ASSESSMENT ON THE IMPACT OF NURSE-LED EDUCATION ON SELF-MANAGEMENT AND QUALITY OF LIFE IN PATIENTS WITH DIABETES

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Globally, diabetes is one of the most common non-communicable diseases, with significant disparities observed across different regions. According to the International Diabetes Federation (IDF), approximately 463 million adults aged 20-79 years were living with diabetes worldwide in 2019 (International Diabetes Federation, 2019). Aljin and Abdullai et al. (2018) assert that type 2 diabetes mellitus (T2DM), is a serious public health concern around the world and affects roughly 422 million adults, accounting for about 8.5 percent of the global population. Iginla (2022) assert that the prevalence of diabetes in developing countries is much higher than that of developed countries, and it is estimated that by 2040 there will be approximately 642 million type 2 diabetes in the world. In Nigeria, the prevalence of DM is also a concern. A study conducted by Ogbera et al. (2018) reported a prevalence of 5.7% among adults in Nigeria, highlighting the increasing burden of diabetes in the country (Ogbera et al., 2018).

Epidemiologically, diabetes mellitus (DM) is a chronic metabolic disease that occurs due to the pancreas unable to produce enough insulin or the body cannot use the existing insulin efficiently (Indonesian Ministry of Health, 2020). Insulin hormone serves to regulate blood sugar levels; if the hormone insulin fails to work, then there is an increase in blood sugar levels. Clinical manifestations of diabetes mellitus include increased urinate (polyuria), arousal (polydipsia), and increased hunger (polyphagia) (Prince & Wilson, 2018).  Because it is a progressive disease, the health status of the affected individual tends to deteriorate over time, when complications begin to appear arising from poor glycemic control (Zainab 2020). This situation can lead to a depreciation in the quality of life (QoL), as it is reflected in different aspects, such as a weakened physical state, impaired physical functioning, lower limb pain, lack of vitality, difficulty in social relationships, and emotional instability.  Uzoch (2019) defined quality of life as a concept deeply influenced by subjectivity; it includes several factors, such as the perception of well-being and satisfaction of the individual in relation to their physical condition, their emotional and spiritual states, and their performance of functions, which are essential components of the human condition and involve values, attitudes and skills that impact on the quality of the participation in the various dimensions of social life. According to Udeme (2021) HRQoL reflects the intention to quantify the impact of a disease and its treatment, according to the perceptions that people have about their abilities to develop their potential and lead a full life.

Apparently, managing diabetes requires not only medical interventions but also a comprehensive understanding of self-management practices, including diet control, physical activity, and medication adherence. DM educational programs have been advocated as one of the care strategies that contribute to improving the indicators related to the perception of the physical aspects, functionality, pain, general health condition, vitality, and social, emotional and mental health aspects that affect the health-related quality of life of the patients. According to (Shrivastava, Shrivastava, & Ramasamy, 2013), nurse-led education programs are emerging as critical components in enhancing diabetes self-management. Nurses, as frontline healthcare providers, play a pivotal role in educating patients about their condition, encouraging lifestyle changes, and ensuring adherence to treatment plans. 

Studies suggest that nurse-led education improves patient outcomes by equipping individuals with the knowledge and skills necessary to manage their diabetes independently This form of education typically focuses on helping patients understand the importance of glucose monitoring, medication management, nutrition, and the need for regular physical activity. As highlighted by Fan, Sidani, & Cooper-Brathwaite (2019) structured diabetes education delivered by nurses leads to significant improvements in the quality of life for patients. Nurse-led education programs also foster a sense of autonomy, empowering patients to take charge of their health, make informed decisions, and take preventive measures against diabetes-related complications. Therefore, the role of nurses in patient education is indispensable to achieving better health outcomes in diabetes care.

1.2 Statement of the Problem

In recent times, diabetes management has become a significant public health concern in Nigeria, where the healthcare system is often ill-equipped to handle the increasing burden of chronic diseases. Patients with diabetes often face difficulties in managing their condition due to a lack of proper education on self-management practices. According to a study by Ogbera and Ekpebegh (2014), many diabetic patients in Nigeria are not adequately informed about essential self-management practices, leading to poor glycemic control and an increased risk of complications. This situation is compounded by the fact that diabetes care is often centered on clinical treatment, with limited emphasis on patient education and self-care practices.

Osazeuwa & Osagie (2014) argued that in Nigeria where healthcare systems faces numerous challenges like inadequate healthcare infrastructure, limited access to specialized care, and a high patient-to-healthcare provider ratio, nurse-led interventions are vital in bridging the gap between patients and effective diabetes management. By providing tailored education and support, nurses can improve both self-management and the overall quality of life for diabetic patients. In a study by Naomi (2022) nurse-led education is essential in resource poor settings such as ours, wherein DM pose great financial burden and calls for urgent participation of clinicians at all levels especially primary care physicians as they are usually the first care givers and come across known as well as recently detected diabetics. These patients can be imparted health education by primary care physicians to adopt healthy lifestyle practices, remain motivated for regular testing of glycemic status, and be aware of diabetic complications.

