Experience of Self-monitoring of Blood Glucose in Pregnancy

Experience of Self-monitoring of Blood Glucose in Pregnancy Lived Experience of Self-monitoring of Blood Glucose among Pregnant Women with Gestational Diabetes Mellitus Abstract Key words:Self-monitoring of blood glucose, gestational diabetes mellitus INTRODUCTION Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance first identified during pregnancy. It is diagnosed using a 75g or 100 g oral glucose tolerance test according to clinical practice guidelines. The prevalence of gestational diabetes mellitus among pregnant women is increasing worldwide because of unhealthy eating and lack of exercise. Prepregnancy overweight and gestational weight gain are the strongest predictors of GDM (Savona-Venturaet al.,2013). Previous studies showed that 5.0-12.9% of pregnant women have GDM (Cho, 2013). Pregnant women who have gestational diabetes mellitus are more likely to develop adverse pregnancy and child birth outcomes. Common maternalhealth complications are hypertensivedisorder (3.0-50.0%), preterm labour (2.0-14%), spontaneous abortion (3.5-25.3%), polyhydramnios (5.0-28.0%, and postpartum hemorrhage (6.0-10.5%). Neonatal complications include macrosomic infant (12.0-17.0%), congenital malformations (6.5-20.0%), shoulder dystocia (9.5-23.3%), birth injury (4.5-13.3%), respiratory distress syndrome (1.5-21.4%), hypoglycemia (20.0-68.5%), hyperbiliruninemia (5.3-48.3%), and admission in neonatal care unit (15.0-20.6%) (Wang, 2013).These maternal and neonatal sequalae develop due to prolonged hyperglycemia. High levels of blood glucose can damage endothelial cells causing hypertensive disorder and its complications. Infants of pregnant women with GDM are also exposed to high maternal blood glucose levels (Webb, 2013). It is suggested that controlling blood glucose within the recommended range (70-120 mg/dl) will decrease these complications. GDM in pregnant women can be treated by medical nutrition therapy, insulin injection, and self-monitoring of blood glucose (American Diabetes Association, 2013). Testing of capillary blood for glucose levels is recommended as a diabetes self-management strategy.Pregnant women with GDM need to be advised and taught to collect blood sample from their fingertip and use a glucometer to measure blood glucose levels. Little is known about their perception and lived experience of self-monitoring of blood glucose. Understanding their perception and meaning regarding diabetes management will be useful to promote self-care, improve glycaemic control, and decrease maternal and neonatal health complications. METHODS Objectives of the study The objectives of this study were to describe perceptions and meaning of lived experience in self-monitoring of blood glucose and utilization of blood glucose levels for glycaemic control among pregnant women who have gestational diabetes mellitus. Research design This descriptive phenomenological study was designed to gain more understanding about lived experienced of pregnant women with gestational diabetes mellitus in self-monitoring of blood glucose. Specific qualitative research methods used in this study included bracketing the researcher perspectives, analyzing, intuiting, and describing perception and meaning of participants’ lived experience (Creswell, 2013; Touhyet al., 2013). Study setting This study was conducted in the antenatal care units, diabetes clinics, and obstetric wards of two government hospitals in southern Thailand which are the referral centers providing advanced management of pregnancy complicated with GDM. Ethical consideration The research project and data collection procedures were approved by Institutional Review Boards and ethics committees of the Faculty of Nursing and Faculty of Medicine, Prince of Songkla University, and selected hospitals in southern Thailand. Participants Potential participants were approached and asked for participation by staff nurses. Informed consent was obtained by the researcher teams. Thirty pregnant women diagnosed with GDM during 24-30 week gestation were recruited for the study. Data collection Data were collected using in-depth interviews following semi-structured interview guides. Digital audio recording was used. The participants were asked to be interviewed at the antenatal clinic, diabetes clinic, or obstetric ward. Two interviews were conducted. Each interview took 30-45 minutes. Data were collected until saturation. Interview data were transcribed to prepare for coding and analyzing. Data analysis Qualitative data were analyzed followingColaizzi’s method and included seven steps: 1) Reading and re-reading descriptions, 2) extracting significant statements, 3) formulating the meaning of lived experiences in various contexts, 4) categorizing the meaning into clusters of themes, 5) describing the phenomenon being studied, 6) validating the finding with participants, and 7) incorporating informants’ view in the findings (Creswell, 2013). FINDINGS The mean age of participants was 32.5 (22-39 years). Seventeen