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 1
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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
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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.
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
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.
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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.
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
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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.
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-
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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.
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.
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