Abstract
Diabetes mellitus is arguably the most prominent metabolic disorder in human health. This condition can easily impact various functionalities within the human body. The holistic prevention approach to diabetes management and prevention introduces an unconventional method of combating the diabetes menace. A holistic human image is one of the least explored tools for tackling diabetes in modern times. Nurses and other medical professionals have turned to a holistic approach to diabetes management that mostly relies on humanistic images. This paper utilizes an integrative review to present research that addresses the issue of how nurses and other medical professionals can utilize the humanistic images of prevention and whether a holistic approach in the management of diabetes.
Introduction: The Problem
There has been a considerable increase in the instances of chronic diseases such as diabetes across the world. More people continue to be diagnosed with diabetes every year across the United States and across the world. The diabetes condition is not entirely curable and it is only ‘manageable’ at best. Healthcare professionals are tasked with helping diabetes patients manage their condition in the most efficient way possible. It is estimated that more than a quarter-billion dollars goes towards prevention and management of diabetes in the United States alone according to statistics by the American Diabetes Association (Kutty & Raju 2009). The most urgent cause of concern in the management of diabetes is that the number of people who suffer from this condition is expected to go up significantly in the next ten to thirty years. Individuals who suffer from diabetes also tend to suffer from other related health conditions including blindness, amputations, and cardiovascular ailments. The pressure that diabetes puts on the current society has prompted health stakeholders to seek ways of preventing and managing diabetes. The current methods of managing diabetes have not yielded the expected amount of impact. Consequently, nurses and other medical professionals have turned to a holistic approach to diabetes management that mostly relies on humanistic images.
The latest developments in diabetes research have prompted health care professionals to turn to a holistic (body, mind, and spirit) approach when striving towards efficient diabetes management. The holistic approach in the management of diabetes does not necessarily take into account the patient’s cultural, ethnic, or religious backgrounds but it encompasses all these characteristics with the view of capitalizing on their humanistic images. Most of the strategies that have been used in the management and prevention of diabetes in the past have mostly relied on overall cost reduction and the glucose-control method of treatment. Nurses and other medical practitioners are finding it hard to keep up with both conventional and holistic methods of diabetes management. For instance, gaining the full understanding of the holistic cum humanistic images approach to treatment requires an extra effort by both healthcare professionals and patients as well. The holistic approach to diabetes management requires a multi-disciplinary collaboration between different healthcare stakeholders. This paper seeks to find out whether in both nursing and other medical disciplines, the humanistic images are a sufficient holistic approach in the management of diabetes.
Methodology
The research for this article consists of an integrative review. The integrative review is a summary of past relevant literature on the main topic. In this case, the integrative review seeks to identify the past theoretical and empirical literature on the subject of holistic approach to diabetes management and the application of humanistic images by nurses and other medical professionals. The main advantage of using an integrative review is that it encompasses research from various sources and periods thereby broadening the topic of discussion. Holism in itself seeks to combine various methodologies and come up with an integrative solution to a certain problem. Consequently, integrative review will be a suitable method of conducting research for this study. For instance, one researcher “describes the use of an integrative literature review as appropriate for holistic conceptualization and synthesis of new emerging topics such as diabetes nursing in primary health provision” (Torraco 2005). The integrative review is preceded by the statement of a problem and it is followed by research, presentation of findings, a discussion of the results, and a conclusion.
Research
Humanistic Images
The concept of humanistic images comes from that of humanism. On the other hand, humanism seeks to have human being operate within the set standards of humanity. Humanism also operates in respect to deities or higher powers that govern or dictate human actions. All humanistic images are sourced from these concepts of humanism. Humanistic images take various forms but religions provide a significant number of these tools. Existentialist philosophers have also come up with various images that are since part of holistic medicine. The humanistic image of a human being in medicine is especially important for people who are in the process of managing chronic conditions, such as diabetes. In addition, the humanistic image of man focuses on the psychological and social aspects that can assist an individual to overcome the difficulties that are caused by a certain disease. The objective of utilizing the humanistic image in the prevention and management of diabetes is to employ the various scientific branches that are concerned with studying a human body, mind, and practices as well as spiritual and socio-economic life. Most individuals use their constructions of humanistic images to adopt a holistic approach to diabetes management through the grounded theory of information packaging. Nurses through the modern medicine can be able to utilize both Christian and universal humanistic images in the formation of a holistic diabetes self-management program.
Historical Applications of Holistic Medicine in Diabetes Prevention
Diabetes has been described as one of the most significant epidemics of this century by the World Health Organization (WHO). The organization also predicts that instances of diabetes have increased significantly in the last five decades. In the course of history, the research on diabetes management has involved thousands of researchers from different fields of medicine and from all over the world. In recent years, researchers have managed to make various advances on how to ease, at least to a certain merit, life of people diagnosed with diabetes. Nevertheless, the application of humanistic images in the treatment of diseases can be traced to the period of Greek Civilization. The concept of using holism in medicine was first propagated by Hippocrates. Throughout history, humanistic images of the human person have been shaped by both religion and other secular views. The universal humanistic image depends on a person’s ability and willingness to participate in social responsibilities and ecological preservation efforts. Other humanistic images are dependent on the plight of humanity and its inherent struggles. For example, the Christian image is consisted of a person’s ability to overcome his/her basic instincts.
