Diabetes is a chronic disease that requires continuous medical care, ongoing patient self-management education and support to prevent its advancement and the occurrence of acute complications. It also requires evidence-based recommendations and management to reduce the risk of long-term complications. Of importance to note is that diabetes care is a complex endeavor that revolves around many issues that go beyond the glycemic control management. Research has shown that other interventions are required to support the improvement of diabetes outcomes (Burant, 2012). These are caring standards provided by patients, researchers, payers, and clinicians. These standards address how children suffering from diabetes and people with pre-diabetes should be taken care of. Many guidelines and frameworks have been suggested to guide how diabetes screening, therapeutic and diagnostic actions should be carried out so as to affect the patient's health outcomes favorably. These interventions are aimed at managing the costs of the diabetic condition by the patients, clinician and parents by clarifying and codifying how each recommendation to the patient should be utilized (American Diabetes Association, 2012). Such guidelines include the American Diabetes Standards Association. The standards are meant to give the patient greater convenience when managing the diabetic condition, thus reducing the stress and illness from daily perturbations of the patient while undergoing the self-management. It also helps in balancing availability of the testing and self-management tools required by the patients and the actual resources that they have in managing the condition. It also describes the relationship between the patient and the health care provider so as to minimize the levels of conflicts that may result during the diabetes management process. This paper is an examination of leadership skills that are required by health care providers to empower them in addressing complex and controversial issues in a health care system. It also examines why solving conflicts in diabetes management is the best way of effectively managing the condition through good leadership strategies. Particularly, this paper examines the need for good communication strategies in ensuring positive outcomes of the diabetes intervention programs by preventing and solving conflicts when they occur as a leadership skill. The paper will argue that leadership, as guided by ADA standards guidelines, is an important component in the management of diabetes by ensuring adherence to prevention and intervention therapies by the patient. It also presupposes that communication as a leadership skill minimizes conflicts in diabetes management thus promoting the attainment of positive outcomes from the diabetes management process.
The American Diabetes Association is a guideline and standards that are published periodically to provide patients, researchers, payers, clinicians as well as other interested stakeholders with general care goals, with tools to evaluate the quality of care and diabetes care components (American Diabetes Association, 2012). The guidelines were prepared by the ADA Professional Practice Committee through systematic searches and consultations with stakeholders. It is continually revised and clarified periodically to give new recommendations based on new evidence from the search. The standards are approved and reviewed by ADA Executive Committee Board of Directors with membership from Healthcare professionals, laypersons, and scientists. Also, revisions of the guidelines incorporate feedback from the clinical community. The guidelines incorporate eight main areas which are critical to diabetes primary care providers. These areas give recommendations regarding individualized care of the disease management, preventing and delaying complications and improving outcomes with evidence-based strategies (American Diabetes Association, 2012). The eight primary areas that ADA standards focus on are cardiovascular risk factor management, diagnosis, hypoglycemia, inpatient diabetes management, microvascular disease screening and management and glycemic targets. These primary areas of care can be made clearer to the healthcare and patient through good communication strategies between the involved stakeholders. This is because the adherence to diabetes management interventions needs a balance of personal priorities between the patient and the health status indicators. Good communication strategies ensure that long-term complications are avoided; mortality rates are minimized and that costs linked to bad diabetic management are minimized or eliminated.
Diabetes management is viewed as an ongoing process that facilitates knowledge, ability and skills transfer between nurses and patients with the aim of ensuring that patients can self-care. This process, therefore, incorporates goals, life experiences, and needs of the diabetic condition patient. The objectives of diabetes self-management framework are to ensure that patients are supported to make informed decisions about their work, can solve their own problems, and possess self-care behaviors. It also ensures that there is an active collaboration between healthcare team and the patient so as to improve the outcomes of lifestyle and clinical interventions, that quality of life is achieved and that patients become healthier (American Diabetes Association, 2012). This means that there occurs training that defines the benefits of the intervention program for the program to be termed as successful. The types of care provided during diabetes self-management intervention program include clinical, behavioral, psychosocial, and educational which should be patient-centered (Powers et al., 2015). This care must be respectful and responsive to the preferences, values and needs of individual patients in making clinical decisions. This means that patient's perspective, as well as priorities, must be elicited in presenting the patients with the options that they have when making decisions about their care. In the process, conflict of interests and priorities may arise thus creating the possibility of conflicts arising in the care. Therefore, all the concerned stakeholders must share in the decision making to improve the social, behavioral and clinical outcomes of the self-management care of the patients. This happens by reducing the negative emotional responses and distress that may arise from the patients when they are being treated and supported during the diabetes self-management program such as helplessness, hopelessness, and feeling overwhelmed by the perceived diabetes-related burdens.
