Attitude of Nurses Towards Diabetes Care

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.

INTRODUCTION

Nurses’ attitude is essential in influencing their patients through exerting an impact on

the way of how they learn to manage their diseases. According to Azjen (1993) as cited in a

study by Anderson, attitudes influence the behavior of health care professionals. Attitude is a

specified target and way of saying and doing things; a learned tendency to evaluate things in a

certain way. This evaluation includes people, issues, objects or events. Such evaluations are

often positive or negative, but they can also be uncertain at times hence there are several

different components that make up attitudes. It is also the predisposition or the tendency to

respond positively or negatively towards a certain idea or situation. In addition, it influences an

individual’s choice of action, and responses to challenges, incentives, and rewards. Thus,

attitudes are important factor in changing behavior as suggested by various health behavior

models. The Health Belief Model (HBM) has been used primarily to increase compliance of

clients to a certain intervention by increasing the perceived seriousness of a specific condition

as one component of the model. A positive attitude of a nurse towards the management of

Diabetes for instance, would gear towards improved patients’ outcome affecting patient’s quality

of life in general.

Because according to the National Diabetes Commission's Report (1975) health-care

professionals’ inappropriate attitudes often lead to negative outcomes for diabetic patients. This

is supported with a study by Odili and Oparah (2012), nurses who had the least favorable

attitude towards diabetes particularly on the seriousness of Type 2 diabetes is least valued as

well as on the glycemic control.

According to Larme & Pugh (1998) their findings on provider’s attitudes toward diabetes

suggest a number of possible explanations for primary care providers' poor adherence to

1


current standards of care. Barriers include attitudes toward diabetes itself and the complexity of

its management, and a perceived lack of support from society and the health care system for

their efforts to control diabetes.

Education is a central part of diabetes care. Without knowledge, individuals, for a variety

of reasons, cannot make informed choices about their self-care. Empowerment of patients and

allowing them to manage aspects of their diabetes in the hospital wards requires the

collaboration of all healthcare professionals, and the involvement of general nurses needs to be

encouraged (Davies & Davis, 1998). Diabetes education is an important clinical nursing

specialty in which diabetes educators’ work at an advanced, autonomous level to provide

education and clinical care for people with diabetes, their families and professional colleagues

(Dunning & Manias, 2008). Likewise, Dunning; Weinberger, Cohen, & Mazzuca (1984) agreed

that a more effective way of achieving behavioral change is through educational programs that

foster critical beliefs rather than just transfer of new medical information.

However, in a study by Odili et al (2012), nurses had the least favorable attitude towards

diabetes particularly that the seriousness of Type 2 diabetes is least valued as well as on the

glycemic control. Diabetes is a chronic disease which by its nature requires multidisciplinary

effort to manage. Much knowledge about the pathophysiology and treatment of the disease has

emerged over the years culminating in the development of standards of care and treatment

guidelines that are meant to improve treatment outcomes and patients' quality of life. Generally,

patient education and continuing medical education has been demonstrated as a means of

changing attitudes of patients and health care providers respectively (Cited in Odili & Oparah,

2012). Diabetes is a rapidly changing field, with information available from many sources.

Keeping up with information is difficult, and may be a key factor in the development of nursing

specialties such as diabetes education, which in turn enable mentors and leaders to emerge.

2


However, if mentors’ knowledge is outdated they may not promote best practice, which is a key

leadership attribute (Dunning & Manias, 2008).

Developed and developing countries are currently encountering an upsurge in

the prevalence of diabetes. The burden of this disorder seems to be disproportionately large in

non-European populations, with Hispanic, Native American, Pacific and Indian Ocean island

populations, and Indian and Australian Aboriginal communities heading the list (Buse, Polonsky,

& Burant, 2003). Diabetic patients are more likely to be admitted to hospital, and diabetes is a

frequent co-morbidity in hospitalised patients. Diabetes also contributes significantly to

prolonged hospital stays and inpatient mortality. For this reason, health care providers,

irrespective of the discipline in which they work, need to have knowledge of inpatient diabetes

management. Moreover, hospitalisation of diabetic patients is costly, and this cost is usually

related to complications of diabetes (Cited in van Zyl & Rheeder, 2008).

