ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR.

INTRODUCTION

Nurses attitude is essential in influencing their patients through exerting an impact on the way of how they learn to manage their diseases. According to Azjen (1993) as cited in a study by Anderson, attitudes influence the behavior of health care professionals. Attitude is a specified target and way of saying and doing things; a learned tendency to evaluate things in a certain way. This evaluation includes people, issues, objects or events. Such evaluations are often positive or negative, but they can also be uncertain at times hence there are several different components that make up attitudes. It is also the predisposition or the tendency to respond positively or negatively towards a certain idea or situation. In addition, it influences an individuals choice of action, and responses to challenges, incentives, and rewards. Thus, attitudes are important factor in changing behavior as suggested by various health behavior models. The Health Belief Model (HBM) has been used primarily to increase compliance of clients to a certain intervention by increasing the perceived seriousness of a specific condition as one component of the model. A positive attitude of a nurse towards the management of Diabetes for instance, would gear towards improved patients outcome affecting patients quality of life in general. Because according to the National Diabetes Commission's Report (1975) health-care professionals inappropriate attitudes often lead to negative outcomes for diabetic patients. This is supported with a study by Odili and Oparah (2012), nurses who had the least favorable attitude towards diabetes particularly on the seriousness of Type 2 diabetes is least valued as well as on the glycemic control. According to Larme & Pugh (1998) their findings on provider s attitudes toward diabetes suggest a number of possible explanations for primary care providers' poor adherence to 1

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. current standards of care. Barriers include attitudes toward diabetes itself and the complexity of its management, and a perceived lack of support from society and the health care system for their efforts to control diabetes. Education is a central part of diabetes care. Without knowledge, individuals, for a variety of reasons, cannot make informed choices about their self-care. Empowerment of patients and allowing them to manage aspects of their diabetes in the hospital wards requires the collaboration of all healthcare professionals, and the involvement of general nurses needs to be encouraged (Davies & Davis, 1998). Diabetes education is an important clinical nursing specialty in which diabetes educators work at an advanced, autonomous level to provide education and clinical care for people with diabetes, their families and professional colleagues (Dunning & Manias, 2008). Likewise, Dunning; Weinberger, Cohen, & Mazzuca (1984) agreed that a more effective way of achieving behavioral change is through educational programs that foster critical beliefs rather than just transfer of new medical information. However, in a study by Odili et al (2012), nurses had the least favorable attitude towards diabetes particularly that the seriousness of Type 2 diabetes is least valued as well as on the glycemic control. Diabetes is a chronic disease which by its nature requires multidisciplinary effort to manage. Much knowledge about the pathophysiology and treatment of the disease has emerged over the years culminating in the development of standards of care and treatment guidelines that are meant to improve treatment outcomes and patients' quality of life. Generally, patient education and continuing medical education has been demonstrated as a means of changing attitudes of patients and health care providers respectively (Cited in Odili & Oparah, 2012). Diabetes is a rapidly changing field, with information available from many sources. Keeping up with information is difficult, and may be a key factor in the development of nursing specialties such as diabetes education, which in turn enable mentors and leaders to emerge.

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. However, if mentors knowledge is outdated they may not promote best practice, which is a key leadership attribute (Dunning & Manias, 2008). Developed and developing countries are currently encountering an upsurge in the prevalence of diabetes. The burden of this disorder seems to be disproportionately large in non-European populations, with Hispanic, Native American, Pacific and Indian Ocean island populations, and Indian and Australian Aboriginal communities heading the list (Buse, Polonsky, & Burant, 2003). Diabetic patients are more likely to be admitted to hospital, and diabetes is a frequent co-morbidity in hospitalised patients. Diabetes also contributes significantly to prolonged hospital stays and inpatient mortality. For this reason, health care providers, irrespective of the discipline in which they work, need to have knowledge of inpatient diabetes management. Moreover, hospitalisation of diabetic patients is costly, and this cost is usually related to complications of diabetes (Cited in van Zyl & Rheeder, 2008). It is important for nurses to identify and understand other cultures and how people individually relate to their own culture. This would enhance understanding and communication with people from different cultures. Culture is not necessarily a barrier to health education; it is dynamic and people are able to develop their own understanding (Osman & Curzio, 2012). It is important to consider how health information given has been understood and interpreted in a cultural context. Moreover, barriers to self-management should be identified; that is, nurses should identify each persons perception of their shared culture, their own individual beliefs and how that affects their behaviour. Individuals should not be seen as a uniform product of culture (Csordas, 2002). Diabetes is termed an epidemic due to the subsequent statistics data gathered by World Health Organization (WHO, 2012). It is also well-known as a chronic illness which entails the requirement of long-term multidisciplinary effort to meet appropriate and adequate management

