92443 Optimising Care In Chronic Conditions 2

Question:

Three case studies

1. Select one case study from below
   1. Case study 1 Jean
   2. Case study 2 Harry
   3. Case study 3 Joel
2. Apply it to your selected chronic illness (see list)
3. Nominate an area or district (anywhere in NSW, Australia).

Case study 1 Jean

Jean is a 55-year-old woman. She has previously been diagnosed with a chronic condition and recently experienced an exacerbation of symptoms. Jean does not like attending the hospital as she has states that everyone is in a rush that no one really listens to her, she is concerned about the lack of privacy when clinical staff discuss her condition and worries if an appropriate care plan has been made that will support her health on discharge. Jean is taking regular medication although she confides that it is sometimes difficult to remember her medication particularly when she is feeling unwell.

Jean describes her marriage of 36 years as fairly happy she enjoys her children and grandchildren. Jean smokes ten cigarettes a day she knows this is not good however finds it difficult to quit as her husband also smokes. Jean had noticed some weight gain over the years regardless she was embarrassed at her last clinic visit when the nurse had suggested a weight management plan. During the week dinner mainly consists of takeaway with a few fruits and vegetables. She does not drink alcohol, however, has six cans of soft drink a day. On the weekend Jean has the family over as she cooks a traditional meal and they socialise.

Case study 2 Harry

Harry is a 68-year-old man who lives alone. His wife of 49 years died five years ago. He has five children, four of whom are married with children and live some distance away from him. Harry has one son who is single and has never married. He lives in the same locality as Harry and visits him at least weekly, during football season they watch the game together.  Harry

shops at his local Woolworths where he purchases frozen ready to cook meals as he finds that fresh produce spoils in his fridge. Harry takes pride in his rose garden and ensures his lawn is always well manicured.

Harry was diagnosed with a chronic condition some time ago. In the past he has managed to maintain a full and active life but recently he has struggled at times to cope with this condition. Now Harry has stopped going to the Bowling Club and attending the Men’s Shed of which he is a foundation member. When asked Harry feels that his health can no longer manage these trips. Harry’s children have developed a belief that Harry has become a hypochondriac over the last four year and attributed this to him being lonely since the passing of his wife.

Case Study 3 Joel .

Joel is a 13-year-old teenager who lives with his mother Kate and 16-year-old sister.. Joel’s parents are separated he visits with his father and paternal grandparents on two days of each week. Kate works part-time at the local council performing administrative duties to make ends meet financially. She maintains a small garden at the rear of the house where she grows produce for the family’s consumption. Joel was diagnosed with a chronic condition some time ago. Kate believes in supporting Joel’s health holistically, this has influenced his dietary choices and preference for health care regimes.

This month Joel is starting high school, like most students he desperately wants to fit in with his new environment. Joel becomes anxious when he speaks of the students finding out about his chronic condition he is convinced that they will treat him differently. He is concerned the condition will restrict him from participating in bonding activities such as camps, parties or sports. Joel confides that he thinks his condition makes him look different from the other boys. He gets angry sometimes as he does not understand why this has happened to him. Joel does not like taking his medication and recently requested that he cease treatment for a short while so he can feel like a normal teen.

Task: Person centred care plan

1. With the selected chronic illness, select one case study and apply the illness to this case (a selection of case studies will be provided).

2. Research the selected chronic illness and optimal care. Consider person-centred, holistic care in which all aspects of the patient’s wellbeing are considered.

3. Introduction -Provide a summary of evidence explaining key factors for optimal care delivery for people living with the chosen chronic illness.

4. Powerlessness – Critically discuss the ways in which nurses can facilitate empowerment and self-management for clients and their families/carers in order to achieve a good quality of life for your chosen chronic illness and case scenario.

5. Local resources – Consider the recommendations for the patient (and their family’s) care within one particular local area or health district. This enhanced by investigation into local resources available, specific to a designated local area or health district.

6. Challenges – Link care recommendations to the available resources and discuss potential challenges or barriers.

7. Conclusion – Provide three specific nursing actions you will take into your future practice to optimise care in chronic conditions.

