Advanced Nursing Practice in Diabetic Care Outcome of .ppt

1、Advanced Nursing Practice in Diabetic Care Outcome of Empowerment in Diabetes Education,Rebecca Yee Man WONG RN, BN, MSc Nurse Specialist (Diabetes Care) Diabetes & Endocrine Centre Prince of Wales Hospital Hong Kong SAR,Diabetes Mellitus,Diabetes is a chronic disease A successful diabetes treatment

2、 program requires patientsactive involvement in the management of diet, exercise and medicationMaking changes in their lifestyle is one of the greatest challenges patients face in controlling their diabetes,Diabetes Mellitus,Glycemic control is an important predictor of many of the chronic complicat

3、ions of diabetes ADA Position Statement 2001,Diabetes Control and Complications Trial (DCCT),Significant risk reduction with tight glucose controlReductions in microvascular complications with HbA1c = 7.2% : - 76% retinopathy - 60% for neuropathy - 56% for nephropathyN Eng J Med 1993;329:683-689,Uni

4、ted Kingdom Prospective Diabetes Study (UKPDS),For every 1% reduction in the HbA1c, there is a 35% reduction in microvascular complications:- Control group 7.9% - Intervention group 7%Lancet 1998;352:837-853.,Results of Diabetes Self-Management Education (DSME) on Glycemic Control,Systematic review

5、reports of 31 published, randomized controlled trials to ascertain the efficacy of diabetes self-management education (DSME) in adults with type 2 diabetesExamine the effect of baseline HbAlc, follow-up interval and intervention characteristics on HbAlcHbA1c improved with DSME, with an average chang

6、e of 0.76%Norris et al., 2002,Results of Diabetes Self-Management Education (DSME) on Glycemic Control,HbA1c was lowered in patients who received education from dieticians or diabetes nurses than those who had not (7.9% vs 8.7% ) Chan et al., 2000Patients discharged early and received a follow up pr

7、ogramme by diabetes nurse specialist had a decrease in HbA1c at 24 weeks when compared with those who remained in hospital until the glycemic control is stable (7.6% vs 8.1%) Wong et al., 2004,Intensive Insulin Therapy Program (IITP) in PWH,Pilot program started since 1998 Saturday morning session i

8、n Diabetes Centre Target groups :,- Type 1 and Type 2 patients with multiple dose injection per day (MDI),- BD injection pending to MDI - Patients with insulin pump,Intensive Insulin Therapy Program (IITP) in PWH,Our Objectives To offer Diabetes self care knowledge and skillsTo enhance participants

9、self-efficacy in disease managementTo facilitate peer group support and sharing,Intensive Insulin Therapy Program (IITP) in PWH,Contents of the Empowerment program :,Patient contract Intensive education Group sharing Clinic follow up Lunch together,Intensive Insulin Therapy Program (IITP) in PWH,Pat

10、ients with insulin pump are designated as group leaders to lead the experience sharing DM nurses as partners to provide information on diabetes self care knowledge and skills Other health care professionals such as dietitians, doctors to give education on specific topics,Intensive Insulin Therapy Pr

11、ogram (IITP) in PWH,Topics of the IITP Education Program:Diet : food exchange, food labels, glycemic index, dining out Exercise and weight reduction Insulin dose adjustment Self Monitoring of Blood Glucose (SMBG) Acute complications : Diabetic ketoacidosis, Hypoglycaemia Special issue : traveling, s

12、ick day management Stress management,Intensive Insulin Therapy Program (IITP) in PWH,Mode of education delivery,- Group - Role play - Games - Competition,Program duration,- 22.9 11 months - 6.74 2.9 visits,Intensive Insulin Therapy Program (IITP) in PWH,A summary of subjects characteristics n=39,Int

13、ensive Insulin Therapy Program (IITP) in PWH,Results,Intensive Insulin Therapy Program (IITP) in PWH,ConclusionUp to 12/2005, total no. of patients on multiple dose insulin injection (4 times injection per day) : 258, increase in 10 folds at 5 yearsFriday afternoon session in diabetes specialist cli

14、nic Group education session and experience sharing Clinic follow up visit,Intensive Insulin Therapy Program (IITP) in PWH,Picture of Peer Group Education Session,Intensive Insulin Therapy Program (IITP) in PWH,Picture of Peer Group Education Session,Weight Management Program for Patients with Diabet

15、es in PWH,Pilot programme:12.2003-3.2004 (14 weeks)Target group : type 2 patients with BMI over 25Organised by DM nurses and social worker from Centre of Rehabilitation Network,Weight Management Program for Patients with Diabetes in PWH,Our Objectives To facilitate participants in learning various w

16、eight management skills and knowledge. To enhance participants self-efficacy in disease management. To promote lifestyle modification through psychosocial interferences by group dynamic and peer support.,Weight Management Program for Patients with Diabetes in PWH,A total of 7 sessionsEach session wa

17、s focused on different themes,Diabetes self-care knowledge was incorporated,- general concepts - individual counseling - exercise, diet therapy - lifestyle modification - stress management - common myths,Weight Management Program for Patients with Diabetes in PWH,Contents of the Program :,- Lecturin

18、g - Practicum - Sharing - Therapeutic Games,Weight Management Program for Patients with Diabetes in PWH,Mode of delivery:,Telephone follow-up by social worker in between of visitsWeekly peer-group partners phone contact Learning contractBiweekly objectives were set with participants,Weight Managemen

19、t Program for Patients with Diabetes in PWH,Pre & Post Assessment tools : Diabetes knowledge score (DKN) Self-efficacy rating on disease management Health parameters e.g. BW, HbA1c and lipids profile.,Weight Management Program for Patients with Diabetes in PWH,Overview of the patient group: Total no

20、. of patients : 6 Female : 6 Occupation : housewife Age: 45-53 Initial BW: 68.9kg - 93.9kg Initial BMI: 30.8 - 35.7kg/m/m,Weight Management Program for Patients with Diabetes in PWH,Results,Weight Management Program for Patients with Diabetes,Type 2 diabetes,Twelve aerobic training studies and two r

21、esistance training studies were included (total 504 subjects). Post intervention HbA1c was significantly lower in exercise than control groups (7.65 vs. 8.31%). But post intervention body weight did not differ between exercise and control groups. Boule et al 2001,Weight Management Program for Patien

22、ts with Diabetes in PWH,Conclusion,A significant improvement in health parameters should be proven in the future programme. Mutual-aid support group (fit 形糖) was set up in 5/2004 Frequency of group meeting : once a month No. of attendance per visit : 25 35 patients Patient as group leader to lead ot

23、her patients to do exercise and experience sharing DM nurses and social workers as partners to provide update information regarding diabetes related knowledge and psycho-social support,Weight Management Program for Patients with Diabetes in PWH,Patient-led Exercise Session,Weight Management Program

24、for Patients with Diabetes in PWH,Patient-led Discussion Session,Weight Management Program for Patients with Diabetes in PWH,Patient-led Discussion Session,Constraints of the Empowerment Program,Healthcare Administrators Acute, symptom-driven patient-care Limited resourcesPractitioners DSME program

25、is complex Limited resources High volume patients load No time,Constraints of the Empowerment Program,PatientsAbility to comprehend the materials Lifestyle; socio-cultural, health belief Motivation and collaboration Financial issue,We are each of us angels with only one wing, and we can only fly by embracing one another Luciano de Crescenzo,Thank You for Your Participation,