Importance of Conflict Solving Skills in Diabetes Management
Engaging the diabetic patients in conflict management include focusing on the decisions of the patients, reasons why such decisions were taken and the overall results that were achieved against the targets. The dialogue between the patient and the healthcare provider focus on the concerns, struggles, and success of the current therapy treatment as compared to the normal treatment that is only concerned with glucose optimization. This engagement gives the direction to be taken when the treatment plan that is currently not effective. The care provider by remaining neutral in the finding the solution to the concerns of the patient ensures that diabetic patients are given more autonomy in choosing diabetes’ solutions that fit their description and will willingly and voluntarily follow thus minimizing the health risks that may result from non-adherence to the imposed program (Munshi et al., 2016). Studies have shown that imposed programs are unpopular and patients may be unwilling to follow them thus posing a risk to them regarding future complications in treatment and probable cases of premature deaths.
Poor adherence to intervention programs is prevalent when there are conflicts between health care givers and patients. Generally, non-adherence to the general diabetes therapies is associated with suboptimal glycemic control, increased premature mortality risk and increased morbidity (Chamberlain, Rhinehart, Shaefer, & Neuman, 2016). Adults, as well as adolescent diabetes patients, have been found to face numerous obstacles in adhering to the diabetes therapies such as family dynamics flux, perceived social pressures and development behaviors. It has been shown that successful diabetes interventions rely on non-judgmental support from the family to the patient in successfully monitoring the daily blood glucose levels as well as insulin administration tasks. The use of problem-solving techniques, motivational interviewing use, dietary recommendations flexibility, supporting the patient with technology and extending the healthcare outreach to include significant people in the program have been found to be successful in making the intervention programs effective. The effectiveness of diabetes' interventions must result from support from the internal and external support of the family, internal motivation, and technology so as to simplify the diabetes management.
In conflict management through good communication skills of health care providers, patient shares diabetes' burden of care with other important members of their community. Good communication strategies in a collective environment reduce conflicts that may arise from perceived neglect and burdens. This therefore causes reduction of stress and depression levels among patients since they can share with others their concerns without fear of being victimized. Studies show that where conflicts are managed well in diabetes treatment patients reported improved control over pain during treatment and they were noted to have decreased negative perceptions of pain interfering with their daily activities (Munshi et al., 2016).
Issues of Concern
Despite communication skills being a vital leadership component in diabetes conflict management, some nurses have been found to be biased when impacting knowledge and skills about diabetes. Biased nurses and health care professionals affect the clarity and objective intention of the diabetic training and message (Powers et al., 2015). This has the potential to cause mislead diabetes patients and eventually mistrust and non-adherence later. The patient may feel shortchanged in which case they may resist the clinical and lifestyle intervention proposed to them and therefore increase the health risks facing them when they realize such unprofessional treatment. Communication strategies may be misused by primary care providers to manipulate the patient to accept a clinical and lifestyle intervention that they can easily resist anytime they get to know the truth. Also, manipulation by the healthcare providers is a crime under the ADA principles and guidelines but can easily be bypassed by healthcare providers among naïve patients, and this can result in damages and health risks in the case of the patient and legal actions taken to the medical doctor.
In addition, open sharing of information between diabetes patient and health care providers’ opens opportunities for the health workers to access sensitive and personal information about the patient. Some healthcare workers may wrongly use such information wrongly despite the need for privacy and secrecy in handling the patient’s medical history. The information put at risk of misuse includes diagnosis records, review medical records and medical history that may land on the wrong hands and be misused. This may affect the confidentiality and security concerns of the patient since they are ethical issues that must be addressed by the ADA standards.
