Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession?

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Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession?

In a formal paper of 1,000-1,250 words you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): https://campaignforaction.org/states

Review your state’s progress report by locating your state and clicking on one of the six progress icons for: education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.

In a paper of 1,000-1,250 words:

Discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.
What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?
Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

List of at least five propositions or assumption statements that clearly connect the concepts described.

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List of at least five propositions or assumption statements that clearly connect the concepts described.

List of Propositions: A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

>>>>This part of the homework is connected to the previous work “Two Practice-Specific Concepts: Identification, discussion, and documentation from the literature of your perspective on at least two concepts specific to your own practice.”

he paper should be thoroughly researched and well documented, with relevant material from the nursing theorists presented incorporated into the paper. The current APA Manual is to be used throughout the paper. Sources should focus on references from nursing theory but may also include conceptual and theoretical material from other professional domains.

Please use the same references you used for the previous work.

Preventing Fetal Alcohol Spectrum disorders in New Zealand

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SUBMITTED BY:


  • Harmanjot Kaur (CIB00002rv)

  • Amandeep Kaur (CIB00002ku)

New Zealand is one of the healthiest and welfare countries. The government is well aware about the fact of healthy citizens. According to Global Health Observatory Data Repository Total expenditure on health in New Zealand is increasing every year, and was 10.3% of Gross domestic product in the year 2013. This level of improvement in health has come through various health organizations. New Zealand is incorporating and following the


Ottawa Charter for health promotion
which was being held for the first time in Ottawa, on 21st of November 1986. It was basically a reaction to the developmental needs of population for general wellbeing. It was based on the advancement made through the Declaration on Primary Health Care at Alma-Ata, the World Health Organization’s Targets for Health all over the world.

Treaty of Waitangi: New Zealand government recognizes that Māori wellbeing and incapacity needs are an obligation regarding the entire area. It likewise recognizes that Māori groups ought to have the capacity to characterize their own particular needs for wellbeing. Thus, while health promotion we need to consider three principles of the Treaty of Waitangi that is a Partnership, Participation, Protection (Ministry of Health, 2014).

1. Partnership: The partnership between people who are promoting health and women of New Zealand who can be Māori or non-Māori or someone else to create, execute, and survey strategies to promote their health.

2. Participation: The Participation is about equal opportunity and results. It comes when both health promoters and women of different cultures participate together to get positive outcomes.

3. Protection: The principal of protection is about maintaining the dignity and protecting the rich Māori culture, interests, values and beliefs while promotion of health.

Drinking liquor is a piece of numerous New Zealanders lives, however, to a noteworthy extent, the example of drinking reasons hurt both to themselves as well as other people. One of the serious emerging threat of alcoholism in New Zealander females is Fetal Alcohol Spectrum Disorders (FASD). It has been noted that about 3000 children born with fetal alcohol spectrum disorder every year in New Zealand (Dastgheib, 2014).


Fetal Alcohol Spectrum Disorders (FASD)

is an umbrella term used for a group of conditions caused by alcohol exposure to fetal. Each condition is somewhat similar to other and its diagnosis are based on the appearance of characteristic features which are different in different individual and may be physical, developmental and or neurobehavioral (National Organisation for Fetal Alcohol Spectrum Disorders, 2013).

Liquor can result in harm to the unborn kid whenever mother consume alcohol during pregnancy and the level of damage is subject to the amount and frequency of liquor consumption. The adverse of alcohol also depend on age of pregnant mother, environmental factors like stress, diet, poverty, and housing.

It encompasses the following diagnostic terms:


Fetal Alcohol Syndrome (FAS):

is utilized to depict a particular identifiable gathering of young people who all impart certain qualities: a particular arrangement of facial peculiarities, focal sensory system (CNS) dysfunction, and regularly development insufficiency. (Blackburn, 2010).


Partial Fetal Alcohol Syndrome (PFAS):

In this case children have few appeared symptoms, some physical symptoms and few intellectual disabilities. (Blackburn, 2010).


Alcohol-related Neurodevelopmental Disorder (ARND):

Causes damage to central nervous system, Child my face challenges in learning, poor motivation control, poor social aptitudes, and issues with memory, consideration and judgment (Blackburn, 2010).


Alcohol-related Birth Defects (ARBD):

Particular physical inconsistencies these can be heart disorders, skeletal, vision, hearing related issues. (Stratton, Howe and Battaglia 1996).

There is no cure for FASD and its effects last a lifetime (Ministry of Health, 2014). So there is need to prevent the cause.


HEALTH PROMOTION PLAN:


Rationale:

There is a need of action to reinforced endeavors to spread word about Fetal Alcohol Spectrum disorder (FASD). It is been identifies as a priority to prevent FASD and to address the gaps in delivery of service to those affected by FASD. It is underpinned by a commitment to the Treaty of Waitangi. It recognizes New Zealand’s obligations under a range of United Nations charters. So there is need have decimate the FAS from New Zealand society as almost half of NZ women are consuming some alcohol while pregnant. The alcohol consumption is not limited to the female consuming it, it is passed through placenta, as other nutrition passes to fetus. There is need to realize the fact and take an action while cooperating in a facilitated, financed and successful key heading.


Population Group:

This program covers all the women in their fertility age.


Program description:

Program includes Primary awareness, Secondary awareness and dealing with the disorder. A scope of methodologies is utilized as a major aspect of a national interchanges project to help New Zealanders settle on positive choices about their liquor utilization especially in pregnant women.


PRIMARY AWARENESS


  • Essential step:

    Our first step will be developing fund sources to incorporate widespread general mindfulness messages to all communities in New Zealand. Few communities including Maori, Pacific Islander females, and migrants need to be focused more because they are less likely to be familiar with terms like FASD. There need of making those people aware of such conditions so that they can abstain from drinking liquor during pregnancy.

