Construction Of Nursing Management Scheme For Elderly Patients With Diabetes And Frailty

Background and objective: Frailty is one of the important complications in elderly patients with diabetes,which can not only lead to an increased risk of poor prognosis in elderly patients with diabetes,but also have an important impact on their hypoglycemic treatment.Many foreign diabetes guidelines emphasize the need for comprehensive evaluation of patients with diabetes complicated with frailty,individualized management plan according to their overall health status,individualized treatment and nursing at early stage,so as to delay the frailty process of such patients and reduce the risk of adverse clinical outcomes.However,China’s attention to the disease management of diabetes patients with frailty is late,and there is still a lack of evidence-based evidence to standardize the diagnosis,treatment and nursing of elderly diabetes patients with frailty.One of the purposes of this study is to investigate the knowledge and behavioral status of endocrine nurses on the nursing management of elderly patients with diabetes and frailty.The other purpose is to summarize the best evidence in the high-quality diabetes guidelines for the management of elderly diabetes patients with frailty,and construct a nursing management scheme for elderly patients with diabetes and frailty,which can provide theoretical guidance for clinical nurses to scientifically manage elderly patients with diabetes in China.Methods:（1）Investigation on knowledge and behavior related to nursing management of elderly diabetes patients with frailty: In order to investigate the knowledge and behavioral status of endocrine nurses on the nursing management of elderly patients with diabetes and frailty,we used the questionnaire survey method to survey the clinical nurses of endocrinology in 19 hospitals from 8 provinces /municipalities in five geographical regions of China by the self-designed knowledge and behavior questionnaire on nursing management of elderly diabetes patients with frailty.（2）Formulation of nursing management scheme for elderly patients with diabetes and frailty: Literature review method was adopted to systematically search the clinical practice guidelines for diabetes mellitus.We used the evaluation tool of AGREE Ⅱ standard to evaluate the quality of included clinical practice guidelines.Then,we summarized recommendations from high-quality guidelines on the management of elderly patients with frailty and diabetes,and combined with the results of the questionnaire survey and the clinical situation in China to preliminarily formulated the nursing management scheme for elderly patients with diabetes and frailty through team discussion.In the end,the Delphi expert consultation was used to review and revise the initial nursing management scheme of elderly diabetes patients with frailty to establish nursing management scheme of elderly diabetes patients with frailty in line with China’s national conditions.Results:（1）Investigation on knowledge and behavior related to nursing management of elderly diabetes patients with frailty: A total of 439 valid questionnaires were collected,of which the average score of the knowledge dimension was 6.23 ± 1.75 and the pass rate was 20.05%;the average score of the behavioral dimension was 25.30±7.13 and the pass rate was 57.40%.The results of univariate analysis are as follows : Endocrinology nurses with different professional titles and working years had differences in the scores of nursing management knowledge of elderly diabetes patients with frailty（P<0.05）.The scores of management related behaviors of elderly patients with diabetes and frailty were different in age,professional titles,working years,whether they were diabetes specialist nurse,whether they had read/studied diabetes clinical practice guidelines,and whether they had participated in training about the management of elderly patients with diabetes and frailty（P<0.05）.The results of the multiple linear regression are as follows: The factors influencing the score of knowledge related to management of elderly patients with diabetes and frailty were the professional title of clinical nurses（P<0.05）.The factors affecting the management-related behavior scores of elderly patients with diabetes and frailty were diabetes specialist nurse（P<0.05）,reading/studying the diabetes clinical practice guidelines（P<0.05）and the participation in the training related to the management of elderly patients with diabetes and frailty（P<0.05）.（2）Formulation of nursing management scheme for elderly patients with diabetes and frailty:Through literature retrieval and quality evaluation,16 diabetes clinical practice guidelines from 10 different countries and regions were included,and recommendations related to the management of elderly patients with diabetes and frailty were extracted and integrated to form the best evidence containing 56 recommendations.Through group discussion,we combined the recommendations with the results of the questionnaire survey and the clinical situation in China to preliminarily developed the nursing management scheme for elderly patients with diabetes and frailty,including 6 first-level items,23 second-level items and 44 third-level items.After two rounds of expert consultation,a nursing management scheme for elderly patients with diabetes and frailty was finally formed,including 7 first-level items,29 second-level items and 54 third-level items.The results of the two rounds of expert consultation are as follows: The positive coefficients of experts were 93.75% and 100%,respectively.The expert authority coefficients were 0.867 and 0.883,respectively.After two rounds of expert consultation,the coefficient of variation of importance of each item was 0-0.117,kendal harmony coefficient was 0.107,operability coefficient of variation was0-0.167,Kendal harmony coefficient was 0.228.Conclusions:（1）At present,the cognition and practice of Chinese nurses on the nursing management of elderly patients with diabetes and frailty were poor,and there is a large demand for related specialized training to Chinese nurses.In the future,effective measures should be taken to strengthen the training of management knowledge about elderly diabetic patients with frailty,so as to improve the nursing quality of elderly diabetes with frailty and the quality of life and clinical outcomes of elderly diabetes with frailty in China.（2）Based on the summary of recommendations from high-quality guidelines on the management of elderly patients with frailty and diabetes,through team discussion and Delphi expert consultation,the nursing management scheme for elderly patients with diabetes and frailty was formed finally,including seven dimensions and 90 items in total.The scheme is comprehensive in content,reasonable in structure,in line with the clinical situation and highly operable in China,which provides a scientific basis for standardizing the nursing management of elderly patients with diabetes and frailty in China.