In Australia, diabetes is a serious public health issue. Statistics shows that about 700,000 Australians have diabetes, and more than 50 percent of them are not aware that they have this disease (Shaw & Tanamas 2012). The prevalence of diabetes in Australia is particularly higher among the Aboriginal Australians, whereby its prevalence is 2-4 times higher when compared with the general population. Current report focuses on the issue of diabetes among Aboriginal Australians. To achieve this objective, the impact of diabetes on the individual, family, and population will be discussed. Besides, the report explains the implications of the identified priority health area (diabetes in Aboriginal Australians) for the role of the nurse.
Impact on the Individual
A cure for diabetes is yet to be found, which means that individual having the disease faces a significant challenge in adapting to the change and understanding the condition (Schabert et al. 2013). The onset of diabetes is accompanied by numerous physical problems that are likely to have a considerable effect on the work and personal life of an individual. The management of diabetes requires maintaining the levels of blood sugar within the recommended safe limits, which does not only pose the need for regular medication but also requires controlling the amount and timing of food intake (Reeve et al. 2014). In the event that the blood sugar levels get extremely low, a condition referred to as hypoglycaemia. A number of physical conditions can occur such as unconsciousness, confusion, concentration problems, tremor, sweating and palpitations can occur because of the difference between exercise and food and medications (Lee et al. 2013). In contrast, when the blood sugar levels are extremely high, a condition referred to as hyperglycaemia. In this state, the diabetic individual is likely to experience symptoms such as regular urinations, thirst, and exhaustion (Reeve et al. 2014). Longer periods of high blood sugar levels may require emergency hospital admission because of the severe metabolic disruption that can cause death (Holt et al. 2011).
In addition to the effects associated with abnormal blood sugar levels discussed above, the long-term impacts of insufficiently managed diabetes on the individual could include a number of complications such as circulatory, nerve, kidney, and eye ones (Seuring, Archangelidi & Suhrcke 2015). In fact, these long-term complications associated with diabetes contribute to health deterioration. In addition, the stress associated with the daily management of diabetes can result in distress, anxiety, and depression, particularly for young individuals (Shaw & Tanamas 2012). As a result, support from family members, friends, and health practitioners is important.
Impact on the Family
The first notable impact associated with diabetes on the family is emotional stress (Minges et al. 2011). Numerous studies have affirmed the emotional impact on the Aboriginal families following the diagnosis of diabetes (Lee et al. 2013). For instance, diagnosis of diabetes has been linked with the increased family stress levels, unhappiness among family members, neglect, and denial. In addition, diabetes diagnosis tends to instil fear in family members who may start worrying about being diabetic while at the same time being anxious for the diabetic patient, who could develop complications and even succumb to the disease (Shepherd, Li & Zubrick 2012).
Secondly, diabetes affects family dynamics. Various authors agree that family dynamics is likely to change following diabetes diagnosis owing to the fact that the diabetic family member may require more attention (Dunning 2013; Holt et al. 2011; Schabert et al. 2013). Additionally, a diabetic parent may need the assistance of his or her children, which in turn disrupts the conventional family roles. Power struggles among family members have also been reported in families with a diabetic individual (Shaw & Tanamas 2012). This stems from the fact that family members force the diabetic person to regulate his/her eating, alcohol intake, and engagement in physical activities (Schabert et al. 2013). Another impact of diabetes on family is communication stress. With respect to this, communication challenges may arise from the need to offer repeated reminders to diabetic persons about their medications, physical exercises, and eating habits. This is likely to result in the diabetic individual feeling pestered or admonished. Diabetes also results in financial stress for families. Effective management of diabetes requires an about $ 4000 for type 1 diabetes and $ 3500 for type 2 diabetes (Holt et al. 2011). This may compel the family to reduce their other expenses in order to care for the diabetic person (Lee et al. 2013).
It has been projected that in the coming two decades at least 20 million Australians will be diabetic (Shaw & Tanamas 2012). This increase further contributes to other serious diseases such as cardiovascular disease (CVD) and kidney disease (Shaw & Tanamas 2012). The outlook for the case of Aboriginal Australians is even worse. Diabetes is the norm among older adults in majority of the Aboriginal communities. Several families have at least one member who is treated by means of dialysis because of a kidney disease linked to diabetes (Shaw & Tanamas 2012). According to Shaw and Tanamas (2012), the increase in diabetes prevalence among Aboriginal Australians and the general population implies that present day children will have a reduced life expectancy when compared to their parents and grandparents. The healthcare costs associated with diabetes in Australia amount to about $ 6 billion per year (Shaw & Tanamas 2012). Additional increase in the prevalence of diabetes patients will significantly blow up this figure. Apart from direct health costs, diabetes also has indirect effects to society in the form of reduced productivity. In this respect, diabetes has been established to lessen productivity significantly because of early retirement, incapacity, absenteeism, and illness (Lee et al. 2013).
Implications for the Role of the Nurse
Diabetes management in Australia is suboptimal, especially in the Aboriginal Australian population, which raises concerns and needs continued support and education. Essentially, the prevalence of diabetes among Australian aboriginals is an issue of health disparity, and the role of nurses is to reduce disparities in health outcomes (Lee et al. 2013).
