'n Ondersoek na die hantering van pasiente met diabetes mellitus tipe 2 deur kliniese verpleegpraktisyns

Thesis (MCur)--University of Stellenbosch, 2011.

ENGLISH ABSTRACT: Complications of chronic conditions pose serious consequenses for the patient and financial implications for the health authorities, in the form of serious procedures, adaptions of medication, hospitalisation or rehabilitation. The goal of the study was to investigate the management of patients with diabetes mellitus type 2 on primary health care level. The objective of the study: • a retrospective investigation into the holistic management of patients with diabetes mellitus type 2 by CNPs. The research design was descriptive, non-experimental with a quantitative approach. The population included 896 files of patients diagnosed with diabetes mellitus type 2 over a period of 6 months at 4 clinics in the George Subdistrict. The sample consisted of 180 files, namely 20% of the population. The researcher gathered the data personally by means of a structured check list. Ethical approval was obtained by Stellenbosch University and above mentioned health authorities. Reliability and validity was ensured by means of a pilot study, as well as inputs from a statistician, experts in the fields of primary health care and a research panel. Descriptive statistics were used for data-analysis. Variables were presented in the form of tables, graphs and frequencies. Statistica Version 9 software were used and relations between the various variables were analysed by means of ANOVA (“Analysis of Variance”). By means of systematic probability sampling every second file that adhered to the inclusion criteria was drawn, until 20% saturation was reached at each clinic. Thereafter every second file was drawn from the rest of the appropriate files, until the sample was sufficient or until there were no more suitable files left over. The results of this study provide evidence that the holistic approach was not constantly applied by CNPs in patients with diabetes mellitus type 2. Drug treatment was renewed by a doctor every six months, but no attention was given to the diabetes mellitus in between the doctor's visits. Health information was given. It varied between 100% to 81%. Complications were not addressed appropriately though. In clinic A for example 6% (n=5) recorded on the condition of the patients' feet, while in clinic B 4% (n=2) addressed this issue. At clinic C nothing was recorded on this aspect, while at clinic D 13% (n=2) recorded on this. Respiratory and cardio-vascular systems often fail in patients with diabetes mellitus type 2. At clinic A CNPs enquired only in 18% (n=16) of cases about these systems, at clinic B 22% (n=11), at clinic C 27% (n=7) and at clinic D 6% (n=1). This study has the potential to stimulate further research, especially regarding the reasons why CNPs do not manage chronic patients holistically.

AFRIKAANSE OPSOMMING: Komplikasies van kroniese toestande het gevolge vir die pasiënt en koste-implikasies vir die gesondheidsdienste, byvoorbeeld ernstige ingrepe, medikasieaanpassings, hospitalisasie of rehabilitasie. Die doel van die studie was om te bepaal hoe KVPs pasiënte met diabetes mellitus tipe 2 op primêre gesondheidsorgvlak hanteer. Die doelwit van die studie: • retrospektiewe waarneming na die holistiese hantering van pasiënte met diabetes mellitus tipe 2 deur KVPs. Die navorsingsontwerp was beskrywend, nie-eksperimenteel, met ‘n kwantitatiewe benadering. Die populasie was 896 lêers van pasiënte wat oor ses maande met diabetes mellitus tipe 2 gediagnoseer was by vier klinieke in die George Subdistrik. Die steekproef was 180 lêers, naamlik 20% van die populasie. Die navorser het persoonlik data ingesamel met ‘n gestruktureerde kontrolelys. Etiese goedkeuring is verleen deur die Universiteit van Stellenbosch en bogenoemde gesondheidsowerhede. Betroubaarheid en geldigheid is verkry deur ‘n loodstudie en deur insette van 'n statistikus, primêre gesondheidsorg eksperts, asook 'n navorserspaneel. Beskrywende statistieke is aangewend vir data-analise. Veranderlikes is voorgestel in die vorm van tabelle, grafieke en frekwensies. Statistica Version 9 sagteware is gebruik en verhoudings tussen veranderlikes is geanaliseer deur van ANOVA (“analysis of variance”). Deur middel van sistematiese waarskynlikheidsteekproefbepaling is elke 2de lêer wat aan die insluitingskriteria voldoen het getrek, tot 20% saturasie by elke kliniek bereik is. Verder is elke 2de lêer uit die oorblywende lêers getrek, totdat die hoeveelheid genoeg was, of totdat daar nie meer geskikte lêers was nie. Resultate van hierdie studie bewys dat pasiënte met diabetes mellitus tipe 2, nie holisties hanteer was deur KVPs nie. Medikasie was meestal elke 6 maande deur 'n dokter hernu, sonder enige aandag aan die diabetes mellitus tipe 2 gedurende die tussen-in periodes. Gesondheidsvoorligting was goed. Dit het gewissel van 100% tot 81%. Komplikasies was egter onvoldoende aangespreek. In kliniek A het byvoorbeeld 6% (n=5) oor die toestand van die pasiënte se voete gerekordeer, terwyl in kliniek B 4% (n=2) hiervan melding gemaak het. By kliniek C was daar niks hieroor aangeteken nie, terwyl by kliniek D 13% (n=2) hieroor gerekordeer het. Respiratoriese en kardiovaskulêre sisteme versaak dikwels by pasiënte met diabetes mellitus tipe 2. By kliniek A het KVPs slegs by 18% (n=16) navraag gedoen oor hierdie sisteme, by kliniek B 22% (n=11), by kliniek C 27% (n=7) en by kliniek D 6% (n=1). Hierdie studie behoort verdere navorsing te stimuleer, veral oor die redes hoekom die KVPs nie kroniese pasiënte holisties hanteer nie.