BOLIVARIAN REPUBLIC OF VENEZUELA

MINISTRY OF PEOPLE'S POWER FOR THE UNIVERSITY EDC

“RÓMULO GALLEGOS” NATIONAL EXPERIMENTAL UNIVERSITY
DEAN OF CONTINUING STUDIES
MOBILE CLASSROOM, EASTER VALLEY
GUARICO STATE

EDUCATIONAL NURSING INTERVENTION IN THE DIABETIC PATIENT

WHO ATTENDS THE RURAL OUTPATIENT TYPE I LA CLEMENCIA,
STATE GUARICO.

Special Degree Work to qualify for the Bachelor's Degree

In Nursing

Author:
TSU Maria Suarez
TSU Leysmar Rivero

Easter Valley, March 2015

DEDICATION

ii
RECOGNITION

iii
 GENERAL INDEX

pp

iv
LIST OF TABLES………………………………………………… ix
SUMMARY………………………………………………………………… xi
.. 1
INTRODUCTION…………………………………………………………..

CHAPTER

I THE PROBLEM…………………………………………………... 3

Problem Statement……………………………….......... 3
Goals………………………………………………………... 6
Justification of the research……………………………………....... 6

II. THEORETICAL 8
FRAMEWORK................................................ ...........................
8
Background of the research……………………………… 11
Theoretical bases………………………………………………......... 11
Conceptual Aspects of Diabetes Mellitus.................... 14
Nursing Intervention in the Diabetic Patient...... 18
Health Education for Diabetic Patients................................... 23
Theory Underpinning the Research................................................. 24
Legal Bases………………………………………………………… 28
Glossary of terms............................................... ...................
31
III. METHODOLOGICAL
FRAMEWORK................................................ ......... 31
31
Kind of investigation………………………………............... 32
Research design……………………………………......... 32
Population and Sample…………………………………………...... 33
Techniques and Data Collection Instrument…………...... 33
Data Processing and Analysis Techniques………… ……...
Validity………………………………………………………....... 34
34
IV. ANALYSIS AND INTERPRETATION OF THE RESULTS.
Presentation, Analysis and Interpretation of Data…………..... 46
46
v. CONCLUSIONS AND 47
RECOMMENDATIONS…………………....... 48
Conclusions………………………………………………………….
Recommendations……………………………………………….... 51
Action plan............................................... ................................ 54
55
REFERENCES................................................. ............................................ 57
ANNEXES………………………………………………………………… 58
…. v
A Research Instrument……………………………………
B Communication addressed to experts for validation…………..
C Questionnaire Validation Format…………………………......
 LIST OF TABLES

CHART. pp.
1. Absolute and percentage distribution of the population,
according to the item “Do you know your importance as an 34
educator ?”

2. Absolute and percentage distribution of the population,

according to the item “ Do you have experience educating 35
diabetic patients ?” ..................................................

3. Absolute and percentage distribution of the population,

according to the item “ Do you instruct and support patients 36
to achieve and maintain self-care?” ...........................

4. Absolute and percentage distribution of the population,

according to the Item “ Do you plan the care of the diabetic
patient on an individualized basis and with the participation
37
of the family to promote self-care

vi
 ?” ....................................................

5. Absolute and percentage distribution of the population,

according to the Item “ Do you guide the diabetic patient 38
and family to recognize behaviors that promote
health?” .....................

6. Absolute and percentage distribution of the population, 39

according to the item “Do you offer psychological support
and motivation to diabetic patients?” ...................................

7. Absolute and percentage distribution of the population, 40

according to the Item “ Do you explain to patients the
importance of monitoring blood glucose
levels?” ......................................
41
8. Absolute and percentage distribution of the population,
according to the Item. Do you advise the patient about
complications due to excessive or inadequate food
intake? ..................... 42

9. Absolute and percentage distribution of the population,

according to the item “ Do you guide the patient about
complications due to non-compliance with pharmacological 43
treatment?”

10. Absolute and percentage distribution of the population, 44

according to the Item: Do you advise the patient about
complications due to infections or
stress?................................... ....................................

11. Absolute and percentage distribution of the population,

according to the Item: Do you educate the patient regarding 45
the control of risk factors such as HTN, obesity,
etc.?................... ..................

12. Absolute and percentage distribution of the population,

according to the Item: Do you educate the patient in
relation to preventive measures to avoid chronic
complications of DM (care and protection of the feet,
general hygiene: skin, mouth, eye
care) ? ................................................

vii
viii
 INTRODUCTION

The recent rapid increase in the number of people with diabetes around the world
constitutes the largest epidemic of a disease in human history. However, in recent
decades, the scientific revolution has contributed led to a greater understanding of
diabetes and the development of new cutting-edge therapies. But, the previous The
prevalence of this disease and the death and disability it causes have continued to
grow rapidly, especially in the developing world.
Therefore, it should be considered that people with diabetes and their healthcare
providers have the right to receive daily education. high-quality diabetes, which
involves education for everyone, that is, doctors, nurses and other health personnel, as
well as adults and children with diabetes, their teachers and family members. That is,
diabetes education must form the foundation of all action plans to overcome these
challenges, since it places people You have diabetes as the protagonist of an ongoing
intervention that involves communicating with a diabetes care team and coordinating
a treatment plan. In this regard, the nurse constitutes an important element of this
team and, in such a situation, must fulfill their teaching function in order to promote
better care and prevention of this condition.
Regarding the organization of the work, it was formed as follows: Chapter I,
corresponds to the problem, its approach, objectives and justification of the research.
For its part, chapter II corresponds to the theoretical framework that consists of,
Background of the research; Theoretical bases: Conceptual Aspects of Diabetes
Mellitus, Nursing Intervention in the Diabetic Patient, Health Education for the
Diabetic Patient; Theory Underpinning Research; Legal Bases and Glossary of
Terms.
Similarly, chapter III refers to the methodology: Type of research, Research
design, Population and Sample, Data collection techniques and instruments, Data
processing and analysis technique, and Validity;

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Likewise, chapter IV corresponds to the Analysis and interpretation of the results.