First, reducing diabetes in Australian aboriginals require nurses to play a forefront role in its prevention. All prevention measures have the objective of curbing and lessening complications as well as mortality in instances where diabetes is a contributing and an underlying factor (Dunning 2013). This can be achieved using primary prevention education programs, which place emphasis on lessening obesity and improving nutrition through ensuring that the community understands the need to reduce the intake of alcohol, sugar, salt, and concentrated fats. Diet management is a crucial step in primary prevention. Nurses play an important role in primary prevention of diabetes, especially through educating the Aboriginal communities in Australia in order to encourage physical activity and adoption of healthy lifestyle. In this respect, nurses can play the role of diabetes educators (Shaw & Tanamas 2012). As a result, they have a responsibility of promoting and encouraging Australian Aboriginals to adopt health lifestyle that lessens the risk of developing obesity and other risk factors. Nurse educators can disseminate weight-related information to the Aboriginal communities in Australia (Sherr & Lipman 2013).
Second, nurse educators should focus on helping Aboriginals having diabetes as well as those at risk of it change their behaviour in order to result in improved health and clinical outcomes (Holt et al. 2011). Nurse educators on diabetes make use of skills and knowledge from various disciplines such as education, counselling, communication, social sciences, and biology to offer self-management training to Aboriginal communities (Sherr & Lipman 2013). Diabetes educators can offer their services in various settings, including local community settings, health care agencies, managed care settings, pharmacies, outpatient settings, offices of physicians, and hospitals. The nurses mainly focus on facilitating behaviour change through counselling patients as well as members of their families regarding ways of adopting healthy lifestyle in order to ensure effective self-management. The core behaviours that diabetes educators should emphasise include lessening risks, problem solving, taking medication, monitoring, physical activity, and healthy eating (Sherr & Lipman 2013).
Third, nurses play a role in increasing community-wide awareness regarding the seriousness associated with diabetes including its prevention (Shah, Kaselitz & Heisler 2013). One more nursing role is to reduce the diabetes menace of diabetes among the Aboriginal Australians. Interventions that enable Aboriginals to have an understanding of diabetes including the lifestyle risk factors is crucial. Nevertheless, this is likely to be more effective when used together with educational programs and materials that tackle the sense of unavoidability that it is normal for Torres Strait Islander and Aboriginal communities to be diabetic. Moreover, nurses should ensure that they disseminate information relating to the complications associated with diabetes, including other chronic illnesses that can accompany disease (Sherr & Lipman 2013). Tailored community interventions can be adopted at individual, family and community levels in order to acknowledge the risks associated with diabetes as well as motivate them to adopt necessary steps aimed at lowering risks (Shah, Kaselitz & Heisler 2013).
Nurses also play a vital role in the secondary prevention of diabetes. Secondary prevention strategies comprise of targeted-population opportunistic screening programs used in monitoring the levels of blood sugar, glucose tolerance tests, and tests to determine other risk factors associated with diabetes such as blood pressure and renal function (Shah, Kaselitz & Heisler 2013). Secondary strategies can also focus on enhancing public awareness regarding the need to undertake periodic tests. Regular medical care for Aboriginal communities in Australia ought to focus on identifying the adjustable risk factors such as unhealthy eating behaviour, smoking, lack of physical activity, body mass index, abnormal waist circumference, and obesity. Nurses can screen for diabetes using a number of tests, including the oral glucose tolerance test (OGIT) and the fasting glucose test (FPG). Systematic diabetes screening has been successfully implemented in various community settings for indigenous communities in North America. Screening has been effective in accessing remote and rural indigenous communities via planning, respect, and dialogue (Dunning 2013).
Nurses should also be involved in the management of diabetes. It is imperative to note that nurses have to modify interventions based on the resources available, assessment, and context. In addition, nurses must make use of culturally competent nursing that takes into consideration the cultural diversity as well as the suitable learning styles and language when dealing with Aboriginal communities (Dunning 2013). With respect to cultural competence, nurses should be able to address the needs of patients having diverse behaviours, beliefs and values as well as take into consideration the linguistic and socio-cultural needs of patients in order to facilitate effective cross-cultural communication. Cultural competence care has been crucial in lessening healthcare disparities, which is the case with diabetes among the Aboriginal communities of Australia. Therefore, to help nurses reduce the prevalence of diabetes in this population, cultural competency training is a pivotal requirement. When interacting with Aboriginals, nurses must be aware of their culture. For instance, community, family and children are important in the Torres Strait Island and Aboriginal cultures; therefore, nurses should prioritise them when devising culturally appropriate interventions in order to empower healthy and strong families throughout the lifespan (Shah, Kaselitz & Heisler 2013). In addition, early trust building and engagement of nurses have been identified as being important to designing culturally appropriate management and prevention measures for diabetes. Nurses should also take into account the fact that diabetes among Aboriginals is an intergenerational issue (McDermott, Li & Campbell 2010).
The impacts of diabetes on the individual are manifold, including physical problems that affect both the personal life and work of a person, the need for frequent medication, short-term symptoms associated with abnormal sugar levels, and long-term complications. Diabetes also affects family in various ways such as emotional stress, family dynamics, communicational challenges, and financial burden. With respect to the impact on the population, diabetes undermines the Australian economy by reducing life expectancy of future Aboriginal generations, and diminishing workers’ productivity. The role of the nurse was also discussed, which included reducing the disparity in diabetes prevalence, development of culturally appropriate interventions, promoting and encouraging Aboriginals to adopt healthy lifestyle, playing the role of diabetic educators, and secondary prevention of diabetes.