The Role of Nurses and Midwives in the Management of Type 2 Diabetes

Health promotion contributes significantly in the management of type 2 diabetes (T2D). Diabetes continues to be ranked among the leading causes of death on the globe hence the need to manage it. Nurses and midwives are identified as the major players in the implementation of various healthcare promotion strategies in order to manage T2D. This paper looked at the role nurses and midwives play in implementing the five major strategies stipulated in the Ottawa Charter for Health Promotion of the year 1986. It has been established that nurses and midwives are in constant interaction with the community members which earns them community trust that enables them to collect information necessary for policy development, educating the community on the various aspects of health, creating a supporting environment, reorienting healthcare systems and encouraging the development of personal skills among the community members as a way of managing T2D. The knowledge generated in this paper can be used by various practitioners in the healthcare profession who handle diabetes patients.

            Keywords: Health promotion, Ottawa Charter, Type 2 Diabetes, Nurses, Midwives

Introduction

Health promotion refers to a process that is aimed at enabling an individual to have an increased control over his/her health as well as bestowing to him/her with the ability to improve his/her health. It focuses on the behavior of an individual to a wide range of environmental and social interventions (“World Health Organisation”, 2018). The concept of health promotion first came to the limelight in the year 1986 following the ”Ottawa Charter for Health Promotion” and ever since professionals in the healthcare sector have constantly re-defined suitable health promotion strategies. Five important action plans were identified in the Ottawa Charter for Health Promotion. These action plans aimed to (i) build a healthy public policy, (ii) strengthen community action, (iii) create supportive environments (iv) reorient health service, and  (v) develop personal skills (Hung, Chiang, Dawson, & Lee, 2014). The aim of this paper is to elucidate the role of nurses/midwives in the implementation of the five major strategies described in the Ottawa Charter with major emphasis on the management of Type 2 Diabetes (T2D).

Type 2 Diabetes (T2D) is a chronic, non-communicable disease that has continuously gained prevalence at the global scale. According to literature, the disease arises from genetic predisposition coupled to environmental factors (Asif, 2014). The disease is characterized by the inability of an individual’s body to secrete enough insulin, total loss of insulin synthesis ability or inability to make use of the synthesized insulin. Its treatment and management remain elusive and expensive while patients are at a higher risk of suffering from other debilitating complications e.g. cardiovascular diseases, nephropathy, peripheral vascular disease, blindness, disability and premature death (Asif, 2014).In addition, it imposes economic and medical burdens on the patients and their families. The aim of this paper is to elucidate the role of nurses/midwives in the implementation of the five major strategies described in the Ottawa Charter with major emphasis on the management of T2D.

Building a Healthy public policy in Management of T2D

            To build a healthy public policy goes beyond the scope of healthcare. In essence, it puts health agenda among the policy makers with the aim of making them appreciate the health consequences that depend on their decisions. In order for policymakers to make sound decisions regarding T2D, it is necessary that they make evidence-based policies. Just like any other health concern, policies aimed at controlling and managing diabetes need to be evidence-based. The nurses and midwives have the sole responsibility of identifying the obstacles faced in the attempt to manage the diseases. This should be attained through sound research carried out by nurses. The evidence obtained from such research findings should be forwarded to policymakers in order to allow them to come up with healthy public policies in the health sectors which can be used to manage diabetes in the affected communities. In addition, various non-health obstacles contributing to diabetes can also be identified during the research and these can be used by policy makers to come up with ways of removing them.

Strengthening Community Action

For health promotion to work effectively, a concrete as well as an effective community action need to be in place. These come in terms of setting up priorities, decision making, strategic planning and their ultimate implementations with the aim of achieving a better health. The entirety of this process depends on community empowerment so as to enable them to gain control and ownership of their destinies and endeavors (WHO, 2018). Nurses and midwives are better placed to strengthen the community action plan towards the management of T2D since they earn public trust as well as respect. In addition, they get access to different population levels during their practice. The nurses and midwives are also strategically placed in such a way that they can provide the much-needed assistance both at the individual and the community level (”Human resource for Heath Observer” 2018). Through their interaction with the community, they are able to educate the community on the various risk factors associated with diabetes. Through this approach, various policies such as the need for a smoke-free environment, promotion of physical activities, provision of education and guidance on the proper diet as well as encouraging cessation in smoking behavior can be effectively achieved.

