Trends in diabetes care and education by primary health care nurses in Auckland, New Zealand

AIMS

To examine trends in the management of patients with diabetes by primary health care nurses, its association with diabetes education and how valued and supported nurses feel in Auckland, New Zealand.

METHODS

Two representative cross-sectional surveys of all nurses providing community-based care, and patients with diabetes they consult, were conducted in 2006-8 and 2016. All participants completed a self-administered questionnaire on biographical details and a telephone interview on their provision of diabetes care.

RESULTS

Significantly more nurses discussed serum glucose and medications with patients, planned follow-up and scheduled practice nurse appointments in 2016 compared with 2006-8, and fewer specialist diabetologist appointments were made (12% versus 2%). Fewer nurses in 2016 than in 2006-8 felt valued (62% versus 75%) and supported (78% versus 89%) when managing patients (p-values = 0.0004). Nurses diabetes education was associated with recommended practice and feeling valued. Significantly more patients were prescribed metformin (81%) and insulin (46%) in 2016 compared with 58% and 30% in 2006-8. Despite this, HbA_1c levels remained unchanged.

CONCLUSIONS

Prescribed glycaemic-related medications increased, and more nurses engaged with patients about glycaemic control and medications in 2016 compared with 2006-8. Nurses undertaking diabetes education was strongly associated with best management practices and nurses feeling valued.

Awareness of oral complications and oral hygiene habits of subjects with diagnosed Diabetes Mellitus

Background/Aim: The aim was to evaluate Diabetes Mellitus (DM) patients' awareness of their risk for oral and dental complications, to evaluate their oral health behaviors, assess their sources of related information, and to detect the influence of their awareness on oral health and dental management. Material and Methods: Total of 240 DM patients presenting to a university outpatient dental facility for routine care completed a self-administered questionnaire about demographic socioeconomic characteristics, oral health care and awareness on oral complications of DM. Dental status of each patient was recorded. Data were analyzed with Chi- square test; p was set as 0.05. Results: The patients' mean age was 52.85 years; the majority had Type 2 DM (72.1%) and 61.7% were females. Two thirds of the patients had tooth loss; 65% brushed daily and used toothpick for interproximal cleaning (35%). Only 12.9% had regular dental visits and 37.5% reported their oral health as 'poor'. DM patients rarely received guidance from their health care professionals regarding their oral health (28.3%). Even though 62.5% were aware of oral complications of DM, only 46.3% knew that oral health may affect DM. The patients with Type 1 and Type 2 DM had similar perceptions about their oral health status (p=0.15>0.05). However, insulin users were more aware of the interaction between oral health and DM (p>0.05), and were more likely to consider their oral health as 'poor' (p>0.05). Conclusions: DM patients' awareness of the effect of DM on oral health was higher than that of the effect of oral health on DM management. Medical health care providers were failing to provide the necessary information regarding these issues when compared to dentists.

Nurse Behavior in Implementation of Diabetes Mellitus Education Based on Theory of Planned Behavior

Introductions: Education is the important component in self-management of Diabetes mellitus patients. Nurse as one of the health care provider should take active role in giving adequate education. The aim of this study were to analyze factors influencing nurse’s behavior in implementation of Diabetes mellitus education based on theory of planned behavior.Methods: This study used cross sectional design. Population in this study were all nurses in medicinal public hall whose were assigned to give education toward patients in 62 puskesmas induk in Surabaya city in 2016. Sampling technique used total sampling and 112 nurses obtained as samples. Variables in this study consist of attitude, subjective norm, perceived behavioral control (PBC), intention and practice in DM education. Data collection was using questionnaire and observation sheet and also analyzed using spearman rho with α 0,05.Results: Statistical analysis result shows there is significant relationship between attitudes, subjective norm, perceived behavioral control (PBC) toward intention with p value of 0,022; 0,048; dan 0,000 respectively and there is no significant relationship between intention and practice of Diabetes mellitus education with p value 0,194. Nurse’s attitudes, subjective norm, perceived behavioral control (PBC) had positive effect toward intention of Diabetes mellitus education but intention had no effect toward practice of Diabetes mellitus education in puskesmas.Conclusion: Theory of Planned Behavior (TPB) stated that individual behavior occurred because of intention that could be affected by attitude, subjective norm, and perceived behavioral control (PBC). Future study was expected to use qualitative approach, and related study regarding development of education media in Puskesmas.

Quantification of diabetes consultations by the main primary health care nurse groups in Auckland, New Zealand

BACKGROUND

Diabetes prevalence continues to increase, with most diabetes patients managed in primary care.

AIM

This report quantifies the number of diabetes consultations undertaken by primary healthcare nurses in Auckland, New Zealand.

METHODS

Of 335 primary healthcare nurses randomly selected, 287 (86%) completed a telephone interview in 2006-2008.

FINDINGS

On a randomly sampled day (from the past seven) for each nurse, 42% of the nurses surveyed (n=120) consulted 308 diabetes patients. From the proportion of nurses sampled in the study, it is calculated that the number of diabetes patients consulted by primary healthcare nurses per week in Auckland between September 2006 and February 2008 was 4210, with 61% consulted by practice, 23% by specialist and 16% by district nurses. These findings show that practice nurses carry out the largest number of community diabetes consultations by nurses. Their major contribution needs to be incorporated into future planning of the community management of diabetes.