Nurse-Led Management of Type 2 Diabetes

This assignment provides a detailed review of nurse-led management approaches for type 2 diabetes. It includes studies on effective nurse communication, educational programs for diabetic patients, and strategies for improving patient self-management. The analysis covers various research articles and positions statements from reputable organizations such as the American Diabetes Association.

Running head: NURSING PRACTISE
Nursing practise
Name of the student
University name
Author’s note

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Table of Contents
Nursing care practices............................................................................................................2
Background................................................................................................................................2
Aim of the research....................................................................................................................2
Search strategy...........................................................................................................................3
Annotated bibliography..........................................................................................................3
Reflective account of learning from a practice visit..............................................................6
References..............................................................................................................................8

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Nursing care practices
Background
The current assignment discusses nursing care practices for type 2 diabetes
management in United Kingdom. Type 2 diabetes management is one of the most common
illnesses affecting almost one fourth of the population within the United Kingdom. Reports
and evidences have shown that around 90 % people in UK are affected with type 2 diabetes
(Powers et al. 2015). It has been suggested that global diabetes cause a death in every six
seconds and accounts which accounts to 8.4% of global mortality in the age group of 20-79.
As reported by Wilkinson et al. (2014), 48% of deaths occur in the ones below the age group
of 60 years. Evidences have pointed out that people with type 2 diabetes have a 55.1%
increased risk myocardial infarction (Mulder et al. 2015). Evidences have shown that
improving dietary habits, active lifestyle and reducing weight are some of the manners in
which the risk of CVD in diabetes affected people could be controlled (Munshi et al. 2016).
The rise in blood glucose level has been linked with the development of diabetes neuropathy.
Under this, the nerves which are responsible for the transmission of impulses from the brain
and spinal cord to the blood vessels, muscles, skin, and other organs are affected severely.
Therefore, severe diabetic neuropathy can lead to leg amputations which can affect the daily
life of people. The nursing practitioners have been seen to improve the health outcomes for
patients affected with type 2 diabetes by their capacity to effectively manage and monitor the
medication doses without the need for authorization from the physician (Evert et al. 2014).
Aim of the research
To find out the influence of the nursing care on the lifestyle and condition
management of people affected with type 2 diabetes.

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Search strategy
The researcher had employed a secondary research design for the gathering of the
required data. The researcher had used secondary database sources for extracting sufficient
information. The researcher had used a number of search criteria for finding out the articles.
In this respect, only articles published within the last 10 years had been taken by the
researcher for consideration. Additionally, the articles and journals published in language
other than English were excluded by the researcher. The researcher had developed a number
of themes based upon the review of the articles. The similar themes had been further grouped
together for the purpose of data interpretation by the researcher. The researcher had also
taken into consideration the different research gaps during the framing of the research
objectives. The thematic analysis helped the researcher in removing the research biases.
During the process of conducting the thematic analysis the researcher had employed a
number of exclusion criteria. For example the articles which are more or less representing
the same idea had been eliminated for the convenience of the research. Additionally, the
researcher has used a number of keywords for finding out the correct articles such as nursing
care, management, type 2 diabetes. Some of the databases which had been used by the
researcher are -PUBMED, NCBI, etc. Additionally, the researcher had also collected data
from practical scenario such as health records from some of the local hospices to check the
affectivity of the nursing care in treatment and management of the symptoms of type 2
diabetes.
Annotated bibliography
Article cited: Everett, J. and Kerr, D., 1998. Nurse-led management of newly diagnosed type
2 diabetes. Journal of Diabetes Nursing, 2, pp.12-22.