It is important for nurses to identify and understand other cultures and how people

individually relate to their own culture. This would enhance understanding and communication

with people from different cultures. Culture is not necessarily a barrier to health education; it is

dynamic and people are able to develop their own understanding (Osman & Curzio, 2012). It is

important to consider how health information given has been understood and interpreted in a

cultural context. Moreover, barriers to self-management should be identified; that is, nurses

should identify each person’s perception of their shared culture, their own individual beliefs and

how that affects their behaviour. Individuals should not be seen as a uniform product of culture

(Csordas, 2002).

Diabetes is termed an epidemic due to the subsequent statistics data gathered by World

Health Organization (WHO, 2012). It is also well-known as a chronic illness which entails the

requirement of long-term multidisciplinary effort to meet appropriate and adequate management

3


as well. Over the years, development of standards of care and treatment guidelines is meant to

improve treatment outcomes and patients' quality of life. Generally, patient education and

continuing medical education has been demonstrated as a means of changing attitudes of

patients and health care providers respectively (Odili & Oparah, 2012).

Diabetes also contributes significantly to prolonged hospital stays and inpatient mortality.

For this reason, health care providers, irrespective of the discipline in which they work, need to

have knowledge of inpatient diabetes management. Moreover, hospitalization of diabetic

patients is costly, and this cost is usually related to complications of diabetes (van Zyl &

Rheeder, 2008), which is highly preventable if diabetic clients management has been delivered

with the appropriate nurses’ attitude.

Over 300 million people worldwide are suffering from diabetes according to the

International Diabetes Foundation’s Diabetes Atlas (IDF, 2011). The total number of people with

diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 while for the urban

population in developing countries where Philippines belongs is projected to double between

2000 and 2030.

Furthermore, according to South East Asia (SEA) IDF (2012) almost one-fifth of all

adults with diabetes in the world live in the South-East Asia Region. Current estimates indicate

that 71.4 million people from SEA have diabetes in 2011. The region apparently has the second

highest number of deaths attributable to diabetes with 1.16 million deaths in 2011.

Nationally, according to 2004 estimates by the American Diabetes Association, the

Philippines is projected to have some 7.8 million diabetics by 2030. In congruent with the figures

from the Department of Health show that diabetes is among the top 10 causes of mortality

among Filipinos, with more than 20,000 deaths from the disease in 2006. Along with WHO

4


(2012) findings, around six million Filipinos are diabetic which will put the Philippines in the top

ten countries with the highest prevalence of diabetes worldwide.

For Baguio City alone there are various tertiary hospitals that can provide specialized

multidisciplinary diabetic care. The Baguio General Hospital and Medical Center (BGHMC)

Diabetes Clinic (2012) as cited by Dar, there is a noted increase in diabetic cases from the less

than 50 new cases a year when they started screening in 1988, it increased to about 150 to 200

a year by 2000. The trend continued over the years and present data indicates about 250 to 300

new cases a year. In addition to this, according to Baguio Health Center, Diabetes is the top five

cause of mortality in Baguio as of 2006 to 2007.

With the current continuously rising trend, number of people affected with diabetes,

demand for apt diabetes care should be delivered effectively and efficiently for a definite health

status improvement of these patients. In line with this, Rorden (1987) has indicated that if

nurses have positive attitudes toward patient education then effective teaching is more likely to

be provided. Research shows that if nurses perceive themselves as educators in patient

teaching they are more likely to be committed to teach patients and family members (Barrett,

Doyle, Driscoll, Flaherty & Dombrowski, 1990).

It is therefore justifiable to know the attitudes of nurses, nevertheless, little is known

about the attitudes of nurses currently enrolled at Saint Louis University –School of Nursing

Graduate Program (SLU-SONGP) towards the involved disease. It is with this reason that

exploring nurses’ attitude towards diabetes is worth-looking at.

Conceptual Framework

The Nursing Role Effectiveness Model developed by Irvine, Sidani, & Hall (1992) served

as the framework of the study.

5


The model proposes that there are specific relationships among the structure, process,

and outcome components and among specific elements within the components in a nursing

care situation. Briefly stated, structure components included the nurse and those elements that

characterize him and may influence one’s processes. The process component consists of

nursing functions and nursing care while for the outcome component it is the health outcomes of

the patients.

