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Effect of Self Management to Quality of Care

in Type z Diabetes, King Narai Hospital

olll ior tv.t yro{lorltJ Ttrl.u. Ampai Thongeiam B. Ns

v^louqryt rJtuetu ?tu.N. Ananya Manit M.N.S.1d4d

qilrJrcr?::fl qnilTrsl{ y{r,.rl. Bupasawan Udompeech M.N.S.

^dafl::RIRll UUyflrJ Ufi.il. Kannikar Niyasom RN B.l\{.A.vvd

G{n{ryt sT?lag ils.U. Sukanya Chatchawan B. Ns

er?{flt .u,flou :rj.ru. Duangporn Kongpium RN., t\{.p.A.4lA

It-l?Rl tylu:y'lll{U yttj.rJ. Yaowapa pianpknich M.N.S.IA A A Ailtiulst ilugtoetrJCIJ ?rsj.u. parichart pinitjitboon B. Ns

v v ,uuoofl:1 lony{ilfi ytu.u. Atchara Akapan B. Ns

il:vnot nolfiu ils.u. prakong Gonghin B. Nsvdunt?I::or t{ilqqe}l ytrl.u. Napapan panput B. Ns

n{runr:6orfituRt:flutilta Nursing organization

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Abstract

Objective

Setting

Design

Subjects

Method

Results

To study the results of self management programe in improving

quality of care of type 2 diabetes.

Out-and-in patient department of medicine, King Narai Hospital

Quasi-experimental study, Pretest-posttest in one group

45 type 2 diabetic patients (30 out-and 15 in-patients) who had blood

glucose more than or equal to 126 mg/dl, were studied during July

1, 2009-September 30, 2009.

The process of self management program were arranged in 3 stage; 1)

problem assessment 2) planning and implementing and 3)evaluation.

At the following aspects were evaluated using questionaries : knowledge

ori diabetes, self care behavior, blood glucose level and quality of life.

Data were analyzed by using descriptive, paired t-test and Wilcoxson

sign rank test with statistical significance at p<0.05. Confounding

factor might be orcurred from another sources that researchers could

not control this situation.

Pre-post test in out-and in-patient on diabetes knowledge were

improved from moderate level to good level (P<0.001 and P= 0.001),

on self care behavior were improved from poor level to good level

(P<0.001 and P=0.041), on blood glucose value were improved from

poor level to good level (P<0.00't and P=0.014) and on quality of life

were improved from moderate levelto good level (P<0.017 and P=0.001).

ln self management program, nurses could improve relationship with

diabetic patients by telephone or home health care team. Further

more, the patients could consult nurse at hospital or called them,

participation in setting goal for controlling their blood sugar and diet

by exchanged foods, exercise, taking medicine and observing side

Conclusion

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effect, attending appointment, stress management, through self

monitoring form. The patients could evaluate and reinforce themselves.

They could achieve good feeling and willingness to self management.

These interventions could improve quality of care and sustainable

effects will be occurred if they were implemented regulary tor at lease

6 months.

I self management, quality of care, type 2 diabetic patientsKey words

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1xu 22 f,o finsuuuad:sm'ir.o 0-36 ncuuu{r . -! a dLnuLrllat{aan\ o-22 nvLluu fiil1elfl.,] fl1:tl

zuafloin1:161il:llnrilnr:'i'on1:qruro.rsioq0rnrilni:qua{ilra]:nrrrvrruryfiofi z l:rrurlran:vu.r:roairnr:rsA,A V AlYl 7 qLtJfr 3 n.fl.-o.n. 2553_,_ lfft",of Self Managerent to Quality of Cre in Type 2 Diabetes, King Nilai Hospital 1 89

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n:{rr?\aJfi1un:: I:.:firuy{!rutuamn:ainr:rnun:uyi.:rj:srnrttyra sirrirl ; 2542.qq

2. ritinl:atri6nria. aqrJruala:.:n1:vi'olJul?iluuu{.:r{nuiiarJfrr-ifin1:u?n1:n?unil

fla.:ri'ul:ntrifinria ri*nirfl.ruil:vrurru 2il7. r11fr)*urum-rmfirdru:rtnr:nrsJnxuneil:FrVA

ni.:fi t ol2s47;2G Ealnru 2547; ru fra.:il:vtLrrl:srfiu ,i'uvriera n:eJa?uqilI:n.d

UUl'lUT: n:YTIT'1.:d1fi1T6lJdA; 2547 .

g. rtufflarunrir?d1:uavd1:dur?rFt. afifirir-hal:nru1fi?1u. nvrri: I:.:vrarula?\:&[J1?1u6liqqqq

il?1'rr1t; 2552.

