13 Ways to Prevent Type 2 Diabetes

Type 2 diabetes is a chronic disease that affects millions of people worldwide. Uncontrolled cases can cause blindness, kidney failure, heart disease and other serious conditions.

Before diabetes is diagnosed, there is a period where blood sugar levels are high but not high enough to be diagnosed as diabetes. This is known as prediabetes.

It's estimated that up to 70% of people with prediabetes go on to develop type 2 diabetes. Fortunately, progressing from prediabetes to diabetes isn't inevitable (1).

Although there are certain factors you can't change — such as your genes, age or past behaviors — there are many actions you can take to reduce the risk of diabetes.

Here are 13 ways to avoid getting diabetes.
1. Cut Sugar and Refined Carbs From Your Diet

Eating sugary foods and refined carbs can put at-risk individuals on the fast track to developing diabetes.

Your body rapidly breaks these foods down into small sugar molecules, which are absorbed into your bloodstream.

The resulting rise in blood sugar stimulates your pancreas to produce insulin, a hormone that helps sugar get out of the bloodstream and into your body's cells.

In people with prediabetes, the body's cells are resistant to insulin's action, so sugar remains high in the blood. To compensate, the pancreas produces more insulin, attempting to bring blood sugar down to a healthy level.

Over time, this can lead to progressively higher blood sugar and insulin levels, until the condition eventually turns into type 2 diabetes.

Many studies have shown a link between the frequent consumption of sugar or refined carbs and the risk of diabetes. What's more, replacing them with foods that have less of an effect on blood sugar may help reduce your risk (2Trusted Source, 3Trusted Source, 4Trusted Source, 5Trusted Source, 6Trusted Source).

A detailed analysis of 37 studies found that people with the highest intakes of fast-digesting carbs were 40% more likely to develop diabetes than those with the lowest intakes (7Trusted Source).

    Summary:
    Eating foods high in refined carbs and sugar increases blood sugar and insulin levels, which may lead to diabetes over time. Avoiding these foods may help reduce your risk.
2. Work Out Regularly

Performing physical activity on a regular basis may help prevent diabetes.

Exercise increases the insulin sensitivity of your cells. So when you exercise, less insulin is required to keep your blood sugar levels under control.

One study in people with prediabetes found that moderate-intensity exercise increased insulin sensitivity by 51% and high-intensity exercise increased it by 85%. However, this effect only occurred on workout days (8Trusted Source).

Many types of physical activity have been shown to reduce insulin resistance and blood sugar in overweight, obese and prediabetic adults. These include aerobic exercise, high-intensity interval training and strength training (9Trusted Source, 10Trusted Source, 11Trusted Source, 12Trusted Source, 13Trusted Source, 14Trusted Source).

Working out more frequently seems to lead to improvements in insulin response and function. One study in people at risk of diabetes found that burning more than 2,000 calories weekly via exercise was required to achieve these benefits (14Trusted Source).

Therefore, it's best to choose physical activity that you enjoy, can engage in regularly and feel you can stick with long-term.

    Summary:
    Performing physical activity on a regular basis can increase insulin secretion and sensitivity, which may help prevent the progression from prediabetes to diabetes.

3. Drink Water as Your Primary Beverage

Water is by far the most natural beverage you can drink.

What's more, sticking with water most of the time helps you avoid beverages that are high in sugar, preservatives and other questionable ingredients.

Sugary beverages like soda and punch have been linked to an increased risk of both type 2 diabetes and latent autoimmune diabetes of adults (LADA).

LADA is a form of type 1 diabetes that occurs in people over 18 years of age. Unlike the acute symptoms seen with type 1 diabetes in childhood, LADA develops slowly, requiring more treatment as the disease progresses (15Trusted Source).

One large observational study looked at the diabetes risk of 2,800 people.

Those who consumed more than two servings of sugar-sweetened beverages per day had a 99% increased risk of developing LADA and a 20% increased risk of developing type 2 diabetes (16Trusted Source).

Researchers of one study on the effects of sweet drinks on diabetes stated that neither artificially sweetened beverages nor fruit juice were good beverages for diabetes prevention (17Trusted Source).

By contrast, consuming water may provide benefits. Some studies have found that increased water consumption may lead to better blood sugar control and insulin response (18Trusted Source, 19Trusted Source).

One 24-week study showed that overweight adults who replaced diet sodas with water while following a weight loss program experienced a decrease in insulin resistance and lower fasting blood sugar and insulin levels (19Trusted Source).

    Summary:
    Drinking water instead of other beverages may help control blood sugar and insulin levels, thereby reducing the risk of diabetes.

4. Lose Weight If You're Overweight or Obese

Although not everyone who develops type 2 diabetes is overweight or obese, the majority are.

What's more, those with prediabetes tend to carry excess weight in their midsection and around abdominal organs like the liver. This is known as visceral fat.

Excess visceral fat promotes inflammation and insulin resistance, which significantly increase the risk of diabetes (20Trusted Source, 21Trusted Source, 22Trusted Source, 23Trusted Source).

