Nursing intervention for the quality of life of diabetic adults

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Abstract

The purpose of this study is to determine the effectiveness of a nurse-directed intervention (NDI) in terms of improvement in the quality of life (QOL) of the diabetic adults. An evaluative approach with a quasi-experimental design incorporating a non-equivalent pretest posttest control group design was adopted. The sample consisted of 30 diabetic adults in the experimental group and 30 in the control group attending the outpatient departments in the two private hospitals selected by convenience non-random sampling technique. The findings of the study showed that there were statistically significant differences between the QOL mean pretest and posttest scores in the experimental group total QOL, health and functioning, social and economic, psychological and spiritual and no significant differences in the control group. The mean posttest and mean gain QOL scores of the total QOL, health and functioning, social and economic, and family subscales of the experimental group were significantly higher when compared to the control group. Thus findings indicate effectiveness of the NDI in terms of significant improvement in the quality of life of the diabetic adults. The demographic and the clinical characteristics were independent of the QOL scores of the diabetic adults.

Introduction

Diabetes mellitus (DM) is an inherited or acquired chronic disease caused by deficiency in the production of insulin or ineffectiveness of the insulin (insulin resistance) produced by the pancreas. This condition causes an increased concentration of glucose in the blood and the condition later affects other organs of the body. Research studies have shown that the progress of diabetes is also associated with a high risk of developing vascular, renal, retinal and neuropathy complications leading to premature disability and death (Samamta et al. 1991; Elmahdi et al. 1991; Misra 1994).

The WHO Health Report (1998, p. 91) quotes that in India diabetes directly causes approximately 38,000 deaths per year and may contribute to as many as 300,000 deaths annually, including many from heart disease and kidney failure. The number of cases is increasing at approximately 6% a year, making diabetes an important and formidable health problem in India (WHO, 1998, p. 84). The prevalence of diabetes has been found to be approximately 2% in the rural and 3% in urban areas with local peaks as high as 8% with urbanization, changing lifestyles and dietary habits. Thus, diabetes can have a deleterious effect on the overall health and quality of life (QOL) of an individual.

Living with diabetes, an incurable illness affects every aspect of the diabetic person’s everyday life and is a stressful event influencing the quality of life. The individuals need to find ways to live a meaningful life despite their illness. The ultimate adult oriented goal of diabetes care aims to maintain a quality of life, defined by Ferrell et al. (1998) as “a personal sense of well-being encompassing physical, psychological, social, and spiritual dimensions” (p. 217). Since QOL is an evolving phenomenon, it has to be defined and researched in multiple dimensions covering both satisfaction and importance areas. This interest in QOL stems from trends towards satisfaction of personal needs and wishes of the patients that would contribute to better and meaningful use of resources (Parmenter, 1994, p. 90).

The approaches to quality of life has two broad categories, labelled by Ferrans (1997, p. 216) as the “normal life approach” and the “evaluation approach” with four domains, i.e., health and functioning, social-economic, psychological or spiritual and family life. The ‘normal life approach’ indicates how well an individual function within society (satisfaction area) and the ‘evaluation approach’ indicates how a person perceives a particular aspect of life (importance area). The diabetic adult’s satisfaction with a domain of greater importance would contribute to higher overall QOL. Since QOL is considered as a subjective sense of well-being involving importance and satisfaction areas, it could be objectively assessed through the QOL tool used for the purpose of the study as expressed by the diabetic adult.

As a major epidemic of the late 21st century diabetes poses a threat to the public health and is associated with increased biopsychosocial morbidity and mortality, if left untreated. Therefore, these patients must attain the knowledge and the skills required for developing a favourable attitude essential for diabetic control. The diabetic adults have to plan and carry out their self-care activities such as, testing urine and blood, adjusting and administering insulin, balancing diets, exercising, maintaining relationships ect.

Since, the nurse is the one functionary consistently at the patient’s bedside, she has become ‘de facto’ educator and coordinator of education in the complexity of patient care. Patient teaching being an integral independent function of nursing practice, it also bridges the gap between health information and health practices resulting in altered patient’s behaviour in the desired direction. One of the approaches used in the study is a nurse directed intervention (NDI) to improve the QOL, which requires theoretical knowledge and practical experience and skill in assuming the role of the nurse educator.

Prepare and validate the nurse-directed intervention for the improvement of quality of life among diabetic adults. Determine the quality of life of diabetic adults before and after the nurse-directed intervention as measured by Ferrans and Powers Quality of life index-diabetes III version. Evaluate the effectiveness of the nurse-directed intervention in terms of improvement in the quality of life of the diabetic adults.

Section snippets

Review of literature

A cross sectional study was conducted by Larsson et al. (1999) to describe the possible differences in clinical characteristics, socio-economic factors and quality of life between diabetes patients in poor and good/acceptable metabolic control, as defined by levels of the glycosylated haemoglobin (HbA1c). Both the diabetic groups reported lower scorings for physical functioning, general health, vitality and mental health, than did a comparable non-diabetic group from another study. Diabetic

Analysis and interpretation

Null hypotheses used in the study were: there is no significant difference between the QOL mean pretest and the posttest scores of the experimental group of the diabetic adults exposed to NDI. There is no significant difference between the QOL mean pretest and the posttest scores of the control group of the diabetic adults exposed to usual care. There is no significant difference between the QOL mean posttest scores of the experimental and the control groups of the diabetic adults. There is no

Discussion

There are numerous research studies reported in the area of QOL but only few nursing intervention studies related to the QOL of diabetic adults. Several researchers have conducted clinical interventions for various diseases like asthma, cancer, coronary, dialysis, etc. and found its relationship with the domains of QOL. These studies are included for the purpose of comparing the study results.

Lok (1996) revealed that limitation of physical activity was the most troublesome stressor followed by

Acknowledgements

Authors are extremely grateful to Dr. Aparna Badura Ed D, Co-ordinator of PG studies in Nursing, MAHE, Manipal, India, for her guidance and suggestions in the research study.

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