Chapter V refers to the conclusions, recommendations and the Action Plan; Finally,
the list of references and annexes are incorporated.
 CHAPTER I
THE PROBLEM

Problem Statement

According to the Pan American Health Organization (PAHO, 2006), Diabetes

Mellitus has come to be considered a pandemic, since more than 35 million people
around the world suffer from it; while the World Health Organization (2004) believes
that this figure will double in the next 20 years (around 65 million people), which
would generate enormous expenses in care for both the disease itself and its
consequences. derived conditions.
In this regard, Jiménez, Contreras, Fouillioux, Bolívar and Ortiz (2005) consider it
as one of the most frequent diseases worldwide and a public health problem, due to
its chronic and acute complications. Furthermore, it is considered a group of
metabolic diseases that are characterized by the presence of high blood glucose
values, being one of the main causes of morbidity and mortality in today's society. In
fact, they point out that because it is a chronic disease, it affects the social and
psychological aspects of the patient, produces a high cost for health care services,
absenteeism from work, disability and vital limitations for patients.
Likewise, they point out that its prevalence has increased in recent decades as a
consequence of a series of factors among which we must mention the greater
longevity of the population, etiological factors such as genetic origin given by a
family history of diabetes, environmental factors such as such as the consumption of
refined sugars, a sedentary lifestyle, multiparity, repeated abortions and especially
obesity, among others.

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However, all these factors always act on a genetic basis, which constitutes the most
important etiological factor.
According to what was mentioned above, it is understood that attention and time
must be dedicated to this public health problem to prevent and early treat the
complications of the disease, which is why the presence of nursing is essential in
order to fulfill a transcendent role in the immediate and long-term care of the diabetic
patient, planning their interventions based on the assessment; the establishment of
nursing diagnoses and the planning of interventions, which are the direct care that
will be carried out for the benefit of the patient, even if he or she is incapacitated.
In this regard, it is assumed that the intervention in question means being able to
transform the patient's health from the perspective of education, because, as
Lowdermilk, Perry and Bobak (2004) state: “Education for health in the individual ,
family and community are an integral part of comprehensive nursing care. Such
education stimulates participation and responsibility for the promotion, maintenance
and restoration of health” (p.1374). From the previous quote, we infer the great
importance of nursing in terms of its teaching competencies in terms of educating the
patient, family and community as a way to promote, restore and maintain health.
Similarly, Ortega (2010) considers that it is through Health Education (EPS) that
the diabetic patient should be approached therapeutically, since in this way, diet,
exercise and medication can be introduced, informing the patient. about its
importance and motivate him to take a leading role in the control of his disease. In
other words, Health Education (EPS) aims to ensure that people are better prepared to
think for themselves, make their own decisions and set realistic goals. The objective
to achieve is for people to be and live as well as possible.
Consequently, the aforementioned author considers that health education should be
provided by the nurse as a protagonist in the care and learning of a diabetic patient,
since she is a health reference in the control and management of her illness. To do
this, you must go through a long and complicated process of diabetes education that
involves: Diet, exercise, self-analysis, medication, control of exceptional situations,
 5

and be aware of an extensive and specific list of measures and recommendations that
a diabetic should know and use. correctly.
For his part, Romero (2010), when referring to nursing intervention, considers that
diabetes education is not new and plays an important role in the sense that through it
therapeutic educational programs are developed by consensus, which must be based
on the application of quality care management: Carry out a regulated assessment in
search of the real or risk problems of the person with diabetes, ensuring compliance
with objectives agreed upon by both parties.
Indeed, these programs should contain, among others, aspects related to: a) The
identification of obstacles to modifying behaviors; b) Combination of quality
educational strategies; c) Take into account individualization; d) Understand that
knowledge is necessary but not sufficient to modify behaviors; e) Education will
guide the person with diabetes on what they should do and not only on what they
should know; f) Education requires continued attention, giving great importance to
Psychosocial factors; g) Family members of people with diabetes will be involved,
giving them an active role; h) The basic objective will be to promote independence
and promote the freedom of the person with diabetes.
On the basis of the ideas presented, it can be stated that in the Rural Outpatient Clinic
type I La Clemencia, Infante Municipality, Valle de La Pascua, where a high number
of diabetic patients attend, it is necessary for them to be educated in health to face
diabetes through the recommendations and measures suggested by nursing, in order
not to complicate the disease, although there are possibilities for the patient to violate
them, due to forgetfulness, lack of knowledge or lack of vigilance. In fact, such action
highlights the importance of the nursing professional in his teaching role in favor of
promoting the health of diabetic patients. To this end, these reasons are sufficient to
raise the following question:
How is the educational nursing intervention in relation to the diabetic patient who
attends the Rural Outpatient Clinic Type I La Clemencia, Infante Municipality, Valle
de La Pascua?
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What will be the educational activities carried out by nursing in the diabetic patient
who attends the Rural Outpatient Clinic Type I La Clemencia, Infante Municipality,
Valle de La Pascua.
Research objectives

General objective

Describe the educational intervention carried out by nursing in the diabetic patient
who attends the Rural Outpatient Clinic Type I La Clemencia, Infante Municipality,
Valle de La Pascua

Specific objectives

Explain the role of nursing in the educational intervention in the diabetic patient who
attends the La Clemencia Type I Rural Outpatient Clinic, Infante Municipality, Valle
de La Pascua.
Identify the educational activities carried out by nursing in the diabetic patient who
attends the AmbulatorioRural Type I La Clemencia, Infante Municipality, Valle de
La Pascua.
Develop and implement a nursing educational action plan for the diabetic patient who
attends the La Clemencia Type I Rural Outpatient Clinic, Infante Municipality, Valle
de La Pascua.