Although losing even a small amount of weight can help reduce this risk, studies show that the more you lose, the more benefits you'll experience (24Trusted Source, 25Trusted Source).

One study of more than 1,000 people with prediabetes found that for every kilogram (2.2 lbs) of weight participants lost, their risk of diabetes reduced by 16%, up to a maximum reduction of 96% (25Trusted Source).

There are many healthy options for losing weight, including low-carb, Mediterranean, paleo and vegetarian diets. However, choosing a way of eating you can stick with long-term is key to helping you maintain the weight loss.

One study found that obese people whose blood sugar and insulin levels decreased after losing weight experienced elevations in these values after gaining back all or a portion of the weight they lost (26Trusted Source).

    Summary:
    Carrying excess weight, particularly in the abdominal area, increases the likelihood of developing diabetes. Losing weight may significantly reduce the risk of diabetes.

5. Quit Smoking

Smoking has been shown to cause or contribute to many serious health conditions, including heart disease, emphysema and cancers of the lung, breast, prostate and digestive tract (27Trusted Source).

There's also research linking smoking and second-hand smoke exposure to type 2 diabetes (28Trusted Source, 29Trusted Source, 30Trusted Source, 31Trusted Source).

In an analysis of several studies totaling over one million people, smoking was found to increase the risk of diabetes by 44% in average smokers and 61% in people who smoked more than 20 cigarettes daily (30Trusted Source).

One study followed the risk of diabetes in middle-aged male smokers after they quit. After five years their risk had reduced by 13%, and after 20 years they had the same risk as people who had never smoked (31Trusted Source).

Researchers stated that even though many of the men gained weight after quitting, after several smoke-free years, their risk of diabetes was lower than if they'd continued smoking.

    Summary:
    Smoking is strongly linked to the risk of diabetes, especially in heavy smokers. Quitting has been shown to reduce this risk over time.

6. Follow a Very-Low-Carb Diet

Following a ketogenic or very-low-carb diet can help you avoid diabetes.

Although there are a number of ways of eating that promote weight loss, very-low-carb diets have strong evidence behind them.

They have consistently been shown to lower blood sugar and insulin levels, increase insulin sensitivity and reduce other diabetes risk factors (32Trusted Source, 33Trusted Source, 34Trusted Source, 35Trusted Source, 36Trusted Source).

In a 12-week study, prediabetic individuals consumed either a low-fat or low-carb diet. Blood sugar dropped by 12% and insulin dropped by 50% in the low-carb group.

In the low-fat group, meanwhile, blood sugar dropped by only 1% and insulin dropped by 19%. Thus, the low-carb diet had better results on both counts (35Trusted Source).

If you minimize your carb intake, your blood sugar levels won't rise very much after you eat. Therefore, your body needs less insulin to maintain your blood sugar within healthy levels.

What's more, very-low-carb or ketogenic diets may also reduce fasting blood sugar.

In a study of obese men with prediabetes who followed a ketogenic diet, average fasting blood sugar decreased from 118 to 92 mg/dl, which is within the normal range. Participants also lost weight and improved several other health markers (36Trusted Source).

For more info, check out this Guide to Healthy Low-Carb Eating With Diabetes.

    Summary:
    Following a ketogenic or very-low-carb diet can help keep blood sugar and insulin levels under control, which may protect against diabetes.

7. Watch Portion Sizes

Whether or not you decide to follow a low-carb diet, it's important to avoid large portions of food to reduce the risk of diabetes, especially if you are overweight.

Eating too much food at one time has been shown to cause higher blood sugar and insulin levels in people at risk of diabetes (37Trusted Source).

On the other hand, decreasing portion sizes may help prevent this type of response.

A two-year study in prediabetic men found that those who reduced food portion sizes and practiced other healthful nutrition behaviors had a 46% lower risk of developing diabetes than the men who made no lifestyle changes (38Trusted Source).

Another study looking at weight loss methods in people with prediabetes reported that the group practicing portion control lowered their blood sugar and insulin levels significantly after 12 weeks (39Trusted Source).

    Summary:
    Avoiding large portion sizes can help reduce insulin and blood sugar levels and decrease the risk of diabetes.

8. Avoid Sedentary Behaviors

It's important to avoid being sedentary if you want to prevent diabetes.

If you get no or very little physical activity, and you sit during most of your day, then you lead a sedentary lifestyle.

Observational studies have shown a consistent link between sedentary behavior and the risk of diabetes (40Trusted Source, 41).

A large analysis of 47 studies found that people who spent the highest amount of time per day engaged in sedentary behavior had a 91% increased risk of developing diabetes (41).

Changing sedentary behavior can be as simple as standing up from your desk and walking around for a few minutes every hour.

Unfortunately, it can be hard to reverse firmly entrenched habits.

One study gave young adults at risk of diabetes a 12-month program designed to change sedentary behavior. Sadly, after the program ended, the researchers found that participants hadn't reduced how much time they sat (42Trusted Source).

