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Knowledge and practices of occupational health nurse practitioners in the management of diabetes mellitus in South Africa
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Diabetes is one of the major non-communicable diseases in South Africa (SA) and in 2008, 6.4 percent of the South African population was reported by Frost and Sullivan to have diabetes (Business Wire, 2008). Furthermore, the prevalence of diabetes in South Africans between the ages of 20 and 70 had been predicted to rise from 3.4% to 3.9% by the year 2025 (Rheeder, 2006:20). There is no clear assessment of the amount of nursing care Occupational Health Nursing Practitioners (OHNPs) provide to diabetic employees in SA. From working experience of the researcher, employees with diabetes were absent from work more often due to poor glucose control than other workers with chronic health conditions. The increasing levels of absenteeism had financial impact on the diabetic employees, other workers, and industry. Therefore, OHNPs working in industries and organizations must have the appropriate knowledge to ensure that workers with diabetes are screened, monitored, and managed effectively in the workplace. The aim of the study is to assess the knowledge and practices of OHNPs in managing diabetes in workplaces in SA. The objectives of the study are firstly, to explore the extent of knowledge and practices of OHNPs regarding screening for diabetes in the workplace; secondly, to describe knowledge and practices of OHNPs regarding monitoring of diabetes in the workplace; and thirdly, to examine the knowledge and practices of OHNPs in management of diabetes in the workplace. Quantitative survey design was selected to focus the study and inform on the data collection tool. The population was all the OHNPs that were members of the South African Society of Occupational Health Nurse Practitioners (SASOHN) and registered on the SASOHN database. SASOHN Executive Office granted permission for use of the database. Ethical approval for the study was obtained from the University Research and Ethics Committee. The sample included all the members of SASOHN that had access to emails. The researcher developed an electronic self-administered questionnaire based on the 2009 American Diabetic Association position statement. The questionnaire contained both closed and open-ended questions which were grouped under specific sections. The questionnaire was emailed to participants accompanied by an invitation to participate and an informed consent form. Results: due to the complexity of industries and factories that OHNPs are employed in, the organisations were divided into eight categories. About 45% of respondents rated their knowledge of diabetes management as either good or average, 55% rated their knowledge of screening as good, 44% rated their knowledge of diabetes management as good and only 7% as very good. Only 51% of OHNPs routinely screened workers for diabetes. The majority of the OHNPs indicated that the Fasting Blood Glucose (FBG) was the diagnostic test they used to diagnose diabetes, which is the preferred test. Between 73 -85% of OHNPs indicated that each of the suggested five aspects of immediate care were performed after diagnosis Conclusions: OHNPs consider their knowledge on different aspects of diabetes to be average to good, however, lack of knowledge on types of diabetes, and some gaps identified regarding the tests for screening and diagnosis of diabetes, are cause for concern. Most OHNPs that participated in the study use different approaches to conduct diabetes awareness initiatives to promote health amongst their employees. There is a gap in OHNPs’ practice of screening for diabetes as well as in their knowledge. The lack of knowledge of the OHNPs that used the Oral Glucose Tolerance Test (OGTT) or other tests is cause for concern. Amongst most respondents the five aspects of care necessary after diagnosis of DM were performed. Recommendations: firstly, a strategy should be developed to encourage males to specialise in occupational health nursing. Secondly, a vigorous marketing strategy must be promoted to inform career guidance teachers on how to attract new applicants to the nursing profession and to promote nursing as a career of choice. Thirdly, the number of nurses trained in occupational health nursing and practising as OHNPs should be determined to assess professional developmental needs. Fourthly, additional research ought to be conducted to determine OHNPs’ actual knowledge of crucial aspects of diabetes and diabetes management. A standard/guideline could be developed to ensure that OHNPs have points of reference, and continuous training and professional development programmes on screening and diagnosing of diabetes should be established. There must be an investigation into constraints that OHNPs are faced with when implementing health promotion in the workplace as well as to determine the impact of such health promotion initiatives on the employees. OHNPs should be informed about the immediate care that needs to be performed on diagnosis of diabetes to improve their knowledge base and to motivate them to change their practice to provide a solid basis for continuity of care and management of newly diagnosed clients. Suggestions for further research: research on the effect of screening programmes in the occupational health setting to diagnose diabetics and the follow up care that is given. More research is required on how much monitoring and supervision is being conducted by OHNPs in the workplace.