Justification

This research work represents the possibility of understanding the nursing educational
intervention for diabetic patients who attend the primary care institution. Well, it is
known that diabetes is one of the chronic diseases, which remain throughout a
 7

person's life, so it is imminent that this person receives health or diabetes education
that allows him or her to face the disease in order to Transform your overall life
behavior. Indeed, this makes this study relevant, since it aims to discover what the
nursing intervention is like with respect to the health education provided to the
diabetic patient who attends the Type I La Clemencia Rural Outpatient Clinic, Infante
Municipality, Valle de La Pascua.
From the nursing point of view, the experience of dealing with diabetic patients on a
daily basis makes possible their permanent updating regarding their demands, which
implies monitoring the life, health and privacy of human beings. In other words,
nursing has to assume the responsibility of educating those affected by diabetes, as
well as their family to accept and adapt to the implications of the disease. This reality
constitutes today a sufficient reason to justify the policy of current health in relation
to reinforcing preventive measures with respect to chronic diseases and to the same
extent improving the living conditions of those who suffer from these types of
pathologies, emphasizing the prevention of high blood pressure, obesity, and
promoting physical activity , since these are risk factors for the progression of
diabetes.
Based on what was stated above, it can be inferred that the study is justified from a
theoretical point of view, given that its results must coincide with the contributions of
the different authors cited in the study. Likewise, this research, from a practical point
of view, becomes an instrument for analysis and reflection by those who suffer from
the disease, for their family who needs guidance to address the requirements of those
who suffer from the disease, and for the health personnel, especially nursing from any
health institution, who wish to expand their knowledge on the topic. From a
methodological point of view, the study provides a new theory that will be valuable
for subsequent research related to the same topic.
 CHAPTER II
THEORETICAL FRAMEWORK

In this chapter, the theoretical aspects that strengthen the research are presented
through the contributions of authors who study the same topic.

Research Background

Regarding this research, some authors with similar studies provide theoretical
elements that allow the present to be improved. Among those are:
Esteban (2013) who, in his study titled: “Importance of diabetes education and its
influence on the prevention of possible complications” aims to highlight the
importance of diabetes education for the acquisition of good habits and knowledge
about the disease. , through documentary research or bibliographic review; in which it
concludes that nursing plays a very important role in the care and education of the
diabetic patient, through the process of assessment, nursing diagnoses, diabetes
education and evaluation with which it can help the patient prevent many of the
complications to be faced. long term.
This background coincides with the objectives of this study, given its orientation
towards the importance of educating diabetic patients from a preventive point of view
in order to avoid complications.
For their part, Gómez and Pierantozzi (2012), in a work called “ Nursing intervention
in the education of people with diabetes mellitus, ” aim to describe nursing
interventions in people with diabetes mellitus, emphasizing the educational aspects. ,
meal plan and physical exercise that involves family members of people with diabetes

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mellitus. Methodologically it corresponds to a documentary research of a descriptive

nature. Their conclusions are that diabetes is a chronic metabolic disorder that affects
the body's ability to produce or respond to insulin; and that in our country it increases
every day, becoming a public health problem; It is the third cause of death; causes
serious socio-health cost problems. It becomes an important challenge for nursing
professionals in the educational intervention of the person with diabetes and their
family, given that their professional work has a direct link that can help guide them
through educational sessions in order to ensure that the person reaches to self-care.
Likewise, they conclude that, although there are programs of preventive measures
for these people, unfortunately the intervention strategies are ineffective, which is
why complications continue to occur. They also consider that education must be
continuous, to achieve in these individuals an attitude of effective and permanent self-
care to maximize their physical well-being since education is a fundamental human
right and is a duty for all those who work in the maintenance and promotion of good
health. In the same way, they consider that diabetes has an economic impact on those
who suffer from it, their families, health systems and countries; Therefore, it is
imperative to improve lifestyles, avoiding obesity, a sedentary lifestyle and toxic
habits such as coffee and alcohol, and a balanced diet are useful tips for people prone
to suffering from diabetes mellitus.
Finally, they consider the importance of nursing staff as an integral part of a team of
knowledgeable people who can decide and help healthy or sick individuals, their
families and the community in solving their problems, addressing in their activity not
only in the biological aspects but also attending, according to their knowledge, the
psychological and social processes that may put people's health at risk. According to
the above, this background means a contribution to the study being carried out and
where it is appreciated that the educational activity represents a strategy for
promoting the health of diabetics, practicing self-care and therefore self-control.
Similarly, Uriarte, Flores and Castro (2010), through their study “Nursing knowledge
in the care of diabetic patients before and after an educational intervention, aim to
compare the degree of knowledge of the nursing staff of the health education model
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in Diabetes Mellitus before and after an educational intervention, using a comparative

study, before and after, of 25 nurses, who attended the educational training
intervention of the Health Education model in Diabetes Mellitus , using teaching
strategies that allowed staff to have greater participation. The study was descriptive,
field. Their conclusions indicate that the effect of the educational intervention was
statistically significant, so the degree of knowledge of the Diabetes Mellitus Health
Education model was greater after the intervention.
This background corresponds to the objective of this study related to the role that
nursing must fulfill in terms of its educational intervention in diabetic patients, on
which the knowledge that the patient can obtain in order to take care of themselves
depends.
Likewise, Rodríguez (2009) in his study called “Educational intervention of the
community nurse in the promotion of self-care in diabetic patients treated in the
diabetes unit of the Bejuma district hospital. Carabobo State, the purpose is
established to determine the educational intervention of the community nurse in the
promotion of self-care in the diabetic patient treated in the outpatient Diabetes Unit of
the Bejuma District Hospital, Carabobo State, through a field design, descriptive,
transversal and retrospective type. The result of the research showed that the
community nursing staff carries out educational activities contributing to the
promotion of self-care of diabetic patients who attend control in the Diabetes Unit.
This background reflects the importance of nursing staff, when they intervene from
an educational point of view in promoting self-care of diabetic patients, offering
consistent strategies that become a guide to perfect the orientation and methodology
when carrying out their educational intervention.
Finally, Suárez, García, Aldana, Díaz and Grupo de Intervención (2009), in a work
titled “Results of diabetes education for health providers and patients. Its effect on the
patient's metabolic control" whose objective is to reduce morbidity and mortality due
to diabetes and to show the results of an educational intervention aimed at doctors
and nurses in family offices so that, in turn, they educate patients. diabetics and
achieve better metabolic control, and their methodology corresponds to an
 11

experimental design, they conclude that the educational aspect is essential to face the
health problem-diabetes and that it must be initiated by health providers so that they
can effectively carry out care. and education of the diabetic population. The
effectiveness of the educational intervention in the intervention area was verified, so
it was taken into account in the interpretation of the rest of the results.
This work is related to the topic under study, since it consists of diabetes education
that is provided to doctors and nurses so that they become educators of diabetic
patients as a way to improve their quality of life. managing to improve metabolic
control.

