Respondents rated their perception of their own knowledge on important aspects of diabetes (see Table 4.4a). Only 9 OHNPs rated themselves as having very good knowledge of diabetes management. The majority of OHNPs rated their perception of their own knowledge on diabetes management, blood glucose control, screening, monitoring, glucose testing and complications of diabetes as average to good. Further information was provided by respondents on their perception of their own knowledge on other aspects of diabetes. In relation to the prevalence of diabetes, nutrition, weight management, physical activity, use of medication, and foot and eye care, respondents also rated their own knowledge as average to good (see subsection 4.4.1). Few OHNPs rated their knowledge on these aspects of diabetes, as poor or very poor.
It appears that OHNPs consider their knowledge of the different aspects of diabetes to be average to good. A paucity of literature was available to support other OHNPs perceptions of the extent of their knowledge on diabetes and related aspects. There may have been other studies on nurses’ perceptions of their own knowledge about diabetes from a PHC perspective. The researcher would have liked to compare respondents’ perception of their knowledge with their actual knowledge because the OHNPs’ knowledge of diabetes will be reflected in his/her practice; however this analysis was not done.
One hundred and fifteen (115) respondents were able to provide information on how many types of diabetes there are. Of the 115, 70 OHNPs indicated there are two types while 6 respondents gave the correct answer of four types of diabetes (ADA, 2009). Six (6) OHNPs were able to give the correct answer and the majority indicated there were only 2 types of diabetes.
All 126 respondents provided information on their knowledge of the predisposing factors for developing diabetes (see Table 4.4d). Most respondents indicated that a parent with diabetes, a BMI greater than or equal to 25kg/m2, physical inactivity, ethnicity with high risk of diabetes, and women employees with gestational diabetes were predisposing factors for developing diabetes (see section 2.6). This has implications for history taking, physical
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examination and health education. Of concern is that only 68 (54%) OHNPs indicated that a history of cardiovascular disease was a predisposing factor for developing diabetes, (ADA, 2009). The number of OHNPs that answered ‘No’, ‘Don’t know’, or did not respond at all raises concern about the OHNPs’ knowledge base. Knowledge is linked to practice and the management of clients with diabetes. An OHNP cannot manage diabetic clients if he/she does not know what to look for and therefore how to manage it. If OHNPs do not know these criteria are predisposing factors for developing diabetes, they might not recognise them, nor treat, provide health education or refer clients.
One hundred and twenty-four (124) respondents provided information on whether IFG and IGT were regarded as pre-diabetic conditions (see Chart 4.4a). Eighty-seventy (87) OHNPs agreed that IFG and IGT were conditions for identifying pre-diabetic workers whereas 19 indicated that they did not know (ADA, 2009). The fact that only 87 of 124 OHNPs gave the correct answer is an issue/concern i.e. once again indication of lack of knowledge base of OHNPs. If the OHNP is not aware of or does not recognise these conditions as risk factors for clients being pre-diabetic, they will not identify or diagnose them on examination. This has implications for clients at risk not being identified nor interventions implemented to prevent the disease from developing.
Of 123 respondents that provided information, 104 agreed that IFG and IGT were risk factors for developing diabetes while 14 indicated they did not know (Chart 4.4a; ADA, 2009). Once again another issue of concern because if they didn’t know how are they able to care for their clients. OHNPs will not be able to assist clients in preventing the development of diabetes nor initiate care for diabetics if they don’t know the risk factors or predisposing factors.
The FBG is one of the diagnostic tests used in screening for diabetes. Out of 123 respondents that provided information, 109 OHNPs (90%) correctly indicated the term ‘fasting’ refers to “no caloric intake for at least 8 hours” (ADA, 2009). The 10% that provided the incorrect answer is an issue because incorrect instructions could be given to clients before the FBG being performed, resulting in inaccurate results and misdiagnosis. Of 121 respondents that provided information on the diagnostic test for IFG, the majority (65%) correctly indicated that FBG was the diagnostic test used to screen for IFG (Chart 4.4b; ADA, 2009). Seventy-one (71%) percent of 114 respondents that provided information, correctly selected the OGTT as the diagnostic test to screen for IGT (Chart 4.4b; ADA, 2009). Eight (8) respondents indicated other tests that were used within their organisations and listed the HbA1C and glucostix, however only HbA1C can be as a diagnostic test (ADA, 2009). This lack of knowledge about the tests used to diagnose IFG and IGT are again an area of concern. If the OHNPs do not know which diagnostic test to use, the results would not be
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accurate. This has implications for the identification and diagnosis of clients with pre-diabetes and could result in clients not being managed correctly.
One hundred and twenty-two respondents provided information on whether both the FBG and the OGTT were used to screen for diabetes. Of these, 50% agreed that both the FBG and the OGTT were used to screen for diabetes while 19 respondents did not know (Chart 4.4c; ADA, 2009). Furthermore, 70 respondents (62%) out of a total of 113 agreed that both the FBG and the OGTT were used to diagnose diabetes and again 19 respondents did not know (Chart 4.4c; ADA, 2009). The time constraints related to this study resulted in no further analysis being done to compare the OHNPs’ perception of their knowledge of screening to actual knowledge as indicated here. A gap is identified here in the knowledge base of OHNPs regarding the tests performed to screen for and diagnose diabetes, which has an implication for OHNPs’ practice of screening. Whether the OHNPs are conducting the tests themselves or referring clients for screening, if the incorrect tests are used, clients are in danger of being misdiagnosed resulting in incorrect, or no, treatment being given. Either way, clients will not be followed up and managed with the result that the complications and consequences of diabetes will not be addressed and the client’s health will be compromised.
A total of 119 respondents provided information on the range of measurements used to diagnose diabetes with the FGB test; whereas 102 respondents provided information on the range of measurements used to diagnose diabetes with the OGTT, (see Chart 4.4d). Ninety- four (94) respondents correctly indicated the FBG test result should be greater than or equal to 126mg/dl (≥ 7mmol/l) for a client to be deemed to have diabetes, (ADA, 2009 ). The range used for diagnosing that a client has diabetes using the OGTT diagnostic test was measured 2 hours after a bolus of glucose was given. Forty-eight 48 respondents indicated the OGTT measurement to be a plasma glucose level of 140-199 mg/dl (7.8-11.0 mmol/l), (ADA, 2009) which is incorrect. Only 37% of the respondents (38) provided the correct answer that the OGTT measurement should be a plasma glucose level greater than or equal to 200 mg/dl (greater than or equal to 11.1 mmol/l). The researcher is not aware of the underlying reasons why some OHNPs indicated the incorrect tests used for the respective conditions or why the other tests were used as indicated. It appears that the OHNPs lacked the knowledge of which tests to use to screen for IFG and IGT and which measurements to use to deem a client diabetic. Therefore clients whose diabetes has not been identified would be missed however would continue to work in high risk areas. This has implications for clients in safety- sensitive jobs that develop hypoglycaemia and/or hyperglycaemias in the course of their work causing health and safety risks at work for them and others.
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