The Importance of the Nurse’s Role in the Management of Complex Diabetic Outpatients: It is the Time to Manage Patient’s Multidimensions
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 3
Abstract
Diabetes is a significant chronic disease, 424.9 million people worldwide are estimated to have diabetes in 2017,and this number is expected to increase to 628.6 million by 2045[1]. More and more patients with diabetes areaffected by other comorbidities, in fact, more than 40% of diabetic people have 3 or more comorbidities [2]. Another important aspect is that, as population ageing, health needs tend to become more complex,multimorbidity, the co-occurrence of multiple diseases in the same patient, represents the mostrelevant featureamong older adults, with a prevalence from 55% to 98% [3]. Inevitably, the coexistence of chronic diseases isoften accompanied by polypharmacy (daily intake of five or more drugs), that could createa frailty condition,poor adherence to therapies, unknown Diabetes Quality of life (DDI) and inappropriatehospital admission, withsignificant implications on economic resources [4,5].In light of these reasons themanagement of complex diabetic outpatients should be reviewed,and nurses might play a central role to improve quality of care and patient quality of life. Thispaper aims to describe our new model to assess complex outpatients affected by diabetesmellitus. In an internal medicine outpatient clinic at the NationalRelevance and HighSpecialization Hospital Trust ARNAS Civico in Palermo (Italy), a specific path way to managecomplex diabetic outpatients based on themultidimensional assessment with strong nursecoordination was set up in 2016 and is described as follow. According to the model a nursemanage the entireprocess and each outpatient is evaluated for specific personal, anamnesticand clinical data and receiveeducational advice by a multi-professional team made ofspecialised physicians, a coordinating nurse, a nutritionist, a podiatrist and a clinicalpharmacologist.At admission, each outpatient does the first clinical evaluation with the specialised physicianwho collects the clinical history also using the Cumulative IllnessRating Scale (CIRS) and doesthe physical examination. Each patient receives a complete cardiovascular, respiratory andmetabolic assessment. The nurse assesses patients’ vital signs, quality-of-life using theDiabetes Quality of life (DQOL) and potential peripheral artery disease through the Anklebrachialindex (ABI). Moreover, the nurse assesses cognitive function by the Mini-Mental StateExamination (MMSE) or the ShortBlessed Test (SBT), this last in the elderly patients. In thesame way, the nurse uses Geriatric depression scale(GDS) and the Hamilton rating scale fordepression. Finally, patient autonomy is evaluated with the BarthelIndex.
Authors and Affiliations
Marika Lo Monaco, RaffaellaMallaci Bocchio, Giuseppe Natoli, Salvatore Corrao
Keywords
Related Articles
- EP ID EP587894
- DOI 10.26717/BJSTR.2018.05.001205
- Views 209
- Downloads 0
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