Set realistic and achievable goals, such as standing while talking on the phone or taking the stairs instead of the elevator. Committing to these easy, concrete actions may be the best way to reverse sedentary tendencies.

    Summary:
    Avoiding sedentary behaviors like excessive sitting has been shown to reduce your risk of getting diabetes.

9. Eat a High-Fiber Diet

Getting plenty of fiber is beneficial for gut health and weight management.

Studies in obese, elderly and prediabetic individuals have shown that it helps keep blood sugar and insulin levels low (43Trusted Source, 44Trusted Source, 45Trusted Source, 46Trusted Source).

Fiber can be divided into two broad categories: soluble and insoluble. Soluble fiber absorbs water, whereas insoluble fiber does not.

In the digestive tract, soluble fiber and water form a gel that slows down the rate at which food is absorbed. This leads to a more gradual rise in blood sugar levels (47Trusted Source).

However, insoluble fiber has also been linked to reductions in blood sugar levels and a decreased risk of diabetes, although exactly how it works is not clear (4Trusted Source, 47Trusted Source, 48Trusted Source).

Most unprocessed plant foods contain fiber, although some have more than others. Check out this list of 22 high-fiber foods for many excellent sources of fiber.

    Summary:
    Consuming a good fiber source at each meal can help prevent spikes in blood sugar and insulin levels, which may help reduce your risk of developing diabetes.

10. Optimize Vitamin D Levels

Vitamin D is important for blood sugar control.

Indeed, studies have found that people who don't get enough vitamin D, or whose blood levels are too low, have a greater risk of all types of diabetes (49Trusted Source, 50Trusted Source, 51Trusted Source, 52Trusted Source).

Most health organizations recommend maintaining a vitamin D blood level of at least 30 ng/ml (75 nmol/l).

One study found that people with the highest blood levels of vitamin D were 43% less likely to develop type 2 diabetes than those with the lowest blood levels (49Trusted Source).

Another observational study looked at Finnish children who received supplements containing adequate levels of vitamin D.

Children who took the vitamin D supplements had a 78% lower risk of developing type 1 diabetes than children who received less than the recommended amount of vitamin D (50Trusted Source).

Controlled studies have shown that when people who are deficient take vitamin D supplements, the function of their insulin-producing cells improves, their blood sugar levels normalize and their risk of diabetes reduces significantly (51Trusted Source, 52Trusted Source).

Good food sources of vitamin D include fatty fish and cod liver oil. In addition, sun exposure can increase vitamin D levels in the blood.

However, for many people, supplementing with 2,000–4,000 IU of vitamin D daily may be necessary to achieve and maintain optimal levels.

    Summary:
    Consuming foods high in vitamin D or taking supplements can help optimize vitamin D blood levels, which can reduce your risk of diabetes.

11. Minimize Your Intake of Processed Foods

One clear step you can take to improve your health is to minimize your consumption of processed foods.

They're linked to all sorts of health problems, including heart disease, obesity and diabetes.

Studies suggest that cutting back on packaged foods that are high in vegetable oils, refined grains and additives may help reduce the risk of diabetes (53Trusted Source, 54Trusted Source, 55Trusted Source).

This may be partly due to the protective effects of whole foods like nuts, vegetables, fruits and other plant foods.

One study found that poor-quality diets that were high in processed foods increased the risk of diabetes by 30%. However, including nutritious whole foods helped reduce this risk (55Trusted Source).

    Summary:
    Minimizing processed foods and focusing on whole foods with protective effects on health may help decrease the risk of diabetes.

12. Drink Coffee or Tea

Although water should be your primary beverage, research suggests that including coffee or tea in your diet may help you avoid diabetes.

Studies have reported that drinking coffee on a daily basis reduced the risk of type 2 diabetes by 8–54%, with the greatest effect generally seen in people with the highest consumption (56Trusted Source, 57Trusted Source, 58Trusted Source, 59Trusted Source, 60Trusted Source, 61).

Another review of several studies that included caffeinated tea and coffee found similar results, with the largest risk reduction in women and overweight men (62Trusted Source).

Coffee and tea have antioxidants known as polyphenols that may help protect against diabetes (63Trusted Source).

In addition, green tea contains a unique antioxidant compound called epigallocatechin gallate (EGCG) that has been shown to reduce blood sugar release from the liver and increase insulin sensitivity (64Trusted Source, 65Trusted Source).

    Summary:
    Drinking coffee or tea may help reduce blood sugar levels, increase insulin sensitivity and reduce the risk of diabetes.

13. Consider Taking These Natural Herbs

There are a few herbs that may help increase insulin sensitivity and reduce the likelihood of diabetes progression.
Curcumin

Curcumin is a component of the bright gold spice turmeric, which is one of the main ingredients in curries.

It has strong anti-inflammatory properties and has been used in India for centuries as part of Ayurvedic medicine.

