A dissertation submitted in partial fulfillment of the requirements for the degree of Masters in Social Work (Family Therapy) by the University of Kwa-Zulu Natal, Durban. Appendix E: Letter of Approval from the Chairman of the KwaZulu Natal Department of Health Provincial Health Inquiry Committee.
ACRONYMS
CHALLENGES FACING PARENTS OF DIABETIC CHILDREN
ABSTRACT
CHAPTER ONE
INTRODUCTION
- BACKGROUND OF THE STUDY
- RESEARCH OBJECTIVES
- RESEACRH QUESTIONS
- SIGNIFICANCE OF THE STUDY
- THEORETICAL FRAMEWORKS GUIDING THE STUDY
- RESEARCH METHODOLOGY
- OPERATIONAL DEFINITIONS
- PRESENTATION OF CONTENTS
- CONCLUSION
According to Ragnar (2004:7) in extreme cases, this can lead to the possible death of the child. It is the parents' responsibility to understand the extent of the disease and the importance of adhering to the treatment regimen (Ragnar, 2004:7).
CHAPTER TWO
LITERATURE REVIEW – TYPE 1 / JUVENILE DIABETES MELLITUS
INTRODUCTION
WHAT IS DIABETES MELLITUS
Juvenile diabetes mellitus is known as type 1 diabetes or insulin-dependent diabetes and is a chronic condition that requires lifelong treatment and is characterized by an increase in blood glucose levels (Hillson, 1992:9). He believes that parents and their children should take responsibility for their treatment and take responsibility for their lives.
PREVALENCE OF THE DISEASE
TYPES OF DIABETES
The body doesn't make enough insulin, or it doesn't use the insulin your body makes properly. The individual with type 2 diabetes can go unnoticed for years because the symptoms are mild and the individual does not present with ketoacidosis.
THE DIFFERENT CAUSES OF JUVENILE DIABETES
The risk of developing type 1 diabetes is five times greater in people who have this type of human leukocyte (HLA). Choosing a sedentary lifestyle instead of walking, sports and no exercise significantly increases the risks of developing type 2 diabetes.
SYMPTOMS ASSOCIATED WITH JUVENILE DIABETES
- Extremely high blood sugar levels/ Hyperglycemia
It is recommended that when blood sugar levels are low, eat or drink a small amount of sweets and retest after 15 minutes. The best way to avoid HHNS is to monitor blood sugar levels closely and daily.
COMPLICATIONS OF DIABETES
Warning signs to look out for are thirst/very dry mouth, frequent urination, high blood glucose, high blood ketones, feeling tired all the time, dry/reddened skin, nausea, vomiting or abdominal pain, shortness of breath , fruity smell/breath, difficulty concentrating and confusion (Daneman et al. Severe nerve damage in people with diabetes is a leading cause of leg and foot amputations.
THE IMPACT OF UNCONTROLLABLE UNDIAGNOSED DIABETES
Furthermore, Davis (2001:40) states that people with diabetes have a higher risk of infections and death from these infections. High blood sugar levels make it harder for the body to fight infections and a greater risk of getting other diseases.
RESPONSES AND REACTION TO A DIABETIC DIAGNOSIS
Fear and anxiety are normal reactions because parents are overwhelmed with whether they will be able to cope with understanding and managing diabetes. The child will eventually pick up cues from the parents and if they see the parent distressed, they may think they are going to die. Sometimes, it is this anger that will help some parents to review their child's diagnosis and make the necessary changes.
Gard et al (1997:127) further point out that during these initial stages, it is vital that the multidisciplinary team supports the parents and the child to ensure a smoother transition into these new roles. The ultimate goal of the study was to gain a better understanding of the challenges parents and families face in managing the disease.
TREATMENT AND MANAGEMENT OF DIABETES
Different types of insulin such as ultra-rapid-acting, rapid-acting and intermediate-acting to long-acting, biphasic and ultra-long-acting insulins are available. It is the only device that can be used in the administration of insulin that is freely mixed. It delivers a constant rate of insulin (basal rate) to keep glucose at a desired level.
According to Guthrie & Guthrie, parental involvement in the treatment, management and administration of insulin is a vital and important function of parents of children with diabetes. It is essential that parents understand and become familiar with the procedures as this is essential before recommending insulin treatment.
EDUCATION AND SUPPORT
Blood glucose levels are controlled by sticking to sensible eating habits and choosing the best foods for our body's system, along with following a healthy lifestyle that involves exercise, not over eating and over indulging in chocolate, sweets and chips. This, along with the administration of insulin, will help protect against long-term complications of diabetes.
DISEASES RELATED TO DIABETES MELLITUS
Coronary artery disease leading to angina or myocardial infarction (heart attack), stroke, peripheral vascular disease (which is associated with pain in the legs and feet), and muscle wasting (diabetic myonecrosis) are common concerns faced by diabetics. This is why diabetics are prone to leg and foot infections and why leg and foot wounds take longer to heal. It is the most common cause of amputation in adults, usually toes and feet in developed countries.
DIABETES AT DIFFERENT DEVELOPMENTAL STAGES IN CHILDREN
The child may be difficult when it is time to inject or test the blood glucose levels. The child can then become disruptive and may constantly test the boundaries to provoke the parents to respond. Giving insulin and taking tests can be difficult when the child is uncooperative.
