Abstract

The number of people being diagnosed with diabetes mellitus is currently increasing each day throughout the world, especially in Cameroon. This work was been carried out at the Regional Hospital Buea, south west region of Cameroon.

This work was basically “to assess nurses’ knowledge on the Causes, Management, and Prevention of diabetes mellitus at the Regional Hospital Buea”. This was a hospital based cross-sectional study, where samples were collected using well-structured questionnaire from participants.

The data collected from a total of 50 participants, was calculated and analyzed using x-cell. Out of the 50 participants who attempted the questions, 92% were aware that autoimmune destruction is the primary cause of type 1 diabetes mellitus (DM), 70% were equally aware that insulin resistance is the primary cause of type 2 DM, while 90% were also aware that hormonal changes are responsible for gestational DM.

However, 100% of the nurses were fully aware that insulin therapy is the most effective in managing type 1 DM, while 80% were equally aware that patient education and engagement into physical exercise can help in managing gestational DM, 80% were also aware that local food habit and belief are some cultural sensitive approaches which a nurse must consider when managing patient with DM.

Nevertheless, 72% of the nurses were aware that genetic studying and immunotherapy are the best way to prevent type 1 DM, 96% were equally aware that lifestyle modifications and dietary changes are the most effective in preventing types 2 DM, 90% were also aware that prematenal educational and engagement into physical exercise can help to prevent gestational DM, while 84% were equally aware that early detection, plus regular monitoring of patient’s blood glucose level are key strategies for preventing diabetes mellitus. Hence, nurses at the Regional Hospital Buea have significant knowledge on the causes, management, and prevention of diabetes mellitus.

However, a better understanding on the causes will help identify patients with DM within our society, as well as home-based intervention program can be applied by nurses to ease the management of DM, while an improve research to elevate the benefits of low-cost screening tools, as well as efficacy, cost-effectiveness, and sustainability of cultural approaches will help prevent the disease.

CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

Diabetes mellitus (DM) is a chronic, metabolic disease caused by defects in insulin function, insulin discharge, or both, which eventually results in increased blood glucose levels. (Galicia-Garcia. et al., 2020) According to the World Health Organization (WHO)., (2022), the actual cause of diabetes mellitus varies depending on the different types: type 1, type 2, and gestational diabetes mellitus. The disease is a serious pandemic disease whose incidence is expected to increase drastically by 2030 to 2045 if nothing is done. (DG Teuwafeu et al., 2021) Approximately one person dies every six seconds for diabetes globally, with increasing frequency and severity of its complications. (DG Teuwafeu. et al., 2021) Diabetes related deaths are mainly secondary to its complication with chronic kidney disease (CKD) being one of the most implicated. Appropriate knowledge towards diabetes mellitus amongst nurses on the causes, management and prevention are mandatory for educating, managing and preventing the disease. Hence, this study aims to assess nurses’ knowledge on the causes, management and prevention of diabetes mellitus at the Regional Hospital Buea.

1.1 Background of the Study

Globally, DM is one of the top four non-communicable diseases and the most common metabolic disorder. The major DM types include type 1 DM (T1DM) and type 2 DM (T2DM), where T2DM is more prevalence compared to type 1 and accounts for 90–95% of all DM cases. (Dabelea D. et al., 2014) DM is considered as a main public health concern globally due to the steady rise in the number of people with diabetes (PWD). (Cho N.H. et al., 2o18 and Zhou B. et al., 2016).

It has been reported by the WHO (2021) that globally, the number of adults with DM has significantly increased from 108 million in 1980 to 422 million in 2014, and up to 537 million adults in 2021.

However, this number will continue to increase to 643 million by 2030 and up to 783 million adults by 2045. (International Diabetes Federation (IDF), 2021) In the adult population, the worldwide occurrence of DM has almost doubled since 1980, increasing from 4.7% to 8.5%. Globally, DM-associated deaths also markedly rose by 70% between 2000 and 2019. DM is rapidly increasing in developing countries wherein around 77% of people with diabetes (PWD) live in middle and low-income countries. (Carstensen B. et al., 2020 and Cho. N.H et al., 2018)

According to the International Diabetes Federation, DM cases will continue to increase and will reach 9.9% by 2030 worldwide.(Whiting D.R. et al., 2011) PWD are at greater risk of complications and more prone towards a longer length of stay in hospital.(Comino E.J. et al., 2015) In 2019, the National Diabetes Inpatient Audit (NDIA) reported that 18% of all hospital beds were occupied by PWD, which had risen from 14% in 2010.(Silhouette F. et al., 2021) Therefore, DM requires attention since DM-related complications can result in poor health outcomes and an overuse of healthcare resources and services.