women were Buddhists and thirteen women were Muslims. Their educational levels were high school (6/30), vocational level (14/30), and bachelor degree (10/30). Most of them were multiparous (22/30) and were employed (18/30). Eight women had previous GDM and experience of self-monitoring of blood glucose. The findings showed three emerged themes regarding perception and meaning of self-monitoring of blood glucose among pregnant women with GDM: being worried about diabetes, trying to control it, and having patience for their child. Being worried about diabetes comprised two dimensions: wondering about the impact of diabetes on the child, and concern about maternal health. After being informed that they had GDM, having high levels of blood glucose, they first thought abouthow diabetes would affect their pregnancy, particularly the effect on their child. They believed that their infant would be harmed or malformed, or have diabetes. The participants’ perceptions regarding GDM impact on child health were as follows. Another dimension of being afraid of diabetes was concern over maternal health. Pregnant women having GDM were also concerned about complications during pregnancy such as abortion, preterm labour, and having diabetes after childbirth. They shared their understanding as these words. The second theme was â€Å"trying to control it†. They gave two dimensions of trying to control diabetes that included: 1) learning to test blood glucose, and 2) being aware of what to eat. Learning to test blood glucose. After being diagnosed with GDM, diabetes nurse educators advised them about how to collect blood from the finger and use the glucometer to test blood glucose levels. Pregnant women needed to learn these new skills of self-monitoring of blood sugar. They shared their experiences as follows. Being aware of what to eat. Pregnant women with GDM paid more attention to take some healthy foods as recommended by doctors, nurses and dietitians. They learned to choose food type, portion size, and appropriate time to have breakfast, lunch, dinner, and snacks between meals. They provided additional data as follows. The third theme was â€Å"having patience for their child†. Pregnant women with GDM expressed the meaning of their experiences of self-monitoring of blood glucose in two dimensions: 1) overcoming food desires, and tolerating the fingerprick pain. The first meaning of having patience for the child was â€Å"overcoming food desires†. The women shared their experience of how they faced controlling their blood glucose. They had a struggle related to hunger due to cutting down on some favorite foods such as sweetened drinks, desserts and fruits. Sometimes they could not tolerate their food desire, they then decided to eat what they wanted. This response supports the idea. The second dimension of having patience for their child was â€Å"tolerating the fingerprick pain†. After being diagnosed with GDM, they were advised to test their blood glucose by pricking the fingertip to collect capillary blood to measure blood glucose levels with a glucometer for 8 to 12 weeks. They experienced mild intensity of pain that they had to cope with in order to achieve good glycaemic control. The women shared their tolerance with fingertip pain as follows. DISCUSSION After being diagnosed with GDM, pregnant Thai women were worried about the impact of diabetes on their child and their own health. They were afraid that their child might have diabetes or other health problems, or even die. A previous study also found that women with GDM experienced fear about the wellbeing of their babies and themselves (Stankiewiczet al., 2014). For maternal health, most of them were worried about becoming diabetic later in life. The research evidence revealed that women who had a history of GDM were at risk to develop prediabetes, diabetes, or metabolic syndrome. Among women with GDM, 5-14% were subsequently diagnosed with type 2 diabetes mellitus during the postpartum period and 7-29% had impaired glucose tolerance (Bihanet al., 2014). Pregnant women with GDM needed to learn to measure their blood glucose levels by self-monitoring technique. They expressed their experience as â€Å"learning to test blood glucose† because it was a new activity with which they had no skill and were not familiar. After being advised by diabetes nurse educators, they could collect a blood sample from the fingertip and test it with the glucometer. This result was supported the finding that women who have GDM can manage to control their blood glucose after they cope with emotional strain (Huiet al., 2014; Stankiewiczet al., 2014). In addition, the women had learned to control their blood glucose by â€Å"being aware of what to eat†. After receiving knowledge about diabetes medical nutrition therapy from a dietitian and nurse educator, they shared their understanding of prior dietary pattern that needed to be changed, such as reducing the consumption of sweetened drink and desserts, or fruit with high glycemic index. They had learned about the kind of foods