In this study, it focused on the nurse structural variables which consisted of the gender,

with or without work experience as a registered nurse and their cultural background. These

elements (structure) could affect nurses' role performance (process) which in turn would directly

relate to the patient health outcomes (outcome). These may affect the attitude of the nurses

regarding diabetes which may consequently contribute to patient outcomes.

Objectives

The study was done with the objective of determining the Saint Louis University

Graduate School Nurses attitude towards diabetes, determining the factors that affect nurses’

attitude towards diabetes such as gender, hospital experience and culture, and to determine if

attitude is dependent with the variables.

6

Nursing Role Effectiveness Model (Irvine, Sidani & Hall, 1992)

Structure> Gender

> Experience> Cultural Background

Process>Nurses’ role performance

Outcome>Patient health outcome


Significance of the Study

This study is significant to the nurse, the diabetic patient, and his family. Provision of

information regarding the attitude of nurses on diabetes mellitus and its treatment, as well as in

identifying their views on the disease and its treatment can be a means to make nurses at SLU-

SONGP more aware of their attitudes towards diabetes. Thus, this gives a glimpse if there is still

necessary further professional improvement on the way to achieving better health care delivery

in pursuit of a more efficient patients’ management of diabetes. Identifying the nurses’ attitude

about diabetes mellitus and its treatment will have a greater impact on what type of information

to be given to diabetic patients and their family members. This may assist them to cultivate a

positive outlook of the disease and its treatment, particularly those nurses, patients, and family

members with a negative view.

Furthermore, the nurses further understand the importance of uniqueness of individuals

and accept their patients as they are. Patients and their family members may also realize the

importance of adhering to the prescribed treatment regimen, and start being more compliant to

it. As a result, complications may then be prevented. Patients and their family members are kept

informed concerning the disease by the health personnel. Thus, patients will benefit and nursing

care can be improved.

Lastly, to simultaneously fulfill the purpose of Department of Health and World Health

Organizations programs against diabetes in which one of the aims is to minimize diabetes

complications and maximize quality of life; and strengthening the control is one of the core

functions accordingly. This also happens to be an innate function of a nurse. It is alarming

though, since in the same study by Odili and Oparah (2012) nurses had the lowest score among

other health care professionals when addressing the psychosocial impact of diabetes, one of

the most important diabetes aspects of care.

7


METHODS AND PROCEDURESLocale and Population

SLU is one of the best schools when it comes to quality produced graduates both from

undergraduate and graduate curricula in the North. At present there are 145 registered nurses

who are enrolled at Saint Louis University School of Nursing Graduate Program (SLU-SONGP).

The total number of those enrolled in the Masters of Science in Nursing and Masters of Nursing

is 86 and 59 respectively. As noticed, younger and younger nurses are working through their

way for a postgraduate degree and this may have a bearing on their attitude towards diabetes

as they are into continuing education.

Research Design

This study made use of the quantitative descriptive design. It was used to observe,

describe, and document aspects of a situation as it naturally occurs (Polit, 2008). This was

conducted to the nurses currently enrolled at SLU-SONGP in Baguio City because of the

immediacy and accessibility of subjects for the study. The purpose of the study was to explore

the attitude of nurses enrolled in SLU-SONGP towards diabetes care and be able to describe

and examine the relationship among these variables. An anonymous survey method was

applied using a questionnaire checklist in gathering the necessary information relating to nurses’

attitude towards diabetes.

Inclusion Criteria

Inclusion criteria included nurses currently enrolled at SLU-SONGP, with or without work

experience as a registered nurse and also taken into consideration were their cultural

background of origin. A sample of 107 nurses with the use of the Slovin’s formula using 5%

margin of error was completed. The total enrollees for this semester were obtained through the

graduate program coordinator’s database. Convenience sampling was used by the researchers

8


to gather respondents. This method of sampling is a form of non-probability sampling in which

decisions concerning the individuals to be included in the sample are taken by the researchers,

based upon a variety of criteria that targets a particular group of people and the researchers’

convenient time (Polit, 2008).