Theoretical Bases

Conceptual Aspects of Diabetes Mellitus

Diabetes Mellitus is fundamentally characterized by an increase in blood glucose

(glycemia) with the appearance of the same glucose in the urine (glycosuria). In this
regard, García (2006) points out that it is an alteration in the metabolism of
carbohydrates or sugars, of which the most important is glucose; but at the same time,
the metabolism of proteins and fats is altered. Consider that, if these alterations occur
less intensely or very gradually, the subject will present symptoms characterized by
eating abundantly (polyphagia), urinating a lot (polyuria) and sometimes fatigue
(asthenia). Sometimes they lose weight, other times they gain weight.
In the same way, he points out that the sudden onset of diabetes, for example, in
young people, or mild diabetes, must be added to other factors, such as weight loss
without apparent cause, and acute complications such as diabetes may appear.
diabetic coma. However, consider that when diabetes appears slowly, in adults,
weight is generally gained. He also maintains that the diabetic is exposed, after many
years, to the appearance of complications in the eyes, kidney, heart, vessels and
nerves, which can be avoided if diabetes is well controlled from the beginning.
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In relation to the classification of the disease, the World Health Organization

(1997) proposed using the terms Diabetes Mellitus Type 1 and Type 2; New values of
normality – disease are defined; A new clinical category is introduced, Altered Basal
Glucose; New screening criteria for Diabetes Mellitus are recommended; The
recommendation for universal screening for Gestational Diabetes disappears, and
selective screening is recommended. Screening is not recommended in low-risk
women: under 25 years of age, normal weight, without a family history of diabetes,
and who are not members of ethnic groups with a high prevalence of diabetes.
Regarding type 1 diabetes mellitus, DelFresno (2010) points out that it is an
autoimmune disease in which hyperglycemia is the final result of an autoimmune
process, which causes the destruction of pancreatic beta cells and a total insulin
deficiency. Furthermore, its origin is not well known and therefore, at present, its
appearance cannot be prevented or cured once the destruction of the beta cells has
occurred. However, progress continues in the characterization of the immunological
phenomena responsible. It appears in people under 30 years of age, generally in
childhood. It usually debuts with diabetic ketoacidosis.
Regarding Diabetes Mellitus type II, it is considered to be due to the result of
hyperglycemia resulting from a combination of defects in the body that include, on
the one hand, insulin resistance that results in excessive production in the liver of
insulin. glucose and poor utilization of this glucose in muscle and adipose tissue, as a
consequence of worse sensitivity to insulin in the cells of these target tissues.
Furthermore, on the other hand, there is a delay and deficit in insulin secretion in
response to the stimulus of glucose provided by food. That is, there is a relative
insulin deficiency, due to peripheral insulin resistance. In any case, insulin levels are
normal, and may even be increased. It appears in people over 40 years of age, and
frequently coexists with obesity. Its manifestation is usually hyperglycemia. It has an
important hereditary factor. Its most frequent complication is hyperosmolar coma.
There are also gestational Diabetes Mellitus and secondary Diabetes Mellitus.
Among the complications of this disease, there are acute and chronic. The acute
complications of Diabetes Mellitus are: Diabetic hypoglycemia, which is a severe
 13

hyperglycemic decompensation. It represents 5-20% of hyperglycemic emergencies

and affects almost exclusively patients with DM2. The mortality rate is greater than
15% and is related to other associated pathologies; ketoacidosis, which can occur in
both type 1 and type 2 diabetics, although it is usually more common in patients with
insulin deficiency, whether or not treated with said hormone. It can occur at any age
but has a greater predilection for younger people. Sometimes, less and less, it can be
the form of debut of the disease, and hyperosmolar coma that manifests itself in
people over 60 years of age, with undiagnosed type 2 diabetes, adverse social
conditions, chronic kidney failure, among others, and what It can trigger infections,
significant ingestion of sugary drinks, serious cardiovascular disease, among others.

Nursing Intervention in the Diabetic Patient

When the patient is diagnosed with Diabetes Mellitus, a nursing assessment must
be immediately performed, through the application of the scientific method known as
the Nursing Care Process (PAE), which allows nurses to provide care in a rational
manner. , logical and systematic. In this regard, Colliere (cited in Hernández, 2008),
considers that “Caring is, above all, an act of life, in the sense that caring represents
an infinite variety of activities aimed at maintaining and conserving life and allowing
it to spread.” continue and reproduce” (p.233). That is to say, the process of caring for
people, families and groups is the essential element of nursing, not only because of
the dynamics of interpersonal transactions that it requires, but also because it requires
a series of complex elements that The nurse possesses and encompasses knowledge,
dedication, human values (given by the personal relationship with the subject of care)
among others.
In other words, nursing defines the procedures that must be used to provide care, the
techniques that will be used to take advantage of and maximize resources and will
evaluate the expected results in the care of users. Therefore, the competencies
required of nursing professionals to provide care imply having knowledge, attitudes,
 14

moral virtues and skills inherent to this and using management tools to anticipate,
organize, direct and control care with quality and sensitivity. , and act in a critical,
reflective and constructive manner. It must be kept in mind that caring and caring are
the work of the nurse through the health of human beings in their living process.
Regarding the nursing assessment, it should be noted that it consists of the collection
and organization of data that concerns the person, family and environment. They are
the basis for subsequent decisions and actions. In fact, the assessment according to
Marjory Gordon's patterns seeks to determine the functional profile of the individual
and the location of those Functional Patterns that are altered, or in danger of
alteration, to some extent, to subsequently determine a nursing diagnosis that
describes that situation. The patterns to consider are the following, according to Mota
(2009):
Pattern 1. Health perception/management: Determine perceptions about health,
management and actions taken to maintain health.
a) Know how you feel and the diseases you suffer from (medical diagnoses).
b) Knowledge and perception you have about the disease.
c) Family history of DM, cardiovascular disease, kidney disease, HTN and/or
dyslipidemia.
d) Personal history (if DM diagnosed previously, assess age, symptoms,
evolutionary stage or complications and their treatment).
e) Signs and symptoms of hyperglycemia and/or hypoglycemia.
f) Medications you take, whether to control diabetes or other pathologies, paying
special attention to those that may alter blood glucose levels (ADO, diuretics,
corticosteroids, etc.).
g) Allergies, vaccines, practices harmful to health (alcohol, tobacco, drugs, etc.).