  • Awareness campaigns for young females



    It is likely to possible that we can conduct seminars and promotional campaigns in schools starting from intermediate or higher levels, because this is the age in which child get addicted to alcohol and other things. They should be aware of fetus alcohol syndrome in there early fertility age, so that they can easily make better choices for their children. Secondly this can lead to spread the words in families and communities as well. No doubt they know about the harmful effect of drinking but not the actual effect on fetus and FASD.

  • Mass media


    Social media have great impact on the young population of the country. We can use social sites, television, YouTube to convey the message to youth. A short documentary videos will prove effective in spreading messages.

As well pamphlets, brochures and health promotion posters to settle on better choices about drinking liquor. Just make people aware by themselves by promoting the adverse effects, for example, wellbeing cautioning marks or labels on liquor cans and bottles will prove effective.

Utilizing broad communications to connect with our gatherings of people, we can provide online devices and other data where individuals can evaluate their own drinking and know about statistics and facts dealing with liquor.


SECONDARY AWARENESS:


  • Screening:

    If female consume alcohol, no matter in which amount, the female is pregnant or likely to get pregnant, it is recommended to get screening from the consultant. This will involve nourishment history, sexual wellbeing, contraception history (if taken in the past), previous pregnancy history, breast feeding etc. This all data can reveal the chances of getting FASD in her child and thus appropriate precautions can be taken to avoid it. Secondary prevention can be done with essential health care and examining nourishment, sexual wellbeing, contraception, origination and/or pregnancy with customers preceding and amid pregnancy and breastfeeding.


Need to consider following advice on alcohol use before and after pregnancy:


‘No liquor in pregnancy is the most secure decision’

We will encourage ladies to quit drinking liquor when pregnant and preferably when they are planning to conceive, quit it right away. Because there is no safe limit or time to drink liquor during pregnancy.

If woman is not able to quit liquor, we will advise her to lessen her liquor consumption, do not refrain yourself to seek medical support.


Action Plan:

First and foremost action is to distribute pamphlets and brochure. The main site of getting attention will be gynecology and obstetrics wards and clinics in Auckland, where it will be of greater use. This will help us to can set up an activity plans, with shorter-term objectives and duties. For long term goals, we will target teenage girls, young women in their early twenties, to prevent FASD from root.


How to deal with


Fetal Alcohol Spectrum Disorders (FASD)


?

FASD is not actually curable, early mediation administrations help child to improve from birth to toddler age and can learn critical aptitudes. Certain therapies and conservative treatments are helpful in making child talk, walk, and collaborate with others. There are projects that can help individuals with FASD with their learning and conduct. These projects can help individuals with FASD be as free and accomplish however much as could be expected.

Last but not least, do not hesitate to consult with your GP.


CONCLUSION:

Health promotion is not only the matter of distributing pamphlets and advertisements, it is a huge responsibility and opportunity to make society aware of its surroundings. We need to utilize the framework’s vision, objectives and managing standards. We need to gather and disperse learning, consequences of assessment and best practices are placed set up at the national level. It is a continuous process, if done with the proper vision and direction, can make effective change in community.


References


What is FASD?

Retrieved on march 12, 2015 from National Organization for Fetal Alcohol Spectrum Disorders:

http://www.nofasard.org/


Fetal Alcohol Spectrum Disorder.

Retrieved on march 15, 2015 from Ministry of Health:

http://www.health.govt.nz/your-health/conditions-and-treatments/disabilities/fetal-alcohol-spectrum-disorder-fasd

Blackburn, C. (2010).

PRIMARY FRAMEWORK: TEACHING AND LEARNING STRATEGIES TO SUPPORT PRIMARY AGED STUDENTS WITH FOETAL ALCOHOL SPECTRUM DISORDERS (FASD).

London, UK: National Organization on Fetal Alcohol Syndrome.

Dastgheib, S. (2014, May 9).

‘3000 babies affected’ by mothers’ drinking.

Retrieved on march 19,2015 from Health Global Drug Survey:

http://www.stuff.co.nz/national/health/10060553/3000-babies-affected-by-mothers-drinking


Fetal Alcohol Network NZ

. Retrieved on March 15, 2015 from

http://www.fan.org.nz/fetal_alcohol_spectrum_disorder

Stratton, K., Howe, C., Battaglia, F. (1996

). Fetal Alcohol Syndrome: Epidemiology, Prevention, and Treatment

. Washington, D.C.: National Academy Press.

Develop your critique in relation to aspects of the articles, offering thoughtful, well-supported proof for your claim-critique each articles

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Develop your critique in relation to aspects of the articles, offering thoughtful, well-supported proof for your claim-critique each articles.

Critically review/critique two scholarly articles (see attached PDF articles) on this topic: “Safe Staffing Levels”.

Requirements:
1. Introduction of the article’s:
Overview of the articles including problem discussed, purpose of the articles, major conclusions, or findings.
2. Develop your critique in relation to aspects of the articles, offering thoughtful, well-supported proof for your claim-critique each articles:
Is the purpose of the articles clear?
Does it make sense?
Do you understand why the author is exploring the topic?
Are the author’s statements clear?
Did the author support his/her claim? (May use supporting articles if needed).

3. Significance of the article’s:
What is the significance of the articles to nursing practice?
How do you plan to utilize the information in the articles in your practice?

4. Conclusion:
Summarize the author’s purpose, your critique, and the relevance to practice.

Please use sub-headers when answering each part, such as “Introduction”, “Critique of the articles”, “Significance of Articles”, “Conclusion”.

Nurses On A Palliative Care Unit Nursing Essay

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According to Olade (2004), nursing practice using observed phenomena and evidences is an example of education which refers to formalized experiences designed to enlarge the knowledge or skills of nursing educators or practitioners. Through experiences and evidences, the ability to learn actual clinical practice and the orientation in health care protocols and policies in handling patients’ needs will be achieved. This method is also termed as Evidence-based practice. Evidence-based practice involves a combination of many disciplines, including aspects of multidisciplinary sciences to promote the restoration and maintenance of health in our clients (Davies, 2005). Much literature has been published on this topic in recent years, an evolving subject and concept for specific practices that promote more effective, safer and more efficient ways of caring (Drenkard & Cohen, 2004).

