The Basic Problem of Diabetes
Uncontrolled levels of blood glucose are the basic problem in patients who admits to our unit. Many related to lack of knowledge and self-care and diabetes management, sedentary lifestyle, food habit. This tells us that when we look into a patient in the hospital a nurse needs to take everything in to consideration and make a care plan accordingly. Nurses need to be non-judgmental and see what factors may limit patients’ abilities to follow lifestyle recommendations. According to American Diabetes Association (ADA) uncontrolled levels of blood glucose remains the basic problem in patients with diabetes (ADA 2014). To prevent complication such as neuropathy, nephropathy, cardiovascular diseases, visual impairment, lower extremity diseases and amputations, ADA has recommended to have proper glycemic control, physical activity, medication, patient self-monitoring of blood glucose (Arlington, 2017).
However, studies by Arlington (2017) shows that self-care activities are insufficient, blood glycose level was high and they were prone to diabetic complications remains high. Question is how can nurses help the individuals with diabetic to motivate in self-care. To combat this situation ADA recommends Diabetes Self-Management Education (DSME) to provide information, skills, strengthening and empowering the patient with diabetes self-care (Arlington, 2017). Nurses and diabetes educators are encouraged to provide individual or group training to these individuals. Other barriers to the diabetes self-management is the duration of disease process that leads to frustration, disappointment and failure to achieving the optimum level of glycosylated hemoglobin over time. When a patient has diabetes for many years blood sugar control becomes worse and a nurse should reinforce, motivate and enable the factors that increases self-care behaviors in diabetes patients (Dehghan et al. 2017).
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Borji, Otaghi and Kazembeigi (2017) had researched on impacts of self-care model on diabetic patients quality of life(QOL) and the results shows that implementation of Orem self-care model helped to improve the QOL of patients except for the general health and emotional role. Diabetes is a chronic disease which causes depression, anxiety, helplessness, lack of mobility and obesity, and have a direct impact on QOL. As described in Borji et al. (2017) the ultimate goal is patient satisfaction, patient’s performance on self-care and QOL. It can be done by identify patient’s educational needs, reason for non-compliance, and finding appropriate solution. Self-care is a learned behavior, where a patient takes an active role of their own health and thus increases patient satisfaction and ultimately reduces cost of treatment (Borji et al. 2017).
Borji et al. (2017) emphasize that Orem’s self-care model provides a good clinical guide for the nurses as a facilitator and change agent on planning and implementing self-care and providing educational support to the patient. They also stress that the person with diabetes should also cooperate in all phases of treatment plan as the person or the caregiver is the important part of blood glucose monitoring, diet, insulin dosage, and doing regular physical activity (Borji et al. 2017). Managing diabetes can be challenging and a nurses should teach how to solve day to day problem, self-medication and make decision. Orem’s model was applied through application of assessment on patient history, diagnosis, ability of self care and after gathering data appropriate self-care plan was implemented and resulted in significant increase in self-care score in five aspects of diet, physical activity, blood glucose monitoring, medicine diet, drug, and diabetic foot care.