4. 6:r.12 aruIzn. n6un1?\fiqnfla.:{fl{mtlLUl?1?1u @naTfilruiirJ36u6yeJfi11r-6ufin). aTzTq e {q q

n1?y{a1u1afr"[vrai. frufininar#a. n!.:rvn\iJfi1rJFn: lfirimsrd'Harfina; 2540.quq

5. nar6n rariroSruqn, n1u1 6:6qnr.rd, q:rfia:6 o1t1uf,ilyl, iinrilvrnsimriffi, au.:Fi'; o v,,

azE.:. :rlrrurnr:dtra3ilfl1:nttanura.:'Luridra[L1?1?1u. 11:41:i{un1{fl1:r"rEJMa

)uoo)r: 115-87. { {

o. rirurm un:Fnu?un5. rlq6'uidfi,{arionr:ana.:zo.::roiurirrtralu16aorua.:liilaarurmmuqqA-vt,JfedaadareJlTlJnlT:nulAU1\:nALUO.I L:{yIUMnU1UA1A A{?1?FrLl\t:U: (?TtEl1Ul\Uf,'11:6U6U'r

ruvrrllrufim). d1?'rd'rfi'rrfu4flFI1dni. rirufininala'fl. n?.r[Try,rrlrl1un:: il,il1enu1#u

rufiora; zs4o.

7. ??rru1 6t1rJ1:n. nrunrlrfiimdqryrfiatrha.:{rJral:nr!'r?1?1uzfiorhid.:6ug6u @neLr

finuii'r-l3onLrermruirufin). armins1fll::vu1Fr. rirufininar#et. fl:{lnilrJm1un::o---o'q

N141??1g1nUlJ14nA; 2542.

8. Coates VE, Boore JRP. Self-management of chronic illness: implication for nursing.

lnternational journal of nursing study 1995; 38: 628-40.

9. Kanfer F, Goldstein A. Helping people change.2"d. New York: Pergamon; 1980.

'10. Berg J, Jacob JD, Sereika SM. An evaluation of a self-management program for

adults with asthma. Clinical Nursing Research 1997; 6: 225-38..otEy-ol-Aa-Vod

11. dilFInn n1fi6uqeJ{Fra. UaouTr}.J,{anav{qnn::8Jn1in?un8J:vFtltu1Fr1a-Lurdanfla.l

{rJrarr,rmutfirrhidt6ugfiu eirrnau.::srir o'.rvr':-orfir*a$nn. fiuqlan: I:rfiruv{qq

n:vnalnfl; 2540.

12. Keeratiyutawong P, Hanucharurnkul S, Melkus GDE, Panpakdee O, Vorapongsathorn

T. Effectiveness of a self-management program for Thais with type 2 diabetes.

Thai J Nurs Res. 2006; 10: 85-97,

ruaro{nr:lfiil:un:ilRi:,i'flRr:erulo,reioqiunrfln'l:quat1il?ul:nru1rlrryfiofi z l:lnouralr:yur:rsairrr:rrya.! v )ufl 7 quuYr 3 n.El.-fi.n. 2553 Effect of Self to Quality of Cre in Type 2 Diabetes, King Nrai 193

13.Fu D, Ding Y, McGowan P, Fu H. Qualitative evaluation of chronic disease self

management program(CDSMP) in Shanghai. Patient Education and Counseling

2006; 61: 389-96.

14. Polonsky wH, Earles J, smith s, Pease DJ, Macmillan M, christnsen R, et al.

lntegrating medical management with diabetes self-management training: a

randomized control trial of the diabetes outpatient intensive treatment program.

Diabetes Care 2003; 26: 3048-53.

t s. 6unur ila{Lryt:. il:cfinB,{aro.:Iil:un:run1?{nn1:nura.r'[un1:aarnru:voirrirnra'[utdaorunvqrunlilfienza.:fit]rarl1?1?1u. nltt?u?: inala-uila.ru,ran:yoarurnfir;

2550.

t o. 6nfietr ogrgRnd ,{nzadil:un:ilfl1:e-nn1:nura{FianlTnxuqilJ:yniurirnra'[ur6an

msnrunr{mntotfr|?Eltu1fi21u 6vrurfiy{udil?ilanilfirt-irufin). arrnr.lalmnFndmi.q{UAAvdAV

u rufl r|lr u1a u. fl ?{ rllTtti?111J OT: Q$tr1n{ n:fuil?l.]'ln U1A U ; 2545qq

1 7. drltl u vr:fi il 6'n:. rJo{ad fi l.r a ri alr q F n::ru2a.,: frdr al:n rtl'l fi ?1 uzfi ntild.r 6ug6u

tunr:nruaru:rrirfinraturdaor. ?mm:a{u:v1J1rd1f,'1:6ud? 2550; t (ar-iura?rt t):

1 0-8.