Research has shown it can be very effective against arthritis and may help reduce inflammatory markers in people with prediabetes (66Trusted Source, 67Trusted Source).

There's also impressive evidence that it may decrease insulin resistance and reduce the risk of diabetes progression (68Trusted Source, 69Trusted Source).

In a controlled nine-month study of 240 prediabetic adults, among the group who took 750 mg of curcumin daily, no one developed diabetes. However, 16.4% of the control group did (69Trusted Source).

In addition, the curcumin group experienced an increase in insulin sensitivity and improved functioning of insulin-producing cells in the pancreas.
Berberine

Berberine is found in several herbs and has been used in traditional Chinese medicine for thousands of years.

Studies have shown that it fights inflammation and lowers cholesterol and other heart disease markers (70Trusted Source).

In addition, several studies in people with type 2 diabetes have found that berberine has strong blood-sugar-lowering properties (71Trusted Source, 72Trusted Source, 73Trusted Source, 74Trusted Source).

In fact, a large analysis of 14 studies found that berberine is as effective at lowering blood sugar levels as metformin, one of the oldest and most widely used diabetes medications (74Trusted Source).

Because berberine works by increasing insulin sensitivity and reducing the release of sugar by the liver, it might theoretically help people with prediabetes avoid diabetes.

However, at this point there are no studies that have looked at this.

In addition, since its effects on blood sugar are so strong, it should not be used in conjunction with other diabetes medications unless authorized by a doctor.

    Summary:
    The herbs curcumin and berberine increase insulin sensitivity, reduce blood sugar levels and may help prevent diabetes.

The Bottom Line

You have control over many of the factors that influence diabetes.

Rather than viewing prediabetes as a stepping stone to diabetes, it may be helpful to see it as a motivator for making changes that can help reduce your risk.

Eating the right foods and adopting other lifestyle behaviors that promote healthy blood sugar and insulin levels will give you the best chance at avoiding diabetes.


 Written by Franziska Spritzler, RD, CDE on January 29, 2017

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PRESIDENTIAL SPEECH FROM 19TH CONFERENCE - KADUNA, 2019

AN ADDRESS BY CHIEF (HON) SOLOMON E.O. EGWUENU, THE NATIONAL PRESIDENT, UNIVERSITY GRADUATES OF NURSING SCIENCES ASSOCIATION (UGONSA) ON THE EVENT OF 19^TH UGONSA NATIONAL PROFESSIONAL CONFERENCE & SCIENTIFIC UPDATE HOLDING AT KADUNA, KADUNA STATE FROM SUNDAY 7^TH TO SATURDAY 13^TH JULY, 2019

I wish to most heartily welcome and congratulate all of you for making out time from your very tight schedule to attend this crucial and memorable conference. Nursing as a profession or vocation is as old as human history. Its central and predominant contribution in the health care industry is incontestable and its global recognition and marketability is heartwarming. However this profession is faced with some incapacitating political and socio-economic problems in Nigeria that tend to stagnate and inhibit its professional growth, development and rewardability in contrast with the same nursing profession in the Western world and developed countries.  A gathering like the event of this National Professional Conference & Scientific Update provides opportunity for appraisal of our situations and modalities for improvement as we believe that with consistent, focused and methodical effort, we shall in no distant time take the nursing profession in Nigeria to the enviable height it has attained in the developed countries.

The UGONSA National Professional Conference and Scientific Update is a classic event where scholars, researchers and administrators in the nursing profession gather to exhibit and review scientific works and underlying theories of nursing practice for the purpose of improving on medico-nursing knowledge and skills for enhanced qualitative client care. As the conference provides another veritable opportunity for us to sieve out vital ingredients for repositioning nursing services more efficiently for care effective and cost effective service delivery, it also provides the opportunity for us to look into factors that might have been diffusely or actively constituting impediments to our unalloyed zest towards elaborating the best of what we can offer as nurses to the services of our clients. Among such factors is the issue of lack of proper placement and poor remuneration of nurses. 

The current professional conference was tagged “PROPER PLACEMENT SUMMIT” because it shall be used to champion the course for proper placement of Graduates of Bachelor of Nursing Science (B.N.Sc) degree at par with their counterparts in other core healthcare disciplines. The Nigerian health system has been provocatively treating the profession of nursing as subservient to other core healthcare disciplines through its deliberate, unfair and inequitable placement of graduates of B.N.Sc degree below their par in the Civil Service. The Industrial Arbitration Panel award, 1981 was unambiguous in its declaration that the profession of nursing is on parity with that of Pharmacy in Nigeria, as is the case in Great Britain. What that simply means is that graduates of first degree of the profession of Pharmacy and those of nursing should be placed on the same entry point into the Civil Service. However, the ugly situation we witness as at date is the aberration of subjugating fresh graduates of B.N.Sc degree to CONHESS 07 (.i.e. Grade Level 08) during internship and to CONHESS 08 (.i.e. Grade Level 09) post-NYSC (National Youth Service Corps) whereas their counterparts from other core healthcare disciplines (such are Pharmacy, Med Lab, Physiotherapy, etc) are placed on CONHESS 08 for internship and CONHESS 09 (.i.e. Grade Level 10) post-NYSC. The reason for keeping graduates of B.N.Sc degree on one Grade Level below their par (who they share similar entry requirement and course duration with for the first degree in the university) has never been explained by anybody till date, perhaps because there is no reason other than a seemingly sinister plot to make nurses remain at the bottom of the food chain in our healthcare system. 

