St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

ADVANCED ADULT NURSING III: DIABETES NURSING

From Theory to Praxis

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A Narrative Report on Diabetes Nursing as a Nursing Specialization in Advance

Nursing Practice

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Presented to
Professor Andr N. Canaria, MSN, RN
Course Professor of the Graduate School
St. Paul University Philippines
Tuguegarao City, Cagayan

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In Partial Fulfilment of the Requirements for the Degree

MASTER OF SCIENCE IN NURSING
Major in Adult Health Nursing

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Joseph Celrin V. Macavinta III, RN

March 11, 2017
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 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

1. What is the essence of Diabetes Nursing as an independent nursing specialization in

advance nursing practice?

Diabetes nursing essence as an independent nursing specialization is that they focus in a

specific disease, Diabetes Mellitus. Diabetes nurses have a responsibility to ensure that they have
adequate knowledge in order to provide competent care to patients with diabetes. The treatment
and management of diabetes is complex, involving numerous lifestyle adaptations and requiring
a great deal of teaching and support. Advances in technology have contributed to the need for
education and patient participation in care. Many procedures formerly performed by health care
professionals, such as blood glucose monitoring, are now routinely done at home by patients. In
the past 20 years, nursing has been a major contributor to the improvement in the quality of care
provided to people with diabetes. (Seley, Furst, Gray, Jornsay, & Wohl, 1999)

The Diabetic nurse will be assessing risk, so that appropriate interventions can be made at
appropriate times. In addition, the nurse should regard every annual review or screening visit as
an opportunity to find out what information the patient has and to fill in any gaps, supported by
educational materials. Exploring why patients may not feel able to make changes to their
lifestyle and to undertake suggested treatments may help the nurse to suggest actions that such
patients are likely to follow. (Stephenson & Ford, 2003)

With a steady increase in people being diagnosed with diabetes, there is inevitably going
to be an increase in the number of people needing treatment and management plans, especially if
further complications develop. The Diabetes nurse plays an integral role within the prevention,
diagnosis and adequate management of diabetes. The specialist role can increase skills,
knowledge and confidence, as well as support and empower the person with diabetes to self-
manage their condition and reduce the chances of developing further health complications
(Ashford et al., n.d.).

2. Conceptualize a framework in Diabetes Nursing utilizing any CARING model of

theory studied in Nursing. (Include concepts learned from the course) grounded from a
caring theory or nursing model used in nursing.

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

This conceptual framework is based on nursings major concept just adding Diabetes Nursing at
the center of these concepts. According to Dorothea Orem, The person (or patient) is the central focus
of nursing care. The person's health state is mediated by his/her environment. A person, who is
healthy, is capable of self-care. When there is illness in the person's health state, the person is not able
to complete all self-care requisites. When this occurs, nursing care is needed to assist the person in
completing his/her self-care. Diabetes nurses must assess the person's ability to provide his/her own
self-care and the environmental context of the person in order to overcome health-associated
limitations. In this framework, all concepts are connected to each other, meeting at the center which is
Diabetes Nursing.

3. What are the challenging roles that an advanced nurse practitioner should assume
to take?

There are challenging roles advance nurse practitioners should undertake. The role of
nurse practitioners has expanded to include the diagnosis and the medical management of both
acute and chronic conditions. One obvious advantage of being nurse practitioners is that they can
legally adjust the diabetes medications, order diagnostic tests, and refer patients for
consultations. Diabetes educators who are not nurse practitioners are often faced with delays in
treatment, lack of continuity of care, and additional expense for patients in obtaining physicians'
orders. This limitation has inspired many diabetes nurse educators to consider additional training
to become nurse practitioners (Seley, Furst, Gray, Jornsay, & Wohl, 1999).

Complex treatment plans, exploding technology, and a myriad of new pharmacological

agents can be overwhelming for even the most experienced nurse. Nurse practitioners, who are
advanced practice nurses, have the ability to do in-depth physical exams, order diagnostics tests,
make a diagnosis based on their assessment, and order medications and other medical
interventions as needed. Overall, the nurse practitioner can provide timely, coordinated, and cost-
effective care to the patient and can also be an educational resource for the home care nurse and
other care providers in planning case management. (Seley, Furst, Gray, Jornsay, & Wohl, 1999)

Studies looking at the effectiveness of nurse practitioners in primary care reveal not only
competence but equivalent or slightly improved patient outcomes, most likely because the nurse
practitioners spend more time talking with patients and individualizing treatment regimens. The
trend for more diabetes nurse educators to become diabetes nurse practitioners can only lead to
better care for people with diabetes. In the future, diabetes nurse practitioners could be utilized in
primary care settings where there is a high volume of patients with diabetes. (Seley, Furst, Gray,
Jornsay, & Wohl, 1999)

