Daly Barbara, Arroll Bruce, Kenealy Timothy, Sheridan Nicolette, Scragg Robert
School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
J Prim Health Care. 2015 Mar 1;7(1):42-9.
The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management.
To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses.
Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day.
Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses.
Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.
糖尿病患病率的不断上升使得初级保健护士在糖尿病管理中的作用得到了扩展。
描述并比较糖尿病患者的人体测量和血糖特征，以及执业护士、社区护士和专科护士对他们的管理情况。
奥克兰的初级保健护士在2006年至2008年期间进行了一项横断面调查，随机抽样，完成了一份邮寄式自填问卷（n = 284）和电话访谈（n = 287）。在随机选择的一天，参与者为总共308名糖尿病患者中的265名（86%）收集了个人信息和糖尿病管理细节。
护士只能获取部分患者的关键临床信息：体重信息占68%；体重指数信息占16%；糖化血红蛋白信息占76%；血清葡萄糖水平信息占34%（任一测量指标占82%）；不过，关于患者是否自我监测血糖水平的记录大部分（96%）都有。大多数护理管理活动集中在提供饮食摄入建议（70%）、身体活动建议（66%）、给患者称重（58%）以及检测或讨论血糖水平（分别为42%和43%）。这些比例因护士群体而异（p<0.05），通常专科护士的比例最高，社区护士的比例最低。
大多数执业护士和专科护士能够获取患者的体重和糖化血红蛋白水平，并在有指征时将临床管理重点放在健康教育上，以降低这些指标水平。需要建立沟通与组织系统以及合同，使社区护士能够在初级和二级卫生服务机构之间开展工作，以改善针对糖尿病患者的社区护理服务。