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The article discusses the implementation of a nurse driven support services for the
ones diagnosed with type 2 diabetes. Here, a structured holistic approach has replaced the
traditional model and enables the patients to self manage their own care. A cohort group of
156 patients were selected who were made a part of the programme for three years. The
patients were provided with education group session and diabetic consultations. The topics of
consultation or education covered in the programme were- managing diabetes health
complications, food and dietary management etc. The programme received success both with
primacy care patients and colleagues. The paper helped me to evaluate the role of the nurses
in helping the patients affected with type 2 diabetes self mange their conditions.
Article cited: Macdonald, L., Stubbe, M., Tester, R., Vernall, S., Dowell, T., Dew, K.,
Kenealy, T., Sheridan, N., Docherty, B., Gray, L. and Raphael, D., 2013. Nurse-patient
communication in primary care diabetes management: an exploratory study. BMC
nursing, 12(1), p.20.
The paper discusses the different aspects of nurse patient communication in type 2
diabetes management. A cohort group consisting of 18 patients and 10 nurses were designed.
Separate interviews were conducted for the patients and the nurses at the end of six months.
The analysis was done using ethnography and interaction analysis. However, both the nurses
and the patient reported that they felt helped though the extended clinical communication as it
led to more transparency. The study helped me in understanding the aspect of implementation
of evidence based communication approaches in an acute care setup.
Article cited: Graffigna, G., Barello, S., Libreri, C. and Bosio, C.A., 2014. How to engage
type-2 diabetic patients in their own health management: implications for clinical
practice. BMC public health, 14(1), p.648.

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The assignment focuses on the use of patient engagement assessment tools which
firmly based on individual patient experience. The paper explores the reasons for the
disengagement of diabetes patient. A narrative qualitative inquiry approach was followed to
ascertain the reasons. It was found that the patient reacted to their diabetes care framework
through a number of dimensions which are –cognitive, behavioural and emotional. The paper
helped me in understanding the development of patient engagement through several phases.
Article cited: Parker, D., Maresco-Pennisi, D., Clifton, K., Shams, R. and Young, J., 2016.
Practice nurse involvement in the management of adults with type 2 diabetes mellitus
attending a general practice: results from a systematic review. International journal of
evidence-based healthcare, 14(2), pp.41-52.
The paper here evaluates the benefits of providing a standard care to patient affected
with type 2 diabetes compared to general care management strategies. It helps in
understanding the additional benefits brought about by the involvement of nurses within the
care plan. Here randomised control trials were used evaluating the responses in patients
health outcome though additional support from nurse. Standardised appraisal instruments
from jonnas brigg’s institute were used for article review. Statistical Meta analysis was used
for quantitative data interpretation. The results showed significant improvement in
cholesterol and blood pressure level of the patients affected with type 2 diabetes. The paper
helped me in learning regarding the parameters of quantitative data estimation.
Article cited: Vissarion, B., Malliarou, M., Theofilou, P. and Zyga, S., 2014. Improvement
of diabetic patients nursing care by the development of educational programs. Health
psychology research, 2(1), pp.58-65.
The paper analyses the improvement of diabetes care in patient through nursing
educational programs. A systematic review had been conducted over here for the collection

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of data. The results show improved patient outcomes with development of an effective care
plan and formation of support groups. The study helped me in understanding the importance
of counselling support programs for management of patient health.
Reflective account of learning from a practice visit
During my practise session as type 2 diabetes care nurse I had come across a number
of situations. They have contributed significantly in shaping up my nursing skills as a
specialist care nurse. Some of these have helped me in honing my skills better and also in
developing a personalized and effective care plan for the patients. Some of the challenges
which have been faced by me in the delivery of the nursing care are insufficient patient
engagement, lack of support from the family members of the patient and the healthcare staffs.
Additionally, lack of finances can also challenge the success of a diabetes care plan.
Long term diabetes can make managing daily life difficult for the patients owing to a number
of health obligations such as the leg amputations and diabetic neuropathy. Therefore, gaining
knowledge regarding some of the evidence based practise methods can me in better accessing
and dealing with some of the patients. Some of the practise methods such as holistic care
regimen and evidence based communication methods can help me in gathering of sufficient
patient details. Additionally, knowledge regarding changes in lifestyle approach can help the
patients affected with type 2 diabetes improve their living standards and also reduces the
number of hospital visits within a year. Self care and medication management are some of the
top priorities of nursing care practices in diabetes management (Wilkinson et al. 2014).
Moreover, reflecting upon one of my last clinical sessions I also think I need to
develop knowledge regarding the methods of development of patient engagement. As
commented by Evert et al. (2014), a disengaged patient is less expected to response
positively to a particular treatment method compared to a patient with utmost cooperation