However, despite the documented benefits of nurse-led education in improving diabetes outcomes, its implementation remains inconsistent in many healthcare facilities in Nigeria. The lack of standardized educational protocols and inadequate training for nurses in specialized diabetes care contribute to suboptimal patient outcomes (Ogunlana et al., 2021). As a result, there is a need for further research on the impact of nurse-led education on self-management and quality of life in patients with diabetes, particularly in the Nigerian context. This study will focus on assessing the effectiveness of nurse-led education in enhancing self-management behaviors and improving the quality of life in diabetic patients in General Hospital, Bwari, Abuja.

1.3 Objectives of the Study

The study has the following objectives:

To evaluate the level of quality of life among diabetes mellitus patients attending General Hospital, Bwari.

To establish whether there is nurse-led education program offered to diabetes mellitus patients attending General Hospital, Bwari

To evaluate the impact of nurse-led education on self-management practices in patients with diabetes at General Hospital, Bwari.

To assess the effect of nurse-led education on the quality of life of diabetic patients attending General Hospital, Bwari.

To determine the challenges faced by nurses in delivering diabetes education at General Hospital, Bwari.

1.4 Research Questions

What is the level of quality of life among diabetes mellitus patients attending General Hospital, Bwari.?

Is there nurse-led education program offered to diabetes mellitus patients attending General Hospital, Bwari.

What is the impact of nurse-led education on self-management practices in patients with diabetes at General Hospital, Bwari?

How does nurse-led education affect the quality of life of diabetic patients at General Hospital, Bwari?

What challenges do nurses face in delivering diabetes education at General Hospital, Bwari?

1.5 Research Hypotheses

Ho: Nurse-led education does not improves self-management practices and the quality of life in patients with diabetes at General Hospital, Bwari.

Hi: Nurse-led education significantly improves self-management practices and the quality of life in patients with diabetes at General Hospital, Bwari.

1.6 Significance of the Study

Practically, The findings of this study will provide valuable insights for healthcare providers at General Hospital, Bwari, and other healthcare institutions in Nigeria on how to implement effective nurse-led education programs for diabetes management. By evaluating the effectiveness of health education interventions, the study aims to provide actionable insights for healthcare providers and policymakers to improve patient outcomes, enhance healthcare delivery, and empower patients to manage their condition effectively. The findings can inform the design and implementation of tailored interventions that address the specific needs of patients in underserved communities, ultimately leading to better health outcomes, reduced healthcare costs, and improved quality of life for individuals living with diabetes

Theoretically, this study will contribute to the existing body of knowledge on diabetes management by providing empirical evidence on the effectiveness of nurse-led education in improving patient outcomes. It will also add to the theoretical framework regarding the role of nurses in chronic disease management, particularly in low-resource settings like Nigeria. The study will fill a gap in the literature by examining the impact of nurse-led education in a Nigerian healthcare context, thus expanding the discourse on diabetes care in developing countries.

1.7 Scope of the Study

This study focuses on patients with diabetes at General Hospital, Bwari, Abuja. It will assess the impact of nurse-led education on self-management practices and the quality of life of diabetic patients. The content of the study will be limited to evaluating nurse-led education programs, excluding other aspects of diabetes management such as medication or clinical treatment. Geographically, the study will be restricted to General Hospital, Bwari, in Abuja.

1.8 Limitations of the Study

One limitation of this study is the relatively small sample size as it focused on Nurses and Patient within General Hospital, Bwari, in Abuja, which may affect the generalizability of the findings to other healthcare facilities in Nigeria. Another limitation is the potential for recall bias in self-reported data on self-management behaviors and quality of life, as patients may not accurately recall or report their experiences. Additionally, cultural factors and the stigma associated with chronic illness may influence patient responses, affecting the validity of the results.

The study’s reliance on nurse-led education programs may also overlook other factors that contribute to diabetes management, such as socio-economic status or access to healthcare resources. 

Regardless of the stated limitation, the study will provide valuable insights into the quality of life, self-managemnt practices and the presence of nurse-led education programs among diabetes mellitus patients

1.9 Definition of Terms

Nurse-Led Education: An approach to patient care in which nurses provide structured education to patients, focusing on managing their health condition, improving self-care behaviors, and promoting better health outcomes.

Self-Management: Diabetes mellitus requires lifelong management through a combination of medication, lifestyle modifications, and regular monitoring to prevent complications and maintain optimal health. Self-Management is the ability of patients to manage the symptoms, treatment, physical and psychological consequences, and lifestyle changes associated with living with a chronic condition such as diabetes.

Quality of Life: A patient’s overall well-being, including physical, psychological, and social aspects, which can be affected by their health condition and the effectiveness of their management strategies.

Diabetes Mellitus (DM): Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood sugar levels (hyperglycemia) resulting from defects in insulin production, insulin action, or both. There are several types of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes, and other specific types. 

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