Nursing consultation and diabetes: an educational and transformative process for primary health care

Silva, Silvana de Oliveira; Moreira, Andréa Carvalho Araújo; Centenaro, Alexa Pupiara Flores Coelho; Girardon-Perlini, Nara Marilene Oliveira; Weiller, Teresinha Heck; Schimith, Maria Denise

doi:10.1590/1518-8345.7546.4464

Objective: to analyze the constituent elements that support nursing consultations with people with diabetes mellitus, and to develop an educational process based on the assumptions of the Chronic Conditions Care Model and mediated by a reflective-dialogical process with nurses, aiming to improve the quality of the practice in the Family Health Strategy.

Method: convergent care research carried out with 12 nurses. Participant observation, semi-structured individual interviews and convergence groups were used to collect data, which were treated by participatory analysis, with an interpretative approach.

Results: the promotion of self-care, the bond between professionals and users, and the support for lifestyle changes for people with diabetes were aligned with the proposed Care Model. On the other hand, attitudes, values and knowledge that weaken care were identified as divergent. The theoretical and practical deepening of the care model, diabetes, dealing with work overload, and the implementation of a guide and a protocol for the development of the nursing consultation were points of convergence for improving the quality of the consultation. It was also observed that nurses’ autonomy was strengthened, critical thinking was awakened, and the search for improvement and redefinition of the relationship with the user was sought.

Conclusion: the nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

Descriptors:
Nursing Process; Diabetes Mellitus; Primary Health Care; Healthcare Models; Chronic Diseases; Problem-Based Learning.

Highlights:

(1) The Nursing Consultation for people with DM by nurses consisted of elements that are similar to and different from the MACC. (2) Elements that align with the MACC: as establishing a bond with users, accountability, longitudinal care, and the social and family approach. (3) Elements diverged from the assumptions of MACC: a limited understanding of the care model, the professional attitude of blaming the user and the weaknesses in the application of the nursing process. (4) The nursing consultation was enhanced through the active participation of nurses in an educational, reflective and dialogical process.

[TFN1] *NC = Nursing consultation; ^†DM = Diabetes mellitus; ^‡NGC = Convergence group narrative; ^§MACC = Chronic Conditions Care Model; ^||ICNP = International classification for nursing practice

Perception of the need for theoretical and practical deepening of NC*	[...] We need to deepen our knowledge about DM^† and user care. Establish a nursing protocol and a NC* guide to help us in our daily work and better structure the NC, the entire process, data collection and interventions in theoretical frameworks (NGC^‡7). [...] In the planning workshops, the way in which the MACC*^§ was presented was denser, with the focus on organizing the service demand and not on the care itself. Now it makes sense to us, we can, with certainty, say in which health model we operate, or are seeking to operate. Now it is clear what is the direction (NGC^‡4).
Strengthened constituent elements of NC*	All the tools we saw, the Systematization of Nursing Care, nursing diagnoses, the use of technologies, the tools that the information system offers that we did not use, we did not know the importance and how much it qualifies the NC*[...]scientific knowledge regarding the definitions of nursing, person, environment, care, health; about the ICNP^\|\| , which we did not know how to use, to prepare a diagnosis. Knowing and discussing all of this and the healthcare models was essential at this time of change (NGC^‡9).
Concerns and desires for change in practice	We saw ourselves in many examples cited and realized that we need to change! Deconstruct our own preconceptions to transform our practice. We do not feel ready yet, but we realize the need to consider what the person brings to set goals with them (NGC ^‡ 6).
Resignified constituent elements of NC*	Now everything makes sense! The consultation is with people who live with diabetes. We had to rethink this, about the context in which it is inserted and our professional role. We did not really consider the relationship with the user! But considering them as part of the diabetes care process is very important. This has been resignified. Because we thought we considered it, but in practice, our actions were prescriptive. We did not consider the user as an actor in the process, their real needs, their perspective as the agent of change. Our practice was like this and it was resignified. Teamwork. We talked a lot about this, “It is not healthy to centralize everything on ourselves, that is what causes overload”, and it was possible to resignify the importance of working as a team [...] (NGC ^‡ 9).
Possibilities to minimize challenges	Doing things without planning has been our practice, and we have realized that it is necessary to establish the division of tasks, plan in a short space of time, analyze the situation. And dividing and delegating tasks will make all the difference in achieving a very good result and not causing the work overload that we feel so much. Regarding communication, we concluded that what we want may be clear to us, but it may not be clear to the team and the user, and paying attention to this is essential (NGC ^‡ 5).
Transformations in the practice of NC* with people with DM^†	Our meetings have helped a lot! We have tried to put this into practice, and the consultation has improved a lot! Users feel valued by the changes we have introduced. The NC* has a different tone, it seems to have become more significant for them[...].Revisiting our knowledge about nutrition was essential. This is something that we often do not even take into account, and here, another challenge, not only the nutrition of the person with DM^† , but healthy nutrition for the whole family! (NGC^‡7).After we started delegating some tasks to the team, we realized that we were able to dedicate more time to the NC. I feel that it has improved*(NGC^‡9).

Nursing consultation and diabetes: an educational and transformative process for primary health care*

Highlights:

Nursing consultation and diabetes: an educational and transformative process for primary health care^*