Diabetes and Cardiovascular Disease in New Zealand

Cardiovascular disease (CVD) and diabetes are major health issues for Maori, Pacific and south Asian people. The impacts of these diseases are increasing hospital admissions and readmissions hence increasing with an aging population. (Kaitiaki Nursing, New Zealand, 2013, pg. 20). Diabetes mellitus has been well pronounced as a cardiovascular risk factor in New Zealand and people with diabetes are 2-4 times more likely to suffer from CVD hence is a leading cause of death in diabetic patients (ministry of health, 2011, pg. 2).

Diabetes mellitus type 2 is a preventable and reversible condition giving rise to a range of serious complications associated with nerve and blood vessel damage that bring on blindness, limb amputations, kidney disease, and increased risk of infection (Powers, 2005). According to Diabetes New Zealand (2008), people with diabetes increases the risk of developing narrowed, thickened or completely occluded arteries (atherosclerosis) due to an elevated blood sugar level. Insulin resistant diabetes (type 2) or a complete absence of insulin (type 1) increases serum lipid levels as cells try to break down fats and protein to form energy.

Lipids are released as the bio-product which then travels in blood increasing the risk for occlusion in blood vessels. Hyperglycaemia, insulin resistance and altered serum lipid levels are responsible for formation of coronary plaque and blood clot in vessels. This leads to health issues such as ischaemic heart disease, stroke, hypertension myocardial infarction etc. (Lewis, 2012, 1388-1389). In New Zealand Maori, Pacific Islanders and South Asians are at a higher risk of developing diabetes, increasing chances of dying of cardiovascular diseases.

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Modifiable factors such as nutrition, physical inactivity, smoking, alcohol consumption and body size influence the risk of getting affected by diabetes and CVD. According to Ministry of Health (2008) diabetes occurs earlier in Pacific and Maori peoples, about 10 years before Europeans which contributes to an increased risk of chronic health conditions and mortality rate. It is appraised that due to demographic trends and projected growth in obesity, the number of diabetes cases will increase and the increase will be greater within the Maori, Pacific, and south Asian populations (Ministry of Health, 2008d). 5% of adults in New Zealand meet the criteria for obesity due to lifestyle, unhealthy nutrition and increased physical inactivity (eg. 42% of Maori and 63. 7% of Pacific peoples meet the criteria for obesity). The New Zealand Medical Journal, 2006 states that Asian new Zealanders especially Indians show a very high percentage of diabetes and CVD which is similar to Maori people (Ameratunga, Rasanathan, Tse, 2006). According to the Ministry of Health (2009), more Maori, South Asian and pacific people died from the year 1987- 2006 when compared to non-Maori.

Obesity is primarily caused by poor nutrition and sedentary lifestyles (Ministry of Health, 2008e). The New Zealand sport and physical activity surveys (conducted in 1997/98, 1998/99, and 2000/01) by Sport and Recreation New Zealand (SPARC) found that Pacific, Maori and south Asian children had higher levels of inactivity than other groups. Additionally, a healthy diet is a key determinant of health outcomes and is particularly important for the growth and development.

With regards to ministry of health (2003), Maori, south Asian and more of pacific people in new Zealand tend to eat more unhealthy food as it came cheaper and children skipped breakfast due to lack of parental supervision. Smoking is seen to be another lifestyle adaptation amongst the New Zealand community and the leading risk factor for many forms of cardiovascular disease and diabetes. More Maori and Pacific individuals’ smoke (45 percent and 31 percent, respectively) compared with the total New Zealand population (20. percent) (Ministry of Health, 2008k). The Youth 2007 Survey found that twice as many Pacific students are regular smokers when compared to European students. Furthermore, level of economic resources available to the pacific and south asian people is another important social determinants of health. Asians generally do not show increased health issues statistically but south Asian particularly Indians are at a very high risk. Despite high levels of disease, Indian New Zealanders are rarely presumed as a priority group in current diabetes strategies.

For example, “Let’s Beat Diabetes Strategy” by Counties Manukau District Health Board fails to mention Indian people specifically but considers the general Asian population. Another possibility for the disproportionate effect on south Asian and pacific people could be higher levels of unemployment and lower income as a group (ministry of health, 2006). This is partly due to a lack of effective settlement strategies for migrant Asians and pacific people to New Zealand.

Lack of employment and difficulties settling into the host community are associated with negative health effects and reduced accessibility to health care facility (Ameratunga, Rasanathan, Tse, 2006). The risk associated with diabetes and cardiovascular disease can be reduced and these conditions only respond well if managed with appropriate care. Evidence proposes that many Pacific individuals are often ignorant of the government services offered to them (Koloto & Associates Ltd, 2007; Paterson, 2004). This demonstrates ineffective communication by health information services and providers.

Primarily, nurses need to build a trusting therapeutic relationship via therapeutic communication techniques such as active listening, paraphrasing etc. It facilitates client autonomy, creates a non-judgmental environment and provides the professional with the holistic view of the client for better management. With reference to the case study by Counties Manukau DHB (Ministry of Health, 2011, pg. 6) the diabetic patient (Mr Cooper) found it difficult to follow instructions given by the doctor therefore his diabetes nurse helped him with all the information he needed.

