Thesis: Community Nurse Diabetic Clinic

Pages: 12 (3696 words)  ·  Bibliography Sources: 10  ·  Level: Master's  ·  Topic: Healthcare  ·  Buy This Paper

Community Nurse Diabetic Clinic

One of the hallmarks of economic progress is ironically the fact that certain kinds of diseases become far more common. Diabetes is one of these diseases. The causes for diabetes are complicated, including genetic as well as environmental factors: It is linked to the abundance of food in modern American society, culinary traditions brought from cultures of origin, lack of easy access to healthy foods to many working-class Americans, lack of education about diabetes, and lack of access to health care by many Americans.

The problem is so complex -- and the personal consequences for those individuals with diabetes -- that it can seem overwhelming. Where does one start in trying to address the problem of the widespread nature of diabetes? And specifically how can one as an individual begin to help individuals fighting the disease?

This thesis explores one possible answer to the problem of an appalling high rate of diabetes in the Hispanic community in Allentown, Pennsylvania. The establishment of a clinic that is aimed at the specific needs of Hispanic patients with diabetes and primarily Type II diabetes. The care given at this clinic will be comprehensive, providing instruction in blood-sugar testing, discussion of the range of drug treatments that are possible, nutrition information, advice on the ways in which exercise can help dramatically increase the health of diabetics, and a variety of types of support that will help promote both behavioral changes and a sense of personal control over each individual's sense of their own health. The clinic will incorporate best practices derived from science and medicine blended with cultural sensitivity to this particular patient population.

Scope of the Problem

It would be difficult to exaggerate the degree of the problem of the rates of diabetes in the Hispanic population in the United States today. Hispanics are a growing segment of the U.S. Population, representing one in seven Americans. There are currently about 47 million Hispanics in the United States today, according to the 2008 American Community Survey 1-Year Estimates by the U.S. Census Bureau, a figure that it certain to rise after the 2010 decennial Census.

Although Hispanics are generally referred to as if they composed a homogeneous group, it is important to note that a number of different communities are classified as Hispanics (or Latinos/as). This proposal uses the definition of Hispanic that is used by the U.S. Census and so focuses on how people self-identify themselves. Generally those who so self-identify are either immigrants from or have forebears who were immigrants from the Spanish-speaking countries of North, Central, and South America as well as the Caribbean or (less often) Spain. Hispanics can be of different races, although most have both European and Native American ancestry.

Because Hispanics have such varied backgrounds, clinical approaches to treating them must be culturally sensitive to this range of social variation. Medicine is -- as we all know -- both science and art, and part of the art of medicine is being able to work with Hispanics within the context of their specific American sub-cultures while instituting all the best practices of medicine.

According to the U.S. Department of Health and Human Services' National Institute of Diabetes and Digestive and Kidney Diseases (which conducts and supports basic and clinical research on many of the most serious diseases affecting public health), diabetes is the sixth leading cause of death for Hispanics and the fourth highest death rate for Hispanic women and elderly (http://www2.niddk.nih.gov/

). According to a 2003 U.S. Centers for Disease Control and Prevention report, more than 1.5 million Hispanic-Americans had diabetes, up from less than 1.2 million in 1997. This high rate of diabetes does not include undiagnosed cases.

The National Institute of Diabetes and Digestive and Kidney Diseases (http://www2.niddk.nih.gov/

) describes some of the issues of particular concern regarding diabetes in the U.S. Hispanic population. Among these factors are the fact that diabetes has an earlier onset in Latinos than in other populations, with the age of onset among Puerto Ricans and Mexican-Americans, between 30 to 50 years old.

Even more disturbing is the fact that Hispanics "are almost twice as likely to have diabetes as non-Hispanic whites of similar age, while diabetes is two to three times more common in Mexican-American and Puerto Rican adults than in whites." Some Hispanics have slightly lower rates: For example, Cuban Americans have lower rates of diabetes than do Mexican-Americans and Puerto Ricans, but their rates are still higher than those of non-Hispanic whites.

