Table of Contents
The issues related to the adequate management of diabetes in the fasting month of Ramadan are among the most important and complicated problems in the modern medicine. Diabetes incorporates a large number of health, social, and cultural aspects. In fact, fasting during Ramadan is compulsory for all adult Muslims (with the only exception of people with serious health problems). There are different opinions regarding considering diabetes as one of the reasons that justify abstaining from fasting. However, the vast majority of Muslims still prefer following their traditional lifestyle regardless of diabetes. Therefore, it is important to examine this issue in more detail by outlining the major risks of fasting during Ramadan and formulating the relevant recommendations for Muslims. The present paper identifies the target population, specifies the five sub-roles of advanced public health nurses (APHN), and designs appropriate intervention strategies.
The current study focuses on the additional health risks faced by people during Ramadan. Thus, it examines only the Muslim population because the representatives of this religion assign the highest spiritual significance to Ramadan and its traditional practices. Within the Muslim population, the major focus is on people with diabetes as changing their eating habits for a comparatively prolonged period of time poses significant health risks (Chentli, Azzoug, Amani, & Elgradechi, 2013). In this context, it is important to clarify the major groups of health threats and design the optimal strategy for their minimization without compromising people’s religious and cultural beliefs.
The problem of managing diabetes during Ramadan is becoming more urgent and significant. The fraction of Muslims with diabetes exceeds the average level of diabetics among other religious groups. Moreover, it is expected that this disparity will rise substantially for the next 25 years (International Diabetes Federation, 2016). Thus, it is crucial to increase their awareness of the major health risks associated with fasting during Ramadan as well as formulate precise recommendations (Monnier et al., 2015). In general, the target population of Muslims with diabetes will constitute the focus group of this study.
Issue Impacting the “Community of Interest”
The major issue impacting the target population is the non-proportionally growing health risks of fasting for people with diabetes. The key health risks associated with fasting are as follows. Firstly, it may cause chronic health problems to aggravate. For example, many people with diabetes have kidney or heart diseases, and thus their health standards may demonstrate negative dynamics. For this reason, many healthcare experts even suggest that people should consider the possibility of abstaining from fasting (Almalki & Alshahrani, 2016). However, it is highly problematic for the devoted Muslims. Secondly, hyperglycemia may occur among patients with diabetes, as people tend to become less physically active while fasting as well as abstain from taking the needed medication. Correspondingly, the health risks increase proportionally. In some cases, diabetic ketoacidosis may occur, and hospital treatment may become the only alternative for such patients (Hassanein et al., 2014). Thus, hyperglycemia is comparatively widespread and requires a proper understanding of the complementary threats.
Thirdly, hypoglycemia may also occur among some patients with diabetes, especially those who take specific kinds of medicine and insulin. Thus, it may be reasonable to stop the patient’s fasting in order to consume sugary fluids to normalize the health condition. However, even the temporary stoppage of fasting is not supported by the devoted Muslims. Thus, this strategy is not universally applicable during Ramadan (Chentli et al., 2013). Finally, dehydration and thrombosis may occur among patients with diabetes if they fast for a prolonged time. Dehydration is typically caused by the restricted fluid intake. It is especially relevant for many Muslim countries where climate conditions presuppose humidity and high temperatures. The intravascular space may be affected by the risks of fasting, and some patients may face high chances of thrombosis and stroke.
The empirical findings demonstrate that the number of incidences of retinal vein occlusion tends to rise during Ramadan, while the frequency of strokes or coronary events remain at the average level. Therefore, the actual situation is very complex as physical and spiritual health are closely interrelated with one another. For this reason, the real increase of health risks appears to be less significant than it is often suggested by healthcare experts who concentrate exclusively on the physical components of health (Almalki & Alshahrani, 2016). At the same time, the overall risk increases in any case, and it should not be neglected while discussing this issue and proposing the solutions for improving the current state of affairs.
