Keywords: diabetes case study essay
Empowerment is a multidimensional build relevant to individuals, organizations, and neighbourhoods (Rappaport, 1987). It really is seen as a construct rather than concept since it is in a roundabout way observable (Jacox, 1974). The case study implies that Patrick lacks both do it yourself control and can power in his management of his diabetes. People with long-term conditions are challenged by often persistent and disruptive health problems which have cognitive, sociable and psychological repercussions (Larsen & Lubkin, 2009). Proven methods of dealing with people who have long-term conditions derive from the assumption that prescriptive instruction by expert medical researchers will guide the user's behaviour, thereby effectively taking care of their condition. However, regular non-adherence to healthcare advice (Zimmerer et al, 2009) and failing to achieve behavior change through education programmes alone (Gibson et al, 2001) show that this approach is often unsuccessful. Self-management programmes typically combine development of action strategies and trained in the skills necessary to apply such action (Lorig & Holman, 2004). Collaboration between your professional and the individual with the long-term condition is required to ensure that advice isn't only provided but personalised relative to the individual's needs and preferences (Bodenheimer et al, 2002). In April 2009 the Team of Health released helpful information on Personal Management.
It complete the "Four Pillar" methodology, firstly Information, a far more informed patient can make smarter decisions about his or her treatment, secondly skills and training, providing the patient with the skills necessary to manage their condition better, thirdly tools and devices aiming to equip the individual with the means to control their condition, and finally the all important support sites, giving the person a sense of involvement in their attention and the ability to communicate any doubts around their disease.
Whilst on my community positioning I was released to an initiative that is used within an area PCT in Birmingham. It really is called the Diabetes Manual (Burden & Burden, Heart and soul of Birmingham PCT). It is a booklet/log publication which is directed at every newly diagnosed diabetic. It seeks to educate and notify patients on their diabetes and exactly how better to control it. It details some/most of the issues/side effects that include having a long time condition such as diabetes. Its main aim is to teach patients through simplified terms and pictures. The built-in log book is used by patients to write down how they control their diabetes over a day to day basis. One key area of the booklet is the action planning page. The book also incorporates target/goal environment for Patrick. On primary interview with Patrick we would aim to present him to the booklet and consult with him, first of all the benefit for using this publication, allowing him to self deal with his condition and to better understand the implications of an permanent condition such as Diabetes. It is important to ensure that Patrick is literate as this plan will not do well if this is not so. Goal-setting for the first few weeks is always to try to maintain blood sugars at a mutually decided safe level.
It would be unreasonable to expect an excessive amount of Patrick within the first few weeks and although it is important for his health that goals are reached we would seek to gradually present more aims as Patrick acquired used to effectively self managing his condition. This built-in logbook and information guide addresses at least two of the four pillars of Self Management (DoH 2009). Information within the book will allow Patrick to learn and break down at his own leisure, bombarding an individual with information during an interview can often lead them to disregard and turn off from the information giver.
It also works as an instrument or device by which Patrick can write down his day to day life in the knowledge that it might be the main element to managing his blood sugar if he continues an accurate food journal. This initiative depends heavily of the idea of Self Efficacy as complete by Bandura (1977). He mentioned that individuals can be characterised mostly on the basis of their beliefs in their capability to regulate their lives, because those beliefs powerfully determine the effort they make to adjust to their area. Self-efficacy theory predicts that the greater an individual seems capable of predicting and controlling threatening incidents, the less prone he or she will be to panic or stress disorders in response to traumatic experiences. Therefore Patrick thinks he holds the main element to managing his diabetes, he will endeavour to place ideas into action to reduce his blood sugar, come to conditions along with his condition preventing further issues associated along with his Diabetes.
The self-management methodology views the average person as a dynamic agent in treatment. The purpose of self-management is to nurture skills such as behavioural management techniques and also to support educated decision making and problem handling, thereby equipping the individual with the required expertise to manage their condition.
This person-centred way focuses on personalisation of treatment and facilitation of self-reliance, allowing Patrick to continue day to day routine as normal without the forbearance on his life. It has been described as a patient-centred way based on value and compassion and has an emphasis on cooperation with patients (including collaborative goal-setting), self-management skills and psychosocial issues. Nurses would play a pivotal role in providing advice, guidance, education and support to Patrick. Self-management is important as it not only benefits the patient, but also provides wider opportunities for community and specialist nurses to use and develop their medical and interpersonal skills.
