| Summary: | Type 2 diabetes (T2D) is considered as a global major health problem, which requires healthcare systems to find solutions to meet the needs of the great numbers of people with T2D. One key to these solutions is nurses who undertake the provision of diabetes care. Nursing care in T2D varies across countries as a result of differences in healthcare systems, the way in which they are organised and other factors relating to nursing practice. The UK and Kuwait are two countries which have high incidences of T2D but differing health care delivery models, which has raised the need to understand the different roles of nurses in providing T2D care in these two countries’ healthcare systems. Key aims of this research were: (1) to investigate the actual roles undertaken by nurses in T2D care; (2) to investigate the extent to which these different roles affect perceived quality of nursing care; (3) to investigate the guidelines of diabetes care in the UK and Kuwait; and (4) to evaluate if nurses are delivering care based on these guidelines. This study investigated two cases in the UK and Kuwait regarding nursing roles in T2D care and how they affect the perceived quality of nursing care. In order to understand the phenomenon, a multiple case study design was employed involving multiple sources of information including documents review, non-participant observations, and semi-structured interviews with nurses and their patients with T2D. The diabetes clinic sites for this study were Nottingham University Hospitals (NUH) Trust in the UK and the Ministry of Health (MoH) hospitals in Kuwait. A thematic approach was utilised as a framework for the within-case and cross-case analyses. The findings of the study showed that nurses are motivated and competent to provide optimum care to achieve patient satisfaction, which is a significant sign of quality of nursing care. The nurse-led system in the UK and the physician-led system in Kuwait indicate different approaches in T2D care. In the UK, the nurse’s part in T2D care has been extended and advanced, making the role comparable to a physician's role. For instance, the status of 'nurse consultant' and 'nurse prescriber', allows the nurse to coordinate and lead diabetes care. In Kuwait, nurses contribute significantly to T2D diabetes care; however, their role is not officially recognised as they are not titled ‘diabetes nurse’ despite the fact they follow physician-established guidelines. Findings from this research further showed that the role of a diabetes nurse in Kuwait lacks clarity, as evidenced by the lack of any published statements specifying their roles according to their specialisation, experience and qualifications. This absence of what nurses are supposed to be doing or a lack of a statement relating to the guideline-informed role of nurses has therefore resulted in an undervaluation and lack of support for this role in Kuwait. The results of this study enhanced understanding of the roles nurses play within T2D care in both the UK and Kuwait. The information gathered also provides better understanding about nurses’ guideline-informed roles and their actual roles in T2D care and therefore that data determines how the differences in the roles of nurses might impact on patients' perceived quality of nursing care.
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