The overall rate for diabetes for people aged 45-74 in different ethnic groups (still using statistics from he National Institute of Diabetes and Digestive and Kidney Diseases, (http://www2.niddk.nih.gov/

15.8% for Cuban Americans

12% for non-Hispanic whites

These figures have been steadily rising and there is no evidence that they have peaked yet.

Another very important aspect of diabetes in the Hispanic population is the fact that many Hispanics do not know that they have diabetes: This is true of all ethnic groups, in fact, but especially so for minorities. According to the American Diabetes Association, the rates of undiagnosed diabetes are as follows:

Total: 23.6 million children and adults in the United States -- 7.8% of the population -- have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

New Cases: 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year. (American Diabetics Association, http://www.diabetes.org/diabetes-basics/diabetes-statistics/)

The seriousness of these figures is underscored -- and exacerbated -- by the fact that so many Americans either do not have any insurance at all or are under-insured. This is especially true for minorities, in large part because they are more likely than are whites to work in jobs that do not offer benefits. Until the just-enacted health-care reform law, people with diabetes were often denied insurance because it qualified as a pre-existing condition. The combination of factors -- the growing number of Hispanics in the United States, the increasing rate of diabetes in Hispanics, the lack of access to quality medical care for many Hispanics, the cost in both money and personal well-being of lack of state-of-the-art medical care for diabetics -- lead to the pressing need for the kind of comprehensive diabetes treatment clinic aimed at Hispanics being proposed here.

The problem in Pennsylvania mirrors that of the nation as a whole. According to the Pennsylvania Department of Health (http://www.portal.state.pa.us/portal/server.pt?open=512&objID=11200&mode=2&PageID=560279

), Pennsylvania has had a significant rate of increase in diabetes hospitalizations, accounting for more than ten per cent over the last two years. Eight per cent of adults of this state are affected by diabetes, which is higher than one per cent above the national average. Moreover patients from various counties in Western Pennsylvania have high rates of end-stage kidney disease, one of the more serious complications of diabetes.

In 2004, diabetes was the principal diagnosis in 23,725 admissions in Pennsylvania hospitals, accounting for 132,000 hospital days and more than $673 million in hospital charges (Pennsylvania Department of Health, www.dsf.health.state.pa.us/health/lib/health/diabetesfastfacts.pdf). Of these 2004 hospitalizations, 15.4% of patients with diabetes were hospitalized two or more times. Multiple hospitalizations were more common among certain populations, such as Hispanics and including Medicaid and Medicare recipients.

In the United States, probably the most important determinant of access to care is whether or not one has health-care benefits. In 2005, there were 46 million uninsured people in the United States (about 16% of the population). The uninsured rate increased from 2002 to 2003 for non-Hispanic Whites (from 10.7% and 20.8 million to 11.1% and 21.6 million). The number of uninsured Hispanics increased from 12.8 million to 13.2 million, which is equivalent to an increase in the rate of uninsured rate of 32.7%. (All figures are from the U.S. Census report "Income, Poverty, and Health Insurance Coverage in the United States," www.census.gov/prod/2005pubs/p60-229.pdf).

The development of community-based diabetic clinics aims to focus on those that are at the greatest risk; the uninsured and under-insured. This project will aim to address those needs by providing free diabetic health care.

Proposed Project

This project is designed to develop a business plan targeting the Hispanic Community of Allentown, Pennsylvania. This business plan will guide the development of a community nurse-managed diabetic health care center. This project will serve as a basis for further DNP work and implementation of this business plan.

Literature Review

Diabetes is a chronic disease affecting approximately 760,000 Pennsylvanians . Many people with Type II and gestational diabetes have no symptoms and learn they have diabetes only when they seek help for one of the many complications. At the present time there is no cure for diabetes, but research has shown that complications of diabetes can be greatly reduced with proper blood sugar control through healthy eating, physical activity, and use of medications. Still, diabetes is one of the leading causes of death in the United States and is responsible for nearly 3,600 deaths in Pennsylvania each year. (Pennsylvania Department of Health, Bureau of Health Statistics and Research,… [END OF PREVIEW]

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