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y (2008) pointed out that the actual settings in the community presented more challenges to be overcome in nursing than the research environment could reveal. The lack of culturally appropriate, low-literacy programs in self-management among diabetics in underserved populations is of particular interest, as will be discussed in this paper.
Among the vulnerable, African-American and Hispanic populations in the United States, type 2 diabetes is twice as prevalent in comparison to the non-Hispanic white population, while the Native Americans have even higher rates (CDC, 2012). Further, complication and mortality rates arising from diabetes are higher among patients within the racial and ethnic minority groups. It is worth noting that even with the differences in prevalence rates of diabetes, complications and mortalities among the different races and ethnicities, the treatment and pathophysiology is the same for all groups. That finding identifies a key problem, which points towards different cultures, health beliefs and behaviors as being the influencing factors in the way patients perceive diabetes and approve of self-management programs. Categorizing the underserved population as the aged, minority or low-income population, Philis-Tsimikas and Walker (2005) suggested that although they participate in studies and educative campaigns, they rarely adopt the interventions taught. In as much as the education and management programs have significant effects on improving health outcomes, gaps are still reported in the translating and implementing approaches in terms of treatment among the said populations. It was suggested by the CDC (2012) that nurses need more training in facilitating access to non-traditional approaches of empowerment and models of self-management among the underserved populations. Apart from improving patient knowledge, it would also promote patient satisfaction and reduce adverse health beliefs founded on culture.
One objective of the American
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The following matrix shows whether the elements were referenced, and if so, how effective that reference was:
This article deals specifically with turnaround in the Petroleum Industry and proposes a generic turnaround process that can be customised by plants and/or companies that are similar in business, to suit their needs.
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