Many patients in the early stages

Many patients in the early stages, or development, of T2DM display no symptoms (Diabetes Australia, 2015). Several of the initial symptoms are subtle and are often dismissed with a false assumption that they are simply an indication of aging, as this type of diabetes is commonly diagnosed at a later age. Signs and symptoms of T2DM include polyuria, lethargy, blurred vision, polydipsia, gradual weight gain, leg cramps, polyphagia, slow healing cuts, skin infections, headaches, dizziness, and mood swings (Diabetes Australia, 2015). However, upon diagnosis of this chronic condition, a multitude of psychosocial factors along with the physical implications that entails a diagnosis of T2DM are affected (S. Kalra, Jena, & Yeravdekar, 2018). Several studies have emphasised that psychological support among T2DM patients is under-resourced and inadequate, resulting in reduced general well-being and poor quality of life (Holt & S. Kalra, 2013; B. Kalra, S. Kalra, & Balhara, 2013; Nicolucci et al., 2013). This indicates that there is a general widespread lack of understanding of the importance of psychosocial impacts that T2DM imposes on patients’ lives. It is often difficult for patients to accept a diagnosis of a chronic condition, and this resistance leads to poor treatment adherence and self-management (S. Kalra et al., 2013). The resulting distress and depression are commonly reported negative effects among people with T2DM, with ‘depression’ being considered through symptom severity or episodes of depressive disorder (Reddy, Wilhelm, ; Campbell, 2013). This further translates into physical issues through a worsening of complications and poorer blood glucose control, compared to those who are not distressed (Nicolucci et al., 2013). Although another study argues that depression in T2DM is difficult to define and measure consistently (Fisher, Gonzalez, ; Polonsky, 2014); the underlying need to address the psychosocial needs of these patients remains regardless. The role of the nurse is to continuously integrate psychosocial monitoring alongside the physical interventions. This can be guided by simple questions surrounding mood changes and exploration of any new or different barriers that arise throughout the progression of visits (Young-Hyman et al., 2016). For instance, making healthy food choices can initially be a challenging concept on its own for a patient with T2DM. However, further feeling of stress or helplessness can arise when they are not empowered or equipped with the skills needed to apply this to social situations. Confusion over meal choices and shame over their condition can lead to an avoidance of social outings and lead to isolation (Williams et al., 2013). A study on the personal accounts of people with T2DM, which explores the psychosocial experiences and adaptive coping strategies from their perspective, outlines realistic interventions for a nurse to implement into practise (Stuckey et al., 2014). The responsibility and role of the nurse in a primary care setting to keep their knowledge current on such issues in order to optimise patient outcomes. Two major negative psychosocial themes were identified as fear surrounding hypoglycaemia and discrimination at work. Adaptive coping behaviours to combat these highlighted


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