Advancing nursing jurisdiction in diabetes care
Nursing has its own unique contribution to make to diabetes care, but that impact is rarely quantified, measured or conceptualised. The thesis makes this contribution in the form of three published research projects and proposes an adaptation to Abbott’s conceptual framework on the division of expert labour. The first research project demonstrates the value of the hospital based diabetes specialist nurse using a randomised controlled trial; the second delineates the competences of different levels of nurses in diabetes care using a nominal group technique and the third project provides a baseline of the state of nursing in relation to the initiation of insulin therapy using a survey approach. Each project is followed by a personal reflection and discussion of the implications in the light of Abbott’s framework. Abbott’s thesis is that the development of professions is determined by a series of jurisdictional disputes rather than by a grand plan of the professions themselves. While this assertion does not always hold true in diabetes care the studies do concur with Abbott in other ways, particularly that the profession can be taken forward by taking responsibility for appropriate educational preparation, extending the boundaries of knowledge and the nursing role where appropriate. The discussion cautions against setting up professional edifices that become self-serving and stifle development, either by rigid enforcement of competences or by fossilising the nursing contribution to diabetes care. In terms of the care of the person with diabetes, nursing remains most effective within the umbrella of a multi-disciplinary team while demonstrating its own contribution. Nursing should show professionalism by continually striving for excellence, developing new knowledge and pushing role boundaries when it is in the best interests of the patient. The original contribution to knowledge is shown in the research projects’ contribution to the evolution of diabetes nursing in the United Kingdom and the proposal that Abbott’s framework be modified to put more emphasis on the task of work to achieve optimum patient outcomes than on the jostling of professions; acknowledging the growth in multi-disciplinary team-working and rise in the power of organisations at the expense of the power of individual professions since his work was first published.
Diabetes, Diabetes treatment, Diabetes nursing
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