INCEPTION, DEVELOPMENT, DESIGN, AND IMPLEMENTATION OF THE FIRST NURSE-LED DIABETES CARE CURRICULUM IN PAKISTAN: A MIXED-METHODS EXAMINATION OF CURRICULUM BRANDING, INSTITUTIONAL VALUE CREATION, AND BIBLIOMETRIC EVIDENCE-LED APPROACH

Abstract

Background: Pakistan ranks among the top three countries with the highest diabetes prevalence globally, with nearly one-third of adults affected. Despite representing the largest segment of the healthcare workforce, nurses and community health providers remain underutilized in diabetes management due to limited structured training and the absence of nationally recognized Nurse Practitioner (NP) and Advanced Nurse Practitioner (ANP) pathways. Strengthening their role through evidence-based, competency-driven education is essential for improving diabetes outcomes and meeting national workforce needs.

Objective: This study introduces Pakistan’s First Nurse-Led Six-Month Diabetes Care Course, designed to build advanced clinical, educational, and community competencies among nurses, community midwives (CMWs), Lady Health Visitors (LHVs), community health workers (CHWs), and allied health professionals.

Methods: The course was developed and delivered by the International Institute of Health & Innovative Research (IIHIR) in collaboration with national nursing leaders and supported by the Foundation of European Nurses in Diabetes (FEND). Using the 5S Framework—Self, Society, State, Systems, and Spirituality—the curriculum included eight structured modules combining evidence-informed theoretical instruction, supervised clinical practicum, simulation-based learning, community screening activities, and reflective assignments. Participant performance was assessed through quizzes, competency checklists, case-based evaluations, and reflective portfolios.

Results: A total of 1,220 participants from 62 cities completed the program. Overall, 89% demonstrated enhanced clinical confidence following the course, while 82% showed improved interpretation of diagnostic indicators including HbA1c, fasting blood glucose, and oral glucose tolerance test values. Additionally, 78% independently initiated community diabetes screening projects. Graduates consistently demonstrated readiness for NP/ANP-level responsibilities in diabetes care, indicating strong potential for advanced practice role transition.

Conclusion: This first-of-its-kind nurse-led diabetes training model in Pakistan establishes a replicable and scalable pathway for developing Diabetes Nurse Practitioners. By integrating global guidelines with structured competency-based education, the program offers a sustainable approach to strengthening national diabetes care capacity and advancing the professional role of nurses.