Analyzing Gestational Diabetes Mellitus in Aboriginal Australian Women

This case study explores gestational diabetes mellitus (GDM) among Aboriginal women in Australia, examining a specific patient's experience and the associated nursing interventions. It covers the patient's symptoms, cultural preferences, and the hospital's response, highlighting the importance of cultural safety in nursing practice. The assignment details the pathophysiology of GDM, its prevalence within indigenous communities, and the critical role of nurses in providing appropriate care, including screening, dietary advice, and postpartum follow-up. It also emphasizes the need for nurses to be culturally sensitive, understanding the unique needs and beliefs of Aboriginal patients to ensure effective communication and treatment. The case study references relevant literature and research to support the discussion, offering a comprehensive overview of GDM management in this specific demographic.

Introduction
Gestational Diabetes among Aboriginal Women and its Management
According to the guidelines proposed by international organizations,
Diabetes during the pregnancy (Gestational Diabetes Mellitus) is one of
the serious problems faced by the women in Australia. Type 2 diabetes
mellitus (T2DM) is found to be one of the leading causes of the deaths
on a global basis. Screening of this disease can be helpful in the initial
years.
Case Study Scenario
Yesterday, a woman named Alisha entered into the hospital with the
complaint of fatigue, nausea, frequent bladder and extreme thirst. The
age of the woman was around 28 years and belonged to the Australian
nationality. She came to the hospital with her husband and lives in
Melbourne. She worked in a private company in the city and is a well
literate woman, who has already been visiting the hospital for the regular
check-ups. She did not have a surgery history in the past. The symptoms
mentioned by her were found to be quite similar to those mentioned by
the pregnant women suffering from Gestational Diabetes Mellitus
(GDM). However, the cultural needs mentioned by the woman were
different and she wanted only a local nurse to take care of her who had
already been taking care of the woman from the past months. She
wanted that she did not trust the nurses belonging to foreign origin. She
also mentioned the similar concern when she visited the hospital
previously. Also, she needs a doctor and nurse who is basically from
Australia so that she does not face any problems related to the
communication. The lady came to the hospital and since the hospital is
highly concerned about the patients and their clients, they fulfilled all
their demands. The woman was immediately attended by the doctor of
Australian origin and all the symptoms indicated the presence of GMD.
The doctor prescribed a good nutritional or diet plan and exercises for
maintaining a good health and weight.
Nursing Interventions and Drug Therapy
• Most of the drugs or medicines which are given to the patients of
GDM are those given to the patients of diabetes mellitus for
controlling the levels of glucose (Donovan & McIntyre, 2010).
• Most of the doctors prefer to give the therapy based on the alteration
of the diet and exercising as they both are highly effective in
maintaining the levels of glucose.
• The management strategy for GDM include basal-bolus insulin
strategy but, it needs it be personalized based on the needs of the
individuals. Metformin is also prescribed by a few doctors in this case
(Chamberlain et al., 2014).
• As a part of the nursing intervention, the high risk mothers or the
indigenous women of Australia need to be tested for GDM within 24
to 28 weeks of gestation with the help of a two hour oral glucose
tolerance test.
• The nurses need to be up to date with the current diagnostic criteria for
the disease, its treatment and management for reducing the adverse
outcomes or any impacts on the child to be born. They need to be
trained for the communication skills and the habits of the indigenous
people belonging to Australia (Chamberlain et al., 2013).
• The nurses need to take regular follow ups of the glucose levels of the
patient for modifying the preventable risk factors and reducing the
complications associated with the disease.
• The nurses need to provide the advice to the patient regarding the
postpartum criteria and checking the blood glucose levels of the
patient after the delivery, to ensure that the patient is not
hyperglycaemic.
• The nurses also need to be trained to treat the patient taking care of
their cultural faiths and beliefs and not discriminating among the
patients regarding their nationalities or religious preferences.
Pathophysiology/Prevalence in
Indigenous Communities References
Chamberlain, C., Joshy, G., Li, H., Oats, J., Eades, S. and Banks, E., 2014. The prevalence of
gestational diabetes mellitus among Aboriginal and Torres Strait Islander women in Australia: a
systematic review and meta‐analysis†. Diabetes Metabolism research and reviews, 31(3), pp.
