The Advocate

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The Advocate



     Winter, 2008 Central Ohio Chapter Volume 18, Issue 3 Association of

     Rehabilitation Nurses FROM THE PRESIDENT…

     By: Norma Clanin MS, RN, CRRN

    Rehabilitation nurses have always known the value of the therapeutic

    rehabilitation milieu - the environment in

    which we practice. All hospitals, skilled care COARN Upcoming Education Events facilities and clinics are usually pretty good at Chapter Meeting

    “Neglect in Acquired Brain Injury” creating a physically accessible environment.

    Speaker: Sharon McDowell, MD Wide doorways, roll-in showers, accessible

    April 15, 2008; 6pm sinks, automatic doors, etc…are all easily Rothermich Room, Dodd Hall seen, measured, adjusted and created. What 480 Medical Center Dr can make rehabilitation so unique is the Columbus, OH 43210

    attitude of the staff and the social environment

    in which we provide care. It is an COARN Board of Directors environment where we provide superb President

    physical care, while, at the same time, Norma Clanin MS, RN, CRRN conveying that life has value. The patient President-Elect

    who has a brain tumor, the one who has had a Maureen Musto MS, RN, CRRN stroke, the person who has a spinal cord injury Treasurer

    - they are here on our rehab unit with life. Deb Thomas RN, CRRN Sometimes we do not know how long that life Secretary

    may continue; but for the present time, they Toni Grice RN

    are with us. Sometimes we know that the Directors

    person will most likely have a long, Lynne Genter MS, RN productive life ahead. As professional Patty Organ RN, CRRN rehabilitation nurses we convey caring and Sharon Scott RN

    hope to all; that they will be more

    Co-Editors independent tomorrow; that they will be able

    Maureen Musto MS, RN, CRRN to cope with our guidance; that they hopefully

    Cindy Gatens MN, RN, CRRN-A will be able to go home; that they will be able

    Submit newsletter articles to Maureen Musto to resume many of their former activities; that

    at they may marry and raise a family. We will


    teach them how. The milieu is therapeutic when it is planned and deliberate. All of our interactions with patients and families make an impact - good or bad; encouraging or discouraging. With length of stay on our rehabilitation units remaining relatively short in comparison with our patients' long journey of progress toward healing, it has become even more important to make every one of our interactions with patients deliberate. Catheterizations are not done without teaching something; patient turns always include comments about the condition of their skin and why and where we are checking; getting ready for therapy means always having the patient do what they can and try something they could not do yesterday; conversations include less social chit-chat and more teaching and guidance. What's the difference between a med-surg unit and a rehab unit? It is not the nursing skills you see being done - IT IS THE NURSES! Rehabilitation nurses create the milieu where our patients and their families can heal physically, emotionally and socially. Take pride in being a rehabilitation nurse - not everyone can do it and do it well!

Diabetes Education

     By Maureen Musto RN, MS, CNS, AP-BC, CRRN

    Diabetes is a condition that causes problems with insulin production or utilization. According to the American Diabetes Association (ADA, 2005), 7% of the United States population, 20.8 million people, have diabetes. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. The total estimated cost of diabetes in the United States in 2002 was $132 billion. Diabetes alone represents 11% of US health care costs with $40.3 billion spent for inpatient hospital care. Diabetes related hospitalizations totaled 16.9 million days in 2002.


    There are two main types of diabetes: Type 1 and Type 2. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes (ADA, 2005). Although the cause of Type 1 diabetes is unknown, it is thought to be the result of a genetic-environmental reaction (McCance & Huether, 2002). Type 1 diabetes develops when the body’s immune cells destroy beta cells in the pancreas. Beta cells make insulin, which regulates glucose. Therefore, those who are diagnosed with Type 1 diabetes will need insulin injections to prevent hyperglycemia and associated complications.

