ABSTRACT
Diabetes
is a metabolic disease in which the glucose level in the blood is high over
extended periods. Self-management poses great problem on patients. Improper glycaemic
control has a link with an increased risk of visual impairment, kidney failure,
cardiovascular disease and lower extremity amputation from foot gangrene. The
aim of self-management of diabetes mellitus is to ensure that blood glucose is
at a normal range thereby reducing the risk of complications. Despite
advancement in diabetes self-management education through recent discoveries
73% of diabetic patients do not practice self-monitoring of blood glucose.
Dorothea
Orem self- care conceptual model was adopted for the study. One group pre/post
quasi-experimental design was chosen to carry out the research. The population
were individuals diagnosed of diabetes mellitus and attend
diabetic clinic of medical outpatient unit of General hospital Lagos. Sample size was 20 patients and purposive
sampling was adopted to select the 20 patients from medical
outpatient clinic of the hospital.A designed questionnaire was used to collect data on knowledge and self-care practiceconcerning diabetes mellitus among diabetic
patientspre/post-intervention. The procedure for collecting data involve
mobilization of respondents at the clinic, one week training and post-test
conducted two weeks post-intervention. Face and content validity of instruments
were determined by the supervisor and other experts in the field. The reliability of the questionnaire was ascertained using Cronbach
alpha reliability test and reliability coefficient was calculated to be 0.83. The training modulewas also pre-tested and found suitable for the study.
Data were processed through statistical package for social science (SPSS),
version 21. Two research questions and two hypotheses were tested through
descriptive statistics of mean and standard deviation as well as inferential
statistics of student t- test at 0.05 level of significance to answer the
research questions and test the hypotheses.
The
results showed that; (a) 30%
were good in knowledge pre-intervention, post-intervention all
the respondent increased by 70% in knowledge. (b)55% were good in self-care practice pre-intervention,post-intervention
45% respondents increased in self-care practice(c) There is significant effect in nurse-led training on
knowledge regarding self-management among diabetic patients with a mean
knowledge score of 14.2 post-intervention (p = 0.000).(d) There is significant
effect in nurse-led training on practice regarding self-care activities among
diabetic patients with a mean practice score of 1.05post-intervention (p=
0.000).Findings showed
that knowledge and self-care practice concerning diabetes mellitus among
diabetic patients was improved as respondents showed improved knowledge and
practice regardingself-management of diabetes mellitus.
This
study recommended that a well-organized and structured
education programme should be introduced to improve knowledge and practice concerning self-management
of diabetes among diabetic patients as well as quality of nursing care.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Diabetes mellitus (DM) is a metabolic disease in which glucose
level in the blood is high over extended periods (World Health Organization,
2014). DM results when the pancreas is unable to produce insulin or cell of the
body is not responding to insulin produced (Shoback,
2011) . In 2013 alone 4.6 million people died of DM (Aschner, Beck-Nielsen, Bennett, Boulton,
& Colagiuri, 2013). Low and middle-income countries of the world is being affected
by DM, there are more than 77 % morbidity and 88 % mortality (International
Diabetes Federation, 2013). Type 2 diabetes mellitus (T2DM) is the commonest
form of DM and it account for 90 % of disease (Aschner
et al., 2013).
13.2% is the prevalence rate of DM with registered 4,600 people
(International Diabetes Federation, 2014). Estimate of the World Health
Organization (WHO) states that DM prevalence among adults in 2014 was 9%, a
prediction of at least 350 million people with T2DM by 2030 (WHO, 2015). In
accordance with a national survey carried out, the prevalence of diabetes
mellitus in Nigeria increased from 2.2% to 5.0% by 2013 estimates of the
International Diabetes Federation (IDF). Complications of diabetes are common
at the time of presentation in Nigeria: neuropathy 56%, erectile dysfunction
36%, nephropathy 9%, and retinopathy 7% (Chinenye & Ofoegbu, 2013). This is
partly because diabetes is a progressive illness with an initial asymptomatic
phase associated with on-going tissue damage and decline in pancreatic beta
cell mass and function.
