NUR3101 Assignment: Type 2 Diabetes, Nursing Practice, USA Context

This report analyzes Type 2 diabetes in the USA, examining its prevalence, social determinants of health, and epidemiological studies. It explores the role of primary health care nurses, emphasizing the importance of cultural competence in addressing the issue. The report discusses factors like low income, education, and discrimination contributing to diabetes. It highlights the need for increased awareness, cultural sensitivity, and effective healthcare strategies to combat the disease. The report also includes the role of the nurse in educating patients, promoting self-care, and advocating for health equity. The report also reflects on the barriers to cultural competence among nurses and suggests ways to improve it, such as providing appropriate training and education sessions. The conclusion emphasizes the need for comprehensive strategies to eradicate the disease in the near future.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Type 2 Diabetes refer to a type of diabetes that is characterized by high rate of blood sugar,
relative lack of insulin as well as insulin resistance. Type 2 diabetes process the potential to
drastically enhance the risk of heart disease, high blood pressure, nerve damage as well as
narrowing of the blood vessels. As per the data obtained from Cdc.gov., (2020), more than 30
million Americans are found to suffering from diabetes, while approximately 95 percent of them
possess type 2 diabetes. While the mentioned heath issue mostly affects people over the age of
forty five, it has been seen that in USA, even children between the he age range of 9 to 14,
adolescents as well as young adults are also suffering from type 2 diabetes. In the following
paragraph, a detailed discussion on the social determinates of health and their contribution in
solving the issue, interpreting epidemiologic studies which has been showed for identifying the
health issue, analysis of the role of primary health care nurses in USA and reflection on the us e
of cultural competence in healthcare for addressing this issue, has been conducted.
Discussion on the social determinants of health
The social determinants of heath refers to the circumstances in which an individuals is
born, grown, work as well as aged. These circumstances are shaped on the basis of the
distribution of money, resources and power at global, national and local levels. According to
Ogunsola & Binuomoyo, (2014), the social determinists are found to have direct relation to the
incidence associated with Type 2 diabetes in USA. In the nation, the type 2 diabetes program are
found to be focusing on the biological as well as behavioral factor that incudes symptom diet
along with physical activity. However it is crucial for addressing the effect of physical as well as
social environments that comprise of low income, low educational attainment, employment in
security, poor health outcomes a living condition.

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According to Hill, Nielsen and Fox, (2013), considering the fact that Diabetes type 2 have
reached to an epidemic level, its increment is typically related to the biological characteristics of
the health care service users along with the behavioral influences. The chief biological factors
that are associated with the genetic predisposition for the action for other medical condition that
include factors like age, family history, usage of atypical antipsychotics and testosterone
deficiency. When it comes to behavioral influences, it includes factors like physical inactivity as
well as inadequate sleep. The association with type 2 diabetes as well as obesity is
multifunctional and thus can further complicate the prevention as well as management.
However, amongst the above discussed social health determinants that are resulting in type
2 diabetes, equity as well as lack of effective social justice have contributed to the occurrence of
the diseases to a great level. In USA, the occurrence as well as occurrence of the type 2 diabetes
is found to be socially graded. Individuals who possess lower income and with lo educational
qualifications are 2 to 4 times more likely to develop the chronic disease. High cost of the
healthcare services as well as high rate of discrimination can be pointed out to be one of the chief
reasons behind this. For people who are below the poetry line, the constant struggle of making
the two ends meet, lack of nutritious diet as well as high stress leads to diabetes type 2 (Clark &
Utz, 2014). Chronic stress, in turn lead to higher amount of metal diseases which in turn
intensify the probability of self-destructive performances and choices. Over the time, these
physiological issues along with harmful psychological replies as well as behavioral practices
enhance the probability of obesity as well as Type 2 diabetes.
Epidemiological studies on Diabetes type 2