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. as well. Over the years, development of standards of care and treatment guidelines is meant to improve treatment outcomes and patients' quality of life. Generally, patient education and continuing medical education has been demonstrated as a means of changing attitudes of patients and health care providers respectively (Odili & Oparah, 2012). Diabetes also contributes significantly to prolonged hospital stays and inpatient mortality. For this reason, health care providers, irrespective of the discipline in which they work, need to have knowledge of inpatient diabetes management. Moreover, hospitalization of diabetic patients is costly, and this cost is usually related to complications of diabetes (van Zyl & Rheeder, 2008), which is highly preventable if diabetic clients management has been delivered with the appropriate nurses attitude. Over 300 million people worldwide are suffering from diabetes according to the International Diabetes Foundations Diabetes Atlas (IDF, 2011). The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 while for the urban population in developing countries where Philippines belongs is projected to double between 2000 and 2030. Furthermore, according to South East Asia (SEA) IDF (2012) almost one-fifth of all adults with diabetes in the world live in the South-East Asia Region. Current estimates indicate that 71.4 million people from SEA have diabetes in 2011. The region apparently has the second highest number of deaths attributable to diabetes with 1.16 million deaths in 2011. Nationally, according to 2004 estimates by the American Diabetes Association, the Philippines is projected to have some 7.8 million diabetics by 2030. In congruent with the figures from the Department of Health show that diabetes is among the top 10 causes of mortality among Filipinos, with more than 20,000 deaths from the disease in 2006. Along with WHO

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. (2012) findings, around six million Filipinos are diabetic which will put the Philippines in the top ten countries with the highest prevalence of diabetes worldwide. For Baguio City alone there are various tertiary hospitals that can provide specialized multidisciplinary diabetic care. The Baguio General Hospital and Medical Center (BGHMC) Diabetes Clinic (2012) as cited by Dar, there is a noted increase in diabetic cases from the less than 50 new cases a year when they started screening in 1988, it increased to about 150 to 200 a year by 2000. The trend continued over the years and present data indicates about 250 to 300 new cases a year. In addition to this, according to Baguio Health Center, Diabetes is the top five cause of mortality in Baguio as of 2006 to 2007. With the current continuously rising trend, number of people affected with diabetes, demand for apt diabetes care should be delivered effectively and efficiently for a definite health status improvement of these patients. In line with this, Rorden (1987) has indicated that if nurses have positive attitudes toward patient education then effective teaching is more likely to be provided. Research shows that if nurses perceive themselves as educators in patient teaching they are more likely to be committed to teach patients and family members (Barrett, Doyle, Driscoll, Flaherty & Dombrowski, 1990). It is therefore justifiable to know the attitudes of nurses, nevertheless, little is known about the attitudes of nurses currently enrolled at Saint Louis University School of Nursing Graduate Program (SLU-SONGP) towards the involved disease. It is with this reason that exploring nurses attitude towards diabetes is worth-looking at.

Conceptual Framework The Nursing Role Effectiveness Model developed by Irvine, Sidani, & Hall (1992) served as the framework of the study.

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. The model proposes that there are specific relationships among the structure, process, and outcome components and among specific elements within the components in a nursing care situation. Briefly stated, structure components included the nurse and those elements that characterize him and may influence ones processes. The process component consists of nursing functions and nursing care while for the outcome component it is the health outcomes of the patients.