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levels. I most importantly think I need to develop and make my communication skills
stronger which will help me in better relating to the grievances of the patient. It was seen that
clinical communication was driven more out of the agenda of the nurses and was restricted in
its mode of dissemination of information to the patients. Additionally, practical or in-house
training sessions can also help me in understanding the assessment methods better.
The life expectancy of an individual diagnosed with type 2 diabetes reduced
drastically. For an individual in their mid 50s detected with type 2 diabetes, the life
expectancy is around 6 years. This is because type 2 diabetes develops a lot of health
problems and complications within the patient affected with the same. Some of these can
have much bigger consequences over the life of an individual which could be improved with
the help of effective nursing care.

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References
Everett, J. and Kerr, D., 1998. Nurse-led management of newly diagnosed type 2
diabetes. Journal of Diabetes Nursing, 2, pp.12-22.
Evert, A.B., Boucher, J.L., Cypress, M., Dunbar, S.A., Franz, M.J., Mayer-Davis, E.J.,
Neumiller, J.J., Nwankwo, R., Verdi, C.L., Urbanski, P. and Yancy, W.S., 2014. Nutrition
therapy recommendations for the management of adults with diabetes. Diabetes
care, 37(Supplement 1), pp.S120-S143.
Furler, J.S., Blackberry, I.D., Walker, C., Manski-Nankervis, J.A., Anderson, J., O’Neal, D.,
Young, D. and Best, J., 2014. Stepping up: a nurse-led model of care for insulin initiation for
people with type 2 diabetes. Family practice, 31(3), pp.349-356.
Graffigna, G., Barello, S., Libreri, C. and Bosio, C.A., 2014. How to engage type-2 diabetic
patients in their own health management: implications for clinical practice. BMC public
health, 14(1), p.648.
Macdonald, L., Stubbe, M., Tester, R., Vernall, S., Dowell, T., Dew, K., Kenealy, T.,
Sheridan, N., Docherty, B., Gray, L. and Raphael, D., 2013. Nurse-patient communication in
primary care diabetes management: an exploratory study. BMC nursing, 12(1), p.20.
Mulder, B.C., Lokhorst, A.M., Rutten, G.E. and van Woerkum, C.M., 2015. Effective nurse
communication with type 2 diabetes patients: a review. Western journal of nursing
research, 37(8), pp.1100-1131.
Munshi, M.N., Florez, H., Huang, E.S., Kalyani, R.R., Mupanomunda, M., Pandya, N., Swift,
C.S., Taveira, T.H. and Haas, L.B., 2016. Management of diabetes in long-term care and
skilled nursing facilities: a position statement of the American Diabetes
Association. Diabetes care, 39(2), pp.308-318.

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Parker, D., Maresco-Pennisi, D., Clifton, K., Shams, R. and Young, J., 2016. Practice nurse
involvement in the management of adults with type 2 diabetes mellitus attending a general
practice: results from a systematic review. International journal of evidence-based
healthcare, 14(2), pp.41-52.
Powers, M.A., Bardsley, J., Cypress, M., Duker, P., Funnell, M.M., Fischl, A.H., Maryniuk,
M.D., Siminerio, L. and Vivian, E., 2015. Diabetes self-management education and support
in type 2 diabetes: a joint position statement of the American Diabetes Association, the
American Association of Diabetes Educators, and the Academy of Nutrition and
Dietetics. Journal of the Academy of Nutrition and Dietetics, 115(8), pp.1323-1334.
Vissarion, B., Malliarou, M., Theofilou, P. and Zyga, S., 2014. Improvement of diabetic
patients nursing care by the development of educational programs. Health psychology
research, 2(1), pp.58-65.
Wilkinson, A., Whitehead, L. and Ritchie, L., 2014. Factors influencing the ability to self-
manage diabetes for adults living with type 1 or 2 diabetes. International journal of nursing
studies, 51(1), pp.111-122.