It was outlined in the case study that Patrick has started to develop Retinopathy. Diabetic Retinopathy is a vascular condition where the retinal capillaries tend to degenerate after a number of years. The condition is characterised by ocular haemorrhages, lipid exudate and the expansion of new blood vessels and connective tissues. This has led to poor eyesight which could prove difficult if not handled soon to prevent blindness. Patrick currently works as a bus drivers so his eyesight is vital to him to have the ability to continue to work and offer fiscally for his family. Diabetes-related difficulties can have a significant affect on the average person and members of the family, and are costly to the individual. There are a number of eyes conditions specifically associated with diabetes. These include temporary disturbances in lens form, related to hyperglycaemia and frequently seen at identification, and cataracts, like the rare 'sweets cataract' only observed in people with diabetes. However, DR is likely to affect most people with diabetes as the period of their condition raises (Williams and Pickup 1999). DR is one of the long-term micro vascular issues of diabetes mellitus which is the leading reason behind blindness in the working human population of the united kingdom (BDA 1995).
Ninety % of people with type 1 diabetes involve some degree of DR within 20 years of analysis and it's been suggested that it is present at diagnosis in 40 per cent of those with type 2 diabetes (Cummings 2002). A review has discovered that blindness was the most well known complication of diabetes (Diabetes UK 2000). Nevertheless the future for Patrick does not have to as bleak as it seems. The National Service Platform for Diabetes (DoH 2001) suggests early and regular verification for those diabetics.
Developing a plan of action/health care for Patrick should get started with a thorough nursing analysis which is vital to ensure a correct analysis regarding diabetic Retinopathy is manufactured. Patrick may complain primarily of the signs or symptoms of vitreous haemorrhage such as 'floaters', which appear to be small, black insects, or a lacy curtain over the field of vision. Macular involvement may be uncovered by the patient's explanation of an over-all deterioration in fine and coloring vision that's not improved by putting on a variety of spectacles. The main aim of screening for diabetic Retinopathy is to recognize patients with sight-threatening Retinopathy who may require preventive treatment. Testing and treatment for diabetic Retinopathy will not eliminate all circumstances of sight damage, but can be important in minimising the number of patients with sight loss as a result of this condition. The aim of a retinal verification program is to ensure that a yearly study of all patients in confirmed area is conducted (Walker and Rodgers 2002). This assessment should be achieved in front of you direct and speedy referral to an Ophthalmologist to screen and measure the degree of Retinopathy. Like a precautionary strategy, health education will include the best available research information to aid patients to make decisions about changes in lifestyle and gain control over their condition (Watkinson and Chetram 2005).
Micro vascular issues may be prevented or onset delayed with good treatment (Kanski 2007). The nurse should require Patrick and with agreement the family to identify areas such as diet and liquor consumption that can be altered to provide better and tighter glycaemic control. Degrees of blood sugar are set at preferably below HbA1c 6. 5-7. 5% based on the individual's concentrate on (NICE 2005). Patrick's is 9. 9% which puts him in the risk zone for expanding problems and increasing his risk of irreversible damage. The mark is based on the chance of macro vascular and micro vascular difficulties. Individuals with type 2 diabetes need to have an ongoing organised analysis every two to half a year, to assess the risk factor. A reduction in the prevalence of diabetic Retinopathy is associated with tighter blood sugar control (Younis et al 2002).
By involving the complete family in this change in lifestyle will persuade Patrick he's not by himself and provide him support. Making use of the initiative I talked about early in this assignment the log booklet/information guide offers helpful advice for lifestyle change. Setting Patrick some SMART goals/troubles allows him to keep up his control of his own body and increase conformity. The goal is to reduce his HbA1c to within the suitable target range reviewed above. A significant lifestyle change is necessary but must be achieved with concordance with Patrick and his family. It is noted that Patrick is over weight with a BMI of 29. 5. This can increase his risk of hypertension, which itself is one factor in Retinopathy as it does increase the pressure within the attention. Effective blood pressure management is as significant as blood sugar control in reducing the chance of development of diabetic Retinopathy in those with type 2 diabetes (UK Prospective Diabetes Study Group 2004). Good blood pressure control is known as to be at or below 140/80mmHg (NICE 2005).