If we accept that injustice permeates where equal things are treated as unequal, it portends that our Health System is a citadel of injustice for treating equal things as unequal vis-à-vis under-placement of graduates of B.N.Sc degree below their par. What is more? This ill treatment meted out against nurses psychologically traumatizes them perennially and adversely impacts their zeal for going the extra mile in service delivery. Such must not be allowed to continue. Because the care of mankind has been entrusted unto nurses, they must be motivated and not traumatized to carry out this task effectively and efficiently.

Nurses are to the healthcare system what mothers are to families. Any family in which the mother is empowered is eternally progressive but families where mothers are subjugated and trampled upon (as done to nurses in the Nigeria health system) never make any inch of progress. This explains why Nigeria health system is almost the ‘first from behind’ in the ranking of the world’s performing and responsive health systems. Proper placement will motivate nurses and oil their latitude to meeting the increasing complexity of health needs, which nurses are in the frontline to drive. I dare say that medical tourism by government officials and affluent Nigerians to other countries shall surely abate with adequate motivation of nurses through proper placement and enhanced remuneration. This is because with a motivated nursing workforce, we stand to get in Nigeria hospitals what is obtainable in high-ranking hospitals in other countries.

I therefore humbly call on our distinguished dignitaries, other well meaning Nigerians and the media to prevail on the powers-that-be to give nurses their due and eligible right of placement at par with their counterparts in other core healthcare professions. Keeping quiet in the face of injustice is not golden. Silence in such a situation portrays acceptance of the injustice and, at worst, complicity in perpetuating it. We count on your voice to put pressure on the Nigerian government to do the right thing on the placement of the graduates of B.N.Sc degree by making their entry point for internship and into the Civil Service post-NYSC to be at par with that of other core healthcare professionals as granted by the IAP award, 1981.

To my fellow Graduate Nurses, although the challenges facing nursing in Nigeria is enormous, they are however not insurmountable. We must brace up to the challenges and tenaciously fight to uproot all obstacles standing on our way to professional growth, development and self actualization. In this crucial conference we shall be brainstorming to take a proactive and collective stand on other issues and policies that bring about desirable changes in nursing profession especially reformation and amendment of the establishment Act of the Nursing and Midwifery Council of Nigeria; upgrade or affiliation of  schools of nursing and midwifery to degree awarding institutions; creation of a substantive directorate of Nursing Services at the Federal Ministry of Health and curtailing the menace of quackery in nursing.

The profession is looking up to us as vectors for productive and positive change and we cannot afford to betray this expectation. The reason for this expectation is not far-fetched; we are products of university-based education and hold professional degrees like our contemporaries in Medicine and pharmacy. This advantage removes the inadequacies of inferiority complex with its associated easy capitulation to inter-professional intimidation by other graduate professionals in the health care industry. The graduates of nursing sciences are also polyvalent graduates adequately versed in clinical sciences, behavioural, social and management sciences that make them unique among the core healthcare professionals.

In this conference, I implore you all to be very committed and professionally patriotic so as to chart a new course for our great and noble profession. We must remain strong and united so as to frustrate our detractors who do not want to see the growth, development and advancement of the nursing profession. We must tirelessly work to gain professional autonomy in Nigeria and take nursing to the acceptable and desirable global standard. We must prove a point that Nursing is the centrifuge and engine room of the health care industry. We must show the world that we are the dominant force in the health care sector. We must take our place of prominence and pride in the health care industry and we must reap the fruits of our professional labour here on earth and thereafter in heaven.

On this note, I appreciate the privilege to welcome you all to the Centre of Learning, Kaduna State, and as we deliberate on professional issues in nursing, I enjoin nurses, members of other healthcare professions, the government, the media and all people of good-will, to join hands and help us bring about a repositioned and more responsive nursing profession in Nigeria as nursing remains that great pot that cooks good health for all of us.

God bless you!

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UGONSA SPEAKS ON OUTCOME OF THE 2017 NMCN KADUNA LEADERSHIP CONFERENCE

 NMCN 2017 KADUNA LEADERSHIP CONFERENCE:  THE ODDS AND GLEES – BY UGONSA

Introduction: The hue and cry trailing the Nursing and Midwifery Council of Nigeria (NMCN) leadership conference that was held in late March, 2017 in Kaduna was prescient. If for nothing else, it showed that nurses, both the leaders and followers, have generally agreed that all is not well with nursing in Nigeria and that we cannot achieve any meaningful professional growth and development without overhauling the structure of the profession in all its ramifications. It also showed that nurses desire a change from the current critically disordered structure of classless multiple qualifications to a well defined meaningful and purposeful vertical professional growth up the ladder to Ph.D. It equally showed that the hideous idea which some retrogressive elements valiantly attempted to foist on us that some other professions – such as Health Education, Psychology, Guidance and Counseling, Nutrition, etc., - were all allied to nursing, have been rejected, killed and buried as no mention of or defense in favour of the term “degrees allied to nursing” was observed in the conference proceedings or any of its originating materials or documents. It is very obvious that those championing such a stupid campaign have been shamed to an extent that they are now afraid to mention it in public.  