Data Gathering Procedure

Data gathering procedure was done from January 14 to January 28, 2013. Prior to the

floating of questionnaires, a duly accomplished letter of permission to conduct the study was

thru and signed by the graduate program coordinator and was then submitted and approved by

the SON dean. This was shown to the respondents as evidence that the study has been allowed

to be pursued during the said period. The researchers also asked verbal permission from the

professors to distribute questionnaires to their class. Unfortunately, the data gathering had been

extended for almost a week because of the scheduled midterm examinations. One professor

actually declined to float on the class from which the examination was due for that day.

Included in the questionnaire was a demographic section that inquires about gender,

work experience as a registered nurse, and cultural background, to assess for possible

association of these variables to attitude towards diabetes. Together with this was an attached

letter stating the title, purpose of the study and clause of confidentiality that was placed on the

top of the questionnaire form as a part of asking for informed consent.

An adopted questionnaire tool, Diabetes Attitude Scale version 3 (DAS-3) was answered

completely by the respondents. The DAS-3 was developed by Anderson et al. (1998) from

Michigan Diabetes Research and Training Center. The DAS-3 had been considered valid and

reliable to measure general diabetes related attitudes for both people with diabetes and health

care professionals and has been already used in a number of published studies. The DAS-3 is

considered the most psychometrically reliable instrument for measuring either positive or

9


negative attitudes towards diabetes and could be used for both health care professionals as well

as diabetic patients.

It was composed of 5 subscales summing up to 33 items in the form of statements. The

questionnaire was accomplished in 10-15 minutes. Each item was either positively or negatively

stated and measured originally on a 5 point Likert scale with the following possible scores:

strongly agree=5, agree=4, neutral=3, disagree=2, and strongly disagree=1. The subscales

were: (1) the need for special training to provide diabetes (2) seriousness of type 2 diabetes (3)

value of tight control (4) the psychosocial impact of diabetes mellitus (5) and the need for patient

autonomy. Nevertheless, before the study was fully approved, the tool had been subjected to a

research and topic experts for its content validity index for its complacency in the Filipino

context use. Some English jargon words were advised to be reworded such as for it to be more

academic-looking questionnaire. Only one question was paraphrased and the rest were left as it

was. Modified scaling for the facilitation of the study was done in collaboration with a consulted

statistician. Instead, only 4-point Likert scale was used so that the data collected would not tend

to be neutralized. The downloaded DAS-3 formula scoring was the basis of giving

corresponding points to the respondents’ answers, however, in this study, four points was the

highest score for each item instead of five points and did not demand for any further necessary

statistical measures to validate the results. Any deviations made from the original tool and so as

with the scaling were made sure that these changes were known and permitted by the author of

DAS-3 tool which was facilitated via exchanges of electronic mails.

Upon the distribution of questionnaires, respondents’ autonomy were taken into

consideration and assured them of confidentiality and privacy by safekeeping of answers

provided along with maintaining their anonymity. While the respondents were answering, a

distance was maintained from them. Collection of accomplished questionnaires after the

estimated time allotted followed immediately. The researchers made themselves available to

10


the nurses for any queries they may have about the study or/and the questionnaire. The

questionnaires collected were counterchecked immediately to ensure that all items were

answered completely. The researchers expressed gratitude to the nurses who participated in

the study. These self-administered reports provided the needed data for the study and were

organized, encoded, tallied, summarized, analyzed and interpreted.

Treatment of Data

The analysis and treatment of data was facilitated through the use of T-test and analysis

of variance after the completion of the figures needed. Computer aided statistics software like

Microsoft excel 2007 was used specifically in tallying, T-test and F-test computations.

Interpretation of results were consulted to some statisticians especially with the values obtained

from the excel computations.

11


RESULTS AND DISCUSSIONS

Data were collected from 107 respondents, they are all currently enrolled at SLU-

SONGP, 71 were females and 36 were males. 70 of them have work experience as a registered

nurse and 37 don’t have work experience as a registered nurse. As to the cultural background,

36 are Cordilleran, 37 are Ilocano, and 34 were categorized to Others which are classified into

12 Pangasinense, 13 Tagalog, 1 Zambalenio, 1 Ghanaian, 1 Bicolano, 2 Visayan, and 4 falls

into ethnic mixes of Ilocano-Cordilleran, Pangasinense-Ilocano, Tagalog-Ilocano, and

Pangasinense-Cordilleran respectively.