Nursing Role Effectiveness Model (Irvine, Sidani & Hall, 1992) Structure > Gender > Experience > Cultural Background

Process >Nurses role performance

Outcome >Patient health outcome

In this study, it focused on the nurse structural variables which consisted of the gender, with or without work experience as a registered nurse and their cultural background. These elements (structure) could affect nurses' role performance (process) which in turn would directly relate to the patient health outcomes (outcome). These may affect the attitude of the nurses regarding diabetes which may consequently contribute to patient outcomes. Objectives The study was done with the objective of determining the Saint Louis University Graduate School Nurses attitude towards diabetes, determining the factors that affect nurses attitude towards diabetes such as gender, hospital experience and culture, and to determine if attitude is dependent with the variables.

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. Significance of the Study This study is significant to the nurse, the diabetic patient, and his family. Provision of information regarding the attitude of nurses on diabetes mellitus and its treatment, as well as in identifying their views on the disease and its treatment can be a means to make nurses at SLUSONGP more aware of their attitudes towards diabetes. Thus, this gives a glimpse if there is still necessary further professional improvement on the way to achieving better health care delivery in pursuit of a more efficient patients management of diabetes. Identifying the nurses attitude about diabetes mellitus and its treatment will have a greater impact on what type of information to be given to diabetic patients and their family members. This may assist them to cultivate a positive outlook of the disease and its treatment, particularly those nurses, patients, and family members with a negative view. Furthermore, the nurses further understand the importance of uniqueness of individuals and accept their patients as they are. Patients and their family members may also realize the importance of adhering to the prescribed treatment regimen, and start being more compliant to it. As a result, complications may then be prevented. Patients and their family members are kept informed concerning the disease by the health personnel. Thus, patients will benefit and nursing care can be improved. Lastly, to simultaneously fulfill the purpose of Department of Health and World Health Organizations programs against diabetes in which one of the aims is to minimize diabetes complications and maximize quality of life; and strengthening the control is one of the core functions accordingly. This also happens to be an innate function of a nurse. It is alarming though, since in the same study by Odili and Oparah (2012) nurses had the lowest score among other health care professionals when addressing the psychosocial impact of diabetes, one of the most important diabetes aspects of care.

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. METHODS AND PROCEDURES Locale and Population SLU is one of the best schools when it comes to quality produced graduates both from undergraduate and graduate curricula in the North. At present there are 145 registered nurses who are enrolled at Saint Louis University School of Nursing Graduate Program (SLU-SONGP). The total number of those enrolled in the Masters of Science in Nursing and Masters of Nursing is 86 and 59 respectively. As noticed, younger and younger nurses are working through their way for a postgraduate degree and this may have a bearing on their attitude towards diabetes as they are into continuing education. Research Design This study made use of the quantitative descriptive design. It was used to observe, describe, and document aspects of a situation as it naturally occurs (Polit, 2008). This was conducted to the nurses currently enrolled at SLU-SONGP in Baguio City because of the immediacy and accessibility of subjects for the study. The purpose of the study was to explore the attitude of nurses enrolled in SLU-SONGP towards diabetes care and be able to describe and examine the relationship among these variables. An anonymous survey method was applied using a questionnaire checklist in gathering the necessary information relating to nurses attitude towards diabetes. Inclusion Criteria Inclusion criteria included nurses currently enrolled at SLU-SONGP, with or without work experience as a registered nurse and also taken into consideration were their cultural background of origin. A sample of 107 nurses with the use of the Slovins formula using 5% margin of error was completed. The total enrollees for this semester were obtained through the graduate program coordinators database. Convenience sampling was used by the researchers