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As per the data obtained in the year 2015, 30.3 million Americans which is approximately
9.4 percent of the population are found to be suffering from diabetes. Considering the fact that
the ratio of detected to undetected cases often varies on the basis of time and between places, the
epidemiological study that are aimed to define the true prevalence of type 2 diabetes, chiefly
relies studies where the presence as well as nonappearance of illness referred to the Oral
Glucose Tolerance Test (OFTT). The prevalence rate is found to be lowest in rural areas of the
developing countries in us. Intermediate in the developed courts and highest in certain ethnic
groups, specifically these who have adopted the western lifestyle pattern. It has also been found
that the residents of USA with highest prevalence of diabetes type 2 also possess highest
prevalence of obesity. According to researcher. Genetic susceptibility of obesity is
disadvantageous during the abundance of food items and advantageous during the scarcity of
food. It has been found that the percentage of Americans of or above the age of 65 years re 25.2
percent more likely to suffer from diabetes type 2 disease compared to individuals below the
mentioned age range (Caspard et al., 2018).
When it comes to the youth approximate 193,000 Americans, under the age of 18 years are
fond to be suffering from the disease which is approximately 24 percent of the total population.
Unhealthy eating habits and lifestyle is considered to be the chief reason behind this.
The rates of diagnosed diabetes in adults by race/ethnic background are:
 7.4 percent of non-Hispanic whites
 8.0 percent of Asian Americans
 12.1 percent of Hispanics
 12.7 percent of non-Hispanic blacks

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 15.1 percent of American Indians/Alaskan Natives
The chief reason behind this high percentage is lack of effective health care facilities,
adaptation of western lifestyle and junk food consumption, lack of cultural competencies
amongst the nurses along with discrimination against people with ethnic background. People
from ethnic backgrounds are found to be provided with lesser opportunities to avail healthcare
resources (Binsaleh et al., 2018). Not only has this, lack of cultural competencies among the
nurses as well as patients made it highly difficult to establish an effective health care service
user-care provider relation. The access to healthcare facilities, of people from ethnic background,
specially, people with lower income rate is lower than that of the natives.
Analysis of the primary health care nurse’s role in USA
In order to deal with the issue of diabetes type 2, it is highly crucial for the nurses to deal
with the existing issues that ire increasing the rate of diabetes type 2 amongst the residents of the
nation. The three chief factors that are responsible for enhancement of the mentioned issue
includes lack of awareness, lack of cultural competencies and discrimination.
Considering the fact that a good number of healthcare service users who are suffering from
prediabetes or diabetes types 2 are unaware of the factors contributing to the disease as well as
the consequences of the heath issue, it is the responsibilities of the nurse to educate the health
care service users about the impact of diabetes type 2 on heath and how the same can be
prevented or reduced. (Elm, J. H., Walls & Aronson, 2019) According to researchers, uses in
order to prevent or detect type 2 diabetes must possess the sill of describing the risk factors of the
heath issue, explain the importance of prevention (da Rocha Fernandes et al., 2016). Along with
this the role of exercises in order to prevent or delay in the progression to the type 2 diabetes

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should also be explained by the nurse. Along with this nurses should also promote self-care. For
instance they should support the healthcare service users along with helping them to develop
their own self-care with guidance from a registered nurse. Along with this nurses should observe
as well as report major concerns that can affect the ability of self-care of the patents. Lastly, they
should encourage the healthcare service user to personalize their care plans.
In USA a good number of awareness campaigns are head each year to enhance the
awareness of the residents about the impact of diabetes type 2. However, more campaigns are
necessary, especially in rural areas and areas and amongst people from ethnic background.
Dalal et al., (2017) stated that lack of cultural competency amongst the nurses of USA along with
effective regulations that can prevent discrimination can be evidenced. 1 among 5 individual are
found to be reporting racial discrimination while opting for healthcare. Hence it is the
responsibilities of nurse leader to ensure enhancement of cultural and language competences so
that an effective care can be provided to the patients.
Reflection on the use of cultural competence in the Primary Health Care nurse role in
supporting this health issue
The US is becoming highly diverse on the basis of ethnicity and race and yet a good
number evidence that disparities and other challenges still exist are there. As being stated
earlier, 1 in 5 healthcare service users are found to be reporting racial discrimination against
them. As per my opinion, one of the best ways to ensure effective healthcare and hence reduction
in diabetes type 2 is to promote culture competence. According to researchers, cultural
competence can be considered as a method of enhancing the access to quality care for all

