Role of Practice Nurse (PN in GP surgery)

HBA1c or glycosylated hemoglobin is a type of hemoglobin that is usually measured in the diagnosis of diabetes type 2 and identifies the average concentration of plasma glucose (Samiul, 2010). When the glucose level in the body is normal, normal glycosylated hemoglobin is visualized but the value will begin to increase with rise in the levels of blood glucose concentration (Anekwe, 2011). In normal circumstances, the level of glycosylated hemoglobin is less than 7%; however, diabetics cannot reach this level due to the level of plasma blood glucose levels in their body (Christiansen, et al., 2012). In the administration of the glycosylated hemoglobin tests, nurses play a critical role as they are the sole custodians of the tools used for self-tests in type 2 diabetic patients (Hunt, 2013). The role of practice nurses in the management and control of diabetes type 2 by lowering the levels of glycosylated hemoglobin will be the basis of this paper.

How to improve HbA1c testing compliance


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According to the American diabetes association, asymptomatic approach should be developed in order to identify the condition at an early stage. A1C levels are used to indicate the presence of the condition and the possibility of an onset in the future. According to results from diabetes control and complication trials, the use of A1C is used to indicate the measure of chronic glycemic without the possibility of fasting (Practice Nurse, 2007). Results from a number of population based studies have highlighted the role of A1C in the detection of undiagnosed diabetes and also in the identification of potential risk to developing the condition in the future. In this study, the levels of A1C were measured in a standardized environment and consistent results produced based on the international A1C-derived average for glucose (Warren, 2010).

Results from clinical trials have demonstrated that improvement in the office based glycosylated hemoglobin test can enhance decision-making, improve patient compliance and the patient outcomes (Hunter & Pearce, 2013). The glycosylated hemoglobin test is the appropriate audit cycle that has been shown to improve the compliance rate by more than a half as compared to results from patients who use other tests (Oluwatowoju, et al., 2010). In a study conducted in NE wham in London borough, 51% of the minority ethnic groups had a high incidence of type 2 diabetes but the healthcare professionals were faced with the challenge of reaching the population and introducing the right control regimen (Wan Nazaimoon et al., 2013). Poor control in the region was attributed to the low compliance with the right diet, exercise and medication which led to destabilization in the patient glucose levels. Some patients have also expressed challenges with the need to find time off work in order to book the GP or come for blood tests using the traditional methods (Degeling & Rock, 2012).

Such patient co-morbidity factors increased the level of compliance and led to increased complication of the condition among the diabetic type patients living within the borough. An introduction of the glycosylated hemoglobin tests produced results which demonstrated that the test can improve the level of compliance in patients and reduce the HbA1c levels in the patients (Twomey, Rayman & Pledger, 2008). The results also demonstrated an increase in the compliance levels by over 55%, a demonstration that HbA1c improves patient compliance and commitment to the diabetic treatment process. The HbA1c test can also be implemented in other diabetic tests to ascertain the level of compliance including the TFT, LFt and the U&Es tests (Piveta, et al., 2014).

Recall system, patient testing and education

            Recall are steps that are implemented in practise in order to remind patients and caregivers of timely reviews and assessment targets, complication risks and patient recall for regular visits. Recall is diabetes  is important in ensuring that insulin therapy and post-visit care is taken in order to check the sugar levels in the patients. Recall systems enable patients make necessary adjustments to their programs and reassess the level of diabetes treatment. Recall systems contribute to the improvement of the quality of care that diabetes patients receive at any given point in time (Lucas, 2013).

Once medication is provided to patients, all directions must be given to enhance follow up and proper adherence to the directions. The next date of visit to the facility is also clearly indicated in order to avoid any possible confusion, which may affect the adherence to the treatment protocol. Three different patient testing methods have been developed for diabetics that include the haemoglobin A1C method among other commonly used approaches (Moberly, 2010). The accuracy of diabetes testing enhances the management of the condition in patients and eliminates issues associated with misdiagnosis and wrong medication. Through patient education, adequate information on diabetes management and care is provided which is critical in ensuring that the progress of the patient is maintained and any possible drug reactions are addressed at an early stage. Different patent education models exist that can be used to mitigate any issues that may affect the effectiveness of the interventions in diabetes (Warren, 2014).

NICE and other guidelines

The national institute for health and care excellence (NICE) is mandated to create guidelines which influence the practises of health practitioners in different parts of the country (Davis, et al. 2014). NICE has provided different guidelines that touch directly on the management and control of diabetes type 2 as way of ensuring patient compliance with the right medication and living style. There are clinical guidelines, which are provided to guide the management of the clinical impacts of diabetes type two and ensure that the patients have the right living environment (Giniş et al., 2013). NICE guidelines also highlight the need for developing the right technological application for the management of diabetes such as the HbA1c tool that is used to improve compliance. The guidelines also provide the right intervention procedures that nurses can adopt in different diabetes emergency situations which can be life threatening (Bennett, 2014). Public health and diagnostic guidelines have also been established to provide directions to the healthcare professionals working towards enhancing the lifestyle of diabetes type one patients (Scott, 2013).

Holistic care and 6Cs in nursing

            Effective nursing care of diabetes patients involves the incorporation of the 6Cs of nursing which include compassion, care, competence, communication, courage and commitment. As a nurse, care must be provided with dedication to diabetic patients in order to ensure that the sugar level does not rise above the normal value (Bhowmik et al., 2013. Compassion also allows nurses to understand the situation that diabetic patients are which encourages empathetic care and management of patients (Alfonso-Rosa, 2014). Competence and communication eliminates issues associated with improper care or mistakes that may occur due to lack of coordination and ineffective transfer of information. Courage and commitment is the basis of the nursing profession and enable professional nurses to commit to the challenges presented by diabetic patients (Yan et al., 2013).     

QOF and HbA1c

In 2010, NICE raised the requirement for QOF HbA1c for patients with type 2 diabetes to 7.5%, which was a concession that there are sufficient uncertainties on the safety of the patients who use the tool (Al Sayah et al., 2014). The move was aimed at lowering the target at an early stage to give room for much tighter and controlled target at a later stage during the management of type 2 diabetes. Despite the popularity that QOF has attained over the years since it was introduced by NICE, it has no role in the individualisation of diabetes therapy in patients (Juarez, et al. 2014).

How improve service to reduce HbA1c

This diagnostic approach can be used in the process of population diabetes screening due to the advantages it presents as compared to the FOG concentration approach. In this approach, there is no need for a fasting or timed sample as has been the case with other approaches (Furler et al., 2014). A1C also indicates the levels of chronic glycaemic levels with a low pre-analytic instability as compared to the 2-h glucose concentration approach. With the prevalence of diabetes, an approach with a consistent relationship with the diabetic micro-vascular complication is preferred (Hunt, 2013).

This makes A1C assay a much better approach as compared to the currently available diabetic diagnostic tools for adults. Despite the benefits of this assay, there is a risk of under diagnosing people with overt levels of diabetes when the A1C cutoff of 6.55 is applied especially to the aging or retired population. In this study, the levels of A1C were measured in a standardized environment and consistent results produced based on the international A1C-derived average for glucose. This paper has thus indicated that early diagnosis of diabetes and the determination of future possibility of developing the condition are critical in its management. Choi et al (2011) is critical base upon which other diagnostic studies on diabetes can be done especially in the development of pre-screening tests.

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