Abstract
BackgroundDiabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes.MethodsThis study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory.ResultsPeople with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring.ConclusionSelf-management consists of a complex and dynamic set of processes and it is deeply embedded in one's unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.
Highlights
Diabetes mellitus is a major public health problem
In the Maastricht shared-care model, diabetes patients have been allocated to three types of care pathways: (a) patients with complicated health problems that may require radical medical decisions are referred to a medical specialist; (b) general practitioners provide basic care for the less complex cases and home health-care nurses provide the essential daily diabetes care; and (c) the diabetes specialist nurse (DSNs) has an intermediate position between the medical specialist and the general practitioner
The analysis of participant's descriptions of their self-management practices as related to autonomy resulted in three processes: daily, off-course, and preventive self-management
Summary
Diabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. In the Maastricht shared-care model, diabetes patients have been allocated to three types of care pathways: (a) patients with complicated health problems that may require radical medical decisions are referred to a medical specialist; (b) general practitioners provide basic care for the less complex cases and home health-care nurses provide the essential daily diabetes care; and (c) the diabetes specialist nurse (DSNs) has an intermediate position between the medical specialist and the general practitioner. DSNs work independently with their patients and are responsible for the care of the ones whose health status is stable but complex [7]. These patients require medium-intensity care [8]. DSNs function in both hospitals and primary care settings This nurse-led, shared-care programme consists of a diabetes outpatient department at Maastricht University Hospital and specialty clinics in general practices. The result is that this particular nurse-led, shared-care setting is characterized by a mix of specific medical care and advanced nursing practice [9]
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