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. to gather respondents. This method of sampling is a form of non-probability sampling in which decisions concerning the individuals to be included in the sample are taken by the researchers, based upon a variety of criteria that targets a particular group of people and the researchers convenient time (Polit, 2008). Data Gathering Procedure Data gathering procedure was done from January 14 to January 28, 2013. Prior to the floating of questionnaires, a duly accomplished letter of permission to conduct the study was thru and signed by the graduate program coordinator and was then submitted and approved by the SON dean. This was shown to the respondents as evidence that the study has been allowed to be pursued during the said period. The researchers also asked verbal permission from the professors to distribute questionnaires to their class. Unfortunately, the data gathering had been extended for almost a week because of the scheduled midterm examinations. One professor actually declined to float on the class from which the examination was due for that day. Included in the questionnaire was a demographic section that inquires about gender, work experience as a registered nurse, and cultural background, to assess for possible association of these variables to attitude towards diabetes. Together with this was an attached letter stating the title, purpose of the study and clause of confidentiality that was placed on the top of the questionnaire form as a part of asking for informed consent. An adopted questionnaire tool, Diabetes Attitude Scale version 3 (DAS-3) was answered completely by the respondents. The DAS-3 was developed by Anderson et al. (1998) from Michigan Diabetes Research and Training Center. The DAS-3 had been considered valid and reliable to measure general diabetes related attitudes for both people with diabetes and health care professionals and has been already used in a number of published studies. The DAS-3 is considered the most psychometrically reliable instrument for measuring either positive or 9

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. negative attitudes towards diabetes and could be used for both health care professionals as well as diabetic patients. It was composed of 5 subscales summing up to 33 items in the form of statements. The questionnaire was accomplished in 10-15 minutes. Each item was either positively or negatively stated and measured originally on a 5 point Likert scale with the following possible scores: strongly agree=5, agree=4, neutral=3, disagree=2, and strongly disagree=1. The subscales were: (1) the need for special training to provide diabetes (2) seriousness of type 2 diabetes (3) value of tight control (4) the psychosocial impact of diabetes mellitus (5) and the need for patient autonomy. Nevertheless, before the study was fully approved, the tool had been subjected to a research and topic experts for its content validity index for its complacency in the Filipino context use. Some English jargon words were advised to be reworded such as for it to be more academic-looking questionnaire. Only one question was paraphrased and the rest were left as it was. Modified scaling for the facilitation of the study was done in collaboration with a consulted statistician. Instead, only 4-point Likert scale was used so that the data collected would not tend to be neutralized. The downloaded DAS-3 formula scoring was the basis of giving corresponding points to the respondents answers, however, in this study, four points was the highest score for each item instead of five points and did not demand for any further necessary statistical measures to validate the results. Any deviations made from the original tool and so as with the scaling were made sure that these changes were known and permitted by the author of DAS-3 tool which was facilitated via exchanges of electronic mails. Upon the distribution of questionnaires, respondents autonomy were taken into consideration and assured them of confidentiality and privacy by safekeeping of answers provided along with maintaining their anonymity. While the respondents were answering, a distance was maintained from them. Collection of accomplished questionnaires after the estimated time allotted followed immediately. The researchers made themselves available to

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. the nurses for any queries they may have about the study or/and the questionnaire. The questionnaires collected were counterchecked immediately to ensure that all items were answered completely. The researchers expressed gratitude to the nurses who participated in the study. These self-administered reports provided the needed data for the study and were organized, encoded, tallied, summarized, analyzed and interpreted. Treatment of Data The analysis and treatment of data was facilitated through the use of T-test and analysis of variance after the completion of the figures needed. Computer aided statistics software like Microsoft excel 2007 was used specifically in tallying, T-test and F-test computations. Interpretation of results were consulted to some statisticians especially with the values obtained from the excel computations.

