Primary Health Care Nurses Caring for People with Diabetes: an integrative review of the literature

The aim of this integrative literature review was to analyse and synthesize findings from primary empirical studies concerning how nurses in primary care, care for people with diabetes (PWD). Diabetes is a recognized health priority in United Kingdom (UK) and New Zealand (NZ). Health policies are directing a shift in diabetes services from secondary to primary care. New Zealand primary health care (PHC) nurses are playing an increasing role in caring for a growing number of people with diabetes (PWD) and as such, need to be positioned effectively to contribute to preventing or minimizing associated long term diabetes complications. This research project has identified contrasted and highlighted similarities or differences in breadth and context in NZ nursing practice with UK practice and established important concepts and subsequent implications for this emerging role in NZ. The findings of this integrated review indicate that PHC nurses have developed extended and in some instances advanced specialised practice in caring for PWD across the breadth of the wellness disease continuum. Contextual factors have had a significant influence on how the role has emerged in both countries. The role is more evident in the UK and findings from the UK literature have implications for this emerging specialised PHC nursing role in NZ, particularly in relation to nurses increased role in medicine management of PWD. Recommendations are that new diabetes policies or programmes of care have structures that promote and support effective relationships and collaboration between all providers of the diabetes team. Education for this role should be provided at a nationally agreed standard where nurses’ competencies are measured. Furthermore appropriately qualified diabetes PHC nurses should have an increased role in medicine management and/or prescribing in NZ primary care similar to UK nurses. Finally, contribution of the emerging role of the diabetes PHC nurse should seriously be considered within the context of ‘Better, Sooner, More Convenient Primary Care’ structures that are designed to address chronic disease management and health inequities within the NZ population.