Ali, Barke, Bullard, Gregg, and Imperatore, (2012) reported that
glycemic control at the suboptimal level likely cost diabetic patients
increased care requirement, complications and related health care costs.
Improper glycemic control has a link with an increased risk of visual
impairment, kidney failure and cardiovascular disease (Balkau, Borch-Johnsen,
Colagiuri, Lee, Shaw &Wong, 2011). The possible reasons for poor glycemic
control includes poor adherence and awareness, manpower insufficiency, time
constraint, lack of appropriate guidelines on diabetic education for health
practitioners and diabetic patients (Amade, Gudina, Ram, & Tesfamichael, 2011).
Because of lack of awareness, patients with DM suffer from its
complications (Gul, 2010) .
The way to self-management includes testing the blood glucose, adequate diet,
regular examination of the foot and eye, all this have shown to reduce
complications from DM (Aschner et al., 2013; Biswas, Ferrari,
Islam, Islam, Lechner &Niessen, et
al., 2015).Therefore, proper blood glucose control among Diabetes Mellitus
patients prevents short and long-term complications and reduce cost and long
hospital stay.
The aim of self-management of DM is to ensure that the blood
glucose level is at a normal range and to reduce the risk of complications.
There are seven self-care behavior people having DM must ensure to keep their
glucose level normal: they include eating healthy, physically active,
self-monitoring of glucose content, compliance with medication, risk-reduction
behaviors, good problem-solving and healthy coping skill (American Association
of Diabetes Educators, 2010). This measures are useful for physicians managing
diabetic patients and it has impacted positively on glycemic control,
complication reductions and improvement in quality of life (American Diabetes
Association, 2009). Self-management goals and its implementation are written in
collaboration with the diabetic patient and health care professionals, it
promotes patient self-management, decrease the prevalence of DM and its
complications (Ahola & Groop, 2013) .
Haidet, Naik, Rodriguez and Teal (2011), also emphasized the importance of patient education for better
outcomes of self-management of diabetes, stated that patient education is
necessary because it promote high quality diabetic care. Diabetic education
programmes stress the importance of patients comprehending the practical
approach to self-manage their disease condition. Knowledge and understanding
are important in helping patients towards better self-management of diabetes
mellitus.
Education help people having DM initiate good
self-management and coping skill. Continuous DM education help people having
the disease care for themselves.(American
Diabetes Association, 2014).There is good report when intervention is
long term, it includes follow-up and patients care is individualized. Intervention
which promotes behavioral changes improves clinical outcome (Haidet, Naik, Rodriguez &Teal, 2011).Anderson and Funnell
(2013), said that self-management education is
a process of facilitating knowledge, skill and ability, is an important
component of an effective diabetic management. Self-Management place patients
at center of care, empowering patients to make decision that will improve
clinical outcome.
1.2 Statement of the Problem
Diabetes Mellitus has significantly contributed to the
reduction of life expectancy by 15 years and have
increased heart disease incidence by four time (IDF, 2014;
WHO, 2014). In Nigeria, diabetes
mellitus contributes to medical morbidity and mortality (Chinenye, Ogbera,
& Onyekwere, 2013). Patients having diabetes stay long on medical
wards and pay high bills with various complications such as stroke, adult-onset
blindness, lower extremity amputation from foot gangrene, heart/kidney failure and premature death (Fasanmade,
Nwaiwu & Olayemi, 2015; Isezuo, Ohwovoriole, & Sabir, 2013). An estimated 3.4 million persons died of high glucose
level in 2004 & 2010 according to WHO (Fact sheets, 2013).
According to International Diabetes Federation, (2010), the
prevalence of DM in Nigeria varies from 0.65% in rural Mangu to 11% in urban
Lagos state. World Health Organization, (2014), suggest that Nigeria have the
highest number of people having diabetes. In Nigeria, up to 73% of diabetic
patients do not practice self-monitoring of blood glucose (Chinenye, Uchenna,
& Unachukwu, 2010; Chinenye, et al., 2013).
