Diabetes in Australia and how primary health care nurses can help

By Elaine Cornford, APNA Project Solutions Officer 

Source: APNA Primary Times Summer 2023-24 (Volume 23 Issue 2)

 

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Diabetes is impacting millions of lives across Australia. At some point in their careers, most primary health care (PHC) nurses will be required to provide diabetes care and manage the disease’s impact on patients and their families. APNA is working with the Australian Department of Health and Aged Care to help build workforce capacity in PHC through the Nursing in Primary Health Care (NiPHC) program to ensure PHC nurses have opportunities to broaden their skills to make an impact on population health outcomes. Find out how you can expand your scope of practice and help to reduce the impact of one of the 5 priority areas – diabetes. 

The number of people newly diagnosed with diabetes is growing rapidly – faster than any other chronic health condition – and the disease has been described as the epidemic of the 21st century.¹ 

According to the Australian Institute of Health and Welfare, 1.3 million people in Australia were living with diabetes in 2021 (i.e., one in 20 people) and 85–90% of those were diagnosed with type 2 diabetes.² The prevalence of diabetes in First Nations peoples is considerably higher than in non-Indigenous people with nearly a 3-fold incidence.³ These statistics are noted to be heavily underestimated due to varying factors, including under-reporting. 

Primary health care nurses of all levels of experience and in all roles can play a huge part in diabetes care. 

The burden of diabetes has a huge impact on sufferers and the impact is seen globally with one person dying from diabetes around the world every 5 seconds. This equates to 6.7 million deaths in 2021.⁴ The Australian health care system also feels the weight of the diabetes crisis financially with an estimated $3.1 billion being spent on diabetes-related health care in 2019–2020.⁵ Diabetes Australia predicts this number will rise to $45 billion per year by 2050 and the number of people living in Australia with diabetes in 2050 is predicted to rise to 3.1 million (i.e., one in 12 people).⁶ These are sobering statistics. 

How can PHC nurses help fight diabetes? 

The Australian National Diabetes Strategy 2021–2030 outlines 7 goals for the future: 

1. Prevent people developing type 2 diabetes 

2. Promote awareness and earlier detection of type 1 and type 2 diabetes 

3. Reduce the burden of diabetes and its complications, and improve quality of life 

4. Reduce the impact of pre-existing diabetes and gestational diabetes in pregnancy 

5. Reduce the impact of diabetes among Aboriginal and Torres Strait Islander peoples 

6. Reduce the impact of diabetes among other priority groups 

7. Strengthen prevention and care through research, evidence and data.⁷ 

PHC nurses can play a vital role in the implementation of these goals. Nurses working in primary health care settings, such as general practice, schools, correctional health, aged care and Aboriginal Community Controlled Health Organisations, are perfectly positioned to make a lasting difference in the fight against diabetes. Increasing knowledge, understanding and skills is essential for best-practice holistic, patient-centred diabetes care, and APNA has several initiatives to support this professional development for nurses.  

Expand your scope of practice 

There is a plethora of diabetes courses available to allow nurses to upskill and fill gaps in their knowledge to become more confident and competent in diabetes-related care (which could include prevention, screening and management). These courses also enable nurses to increase their scope of practice. One such example is APNA’s suite of Diabetes Online Learning modules, developed to help increase knowledge of diabetes care for PHC nurses.  

All nurses should work within their individual scope of practice when undertaking any tasks. ‘Scope of practice’ is defined by the Nursing and Midwifery Board of Australia as follows: ‘that in which nurses are educated, competent to perform and permitted by law. The actual scope of practice is influenced by the context in which the nurse practises, the health needs of people, the level of competence and confidence of the nurse and the policy requirements of the service provider.⁸ 

The National Diabetes Nursing Education Framework9 was created to increase workforce capacity and benchmark standards in diabetes care for all nurses in Australia. It is impossible for health care professionals to know everything, and we are continually learning. The framework therefore outlines the competencies required of nurses at differing levels (from students to experts) to meet and deliver high standards of diabetes care. Nurses and service providers should utilise the framework to acknowledge gaps in comprehension and skills. This will then help to guide professional development requirements, which, when fulfilled, could help nurses increase and work within their full potential scope of practice relating to diabetes care.  

The framework also provides guidance for people with diabetes and their families about the expected knowledge of nurses providing diabetes care and the level of support they might expect to receive from nurses. 

Start a nurse-led diabetes clinic 

The role of nurses working with people with diabetes or to prevent and screen for diabetes can be vast but is essential to improving health outcomes and lessening the burden of disease. Nurse-delivered, team-based models of care (nurse clinics) are an innovative example of how nurses in PHC can utilise their knowledge and skills in the diabetes space. Examples of roles nurses can play in diabetes care as part of a multidisciplinary team approach include health coaching and motivational interviewing, education on medication devices, digital health technologies, screening for complications and utilising referral pathways by the way of care coordination.

APNA’s Building Nurse Capacity Program, funded by the Department of Health and Aged Care, provides funding and support to nurses and organisations to implement nurse clinics. Diabetes is one of the 5 priority areas in which APNA is seeking expressions of interest from nurses and organisations to set up nurse clinics with project activities set to commence in April 2024.  

By taking action now to increase knowledge, understanding and skills in diabetes, PHC nurses and their workplaces will undoubtedly contribute to the long-term benefits for individual patients and their families. In addition to this, nurses working to their full scope of practice increase workforce capacity, which ultimately supports the wider community and improves population health outcomes nationally. It also increases job satisfaction and workforce retention. 

Further learning options 

PHC nurses of all levels of experience and in all roles can play a huge part in diabetes care. However, some nurses may wish to expand their scope of practice even further and achieve a specialist level. The Graduate Certificate in Diabetes Education and Management is part of the pathway to becoming a Credentialed Diabetes Educator (CDE). Susan Davidson, CEO of the Australian Diabetes Educators Association, notes that ‘Nurses are at the frontline of diabetes education, care and management; many nurses find working in diabetes education to be personally rewarding, as they help people living with diabetes lead healthier lives.’ For more information on the ADEA, please visit www.adea.com.au. 

Conclusion 

APNA is committed to improving health outcomes by increasing workforce capacity and championing the role of all PHC nurses, from students and those new to PHC through to experienced nurses and nurse practitioners. By developing your knowledge, skills and experience and working together, you can make a meaningful difference in the fight against diabetes and help to change the course of direction of a major public health crisis. 

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Elaine Cornford  

Originally from Scotland, Elaine Cornford completed her registered nurse (RN) training in 1999. She started her career in the acute sector but after moving to Australia she discovered the diversity of PHC. Elaine has a Graduate Certificate in Diabetes Education and Management, and is a Credentialled Diabetes Educator (CDE). She is a passionate advocate for PHC nurses, and her current role is a Project Officer with APNA. 

APNA’s Building Nurse Capacity team are seeking applications relating to five priority areas: diabetes, cardiovascular disease, cancer control, injury prevention and control, and mental health. For more information, scan the QR code, visit 

https://nurseclinics.apna.asn.au/ or contact buildingnursecapacity@apna.asn.au.