Recommendations
The importance of communication in diabetic management by healthcare providers in their leadership role for preventing and solving conflicts when they arise has the implication that: The guiding standards and principles that patients must be engaged, important information must be shared with them, facilitate behavioral and psychosocial support, adopt a coordinated care and integrate diabetes care with other life therapies. These principles should be aimed at guiding the interactions between the patient and the healthcare providers. Primary care providers’ interaction with diabetes patients is meant to help the patient to learn and apply skills, and knowledge in the context of their life thus balancing their priorities and those of the diabetes management (Powers et al., 2015). This calls for a delicate balance between the clinical status, values, family, culture, and community and the social environment. It therefore, means that conflict management in diabetes management is dynamic and multidimensional and should focus on effective communication as well collaboration in engaging the customers thus reducing any conflicts occurring. Normally such a route would involve emotions eliciting, reflective listening, perceptions incorporation, and exploring the desires of the patient to learn and change by asking open-ended questions. Also, there should be sufficient support for self-efficacy by letting the patient explore their options that they have in the disease control having been empowered to make their decisions.
At the diagnosis stage, the primary care provider in this care is the nurse and has the responsibility of answering questions as well as providing the emotional support that is needed in the actual diagnosis procedure. They provide the patient with treatment overview and treatment goals as well as teach the patient with survival skills that address the immediate requirements such as hypoglycemia treatment, use of mediation and eating guidelines introduction. The nurse must also identify and discuss any resources that will be used in the education and ongoing support. The clinical officer also assesses the areas of self-management and reviews the problem-solving skills that the patient possesses. Finally, the nurse needs to identify the strengths and weaknesses of the patient and discuss the complications that may be experienced by the patient and which have a potential to affect the success of the diabetes self-management program (Fisher et al., 2013). The diabetes education should mainly be focused on such areas that provide patients with knowledge and skills on medications such as choices titration and side effects, monitoring glucose levels such as testing, interpreting as well as using glucose pattern management in the intervention. It is also concerned with aspects such as risk reduction such as foot care and smoking cessation, nutrition such as preparing meals, food plan, and portioning food, developing personal strategies in addressing psychosocial concerns and issues, promoting behaviors and health changes, reinforcing treatment strategies and emphasizing ways to prevent side effects.
Conclusion
When clinicians are screening for diabetes complications and operating diabetes clinics, the nurses must be aware that social and psychological issues have significant effects on how diabetic patients view their condition and how they make lifestyle changes to help them manage the condition (Newton et al., 2013). The diabetic patient has a role of being active in making decisions that affect their life while the nurse has a role of providing information, support and direction during the disease management. The nurse must assess the risk so as to provide the patient with appropriate and timely intervention. This means that the nurse must conduct a periodic review and screening visit reports of the patient to find out more information about the patient and identify opportunities to establish information that the patient lacks so as to fill it. This includes exploring the various reasons why the patients are unable to undertake the necessary lifestyle changes. Alternative treatments and recommendations suggest appropriate actions that the patients can follow in managing the diabetes condition. Also, the cooperation between primary care providers, nurses, and the patient ensures that conflicts within the Diabetes disease management process are solved well before they become a major hindrance to the management of diabetes among the patients. Early conflict management reduces the possibilities of long-term complications that may arise from the untimely diabetes management. Also, conflict management in diabetes management ensures that the patients have enough support that they need to live normal lives thereby reducing the costs of managing the disease. This occurs if the condition was not well managed by adopting good communication strategies when they are relating to the patients (Umpierrez et al., 2015). This, therefore, implies that healthcare providers such as nurses in a diabetic management must be equipped and empowered with leadership skills that allow them to work in a team environment. Team environments are complex in that the nurses must address issues such as patient's health beliefs, current knowledge, cultural needs, emotional concerns, numeracy, medical history as well as other factors that influence their ability to meet the demands of the diabetes self-management process (Burant, 2012). The above discussion shows that communication as a leadership skill is required in solving conflicts within the diabetes management ecosystem for positive intervention implementations outcomes on the patient.
References
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Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., & Vivian, E. (2015). Diabetes self-management education and support in type 2 diabetes a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 41(4), 417-430.
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 97(1), 16-38.