for diabetes and portion sizes. They perceived that awareness of dietary behaviors was necessary to control their blood glucose levels. A previous study also reported that pregnant women with GDM changed their health behavior after being informed of their health problems andthe way to improve their health (Bandyopadhyayet al., 2011; Hjelmet al., 2012). Lastly, pregnant women with GDM shared their experiences that they were â€Å"patient for their child†. They had to overcome their food desires and cope with pain from fingertip pricking during blood testing. Normally, they had their favorite foods such as Thai fruits and desserts. After becoming pregnant with GDM, they had to adapt their food habits in order to achieve good glycemic control. Sometimes, they would like to eat something that they wanted but they were concerned about its impact on their child. Eventually, they decided not to eat that food or took only a small amount. However, some women could not resign their food desire and chose to take food to eat it for their satisfaction. After they fulfilled their need, they tried to practise as recommended. This was her voice â€Å"In the afternoon, I felt thirsty. I tried to drink some water but it did not satisfy me. I continued to seek some sweetened drink that I like. I could not stop my desire, then I decided to tak e it. After that my blood sugar was as high as 215 mg/dl. I have learned what food raises my blood sugar. So I tried to face my feeling and overcome it for my child wellbeing and my health too.† Another experience of having patience for the child was â€Å"tolerating fingerprick pain†. Pregnant women with GDM were advised to self-monitor their blood glucose 2 to 3 times a day, before or after meals, for 8 to 12 weeks until they gave birth. They had to cope with mild intensity of pain. They expressed their responses that they could do it in order to prevent health problems of their child and themselves. This supports the finding that perception that GDM affects behaviors related to maternal and child health and influences the adoption of a healthy lifestyle (Poth Carolan, 2013). Limitations of the study Lived experienced of self-monitoring of blood glucose in this study was obtained from the perspectives among pregnant women with gestational diabetes. It might not fit with the meaning and perception of individuals who have experience the management of type 1 or type 2 diabetes over a longer time. Conclusions Pregnant women being diagnosed with gestational diabetes mellitus had lived experienced characterized by two main themes: being afraid of the effect of high blood glucose on their own healthand the impacts on their child, and trying to control blood sugar by being aware of what to eat, overcoming the food desires, responding to satiety, and tolerating to skin pricking. Understanding of the women’s perception is useful to promote diabetes self-management.

My Papa S Waltz Final Draft

With his use Of pathos and ambiguity usually leaves the interpretation Of the poem up to the reader. Some people may consider this poem to describe an abusive relationship between a young boy and his father. On the contrary, some believe this poem reflects on fond memories between a father and son. In the first stanza, Reroute starts off by setting a sort of ominous tone. ‘ ‘The whiskey on your breath / Could make a small boy dizzy/' (1-2). Here he reveals to his readers that his father was drunk and the smell of his breath was unbearable.Subsequently, he goes on to describe the manner in which he was holding on to his father. â€Å"But hung on like death / Such waltzing was not easy† (3-4). The simile here shows the boy holding onto his father as tight as he possibly could. It was not an easy task for the child but he was determined not to let go. Now, if the reader portrays this in a negative fashion it can be interpreted as a drunken father coming home, reeking of whiskey, while the child tries as hard as he can to get through this current beating, or dance as he calls it.However, if the reader sees this in a more costive light, one can almost see the small boy standing on his feet, holding on so he won't fall, dancing around with his drunken father. Naturally, it would not be easy to maintain your balance while standing on the feet of another person. The second stanza sounds quite violent. â€Å"We romped until the pans / Slid from the kitchen shelf / My mothers countenance / Could not unfrozen itself' (5-8). Here, Reroute describes an almost chaotic scene, with pans falling to the floor caused by the movement of the two. The mother's look on her face clearly indicates that she is not happy with what is going on. Inning the word romp negatively, could imply the boy easily being tossed around the kitchen, pans crashing onto the floor as his father would chase him, and the clear displeasure on the mother's face. On the contrary, the use of romp can be used to describe an overly excited child and his father, carelessly dancing, running and jumping around the kitchen. Meanwhile, the mother could