20 discussion 25 references 27 v barriers to diabetic

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ADMINISTRATIVE SUPPORT……………………………………………….. 20DISCUSSION……………………………………………………………………………. 25REFERENCES…………………………………………………………………………… 27v
BARRIERS TO DIABETIC EDUCATIONBARRIERS TO MENTAL HEALTH NURSES WORKING IN COMMUNITY MENTAL HEALTHCLINICS TO PROVIDING DIABETIC SCREENING, MONITORING, AND EDUCATION TOPEOPLE LIVING WITH SCHIZOPHRENIAPurposeSchizophrenia (SMI) is a severe mental illness which is chronic and life-long. It is a thought disorder which detracts from the individual’s ability to think clearly and follow logical thought patterns. The person may experience auditory, visual and other perceptual hallucinations. Delusional thoughts of association, paranoia and inappropriate social behavior may also plague people with SMI (Hardy & Gray, 2012). According to the Diagnostic and Statistical Manual 5 (2013) SMI is defined as a psychotic disordercharacterized by “abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms,” (p. 87). People living with SMI commonly live in unsafe, unhealthy settings, exposed to risk factors of poor nutrition, pollution, crime, violence, unprotected sex, and other related risks to physical health, and due to compromised cognitive faculties, may not seek preventative care and treatment when needed (Hultsjo & Hjelm, 2012; Marion et al., 2004) According to the World Health Organization (2011), 80% ofpeople with SMI do not receive necessary health care services in low- and middle-income countries (World Health Organization, 2011). Regrettably, people living with SMI also live with the risk of increased morbidity and mortality rates, even with the exclusion of completed suicide statistics (Beebe, 2008; Druss, Von Esenwein, Compton, Zhao, & Leslie, 2011; Jensen, Decker, & Andersen, 2006; Verhaeghe, De Maeseneer, Maes, Van Heeringen, & Annemans, 2011). It is well documented in the literature that persons with SMI have poorer health outcomes than the rest of the adult population. Mortality occurs 10-25 years sooner than others of comparable age, with more frequency than thirty years ago, primarily due to complications from comorbid conditions (Bradshaw & Pedley, 2012; Happell,1
BARRIERS TO DIABETIC EDUCATIONPlatania-Phung, & Scott, 2013;Hardy & Thomas, 2012; Hemingway, Trotter, Stephenson, & Holdich, 2013; MacHaffie, 2002; Nover, 2013;Robson & Gray, 2007; Tranter, Irvine, & Collins, 2012). At least 50% of people with SMI have diagnosed comorbid medical illnesses, and an additional 35% have undiagnosed conditions (Jensen et al., 2006; Marion et al., 2004). Three primary chronic conditions which lead to premature death rates in the SMI are diabetes mellitus type II, hypertension, and cardiovascular disease all of which are interconnected conditions often beginning with chronically high blood glucose levels, indicated by HgbA1c levels greater or equal to 7% ( Casey et al., 2004; Scain, Dos Santos, Friedman, & Gross, 2007; Tranter, Irvine, & Collins, 2012).

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