SCHOOL OF NURSING GOES TO HND

The main take of the conference was that schools of Nursing will be re-branded into colleges of Nursing to award HND, RN, RM and RPHN. With this development, it means we are set to re-integrate nursing education and training into the mainstream of Nigerian Educational System and policy. Although, the re-integration is at HND level – a level lower than our expectation of minimum of first degree in nursing and midwifery as “stat” for all nurses and midwives, it remains better in all ramifications than the current apprenticeship bedside training that has no academic value. HND is never and can never be our destination but certainly it is a good “appian way” to our destination. 

DOES THIS DEVELOPMENT REFLECT UGONSA’S POSITION?

Yes – to a good extent! UGONSA’s position has remained making first degree in nursing the baseline for nursing practice. For this, UGONSA has been advocating for upgrade or affiliation of Schools of Nursing and Midwifery to degree awarding institutions. UGONSA has also made a call to reduce the study period for acquiring nursing degree by RN holders to 2 years, from the current 5 years in Nigeria, as is the case in many academically developed countries, to ease the process of upgrade and transition to B.N.Sc. It should be recalled that on 10^th November, 2014, UGONSA in a letter – Ref No. UGONSA/014/NUC/O1/SG, addressed to Secretary General of the National University Commission (NUC) –  described the five (5) years spent by nurses and midwives with the basic qualifications (RN/RM) of the NMCN to get first degree in nursing from Nigerian universities as outrageous and requested that RN/RM, which have been recognized as a HND [for employment purposes] be equally treated as HND in academics –  to shorten the course duration for transition from RN/RM to degree from 5 to 2 years. It is instructive to add that UGONSA made such call on the premise that all the post-basic programmes must be upgraded and transformed to post-graduate programmes to be run as masters’ and Ph.D.

 The current move by the council therefore will add the lacking academic skin to RN, which has for long been treated as HND in the civil service but as an equivalent of SSCE in the academic arena. With this development the transitional period from RN to degree would be shortened from 5 to 2 years.

 ARE THERE OTHER BENEFITS TO THIS DEVELOPMENT?

Yes! The firm hegemonic grip of outsiders especially Clergy and Chief Medical Directors, who are not nurses, on the affairs of our educational institutions will be check-mated. Those in missionary and Teaching Hospital owned schools of nursing and midwifery understand better the level of disturbing meddlesomeness witnessed in the hands of these chief executives. Going HND will create a form of autonomous environment for the schools and check-mate the excesses of outsiders on the activities our education and training institutions. 

Besides this, it will equally phase out the era of using poorly prepared tutors to teach in our schools. In schools of nursing and midwifery, it is common to see those that became tutors by the way of RNT programme. After acquiring RN qualification, they zoomed off for the short-cut RNT programme and come back to teach our students without adequate exposure. A lecturer should have advanced preparation and exposure especially at Masters’ and Ph.D levels. Whether we like it or not, the quality of persons handling our educational activities vis-à-vis their academic qualifications contributes a great deal to our public image and respectability. The era of “RN teaching RN” in the name of RNT will be over with our going collegiate.

ARE THERE THINGS THAT ARE YET TO BE PROPERLY PUT IN PLACE?

Yes! While we are not filled with glee at the prospect of something amiss, the loud silence on what becomes of the basic schools of midwifery and our post-basic specialty schools compels otherwise. What seems like a blanket decision to maintain the status quo for schools of midwifery and post-basic specialty schools while only schools of nursing is being touted for upgrade to HND casts specks on  the intention of the promoters of the exercise. We agree that 5 years is too much time to be spent by RN holders in pursuing a nursing degree but strongly disagree that a HND or degree holder has to regress to the post-basic schools to get baseless unclassified qualifications with no academic value in the specialty areas. We equally disagree that schools of midwifery will maintain their current state while only schools of nursing port to HND.

What is worth doing is worth doing well. In whose interest are we retaining the post-basic specialty schools? In whose interest are we abandoning the basic schools of midwifery to remain the way they are? We must put things in their places. Accordingly, post-basic schools should be concurrently upgraded to post-graduate to pave way for a HND or B.N.Sc holder who wishes to specialize in any specialty area of nursing – such as Peripoerative nursing, Anaesthesiology, Accident and emergency, Paediatric nursing, Ophthalmic nursing, ENT nursing, Orthopaedic nursing, Psychiatric and mental health nursing, etc, – to do so progressively at masters’ and then Ph.D level. The intention to retain the specialties at “qualification level” to make us continue to pursue multiple unclassifiable “qualis” after HND or B.N.Sc is misguided and implies that we are not yet ready for any genuine radical change but rather have accepted mediocrity as our inalienable norm.