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healthcare service users, irrespective of their age, gender, sex as well as racial origin
(Subramanian, Midha & Chellapilla, 2017).
When it comes to USA, I have noticed that some of the major factors are acting as barrier
to cultural competence of nurses. The chief barriers to cultural competence that are hindering the
nurses is to provide effective care to the patients suffering from diabetes type 2 includes lack of
knowledge of various cultural and ethnic group bias, ethnocentrism, lack of skills needed for
assessing the difference, lack of organizational support as well as perceived lack of time.
As a healthcare service provider in USA, I have noticed that very few nurses in USA
possess potential knowledge of the various ethnic group as well as cultural background. As a
result of this, nurses faces difficulties to understand the language as well as psychology of the
healthcare service users suffering from diabetes type 2 (Willis et al., 2018). This eventually
lower the quality of the service provided as well as the satisfaction of the heath care service
users. Moreover, lack of respect towards other cultural background also hampers effective
treatment of the disease. Another thing I want to point out is lack of nurses from ethic
background in the USA healthcare system. Considering the fact that working with employees
from different cultural background will allow the healthcare service users to enhance their
respect and knowledge about people from other ethnicity, lack of ethnic staffs is hampering
development of cultural competence (Assari et al., 2017).
I believe that it is high time for the management of heath care organizations to take
effective step in order to enhance the cultural competencies of the healthcare users. Healthcare
organizations should implement appropriate training and education session in order to enhance
cultural competencies amongst the nurses. Along with this cultural liaisons should be recruited in
order to help the nurses to communicate with patients from different culture background.

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Conclusion
From the above discussion, it can be concluded that diabetes type 2 is highly prevalent in
USA. The chief determinants of heath that are responsible for the occurrence of the dieses
includes genetic factors, lack of equity as well as access to healthcare services. Effective
strategies that can ensure efficient provision of care for the mentioned disease has been
discussed. It is expected that by implementing this strategy the nation will be able to eradicate
the disease in near future.

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References
Assari, S., Lee, D. B., Nicklett, E. J., Moghani Lankarani, M., Piette, J. D., & Aikens, J. E.
(2017). Racial discrimination in health care is associated with worse glycemic control
among black men but not black women with type 2 diabetes. Frontiers in public
health, 5, 235.
Binsaleh, A. Y., Perez, A., Popovici, I., & Rabionet, S. E. (2018). Impact of antidepressant use
on healthcare utilization among individuals with type 2 diabetes and depression
symptoms in the United States: sociodemographic, clinical, and behavioral factors
matter. International journal of environmental research and public health, 15(9), 1904.
Caspard, H., Jabbour, S., Hammar, N., Fenici, P., Sheehan, J. J., & Kosiborod, M. (2018). Recent
trends in the prevalence of type 2 diabetes and the association with abdominal obesity
lead to growing health disparities in the USA: an analysis of the NHANES surveys from
1999 to 2014. Diabetes, Obesity and Metabolism, 20(3), 667-671.
Cdc.gov. (2020). Type 2 Diabetes | Basics | Diabetes | CDC. Retrieved 28 January 2020, from
https://www.cdc.gov/diabetes/basics/type2.html
Clark, M. L., & Utz, S. W. (2014). Social determinants of type 2 diabetes and health in the
United States. World journal of diabetes, 5(3), 296.
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Dalal, M. R., Kazemi, M., Ye, F., & Xie, L. (2017). Hypoglycemia after initiation of basal
insulin in patients with type 2 diabetes in the United States: implications for treatment

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Elm, J. H., Walls, M. L., & Aronson, B. D. (2019). Sources of stress among Midwest American
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Willis, J. R., Doan, Q. V., Gleeson, M., Haskova, Z., Ramulu, P., Morse, L., & Cantrell, R. A.
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