Meeting the needs of Māori with diabetes: Evaluation of a nurse-led service
Josephine Janssen, MN, PGcert, BN, RGON, Nursing Tutor, Nelson Marlborough Institute of Technology, Blenheim, NZ
Katherine Nelson, PhD, TN, Senior Lecturer, Victoria University, Wellington, NZ
Reference: Janssen, J., & Nelson, K. (2014). Meeting the needs of Māori with diabetes: Evaluation of a nurse-led service. Nursing Praxis in New Zealand, 30(3), 6-18.
Aims and Objectives. To explore the effectiveness and acceptability of a nurse-led Māori diabetes programme run by Te Hauora O Ngāti Rārua for their client. Background. Nurses have a key role in diabetes management, but little is known about nurse-led services for indigenous populations. The Te Hauora O Ngāti Rārua programme consisted of an educaiton course, case management and support services. Design and methods. An embedded case study evaluation was used. Data sources included: i) documentation, ii) interviews with clients (n=7) and health practitioners (n=5), iii) pre and post-course psychological, knowledge and lifestule behaviour client data, and iv) researcher observation. Results were triangulated and organised using the Wagner Chronic Care Model. Results. The programme successfully addressed all elements of the Chronic Care Model. It was culturally appropriate, supportive and beneficial to the clients in meeting their health objectives. Staff demonstrated high levels of goodwill and commitment to clients and the organisation. Relaxed interpersonal relationships, especially the use of humour encouraged clients to remain engaged with the service and to make lifestule changes. A high prevalence of co-morbidities impacted on clients' ability to self-manage their diabetes. Four clients had short term improvements in health outcomes, but were unable to maintain these when programme support reduced. All clients gained new knowledge and awareness related to diabetes and how to make personal changes. Conclusions. This study confirms the importance of providing 'culturally appropriate' health services delivered by specialist Māori nurses. Targeted diabetes programmes need to recognise the complexity of clients' day-to-day lives and co-morbidities as part of increasing client self-management. Clients need both short and long term professional and peer-group support to make and sustain changes. Relevance to clinical practice. The findings can be used by nurses to assist people with diabetes to make sustainable changes to improve their health outcomes.
Māori, indigenous, diabetes, nurse-led, case study