Pattern 2. Nutritional/metabolic: Assess the patient's nutritional status. Assessment

of the skin and fluid intake are included in this pattern.
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a) Number of meals and times (if you have been prescribed a special diet,
increasing dysphagia, painful swallowing, feeling of fullness, nausea and/or
vomiting, teething, heartburn, etc.). Tastes and preferences.
b) Distribution and types of carbohydrates in different meals.
c) Hydration status. Quantification of fluids/day. Skin fold sign, feeling of thirst.
d) Examination of the skin, mouth, legs, feet, and injection sites. showering
and/or bathing habits, frequency.
e) Weight, height, BMI and/or abdominal circumference, blood glucose.

Pattern 3. Elimination: Assess elimination through the different renal, digestive,

cutaneous and respiratory routes. It includes the assessment of quantity and quality.
a) Habitual evacuation pattern: constipation or diarrhea, frequency, hemorrhoids.
b) Urinary: polyuria, urine characteristics.
c) Sweating: excessive, with strong odor.
d) The patient has an ostomy, drainage or catheter. Presence or not of signs
and/or symptoms of alterations.

Pattern 4. Activity/exercise: Assess the respiratory and cardiac status, the type of
activity carried out, mobility, state of the joints, muscles
a) Self-care: need for help with hygiene, food, clothing, mobility in general.
Presents weakness, fatigue.
b) Practice of regular aerobic exercise. Type of exercise and schedules.
Limitations.
c) Blood pressure and breathing.

Pattern 5. Rest/sleep: Assess the rhythm of rest and the satisfaction that this rest
produces.
a) Assessment of signs and symptoms of insufficient sleep: nervousness,
irritability, lethargy, apathy, yawning and frequent postural changes.
b) Take sleeping medications.
 16

c) Assessment of factors that affect sleep: internal (nocturia, cough,

regurgitation, etc.). External (environmental, social changes, etc.).

Pattern 6. Cognitive/perceptive: Assess the state of the senses, the perception of

pain and all those situations that may pose a risk to the patient.
a) Ability to read and write.
b) Sensory alterations that can influence the management of diabetes and its
treatment, such as decreased visual capacity, hearing, memory, and reflexes.
c) Knowledge about the disease and its treatment (diet, exercise and
pharmacotherapy). Also complications and the use of health services.
d) You feel pain or physical discomfort, how it improves.

Pattern 7. Self-perception/self-concept: Assess the feelings you experience in

relation to the circumstances you experience and the perception you have of yourself.
a) Feelings generated by the diagnosis of DM and its influence on daily life,
alteration of self-esteem, fear.
b) Ability to express emotions and fears.

Pattern 8. Role/relationships: Assess the social situation, your relationship with the
family unit, the development of your role in the social group where you live, etc.
a) Family relationships, live alone or with family. Caregiver presence. How does
the family accept the current illness?
b) Work/activity. Participate in community activities.

Pattern 9. Sexuality/reproduction: Assess the subject's fertility, state of the

reproductive system, sexual satisfaction of the person, acceptance of sexuality.
a) Question about sexual problems. Man: prostate problems. Woman:
menstruation, menopause. Use of contraceptive methods.
 17

Pattern 10. Adaptation/stress tolerance: Assess adaptation and effectiveness in

terms of stress tolerance. It includes individual reserve or the ability to resist threats
to one's integrity, ways of managing stress, family or other support systems, and
perceived ability to control and manage situations.
a) Coping with the disease, alteration in communication patterns.
b) Significant changes in your life and how you have lived it. Someone close to
tell you about your problems.
c) Ability to recognize symptoms of hyperglycemia or hypoglycemia, and to
correct them.

Pattern 11. Values/Beliefs: Assess what the values and beliefs are and the
difficulties that in certain circumstances you may have in being able to satisfy them.
a) Interferences of the disease in habitual religious practices or beliefs, family
traditions, culture.

In relation to the aforementioned patterns, Mota (op.cit), points out that it must be
considered that the 13 care to be provided to the diabetic patient must be adequately
planned taking into account the individuality of the human being, and therefore his
lifestyle. Likewise, it is considered that the nurse, through her care and the helping
relationship, allows the affected individual to live their life with autonomy and
quality, but the key must be through effective health education, which must be given
under a significant process. and therapeutic, which must start from the premise of
understanding human behavior and the meaning of the disease for the individual who
suffers from it.
Then, information and education must be offered to the patient regarding the
resources that can be used to change certain behaviors, and finally, begin a process of
personal development that allows the individual to feel alive and healthy, as well as
help them progress, mature, create new life possibilities and experience satisfaction to
live fully.
 18

Health Education for Diabetic Patients

The need for accompaniment, support and continuous monitoring of the diabetic
patient by a multiprofessional health team, according to Otero, Zanetti and Daguano
(2008), can prevent or postpone chronic complications during the evolution of
diabetes mellitus. This makes relevant the importance of multi-professional health
work for the education of diabetic patients, which has resulted in the development of
countless educational projects and programs both internationally and nationally. That
is, education is fundamental in the treatment of diabetic patients, since it implies:
Training, knowledge, pedagogical skills, communication and listening skills,
understanding and negotiation skills of the multiprofessional health team.
In other words, the need to develop teaching activities or health educational
practices aimed at diabetic patients and their families is related to the prevention of
complications through self-management of the disease, which enables the patient to
live better with it. In any case, education for self-management of diabetes mellitus
becomes a process to teach patients to manage their disease. In the same way, the
aforementioned authors maintain that the goals of diabetes education are oriented
toward improving metabolic control, preventing acute and chronic complications, and
improving quality of life at reasonable costs.
For their part, Peeples, Koshinsky, and McWilliams (2007) consider that to control
diabetes, people need to acquire and develop a broad base of knowledge and skills, in
addition to adopting a series of daily lifestyle decisions that facilitate and improve
self-care. Diabetes education is an active process that helps people develop self-care
skills and provides those involved in the decision-making process with information
on how to best adjust diabetes treatment on a day-to-day basis.
But, according to the cited authors, this education must recognize the cultural
origin of people with diabetes and their ability to understand that health information
can improve their ability to follow a treatment routine. For this, it is necessary that
educational programs be designed based on appropriate strategies that address these
areas, in addition to taking into account the availability of each person and their
 19