Maintaining and improving high satisfaction among nurses is an important area to discover (Ebell, 2008). To achieve this, we need a workforce to continually strive for excellence, specifically in caring for clients experiencing loss and bereavement be responsible and flexible enough, have the confidence to face the challenges, and inspire everyone with a shared vision. These are strengths needed by nursing staff to motivate others health care provider to fulfill their potential and achieve goals (Littlefield, 2005). Researches, studies and articles were utilized and analyzed in gathering the necessary information needed. Clinical education, skills and practices are the key concepts used in this paper.

Possession of knowledge and competency in performing skills and interventions for clients experiencing grief and bereavement which can be acquired in hands on training are essential in practicing the profession especially in the palliative care unit of NHS hospital is important. As a nursing professional, tangible skills and knowledge in a hospital setting is very important in managing clients and supervising clients (Burns & Foley, 2005). Evidences were identified through thorough assessment and research. The challenges discussed below were identified through gathering of recent information in the palliative care unit and data that focuses on this subject.

Decisional Teachings and Interventions

As a nurse, you need to ensure that the client is treated with dignity, that is, with honor and respect. Dying clients often feel they have lost control over their lives and over life itself. Helping patient die with dignity involves maintaining their humanity, consistent with their values, beliefs, and culture. By introducing available options to the client and significant others, you can restore and support feelings of control. Some choices that clients’s family can make are location of care (home, hospital or hospice), time of appointments with health professionals, activity schedule, use of health resources, and times of visit (Matzo and Sherman, 2004). The family of dying patient wants `to be able to manage the events preceding death so she can die peacefully. You can help client to determine her own physical, psychological, and social priorities. Dying people often strive for self fulfillment more than for self preservation, and may need to find meaning in continuing to live while suffering. Part of the nurse’s challenge is to support the client’s hope and will (Smeltzer, 2009). Nevertheless, the communication between client’s families may not solve all decisional differences, her mother insist on interventions that health care professionals consider inadvisable. In case like this, the initial step is for all parties to focus on having clear goals of care.

Hospice Support to facilitate proper bereavement

The decision of client’s family for home care with hospice support focuses on symptoms control and pain management. Hospice care is always provided by a team of both health professionals and nonprofessionals to ensure a full range of care services. In the case of many patients, palliative care will be the option. This care may be given to meet their physiological need (Matzo, 2005). Ventilatory support for patient can improve her respiratory functioning and relieve symptoms of respiratory distress using mechanical ventilation. While the decisions made by the family wanting their family member to be vented are often reached by consensus with the patient and her family, patient does have an opportunity to designate a family member as a healthcare proxy.

Family Teachings and Interventions

The reaction of any person to another person’s impending death depends on all factors regarding loss and the development of the concept of death. In spite of the individual variations in person’s view about the cause of death, spiritual beliefs, availability of support systems, or other factor, responses tend to cluster in the process.

To help the family, spiritual support is of great importance in dealing with death. Although not all clients identify with specific religious faith or belief, most have a need for meaning in their lives, particularly as they experience a terminal illness. Establish a communication relationship that shows concern for and commitment to the family and client. There are also communication strategies that let client and her family knows that you are available to talk about death (Smeltzer, 2009). Caring for client’s family members is an important intervention in caring for the terminally ill patient. Family-centered interventions and care is focused on the goal, needs and values of the family and patient including their understanding of the treatment options, illness, prognosis and their preferences and expectations for decision making and treatment (Matzo and Sherman, 2004).

Specific interventions appropriate for client’s family includes providing hope within parameters of individual situations without giving false reassurance. Listening to their expressions regarding their perceptions of the situation is also important to determine how they handle the situation (Zerwekh, 2006). Giving honest answers to their questions and giving correct information will assist the family in dealing with the situation. Encouraging strength, promoting support systems and referring to other resources such as pastoral care, counseling and organized support groups will promote wellness and facilitate long term action (Smeltzer, 2009).

Communicating effectively at all levels is a common barrier in the implementation of change among health care in various settings (Kleinman, 2004). As a member of the hospital workforce, a nurse must have the capability to communicate effectively in a non-judgmental way and stimulate other colleagues to think critically. They must also arouse enthusiasm and develop quick thinking and imagination. Moreover, they must also demonstrate resourcefulness and professionalism with infinite patience, understanding, confidence and perseverance are also challenges (Bryar et al, 200).

Emotional and Physical Support

The skills most relevant to this situation of the family are attentive listening, silence, open and close questioning, clarifying and reflecting feeling. Less helpful to family members are responses that give advice and evaluation, those that interpret and analyze, and those that give unwarranted reassurance. To ensure effective communication, the nurse must make an accurate assessment of what is appropriate for the client. Communication with the family needs to be relevant to their feeling and situation. Whether the clients are angry or depressed affects how the client hears messages and how the nurse interprets the client’s statement (Matzo, 2005).

In facilitating nursing interventions, the nurse must explore and respect the family’s ethnic, cultural, religious and personal values inn their expressions of feelings. Teach the family what to expect in the process, such as certain thought and feelings and that labile emotions, feeling of sadness, anger, guilt, loneliness and fear will lessen or stabilize over time. Knowing what to expect may lessen the intensity of some reactions. Encourage her family to express their thoughts and feelings, not to push the family to move on or enforce their own expectations of inappropriate reactions. Encourage the family to resume normal activities after death on schedule that promotes psychological and physical health. Some family member may also try to return to normal activities too quickly. However, a prolonged delay in return may indicate dysfunctional grieving (Matzo and Sherman, 2004).

