Daily living and coping strategies in insulin-dependent diabetics diagnostic reasoning in nursing

Abstract: Within a defined geographical area, all patients, 192 in total, with insulin- dependent diabetes of at least 2 years' duration and free from long-term diabetic complications were identified. Their experiences of the influence of the disease on daily living, tedium, and smoking habits were evaluated using a questionnaire and related to metabolic control. A case-referent study concerning smoking habits among 25 patients with good, and 25 with poor metabolic control was performed. The influence of mentruation on metabolic control was studied among 20 diabetic women and 20 healthy controls. Coping strategies and their outcomes were studied among 20 patients, using the interview technique. Among those with unsatifactory metabolic and/or emotional outcomes, plans for nursing intervention were agreed on, using diagnostic reasoning. Only a minority of the patients reported that the disease caused them considerable problems in their daily lives. The greatest problems occurred in connection with regularity in daily life, diet management, and exercise. Patients with good metabolic control (HbAic<6.7) had a higher number of hypo-glycemic cornata (7 vs 1, p<0.001). Patients with poor metabolic control (HbAic>9.0) reported more often that they were smokers (pcO.Ol) and the women fertile aged in this group more often reported problems with metabolic control during menstruation (p<0.05). Twenty-nine (18%) were defined as suffering from tedium. There was a higher proportion (NS) of high tedium scores among patients in both good and poor metabolic control groups than in those with intermediate metabolic control. Sixty (31%) of the patients were smokers, prevalence of smoking increased significantly with increasing HbAic- levels (17.5% among patients with the best metabolic control, 47.5% among those with the worst metabolic control). In the case referent study exposure to smoking was found to be significantly more common among those with poor control (odds ratio 6.0). No systematic change in metabolic control during the menstrual cycle could be found. Problem-solving coping strategy based on the monitoring of blood glucose in combination with sensitivity to signs of actual blood glucose level and logical reasoning, was found to have the best coping outcome, both regarding metabolic control and well-being. The results are summarized in a model for diagnostic reasoning in nursing.