Nursing evaluation of diabetes self-management in tertiary healthcare settings in Croatia.

BACKGROUND Systematic and efficient education on patient self-management behaviour represents one of the key approaches to diabetes treatment. The aim of this paper was to evaluate the current process and content of nursing assessment of illness self-management behaviour in persons with diabetes treated at a tertiary healthcare facility. SUBJECTS AND METHODS Electronic patient records of N=15,116 persons with type 2 diabetes (51.3% men) who took part in nursing evaluation and education throughout 2011 were collected. The patients' mean age was 65.0±11.1 years, with mean diabetes duration of 12.6±8.3 years; they were mostly treated with oral anti-diabetic drugs (38.4%) or insulin therapy (38.5%). The likelihood of non-participation in the nursing evaluation was predicted based on a number of patient characteristics using a multivariate logistic regression. RESULTS The nurses mostly rated the patients' self-management knowledge and real-life application of that knowledge as appropriate; however, in a large number of patients, the nursing evaluation was not evidenced in the electronic patient record. Multivariate logistic regression revealed that longer diabetes duration, insulin treatment and better glyceamic control as measured by glycated haemoglobin were associated with a higher likelihood of participating in a nursing evaluation and diabetes re-education. CONCLUSION Diabetes specialist nurses may use informal criteria when deciding which type 2 diabetes patients to interview about diabetes knowledge and self-care. Participative research on the processes of nurses' decision-making may be needed.