The monetary resources expended to obtain a post-basic qualification is more than what is spent to get a masters’ degree yet one million “post-basic qualis” can never equal a bachelor’s degree let alone a masters’ degree. Whatever informed the decision to maintain the staus quo for the post-basics can be for any other thing but certainly not for the progressive interest of the nurses. Whatever be the case, the message is very loud and clear – that nurses have said NO to “unclassified qualifications devoid of academic value” be it at basic or post-basic level and anything short of that is unacceptable.

We are too much of a cynic to believe that nothing is amiss in the current adventure if the post-basic specialties are not concurrently upgraded to post-graduate levels such that after bagging the HND or B.N.Sc, nurses can progress vertically to get their masters and then PhD rather than moving in a vicious cycle of waste in the name of multiple unclassified post-basic qualifications as is obtainable today. 

MIDWIFERY vs NURSING: ARE WE FAIR ENOUGH?

Our council is named “Nursing and Midwifery Council of Nigeria” because it regulates both nursing and midwifery. But an unbiased evaluation of its activities and policies can leave one to infer that it is more of a nursing than midwifery council. This is because midwifery is yet to receive the type of attention that has been given to nursing. 

In our universities, we run only bachelor of nursing science. We are yet to commence bachelor of Midwifery. Now we are set to run HND in Nursing but remain mute on what becomes of midwifery. Most midwives that ran the basic midwifery programme find it difficult to secure admission into the B.N.Sc programme, yet we feel less concerned about their plight. It is high time we created a Bachelor of Midwifery (B.M) degree programme, as a single honours, or modify the existing BNSc programme into dual honours – to be awarded as bachelor of nursing and midwifery. Our sister profession, Medicine, awards its degree as a dual honours in Nigeria to accommodate medicine and surgery. Thus, their first degree is bachelor of medicine and surgery abbreviated as MBBS. We stand to gain more if we run ours as Nursing and Midwifery to cover our much neglected midwifery in our degree programmes by making our first degree a “double majors” of Nursing and Midwifery – BNBM (Bachelor of Nursing, Bachelor of Midwifery). This will give midwifery equal stake and ease off abridgement to degree of those that had studied midwifery at basic level or HND as the case may be. For equity and fairness, the current metamorphosis into HND should be equally extended to Midwifery.

CONCLUSION

1.   Nurses have said no to unclassified bedside, apprenticeship-type nursing and midwifery education – be it at basic or post-basic level.

       2. Nurses want the critical disorder in our training and educational systems to be overhauled such that our qualifications shall have academic value with a progressive vertical advancement up the ladder to PhD level.

3. UGONSA re-affirms its desire to see first degree(s) in nursing and midwifery become the basic qualification(s) for practice of nursing and midwifery in Nigeria in the near future.

        4. UGONSA abhors the 5-year duration currently spent by Registered Nurses in pursuing first degree in nursing in Nigerian universities especially as it takes holders of such qualification two years or less to get same nursing degree from universities in developed countries that are better ranked than Nigerian universities.

  

       5. UGONSA equally abhors the hegemonic grip, meddlesomeness and interference in our education and training by outsiders especially Chief Medical Directors and Clergy, whose institutions own a great number of the existing schools of Nursing and Midwifery, and supports any effort or move to tame such.

       6. UGONSA welcomes the current move for upgrade from schools of nursing to colleges of nursing for the award of HND but advises that such be extended to midwifery and that post-basics should not be left out but concurrently upgraded to post-graduates as masters’ and Ph.D in nursing.

     7. UGONSA envisages that in the forseeable future, dons – in the likes of Doctors/Professors of Perioperative Nursing, Anaesthetic Nursing, Paediatric Nursing, Orthopaedic Nursing, etc – will be very visible in the clinical settings, only if we respect the burning nurses’ wish and desire  for a vertically structured progressive system of education and training that shall count both in professional and academic sense unlike the current critically disordered system that awards multiple qualifications that are devoid of academic value.

      

     8. UGONSA makes case for establishment of departments of midwifery in our universities or on the alternative – modifying the existing B.N.S c degree to a “double majors” to be awarded as Bachelors of Nursing and Midwifery (BNBM).

  

        9. UGONSA encourages schools of nursing to go for direct affiliation with nearby universities as such is more beneficial than transformation to HND awarding institutions. But where such is not feasible, the HND structure should be embraced as it remains better than the current bedside structure. 

UGONSA…….Make a positive change!

Citation

This piece should be cited as follows:

University Graduates of Nursing Science Association [UGONSA]. (2017). NMCN 2017 Kaduna Leadership Conference:  The Odds and Glees. Position Paper/Diary.