Physiological and other specific end-life care Support

Nursing management of the client experiencing a loss is important. Physiological need must be addressed first including palliative care such as pain management and life support. Weakness and paresis are common symptoms that may affect muscle groups. With the loss of muscle innervations the muscles athrophy, paralysis and progressive fatigue result. Dysphagia, dysathria, fasciculations, hyperreflexia, immobility, respiratory failure and aspiration will likely occur. Emotional effects such as lability, loss of control and depression are also common. The goal of management in end-of-life care for every client is the prevention or alleviation of these symptoms. Hygiene and psychological support is also important factor to consider (Zerwekh, 2006). To gather a complete database that allows accurate analysis and identification of appropriate nursing diagnoses for dying client and their family, the nurse first needs to recognize the states of awareness manifested by the client and the family members (Smeltzer, 2009). In case of many patients, the state of awareness shared by the dying person and the family affects the nurse ability to communicate freely with clients and other health care team members and to assist in the grieving process. The nurse must also need to be knowledgeable about the client’s death related rituals such as last rites, chanting at the bedside and other rituals. The nurse must also recognize the states of awareness manifested by the client and family members. As nurses, we also need to maintain physiologic and psychological comfort and achieving a peaceful and dignified death, which includes maintaining personal control and accepting declining health status (Matzo and Sherman, 2004). The roles of health care team in care management of dying patient are very important. This implies the vital responsibilities of nurse to do the best and competent care to achieve the peaceful death of the patient. The primary role is to ensure that the patient received the highest possible intervention best suited for her. Nurses must include the family of the patient in the care management, emphasizing nurses’ role as essential factor to maintain dignity of dying client (Matzo, 2005).

Conclusions

Knowledge and competitiveness is a product of excellent nursing practice. In caring for patient experiencing grief and bereavement, experience and effective learning are essential processes in actual clinical practice of the nursing profession. To be an effective nurse, one should begin with the individual appraisal of one’s self competency and enhanced education based on practices and trainings taken previously during undergraduate and graduate studies, workshops, trainings, continuing education, and preparation for teaching seminars or modules including the conceptual, academic and clinical orientation (Foster, 2007). Competitiveness is largely based on innate potentials and motivations afforded by the familiarity of a learning environment. Accordingly, the primary responsibility of the nurse to the patient is to give him/her the kind of care the patient condition needs regardless of race, creed, color, nationality or status (Salsberg, 2008). Advocate the rights and serve as facilitator of patient’s well being (Foster, 2007).

In doing so, the patient’s care shall be based on subjective and objective evidence, needs, the physician’s order and the ailment; shall involve the patient and the family. It promotes understanding of the differing values held by people in other cultures (Henderson, 2009). For example, it helps client to understand why other people in one culture may regard with approval of their practices of exposing their elderly members to the harmful elements, while people in other cultures may abhor such practice. The strength this critical thinking and decision making is its recognition of the relationship between personal values and a choice of action and it equates personal values and wrong action, it also recognize limits of personal experience and perspective and it implies that a person’s moral judgments are infallible.

I believe the richness or intensity of the inculcation of knowledge, positive values and skills of a person is not simply based on the innate capacity of one to evaluate, think, reason and interact in a learning situation. It also equally depends on the quality of the nursing experiences which are either limited by the nurses’ ability and will to choose or by what is desirable to her which is readily accessible in the environment. Nursing education, concepts and programs for improving the knowledge in health facility should also be provided to maintain theoretical and clinical competence of health setting and facilities. From what I have learned in my own area of practice, the key to successful knowledge development is competent learning and effective communication during the practice to achieve the goal of competency. This will determine the path of being an effective and competent nursing professional.

In general, the main role of nurses in palliative care unit is focused on providing effective, quality care. Hence, more advanced and competent means of preparing nurses to supervise and manage their patient is important (Briggs et al., 2004). These challenges must be addressed properly by the implementation of appropriate approach and programs to increase the knowledge and experience. Skill development for nursing educators must constantly be framed within the context of individualized patients. Nursing educators should make themselves aware of every situation happening in the field and make it a motivational means to improve the profession by proper preparation and education (Welk, 2007). Therefore, the need for implementing evidenced-based approach to nursing practice is essential in addressing these issues.

As nursing profession enter a new era not knowing what to expect. Yes, patient care is the “same” everywhere, but they must be comfortable with the environment they are placed in. Adaptation is crucial in the clinical arena (Kleinman (2004). Evidenced-based practice and clinical experience may become a highly useful and effective strategy in clinical practice. The nurse becomes less apprehensive about the clinical environment and becomes more client-focused, therefore increasing the effectiveness of care. This also provides the nurse an opportunity for role modeling as the client and family maintains and develops standards of practice and competent care in a familiar environment (Foster, 2007).

Explain the function of the complement system and do some research to investigate how the HIV virus turns the complement system against the human body.

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Explain the function of the complement system and do some research to investigate how the HIV virus turns the complement system against the human body.

Discuss the function of HIV protease, integrase, and reverse transcriptase.
Identify the characteristics of HIV which account for its transmission. Include the basic epidemiology of this virus and its method of transfer.
Discuss the normal function of B-lymphocytes, killer T-lymphocytes, helper T-lymphocytes, and macrophages in the immune system. Explain how HIV affects these components of a healthy immune system.
Explain the function of the complement system and do some research to investigate how the HIV virus turns the complement system against the human body. How has this led to new treatments against this disease?
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Difference between an index system and an electronic database

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Difference between an index system and an electronic database

Difference between an index system and an electronic database

When researching  information regarding evidence-based practice associated with hand hygiene methods and products used when caring for a patient-ordered contact precaution,  you could access the library’s nursing databases.

  1. What is the difference between an index system and an electronic database ?
  2. What different attributes/features would you use to conduct an effective, concise online search for appropriate nursing literature?
  3. What advantage will a federated search provide for your search?

This doesnt have to be in a certain format or have a cover page. You can just answer each question with a few sentences and that will be fine.

This is the book




ORDER NOW FOR CUSTOM-WRITTEN, PLAGIARISM-FREE PAPERS




You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.



ADDITIONAL INSTRUCTIONS FOR THE CLASS


Discussion Questions (DQ)


Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.


Weekly Participation


Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.


APA Format and Writing Quality


Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.


Use of Direct Quotes


I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.


