Life with diabetes - monologue or dialogue

Diabetes nurse Mette Due-Christensen

Background
The development of late diabetic complications of type 1 diabetes is a severe physical, psychological and social strain for the sufferer and also very costly for society. Improved diabetes monitoring means a reduction of the risk of late diabetic complications, and in most cases also an increased sense of wellbeing for the individual. Although medical treatment has made a difference, the key to good diabetes management lies in the individual relating to his/her diabetes.

Purpose
The starting point was how the individual relates to his/her diabetes. The aim of the project was to discover who or what motivates the person with diabetes to improve his/her management of the disease, and also to investigate the significance of nursing consultations in changing the individual’s behaviour.

Design
Data were collection during face-to-face interviews using a semi-structured interview guide. The participants were aged 21 years or older, and had had type 1 diabetes for at least three years. The management of their diabetes had improved, assessed from a drop of 1.5% in HBa1C over a maximum period of one year; this improvement had been maintained. Sister Callista Roy’s synthesis of chronic disease was used as a reference frame for the analysis of the interviews. Based on the synthesis, the interviewees were divided into three sub-groups according to the following characteristics:

Developing realization / the integrated
Consequential realization / the compensatory
Stationary realization / the distanced

The project’s conclusion:

recognition of which influence diabetes has on the individual’s self-realization plays a role in motivating the individual to consciously change behaviour in order to improve his/her management of diabetes
the dialogue about diabetes and the precautions that accompany the illness, promotes the individual’s motivation to develop the ability to master diabetes in all areas of life
the motivation to develop the ability to master diabetes in the physiological area is increased when the individual can relate to actual late diabetic complications and their consequences
improved diabetes management is not necessarily founded in motivation for improvement

Conclusion concerning the significance of the nursing consultation
In general, the nursing consultation provoked changes in the interviewees’ self-injection technique.

Those from the “integrated” group thought that it would be beneficial if the nurse focussed more on the psychological aspects of life with diabetes

The project’s recommendations:

to educate the diabetes care team to better enter into a dialogue with the individual patient on the psychological aspects of life with diabetes
to perform additional studies on the significance of realization in improved diabetes management
to educate the nurses to better evaluate the degree of realization in people with type 1 diabetes
to examine how different educational strategies can be applied to different types of people with type 1 diabetes