Effect of a new health education model on continuous nursing in elderly patients with diabetes mellitus

This study used convenience sampling to select 59 cases of elderly patients with fracture and diabetes mellitus, who attended the Department of Orthopedic Surgery in a hospital of Tai’an City from September 2016 to February 2017. The patients ranged in age from 60 years to 86 years, with an average age of 77.5 years. Among them, there were six cases of fibular fracture, 11 cases of tibial fracture, nine cases of femoral fracture, 27 cases of radius fracture, and 12 cases of ulnar fracture. The history of diabetes ranged from 17 years to 1 year, and the patients’ fasting blood glucose concentrations ranged from 8.3 to 16.4 mmol/L. Among them, 37 cases had a history of diabetes and 12 cases were diagnosed with diabetes after hospitalization.

Finally, the patients were divided into experimental (33 cases) and control (26 cases) groups: foreign patients and patients for whom community nursing observation was not convenient were included in the control group, and patients residing in the city and patients for whom community nursing was convenient were included in the experimental group. There was no significant difference between the two groups in terms of age, sex, disease severity, and educational level (P > 0.05).

The nurses administered anti-inflammatory, oral hypoglycemic drugs, or insulin injections to the 59 patients after surgery, helped reduce local edema, provided diet guidance and early functional rehabilitation exercises, and established personal health registration forms.

On the day of discharge, health-care-related education was provided, to inform the patient of hospital procedures and matters requiring attention, by a responsible nurse according to the patient’s condition and operational situation of the hospital.

Blood glucose control: patients were informed of the correct use of hypoglycemic drugs according to the doctor’s instructions, the need to regularly monitor blood sugar levels, and the adverse reactions to and countermeasures for hypoglycemic drugs.

In addition to the routine care provided to the control group, the observation group was also offered a voluntary health education menu, according to the Tai’an municipal civilization office guidelines, which was developed to meet the living needs of the community residents and improve their quality of life, as follows:

The “meal preparation service” team consisted of members of four departments, including orthopedics specialists (two chief physicians and two residents), two diabetes specialists (two physicians), one psychologist, one public nutritionist, four nurse specialists (two from the Department of Orthopedics and two diabetes specialist nurses who earned the title after system specialist training), and two community health service center members of the medical staff. The titles and expertise of the 14 medical personnel were included in a booklet issued to the patients; the community health workers were responsible for answering patient questions and collecting basic information from patient records, including name, address, age, clinical diagnosis, surgery date, time to discharge, and contact information.

Treatment compliance: diabetes treatment adherence was assessed based on the scale proposed by Chen10 in 2007, according to Li and Cai,11 who developed the diabetes compliance questionnaire; after repeated revision and expert consultation, the content validity was 0.83, the test–retest reliability was 0.86, and Cronbach’s alpha was 0.86. A total of five dimensions and 20 entries were used to evaluate patient compliance with medication, reasonable diet, regular exercise, blood glucose tests, and regular follow-up. Each item was scored as follows: regularly (one point), occasionally (two points), and never (three points). The total score ranges from 20 to 60 points, with a higher score indicating better compliance.

The data were recorded in a Microsoft Excel spreadsheet and analyzed using IBM SPSS Statistics for Windows, version 20.0. Data were expressed as average ± standard deviation (M ± SD), and the differences between the two groups were assessed using the two-sample t-test (α = 0.05).

The patient compliance in terms of medication, reasonable diet, regular exercise, blood glucose monitoring, and regular follow-up improved significantly in the experimental group compared to those in the control group (P < 0.05). Analysis of blood glucose and lipid levels revealed significant changes in FPG, 2hPG, TG, HDL-C, and LDL-C levels in the experimental group (P < 0.05), while the changes in HbA1c and TC did not change significantly between groups (P > 0.05) (Tables 1 and 2).

Table 1

Patient compliance before and after the intervention (M ± SD, n = 59)

Table 2 shows the changes in blood glucose and lipid levels before and after intervention in the control and experimental groups.

Table 2

Blood glucose and blood lipid changes (M ± SD, n = 59)

The dysfunction and annoyance indexes of the control and experimental groups before and after intervention are shown in Table 3.

Table 3

Comparisons of dysfunction and annoyance indexes (M ± SD, n = 59)

Research has shown that behavior change can be used to measure the success of diabetes education programs.14,15 In this study, the effects of the application of a menu-based volunteer health education in community patients with diabetes on compliance are shown in Table 1. Patient compliance was significantly higher after the intervention (P < 0.05). The reasons for this finding may be the following:

the “delivery” process, which used a variety of ways to provide volunteer education that allowed patients with diabetes in the community to participate actively in the nursing process of the disease; through the study of related knowledge, patients were better able to understand the importance of diet, exercise, medication compliance, and blood glucose monitoring;

Table 2 shows that the voluntary service menu health education intervention reduced the FPG, 2hPG, TG, and LDL-C levels and increased HDL-C level (P < 0.05), which may be related to health education that improved compliance, modified poor habits, and encouraged a reasonable diet and regular exercise. The HbA1c and TC levels tended to decrease, but the difference was not significant (P > 0.05), which might be related to the short intervention period.

Table 3 shows that the menu service for nursing health education promoted the functional recovery of patients (P < 0.05), facilitated fracture recovery to progress to isotonic and isometric exercise, and increased patient confidence to overcome the disease (P < 0.05) in the experimental group, compared to the control group, in order to improve patient mental health.