LopesWrite Policy


For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.


Late Policy


The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.



Difference between an index system and an electronic database


How might a resolution cause conflicts between personal values and beliefs and the perspective of the community or organization?

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How might a resolution cause conflicts between personal values and beliefs and the perspective of the community or organization?

Consider yourself in a role in which you are accountable for allocation of scarce health care resources for a given situation.

Discuss how ethical principles, virtues, and values affect your decision making.

Describe your process for ethical decision making. How might a resolution cause conflicts between personal values and beliefs and the perspective of the community or organization? 1 page, 2 sources.

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Review Of Literature Related To Diabetes Mellitus Nursing Essay

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It refers to the activities involved in searching for information on a topic and developing a comprehensive picture of the state as knowledge on that topic (Polit & Hungler, 1999).

The review of literature for the present Study has been done on knowledge regarding lifestyle modification among diabetes mellitus patients from published articles, textbooks, reports, newsletters, medline and internet search. The reviewed publications have been organized and presented as follows:

SECTION A: Literature related to diabetes mellitus

SECTION B: Literature related to effectiveness of structured teaching programme on diabetes mellitus

SECTION A: Literature related to diabetes mellitus

The retrospective cohort study was conducted among 4,368 hospitalized patients including 2,582 diabetic patients. It was conducted from Jan-2003 to Aug-2004 in general ward. The researcher analyzed the association of hypoglycemic episodes with death rate of inpatients and length of stay in the hospital with death rate of patients within one year after the discharge. Around 7.7% of hospitalized patients developed hypoglycemia. Multivariable analysis was undertaken to evaluate the associations. Around 85.3% increase of inpatient death rate and 65.8% death of patients within one year after discharge were associated with each additional day of hospitalization with hypoglycemia. During hospitalization, the number of inpatient death also peaked to threefold for every 10mg reduction of blood glucose level. For each additional day of hypoglycemia was associated with increasing of 2.5 days in the length of hospital stay. Thus the results revealed that the length of stay and death rate were increased both during and after hospitalization due to hypoglycemia. (Alexander Turchin , 2009).

A Markov model simulating individuals movement across different Body Mass Index categories, the incidence of diabetes, screening for diabetes, the natural history of diabetes and it’s complications over the next 25years. The study population was 24 to 85 year old patients. Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1million. The obesity distribution in the population without diabetes will remain stable over with 65% of individuals of the population being overweight or obese. Annual diabetes related expenditure is expected to increase from 113 billion to 336 billion dollars. For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034, associated expenditure is estimated to rise from 45 billion to 171 billion dollars (Elbert S, et al., 2009).

A survey was conducted to analyze the medical records and administrative data of health plan. It was conducted as Translating Research into Action for Diabetes. The samples of the study were aged diabetic patients those who under diet, exercise and oral hypoglycemic agents at baseline, had HbA1c value of more than 7.2%. The sample size of the study was 1,093 diabetic patients. Among these patients 520 patients were undergone intensified therapy with insulin or oral hypoglycemic medications. Patients with intensified therapy were Compared with patients with not intensified therapy. Patients with intensified therapy had reduced 0.49% of HbA1c level, weight reduction of 3 pound. But there was no reduction in anxiety of patients with intensified therapy. The results revealed that there was a significant association between the HbA1c level and old age, black race, lower income and more number of physician visits (Laura N. McEwen, et al., 2009).

A randomized clinical trial was conducted as Diabetes Prevention Programme. The samples of the study were 3,234 participants who were at high risk for diabetes from 27 centers. Regression from pre diabetes to Normal Glucose Regulation during 3years follow up was identified by Cox proportional hazards model. Lower baseline fasting blood glucose (hazard ratio 1.52) and 2 hours blood glucose (hazard ratio 1.24) reduced to Normal Glucose Regulation. In the same way, younger age (hazard ratio 1.07) and better insulin secretion (hazard ratio 1.09) were resulted in regression to Normal Glucose Regulation. Further, there was a significant and independent effects on regression to Normal Glucose Regulation associated with Intensive life style modification (hazard ratio 2.05) and reduction of weight (hazard ratio 1.34). Metformin (hazard ratio 1.25), male sex (hazard ratio 1.17) and insulin sensitivity (hazard ratio 1.07) predicted a non significant regression. Results revealed that the younger age with better insulin secretion is the benchmark to restore Normal Glucose Regulation among pre diabetic people. However Normal Glucose Regulation could be achieved through reduction of weight and some other aspects of Intensive Life Style Modification (Richard F, Hamman, et al., 2009).

A study was assessed the effectiveness of Intensive Life Style Modification on diabetes prevention and sex related risk of diabetes. The samples of the Intensive Life Style Modification randomized from the subjects of the Diabetes Prevention Programme , those who are meeting the goals of Intensive Life Style Modification. Men were higher than women in meeting the more Intensive Life Style Modification goals. However men and women had same incidence of diabetes. There was no sex difference in risk factors for diabetes mellitus among those who reduced body weight of less than 3% during the first year of preventive programme. Men had better outcome in 2hrs blood glucose, concentration of insulin and insulin resistance than women due to 3-7% of weight reduction. Men had greater improvement in reduction of 2hrs blood glucose level, HbA1c and triglyceride level than women due to reduction of more than7% of weight. (Leigh Perreault, et al., 2008).

A study to assess the knowledge, attitude and practice regarding the effectiveness of counseling on lifestyle modification including disease condition and medications among selected hospitalized diabetic patients. Counseling was provided to the diabetic patients through regular bedside meetings, distribution of leaflets during hospital stay and during their regular follow-up visits up to 2 months after the hospital discharge. Around 46 samples recruited for the study. Among these patients 19 patients were in the experimental group and 27 patients were in the control group. In experimental group, 12 samples (63.1%) were given counseling by Kannada (local language of the study area). The counseling was given nearly 30 – 60 minutes. Around 13 patients (68.4%) were taught information regarding insulin. In the experimental group,10patients(52.6%) were given education regarding oral hypoglycemic agents. Knowledge scores of patients improved in the experimental group. Whereas there was no improvement in the knowledge scores of patient in the control group. Data was analyzed by Mann-Whitney test. However attitude and practice outcomes were not improved among those patients. The results revealed that the counseling regarding lifestyle modification among diabetic patients was effective (Suish palaian , et al., 2007).

