page
i
Certification
ii
Dedication
iii
Acknowledgements iv
Abstract
v
Table of Contents
vi
List of Tables
viii
List of Figures
ix
List of Appendices
x
CHAPTER ONE: INTRODUCTION
1.1Background
to the Study
1
1.2Statement
of the Problem
3
1.3
Objective of the Study
3
1.4 Research Questions 4
1.5 Hypotheses
4
1.6 Scope
of the Study
4
1.7
Significance of the Study
4
1.8
Operational Definition of Terms
5
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction
6
2.1 Definition, cause, symptoms, complication and types
of diabetes mellitus 6
2.2Epidemiology of Diabetes mellitus 8
2.3 Impact of Diabetes in Nigeria 9
2.4Organizations of diabetes care in Nigeria 9
2.5 Profile of patients with diabetes in Nigeria 11
2.6 The way forward 12
2.7 Previous research in diabetes self-management intervention 14
2.8 Diabetes self-management Education 15
2.9 Diabetes self-management 17
2.10 Barriers to diabetes care 20
2.11 Conceptual model 22
CHAPTER THREE: METHODOLOGY
3.0 Introduction 25
3.1 Research Design 25
3.2 Population 25
3.3 Sample size and
sampling Technique
25
3.4 Instrumentation 26
3.5 Validity of Instrument 27
3.6 Reliability of Instruments 27
3.7 Data Collection
Procedure
27
3.8 Method of Data
Analysis
28
3.9 Ethical
Consideration
28
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0 Introduction
30
4.1 Data analysis and
results
31
4.2 Discussion of
Findings
39
CHAPTER FIVE: SUMMARY, CONCLUSION
AND RECOMMENDATIONS
5.1 Summary 44
5.1.1 Nursing Implication 45
5.2 Conclusion 45
5.3 Recommendations 46
5.4 Suggestion for Further
Studies
47
REFERENCES
48
APPENDICES
57
LIST OF TABLES
Table
Page
1 Frequency and percentage on demographic
data of respondents 31
2 Descriptive statistics of diabetic
patient’s knowledge regarding self-management 33
3 Comparative frequency distribution of Knowledge Responses
from questionnaires 34
4Descriptive statistics
of diabetic patient’s practice of self-care activities 36
5 Comparative frequency distribution
of Self-care Activities Responses from 37
6Descriptive and inferential statistic of diabetic
patient’s pre/post-intervention 38
Knowledgeregarding self-management
7Descriptive and inferential
statistic difference of diabetic patient’spre/ 38
Post-interventionpractice of self-care activities
LIST OF FIGURES
Figure
Page
1 Dorothea Orem self-care conceptual model 22
2 Self-care conceptual model 24
APPENDICES
Appendix Page
A: Informed Consent form
57
B: Questionnaire
58
C: Training program hand-out
61
D: Pictures from the field work 66
E: Study Setting Clearance 68
F: BUHREC 69
G: Turnitin Report 70
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Diabetes mellitus (DM) is a metabolic disease in which glucose
level in the blood is high over extended periods (World Health Organization,
2014). DM results when the pancreas is unable to produce insulin or cell of the
body is not responding to insulin produced (Shoback,
2011). In 2013 alone 4.6 million people died of DM (Aschner, Beck-Nielsen, Bennett, Boulton,
& Colagiuri, 2013). Low and middle-income countries of the world is being affected
by DM, there are more than 77 % morbidity and 88 % mortality (International
Diabetes Federation, 2013). Type 2 diabetes mellitus (T2DM) is the commonest
form of DM and it account for 90 % of disease (Aschner
et al., 2013).
13.2% is the prevalence rate of DM with registered 4,600 people
(International Diabetes Federation, 2014). Estimate of the World Health
Organization (WHO) states that DM prevalence among adults in 2014 was 9%, a
prediction of at least 350 million people with T2DM by 2030 (WHO, 2015). In
accordance with a national survey carried out, the prevalence of diabetes
mellitus in Nigeria increased from 2.2% to 5.0% by 2013 estimates of the
International Diabetes Federation (IDF). Complications of diabetes are common
at the time of presentation in Nigeria: neuropathy 56%, erectile dysfunction
36%, nephropathy 9%, and retinopathy 7% (Chinenye & Ofoegbu, 2013). This is
partly because diabetes is a progressive illness with an initial asymptomatic
phase associated with on-going tissue damage and decline in pancreatic beta
cell mass and function.
Ali, Barke, Bullard, Gregg, and Imperatore, (2012) reported that
glycemic control at the suboptimal level likely cost diabetic patients
increased care requirement, complications and related health care costs.
