Diabetes Management By Primary Health Care Nurses In Auckland

Abstract

Aims: Identify the key issues in the clinical management of diabetes patients by Primary Health Care (PHC) nurses. Objectives: Describe the management of diabetes by PHC nurses. Methods: Approximately 25% (n=287) of PHC nurses were randomly sampled in Auckland, comprising practice nurses (PN) (n=210), district nurses (DN) (n=49) and diabetes nurse specialists (DNS) (n=28). Information was collected from postal and telephone questionnaires, between 2006 and 2008, on education, experience, knowledge and diabetes management practice, and from 265 diabetes patient records consulted on a randomly selected day. Results: 80% of nurses reported having any diabetes education, with workshops (63%) and workplace (48%) being the most common sources, followed by conferences (23%), community-based courses (17%) and tertiary institutes (13%). Knowledge of best practice varied between nursing groups with only 51% of DN and 70% of PN aware of the NZ Diabetes Management Guidelines compared with 93% of DNS (p=0.0005). Practice (32%) and district (35%) nurses were more likely to have been in their present practice for over ten years compared with DNS (14%, p=0.0042), although DNS (64%) more likely to work 40 or more hours per week compared with DN (42%) and PN (27%, p=0.0107). The median number of patients consulted on the randomly selected day was one by 38% of PN, two by 47% of DN and 4-5 by 57% of DNS. Of the 265 diabetes patients seen on the randomly selected day, 58% were seen by PN, 18% by DN and 25% DNS. Conclusions: PN play the major role in the clinical management of diabetes patients by nurses in primary health care, carrying out nearly 60% of daily consultations. Education around the NZ Guidelines should be targeted toward PN, because they see the majority of diabetes patients, and also DN.