A retrospective population based matched cohort study (1984-2004) performed using the population health information system in Canada to assess the effect of diabetes on fracture rates and possible interaction with age and duration of diabetes. The cohort study consisted of 82,094 diabetic adults and 236,682 non diabetic matched controls. Diabetes was classified long term, short term and newly diagnosed. Poisson regression was used to study counts of combined hip, wrist and spine osteoporotic fractures. Independent effects of longer duration of diabetes were observed on fracture rates. Newly diagnosed diabetes mellitus patients showed a reduction in osteoporotic fractures. Long term diabetes patients showed an increase in osteoporotic fractures. The study concluded that long term diabetes is associated with increased osteoporotic fractures (Leslie William, 2007).

A study was carried out to understand the knowledge, attitude and practices (KAP) regarding diabetes mellitus among the diabetic patients attending a diabetic education programme in Nepal medical college, results showed that the majority of patients had correct knowledge regarding diabetic diet, three fourths of them were subjected themselves to blood sugar checking at good intervals and almost all were under regular contact with physicians (Shrestha L, et al., 2006).

A study to assess the awareness of diabetes in individuals attending outpatient department of Ghurki trusts teaching hospital, Lahore. The study was conducted among a sample of 50 individuals recruited by convenience sampling technique, data was collected by administering a structured questionnaire during a two week period and resulted general awareness of diabetes mellitus in the participants of the study was poor (Robert J, 2006).

A study was conducted to assess the knowledge, attitude and practice outcomes among patients with diabetes mellitus in Manipal hospital. It was conducted in the year of 2006 between the period from 22ndAug to 7thDec. Structured questionnaire was used to collect the data from the samples. The sample size of the study was 182 diabetic patients. Among these 103 (56.59%) patients were men and 79 (43.41%) patients were women. Majority of the patients were the aged between 51-60 years. Descriptive and inferential statistics were used to analyze the data. The scores of mean, knowledge, attitude and practice were 7.78 ± 3.8, 4.90 ± 3.34, 2.03 ± 0.95 and 0.84 ± 0.7 respectively. The maximum possible scores of knowledge, attitude and practice were 18, 4 and 3 respectively. The results revealed that the patients scores regarding knowledge, attitude and practice were low. So further educational programmes are essential to impart the knowledge, attitude and practice outcomes (Dinesh K. Upadhyay, et al., 2006).

A study was conducted regarding the awareness about eye diseases among diabetics in South India. The researcher conducted a survey using a 20-point questionnaire among 1000 diabetics who attended the diabetic clinic. A structured questionnaire was used to assess the awareness regarding eye diseases due to diabetes mellitus and to receive opinion to improve the awareness regarding eye complications among diabetes patients. The study reported that amongst the population surveyed, the awareness that diabetes mellitus could affect the eye was about 84%, whereas the knowledge about diabetes among diabetics was less, only 46.9% of the persons interviewed knew that retinopathy was related to control of diabetes and 40.3% knew that it was related to duration of diabetes mellitus. Thus the report suggested that there was a definite need to increase the knowledge of diabetes patients regarding the eye complications associated with diabetes mellitus (Saikumar, et al., 2005).

A study was conducted to identify the prevalence of diabetes mellitus and the number of people affected with diabetes mellitus between the year 2000 and 2030. Prevalence of diabetes with regard to age and sex were estimated from 191 WHO states including US. In developing countries, people from urban area and rural area were separately taken for the study. Globally, people with diabetes mellitus were 2.8% in 2000 in all age groups. Whereas the prevalence diabetes mellitus is expected to increase at 4.4% by the year 2030 among all age groups. There were 171 million of patients with diabetes mellitus in 2000 and it is expected to raise the peak rate of 366 million by the year 2030. With regard to sex, men had higher prevalence of diabetes than women, but women with diabetes were higher than men. The results revealed that in developing countries, the urban people with diabetes were expected to double the number from 2000 to 2030. Further obese people had high prevalence of diabetes than non-obese people. So, obesity is one of the dangerous risk factors for diabetes mellitus (Sarah Wild, et al., 2004).

A study conducted on “knowledge and beliefs regarding Diabetes Mellitus” in overall Mexico. The findings revealed that, the glucose-screening project enrolled 521 Participants. Interviews were conducted with 37 of these with previously diagnosed Diabetes. Majority of participants received information regarding diabetes mellitus through a casual explanation and non-scientific way. Most of the informants were taught regarding one or more methods of Home remedies. Majority of the samples reported that the family members were given more social support than others. Most of the participants were liked to manage the diabetes with maximum resources. The results revealed that the dietary management, exercise management and other approaches can be modified with the help of family members and community than individual approaches (Anne Thomas, 2004).

A population based cross sectional study to assess the awareness and practices regarding diabetic retinopathy was conducted among non-medical population in south India. Semi-structured interview was held by the trained social workers with the help of structured questionnaire. The sample size of the study was 404. Among these 200 samples were paramedical personnel and 204 samples were community people. Samples were selected through randomization. Five-point likert scale was used to collect the data from the samples. More than 50% of people had no awareness regarding risk factors of diabetic retinopathy. One in five participants from the paramedics and one in ten participants from the community had awareness risk factor of diabetic retinopathy. Nearly 75% of participants had no awareness regarding either laser therapy and surgical intervention for diabetic retinopathy. Almost 80% of subjects in community group recognized the necessity of annual eye screening. But among those subjects only 43.5% of patients visited ophthalmologist. Nearly 75% of paramedics not had any resources regarding health education for diabetes mellitus. The results revealed that the maximum effort is needed to impart the awareness regarding diabetic retinopathy and to apply this improved awareness into practices (Namperumalsamy,et al.,2004).