Table 1. Demographics of the Study Sample (N = 107)

GENDERFemaleMale

7136

WORK EXPERIENCEWith work experience as RNWithout work experience as RN

7037

CULTURAL BACKGROUND

CordilleranIlocanoOthers*Pangasinense (12)*Tagalog (13)*Zambalenio (1)*Ghanaian (1)*Bicolano (1)*Visayan (2)*Mix Ethnicity (4)

1 Ilocano-Cordilleran 1 Pangasinense-Ilocano 1 Tagalog-Ilocano 1 Pangasinense-Cordilleran

363734

Currently, there were more females than males enrolled in the total population of SLU-

SONGP and so our sample size was composed of more females than males. This may be due

to nursing deemed as a caring profession where caring part is more of a female role. Gender-

12


role attitudes are social constructions of complex patterns of attitudes and even expectations

(King & King, 1997). However, this assumption has started to veer away as time approaches.

As for the work experience, the sample size had a higher number of nurses with work

experience as compared to those with no work experience as a registered nurse. There are

more nurses whom are already working but opted to study a master’s degree for their own

professional advancement and career path development aspiring for a position as compared to

that number of nurses who were just graduated and passed the board examinations recently

and immediately enrolled in the graduate program which was accounted for those who had no

experience working as a registered nurse.

Majority of the cultural background which emerged from the study were Cordilleran and

Ilocano because basically we are in the Cordillera Administrative Region as well as the

proximity of Region 1 to Baguio City had been accounted for that. Still, the SLU- SONGP

populace was a diverse mixture of with different cultural background because the university is

known as the light of the north which has an honorable reputation of being excellent when it

comes to teaching and enhancing students making it one of the top performing schools in the

country (Commission on Higher Education, 2012).

Generally, our study revealed that nurses enrolled at SLU-SONGP have positive attitude

towards diabetes care in all the 5 subscales.

Need for Special Training

Seriousness of NIDDM

Value of Tight Control

Psychosocial Im-pact of DM

Patient Autonomy

General Mean Scores

3.39545606975184

3.10068745808183

2.87662083612788

3.1611567553469

3.22667253521126

2.652.853.053.253.45

Table 2. General Mean Scores

13


Nurses enrolled in SLU-SONGP have a positive attitude because their mean scores

were between 2.6 – 4. On the other hand, mean scores classification for 1- 2.5 would be

considered as having a negative attitude.

When grouped according to gender, females have a more positive attitude than males

[p= 1.77 E-14; where p<.05 is significant]. Because nurses may work with diverse clients from

their own gender-role framework, gender-role attitudes could be a crucial factor in research and

practice (Berkel, 2004; King & King, 1997).




Psychocosial Im-pact of DM

Patient Auton-omy

Male 2.988095238 2.988095238 2.805555556 3.115740741 3.18750000000001

Female 3.802816901 3.213279678 2.947686117 3.20657277 3.26584507

0.25

0.75

1.25

1.75

2.25

2.75

3.25

3.75

Table 3. Gender Mean Differences

Wei

ghte

d M

ean

Scor

es

There is a very significant difference in the need for special training and a significant

difference in seriousness of NIDDM subscales (p=0.015). These mean that female nurses

consider that they would actually benefit more from special trainings than the males do;

furthermore, female nurses also have higher regards in taking up the seriousness of NIDDM as

compared to the male nurses.

For the work experience, both groups showed a positive attitude towards diabetes care

when they were analyzed according to their absence or presence of work experience as a

14


registered nurse. Those with work experience had higher scores on each of the subscales when

compared to the group who had not a work experience. However, regardless of the variation in

weighted mean scores, there is no significant difference (p>.05) with their positivity of attitudes.





Patient Automy

With 3.682857143 3.18571428600001

2.932653061 3.19761904800001

3.255357143

With-out

3.664864865 3.046332046 2.837837838 3.135135135 3.209459459

0.25

0.75

1.25

1.75

2.25

2.75

3.25

3.75

Table 3. Work Experience Mean Differences

Wei

ghte

d M

ean

Scor

es

According to Benner’s theory of clinical competence, the model posits that in the

acquisition and development of a skill, a student passes through five levels of proficiency until

the nurses’ performance become fluid and flexible and highly proficient. This was used as the

basis for the comparison of those who have or have not a work experience as a registered

nurse. However our findings were that they have actually no significant difference in overall

scores.