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Five Sub-Roles of APHN
As the analyzed problem has been proven important, and many related issues are still not clarified properly, the role of advanced public health nurses (APHNs) is significant, especially when addressing the long-term health complications among the patients with diabetes. The first sub-role performed by APHNs refers to function of a clinician. It is necessary to analyze the interventions organized in this sphere as well as design the necessary adjustments if any deviations or negative trends emerge (Hassanein et al., 2014). For this reason, it is crucial to be able to determine the source of deviations and consider proper response strategies. In this context, it is reasonable to consider both objective health indicators and subjective perception of the interventions by the Muslim people (Chentli et al., 2013). The available technologies and professional skills allow a precise assessment of the health states of different patients. It is also possible to specify the statistical significance of interventions introduced within different sub-groups of the population. It is also reasonable to closely evaluate the feedback previously obtained from the Muslim people. They need to be able to appreciate the assistance and perceive it as culturally competent. It is the major condition for the long-term success of the developed healthcare program.
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The second sub-role of APHNs refers to fulfilling the functions of a manager. It is important to ensure the commitment of the staff to the formulated goals and objectives. The ultimate results will largely depend on the ability of nurses and other healthcare professionals to make timely and responsible decisions. Both their professionalism and devotion matters for addressing the needs of a given patient. In relation to professionalism, both formal and informal forms of control should be used (Monnier et al., 2015). The former refers to the existing norms and regulations in this sphere. The latter refers to the APHNs’ position regarding other professionals’ ability to perform a specified set of functions and responsibilities. In relation to devotion and orientation towards individual differences, all healthcare professionals should be aware of the major characteristics shared by the Muslim people while also recognizing the fact every individual is unique (Hassanein et al., 2014). Therefore, it is always crucial to specify the most urgent needs of a particular patient and evaluate several available alternatives for addressing those (Almalki & Alshahrani, 2016). The optimal decision should correspond to the maximum health benefits and minimum risks for the patient.
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The third sub-role of APHNs is performing the functions of an educator as well as assisting with designing policies for dealing with the analyzed problem. The developed policy and guidance should incorporate the analysis and recommendations formulated during the discussion of the existing challenges and potential solutions within the professional community (Amin & Chewning, 2014). If there is a lack of empirical information, APHNs should perform an additional assessment of the current trends and tendencies. It may be reasonable to specify the dynamics of health standards among the Muslim population in different countries as well as compare the situation during Ramadan to that during other months. On this basis, the optimal interventions can be conceptualized.
The fourth sub-role is contributing to organizing further research in this field as well as exchanging professional opinions regarding the risks faced by the patients with diabetes during Ramadan. APHNs may organize conferences where researchers may present their theoretical or empirical findings. On the one hand, it is important to specify the actual health risks that the patients with diabetes are prone to encountering. It may be also helpful to clarify whether the Muslim people have a higher likelihood of experiencing these problems due to the climate conditions or other significant factors. On the other hand, the innovative methods of addressing this problem should be discussed (International Diabetes Federation, 2016). The professionals can make suggestions, which should be examined from the perspective of potential results and their cultural relevance to the target population.
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The fifth role of APHNs is providing consulting services to the patients with diabetes. When working with the Muslim people, it is crucial to demonstrate the highest cultural competence. It means that nurses should explain the major health risks associated with fasting during Ramadan; however, they should not impose their views or recommendations on the patients (Ibrahim, Bahijri, & Tuomilehto, 2015). They should respect other people’s religious and cultural views. The provided information should be objective and supported by the recent statistical data as well as empirical research. Nurses should also provide the clarifications for the patients whenever they are needed.
Finally, APHNs should achieve the balance among all sub-roles performed in the context of the issue under analysis. All their functions and responsibilities should be complementary in relation to one another. Additionally, they ought to contribute to the maximum synergic effect and the improvements of patients’ health status in the long run.
As the problems associated with the health of patients with diabetes are very significant, it is important to design rational intervention strategies. Moreover, they should be consistent with the abovementioned five sub-roles of the APHNs. The first aspect that should be addressed is the activities of APHNs as the clinicians. A close examination of trends, complications, and cultural views of the Muslims from different countries should help develop detailed nutrition plans for children, men, and women in various countries and regions of the world. It is reasonable to consider the climate, the distribution of health risks, and cultural aspects prevalent in the particular country or region.
