A PROTOCOL FOR A NURSE-LED SELF-CARE DIABETES PROGRAM IN FEDERAL MEDICAL CENTER ABEOKUTA OGUN STATE, NIGERIA BASED ON LESSONS LEARNED FROM A SYSTEMATIC REVIEW OF LITERATURE

Abstract

Title: A Protocol for a Nurse-led Self-care Diabetes Program in Federal Medical Center Abeokuta Ogun State, Nigeria Based on Lessons Learned from a Systematic Review of Literature

Background: Diabetes mellitus, known as Type 2 diabetes mellitus (T2DM), is a chronic metabolic disease characterized by high blood glucose levels, when poorly managed, it can lead to various health complications. Globally, T2DM is the leading cause of death. In sub-Saharan African, the prevalence of diabetes has been rapidly increasing over the last decade. Self-care is a key element for the proper management and preventing complications. Nurses play a critical role in empowering patients to self-care for their disease. In Nigeria, my home country, the role of nurses in empowering diabetic patients to self-care for their disease is not well established, which can be considered as a predisposing factor influencing inadequate patient glycemic control and resulting in poor outcomes of care. This project is meant to shed the light on this gap. There are two parts to this project. The first part aims to conduct a systematic review to synthesize existing programs, strategies and interventions conducted in sub-Saharan countries for improving self-care among diabetes mellitus patients. The second part uses the findings of this systematic review to develop an evidence-based protocol for a nurse-led self-care diabetes program in the Federal Medical Center Abeokuta Ogun State, Nigeria.

Method: The Donabedian theoretical framework was used to guide the systematic review and to build the protocol.

Part 1: Systematic review We used a comprehensive search strategy with the help of a librarian to identify eligible articles from different database engines including CINAHL (1983–2021); MEDLINE (1946–2021); and GLOBAL INDEX MEDICUS. Inclusion and exclusion criteria were set to identify eligible studies reporting on programs targeting self-care empowerment strategies in sub-Sahara Africa (SSA). A rigorous screening and data retrieving method was implemented. Reporting of this systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: A total of 2,479 abstracts and 307 full-text articles were assessed. Eighteen studies met the inclusion criteria. Based on the three domains of the Donabedian framework including structure, process and outcome, we found that in SSA most programs were led by a multidisciplinary health team under the leadership of physicians. The nurse-led programs were least documented where only one study was led by a diabetes specialist nurse in Ghana and two others by registered nurses in South Africa and Cameroon. In terms of the process, the self-care approach was based mainly on education using group education sessions. One study used a motivational behavioural modification approach. As for the outcomes, the following were used to measure the effectiveness of these programs: controlled HBA1C, blood pressure control, adherence to medication, diet and self-monitoring of blood glucose. Foot care had the least reported outcome, and most programs lacked follow-up. The diabetes specialist nurse-led intervention was exceptional because of the strategy they adopted. The patients were guided by diabetes specialist nurses to set and evaluate personalized goals and plan actionable daily self-care activities in between clinic visits, thus reminding and facilitating the translation of self-care knowledge into practical living. The diabetes specialist nurse-led the intervention focused on monitoring and modification in self-care practices.

Part 2: Protocol The lessons learned from this systematic review enabled us to build our evidence-based protocol. Based on the Donabedian theoretical framework, we propose the following: Structure: The clinic will be led by a nurse in coordination with a multidisciplinary addressing the different dimensional needs of the newly diagnosed T2DM patients A nurse-led clinic embedded in the endocrinology clinic at federal medical centre Idi Aba Abeokuta Process: The delivery of service will be based on an adapted practice guideline for self-care of newly diagnosed T2DM. The guideline needs to include the following three elements: education, motivation and follow-up. To ensure adequate implementation, a training workshop will be conducted two weeks before the start of the clinic. In addition, the patient-encounter process will be laid out. Instructions on the patient-nurse encounter include preparation in the pre-visit; during the encounter, and after the visit. Outcomes: a monitoring and evaluation plan is proposed. The monitoring plan examines the fidelity, acceptance and feasibility of the protocol. The evaluation plan examines the output and outcomes of the nurse-led clinic.

Conclusion This project synthesized programs focusing on self-care for diabetic patients in SSA. It also proposed a protocol for a nurse-led clinic to empower newly diagnosed T2DM patients to self-care for their disease.