The study was conducted on “awareness and knowledge of diabetes in Chennai”-the Chennai urban rural epidemiology study. A structured Questionnaire administered to 26,001 individuals and the result shows that only 75% (19642/26001) of the whole population reported that they know about a condition called diabetes, nearly 25% of the Chennai population was unaware of the condition called diabetes. In the study, 60.2% (15652/26001) of all participants and 76.7% (1173/1529) of the self reported diabetic subjects know that the prevalence of diabetes was increasing in India. Only 22.27% (574/26001) of the whole population and 41.0% (627/1529) of the Known diabetic subjects were aware that diabetes could be prevented. Awareness and knowledge regarding diabetes is still grossly inadequate in India. Massive diabetes education programmes are urgently needed both Urban and rural India (Mohan D, et al., 2003).

A cross sectional study describes the knowledge, attitude and practice (KAP) among 100 patients attending the diabetic clinic at Klinik Kesihatan Seri Manjung from December 2002 until January 2003. A face-to-face interview using a structured questionnaire was carried out for data collection. The results revealed that 87% of the respondents were able to answer 50% or more questions on knowledge correctly, while 98% of them had 50% or more score for the attitude questions. Ninety-nine percent of them reported 50% or more score for the questions on practice. However, only 56% of them practice all 4 of the practices that were asked regular exercise, healthy diet, monitoring blood glucose level and monitoring body weight respectively. There was a significant positive correlation between knowledge and attitude (r=0.536, p<0.01), but there was no significant correlation found between attitude and practice. The results indicate that an increase in knowledge will increase attitude, however this is not necessarily the same between attitude and practice. A better structured educational programme on diabetes and preventive measures should be conducted for all especially those with diabetes to improve their practice towards diabetes (Ranjini ambigapathy, et al., 2003).

In Bahrain, a study was done to assess the knowledge of diabetes mellitus among school teachers. A pre designed self-administered questionnaire was distributed to all the 1248 male and female teachers serving in those schools. The questionnaire was collected after one day. The response rate was 89% (n=1140). One thousand and sixty four teachers (93.3%) responded to the knowledge part of the questionnaire. The study showed that the school teachers in Bahrain are deficient in diabetic knowledge. The mean knowledge score was 5.34. Married teachers, primary school teachers and female teachers had better knowledge than other teachers. Also, knowledge was related to whether the teachers had an experience with illness, their qualifications or whether they adopt a healthy life style. Eighty one percent of teachers had university education and 19% had completed high school only. Science teachers had better diabetic knowledge (89.6%) than Arts teachers (83.6%) [P. value -0.05 Chi. Sq.value-4.505].The results reveal that teachers have inadequate knowledge of the basic facts of diabetes and its treatment (Faisal A. Latif, 2003).

A cross sectional study was conducted to assess the prevalence of diabetic retinopathy among diabetes patients. The samples of the study were diabetic patients those who aged above 50 years. Cluster sampling technique was used to select the samples. The sample size of the study was 5212 diabetic patients. Among these patients, response rate was 92%. Among 260 self reported diabetes patients, 68 (26.2%) patients had diabetic retinopathy. Nearly 5.1% of diabetic patients those who aged above 50 years had age-sex related diabetes mellitus. Whereas 26.8% of age-sex related diabetic patients had diabetic retinopathy. Further 94.1% of patients had non-proliferative diabetic retinopathy and it was the most common prevalence. The results revealed that preventive measures should be implemented to prevent the occurrence of blindness due to diabetic retinopathy (Narenderan, et al ., 2002).

A study was assessed regarding the etiology and natural history of diabetes. The purpose of the study was to reduce the risk factors of diabetes through lifestyle modifications and environmental changes. The study was organized in 25 centers. The sample size of the study was 4000 participants those who at risk for diabetes mellitus. The risk factors were old age, obesity, family history of diabetes mellitus and history of gestational diabetes. Samples were selected through randomization. Samples underwent semi-annual visits to check fasting blood glucose and yearly visit to measure oral glucose tolerance test at 75g of glucose uptake. Samples were monitored closely throughout their 3 to 6 years follow up period. The primary outcome of the study was the confirmation of non insulin diabetes mellitus based on WHO criteria. Diabetes was confirmed when the fasting blood glucose level of 140mg/dl and 2 hours blood glucose level of 200mg/dl after the uptake of 675g oral glucose tolerance test. Further the study results explored that the risk factors for cardiovascular disease alteration in blood glucose level, insulin sensitivity, insulin secretion, overweight, physical inactivity, dietary changes and poor quality of life (Berger H, 2002).

A study was conducted to assess the knowledge and practice on management of diabetes among 150 diabetic residents in Pondicherry. The study findings shown that, most of the diabetic patients were aware of the need for dietary care or medication, but only 50% modified their diet. Of the 97% were using anti-diabetic agents, some were using them wrongly and only 10.6% of the subjects tested their urine, although 71% were aware of the need for urine test. None of the patients had any formal education regarding diabetes and only 34% consulted the physician regularly. The results of these studies showed a large gap between knowledge and action and a need to reorient and motivate health personnel toward patient education regarding diabetes (Gopalan R, 2002).

A cross sectional study that examined the relationship between chronic physical activity and impaired blood flow in patients with type II diabetes mellitus and control subjects. Participants were separated into four groups based on a physical activity questionnaire – control exercise, control sedentary, diabetic exercise and sedentary subjects. Observation included a physical examination, neuropathic testing and skin blood flow measured non invasively by continuous laser Doppler assessment of lower limb blood flow in response to various stimuli. Control exerciser had greater perfusion than diabetic exerciser. Blood flow was higher in the control sedentary group than in the diabetic sedentary group. Regular exercise is associated with better skin blood flow (Colberg S.R, et al., 2002).