Improper glycemic control has a link with an increased risk of visual
impairment, kidney failure and cardiovascular disease (Balkau, Borch-Johnsen,
Colagiuri, Lee, Shaw &Wong, 2011). The possible reasons for poor glycemic
control includes poor adherence and awareness, manpower insufficiency, time
constraint, lack of appropriate guidelines on diabetic education for health
practitioners and diabetic patients (Amade, Gudina, Ram, & Tesfamichael,
2011).
Because of lack of awareness, patients with DM suffer from its
complications (Gul, 2010).
The way to self-management includes testing the blood glucose, adequate diet,
regular examination of the foot and eye, all this have shown to reduce
complications from DM (Aschner et al., 2013; Biswas, Ferrari,
Islam, Islam, Lechner &Niessen, et
al., 2015).Therefore, proper blood glucose control among Diabetes Mellitus
patients prevents short and long-term complications and reduce cost and long
hospital stay.
The aim of self-management of DM is to ensure that the blood
glucose level is at a normal range and to reduce the risk of complications.
There are seven self-care behavior people having DM must ensure to keep their
glucose level normal: they include eating healthy, physically active,
self-monitoring of glucose content, compliance with medication, risk-reduction
behaviors, good problem-solving and healthy coping skill (American Association
of Diabetes Educators, 2010). This measures are useful for physicians managing
diabetic patients and it has impacted positively on glycemic control,
complication reductions and improvement in quality of life (American Diabetes
Association, 2009). Self-management goals and its implementation are written in
collaboration with the diabetic patient and health care professionals, it
promotes patient self-management, decrease the prevalence of DM and its
complications (Ahola & Groop, 2013).
Haidet, Naik, Rodriguez and Teal (2011), also emphasized the importance of patient education for better
outcomes of self-management of diabetes, stated that patient education is
necessary because it promote high quality diabetic care. Diabetic education
programmes stress the importance of patients comprehending the practical
approach to self-manage their disease condition. Knowledge and understanding
are important in helping patients towards better self-management of diabetes
mellitus.
Education help people having DM initiate good
self-management and coping skill. Continuous DM education help people having
the disease care for themselves.(American
Diabetes Association, 2014).There is good report when intervention is
long term, it includes follow-up and patients care is individualized. Intervention
which promotes behavioral changes improves clinical outcome (Haidet, Naik, Rodriguez &Teal, 2011).Anderson and Funnell
(2013), said that self-management education is
a process of facilitating knowledge, skill and ability, is an important
component of an effective diabetic management. Self-Management place patients
at center of care, empowering patients to make decision that will improve
clinical outcome.
1.2 Statement of the Problem
Diabetes Mellitus has significantly contributed to the
reduction of life expectancy by 15 years and have
increased heart disease incidence by four time (IDF, 2014;
WHO, 2014). In Nigeria, diabetes
mellitus contributes to medical morbidity and mortality (Chinenye, Ogbera,
& Onyekwere, 2013). Patients having diabetes stay long on medical
wards and pay high bills with various complications such as stroke, adult-onset
blindness, lower extremity amputation from foot gangrene, heart/kidney failure and premature death (Fasanmade,
Nwaiwu & Olayemi, 2015; Isezuo, Ohwovoriole, & Sabir, 2013). An estimated 3.4 million persons died of high glucose
level in 2004 & 2010 according to WHO (Fact sheets, 2013).
According to International Diabetes Federation, (2010), the
prevalence of DM in Nigeria varies from 0.65% in rural Mangu to 11% in urban
Lagos state. World Health Organization, (2014), suggest that Nigeria have the
highest number of people having diabetes. In Nigeria, up to 73% of diabetic
patients do not practice self-monitoring of blood glucose (Chinenye, Uchenna,
& Unachukwu, 2010; Chinenye, et al., 2013).
A study done in Malaysia, (Azmi,
Barakatun-Nisak, & Firouzi, 2015) show 72 % of patients with poor
glycemic control and in Ethiopia (Abebe, Alemu, Berhane, Mesfin,
& Worku, 2015)
show two third of patients with poor control.
American Association of clinical Endocrinologist, (2010) report that 1 in 3 patients having T2DM is controlled while one
and half of patients comply with medication.
It was obvious from this and other surveys that the status of glycemic
control and other targets such as lipid, glycated hemoglobin (HbA1c), blood
pressure levels and adequate education were below expectations (Chinenye, et al., 2013; IDF, 2012).Therefore, the
need for a study on effect of nurse-led training on self-management of diabetes
amongst diabetic patients attending medical outpatient clinic in General
Hospital Odan, Lagos.
1.3 Objective of the Study
EFFECT OF NURSE-LED TRAINING ON SELF-MANAGEMENT OF DIABETES AMONG DIABETIC PATIENTS ATTENDING MEDICAL OUT-PATIENT CLINIC IN GENERAL HOSPITAL ODAN LAGOS STATE