This was may be due back to the undergraduate curriculum in which patient-care

simulation such as various return demonstrations, re-enactment activities or even those different

areas of exposures during related learning experience hours may have contributed to the

positive attitudes even to those who have not yet any work experience in the nursing profession.

In a study by Larew C, Lessans S, Spunt D, Foster D, Covington BG. (2006) said that the

innovations in clinical simulation: application of Benner's theory in an interactive patient care

15


simulation, where an interactive patient care simulation were done like the things mentioned

earlier, provided a positive learning experience in which students refine their patient

management skills and collaborate with multidisciplinary team members to resolve common

problems.

Moreover, it could also be a factor that as community services workers or had tried being

into community duties, nurses or aspiring nurses for that matter already learned to provide

service that meets the needs of the target groups, and so the need to be aware of own personal

attitudes and be prepared to adopt the professional values of nursing—and not impose own

ideas on clients.

When nurses were further grouped according to their cultural background, Cordilleran,

Ilocano, and others; yield a positive attitude towards diabetes care. The Ilocanos however

scored highest in all the subscales among groups however; there is no significant difference on

which cultural group may have been a more positive attitude towards diabetes care.





Patient Autonomy

Cordilleran

3.61111111 3.07936508 2.83333333 3.12037037 3.24652778000001

Ilocano 3.72432432000001

3.19305019 3.00772201 3.2972973 3.25675676

Others 3.69411765000001

3.13865546 2.85294117999999

3.10294118 3.21323529

0.250.751.251.752.252.753.253.75

Table 4. Cultural Background Mean Differences

Wei

ghte

d M

ean

Scor

es

16


In a culture, socialization or how one relates to other people is vital. This definitely

affects the attitude in return. Social roles can have a strong influence on attitudes because

social roles relate to how people are expected to behave in a particular role or context.

(Hockenbury, D & Hockenbury, S, 2007; Myers, 1999; Smith, Mackie, 2007). Accordingly,

Gabbay et al (2003) argued that cultural and racial factors can affect relationships between

health professionals and affect treatment outcomes.

In our study however, there is no significant difference on their positive attitudes. While it

is true that culture may have a bearing on the attitude and the way we deal with people, but the

way one should render care to the patients are learned through exposure in almost the same

nursing discipline simulation as discussed earlier. This is because there is no such double

standard in the primary goal of nursing: nurses share one common objective among them which

in turn provided unitary actions geared towards achieving and maintaining standards of nursing

practice.

Elaborating the subscales of DAS-3, nurses enrolled at SLU-SONGP have a positive

attitude towards the need for special training. This issue becomes more important as the

treatment of diabetes becomes more complex, through the increasing use of sophisticated

insulin delivery systems and blood glucose monitoring technologies. Though in the Philippines,

we do not have certified diabetes educators whom possess a body of specialized knowledge,

encompassing technical, psychological and educational facets; floor nurses should suffice to fit

in the role. Patients become increasingly more reliant upon this knowledge and to the nurse

(Anderson, Fitzgerald, Gorenflo, & Oh, 1993). Some authors (Torres, France, Stradioto, Hortale

& Shall, 2009; Funnell & Anderson, 2004) have emphasized that any intervention to improve

health services should train the health team in a constant effort to improve.

With regards to the second subscale, nurses have a positive attitude towards the

seriousness of NIDDM. This finding has important implications for patient education because

NIDDM require difficult and long-lasting behavior changes on the part of patients and the family.

17


It is unlikely that such changes will be made and sustained unless patients and health care

professionals alike understand and accept the serious nature of NIDDM.

While on the third subscale, nurses have a positive attitude towards the value of tight

control. They actually believe that tight control is one of the key factors for preventing diabetes

complications. Until recently, initiatives for tightly controlling blood glucose levels focused on

outpatient and community settings. Hyperglycemia in acute care was considered less important

and an often inevitable consequence of hospitalization. Nurses are in the best position to

coordinate possible necessary adjustments and patient education. And many of the

interventions geared toward improving glycemic control, such as better timing of glucose

monitoring, insulin administration, and meals, occur at the bedside (Peeples & Seley, 2007).