A randomized controlled trial on evaluation of clinical practice management of diabetes mellitus. Implementing a clinical practice guidelines for diabetes mellitus was the main purpose of the study. The study was carried out among diabetic patients in 2 diabetic outpatient department for 15 months during their follow up period. Around 144 type 2 diabetic patients those who aged 25-65 years were participated for the study. More than 75% of patients were African- Americans and Hispanic. Remaining participants were doctors and staffs who were trained regarding diabetes management practice guideline. A problem based teaching programme was provided regarding step by step approach to control diabetes mellitus. HbA1c value was checked during baseline, 9th month and 15th month of follow up. Descriptive and inferential statistics were used to analyze the data. From the analysis, the mean value of change in HbA1c was 0.90% in the experimental group. Whereas the mean value of change in HbA1c was 0.62% in the 15-month in the experimental group. The results revealed that there was a significant improvement in HbA1c value of experimental group. Whereas in the control group, there was no significant improvement in HbA1c level. The patients from the experimental group also followed standard of care as per doctor’s guidelines. The results revealed that effective management of diabetes can be achieved by the clinical practice guidelines (Benjamin E.M, 2000).

A study to evaluate the long term feasibility of a high fiber diet composed exclusively of natural food stuffs and the efficacy of this diet in controlling blood glucose levels and incidence of hypoglycemic episode in diabetic clients. The diet which was introduced to randomized parallel groups of 63 patients of diabetes aged 25- 35 yrs were included in the study. The result showed that when compared with low fiber diet, the high fiber diet after 24 weeks increased both mean daily blood glucose concentration (11.8+3.3 vs 14.5+4.5 mmol/L. F=3.9; p<0.05) and number of hypoglycemic events (0.73+0.7 vs 1.5+1.2 events per patient per month, p<0.01). The compliance to high fiber diet was 83% and to low-fiber diet was 45%. The study conducted that a high fiber diet is feasible in the long term when compared with low fiber diet, improves glycemic control and reduces the number of hypoglycemic events in diabetic patients (Giaco, et al., 2000).

SECTION B: Literature related to effectiveness of structured teaching programme on diabetes mellitus

A randomized controlled trial was conduced among of 184 diabetic patients. Samples of the study were newly diagnosed type 2 diabetic patients and were not under insulin and they were selected through randomization. A planned teaching programme and planned teaching programme with additional guidelines and education regarding self-monitoring of blood glucose. Patients underwent regular follow up visits for once in every three months and they were followed the treatment guidelines according to HbA1c level. Nearly 66% of patients from the group of self monitoring of blood glucose. These patients were completed more than 80% of required treatment measures. With regard to HbA1C and hypoglycemia, there was no significant difference between the two groups. HbA1c level was 6.9% in both groups; the value of mean difference was 0.07% in the incidence of hypoglycemia. The patients in the group of self monitoring of blood glucose had high well being scores (O’kane M.J, et al., 2008).

The impact of diabetes education in maintaining lifestyle changes and stated that self-management education had a significant positive impact on regimen adherence and healthy eating sustained at 2 years. Areas of improvement included self-testing, exercise, foot care and multiple aspects of healthy eating. Long-term improvement in diabetes specific quality of life, degree of diabetes interference and self-efficacy were also found. Predictor analyses indicated that self-management education was more effective for those with a more recent diagnosis, previous diabetes education and less psychological impact from the disease. Age, duration of diabetes and regular meal patterns predicted long-term metabolic benefit. Finally, those with a higher initial body mass index and more psychosocial problems were more likely to drop out of self-management education (Michael Vallis, et al ., 2005).

A study to evaluate the possible influence of a structured teaching programme for interactive group education of diabetic patients on their overall wellbeing and metabolic control. The study included 110 diabetic patients. They were followed for one year after a 4 day structured teaching programme performed at University Department of Endocrinology, School of Medicine in Skopje. A re-education session one year after education, a significant improvement in metabolic control was noticed, HbA1c decrease from 9.2+ 1.3 to 7.7+1.8% (P<0.0005), diabetes related knowledge improved from 49.1+16.8 to 85.4+14.3% (P<0.05) and patient overall wellbeing improved from 46.6+8.3 to 54.8+5.9 (P<0.05) . Study results confirmed the improvement of overall wellbeing, metabolic control and diabetes related knowledge in diabetic patients after a structured teaching programme (Tatjana Milenkovic, 2004).

A structured teaching programme was conducted by 2 trained health care personnel for 6 hrs among newly diagnosed type 2 diabetic patients. The experimental group was compared with control group those who received usual care. At the end of the educational programme, researchers checked the level of HbA1c, weight, Bp, blood lipid levels, smoking habit of the patients, physical inactivity, quality of life, health-illness beliefs, emotional status of diabetic patients during baseline and up to one year period. During the 12th month 1.49% of reduction in the level of HbA1c was found in the experimental group. Whereas in the control group, 1.21% of reduction in the HbA1c value was observed. There was no significant difference between the experimental and control group in the level of HbA1c at 5% level of significance. But there were greater improvements in reduction of weight, quitting of smoking, positive beliefs in health and illness among patients with newly diagnosed type 2 diabetes mellitus. So the structured teaching programme was effective in improving the patient outcomes (Simmons, et al., 2003).

A meta analysis of 62 randomized controlled trials of educational and behavioral interventions to improve diabetic control in 8076 diabetic patients over a median of 4 months follow up, showing a fall in HbA1C of 0.45%. They currently employed educational and behavioral interventions in patients with type II diabetes mellitus produce measurable modest improvement in glycemic control (Garry, et al., 2002).

A study to assess the effectiveness of diabetes education programme was conducted among eighty three diabetic patients. The education was focused regarding self management of diabetes, self monitoring of blood glucose, motivational teaching and care of foot. The findings of the study shown that no amputations, no worsening foot risk category, only one admission for vascular related problems, reduced HbA1c, increased quality of life and improvement in self management behavior in the study group. Whereas in the control group, five amputations, worsening of foot risk category, ten vascular-related admissions, increased HbA1c, no improvement in quality of life and self management behavior were observed. So the education programme was effective. (Murray, 2000).

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