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Keywords:

  • diabetes;
  • gerontology;
  • nursing;
  • older people;
  • phenomenology;
  • rural health;
  • self-management

george s.r. & Thomas s.p. (2010) Lived experience of diabetes among older, rural people. Journal of Advanced Nursing66(5), 1092–1100.

Abstract

Title. Lived experience of diabetes among older, rural people.

Aim.  This paper is a report of a study conducted to elucidate experiences and perceptions of self-management of diabetes as narrated by older people diagnosed with insulin-dependent diabetes living in a rural area.

Background.  Older people worldwide are disproportionately affected by diabetes and are more likely to have co-morbidities and disabilities. Guidelines for management, developed by the American Diabetes Association, are not targeted for this population. A plethora of quantitative research has investigated self-management issues, with little change to outcomes. This pleads for consideration of a new diabetes education model, which includes consideration of experiences within clients’ worldviews.

Method.  Unstructured interviews starting with an open question were conducted from a purposive sample in 2005. Interviews were transcribed and analysed according to the tenets of existential phenomenology, a process which began with bracketing the researcher’s biases.

Findings.  Living with poorly controlled diabetes led participants to introspection and existential questioning. Four connected themes were identified: ‘Your Body Will Let You Know’; ‘I Thought I Was Fine, But I Wasn’t’; ‘The Only Way Out is to Die’; and ‘You Just Go On’.

Conclusion.  Currently designed from a medical perspective, diabetes education should be based on a nursing model incorporating the client’s insights and experiences. When managing diabetes is viewed from a client’s perspective, the focus becomes solving problems that arise in self-regulation of one’s own regimen rather than in complying with doctor’s orders. Nurses need to reframe the problem by excluding the compliance/noncompliance model and developing a conceptual perspective on self-management that is grounded in world and body.