The Basic Problem of Diabetes

Uncontrolled levels of blood glucose are the basic problem in patients admitted to our unit. Many are related to lack of knowledge and self-care in diabetes management, sedentary lifestyle, and food habits. This reveals that when assessing a patient in the hospital, a nurse must consider all factors and design a care plan accordingly. Nurses need to be non-judgmental and assess what factors may limit patients' abilities to follow lifestyle recommendations. According to the American Diabetes Association (ADA), uncontrolled blood glucose levels remain the primary problem in patients with diabetes (ADA, 2014).

To prevent complications such as neuropathy, nephropathy, cardiovascular diseases, visual impairment, lower extremity diseases, and amputations, the ADA recommends proper glycemic control, physical activity, medication, and patient self-monitoring of blood glucose (Arlington, 2017).

Arlington's studies (2017) show that self-care activities are insufficient, blood glucose levels are high, and individuals' susceptibility to diabetic complications remains elevated. The question is: how can nurses help individuals with diabetes to become self-motivated in their care? To combat this situation, the ADA recommends Diabetes Self-Management Education (DSME) to provide information, skills, and empowerment to diabetic patients in their self-care (Arlington, 2017). Nurses and diabetes educators are encouraged to provide individual or group training to these individuals. Another barrier to diabetes self-management is the duration of the disease process, which leads to frustration, disappointment, and failure to achieve the optimum level of glycosylated hemoglobin over time. When a patient has had diabetes for many years, blood sugar control often worsens. A nurse should reinforce, motivate, and enable the factors that increase self-care behaviors in diabetic patients (Dehghan et al., 2017).

Borji, Otaghi, and Kazembeigi (2017) researched the impact of a self-care model on the quality of life (QOL) of diabetic patients. The results showed that the implementation of Orem's self-care model helped to improve the QOL of patients, except for general health and emotional role dimensions. Diabetes is a chronic disease that often causes depression, anxiety, helplessness, decreased mobility, and obesity, all of which directly impact QOL. As described in Borji et al. (2017), the ultimate goal is patient satisfaction, patient adherence to self-care, and improved QOL. These goals can be achieved by identifying patients' educational needs, the reasons for non-compliance, and by finding appropriate solutions to these issues. Self-care is a learned behavior, wherein the patient takes an active role in managing their own health, thus increasing their satisfaction and, ultimately, reducing the cost of treatment (Borji et al., 2017).

Borji et al. (2017) emphasize that Orem's self-care model provides a good clinical guide for nurses, functioning as a facilitator and change agent in planning and implementing self-care, and providing educational support to the patient. They also stress that the person with diabetes should cooperate in all phases of the treatment plan, as the individual or the caregiver plays an important role in blood glucose monitoring, diet, insulin dosage, and regular physical activity (Borji et al., 2017). Managing diabetes can be challenging, and nurses should teach how to solve day-to-day problems, manage self-medication, and make decisions. Orem's model was applied through the assessment of patient history, diagnosis, and ability for self-care. After gathering this data, an appropriate self-care plan was implemented, resulting in a significant increase in self-care scores in five aspects: diet, physical activity, blood glucose monitoring, medication diet, drug use, and diabetic foot care.

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