Nurses Role In Diabetes Management – Rebecca Ortiz La Banca, Maria Gabriela Cecco Cavicchioli, Jennifer Pereira, Naomi Santos Cerguera, Gabriela Dominguez, Odette de Oliveira Monteiro
This study aims to explain the roles of nursing staff in diabetes camps. A systematic search of ten health science databases identified ten articles for analysis. Records show that medical staff perform health, educational and administrative tasks at camps for young people with diabetes. Most of the studies were conducted before 2000. Description of the activities performed by the nursing staff will help in the development of guidelines and quality indicators in this area.
Type 1 diabetes is one of the most common chronic conditions in childhood, and young people with the condition and their families require psychological and behavioral adjustments. Providing educational and emotional support is one way health teams can benefit children and their families (Young-Hyman et al., 2016). One strategy that promotes education and support for children is diabetes activity camps.
At diabetes camps, young people have the opportunity to meet other children and adolescents and exchange experiences. Furthermore, diabetes camps help young people to gain independence in self-care, achieve better glycemic control and improve acceptance of the condition (Barone et al, 2016; Venancio et al, 2017, Weisserg et al, 2019).
Camps for youth with diabetes are common in countries such as the United States and Canada. Camp format varies according to specific goals. For example, day camps for children with diabetes and their parents may aim to provide family fun, while full-week camps in which youth participate without parental supervision may aim to promote independence in self-management of diabetes.
Training for health professionals willing to work in diabetes camps is typically provided by organizations such as the American Diabetes Association (2012). Nursing staff are part of the health team responsible for diabetes management and education in the camps. To the authors’ knowledge, most camp staff are undergraduate nursing students who take on this role as a volunteer or summer job. However, the specific role of nurses in this context remains unclear. Therefore, this study aimed to investigate the role of nurses in diabetes camps to inform guidelines on diabetes care.
A systematic review was conducted based on the following research question (Moher et al., 2009; Hastings and Fisher, 2014): “What is the role of nursing staff in diabetes camps?” As shown in Table 1, specific search strategies were used for each of the ten major health science databases.
The search was conducted in April 2019 and included primary studies describing activities undertaken by nursing staff in diabetes camps. Studies of camps for children with chronic diseases other than diabetes were excluded. There is no language or time limit. Two independent reviewers assessed the titles and abstracts of all identified studies and removed duplicates. Eligible studies were consulted for their full texts. A third reviewer was consulted in case of disagreement to reach consensus.
For data extraction and synthesis, the reviewers prepared a table in Microsoft Excel containing the following items: authors; country and year of publication; Study scope and design; Characteristics of the nursing team; and nursing team role.
A search of databases revealed 107 potential studies, and two studies were included through unsystematic searches of reference lists. After reading titles and abstracts, 18 full-text articles were analyzed, yielding a final sample of 10 studies for analysis. Figure 1 depicts the screening and selection for this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (Moher et al, 2009).
Studies included in the compilation were published between 1954 and 2011; Nine were in English and one in Portuguese. Nine studies were empirical reports and one qualitative descriptive study.
High-level details of the ten studies are presented in Table 2. Studies highlight many roles for nursing staff in diabetes camps. The most important of these is to check and evaluate blood glucose data, as well as to diagnose and treat hyper- and hypoglycemic episodes. Performing nocturnal rounds provides better monitoring of glycemic variability, which often lacks signs and symptoms (Kay, 1954; Keyes, 1967; Alcantara and Gonçalves, 1985). Circuits are essential to understand glycemic variability and prevent serious complications.
Nurses were seen in all studies as important to the educational process for diabetes self-management. Supervision and education of insulin therapy improves the quality of life of individuals and reduces the incidence of inadequate insulin absorption and lipohypertrophy (Spray, 2009).
The role of nurses in promoting self-care and autonomy was observed in seven studies. By being encouraged in this, young people with type 1 diabetes change their attitudes and become active agents in their own diabetes management (Kay, 1954; McFarlane and Hames, 1973; Hernshaw, 1975; Rose, 1977; Alcantara and Gonçalves; Morans, 1985, 1985). ; Vogt et al., 2011). Greater adherence to diabetes treatment can provide young adults with healthy lifestyle habits and improve metabolic control (American Diabetes Association, 2019).
Although dietitians have a role in many camp education teams, this review also highlighted the role of nurses in assisting with carbohydrate counting (Vogt et al, 2011). It is highly relevant that nurses receive additional training in nutritional management of diabetes (Ojeda, 2016). Improving healthy eating habits prevents hypo- and hyperglycemic episodes, facilitates insulin dose adjustments and increases safety during physical activity. By teaching carbohydrate counting management, nurses can also help young people with diabetes to have a more varied diet, dispel the belief that people with diabetes cannot eat certain foods, and improve their social lives.
Regarding family involvement in diabetes care, the development of reports and post-camp meetings with family members reinforce the importance of sharing the learning benefits achieved at camp with all family members (McFarlane and Hames, 1973; Venancio et al, 2017) . The role of nurses in family-centered communication was also described in one study, highlighting that some of the difficulties experienced by campers may be part of family issues related to diabetes management. Nursing reports can help family members feel safe and confident in their child’s care when they return home.
Before planning and implementing educational programs aimed at strengthening self-care practices, it is necessary to recognize the problems that each person with type 1 diabetes faces. The managerial role observed in this study suggests that nurses are best positioned to lead educational efforts in diabetes camps. Nursing staff were recognized as responsible for managing the camp’s health supplies and organizing the emergency team (Alcantara and Gonçalves, 1985; Foster, 1989). As nurses are trained to manage physical, human and informational resources to achieve better health care (Molayaghobi et al, 2019), our findings strengthen the capacity of nurses in coordinating camp activities to provide better care to youth with diabetes.
The role of nursing staff in diabetes action camps includes hygiene, psychosocial support and camp management. Studies of the role of nurses in diabetes camps recognize the work of these professionals and improve practice. Future studies are needed to understand the training standards required by nursing staff to assess nursing performance and quality indicators. Furthermore, future work in the field of diabetes nursing in camps should document the characteristics of these professionals and expand the current understanding of their roles, strengthening the relevance of nurses in diabetes camps and nursing education.
Mohr T, Liberati A, Tetzlaff J, Altman TG; PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA report.
Molayaghobi NS, Abazari P, Taleghani F et al (2019) Overcoming the challenges of implementing a chronic care model in diabetes management: an action research approach.
Ojeda MM (2016) Carbohydrate counting in the acute care setting: development of an educational program based on cognitive load theory.
Venancio JMP, La Banca RO, Ribeiro CA (2017) Benefits of participating in a self-care summer camp for children and adolescents with diabetes: mothers’ opinion.
Vogt MA, Chavez R, Schaffner B (2011) Undergraduate nursing student experiences at a camp for children with diabetes: impact of a service-learning model.
Young-Hyman D, de Groot M, Hill-Briggs F et al (2016) Psychosocial care for people with diabetes: American Diabetes Association position statement.
Weissberg-Benchell J, Vesco AT, Rychlik K (2019) Diabetes camp still matters: relationships, strengths, and self-care skills with diabetes.
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