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

4. As a Diabetes nurse educator, how will you help improve the quality of life of
persons with diabetes?

Improving the quality of life of a diabetic patient is very important. A diabetes nurse
educator focuses on educating individuals with and at risk for diabetes and related conditions to
become effective self-managers. They are effective because they understand the fundamental
concept that the vast majority of diabetes care is provided at the individual and the family
level. In addition, the therapeutic alliances they establish with their patients foster respect,
empowerment, and shared decision making. Beyond academic preparation in their respective
disciplines of origin, diabetes nurse educators possess in-depth knowledge and skills derived
from the biological and social sciences, communication, counseling, and education. This
background, coupled with an extensive knowledge of diabetes management, enables the diabetes
nurse educator to concentrate on helping individuals to identify and to achieve self-management
goals. These goals, often focused on changing behavior, not only lead to improvements in
clinical outcomes, self-management goals also improve problem-solving skills, perception of
overall health status, and quality of life (Burke, Sherr, & Lipman, 2014). Diabetic nurse educator
should manage patients with diabetes effectively and requires a great deal of time, effort, and
patience. Diabetes nurse educator delivers quality, cost-effective care by applying all of the
combined skills and knowledge from their training as nurses, advance nurse practitioners, and
diabetes nurse educators. (Seley, Furst, Gray, Jornsay, & Wohl, 1999)

Diabetes nurse educator should be equip with latest information on how to improve the
quality of life of their patient and should always be ready to improve their knowledge of the
current treatment of diabetes. Professional education that increases awareness of the importance
of diabetes management is a valuable tool in reducing and preventing the complications of
diabetes. Diabetes nurse can serve as role models and educators, offering professional education
in diabetes care and management to their colleagues in primary care. (Seley, Furst, Gray,
Jornsay, & Wohl, 1999)

5. Discuss challenging responsibilities, roles, duties/functions related to this nursing

specialization.

Diabetes Nurse has challenging roles, duties and responsibilities. The role of a Diabetes
Nurse Specialist is diverse and needs to continually evolve to respond to the needs of the
population and the resources available. There are challenges associated with restructuring roles
and financing the recruitment and development of staff. It is clear, however, that the role has an
immensely positive impact upon the prevention and management of diabetes, which in the long
term proves to be extremely cost effective. It is therefore apparent that long term investments

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 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

need to be made for the future care of patients. (Ashford et al., n.d.). Combining the roles of
diabetes nurse educator and nurse practitioner promises to provide more specialized, high-quality
care to patients with diabetes. Nurse practitioners perform certain medical tasks, such as carrying
out physical examinations, ordering and interpreting laboratory tests, and prescribing
medications, while Diabetes Nurse Specialist place a greater emphasis on the role of consultant
and educator to patients, families, and staff. Often not directly involved in care itself, it provides
care providers with the necessary knowledge and skills to deliver care. The blending of the roles
has many advantages. They include greater likelihood of reimbursement and cost effectiveness,
as well as greater role flexibility to include consultation, education, and research. Cost
effectiveness includes any activities that lead to improved outcomes and a reduction in the use of
expensive health care services. Whether involved in direct or indirect care, it is important for
advanced practice nurses to serve as role models and continue to be leaders who creatively adapt
to our rapidly changing health care delivery system. (Burke, Sherr, & Lipman, 2014).

They are also responsible in taking histories, performing physical assessments,

developing differential diagnoses, and actually managing disease, as well as using research
findings to improve outcomes. Prescribing is particularly important in the care of people with
diabetes since medications and devices are commonly recommended (Burke, Sherr, & Lipman,
2014).

6. Cite your references appropriately. Use APA format 6th edition.

Ashford, Cable, S. The role of the diabetes specialist nurse. Retrieved March 5, 2017, from
http://www.southsudanmedicaljournal.com/archive/august-2016/the-role-of-the-diabetes-
specialist-nurse.html
Burke, S. D., Sherr, D., & Lipman, R. D. (2014). Partnering with diabetes educators to improve
patient outcomes. , 7, . Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926770/
Murray, R. R. (2001). The nurse practitioner and home care of the diabetic patient: The role of
clinician and educator. Home Health Care Management & Practice, 13(5), 367374.
doi:10.1177/108482230101300506
Seley, J. J., Furst, P., Gray, T., Jornsay, D., & Wohl, N. R. (1999). The diabetes nurse
practitioner: Promoting partnerships in care. Retrieved March 5, 2017, from
http://journal.diabetes.org/diabetesspectrum/99v12n2/pg113.htm
Stephenson, J., & Ford, S. (2003, January 14). Diabetes: Treatment and complications - the
nurses role. Retrieved March 5, 2017, from https://www.nursingtimes.net/clinical-
archive/diabetes/diabetes-treatment-and-complications-the-nurses-role/205780.article