be annoyed at the mess the two are making. Reroute describes the roughness of his father's hands as well as his ear scratched ear in the third stanza. ‘The hand that held my wrist Was battered on one knuckle† (9-10).As his father held onto his wrist, the boy could see calloused and cuts prominent on one knuckle. From an optimistic standpoint we can see the boy notices his father's injured hand. The cut is assumed to come from the gardening work in the greenhouse in which the family owned. On the other hand the father's battered hands could be an indication of abuse. The cuts could have possibly occurred from previous altercations. Next, Reroute describes how the alcohol has made his father clumsy and every time his father stumbled the boys ear would scrape on the belt buckle. At every step you missed / My eight ear scraped a buckle† (1 1-12). The scraping of the boys ear could paint a picture of the drunken father stumbling around trying to hit the boy with the belt or it can be portrayed as a stumbling father dancing around with the boy on his feet. Because of the height difference, the boys ear is getting scraped. In the fourth and final stanza it becomes apparent it's the young boy's bed time. Once again Reroute describes his father's hands as rough and dirt stained, probably from the gardening work in the greenhouse. â€Å"You beat time on my head / With a palm caked hard by dirt† (13-14).Just like most children, he doesn't want to go and so he clings to his father; â€Å"Then waltzed me off to bed / Still clinging to your shirt† (15-16). In a negative aspect, one can assume that this stanza is used to describe more physical abuse from the father. For example, the boy gets sent off to bed still holding on to his father's shirt as if he is protecting himself from further blows. On the other hand one could imply his father's dirty hands are simply imitating music in the same way one would beat on the kitchen table singing along to a song, as he father dances the boy to his bed.Clearly the child is having a good time and does not want it to end, so he holds on tightly to his father. Reroute uses pathos throughout the entire poem. With every written line, the reader's emotions are pulled into different directions. Reroute causes his audience to not just respond emotionally but to identity#y' with his point of view. In essence to feel what he is feeling. The most remarkable thing about his use of pathos, is that it is undefined in a sense. The reader's interpretations from his choice f words creates the emotional rise.When I was first introduced to this poem was in my late teens. Maybe it was my inexperience with life or just an immature mindset, but just like most people, too thought this poem was about an abusive father. With the contradictory terms he uses in this piece it is easy to see the negative undertones. However, as time passed and I grew, my outlook on life changed. Perhaps it was becoming a mother that helped me see this piece in a new light; but when I read it now smile at the thought of a young boy. Dancing around with his father.

Personal Writing My Personal Narrative - 1036 Words

Do you remember those journal entries we all had to do at school as little kids? When your teacher would pass out everyone’s notebooks and write a short prompt on the whiteboard? Most kids dreaded that part of the day, but not me. I loved to write. Even at the age of eight, in Mrs. Greenfield s second grade class, I thought it was something special. I would take the prompt into careful consideration and write my thoughts in the neatest penmanship my little hands could muster. But my favorite part was the next day when we were able to see how our teacher liked our stories. Mine journal would always be filled with words of praise and tiny smiley faces she had drawn in the margins. This left me feeling unstoppable. I had finally found†¦show more content†¦This horrified me. I can’t speak in front of three people, let alone the entire school! But my teacher, Mrs. Huff, knew that I could write. She believed in me and basically had to force me to do the class present ation. I remember my face glowing red and my hands shaking while I griped my paper too tightly, almost ripping it. I don’t remember actually saying my speech, but I do know it was a narrative I titled â€Å"The Best Birthday Ever†. I don’t know how or why, but I won the classroom portion. Mrs. Huff stood in the front of the classroom and called at my name as the one who will be representing the fourth grade class at the school-wide Tropicana Speech Contest. About a week or so later, the day finally arrived. I presented my speech, and to my astonishment, I wasn’t as scared as I thought I would be. Don’t get me wrong, I was terrified, but once I actually walked to the microphone a sense of calm washed over me. I said my speech and walked back to my seat on the stage, just glad that whole thing was over with. I didn’t place, but I was honestly just proud that I faced one of my biggest fears. 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