The start of school coincides with a child's need to move away from his family. Teachers should be informed of the child's diagnosis to assist with supervision at school (Davis.
DIABETES MANAGEMENT: THE CHILD AND FAMILY
This is because the diabetic child has so many existing rules relating to treatment that the parents do not want to frustrate or burden the child further and therefore tend to be very lenient with them. The child can take on diabetes care and responsibility because he/she believes they can do it. Parents may become overprotective and the child may react by wanting too much control or rebelling against the treatment.
The parent may be angry with the child for being diagnosed with the illness, although the parent may realize that this anger is illogical. Many siblings become jealous or feel left out because the child with diabetes suddenly begins to get more attention.
ADDITIONAL INFORMATION TO ASSIST PARENTS IN MANAGING THE DIABETIC CHILD
The diabetic child can receive extra insulin that day so that he/she can participate in the party. Siblings are a support network for the diabetic child, and the older siblings can take over the diabetes treatment from their parents. According to Ragnar, because type 2 is far more common than type 1 diabetes, you may find that adults have misconceptions about your child's condition based on their experiences with people with type 2 diabetes.
The adults in your child's life may be afraid of making mistakes in caring for a diabetic child and more information may be needed to allay the fears of many. Parents should point out that your child's diabetes is under control and that he/she is healthy and active.
THE IMPORTANCE OF THE MULTI DISCIPLINARY TEAM IN DELIVERING DIABETES CARE
This section focuses on the members of the therapeutic team with particular emphasis on the role of the social worker. The medical team consists of endocrine doctors, nurses, a psychologist, a dietitian, a physiotherapist and a social worker. The doctor will first treat the child and then refer the child to a social worker for home conditions.
The social worker will conduct psychosocial examinations to determine the families' level of understanding of the diagnosis and assess their family's coping skills. These efforts are ongoing and the social worker is an active member of the team.
CHAPTER THREE
RESEARCH METHODOLOGY
- INTRODUCTION
- THE SETTING OF THE STUDY
- THE APPROACH AND DESIGN USED
- THE RESEARCH PROCESS
- LIMITATIONS
- ETHICAL CONSIDERATION
- ENSURING RELIABILITY and VALIDITY
I also informed the participants that the data will be used for writing my dissertation and recommendations will be made to relevant stakeholders depending on the outcome of the research. She was also instructed to convey the message in the participants' words to avoid distortions and ensure reliability. As suggested by Kvale, I followed an interview guide and focused on topics related to the purpose of the study.
I described the purpose of the study, the interview process and the approximate length of the interview. The researcher is aware that the human rights of the participants must be protected at all times, therefore I assigned pseudonyms to the participants when reporting on the date to protect their identity.
CHAPTER FOUR
ANALYSIS AND DISCUSSION OF RESULTS
- INTRODUCTION
- The Table – Demographic Details
- DISCUSSIONS OF THE FINDINGS
- SUMMARY
Most of the participants have additional children in addition to the diabetic child to look after. Most of the children go to school and the mothers are the main caregivers for the diabetic child. Most of the participants indicated that the children had no other related diseases apart from diabetes.
What was interesting was that a number of participants shared this information with the child's school. Most participants indicated that it is difficult to deal with diabetic children and that they still experience problems.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
- INTRODUCTION
- CONCLUSIONS DRAWN FROM THE STUDY
- RECOMMENDATIONS
- LIMITATIONS
- CONCLUSION
Most participants did not have much knowledge about diabetes before the child's diagnosis. Finances were also seen as a challenge that most participants still struggle with as food for diabetes is expensive. The majority of participants strongly indicated a need for support groups for both diabetic children and their parents.
What was very clear from this study is that the majority of mothers are the main caregivers of the diabetic child. The results of the study revealed that the participants and the diabetic children receive adequate education, support and guidance from the hospital team.
The Complete Holistic Guide to Managing Type 1 and 2 Diabetes and Metabolic Syndrome. 1993).Research in social work practice. 1993). The practice of conducting, critiquing, and using nursing research. Self-care of adults with non-insulin-dependent diabetes mellitus: influence of family and friends. Diabetes mellitus- Experience a chronic disease. 1998) Qualitative Inquiry and Research Design: Choosing between Five Traditions. 1999) When a child has diabetes - An additional common guide for families, friends and other carers. Theory, practice, and trends in human services – An overview of an evolving profession: California: Cole Publishing Company.
LIST OF APPENDICES
APPENDIX A
RESEARCH TOPIC: Challenges facing parents of diabetic children
ISIGAXA A
INCWADI YESIVUMELWANO SOKUZIMBANDAKANYA OCHWANINGWENT
List the professions you have seen (doctor, social worker, diabetes nurse, other counselor, community. Did you feel you received the right support through this process. Impact of the illness on the child. How this diagnosis has affected the child. in terms of functioning - social, diet, activities, etc.). How has your child's diagnosis affected the family? in terms of functioning - social, diet, activities, etc.). How the diabetes care team can help you get better at managing the disease. The purpose of the study will be discussed with the participants before the start of the interview.
The researcher will use pseudonyms to protect the participants' true identity when analyzing and writing the report.
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HEALTH