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Friday, 30 May 2014 12:38

Problems And APN Interventions In Pregnant Women With Diabetes. Featured

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Problems And APN Interventions In Pregnant Women With Diabetes.


The role and use of advanced practice nurses has greatly expanded in the global as a result of the increased need for care providers with increased knowledge and skills.  This increase and expansion of the role of advanced practice nurses, for patients with chronic health problems and high risk of poor outcomes, has been important for patients with limited access to care. Diabetic women during pregnancy are such a group of patients that requires the attention of nurses. Negrato & Brito notes that diabetes is the most common metabolic disorder affecting pregnancy.  According to Noctor & Dunne (2011), some of the predisposing factors for gestational diabetes include a family history, body mass index greater than 30, maternal age above 30 years, previous unexplained perinatal death, current glycosuria and long-term use of steroid.


As the prevalence of diabetes is increasing, the number of pregnancies complicated by pre-existing diabetes or gestational diabetes is rising.   Diabetic women during pregnancy encounter many pregnancy discomforts.  For those who enter pregnancy with diabetes, maintaining appropriate diets and blood sugar is challenging given the increasing physiological changes, including those that compromise insulin use.  Women suffering from gestational diabetes must learn about diabetes and how to manage it. According to Dorothy et al (2012), most of previous research on pregnant diabetic women has focused on providers’ directives regarding adherence to specific medical treatment plans such as monitoring blood sugar and the use of insulin.   The postpartum management is focused on directives to stabilize preexisting diabetes and monitoring the effects of gestational diabetes.


 Health problems and APN interventions.

Dorothy et al (2012) conducted a content analysis of interaction logs containing the process of APN care during tow clinical trials. The study compared health problems and advanced practice nursing (APN) interventions in two types of APN care provided to childbearing women. The study explored two models of care that included the additive APN care and the APN substitution care. Results of the study indicate that, the 41 women involved in the study suffered 61,004 problems with the majority of the problem being experienced antenatal.  The problems were identified and classified using the Omaha system’s Problem scheme.  Each of the problems was assigned to Omaha scheme as environmental, psychosocial, psychological and health-related behaviors.


 Health-related behaviors are the most common problems. Antenatally, psychological problems were many in the APN substitution group. In postpartum, physiologic problems are the majority followed by psychological problems.  During antenatal, diabetic women suffers from environment-related problems from income and sanitation. They suffer psychosocial problems related to caretaking or parenting, and child neglect. They include challenges in coping with body changes, rest, exercise, diet and fearing regarding delivery. In addition, women also suffer from elevated blood pressure, cramping, coughing and difficulties in breathing. The lead health-related problems include nutrition, prescribed medication regimen and health care supervision.


  Nutrition problems include elevated blood sugar, weight gain and adherence to the prescribed diet.Most of the APN interventions are provided antenatally. The predominance interventions in both antenatal and postpartum include health teaching/guidance and counseling, treatment and procedures, case management and surveillance. The leading surveillance interventions include reporting and intervening with laboratory findings such as blood sugar, hemoglobin and white blood cells.  The case management focused on medical or dental care and communication.The study offer important insight about APN practice in caring for women with diabetes in pregnancy and potential differences between additive and substitution model of care.


The additive model involved collaboration between APN and physicians, APN care was added t o the routine physician prenatal and postpartum care. In the APN substitution model, antenatal and postpartum care was shared equally between APNs and physicians.The study provided a range of problems encountered by diabetic women.  The distribution of health problems in APN reflects physiologic problems of women with diabetes in pregnancy.  These women require close monitoring of their health behavior so as to optimize maternal and newborn outcomes.  The psychological problems reflect problems often encountered by low socioeconomic women and single. Surveillance is the predominant APN function in providing care to women with diabetes.


 In addition, APN provides health teaching, guidance and counseling. According to the study, the role of APN in treatment and procedures was minimal.  The APN surveillance, early detection and focused health teaching and counseling of women, regarding prevention and early detection of problems increases pregnancy outcomes and reduces health related charges.   The role of APNs, knowledge, well-developed assessment skills and effective teaching and communication play an important role in reducing morbidity and health care charges.Therefore, when APNs share care with physicians, they intervene differently in type and number of interventions.  The broad skills and the depth of their understanding in clinical practice, health systems, family and personal issues allow nurses to intervene early and effectively.


 References

Dorothy B., JoAnne M., Hanna J et al (2012). Health problems and APN interventions in pregnant women with diabetes. Pacific Rim International journal of nursing research. Vol.16, issue 2: p 85-96.

Negrato, A.  Marilia Brito (2013). Historical facts of screening and diagnosing diabetes in pregnancy. Diabetology & Metabolic Syndrome. Vol. 5 Issue 1, p1-8

Noctor E. & Dunne F (2011). A practical guide to pregnancy complicated by diabetes. Diabetes & Primary Care. Vol. 13, issue 5, p22


 

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