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. RESULTS AND DISCUSSIONS

Data were collected from 107 respondents, they are all currently enrolled at SLUSONGP, 71 were females and 36 were males. 70 of them have work experience as a registered nurse and 37 dont have work experience as a registered nurse. As to the cultural background, 36 are Cordilleran, 37 are Ilocano, and 34 were categorized to Others which are classified into 12 Pangasinense, 13 Tagalog, 1 Zambalenio, 1 Ghanaian, 1 Bicolano, 2 Visayan, and 4 falls into ethnic mixes of Ilocano-Cordilleran, Pangasinense-Ilocano, Tagalog-Ilocano, and

Pangasinense-Cordilleran respectively. Table 1. Demographics of the Study Sample (N = 107) Female Male With work experience as RN WORK EXPERIENCE Without work experience as RN Cordilleran Ilocano Others *Pangasinense (12) *Tagalog (13) *Zambalenio (1) *Ghanaian (1) CULTURAL BACKGROUND *Bicolano (1) *Visayan (2) *Mix Ethnicity (4) 1 Ilocano-Cordilleran 1 Pangasinense-Ilocano 1 Tagalog-Ilocano 1 Pangasinense-Cordilleran GENDER 71 36 70 37 36 37 34

Currently, there were more females than males enrolled in the total population of SLUSONGP and so our sample size was composed of more females than males. This may be due to nursing deemed as a caring profession where caring part is more of a female role. Gender-

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. role attitudes are social constructions of complex patterns of attitudes and even expectations (King & King, 1997). However, this assumption has started to veer away as time approaches. As for the work experience, the sample size had a higher number of nurses with work experience as compared to those with no work experience as a registered nurse. There are more nurses whom are already working but opted to study a masters degree for their own professional advancement and career path development aspiring for a position as compared to that number of nurses who were just graduated and passed the board examinations recently and immediately enrolled in the graduate program which was accounted for those who had no experience working as a registered nurse. Majority of the cultural background which emerged from the study were Cordilleran and Ilocano because basically we are in the Cordillera Administrative Region as well as the proximity of Region 1 to Baguio City had been accounted for that. Still, the SLU- SONGP populace was a diverse mixture of with different cultural background because the university is known as the light of the north which has an honorable reputation of being excellent when it comes to teaching and enhancing students making it one of the top performing schools in the country (Commission on Higher Education, 2012). Generally, our study revealed that nurses enrolled at SLU-SONGP have positive attitude towards diabetes care in all the 5 subscales.

Table 2. General Mean Scores

3.6 3.4 3.2 3 2.8 2.6

Need for Special Training 3.39545607

Seriousness of Value of Tight Psychosocial NIDDM Control Impact of DM 3.100687458 2.876620836 3.161156755

Patient Autonomy 3.226672535

General Mean Scores

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. Nurses enrolled in SLU-SONGP have a positive attitude because their mean scores were between 2.6 4. On the other hand, mean scores classification for 1- 2.5 would be considered as having a negative attitude. When grouped according to gender, females have a more positive attitude than males [p= 1.77 E-14; where p<.05 is significant]. Because nurses may work with diverse clients from their own gender-role framework, gender-role attitudes could be a crucial factor in research and practice (Berkel, 2004; King & King, 1997).

Table 3. Gender Mean Differences

4 3.5 Weighted Mean Scores 3 2.5 2 1.5 1 0.5 0 Need for Special Training 2.988095238 3.802816901 Seriousness of NIDDM 2.988095238 3.213279678 Value of Tight Control 2.805555556 2.947686117 Psychocosial Impact of DM 3.115740741 3.20657277 Patient Autonomy 3.1875 3.26584507

Male Female

There is a very significant difference in the need for special training and a significant difference in seriousness of NIDDM subscales (p=0.015). These mean that female nurses consider that they would actually benefit more from special trainings than the males do; furthermore, female nurses also have higher regards in taking up the seriousness of NIDDM as compared to the male nurses. For the work experience, both groups showed a positive attitude towards diabetes care when they were analyzed according to their absence or presence of work experience as a 14

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. registered nurse. Those with work experience had higher scores on each of the subscales when compared to the group who had not a work experience. However, regardless of the variation in weighted mean scores, there is no significant difference (p>.05) with their positivity of attitudes.