1 8. qviavl::ru ?FrFht. ruaza.:Iil:un:iln1:a'Flnlrrlura.tria:criuA[rJInaiudfirlrnlaLfl.tgtq

Lrasq6uR1v{frinrza.,:{6.,:aIe1l:nru'rfi?1u 1inarfinurfiJ3qryrrurrfrufin). atrrq qq q

-doAAv6,avv{UlulaFIlflFl:. Uru6nn?nej1aU. n:{t11v{lJfi1unT: Qu[1n.0nrdilfi1TmU1d'eJ; 2549.

dr'lu uort6oru, oritytgr rurfiord, qrJzuraa::ri qnrr,'vri, n::finrf fitraaru,

{riqqr #rylad, o:rlr: nuflor, rut:nt rfiu:urfiry. ilr:^m6 nfior6orr;ry, d , u d

1 94 u"""' "toorl' ,uniu;,",lirrir""nuuau,'ur,*#*"#rdrr*'"''"'*"' ar::d'rl:vmindrrzar:

I o v-"- -'-' ^t'':'^- j't.:uzuunfidruuon ttasmarid?uolurn::$l druunm1?1{n101u'tuuns:oflaefla{nqiln?aE { q q

vadFllt o'tEl tv'{FI ?sn!n1:Flnu1 dnlufllv,ldeJ:d LLas 01t1\

q

frarynrTrtr-JoPD (N = 30) IPD (N = 15)

vTAUAg

uT2sJThl?lA.lFl (N=45)

a1ulua1u'luv:aflas

o9q1u?u Tagas

01uq

21-30fl31 - 40 fl41-50tl51-60fl

o,3u,61 U ?IULU

tl^l FI

r€.r

tlElVA

:sFtufl1:F|fl141

l:varufinurva

s.rfl'flr.rFInu1

aqr-l?ryryr, rhz.d

1l:f:lrfl1Fl:

aarunrvralr:aILda

Fi{v

fis,r1u

mdt, uetn

o1ty,l

Inun?n::].rIn1?1fl

fl1:1tfl1:

0

0

Ib

16

19

11

12

11

0

7

3

19

5

3

I14

I

0

0

26.7

20.0

53.3

63.3

36.7

40.0

36.7

0

23.3

10.0

63.3

16.7

10.0

26.7

46.6

26.7

1

0

4

2

8

1

8

5

1

2

10

1

2

5

4

6

6.7

0

26.7

13.3

53.3

53.3

46.7

6.7

53.3

33.3

6.7

13.3

66.7

6.7

13.3

33.3

26.7

40.0

1

0

12

8

24

27

18

13

19

5

I

5

29

6

5

13

18

14

2.2

0

26.7

17.8

53.3

60.0

40.0

28.9

42.2

1 1.1

17.8

11.1

M.5

13.3

11.1

28.9

40.0

31.1

nalo{n1:1iIi:uniilnr:0'onr:nuro.rsioqsuulilnr:arlarhhul:nr!.tv':rus,fiofi z I:ruo.tuau:vur:roafum:rt

ttii z quTui4 3 n.fl.-E.n. 2553 Effect of setf Managemenr ro Quatiry of Ctre in Type 2 Diabetes, King Ndai Hospital 1 95J ,a a oi s ^ v Y

n1fl.:fi e rrlTuurfiuun?1eJi6orl:nrurnrlu ?\qmn::ilfl1:n[nnura.] :sriurirmrnturdan

lrfiin'ua.,:nriruoiroe.i'r.:uruunfrilrfluonuavilofrdxsolErrn::$lriouuar ma-.rqq{q

n1;flnaa{

riruu.l:riaurfrrlrl:un:ru m#.:rftIrl:un:e.r

7 (SD) x (SD)P value

vAn?1iltt:a{

I:nrurvmru.

OPD

IPD

1^|lqa flTTSJnl:n LLAnUO{.

OPD

IPD

-YoaTsFtuulFlla Lu[aan*

OPD

IPDda

nftJfl11\t?Ft*"' oroIPD

14.7 (2.e)

15.0 (2.1)

26.e (4.5)

23.1 (6.3)

145.2 (14.8)

151 .9 (49.2)

147.4 (42.0)

13e.3 (13.6)

17.8 (2.6)

18.5 (2.7)

30.7 (2.3)

27.7 (4.8)

123.0 (27.5)

115.4 (17.1)

153.3 (5.5)

156.1 (7.5)

<0.001***

0.001***

<0.001***

0.041 ***

<0.001"**

0.014***

0.01r4.m1*

* rndaufira** nndaLff?Er*** P < 0.05

Wilcoxon sign rank test

Pair t-test