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New Mexico State University

New Mexico State University

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NMSU nursing professor studies self-care practices of people with diabetes

More than 90 percent of care for chronic diseases such as diabetes is done by the patient and not by doctors or nurses, but brief educational interventions from health practitioners can increase self-care behaviors in patients with diabetes, says Wanda Borges, an assistant professor of nursing at New Mexico State University.

have to live with and learn to manage their diabetes because it will last a lifetime, but education from health practitioners can increase patient confidence in their abilities to manage their care," Borges said. "This is an important finding for this area because Hispanics are three to four times more likely to develop diabetes and 63 percent of Dona Ana County is Hispanic. Mortality rates from diabetes also are higher in border states than the rest of the country."

In a recent study, Borges worked with patients who were recruited from the emergency rooms of both Las Cruces hospitals. She asked patients with diabetes who were seeking non-emergency care not related to their diabetes to participate in the study. She conducted brief interventions with 167 patients to determine their self-care practices for diet, exercise and self-monitoring of blood glucose. She then focused her educational intervention on foot care.

Foot care is especially important for people with diabetes because they can develop peripheral neuropathy, which causes a loss of feeling in the feet and hands. Sores, ulcers or infections may not be detected as early in patients with this condition. For people with diabetes this can lead to amputation of limbs because their diabetes also affects the healing process, Borges says.

"About 15 percent of patients with diabetes will develop foot ulcers and people with diabetes are 15 to 40 times more likely to have a lower extremity amputation than the general population," she said. "At least 50 percent of the amputations could be prevented by simply checking their feet every day and recognizing there is a problem."

Findings from the study indicate there was an improvement in foot self care in all of the groups participating in the study with a greater improvement in the intervention group, Borges said.

Borges considered factors associated with the use of the emergency room for non-emergency care and found that the majority of participants in this study had a primary care provider and some form of insurance, which she says challenges the perception that patients who use the emergency department for non-emergent reasons don't have access to health care services.

Borges was discouraged to discover that although the patients did have primary care providers, only 39 percent had received formal diabetes education. She said she believes this is because there are a limited number of diabetes educators in the community, which was another reason that brief interventions may prove to be beneficial.

The study also evaluated the participants' self efficacy - their confidence in their ability to perform the self-care techniques.

Borges said most of the participants already had a high self efficacy, but the study was designed to improve their confidence in their abilities to perform self care in addition to their knowledge of good foot self-care practices. She said the education was individualized for each participant, which kept them interested in the study. She did note that men had lower self efficacy and monitored their glucose less often than females.

Borges presented the findings from her study this summer at the National Association of Hispanic Nurses Conference in Las Vegas, Nev.

"Translating research into practice is the only way to make changes for people with chronic diseases," Borges said. "We need to continue our research efforts to find better ways to help patients perform self-care behaviors that reduce their chances of developing further health problems. Only then can we have an impact on diseases such as diabetes."

It is estimated that 51 percent of patients who have an amputation require a second amputation in five years and 68 percent of patients with amputation die within five years.

"The importance of these interventions cannot be overstated." she said.