A study done in Malaysia, (Azmi,
Barakatun-Nisak, & Firouzi, 2015) show 72 % of patients with poor
glycemic control and in Ethiopia (Abebe, Alemu, Berhane, Mesfin,
& Worku, 2015)
show two third of patients with poor control.
American Association of
clinical Endocrinologist, (2010) report
that 1 in 3 patients having T2DM is controlled while one and half of patients
comply with medication. It was obvious
from this and other surveys that the status of glycemic control and other
targets such as lipid, glycated hemoglobin (HbA1c), blood pressure levels and
adequate education were below expectations (Chinenye, et al., 2013; IDF, 2012).Therefore, the need for a study on effect
of nurse-led training on self-management of diabetes amongst diabetic patients
attending medical outpatient clinic in General Hospital Odan, Lagos.
1.3 Objective of the Study
The main objective of the study is to evaluate the effect of
nurse-led training on self-management of diabetes amongst diabetic patients.
The specific objectives are to
1.
assess diabetic patient’s
knowledge of self-management of diabetes pre/post-intervention;
2.
determine diabetic patient’s
practice of self-care activities pre/post-intervention;
3.
implement the nurse-led
training on self-management of diabetes;
4.
determine the effect of
nurse-led training on diabetic patient’s knowledge of self-management of
diabetes pre/post-intervention and
5.
determine the effect of
nurse-led training on diabetic patient’s practice of self-care activities
pre/post-intervention.
1.4 Research Questions
The following research questions were answered:
1.
What is diabetic patient’s
knowledge regarding self-management of diabetes pre/post intervention?
2.
What is diabetic patient’s
practice of self-care activities pre/post intervention?
1.5 Hypotheses
The following hypotheses were tested at 0.05
level of significance.
HO1 There is
significant effect in nurse-led training on diabetic patient’s knowledge regarding
self-management of diabetes between pre/post-intervention respondents.
HO2 There is
significant effect in nurse-led training on diabetic patient’s self-care
practice between pre/post-intervention respondents.
1.6 Scope of
the Study
The researcher studied the effect of
nurse-led training on self-management of diabetes mellitus among diabetic
patients. The study was limited to
diabetic patients who attend the medical out-patient’s clinic of general
hospital odan Lagos.
1.7 Significance of the Study
Patients may benefit from this study as the outcome may help
improve clinical performance and decision making. Also, training program may
improve knowledge of diabetes mellitus. It may influence patient’s
satisfaction, cost of care, prevalence, morbidity and mortality rate. It may
improve blood glucose level, prevent acute and chronic complication, enhance quality
of life, maintain cost effectiveness and reduce diabetes burden globally. They
may also benefit as the outcome may improve behavioral changes which includes
blood glucose self-monitoring, adequate diet, adherence to medication, eye
examination and foot care. The hospital management may benefit from the study
as it may positively influence the utilization of hospital resources for better
purpose.
1.8 Operational
Definition of Terms
Operational definition was utilized to define the following terms in the study:
1. Effects: the extent to which a planned training program on
diabetes mellitus achieves the desired outcome as measured
by gain in knowledge and control.
2. Nurse-led
training programme: teaching on diabetes mellitus, prevention, treatment,
and management designed, organized and given by a nurse to improve patient’s
knowledge and control.
3. Diabetes Mellitus (DM)
- A metabolic disease in which the body cannot properly control the amount of glucose in the blood because
it does not have enough insulin.
4. Self-Management- are
activities individuals perform on their own throughout life to promote and
maintain personal well-being thereby preventing complications that arise from
diabetes mellitus.
5. Patients- A person
who is receiving nursing care on diabetes mellitus and has medical diagnosis of
diabetes mellitus.
6. Outpatient clinic- A
patient who receives treatment in a medical facility for the diagnosis and treatment of diabetes mellitus but is
not admitted overnight.
7. General hospital- a state owned
hospital that provides secondary healthcare services as well as training health
professionals.
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