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Lived experience of diabetes among older, rural people

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george s.r. & Thomas s.p. (2010) Lived experience of diabetes among older, rural people. Journal of Advanced Nursing66(5), 1092–1100. Abstract Title. 

Lived experience of diabetes among older, rural people. Aim. 

This paper is a report of a study conducted to elucidate experiences and perceptions of self-management of diabetes as narrated by older people diagnosed with insulin-dependent diabetes living in a rural area. Background. 

Older people worldwide are disproportionately affected by diabetes and are more likely to have co-morbidities and disabilities. Guidelines for management, developed by the American Diabetes Association, are not targeted for this population. A plethora of quantitative research has investigated self-management issues, with little change to outcomes. This pleads for consideration of a new diabetes education model, which includes consideration of experiences within clients’ worldviews. Method. 

Unstructured interviews starting with an open question were conducted from a purposive sample in 2005. Interviews were transcribed and analysed according to the tenets of existential phenomenology, a process which began with bracketing the researcher’s biases. Findings. 

Living with poorly controlled diabetes led participants to introspection and existential questioning. Four connected themes were identified: ‘Your Body Will Let You Know’; ‘I Thought I Was Fine, But I Wasn’t’; ‘The Only Way Out is to Die’; and ‘You Just Go On’. Conclusion. 

Currently designed from a medical perspective, diabetes education should be based on a nursing model incorporating the client’s insights and experiences. When managing diabetes is viewed from a client’s perspective, the focus becomes solving problems that arise in self-regulation of one’s own regimen rather than in complying with doctor’s orders. Nurses need to reframe the problem by excluding the compliance/noncompliance model and developing a conceptual perspective on self-management that is grounded in world and body.
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Keywords: diabetes; gerontology; nursing; older people; phenomenology; rural health; self-management

Document Type: Research Article

Affiliations: 1: Sharon R. George PhD RN CNL Assistant Professor, Graduate Faculty College of Nursing, The University of Alabama in Huntsville, USA 2: Sandra P. Thomas PhD RN FAAN Coordinator for Doctoral Program,and Co-Director Cooperating Site, International Institute for Qualitative Methodology, The University of Tennessee, USA

Publication date: 01 May 2010

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