was also documented that in 2009, there were a further 0.5 million people who had type 2 diabetes but were not aware of it (Diabetes UK 2009). There are several treatment options available to patients, of which weight reduction and administration of oral agents are proven to be effective. Aschenbrenner and Venable (2008) assert that nurses have an integral role in the treatment and management of diabetic people. The effective treatment of diabetes requires that good compliance behaviours are promoted. However research has shown that patients do not show a high rate of compliance after being discharged. In this regard, the role on nursing comes into limelight. Nursing interventions can help improve the degree of compliance. This research paper will aim to review the literature on the use of nursing interventions to improve compliance. 2. Rationale Researchers have repeatedly asserted the practice of case management. Effective case management by nurses encompasses access, decision support, and accomplishment of results (Huber 2006). Case management is seen to be successful in providing care to the chronically ill (Erkel 1993). However, reviewing 18 studies of inpatient case management published between 1988 and 1995 showed inconsistent results. The author who conducted the review affirmed that there was no data to prove conclusively if nursing case management was effective (Huber 2006). It is argued that for the better management of diabetes and for the eradication of non-compliance behaviour, effective nursing intervention can be resourceful (Anon 2011). Hearnshaw et al. (2006) puts forward the point of view that there are very less studies conducted on the effectiveness of nursing-led interventions aimed at increasing compliance to diabetic care, which forms a vital element in the framework of nursing management. There are a number of initiatives in UK for the prevention of diabetes type 2 and for better outcomes for people with this condition. For instance, one of the goals of National Service Framework for Diabetes is the improvement of health outcomes for people with diabetes. National Institute for Clinical Excellence (NICE) has published guidelines for the management of type 2 diabetes. Recommendations for future research, as proposed by NICE (2002), encompass studies on effective implementation of methods. In this regard, nursing interventions and management should be given more importance and forms the rationale for critically reviewing the literature on the topic. 3. Search Strategy For finding the widely discussed themes on the required topic, the words ‘diabetes type 2’ and ‘compliance’ and ‘diabetes type 2 compliance’ and ‘nursing interventions’ were used. In CINAHL, for the research terms ‘diabetes type 2’ and ‘compliance’, 128 results were yielded. The time limit placed was from 2000 to current. This is because with changing times more awareness nullifies the validity of resources older than a couple of decades. A CINAHL search of ‘diabetes type 2 compliance’ and ‘nursing interventions’ yielded six results, of which one was related to type 2 diabetes and hence the rest were discarded. The same time range was followed. The search for CINAHL was set for articles in Europe. The Cochrane Library gave five results on ‘diabetes type 2’ and ‘compliance’, of which only one review article was relevant to the topic. The British Nursing Index gave 29 results for ‘diabetes type 2’ and ‘compliance’. The publication date limits were 2002 and 2010. ASSIA yielded two results arranged from recent most to older articles. The two entries were from 2000 onwards. One of the dominant themes in the results was the role of nurses in improving the adherence to medications for individuals diagnosed with diabetes type 2. Also a number of researches investigated the adherence to medications by patients with diabetes type 2. Researches also explored the barriers to compliance to medications and the effects of self-monitoring. Many of the articles and journals from CINAHL and British Nursing Index were not relevant to the topic and often researched the use of certain measures for improving diabetic control, in contrast to nursing interventions. 4. Literature Review There are three main themes that are to be discussed in this section. 4.1. Theme: adherence to type 2 diabetes treatment by nursing interventions The first theme relates to improvement of adherence to type 2 diabetes treatment by various nursing interventions. According to Vermeire et al. (2005), researches conducted on the adherence of patients to type 2 diabetes treatment is not very high. The background of the research was that interventions could improve adherence and improve the health status of the individuals. Since it was a review article, the search strategy encompassed collection of data from a number of electronic bibliographic databases as well as hand searches of references. The selection criteria for the articles were those studies which were randomised controlled and controlled clinical trials, before-after studies and epidemiological studies. Two teams were set up to judge the articles for selection in the review, with one team focusing on the quality of the article and the other on the narrative portion of the journal. The authors found out that the studies that had been carried out on the improvement of adherence to treatment do not represent any major benefit or harm to the patients. The review concluded that there is not adequate research to conclusively establish if nurse-led interventions and other interventions could facilitate the achievement of positive results (Vermeire et al. 2005). However one drawback of this study is that the results may not provide a reliable insight into the topic. This is because the studies selected for review compromised of both narrative reviews and meta-analysis, with narrative reviews being based more on broad recommendations and frequently basing results on personal opinions (Rosenfeld & Bluestone 2003). On the contrary, Hearnshaw et al. (2006) argues that there is definite potential for nursing interventions in increasing the compliance of diabetic patients to their treatment. In a review article put together by Hearnshaw et al., the role of the nurses in promoting education and support to clients was emphasized. It was stressed that not much literature is present regarding the topic. The review article studied four researches from a subgroup of a Cochrane review on nurse-led interventions for diabetic patients. The studies which considered the compliance of patients to medical treatment only met the inclusion criteria. The four studies thus selected were based in the US and employed the telephone for relaying information. The patients were seen to have an improvement in their self-care attitude; however only one of the studies came up with empirical evidence by measuring blood glucose to ascertain the improvement brought by the interventions. Another drawback of the study was that the replies and reactions of the patients were not presented clearly and cogently. The review concluded that there is more research required on the topic and more substantial ways need to be employed to demonstrate the effects of the interventions on diabetic control (Hearnshaw et al. 2006). The validity of the review is compromised because the articles reviewed are not providing conclusive evidence about the success of such interventions; also these interventions were not judged by the studies, except for one, using a strong criterion such as blood glucose levels. From the review article by Hearnshaw et al. (2006) and Vermeire et al. (2005), it can be assumed that there is no conclusive evidence to support the proposed hypotheses. Contrary to the studies reviewed by Hearnshaw et al. (2006) and Vermeire et al. (2005), Hee-Sung (2007) carried out a study on the effect of web-based nurse's education on the health of type 2 diabetic people using a reliable measure as a criterion for judging i.e. glycosylated haemoglobin. The nurse used short message service of cellular phone to relay the information and the researchers set up a control group pretest and post-test design to find out the effect of the interventions. 51 people were part of the research, of which 25 were in the interventions group and the rest were in the control group. The second step was to divide the controls and interventions into two groups based on whether their baseline- glycosylated haemoglobin was ?7·0% or Read More