234-247.
Chamberlain, C., McNamara, B., Williams, E.D., Yore, D., Oldenburg, B., Oats, J. and Eades, S.,
2013. Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and
the United States: a systematic review of the evidence for screening in early pregnancy.
Diabetes/metabolism research and reviews, 29(4), p. 241–256.
Commonwealth of Australia , 2017. Australian National Diabetes Strategy, Commonwealth of
Australia .
Donovan, P. J. & McIntyre, H. D., 2010. Drugs for gestational diabetes. Australian Prescriber,
33(1), pp. 141-144.
Forbes, L. E., Graham, J. E., Berglund, C. & Bell, R. C., 2018. Dietary change during pregnancy
and women’s reasons for change. Nutrients, 10(8), pp. 1-10.
Ishak, M. & Petocz, P., 2003. Gestational diabetes among Aboriginal Australians: prevalence,
time trend, and comparisons with non-Aboriginal Australians. Ethnicity & disease, 13(1), pp. 55-
60.
Plows, J., Stanley, J., Baker, P., Reynolds, C. and Vickers, M., 2018. The pathophysiology of
gestational diabetes mellitus. International journal of molecular sciences, 19(11), pp. 1-21.
Ride, K., 2017. Plain language review of diabetes among Aboriginal and Torres Strait Islander
people. Australian Indigenous Health Reviews, pp. 1-32.
Pathophysiology
• GDM is caused as a result of the β-cell dysfunction on the background
of chronic insulin resistance during the pregnancy and tissues insulin
resistance and β-cell impairment are the main components of its
pathophysiology (Ishak & Petocz, 2003).
• β-cell impairment is caused due to insulin resistance and it contributes
to hyperglycaemia. Pancreatic samples are taken from the patients
suffering from GDM for checking the reduction in the secretion of β-
cells.
• Chronic insulin resistance occurs when the cells do not respond to
insulin properly and the rate of glucose up-take decreases up to 54%.
It was also checked using the pancreatic samples (Chamberlain et al.,
2013).
• The studies have suggested that the prevalence of this type 2 diabetes
is very high in the indigenous women in Australia, Canada, New
Zealand and the United States.
Cultural Safety in Nursing Practice
• The nurses need to be provided with the training pertaining to the
cultural safety and their skills need to be improved from time to time.
• The major aim of the cultural safety program is to develop a relation
of partnership between the nurses and the patients and, the patients
have the right to negotiate with the hospital authorities as well as the
nurses based on their cultural preferences.
• In this case, the woman wanted a nurse belonging to the same cultural
background as hers so that she can communicate with her regarding
the issues faced by her and she can understand them
• The nurse attending the patient was first made aware about the cultural
preferences which the woman kept in front of the hospital authorities.
• The nurses need to be made aware of the two major indigenous
cultural groups prevalent in Australia – the aboriginal people and
Torres Strait Islander people. The two nursing groups need to be
prepared based on these indigenous group so that the issues pertaining
to cultural communication are not faced by the people (Ride, 2017).
• The nurses must be trained for fulfilling the demands of their clients
irrespective of which culture they belong to, so that they can have a
good understanding of the cultural beliefs and demands of the people.
The decision-making in such cases is highly crucial.
• In this case, where the dietary habits of the woman play a very
important role in the treatment of the disease, the food habits of the
indigenous women must also be highlighted by the trainers so that
they can be given an effective diet (Forbes, et al., 2018).
• The domains of expectations (perceptions, enablers and nurturers);
cultural identity (extended family, person and neighbourhood); and
cultural environment (existential, negative and positive) need to be
well informed to the nurses
• The nurses must be asked to communicate with the family members of
the patient regarding the food habits, cultural beliefs and medication
history of the patient so that an effective treatment can be provided to
them.
• The rate of the GDM in the indigenous population of Australian
women during the pregnancy was found to be about 2.5 times higher
than the non-indigenous population belonging to Australia (Plows et
al., 2018).
• Obesity was found to be one of the major contributors of the GDM in
the indigenous population of Australian women. Apart from this, the
other reasons contributing for the same include consumption of
alcohol and smoking, allergy or any other types of background history
of diabetes (Chamberlain et al., 2013).