On the fourth subscale, nurses had a positive attitude towards the psychosocial impact

of DM. Nurses acknowledge the needs of the diabetic clients for psychosocial care due to the

fact that they are aware that DM has actually causing these patients a sort of psychosocial

struggles. Nurses may be cognizant of the problems in living with diabetes and the impact of

these difficulties on patients however, they may not able to convey on how to address these

probable problems associated with diabetes and so according to Peyrot, Rubin, & Siminerio

(2006) all patients are entitled to be treated by a provider who is sensitive to their psychosocial

needs, and all providers should receive the training necessary to attain the appropriate level of

expertise.

Finally, the nurses have a positive attitude towards the fifth subscale in which patient

autonomy has to be taken into consideration for planning of care and should be respected

especially in the management of their disease. Diabetes care, especially when it involves the

administration of insulin, requires that the patient be able to make complex daily treatment

decisions. Having the patient make treatment decisions may be counter-intuitive for physicians

and nurses who have been trained to make such decisions themselves. Nurses may have an

18


important role to play in facilitating the delegation of responsibility for making treatment

decisions from physicians to patients.

CONCLUSION

Nurses currently enrolled in SLU-SONGP have a positive attitude towards diabetes care.

When grouped according to gender, the Need for Special Training subscale has a very

significant difference. Female nurses have a positive attitude that they would benefit from

special trainings required in the diabetes care. Furthermore, in the Seriousness of NIDDM

subscale there was also a significant difference between female and male nurses. Female have

a more positive attitude towards seeing that NIDDM is as serious as it imposed to be. For the

rest of the subscales, there is no significant difference but all have with positive attitude. When

categorized according to their work experience and was further classified according to their

cultural background, the nurses currently enrolled in the SLU-SONGP have a positive attitude

towards diabetes care even in each of the 5 subscales. However, there is no significant

difference as how their positivity in attitude varies.

RECOMMENDATION

Nurses are in the best position to coordinate the necessary changes to patients’ practice

and education and many of the interventions geared toward improving patients’ quality of life

and diabetes management. Therefore, nurses should join if there are any trainings or seminars

made available for the improvement of delivery of care towards diabetes for them to achieve or

maintain a more positive attitude towards diabetes care. Moreover, having a continuing

education could also be one of the attributes for having a positive attitude towards speciialized

care. Nurses should take advantage of this effort and lead unit-based and hospital-wide efforts

to measure, manage, and improve management of diabetic individuals and to the populations

who may be directly or indirectly be affected when caring for these clients. Assuming a nurse-

19


led diabetes management education for this may open new opportunities here in the Philippines

as a counterpart of diabetes specialty nurses.

More researches could be done similar to our study but to a wider locale of nurses that is

ought to be more sensitive to measure the transferability and generalizability of the results so

that further researches could be made especially studies on the feasibility of diabetes specialty

nurses in the Philippines since nurses in our study have already a positive attitude and a more

positive attitude towards diabetes care.

LIMITATIONS

The study has a limited number of respondents because it had only been conducted in

SLU- SONGP. There were also unequal sample variances for each variable for the reason that

we used the convenience sampling method because of the limited time we had. Another

limitation of our study was that it has yielded a more than expected non-significant data.

20


REFERENCES

Anderson R. M., Donnelly M. B., Davis W. K. (1992). Controversial Beliefs About Diabetes and its Care. Diabetes Care, Volume 15, Number 7

Anderson, R., Fitzgerald, J., Gorenflo, D., & Oh, M. (1993). A Comparison of the Diabetes Related Attitude of Health Care Professionals and Patients. Patient Education and Counseling, 41-50.

Anderson MR Funnell MM, (2004): Empowerment and Self-Management of Diabetes. Clinical Diabetes 2004, 22:123-127.

Baradaran HR et al (2006) A Controlled Trial of the Effectiveness of a Diabetes Education Programme in a Multi-Ethnic Community in Glasgow. BMC Public Health

Barrett C. Doyle. M .Driscoll. S.. Flaherty. K.. & Dombrowski, M. (1990). Nurses' Perceptions of their Health Education Role. Journal OR Nursing Staff Development, 6, 238-286

Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park: Addison-Wesley, 13-34.

Berkel, L. A. (2004). A Psychometric Evaluation of the Sex-Role Egalitarianism Scale with AfricanAmericans. Sex Roles, 737-742.