confidence to learn a skill, identifying the need for change and defining objectives in
collaboration with the patient to make said changes.
In relation to the people who will provide health education to diabetics, Dunning
(2007) considers that they must be health professionals who are qualified to work
with people in their diabetic control, taking into account fundamental concepts such
as clinical care, education , advice, investigation and control. Additionally, the role of
the diabetes educator includes health promotion and prevention of diabetes and its
complications.
In this regard, Mota (2009) considers that diabetes education should be focused on
prevention, aimed at promoting healthy lifestyles and this will be the work
fundamentally of the community nurse, through the control and suppression of risk
factors. , secondary (early diagnosis), which can considerably modify the course of
the disease itself, or tertiary (prevention of sequelae and complications, whether acute
or chronic).
Likewise, the aforementioned author considers that Education should be aimed at
reinforcing correct habits and modifying incorrect ones and of course at motivating,
to continue involving the subject in their self-care, which is usually a continuity
educational strategy; It is not an easy task since a person who has been evolving for
years adds up to many factors, in addition to fatigue, lack of time and differences in
criteria between the professionals themselves regarding what should be taught, the
lack of equipment in many cases that reinforce educational content (absence of
common language), creates such confusion in the patient that it generally only reflects
tiredness and lack of motivation, for which the use of group educational techniques
will be necessary, in addition to individual education.
In short, patient education about their own disease continues to be the fundamental
tool for diabetes control. Well, it is evident that people who suffer from diabetes need
to know about the control they must maintain over the factors that, such as
differences in diet, exercise, stress level, or other factors, can affect blood sugar
levels. blood. Thus, the nursing intervention in the educational aspect must include
interviews that:
 20

a. Evaluate compliance with pharmacological treatment, and possible adverse

effects and interactions.
b. Assess compliance with dietary restrictions (sugars, fats, “diabetic products,”
etc.).
c. Assess the presence or absence of health-generating behaviors (exercise
practice, diet, toxic habits, etc.), as well as the patient's motivation and
response to the disease.
d. Assess records from the patient's self-analysis notebook, as well as the
incidence of hyper/hypoglycemia symptoms.
e. Evaluate the presence of signs and/or symptoms of complications (changes in
visual acuity, chest pain with effort or at rest, intermittent claudication,
impotence, paresthesias, etc.)

Likewise, in this educational intervention, dietary treatment is a fundamental pillar

in the management of DM and in many cases it is probably the only necessary
intervention. In general terms, the diet should be oriented towards achieving and
maintaining an acceptable weight and optimal levels of glucose, lipids and blood
pressure. The proportion of nutrients will not be different from that recommended in
the general population, and you should eat enough carbohydrates at each meal and
avoid soluble sugars and their derivatives due to their rapid absorption, which
increases post-prandial blood glucose. It is recommended that the total calories
consumed throughout the day be divided into 4 or 5 meals.
In addition, the diet should also serve to prevent and treat acute complications of
DM treatment (hypoglycemia) and chronic complications. It is very important that
diabetics undergoing pharmacological treatment know perfectly well that, in the event
of typical symptoms of hypoglycemia, they must immediately drink 3-4 sugar cubes
or a sugary drink (for example, fruit juice) and that they must always carry this type
of food with them. Likewise, exercise is important to improve insulin sensitivity and
should be done at least 3 or 4 days per week.
Finally, the patient must be aware of basic information for survival:
 21

a. About the disease: definition, how to monitor blood glucose levels, control
objectives in terms of numbers.
b. Regarding acute complications: hyperglycemia (the increase in blood glucose
levels may correspond to factors such as excessive or inadequate food intake,
non-compliance with pharmacological treatment, stress, infections, etc.;
accompanied by symptoms such as polyuria, polydipsia and polyphagia .);
hypoglycemia (due to fasting, exercise, medication, manifested by hunger,
nervousness, tremors, dizziness, drowsiness,...), and how to resolve them.
c. On the importance of drugs (do not suppress OAD intake; regarding insulin:
route of administration, injection sites, rotation, etc.), diet (dietary information
on foods and schedules), and exercise for DM control.
d. About where to buy and store insulin and other necessary materials, as well as
when and how to contact the doctor or nursing staff.
e. Once the patient knows and manages these principles, he or she can move on
to more in-depth education, which includes the control of other risk factors
that may coexist (HTN, obesity, dyslipidemia, toxins), and more detailed
information related to survival skills. (such as varying diet, preparing to
travel, etc.), as well as preventive measures to avoid chronic complications of
DM (care and protection of the feet, general hygiene -especially of the skin
and mouth-, care of the eyes).

Special consideration must be given to certain aspects when communicating, which

can influence the patient's good understanding of the education.
It can be highlighted that:
a. Nursing must adapt to each patient when diagnosed with diabetes, since they
may suffer stages of grief.
b. The prior information available, the motivation to learn and their sociocultural
level must be assessed.
c. The patient should be asked and assessed about their greatest fears regarding
the diagnosis of the disease, and thus clarify doubts and misconceptions, while
 22

offering support. In this way, reducing anxiety levels can contribute to a better
patient disposition and greater achievement of goals.
d. Effective communication will achieve better understanding on the part of the
patient.

Theory Underpinning the Research

It must be taken into account that the nursing intervention is extremely important,
given that it has a theoretical guide that allows each care intervention to be organized
and thus qualitatively and quantitatively measure the impact of the intervention. In
this regard, Ávila and Others (2007) point out that one of the most used theoretical
models in the world is the general theory of self-care deficit, by Dorotea Orem, which
is made up of medium-range theories, such as: Theory of self-care; self-care deficit
theory and nursing systems theory.
Based on what was stated above, this study can be based on the aforementioned
theory, because it takes up the concept of Self-Care Capacities (SAC), considered as
the skills that allow the individual to take care of themselves; In fact, these skills are
developed or not depending on the sociocultural environment, and can be reinforced
in attitude and action. In relation to the theory of the nursing system, the three
subsystems are taken up to assess the degree of dependence on the nurse: a) fully
compensatory, where the patient depends totally on nursing care, a situation that can
occur in a patient undergoing intensive therapy. b) partially compensatory, where the
care recipient has physical and cognitive skills to care for themselves, but they are not
sufficient and needs nursing support. e) educational support, a system that is always
present in any of the situations in which the patient presents (includes the other two
systems). Both theories are related by a common denominator: self-care, the primary
element or goal of the model.