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IMPROVING PUBLIC HEALTH INDICES: NEED FOR NURSES AT PRIMARY HEALTH CARE LEVEL- By Garba Abdullahi Mustapha Rn, Bnsc, MDRM

Healthcare delivery over the past three decades has witnessed a gradual yet significant shift from curative to preventive health, from a traditional hospital based care to care at the community level, from individualized care to care of a group or community.
 

Nursing as with all other health professions in Nigeria has also paid attention to the need for nursing presence at the community level with the introduction of revolutionary concepts to that effect. Typical examples include the introduction of community midwifery program and the midwifery service scheme which where both designed based on the need to increase the community or primary health care presence of nurses to enable members of the community  to adequately benefit from their broad perspective of healthcare knowledge gained through training and knowledge. It’s obvious that Nigeria’s PHCs, which should be the first contact for healthcare services, are at best comatose or at worse non-existent. This is as a result of shortage of human resources – large chunk of which should be nurses – rendering the centers into safe haven for rodents and reptiles and also hideouts for criminal elements. 

Additionally, many of such centers have tuned into practicing and molding grounds for quacks. Its common sights these days to behold PHCs without a single professionally trained or skillfully qualified health care personnel in the roll calls. Even where one is fortunate to find some, they usually abandon their responsibilities for the quacks to be having hay days irrespective of the repercussions. In an effort to salvage the situation and revive those centers into functionally efficient institutions, wide attempts were made ranging from technical, infrastructural, administrative and partnerships.

Technically, with the poor record of maternal and infant mortality the National Primary Healthcare Development Agency (NPHDA) in 2009 mobilized newly qualified, unemployed and retired midwives for the one year Midwifery Service Scheme (MSS) aimed at increasing the number of Skilled Birth Attendants at the rural areas of country. As at 2005 the maternal mortality rate, as posited by the Mamaye Initiative, was put at 74 to 1000 livebirths but dropped to 56 to 1000 by the year 2013 – a feat achieved through various initiatives and chief among was the Midwifery Service Scheme.

The introduction of the Community Midwifery Program by the Nursing and Midwifery Council of Nigeria (NMCN), though at its infancy and can’t be measured to determine its success and impact on the overall health matrix of the country, points to a remarkable feat towards reducing maternal and infant mortality through enhancing the professionalism of the midwifery practice and averting the dangers of quack practice.  The program which is run by only 5 institutions, at least for now, spread across the north western states of Sokoto, Zamfara, Kano and Katsina  and one in the north eastern state of Bauchi. Note that these are the regions with the highest number of maternal and infant mortality in Nigeria. Laudable as this initiative is, it’s grossly inadequate and unevenly spread if the aim of the program is to be achieved. More schools in different regions of the country therefore need to commence the Community Midwifery program to ensure equitable distribution and presence of skilled birth attendants in the primary healthcare sector of Nigeria.

The innovations and creativity that brought great success at the primary health care level with midwifery can be replicated with general nursing through the introduction of the Nurses’ Service Scheme (NSS) which would mobilizes and deploys newly registered, retired and unemployed nurses to the rural areas with the view to providing healthcare services at the grassroots, as was done with the Midwifery Service Scheme. This will, in essence, reduce the healthcare burden of major communicable diseases which account for a great majority of mortality and morbidity. 

Also a basic Community Nursing program can be designed and run by schools of nursing which would guarantee a more permanent presence of nurses at the community level providing both preventive and curative health services. It will also ensure ownership of primary healthcare services as those to be trained or mentored must be permanent residents of such communities. There’s also the issue of rampant negligence and misdiagnosis and or treatment carried out by quacks. The presence of nurses at the primary healthcare centers would address such through efficient service delivery.

One of the major causes of mortality of whatever nature is absence of effective referral system. Many PHCs are run and administered by large number of quacks, making it difficult for referral to be made when necessary. Many do not even know or understand what referral is and or how referral works. They remain bent on treating every ailment irrespective of their complications and sophisticated nature. Nurses presence at such centers will go a long way in checking this tragedy and reduce the unnecessary difficulty patients are being subjected too through quacks. On a final note, one major problem with Nigeria’s healthcare system generally is the absence of reliable data, if at all it’s available. I believe a good starting point are the PHCs equipped with professionally trained nurses, not quacks masquerading as nurses) especially as we have thousands of them now all over the country, of which many are unemployed). The nurses, as part of their routine duty, will record every patient and case efficiently and ensure the confidentiality of such data. Such data in return can be used in evaluating and reviewing the impact and otherwise of government policies and as yardstick for luring NGOs partnerships for modern service delivery.

The place of the nurse in healthcare is irreplaceable and indisputable as core professionals with the technical skills backed by theoretical concepts which are employed for the betterment of patients, community and the system. Healthcare system is a team comprising of various professionals and nurses are core members of the team. Having them at all levels is an asset that cannot and must not be ignored, all the time.

G.A Mustapha

Collage of Nursing and Midwifery Sciences Sokoto

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