One of the key issues that dictate the way in which diabetes is managed is the complexity of this chronic condition. Diabetes has been found to be a condition that evolves over time. Furthermore, diabetes as a health condition shares various risk factors that are similar with those of other chronic conditions including obesity, smoking, and high blood pressure. Physicians have also become aware of the fact that diabetes as a condition is often accompanied by other co-morbidities like hypertension which requires constant management in a similar manner to glucose control. Long-term organ damages are also akin to the management of diabetes. It has been found out that failure to manage diabetes in an effective and timely manner often leads to long-term care requirements such as kidney dialysis or transplantation and amputation. Sexual dysfunction is another condition that has fueled the influence of humanistic images in the management of diabetes.
Another trigger to holism in the management of diabetes comes from the fact that individuals with diabetes are at a “great risk of developing cardiovascular, cerebral-vascular, and peripheral artery diseases” (Shrivastava & Ramasamy 2013). Therefore, nurses and other medical professionals have often been prompted to deal with diabetes from a more ‘holistic’ perspective. Diabetes patients have to contend with increased rates of mortality when they are managing their conditions. Research also indicates that the mortality rate that is associated with diabetes increases by a factor of seven where there are additional complications. Holistic medicine allows patients to deal with complication issues in the very moment when they arise. Most diabetes patients are also aware that the ability to contain diabetic-related complications is the key to effective and adequate management of the condition. Consequently, a holistic approach to diabetes management has been found to improve the patients’ quality of life in a significant manner (Kutty & Raju 2009).
Holistic Training and Diabetes Self-Management
When nurses and other medical professionals are approaching diabetes from a holistic angle, they have to contend with various challenges including training. Mainstream medicine does not offer any adequate training in holistic diabetes management. Consequently, the application of holistic medicine in diabetes management mostly relies on formal and informal guidelines. For instance, the current approach to diabetes training is mostly captured in the guidelines that are stipulated by various organizations. The American Diabetes Association provides professionals with various clinical-practice guidelines that apply to the management of diabetes. Most of the available training guidelines point towards the management of hemoglobin using Ace Inhibitors. Other training guidelines can be found within secondary and tertiary diabetes stakeholders such as the National Committee for Quality Assurance (NCQA), Accountable Care Organizations (ACOs), among others. Nevertheless, it is clear that none of the currently available diabetes training guidelines specify a holistic approach. The focus on hemoglobin management in diabetes training manuals is informed by the fact that this approach is one of the time-tested methods of prevention. On the other hand, glycaemia-control has proved to be a source of complications in instances when it does not work.
Nurses and other primary healthcare professionals realize that the available training avenues do not address the true nature of diabetes. Diabetes as a multi-factorial ailment affects several spheres of a patient’s life. Furthermore, diabetes training “requires a more holistic approach that goes beyond glucose, and includes careful management of other risk factors” (Crenshaw 2010). The professionals who have been tasked with diabetes prevention and management have adopted a holistic approach. Nevertheless, the adoption of the holistic approach in the management of diabetes does not usually feature in the professionals’ training stages. Adopting a holistic approach in the training of diabetes has been a slow process that is exacerbated by the fact that professionals tend to focus solely on risk factors. It is also important to note that statistics indicate that “people with diabetes who maintain a normal blood pressure reading can reduce their chances for complications of the eyes, kidneys and nerves by about 33%, as well as their risk for cardiovascular disease by up to 50%” (Shrivastava & Ramasamy 2013). The available statistics also indicate that there is a need to adapt a holistic approach in the management of diabetes. Treatment therapies and training for other diseases have had a more positive adoption of holistic solutions. Diabetes treatment has however lagged behind in the efforts to adopt a holistic human image in its management.
Risk Centric Behaviors and Lifestyle Strategies among Patients
Most of the scholars who have covered DM’s holistic management agree that this approach is necessitated by DM’s evolutionary tactics (Rydén, Grant & Anker 2013). The initial management practices when dealing with the condition keep changing from time to time. This challenge incorporates a vital aspect of holistic learning. Diabetes is associated with various other conditions such as obesity, lifestyle habits, and high blood pressure. The varied aspects of diabetes make holistic learning compatible with the prevention and management of the condition. Another study catalogs all the factors that contribute towards high/low cases of DM. These factors include: “obesity, low birth weight, ethnicity, family history, increasing age, physical inactivity, low-fiber diet, high-fat, urbanization, insulin resistance, hypertension, impaired glucose-regulation, and age” (Castillo, Giachello & Arrom 2010).
There are several approaches to instituting behavior changes with the view of diabetes prevention. According to Satterfield and Volansky, “lifestyle modification requires behavior change, therefore, counseling is necessary…(and) should employ evidence-based behavior change techniques, such as cognitive behavioral therapy and motivational interviewing” (2012). This approach capitalizes on peoples’ desire to pursue good health by overcoming any personal barriers. For instance, a person can pursue self-management in diabetes by overcoming any impediments to change and prioritizing on risk factors, practicing self-efficacy, and increasing their confidence. Nevertheless, research indicates that success in self-management has to involve a certain level of environmental congruence and holistic human images.