Legal Bases
 23

The conduct of this research is supported from a legal point of view by the following
legal instruments:

Constitution of the Bolivarian Republic of Venezuela .

Article 83 .
Health is a fundamental social right, and it is the obligation of the State,
which will guarantee it as part of the right to life. The State will
promote and develop policies aimed at raising the quality of life,
collective well-being and access to services. All people have the right to
health protection, as well as the duty to actively participate in its
promotion and defense, and to comply with the health and sanitation
measures established by law, in accordance with the signed
international treaties and conventions. and ratified by the Republic.

This article shows the obligation that the State has with health as a fundamental
right of the people. Therefore, it is up to you to promote health policies to improve
the quality of life. This implies citizens' duties and rights around health promotion.
The role of nursing is understood in relation to offering quality care and fulfilling its
independent functions such as educational functions.

Article 84

To guarantee the right to health, the State will create, exercise

stewardship and manage a national public health system, of an
intersectoral, decentralized and participatory nature, integrated into the
social security system, governed by the principles of free, universality,
comprehensiveness, equity, social integration and solidarity. The
national public health system will prioritize health promotion and
disease prevention, guaranteeing timely treatment and quality
rehabilitation. Public health goods and services are property of the State
and may not be privatized. The organized community has the right and
duty to participate in decision-making on the planning, execution and
control of specific policy in public health institutions.
 24

In this article, the right to health of people is guaranteed through the creation of a
public health system which will promote health and the prevention of diseases, the
delivery of timely treatments and quality rehabilitation to the sick; In addition, the
right of communities to organize to participate in decision-making in health
institutions is recognized.

Organic health law

Official Gazette No. 36,579 dated November 11, 1998

Article 25.-

The promotion and conservation of health will aim to create a health

culture that serves as a basis for achieving the health of individuals, the
family and the community, as a primary instrument for their evolution
and development. The Ministry of Health will act in coordination with
the organizations that make up the National Health Council, in order to
guarantee the elevation of the socioeconomic level and well-being of
the population; the achievement of a lifestyle aimed at preventing health
risks, overcoming poverty and ignorance, creating and preserving a
healthy environment and living conditions, preventing and preserving
the physical and mental health of people, families and communities, the
formation of cultural patterns that determine customs and attitudes
favorable to health, occupational risk planning and the preservation of
the work environment and the organization of the population at all
levels.

This article refers to the importance of health promotion and conservation aimed at
establishing an optimal health education and culture that allows improving the quality
of life and guaranteeing the health of the people, the family and the community in
general where they reside or that belongs. It is understood that diabetes education
implemented by nursing would allow diabetics to self-manage in order to minimize
the appearance of complications and guarantee a better quality of life.

Law of Professional Nursing Practice

Official Gazette Number: No. 38,263 of 01-09-05
 25

Article 2. For the purposes of this Law, the practice of nursing is

understood to be any activity that tends to:
1. The health care of the individual, family and community, taking into
account the promotion of health and quality of life, the prevention of
disease and the participation in its treatment, including the rehabilitation
of the person, regardless of the stage of growth and development in
which it is found, must maintain to the maximum the physical, mental,
social and spiritual well-being of the human being.
2. The practice of their functions in the care of the individual, where
this is based on a relationship of human and social interaction between
the nursing professional and the patient, the family and the community.
The essence of nursing care is to care for, rehabilitate, promote health,
prevent and contribute to a person's dignified life.
3. Perform their functions in the areas of planning and execution of the
direct nursing care offered to families and communities.
4. Exercise practices within the dynamics of teaching and research,
based on scientific principles, knowledge and skills acquired from their
professional training, updating through experience and continuing
education.

This article makes evident the work of nursing in the sense of human care,
as a way of acting in pursuit of the physical, mental, social and spiritual well-
being of the person, in order to contribute to a life worthy of it. It also
expresses the nursing functions in the different areas: Care, administrative,
teaching and research. All these functions are reflected in the work that must be
carried out when interacting with the diabetic patient, the teaching function
being the most important because through it it can educate the patient in
relation to the activities to be carried out in pursuit of their well-being. .

Article 13.

Without prejudice to what is established by current legal

provisions, nursing professionals are obliged to:
1. Respect life and the human person in all circumstances, as the
main duty of the nurse.
2. Assist users, attending only to their health demands, without
discrimination based on race, sex, creed, social or political
condition.
3. Act in accordance with the circumstances and scientific
knowledge possessed by patients in states of unconsciousness
 26

and health emergency that may constitute an obvious danger to

their lives.
4. Provide collaboration to the authorities in case of epidemics,
disasters and other emergencies.
5. Protect the patient, while under your care, from humiliating
treatment or any other type of offense to their dignity as a
human being.
6. Exercise your profession responsibly and effectively
whatever your scope of action.

In this article there is a moral and ethical commitment of nursing in relation to its
duties to fulfill with respect to the human person, without interfering in its
responsibilities, aspects of a discriminatory nature. Furthermore, their actions must be
consistent with the circumstances experienced by the patient or person in states of
unconsciousness and urgency.

Nursing Code of Ethics

Likewise, mention is made of the Nursing Code of Ethics (2008).

where the responsibility of the nurse is clearly expressed, specifically in the articles
mentioned below:

Article 3.
The nurse's goal in her actions will be to provide her professional services to
the individual , family and community , with responsibility, efficiency,
capacity, mystique and a true vocation for service .

Single Paragraph .

"The fundamental responsibility of the nurse is to preserve life, alleviate

suffering and promote health."

In relation to the previous text , it is important to point out that the nurse has the
obligation and responsibility to provide a quality service that contributes to the
prompt recovery of health of the sick, especially those who suffer. To do this, the
 27

nurse must put her teaching function into practice in order to guarantee teaching to
the diabetic patient in relation to the way in which they should take care of
themselves. This involves, for example, diet, pharmacology, exercises, etc.