Table 3. Work Experience Mean Differences

4 3.5 Weighted Mean Scores 3 2.5 2 1.5 1 0.5 0 Need for Special Training 3.682857143 3.664864865 Seriousness of NIDDM 3.185714286 3.046332046 Value of Tight Control 2.932653061 2.837837838 Psychosocial Impact of DM 3.197619048 3.135135135 Patient Automy 3.255357143 3.209459459

With Without

According to Benners theory of clinical competence, the model posits that in the acquisition and development of a skill, a student passes through five levels of proficiency until the nurses performance become fluid and flexible and highly proficient. This was used as the basis for the comparison of those who have or have not a work experience as a registered nurse. However our findings were that they have actually no significant difference in overall scores. This was may be due back to the undergraduate curriculum in which patient-care simulation such as various return demonstrations, re-enactment activities or even those different areas of exposures during related learning experience hours may have contributed to the positive attitudes even to those who have not yet any work experience in the nursing profession. In a study by Larew C, Lessans S, Spunt D, Foster D, Covington BG. (2006) said that the innovations in clinical simulation: application of Benner's theory in an interactive patient care 15

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. simulation, where an interactive patient care simulation were done like the things mentioned earlier, provided a positive learning experience in which students refine their patient management skills and collaborate with multidisciplinary team members to resolve common problems. Moreover, it could also be a factor that as community services workers or had tried being into community duties, nurses or aspiring nurses for that matter already learned to provide service that meets the needs of the target groups, and so the need to be aware of own personal attitudes and be prepared to adopt the professional values of nursingand not impose own ideas on clients. When nurses were further grouped according to their cultural background, Cordilleran, Ilocano, and others; yield a positive attitude towards diabetes care. The Ilocanos however scored highest in all the subscales among groups however; there is no significant difference on which cultural group may have been a more positive attitude towards diabetes care.

Table 4. Cultural Background Mean Differences

4 Weighted Mean Scores 3.5 3 2.5 2 1.5 1 0.5 0 Need for Special Training 3.61111111 3.72432432 3.69411765 Seriousness of NIDDM 3.07936508 3.19305019 3.13865546 Value of Tight Control 2.83333333 3.00772201 2.85294118 Psychosocial Impact of DM 3.12037037 3.2972973 3.10294118 Patient Autonomy 3.24652778 3.25675676 3.21323529

Cordilleran Ilocano Others

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. In a culture, socialization or how one relates to other people is vital. This definitely affects the attitude in return. Social roles can have a strong influence on attitudes because social roles relate to how people are expected to behave in a particular role or context. (Hockenbury, D & Hockenbury, S, 2007; Myers, 1999; Smith, Mackie, 2007). Accordingly, Gabbay et al (2003) argued that cultural and racial factors can affect relationships between health professionals and affect treatment outcomes. In our study however, there is no significant difference on their positive attitudes. While it is true that culture may have a bearing on the attitude and the way we deal with people, but the way one should render care to the patients are learned through exposure in almost the same nursing discipline simulation as discussed earlier. This is because there is no such double standard in the primary goal of nursing: nurses share one common objective among them which in turn provided unitary actions geared towards achieving and maintaining standards of nursing practice. Elaborating the subscales of DAS-3, nurses enrolled at SLU-SONGP have a positive attitude towards the need for special training. This issue becomes more important as the treatment of diabetes becomes more complex, through the increasing use of sophisticated insulin delivery systems and blood glucose monitoring technologies. Though in the Philippines, we do not have certified diabetes educators whom possess a body of specialized knowledge, encompassing technical, psychological and educational facets; floor nurses should suffice to fit in the role. Patients become increasingly more reliant upon this knowledge and to the nurse (Anderson, Fitzgerald, Gorenflo, & Oh, 1993). Some authors (Torres, France, Stradioto, Hortale & Shall, 2009; Funnell & Anderson, 2004) have emphasized that any intervention to improve health services should train the health team in a constant effort to improve. With regards to the second subscale, nurses have a positive attitude towards the seriousness of NIDDM. This finding has important implications for patient education because NIDDM require difficult and long-lasting behavior changes on the part of patients and the family. 17