In most cases, DM is a secondary reason instead of the primary reason for hospital admission, thus individuals are more commonly under the care of non-diabetes specialists. Furthermore, it has been reported that the doctors in training in these teams often lack extensive knowledge in managing DM, where only 28% were found to be fully confident in DM management.(George  J.T. et al., 2011) Along with other specialties, specialist nurses and nursing teams are increasingly becoming involved in providing care to people with diabetes (PWD).

These nurses deliver education and support for both patients and staff across specialties and give clinic or phone contact to facilitate the discharge of patients or avoid hospital admission in a timely manner. Nurses are in a better position to provide care and education to PWD compared to other healthcare professionals since nurses spend most of their time with patients.

In addition, nurses are also in a better position to provide measures and best care practices to patients regarding diabetes management compared to other healthcare professionals including doctors.(Alhaiti.A.H et al., 2019) In a study, Lou et al., (2014), concluded that nurses are typically better listeners and possess better knowledge of PWD compared to other healthcare professionals.

Collectively, these findings suggest that the commitment and attitude of nurses to the care of PWD are usually higher compared to other healthcare professionals. (Alhaiti A.H. et al., 2019) Diabetes inpatient specialist nurses are highly skilled nurses who can coordinate, educate, counsel, motivate, lead, and help in the care management of PWD in diabetes care. The National Health Service (NHS) also reported the significance of diabetes inpatient specialist nurses (DISNs). Moreover, the National Institute of Clinical Excellence (NICE) recommended that there should be at least one diabetes inpatient specialist nurses (DISNs) per 300 hospital beds. (Dhatariya K. et al., 2012) However, still there is a lack of dedicated DISNs in clinical settings. In 2018, the NDIA reported that there are still no dedicated DISN in 22% of hospitals. (Dhatariya. K et al., 2018)

The growing rate of DM indicates that there is a need for new models of practice and care for DM management. Various studies have also suggested the necessity to prepare nurses with the required knowledge to facilitate best practices for PWD. There is also ambiguity regarding the roles of nurses in providing care for PWD, which is predominantly seen in countries including Saudi Arabia that do not have DISNs as a recognized group.

Moreover, although nurses contribute significantly to efficient DM management, their collaborative contributions with other healthcare providers are less recognized. (Alshammari M.A. et al., 2021) Nevertheless, healthcare systems are increasingly embracing nurse-led models that are supposed to be more patient-centered, as opposed to the traditional physician-led models that reflect a medically-oriented model of care.

It has been revealed that with proper training, nurses can efficiently play roles in the management of DM, and present trends have observed a change in the tasks executed by nurses, which were formerly provided by physicians. (Alshammari. M.A et al., 2021) Furthermore, nurses can develop, implement, and ensure effective DM interventions by directly providing care delivery, supervising care delivery, and training non-medical personnel in providing DM care for a range of patients. (Hunt. C.W et al., 2013)

This review project summarizes a number of nursing interventions and roles as educators and motivators as well as caregivers that play important roles in DM management. In addition, a range of outcomes that are measured to evaluate the impact of nursing interventions and the strategies to overcome the existing and emerging challenges for nurses in diabetes care are extensively discussed.

1.2 Statement of the Problem

Diabetes mellitus is a growing public health concern worldwide, with increasing prevalence and complications that pose significant challenges to the healthcare systems. Nurses play a critical role in the prevention, management, and education of patients with diabetes. However, inadequate knowledge among nurses regarding the causes, management, and prevention of diabetes mellitus can lead to suboptimal patient care, delayed interventions, and poor health outcomes.

At the Regional Hospital Buea, the level of nurses’ knowledge on diabetes mellitus remains unclear, raising concerns about the quality of care provided to diabetic patients. Despite various training programs and clinical exposure, gaps may exist in nurses’ understanding of the causes, management, and preventive strategies of the disease. Identifying these gaps is essential to improve nursing education, enhance patient outcomes, and reduce diabetes-related complications.

This study aims to assess the knowledge of nurses at the Regional Hospital Buea regarding the causes, management, and prevention of diabetes mellitus. The findings will help identify areas that require further training and policy improvements to strengthen diabetes care and education within the hospital setting.

1.3 Rationale

This study is as a result for better understanding of the present state of my mother and other family members who have already been diagnosed of DM.  It will also help to know how to manage her present health condition properly and those of the others. And equally, this study is going to help me know how to prevent myself and others who have not yet been diagnose from having the disease.

1.4 Research Questions

1.4.1 General Research Question

• What knowledge do nurses at the Regional Hospital Buea have on the causes, management, and prevention of diabetes mellitus?

1.4.2 Specific Research Questions

1. What knowledge do nurses at the Regional Hospital Buea have on the causes of diabetes mellitus?
2. What are the management strategist employ by nurses in the management of diabetes mellitus at the Regional Hospital Buea?
3. What are the preventive measures employ by nurses in the prevention of diabetes mellitus at the Regional Hospital Buea?

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