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The developed nutrition plans should consist of several groups, such as those including 1,200 kcal/day, 1,500kcal/day, 1,800kcal/day, and 2,000 kcal/day (International Diabetes Federation, 2016). In this way, it is possible to organize food consumption of different individuals with the corresponding energy needs. Moreover, APHNs should establish a system that will enable them to revise the initial plan if a given patient has additional health concerns or chronic illnesses. This information may be stored in databases and used for further interventions as well as analysis.
The second aspect of interventions refers to the functions of managers. As the actual system of providing services to the Muslim patients with diabetes includes the cooperation of different individuals, it is crucial to establish effective distribution of their responsibilities. APHNs should address this issue both at the planning stage and during implementation. Professional qualities of nurses and other healthcare professionals should be reviewed regularly. If they do not meet the requirements, the experts should be advised to attend additional courses and training programs in order to increase their knowledge and cultural awareness (Chentli et al., 2013). APHNs should also concentrate on the major strategic decisions as well as differentiate between preparing and developing general instructions throughout the year and assessing the performance of the personnel with urgent potential adjustments during Ramadan.
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The third aspect refers to introducing interventions from the perspective of educators. APHNs should educate the general community about the special needs of diabetics. It is important to explain the major symptoms of various health problems in order to promote timely responses to them. In particular, the general population should comprehend when it is necessary to apply for hospitalization and what groups of patients face the highest risks while fasting (Amin & Chewning, 2014). In addition, various types of communication tools should be utilized to ensure the most favorable results.
The fourth aspect refers to performing the functions of researchers. During the implementation of the designed programs and nutrition plans for the Muslim people in different regions, APHNs gather a variety of empirical information. This data encompasses the dynamics of the patients’ health, their responsiveness to different types of treatment, and the prevalence of complications in various regions. This information may serve as a foundation for the subsequent examination and systematization. It is possible to formulate new hypotheses regarding the major factors impacting the ultimate health outcomes (Ibrahim et al., 2015). It may also be reasonable to create the formal model of interventions for the patients with of for different age and gender groups. APHNs can also cooperate with other experienced researchers in the process in order to improve the existing modes of interventions.
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The fifth aspect refers to acting as consultants and catering for the specific needs and concerns expressed by the patients. APHNs should examine the following key issues: the major risks of diabetes for a given individual, his/her typical food consumption habits, the intensity of physical activity during Ramadan, the role of religious principles, and role of cultural norms in the life of an individual. This approach will allow to create a general social and cultural context for evaluating the health needs and optimal interventions for a given individual (Hassanein et al., 2014). While providing consulting services, APHNs should pay closer attention to the patients’ feedback. It is crucial to find the suitable solutions that will incorporate the interests of patients and contribute to the harmony between their physical and spiritual health. The prolonged consulting sessions are reasonable in this context in order to ensure positive long -term dynamics.
To summarize, managing diabetes during Ramadan constitutes a complicated issue due to the combination of health and cultural factors. A large fraction of the Muslim people follow religious practices precisely, which may create additional health risks for the patients with diabetes. Therefore, it is necessary to design the detailed plan of intervention, and APHNs should play the central role in this process. A variety of health risks, including dehydration, thrombosis, hypoglycemia, and hyperglycemia, may impact the target population. In order to improve the designed intervention strategies, it is necessary to utilize the five main sub-roles of APHNs.
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As clinicians, APHNs should develop effective nutrition plans that will classify patients into various groups according to their gender, age, and country, or region. Moreover, the specific characteristics of a given patient should be considered while adjusting the plan to his/her needs. As managers, APHNs should improve coordination among other nurses and healthcare specialists. In the role of educators, they should increase the general social awareness of the diabetes and the major patients’ needs. As researchers, APHNs should accumulate the necessary empirical information and formulate the corresponding hypotheses or develop specialized models. In the role of consultants, they should consider the cultural framework faced by a given patient in order to propose the optimal set of interventions. All the sub-roles mentioned above should be integrated to ensure sustainable improvements of the patients’ health outcomes.