Diabetes Mellitus in Rural Settings Peer Reviewed Journal

Clinical Problem: Diabetes Mellitus in Rural Settings



Mid-range nursing theories can be extremely useful in understanding specific clinical issues. These theories are less broad and all-encompassing than so-called grand theories of nursing such as Jean Watson’s Theory of Human Caring and seek to offer a more technical and practical approach to applying theory in daily practice (Alligood, 2018). This paper will specifically examine the application of Kristen Swanson’s Theory of Caring to the treatment of patients suffering from diabetes mellitus living in rural settings without adequate access to healthcare. Virtually all nursing theories are composed of four essential core definitions, that of person, environment, health, and nursing itself. Swanson’s theory, however, specifically focuses on nursing, which Swanson defines as a very specific type of caring.



Clinical Issue



Although obesity is increasing across the nation, obesity is often particularly rife in rural settings with limited access to healthcare and healthy foods. Health literacy has likewise been lacking at the rural health family practice clinic out of which I operate. As noted by Ricci-Cabello (et al. 2013), there are a number of systemic factors which have resulted in obesity being more prevalent in rural areas, as well as higher rates of poorly-controlled type 2 diabetes. “Individuals living in rural communities often have to travel longer distances to obtain appropriate healthcare, which has been strongly associated with poorer glycemic control,” and limited diabetes education (p.2). Poor health literacy is often linked to low levels of literacy itself, which can make reading nutrition labels, understanding how to count calories, and also correct insulin and drug dosages difficult.



Remediating the effects of diabetes is absolutely critical. Without proper management, diabetes can result in significant life limitations that further impede the patient’s economic and professional viability and further limit their access to adequate healthcare. Structured diabetes programs have been found to be effective in helping even hard-to-treat patients. It is critical that treatment is grounded in evidence-based principles. It has also been found that educational programs must “meet the cultural, linguistic, cognitive and literacy needs within the local area,” as the nursing application must be attuned to the unique challenges and worldview of specific patients to be helpful (“Type 2 Diabetes,” 2015, par.15).



Nursing Metaparadigm



Swanson (1993) based her original theory on Jean Watson’s grand theory of human caring. For Watson, the nursing process is based upon the caring moment or interpersonal connection between nurse and provider. Like Watson as well, Swanson affirms that nursing has a profound spiritual dimension, although she applies that spirituality in a more practical, less esoteric, and step-by-step approach (Hsiu & Shu-Ming, 2016). Swanson views expert nursing as the ability to synthesize expertise with technical knowledge. She also draws upon Benner’s theory of novice-to-expert in her analysis, which suggests that expertise is when years of experience become internalized to the point that nurses can select just the right interpersonal response combined with the right nursing intervention (Lyneham, Parkinson, & Denholm, 2008).



One example used by Swanson in her initial application of her theory is that of wound care. While a novice nurse may try to eagerly help a patient with a wound, an expert nurse will assess the expertise of the patient and will empower the patient, if the patient desires and is capable of it, by showing how to engage in wound treatment and care so the patient is prepared for discharge (Swanson, 1993). But if a novice nurse is struggling, Swanson’s theory of human caring also suggests that more expert nurses should intervene and enable the novice to engage in a more informed approach, using the experience as a teachable moment rather than an excuse to dominate or belittle…