He verbalised ‘I learned a lot from the nurse. I learned how serious diabetes is and how it is not going to go away, but also how it is possible to live a normal life if you manage what you eat, etc. ’ This specifies that nurses are the closest health professionals who spends the most time with patients and so can work with the patients in partnership. In order to manage diabetes and CVD effectively (Ministry of health, 2011, pg. 2), it is very important for nurses to educate their patients about the risk factors and what needs to be done to improve early detection and management of diabetes and CVD.

Adherence to therapies anticipated to control risk factors such as lipid levels or blood pressure for patients with type 2 diabetes is seen to reduce major cardiovascular complications and increase survival (Barrat, Butow, Caldwell, Davey & Travena, 2006,pg. 13-23) . One probable way to improve patients’ metabolic control is to help them understand the risks of the disease and the likely benefits of available therapy options. Research has shown that information on the potential benefits of improving modifiable risk factors may assist both health professionals and patients in making treatment decision.

This may increase patients’ willingness to accept management strategies recommended by their doctors and nurses. In fact, nurses as health educators can use diverse formats (e. g. decision aids, brochures, verbal advice) increasing patients’ knowledge and understanding (Barrat, Butow, Caldwell, Davey & Travena, 2006, 13-23). However, as suggested by the New Zealand Guidelines Group (2003) nurses and other health professionals need to make use of an evidence-based practice in the management of diabetes as well as assessing the risk of cardiovascular disease.

However, despite CVD and diabetes assessments being developed, uptake is often low. A possible reason for this is that many Pacific and Maori people do not prioritise health and generally would not seek any help unless they have physical symptoms such as pain or discomfort. With reference to nursing council of New Zealand competency 3. 2 forming partnership with the client and raising awareness for example informing and referring Maori patients about management programmes such as “Get Checked” which provides free annual check-up for people with diabetes.

This programme focuses on physical health, lifestyle and disease management. According to Robson and Harris (2007), Maori enrolment in get checked programme in 2006 was lower than non-Maori. This is a clear indicator of moari people’s lack of knowledge about services being provided. However, nurses as professionals should practice nursing in a very culturally safe manner by acknowledging patients values beliefs and attitude towards health care. For example Maori people believe in “kanohi te kanohi” meaning face to face communication therefore nurses need to have more in person communication (Reid & Robson, 2007).

Nurses should also inform clients about initiatives for example “one heart many lives” which allows Maori and pacific men to get their hearts checked, improve awareness of heart disease and lifestyle habits. Furthermore, CVD assessment allows an early detection of the number of people being at risk of cardiovascular disease. The sooner it is detected the earlier these issues can be controlled as stated in the document published by the ministry of health (2011). The practice nurse is the key person to co-ordinate care for instance after reviewing a diabetic patient he or she may decide to refer the patient to the dietician.

This way the patient is given an efficient holistic care with appropriate information (Kaitiaki Nursing, New Zealand, 2013, pg. 27) Nurses need to collaborate with the clients, agree on patient centered health goals such as promotion, prevention and early management of diabetes and cardiovascular disease by setting achievable and measurable goals. For example, ministry of health national health information Board launched a Shared Care Plan in 2011 which was in response to increasing number of deaths due to poor management of chronic illnesses.

This programme aims to improve care of patients by increasing patient involvement (Kaitiaki Nursing, New Zealand, march, 2013, pg. 26). The New Zealand Cardiovascular Risk Chart shows that diabetic people who smoke are at much higher risk of developing CVD when compared to a non-diabetic and non-smoker (New Zealand guidelines Group, 2009). According to Solberg (2006) there is evidence that professional advice given by the health care provider helps patients to quit smoking. Nurses can effectively use the ABC tool provided by the ministry of health (2007) to help patients to quit smoking.

Nurses need to inform clients about the advantages of being a non-smoker financially and health wise and provide alternative as to how nicotine replacement therapy helps minimise the urge to smoke. A practice nurse is responsible for most of patients’ assessments and health education, therefore nurses need to understand the standpoint of her patient and what does being healthy means to them. Establishing relationships and understanding their culture and customs. For example food plays a big role in pacific, Maori and south Asian culture.

Family involvement in care plan is very important in shaping attitudes and activities as family plays an important role in their lives also explaining the effects of unhealthy and sedentary lifestyle. Nurses should use plain language and ensure the patient and their family understands what changes they need to make and why they need to make them. They should also make sure that the patient and family are fully informed about the care plan and any procedures being done to maximise care (Blakely, 2007). In conclusion it can be said that patients are fully dependant on nurses with regards to any health issues they have.

Nurses are the first form of contact to patient in primary and secondary care setting who provides them with accurate information. It is very important for nurses to be aware of the fact that Maori, Pacific and South Asian New Zealander are more proned to diabetes and CVD therefore more emphasis should be given to them. During the assessment nurses should always consider patients socio-economic inequality, access to and quality of health care, and health risk factors such as tobacco, diet, and other lifestyle factors.

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