Adherence to recommended anti hypertensive treatment is essential as diabetic patients with hypertension have a poor visible prognosis (NICE 2005). An appointment with Patrick's GP should be assemble to ascertain when there is any hypertension if found it's been shown that ACE inhibitors verify extremely effective in the reduction of high blood pressure in Diabetics. (NICE 2005). A couple of new techniques devised by the Division of Health to reduce the use of medication in weight loss and increase exercise in the population. Free weigh damage classes are offered to patients who meet the requirements. Patrick would benefit from these strategies. Medication management and demanding concordance with the plan is incredibly important to ensure Patrick preserves an even of the drugs in his body. If it's adhered to it can be that he'll not have to adopt insulin.
By providing ongoing internal support to Patrick and also to his family the nurse can help the patient to maintain his or her self-esteem and improve self-management of the condition. Visible impairment in patients with diabetes is often compounded by the increased loss of self-management skills, which may have psychosocial implications (Hall and Waterman 1997). Reactions to aesthetic damage can also lead to mental health problems such as melancholy, suicidal thoughts and anxiousness (Hall and Waterman 1997). It is therefore the nurse's obligation to discuss these issues with the patient and relatives and offer appropriate support (Nursing and Midwifery Council (NMC) 2004). Organisations such as Diabetes UK and the Royal Country wide Institute of Blind People (RNIB) can also provide ongoing help and support. Regular verification and do it again follow ups should ensure Patrick's Retinopathy will not continue to aggravate.
Nearly two decades ago Fielding and Llewellyn (1987) remarked that effective nurse-patient communication was central to the grade of treatment that patients received, saying rather poignantly that: 'Communication is both one of the most strenuous and difficult areas of a nurse's job, and one that is frequently averted or done badly although central to the grade of patient care. 'Encouraging people to change their frame of mind towards a ailment is an important part of any health education programme, but people's prices can be specifically resistant to improve. Even when clients are persuaded to change their attitude (for example towards diet, smoking, safer gender) it is aggravating for nurses to realise that this might not lead to a big change in their behaviour. An understanding of the complex relationship between someone's knowledge, attitude and behaviour can help medical researchers in realising why clients may continue to respond in a certain way, despite health advice to the in contrast. Persuasive communication theory offers specific techniques that can be used effectively within health advertising. It's important for the nurse to listen to Patrick's concerns and endeavour to offer counsel or help.
I have attempted to prove in this project that communication with Patrick and his family is of the utmost importance to ensure concordance and so improve his control of his condition. By educating both gatherings it shows Patrick that he's not by yourself and he can gain support from his family and other networks accessible to him such as local organizations.
It has been brought up in the event study that Patrick drives a bus and consequently of his poor control of his Diabetes, he has been falling asleep at the steering wheel. This gives the nurse with a significant ethical dilemma. Bound by the NMC professional code of conduct means nurses are restricted to what information they can release.
A disconcerting feature of ethics can be its association with apparently sophisticated ideas such as utilitarianism (the moral value associated with an action depends upon its overall gain) and de-ontologyy (worried about sticking with moral rules or moral work rather than with the consequences of activities) (Beauchamp and Childress 2001). These founded theories are important the different parts of ethics and can help to guide decisions. The general guidelines of Ethics are that of Keeping away from Damage and moral obligations and duties. As a nurse we've a moral obligation to inform the DVLA as it is in the public best interest to prevent harm approaching to others if Patrick falls asleep at the wheel, thus avoiding injury to others.
In this project I've endeavoured showing that the key to managing Patrick's Diabetes is through effective communication, self-efficacy/self management and family engagement. By stimulating Patrick to check out his life and analyse his lifestyle he's on the path to effective self applied management. Change is only possible if Patrick's frame of mind towards his condition alters. By offering him the option of utilising the logbook he can challenge his attitudes with the main seeks/challenges of keeping further problems at bay, preserving tighter glycaemic control and thus lowering his HbA1c.