Attitudes in diabetes education

A contribution of qualitative research to a better understanding of diabetic patients

“…The average Amencan child who developed diabetes at age 10 years m the beginnmg of the 1980s could expect to live only to age 55 m companson with an expectahon of 70 years and over for the average non-diabehc child of similar age (MacnuUan et al 1983) Today, some experts hold a more optirmstic view because of new techniques, such as self-momtormg of blood-glucose which is ]udged to be crucial for metabolic control of msulm-dependent diabetes melhtus (Dupuis et al 1980 Self-care demands knowledge and thus diabetes educahon is seen by many as an mtegral part m the care of diabetic pahents (McCulloch et al 1983, Assal et al 1985, Dunn & Turtle 1987 Neither education nor self-monitonng per se, however, seem to be effective m improving metabolic control or quality of hfe (Alberti et al 1982, Assal & Aufseesser-Stem 1986, Dunn & Turtle 1987, Ferguson 1988, Korhonen et al 1983, Lockington et al 1989, Tattersall & Gale 1981 Recent studies about pahent educahon stress the importance of givmg proper considerahon to athtudes and behefs (Ferguson 1988, Lodangton et al 1989 Some Swedish studies report most of the lnsuhn-dependent patients as having poor control (Karlander & Kmdstedt 1983, Uthne 1988), which IS not surpnsmg ccmsidenng that compliance in chrome illness, m general, is estimated at a mere 50% (Surwit et al 1982, Cameron & Gregor 1987 Poor metabolic control could also be explamed by the fact that pharmaceuhcal remedies for hreatmg di^jetes are shll poor subshtutes for the funchon of the healthy pancreas Emanahng from the assurance that metabohc control is a means of aduevmg a normal life span and a good quality of We, the care of diabetK pahents m general carmot m any way be viewed as a success (Macmillan et al 1983, Assal et al 1985, Luft 1986, Uthne 1988 In the recent hiaahnx there is a concem about the paradox, 'that we believe that we know so much about diabetes but still are not able to reach the goal to hmit the late complications' (Luft 1986) Luft mentions three 'roadblocks' for good care on the way to the patient 1 the distance between basic and apphed research, and diabetes care m broad terms, 2 the distance between care aimmg at a few diabehcs, and care for the total populahon of diabetics, and 3 the distance between diabetes as defined from a stnct medical viewpoint as a metabolic disturbance, and the pahent's expenence of his disease as a medical but also social and psychological problem…”

“…The patient himself is the most important person m the management of his own diabetes Diabetes melhtus is the result of msuffiaent insulm production by the pancreas m that resjject it ts obvtously a disease, m the medical sense However, the mdividual, diagnosed as havmg diabetes, is not necessanly defmmg himself as having an i//ness, if refernng to the person's subjedive expenences (Bond & Bond 1986) The mdividual will not evaluate his regimen m terms of whether or not it allows him to mamtam a state of physical health Rather as Strauss et al (1984) state, regimens 'are judged on soaal rather than medical bases' This sometimes leads to a misconception by the health care personnel that the person is dismterested m his health, a matter which may or may not be true It has been lmpked that non-comphant pahents are those who have most anxiety about the management of their disease (Anderson et al 1981,Allenrffl/ 1984) Thissupportsthenotionthatnoncompliance is not the same as carelessness Non-compliant behaviour might be caused by complicated circumstances People act differraitly dependmg on their mterpretahons of the total situation Dial^ic pahents and their families need help and support from the health care system, m order to balance the complex connechons between food, msulin, exercise and emohons, which are some of the mfluencmg factors It has already been imphed that diabehc pahents, like many others sufieni^ from c^onic ccmditions, need more 'canng' than 'cunng' -at least as loi^ as the disease is uncomplicated fiiom a mabcal pomi of view The need to mtegrate knowledge frc»n the biomedtca], psycJioscKial and fields has long been acknowledged (Assal & Aufseesser-Stem 1986, Bradley 1985, Ferguson 1988, Johnsson 1980 Although these authors do not exphatly menhon nursing care, their ideas are in line with the foundations of professional nursing care Professional nursmg care implies that canng is the essence of nursmg and the unique and unifymg focus of the profession (Leimnger 1985) Canng means dealmg with pahents rather than dealmg vnth diseases There is, m nursmg, an ambihon to integrate knowledge and expenence from different sources in order to mterad with pahents and their health problems A qualitative paradigm…”

The Fine Balancing Act of Managing Diabetes

“…Recognising patients' difficulties in maintaining appropriate selfcare, researchers have produced a growing body of literature into diabetes management and diabetes care. Examples are studies on psychological and psycho-social aspects of diabetes, such as the effects of stress on diabetes control (Jacobson et al 1985), and studies of the outcome of diabetes education (Dunn & Turtle 1987, Ferguson 1988. Some research in this field has its focus on coping and adaptation (Armstrong 1987, Hamburg & Inoff 1983.…”