Buse JB, Polonsky KS, Burant CF (2003). Type 2 Diabetes Mellitus. In: Reed Larsen P, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia: Saunders, 1427-1483.

Capell J et al (2008) The Relationship between Cultural Competence and Ethnocentrism of Health Care Professionals. Journal of Transcultural Nursing, 121-125

Csordas T (2002) Body/Meaning/Healing. Hampshire: Palgrave Macmillan.

Davies, M., & Davis, R. (1998). Role of the Hospital Diabetes Specialist Nurse: Perception vs Reality. Journal of Diabetes Nursing , 105 - 1-7.

Dunning, T., & Manias, E. (2008). Diabetes Nurse Educators' Perceptions of Leadership Characteristics. Journal of Diabetes Nursing , 390 - 398.

Gabbay M et al (2003) Patient-Practitioner Agreement; Does it Matter? Psychological Medicine, 244-249.

Hockenbury, D., & Hockenbury, S. E. (2007). Discovering Psychology. New York, NY: Worth Publishers.

King, L. A., & King, D. W (1997). Sex-Role Egalitaiianism Scale: Development, Psychometric Properties, and Recommendations for Future Research. Psychology of Women Quarterly, 21, 71-87.

21


Kronenberg HM, Melmed S, Polonsky KS (2003),. Williams Textbook of Endocrinology. 10th ed. Philadelphia: Saunders, 1427-1483.

Larew C, Lessans S, Spunt D, Foster D, Covington BG. (2006) Innovations in Clinical Simulation: Application of Benner's Theory in an Interactive Patient Care Simulation. Nurs Educ Perspect

Larme, A. C., & Pugh, J. A. (1998). Attitudes of Primary Care Providers toward Diabetes. Diabetes Care , 1391 - 1396.

Lewis G (2000) Mentoring Manager: Strategies for Fostering Talent and Spreading Knowledge. Prentice Hall, London

Mueller. D. J. (1986). Featuring Social Attitudes: A Handbook for Researchers and Practitioners. New York: Teachers College Press

Myers, D. G. (1999). Social Psychology. McGraw-Hill College.

Odili, V., & Oparah, A. (2012). Attitudes of Health Care Professionals Towards Diabetes. West African Journal of Pharmacy , 54 - 59.

Osman, A., & Curzio, J. (2012). South Asian Cultural Concepts in Diabetes. Nursing Times , 28-32.

Peeples, M., & Seley, J. J. (2007). Diabetes Care: The Need for Change. American Journal of Nursing , 13 - 19.

Peyrot, M., Rubin, R., & Siminerio, L. (2006). Physician and Nurse Use of Psychosocial Strategies in Diabetes Care. Diabetes care , 1256 - 1262.

Rorden, J.W. (1987). Nurses as Health Teachers: A Practical Guide. Philadelphia: Saunders.

Smith, E. R. & Mackie, D. M. (2007). Social Psychology. London: Psychology Press.

Torres HC, Franco L, Stradioto M, Hortale V, Shall V (2009): Avaliação Estratégica de Educação em Grupo e Individual No Programa Educativo em Diabetes. Rev Saúde Pública

Van Zyl, D., & Rheeder, P. (2008). Survey on Knowledge and Attitudes Regarding Diabetic Inpatient Management by Medical and Nursing Staff at Kalafong Hospital. JEMSDA , 90-97.

Vyas A et al (2003) A Pilot Randomised Trial in Primary Care to Investigate and Improve Knowledge, Awareness and Self- Management Among South Asians with Diabetes in Manchester. Diabetic Medicine

Weinberger M, Cohen SJ, Mazzuca SA (1984). The Role of Physicians' Knowledge in Effective Diabetes Management. Soc Sci Med.

Electronic sources

22


http://www.baguiocity.com/news_article/cases-diabetes-increasing-obesity-and-sedentary-lifestyle-primary-risk-factors-experts

www.idf.org/diabetesatlas/5e/the-global-burden - United States

www.med.umich.edu/mdrtc

www.who.int/mediacentre/events/annual/world_diabetes.../index.html

23

http://www.who.int/mediacentre/events/annual/world_diabetes.../index.html




APPENDICES

24

Documents

Attitude of Nurses Towards Diabetes Care