article review

The Role of the Nurse in Diabetes Management in Primary Care

Kieonna Stewart

Indiana Wesleyan University

GNUR-501: Evidence-Based Communication

Sandra Horton

January 29, 2020

Abstract

Nurses play a major role in the education of diabetic patients. Together with the provider, the registered nurse helps educate the patient about the disease process, medications needed to control the disease and lifestyle changes that need to be met to ensure optimum health. The nurse also provides a contact person for the patient and for the other disciplines involved, such as pharmacy and dietary, necessary to effective patient care. The goal is to help the patient realize that they are ultimately responsible for their own care while giving them the necessary tools to ensure compliance with the agreed-upon treatment plan. Research has shown the use of a transtheoretical theory model of behavior change and empowerment can improve patient engagement. When the nurse is involved in patient care, research has shown improved measurables of blood pressure, hemoglobin A1C, and cholesterol. The use of critical thinking skills to implement a plan is vital for diabetes management.  

The Role of the Nurse in Diabetes Management in Primary Care

At the beginning of my nursing career, I worked in the hospital as a floor nurse. Healthcare providers, including physicians and nurses in acute care settings, are more focused on the disease process, not holistic care.  I noticed many of the patients were admitted for the same issue—complications of their diabetes. I wanted to make a difference in their lives using prevention instead of dealing with the complications of the advanced disease process. I switched positions and became a nurse in primary care. I specialize in diabetes management education. The unique role of the nurse in primary care will be explored. The theories used when helping the patient manage their disease will be described. The best practice for diabetic patients will be reviewed. The ethical considerations to identify when treating an individual with diabetes will be examined. My role as a diabetes nurse is unique. 

The Unique Role of the Nurse in Primary Care

In 2017, the cost of diabetes annually was 327 billion dollars (American Diabetes Association, 2020, p. S8). In primary care, the nurse has a unique role with the diabetic patient. The purpose of the nurse’s role is to give the patient the tools required to self-manage his or her chronic disease. The nurse also helps the patient with cost containment by making sure the medication list is accurate and cost-effective. It is different in acute care where at discharge, there was a small education piece, and then the patient was instructed to follow up with their primary care provider. It is required to know how to think critically in an environment where the patient has more control in comparison to the hospital. Diabetes is such a complex disease; it can be challenging to manage the condition without a support system. “Patients with diabetes are increasingly monitored by nurses in . . . family practice. These nurses can play a crucial role in helping patients to engage in behaviours that affect their health in a positive way” (van Dijk-de Vries et al., 2016, p. 59). 

A typical appointment with the primary nurse is 60 minutes in length. During this time, the patient will answer basic questions about their general health The nurse explores the patient’s learning preferences, such as if they prefer visual or audio teaching aids. This appointment also allows the nurse to learn about the patient’s social determinants of health and support system at home. Goals are set with the nurse, and the patient is held accountable for the progress of the goals set in follow up visits. But to set goals, the nurse educator must first assess the patient’s readiness to learn.

The Use of the Transtheoretical Model of Behavior Change and Empowerment

To assist the patient in lifestyle change, first, the nurse must assess the patient’s willingness to change. The trans-theoretical model of behavior change is a resource I use in my practice. According to Newell (2018)

The use of the trans-theoretical model (TTM) of behaviour change can assist the DSNIC [diabetes nurse specialists in integrated care] in providing the most appropriate support and information based on a patient’s readiness for change and his or her level of confidence to engage in the behaviour, e.g. smoking cessation, increased physical activity and eating healthy foods. If the patient is not ready to change lifestyle behaviours, the DSNIC accepts his or her decision and offers friendly non-judgemental advice, leaflets and future support. If the patient intends to make changes in the near future, the DSNIC assists him or her to consider specific, measurable, achievable, realistic and timely (SMART) goals while providing support and encouragement with relevant information. (p. 2)

 The next technique used as the diabetes nurse is empowerment. It is shown when the patient is empowered; they are more likely to see the benefits of changing their behavior to improve their health. It also increases the likelihood of effective self-management skills (Newell, 2018). It is crucial to ensure the goals are collaborative to increase the chance of accomplishment. The use of motivational interviewing will help the patient realize the problems and develop a plan. Patient education is vital. Once I have gauged the patient’s willingness to change, I introduce other disciplines in the care of the patient.