    Type 2 diabetes is more common and accounts for about 90% to 95% of all diagnosed cases of diabetes (ADA, 2005). Cellular resistance to the effect of insulin is a major factor in Type 2 diabetes (McCance & Huether, 2002). As the disease progresses there is some type of B-cell dysfunction. Risk factors for Type 2 diabetes include aging, family history, race/ethnicity, obesity, and sedentary lifestyle. Abdominal adiposity (waist-to-hip ratio greater than 1) appears to be the greatest risk factor. Individuals with Type 2 diabetes are often overweight, hyperlipidemic, and hypertensive.

    Chronic complications of diabetes may be manifested as problems with neuropathy, vascular disease, and infection (McCance & Huether, 2002). Vascular changes include microvascular disease (retinopathy and diabetic nephropathy) and macrovascular disease (coronary artery disease, stroke, and peripheral vascular disease). It is extremely important for those diagnosed with diabetes to maintain glycemic control to prevent these complications.

    Diabetes is an ever-growing problem in our society. Obesity and sedentary living are powerful determinants of diabetes (Wylie-Rosett, 2006). With obesity becoming more prominent, diabetes will be even more prevalent. Diabetic patients in the hospital setting often have a co-morbidity that is perpetuated by their lack of diabetes management. Cardiovascular, renal, and peripheral vascular diseases as well as infection are often the admitting diagnoses of these patients.

     Controversy has existed as to whether the hospital setting is the best place to educate the person with diabetes (Nettles, 2005). It can be argued that patients are unable to retain information in an acute phase of illness or that hospital staff lack the knowledge to educate. However, in the outpatient setting patient reimbursement for education is limited and the amount of education a patient receives is variable. Therefore, education should be provided in both settings.

    Research suggests that diabetes self-management education is associated with improved glycemic control in both Type 1 and Type 2 diabetes (Strine, 2005). Diabetes can be a progressive disease, and new management skills may need to be learned over time. The ADA recommends that education be provided on an ongoing basis, and that diabetes self-management education be an integral component of medical care.


    It has been estimated that 50 80% of people with diabetes have significant deficits in

    knowledge pertaining to disease management (Strine,, 2005). A Healthy People 2010 objective is to increase the proportion of people with diabetes who receive formal diabetes self-management education from 40% in 1998 to 60% by 2010.

    A task force made up of multiple organizations, federal agencies, and federally funded programs has established national standards for diabetes self-management education (Mensing,, 2002). This task force consisted of the following: American Diabetes Association, American Association of Diabetes Educators, American Dietetic Association, Veteran’s Health Administration, Centers for Disease Control and Prevention, Indian Health Service, National Certification Board for Diabetes Educators, Juvenile Diabetes Foundation International, and Diabetes Research and Training Centers. These organizations have come together to formulate standards in regard to diabetes self-management education, because it is the cornerstone of care for all individuals who want to achieve successful health-related outcomes. These standards were to be implemented in diverse settings and facilitate improvement in health care outcomes.

    According to a study done by Persell, et al. (2004), knowledgeable patients were more likely to perform self-management activities. If patients would manage their diabetes and maintain good glycemic control, the rate of diabetic complications should decrease. Studies have shown that systematic control of glucose levels, blood pressure, and cholesterol in patients with diabetes can reduce the risk of them developing complications and result in considerable cost savings to the health care system (Greusinger, 2004).


    American Diabetes Association. (2005). National Diabetes Fact Sheet, 2005. Retrieved

    February 13, 2006 from

    American Diabetes Association. (2005). Direct and Indirect Costs of Diabetes in the United

    States. Retrieved February 13, 2006 from

    Greisinger, A., Balkrishnan, R., Shenolikar, R., Wehmanen, O., Muhammad, S., &

    Champion, P. (2004). Disease Management, 7(4), 325-332.

    Nettles, A.T. (2005). Patient Education in the Hospital. Diabetes Spectrum, 18(1), 44-48.

    Mensing, C., Boucher, J., Cypress, M., Weinger, K., Mulcahy, K., Barta, P., Hosey, G.,

     Kopher, W., Lasichak, A., Lamb, B., Mangan, M., Norman, J., Tanja, J., Yauk, L.,

    Wisdom, K., & Adams, C. (2002). National Standards for Diabetes Self-Management

    Education. Diabetes Care, 25 (suppl. 1), s140-s147.