Creating supportive environments

Supportive environments are key concepts not only in the management of diabetes but in health promotion as a whole. These environments are aimed at making the physical, economic, social and political environment supportive of health (Pham & Ziegert, 2016). Nurses and midwives can promote health through health education. Through health education forums, the community is taught on the need of getting involved in physical activities as an approach to controlling T2D. Nurses and midwives can also use these education fora to teach members from a disadvantaged community on the need of taking control of their health as well as their environment. The community can, for instance, be taught on the need of researching on the local health needs. Nurses and midwives get involved in creating a supportive environment for diabetic patients by ensuring that diabetic patients have access equitable health facility. They can also consult with the diabetic patients and identify the best approach to handling their wellbeing and health. Diabetic patients are most likely to sink into stress and depression and as such nurses and midwives can be involved by putting in place stress management programmes for the T2D patients (”Department of Health and Human Services” 2018)

Strengthening community action

Strengthening community action is vital for the effective functioning of health promotion. Nurses and midwives can help to strengthen the community actions in a number of ways such as making decisions, setting priorities, planning strategies and the implementation of the set strategies so as to achieve a better health (WHO, 2018). Through this actions nurses and midwives are able to empower the community in relation to taking ownership of their health as well as controlling their destinies and endeavors. As an attempt to meet the goal of strengthening community actions, nurses can champion for health actions that aid in bringing about favorable economic, political, social, cultural, behavioral, environmental as well as biological factors among members of the community. Through such, community members will get the need to take control of factors influencing their health. For instance, diabetes is an epigenetic disease. This means that individuals may be bearing mutations that predispose them to T2D. These mutations need to be stimulated by interacting with the right environment to give rise to a pathological condition. As such, when the community is strengthened through education where they are made aware of the risk factors associated with diabetes, they will be cautious of such factors hence promoting health.

Reorienting health services

According to the ”Ottawa Charter on Health Promotion”, health promotion responsibility in health services should be shared among a myriad of individuals, health professionals, community groups, governments and health services institutions. The different groups need to work concurrently in order to ensure an effective health care system is attained so as to manage the non-communicable diseases such as diabetes. T2D diabetes patients have specific health needs which are different from other patients hence nurses and midwives should come up with ways of supporting this group of patients in order to enable them to achieve a healthier lifestyle. Nurses and midwives need to adopt universal health care policies so as to achieve high quality health services tenured to diabetic patients. In most cases and most often among the developing countries, the bulk of diabetic patients come from poor backgrounds such that most of them rely on the government offered facilities for treatment. Their social status denies them the opportunity of accessing quality health that is offered by private health care facilities. It is thus the responsibility of nurses and midwives to ensure that the T2D patients coming from poor background receive the best quality of health they deserve and stop viewing the care offered to them as a charity which is the scenario in most public health care facilities (Bhojani, 2016).

Nurses and midwives should get involved in reorienting the health care systems such that the six blocks that define a working health care system are attained. These include the availability of a health workforce, provision of quality health services, provision of information to the patients, ensure that diabetic patients have access to modern technologies and most importantly ensure proper leadership. In addition, nurses need to work as role models to the community. Obesity is known to be a predisposing factor to T2D hence the health professionals need to remain fit as a way of educating the community on the need of physical fitness (Bhojani, 2016).

Developing personal skills among diabetic patients

Personal skills can be developed by the community through access to health education, health information and enhanced life skills. Nurses and midwives have the responsibility of ensuring that the T2D patients get access to vital health education and information. In addition, they should ensure that the community at large has access to health information about diabetes management and control. Through such approaches, people will have the chance to learn throughout their life on the various aspects of the disease and measures that can be put in place to curb the disease. The patients will also gain vital information that will enable them to cope with the chronic condition.

Conclusion

In conclusion, nurses and midwives are central to the management of diabetes within a community set up. Their constant interaction with the community members earns them trust among community members and this trust is key to attaining health promotion. Their interaction with the community at various stages also enables them to collect vital information necessary for policy development. These then implies that nurses and midwives have a significant role to play in the implementation of five strategies for health promotion stipulated in the Ottawa health promotion charter.

References

Asif, M. (2014). The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion, 3(1), 1. https://doi.org/10.4103/2277-9531.127541

Bhojani, U. (2016). Enhancing care for urban poor living with chronic conditions: role of local health systems. https://doi.org/9789078344445

Department of Health and Human Services, Supportive environments. Retrieved on April 7,            2018    from http://www.dhhs.tas.gov.au/wihpw/principles/supportive_environments

Hung, T. T. M., Chiang, V. C. L., Dawson, A., & Lee, R. L. T. (2014). Understanding of factors that enable health promoters in implementing health-promoting schools: A systematic review and narrative synthesis of qualitative evidence. PLoS ONE, 9(9). https://doi.org/10.1371/journal.pone.0108284

Pham, L., & Ziegert, K. (2016). Ways of promoting health to patients with diabetes and chronic kidney disease from a nursing perspective in Vietnam: A phenomenographic study. International Journal of Qualitative Studies on Health and Well-Being, 11, 30722. https://doi.org/https://dx.doi.org/10.3402/qhw.v11.30722

The Ottawa Charter for Health Promotion. Retrieved on April 7, 2018 from          http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html