| ObjectiveDM (Diabetes Mellitus, DM) is a chronic life-long disease of which late complications are seriously harmful to people's physical and mental health. High prevalence and longer duration characterized type 2 middle-aged and the old diabetes patients. With poor blood glucose control, it is prone to result in complications in heart, brain, kidney, eyes,great vessels and peripheral neuropathy systems and so on. These complications often lead to advanced kidney diseases, lower limb amputations and blindness, which seriously affect the quality of life of patients with DM.In our country, DM patients, particularly middle-aged and the elderly patients are lack of basic knowledge, examination and treatment and self-care knowledge on DM, and their compliance behaviors are poor. Generally, their blood glucose is well controlled in hospital, while poor controlled after discharge. Of course, there are several reasons leading to the phenomenon, such as lack of professional supervision and guidance, as well as low autonomy of older people. Poor glucose control always results in premature chronic complications affecting the quality of life. Therefore, the intervention management of elderly patients with DM should not be stayed in hospital, but also extended to the lobby. In the present study, the elderly patients were supplied for entire nursing intervention, including the period in hospital, at home and in outpatient department. The innovation of the study was that the objective middle-aged and old in-patients were served in outpatient nursing specialist department after discharge. The aim of the study was to explore an effective, feasible, scientific management model to improve compliance of patients outside hospital, to increase their knowledge of DM, to delay the occurrence of chronic complications of DM, and eventually to improve their quality of life.MethodsWith randomized controlled method, the objectives were served for entire nursing intervention which contains three stages-inpatient period, at home and outpatient nurse specialist department stage.1.Nursing intervention for the elderly with DM in hospitalDuring July 2004 to December 2006,236 mid-elderly patients with DM checking in Endocrinology Department and Nephrology Department of Guangdong Province People's Hospital were chosen, while only 82 patients met the inclusion criteria for study. At first, investigation of baseline knowledge about DM was implemented. Then effective nursing intervention with self-control method was put in practice. There were 49 males and 33 females of 82 cases. Their ages were between 45 and 85(66±9.836 years).Methods:(1)With self-designed questionnaire about DM knowledge, the chosen 82 cases were investigated when they were admitted in hospital and after discharge.82 patients were divided into different levels and stages for individualized nursing intervention about DM knowledge. After the intervention, the researcher evaluated the effect of health education. A total of 164 questionnaires were released and 164 were received. There were 6 dimensions of the self-designed questionnaire. They were diet, exercise, medication on DM, self-monitoring, complications and diabetic foot. There were 2 to 5 items in each dimension, while each item included 2 to 5 sub-items. Each item was divided into three levels, understanding (All items was clear), some understanding (2 to 5 items were clear), little understanding (all the items were not known), using individual or multiple selection.(2)The survey of Quality of Life Scale (The medical outcomes study 36-item short-form health survey, SF-36)The reliability and validity of SF-36 were well verified and it can be used for type 2 DM patients in our country.82 cases were investigated using SF-36, and 82 questionnaires were returned and all reliable. There were two categories including 8 dimensions which contained 2 to 10 items respectively. The 8 dimensions were Physical functioning (PF), Social functioning (SF), Role Physical (RP), Bodily Pain (BP), Mental Health (MH), Role Emotional (RE), Vitality (VT), General Health(GH). Another health changing indicator was health target (HT) which was used to evaluate changes in health status over the past year.Inclusion criteria:According to the DM diagnostic criteria made by WHO in 1999, patients who were diagnosed with type 2 DM patients, aged between 45 and 85, post-primary education, and of residence in Guangzhou were chosen for this study.Exclusion criteria:patients with serious cardiovascular disease or dementia or serious cerebral hemorrhage or cerebral infarction, or nephrotic syndrome, or illiteracy were exclusive of the study.These two questionnaires were implemented by well-trained nurses with unified guidance words. The patients filled out the questionnaires by themselves. For those who didn't understand the contents of the questionnaires, nurses would offer explanation to them.2. Family nursing intervention With various reasons such as removal and so on, there were only 60 patients of the 82 inpatients chosen in the study who can completely join in this part of study. There were 49 females and 11 females, aged from 45 to 85 years old (65±10.417 years).Methods:60 patients were randomly divided into two groups. There were 30 patients respectively in both exposed group and control group. The patients in control group took self-management according to their own lifestyle after discharge. While those in exposed group were offered family intervention. The intervention included telephone follow-up per week, family follow up per month, and regular nursing specialist out-patient follow-up. The telephone follow-up content contained the condition of taking medicine at home, diet, exercise, self-monitoring of blood glucose and food condition. These items aimed at controling the status of blood glucose. In addition to the telephone follow-up contents, family follow-up including the following:the economy condition of the