Abstract
Objective. To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design. Focus-group interviews. Subjects and setting. Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results. Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion. Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.
Highlights
The dramatic increase in the prevalence of diabetes worldwide threatens the health and quality of life of millions of people and represents a major challenge to already burdened health care services in providing high-quality diabetes management [1,2]
Nurses and nurse assistants in primary care settings depended on various types of support from colleagues with specific clinical knowledge of diabetes to interpret and act on their clinical observations
This, in turn depended on their diabetes-related knowledge and competence: We have to find out what to discuss with the doctor and what we can do ourselves ... and whether it is good enough for ... what is best for the patient
Summary
The dramatic increase in the prevalence of diabetes worldwide threatens the health and quality of life of millions of people and represents a major challenge to already burdened health care services in providing high-quality diabetes management [1,2]. Many elderly people have several comorbidities and complex care needs, take multiple medicines, are vulnerable to isolation and depression, and are at risk of adverse events such as falls and medicine mismanagement [3,4]. Nursing home residents in the United Kingdom have an average of four comorbid conditions in addition to diabetes and have significant care needs and deficiencies [5,6]. Care of elderly people is inadequate in the Nordic countries [9,10]. Less than 20% of the people with type 2 diabetes in Norway achieve the recommended treatment goals in primary care [9], and diabetes care in Sweden’s home nursing services is inadequately documented [10]
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