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. It is unlikely that such changes will be made and sustained unless patients and health care professionals alike understand and accept the serious nature of NIDDM. While on the third subscale, nurses have a positive attitude towards the value of tight control. They actually believe that tight control is one of the key factors for preventing diabetes complications. Until recently, initiatives for tightly controlling blood glucose levels focused on outpatient and community settings. Hyperglycemia in acute care was considered less important and an often inevitable consequence of hospitalization. Nurses are in the best position to coordinate possible necessary adjustments and patient education. And many of the interventions geared toward improving glycemic control, such as better timing of glucose monitoring, insulin administration, and meals, occur at the bedside (Peeples & Seley, 2007). On the fourth subscale, nurses had a positive attitude towards the psychosocial impact of DM. Nurses acknowledge the needs of the diabetic clients for psychosocial care due to the fact that they are aware that DM has actually causing these patients a sort of psychosocial struggles. Nurses may be cognizant of the problems in living with diabetes and the impact of these difficulties on patients however, they may not able to convey on how to address these probable problems associated with diabetes and so according to Peyrot, Rubin, & Siminerio (2006) all patients are entitled to be treated by a provider who is sensitive to their psychosocial needs, and all providers should receive the training necessary to attain the appropriate level of expertise. Finally, the nurses have a positive attitude towards the fifth subscale in which patient autonomy has to be taken into consideration for planning of care and should be respected especially in the management of their disease. Diabetes care, especially when it involves the administration of insulin, requires that the patient be able to make complex daily treatment decisions. Having the patient make treatment decisions may be counter-intuitive for physicians and nurses who have been trained to make such decisions themselves. Nurses may have an

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. important role to play in facilitating the delegation of responsibility for making treatment decisions from physicians to patients.

CONCLUSION Nurses currently enrolled in SLU-SONGP have a positive attitude towards diabetes care. When grouped according to gender, the Need for Special Training subscale has a very significant difference. Female nurses have a positive attitude that they would benefit from special trainings required in the diabetes care. Furthermore, in the Seriousness of NIDDM subscale there was also a significant difference between female and male nurses. Female have a more positive attitude towards seeing that NIDDM is as serious as it imposed to be. For the rest of the subscales, there is no significant difference but all have with positive attitude. When categorized according to their work experience and was further classified according to their cultural background, the nurses currently enrolled in the SLU-SONGP have a positive attitude towards diabetes care even in each of the 5 subscales. However, there is no significant difference as how their positivity in attitude varies.

RECOMMENDATION Nurses are in the best position to coordinate the necessary changes to patients practice and education and many of the interventions geared toward improving patients quality of life and diabetes management. Therefore, nurses should join if there are any trainings or seminars made available for the improvement of delivery of care towards diabetes for them to achieve or maintain a more positive attitude towards diabetes care. Moreover, having a continuing education could also be one of the attributes for having a positive attitude towards speciialized care. Nurses should take advantage of this effort and lead unit-based and hospital-wide efforts to measure, manage, and improve management of diabetic individuals and to the populations who may be directly or indirectly be affected when caring for these clients. Assuming a nurse19

ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. led diabetes management education for this may open new opportunities here in the Philippines as a counterpart of diabetes specialty nurses. More researches could be done similar to our study but to a wider locale of nurses that is ought to be more sensitive to measure the transferability and generalizability of the results so that further researches could be made especially studies on the feasibility of diabetes specialty nurses in the Philippines since nurses in our study have already a positive attitude and a more positive attitude towards diabetes care.

LIMITATIONS The study has a limited number of respondents because it had only been conducted in SLU- SONGP. There were also unequal sample variances for each variable for the reason that we used the convenience sampling method because of the limited time we had. limitation of our study was that it has yielded a more than expected non-significant data. Another

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. REFERENCES

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http://www.baguiocity.com/news_article/cases-diabetes-increasing-obesity-and-sedentarylifestyle-primary-risk-factors-experts www.idf.org/diabetesatlas/5e/the-global-burden - United States www.med.umich.edu/mdrtc www.who.int/mediacentre/events/annual/world_diabetes.../index.html

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ATTITUDES OF NURSES TOWARDS DIABETES CARE Baniqued C., Merdegia, C., Pacana, MR. APPENDICES

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