patients' family, family support coping with DM, checking the expiration of the medicine stored at home, demonstrating the correct use of insulin and so on. When any problems were found, the well-trained nurse would give correct method to resolve. For those having no glucose meter, nurses should measure glucose for them. After discharge for 1.2 years, the researcher distributed SF-36 to the 60 cases both in exposed group and control group.60 were returned and valid for analysis.3.Nursing specialist intervention for outpatient careIn December 2006,42 patients of the valid 60 cases were transferred to the outpatient intervention by nursing specialists.Method:The self-designed DM related knowledge questionnaires were contributed to the 42 patients in this stage of study at the time of assessment and after follow-up for 1.5 years. After 1.5 years' follow-up, SF-36 was also used. The contents of DM related knowledge questionnaire and SF-36 were the same as the former. Totally, DM related knowledge questionnaires were released for 84 and validly returned for 84, while SF-36 was contributed for 42 and all of them were valid. The nursing specialist offering intervention for outpatient found that the knowledge of DM was well delivered among the 42 cases.Out-patient specialist nurses reevaluated the condition of the target patients in the study. And they gave them individualized education according to their condition. If the patient's medication or glucose control was incorrect, they would introduce the-patients to the doctor. And if they found the glucose of patient was high or the complication was serious, they suggested that the patient go to hospital for advanced treatment.Statistical MethodsThe software SPSS for Windows, version 13.0 for personal computers was used for statistical activity. Statistical methods included descriptive statistics analysis, independent sample T test, paired-sample T test, paired-sample rank test and two independent sample rank sum test. The statistical significance was set at a level of a=0.05.Results:1.The result of 82 elderly patients' knowledge about DM by self-control study showed that there were statistically significance in the 6 items by Paired sample rank test(P<0.001).Thus, through the hierarchical level of individual health education by professional nurses in hospital, there was great increase in DM knowledge. Therefore, the health education by nurses was remarkable and the desired purpose was achieved.2.Results of SF-36 scale surveyThe results of SF-36 scale survey during hospitalization and 1.2 years after discharge showed that:(1)There was no significant difference in the 8 dimensions of SF-36(P>0.05) between the experimental and control group before implementing home care during hospitalization. (2) One year and two months after intervention, there was statistical significance in PF, PR, BP, RE dimensions of SF-36(P<0.001)in two groups. So, there was improvement in the quality of life of DM patients.3.The results of specialist nurse' intervention in outpatient department3.1 Results of investigation about DM knowledge patients' held before intervention by nursing specialistThere was no significant difference in DM knowledge before out-patient specialist nurse health education about DM and after education intervention in hospital by two independent sample rank sum test (p>0.05). This showed that effect of the staged hierarchical individual health education for elderly DM patients was remarkable, and they firmly mastered related DM knowledge.3.2 Findings of investigation in patients' master of related knowledge before and after intervention by out-patient specialist nurse42 cases of DM patients were offered intervention by out-patient specialist nurse. There were statistical significance in dimensions of diet, diabetic foot, exercise, medication, complication and glucose self-monitoring between 1.5 years after intervention by nurse specialist and before intervention (p<0.05). This made out that the continuing intervention by out-patient specialist nurse increase patients' knowledge about DM greatly. It was better for patients' accepted targeted education in outpatient department.3.3 Results of SF-36 nurse specialists' intervention in outpatient departmentAfter nurse specialists'intervention, There were significant differences of the 42 cases in PF, RP, BP, RE, and HT (P<0.05). So, the effect of continuing intervention offered by nurse specialists in outpatient department was great. They could effectively improve the patients' quality of life.Conclusions:It needs skills to offer health education to the elderly who are suffering diabetes.The results are as follows:1.the style of health education on DM to the old people should be a staged hierarchical method which lead to a better result, not a one-time forced indoctrination, in other words,before the health education to the elderly,we'd better evaluate the level of their knowledge about DM in advance.2.The results of SF-36 showed that it is a good method to offer continuing nursing interventions for patients after they discharge, and this way could effectively improve their compliance for treatment and inmprove their quality of life.3.The patients, who were choosen to participate in the intervention conducted by the specialist nurses,know more about DM than before,and their quality of life has been improved effectively.This result indicated that,in this way,the patients have access to continue nursing interventions,which plays a great role in improving their compliance for treatment and bettering their quality of lifeThe aim of this study was to explore an effective and feasible DM patient management model named entire nursing intervetion model. The results of the study showed that the model was feasible and effective, and it was valid to increase the middle-aged and the elderly patients' knowledge about DM and to improve their quality of life.
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