Presentation of Findings
A majority of the research indicates that holistic medicine and humanistic images are part of the present and future diabetes-management practices. Consequently, the treatment and management of diabetes should maintain relevance to the holistic human images that abide with diverse factors such as age, health condition, cultural backgrounds, religion, and related complications among other factors. The integrative research also indicates that various stakeholders around the world have began considering the management of diabetes from diverse angles (holistically). In countries such as the USA and the UK, there is extensive research on the matter and an ongoing effort to incorporate the holistic approach in DM prevention. The cost-effectiveness of this method has also been acknowledged considering the current high costs of diabetes management. The healthcare of the 21st century aims at prevention rather than effective treatment. Hence, it is clear that DM prevention will receive the necessary attention. The holistic approach is also seen as a potential solution to the problem of the epidemic threat of DM. Multidisciplinary teams should be created in every healthcare facility (Kutty & Raju 2009). The educational sphere is the next step in the implementation of the holistic approach as young generations should also be aware of the hazards associated with certain lifestyles and some health conditions.
The results also indicate a tendency to use holistic training as one way of combating the diabetes pandemic because it focuses on both health professionals and the public interests. Currently, there are several organizations that focus on diabetes-centered training on primary, secondary, and tertiary levels. The holistic human image is yet to be fully incorporated into diabetes training. When holistic training in diabetes self-management is used, it takes into consideration “all aspects of a patient’s needs, as it relates to health training” (Teixeira 2010). Reduction of risk factors is often reiterated in the management stage of diabetes and not in the training stages. Nevertheless, there are various avenues of incorporating holistic training through ‘guideline-recommended goals’. This approach would be effective on both a primary training level (by creating awareness amongst physicians) and a secondary level (where patients are able to identify diabetes-related complications even before they occur).
Discussion
The holistic approach to diabetes treatment continues o gain popularity around the world. The lifestyle-related changes and medical management are two components of the holistic diabetes-management strategy that have already proved resourceful. The adoption of the holistic approach will require a significant amount of resources to implement, but the healthcare fraternity is inclined towards prevention rather than treatment of diseases. Therefore, the holistic image of DM prevention is a futuristic component of the healthcare system.
The overall management and prevention of diabetes can be enhanced through the application of the holistic approach when training nurses and other medical professionals. Diabetes management has various issues that challenge the validity of the current prevention methods. A holistic learning approach is set to reduce instances of diabetes whilst improving the quality of life of patients and the overall productivity of the medical professionals. The training of nurses and other professionals can incorporate psychological, physical, social, existential, and spiritual factors that can be utilized in the holistic self-management of diabetes.
Currently, there is a direct correlation between the general humanistic image of a human being in medicine and other factors such as culture, environment, religious practices, and body-image issues. It is important for people who are managing continuous medical conditions such as diabetes to adopt behavior changes because they focus on the psychological and social aspects of overcoming difficulties caused by a disease. The implementation of the humanistic image in diabetes management is only possible within the interdisciplinary environment.
Conclusion
Diabetes is now a big healthcare problem all over the world. The complexity of managing the condition has led nurses and other healthcare professionals to turn to the holistic approach of managing the condition. The popularity of holistic medicine lies in its ability to have a positive effect on the spiritual and psychological attitude of the patients with diabetes. Furthermore, holistic medicine contributes to the humanistic image since it does not reduce the patients with diabetes to purely biological aspects, but it employs the advances of other branches of science that are associated with humanistic-studies.
References
Castillo, A, Giachello & Arrom, J 2010, “Community-based diabetes education for Latinos Diabetes Empowerment Education Program”, The Diabetes Educator, vol. 36, no. 4, pp. 586-594.
Crenshaw, K 2010, “Is physician engagement with Web-based CME associated with patients’ baseline hemoglobin A1c levels?”, Journal of the Association of American Medical Colleges, vol. 85, no. 9, pp. 1511-1512.
Kutty, B & Raju, R 2009, “New vistas in treating diabetes-insight into a holistic approach”, Indian Journal of Medical Research, vol. 131, no. 5, pp. 606-608.
Rydén, L, Grant, P & Anker, D 2013, “ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD”, European Heart Journal, vol. 34, no. 39, pp. 3035-3087.
Satterfield, D & Volansky, M 2012, “Community-based lifestyle interventions to prevent type 2 diabetes” Diabetes Care, vol. 26, no. 9, pp. 2643-2652.
Shrivastava, R & Ramasamy, J 2013, “Role of self-care in management of diabetes mellitus”, Journal of Diabetes and Metabolic Disorders, vol. 12, no. 1, pp. 1-2.
Teixeira, E 2010, “The effect of mindfulness meditation on painful diabetic peripheral neuropathy in adults older than 50 years”, Holistic Nursing Practice, vol. 24, no. 5, pp. 277-283.
Torraco, R 2005, “Writing integrative literature reviews: Guidelines and examples”, Human Resource Development Review, vol. 4, no. 4, pp. 356-367.