Glossary of terms

Diabetes Mellitus (DM): According to the Committee of Experts on the Diagnosis

and Classification of Diabetes Mellitus of the American Diabetes Association, it is a
set of metabolic alterations that is characterized by the presence of hyperglycemia, as
a result of defects in the secretion of insulin, in the action of it or of both at the same
time. This chronic hyperglycemia is associated with long-term complications that
especially affect the eyes, kidneys, nerves, heart and blood vessels.
Primary Care: According to the World Health Organization (WHO, 2004), primary
care is essential and is based on practical, scientifically founded and socially
acceptable methods and technologies, made available to all individuals and families
in the community, through their full participation. Furthermore, it is an integral part
of both the national health system and the global social and economic development of
the community. It represents the first contact of individuals, the family and the
community with the national health system; It brings health care as close as possible
to where individuals live or work and is the first element of an ongoing health care
process. (p 47)
Diabetes education: According to Mota (2009), in primary care, it should be focused
on prevention, aimed at promoting healthy lifestyles and this will be the work
fundamentally of the community nurse, through the control and suppression of
factors. risk, secondary (early diagnosis), which can considerably modify the course
of the disease itself, or tertiary (prevention of sequelae and complications, whether
acute or chronic)
Caring: It is described by Leininger (1998) as "the essence of nursing and is the
central, dominant and unifying characteristic of nursing" (p.46). As a universal
characteristic, caring in general is perceived as a constant basic characteristic that
 28

forms the basis of human society. Care is considered necessary for human survival,
an essential component of being human.
Nursing Care Process: According to Dueñas (2009) It is a planning system in the
execution of nursing care, composed of five steps: assessment, diagnosis, planning,
execution and evaluation.
Patient assessment: According to Jiménez and Others, (2005), it is the first step of
the process and consists of the deliberate and systematic collection of data to
determine their health status. With these data, nursing diagnoses are established,
appropriate interventions are planned and implemented, and their effectiveness is
subsequently evaluated.
Community Nursing: According to the statutes of the Community Nursing
Association (2004), Community Nursing is understood as " that discipline that the
nurse develops through the comprehensive application of care, in the health-disease
continuum, fundamentally to the individual, the family and the community."
community, all within the framework of public health. This discipline specifically
contributes to individuals, families and communities acquiring skills, habits and
behaviors that promote their Self-Care" (p. 2)
Nursing Care Plan: According to (MOSBY Dictionary, 2004), it is a plan made by a
nursing professional based on the nursing assessment and diagnosis. It has four
fundamental components: Identification of nursing care problems and verification of
the nursing approach to solve them; determination of expected benefits to the patient;
indication of the nurse's specific actions that reflect nursing criteria and achieve the
specified objectives, and evaluation of the patient's response to nursing care, and
readjustments of these, if necessary.
Nursing intervention: According to the ICD (Classification of Nursing
Interventions, 2007), NIC interventions include physiological, psychological and
social aspects; and interventions exist for disease treatment, disease prevention, and
health promotion. In any case, it considers that the interventions are not only designed
for individuals but also consider the family and the community.
 CHAPTER III

METHODOLOGICAL FRAMEWORK

This chapter describes the methodology that serves as an instrumental basis for this
research.

Kind of investigation .

The present research is located at the descriptive level, whose interest is, according to
Arias (2006), “to provide clues about the possible causes of a phenomenon” (p.25).
This particular study focuses on nursing educational praxis in diabetic patients.

Research design

The research design on which this study was based, according to UNERG (2006), is
field-based, because the data were collected directly from reality, that is, the
phenomenon was studied in the real situation where it occurs. In this regard, UNERG
(2006) says that:

Field research is understood as the systematic analysis of problems in

reality, with the purpose of either describing them, interpreting them,
understanding their nature and constituent factors, explaining their causes
and effects, or predicting their occurrence, using characteristic methods
of any of the known or developing research paradigms or approaches
(p.9).

31
 32

Population and Sample

Population

According to Arias (2006), “population is a finite or infinite set of elements with

common characteristics to which the research conclusions will be extensive” (p.81).
In this case it corresponds to the seven nurses who work at the La Clemencia Type I
Rural Outpatient Clinic.

Sample

The sample, according to Arias (2006), “is a representative and finite subset that is
extracted from the accessible population.” In fact, to choose the nursing professionals
required for the study, the researcher followed the doctrinal criterion that indicates
that when dealing with a finite population, as in this case (07) and less than 100
subjects, it is recommended consult them all. For this reason, it was not considered to
take any sample and thus, the only prevailing aspects were that these professionals
had to be active staff of the AmbulatorioRural Type I La Clemencia.

Data Collection Techniques and Instrument

Hernández, Fernández and Baptista (2006) point out that, “Collecting data involves
developing a detailed plan of procedures that lead us to collect data for a specific
purpose” (p.274). Likewise, they define the instrument as “…one that records
observable data that truly represents the concepts or variables that the researcher has
in mind” (p. 278).
 33

Furthermore, they point out that the questionnaire consists of a set of questions,
normally of various types, prepared systematically and carefully, about the facts and
aspects that are of interest in an investigation or evaluation, and that can be applied in
varied ways. Indeed, the research instrument used corresponded to the questionnaire,
consisting of 12 dichotomous items, with closed answers, limited to answering YES
or NO, according to the criteria of the respondent, and was constructed according to
the objectives of the research.

Data Processing and Analysis Techniques

After collecting the data, through the application of the instrument, the information
obtained was analyzed, which made it possible to determine the achievement of the
objectives set at the beginning of the research. The presentation and analysis of the
results for the research objectives was carried out through the use of the descriptive
and inferential statistics method. That is, frequency tables and percentages were used,
which allowed the analysis of the results to be carried out in a serious and precise
manner.

Validity

The validity of the instrument was determined through a technique recommended by

Palella and Martins (2010) known as the expert judgment technique, where three
experts reviewed the content, wording and relevance of each item and subsequently
made the necessary adjustments. . In this case, the experts were three nursing
professionals, with knowledge of methodology.
34