8. Referencing – all discussions must be supported from high quality sources (including journals, textbooks or government policy). Additional references, beside the subject materials are essential to inform optimal care and management for this assignment.

Answer:

Introduction:

Diabetes mellitus is a chronic disease condition that has major social and economic impact. It is a disease characterized by metabolic dysfunction with a degenerative potential and changes in the production of insulin. The burden of the disease is increasing worldwide and people living with the condition need continuous self-management support to adapt to the illness. The factors that is necessary for optimal care delivery of people living with chronic illness includes empowerment, social support, education, good diet, physical activity and healthy lifestyle. The main purpose of this essay is to discuss about the disease in the context of the case study of Jean, a 55 year old woman who has been diagnosed with diabetes and living in the local district of western Sydney. Recently she has experienced exacerbation of symptoms. The main purpose of this report is to critically discuss ways in which nurse can facilitate empowerment and self-management for Jean and find local resources that may be useful in the management of the condition. The essay will look at potential challenges or barriers to utilization of local resources for the management of health condition of Jean.

Powerlessness:

After looking at the health condition of Jean, it can be said that he is need of empowerment related support too. This is said because despite exacerbation of symptoms, she did not wanted to visit the hospital. She does not trust the hospital care staffs and she believes that the clinical staffs violate their privacy during discussion. Patients diagnosed with diabetes often experience powerlessness and feelings of disempowerment. Powerlessness is defined as a state or feeling of no control over oneself and lack of direction regarding management of issue. In addition, Castro et al. (2016) defined empowerment as the ability to self-manage the disease and implement treatment through reinforcement of self-efficacy and control over one’s health behaviour. Evidence on perspective of patient with chronic disease condition revealed that by promoting empowerment into practice, a negotiation process can be implemented to help patient participate in their care decisions. The key features of an empowering staff-patient relationship include patient-centredness, continuity, acknowledgment and relatedness (Gomez-Velasco et al., 2019). Nurses have a critical role in empowering clients like Jean so that they develop the skills to cope with the burden of chronic disease. Using the empowerment approach, nurses can work to promote empowerment of Jean by helping her make informed decisions and address feelings of poor knowledge on management of the condition. By providing complete knowledge on diabetes, its risk factor and its management, nurses can empower patients to make rationale decisions, use resources to implement decisions and achieve better compliance with treatment regimen (Tol et al., 2015). In addition, knowledge and skills on disease management can empower Jean as she will be able to control her negative behaviour to improve quality of life. The goal of empowerment will be achieved when she develops the ability for critical thinking, self-care and independence to take sound decisions regarding health (Gomez-Velasco et al., 2019).

In addition, self-management related support is vital for Jean as currently she lacks skills to appropriate control her blood glucose level. She also has other health behaviour that can negatively influence her health. For instance, Jean is engaged in smoking, experiencing weight gain issues and consumes six cans of soft drink per day. If she continues with smoking, it may affect lead to hyperglycemia and accelerate vascular damage. Hence, proper self-management related education may promote Jean’s interest in quitting smoking and reducing risk of macrovascular and microvascular complications (Campagna et al., 2019). To increase self-management education, nurses can promote self-efficacy and self-care behaviours of Jean by increasing her access to health information that promotes self-care. With the availability of internet and mobile applications, nurses can use mobile apps and telemedicine to develop diabetes knowledge and self-care skills and reduce frequency of diabetes. The areas that can be explored by nurses include physical activity, medication, self-monitoring, nutritional plan and behavioural change. The context of behavioural change is particularly more important for Jean as she is consuming soft drinks every day. Aerated drinks can have negative impact on glycemic control and restricting use of such drinks can promote weight loss and improvement in glucose control too (Hollrah et al., 2017). Thus, when nurse will implement self-management education (SME), Jean can develop coping skills and behaviours needed to self-manage on a continuous basis. SME strategy can address patient’s health belief, cultural needs, financial status and emotional concerns of patient with diabetes (Powers et al., 2017).

Local resources:

According to the guidelines for the management of diabetes in Western Sydney, the goal is to increase the proportion of healthy population and reduce the number of people who are at risk of diabetes. The Western Sydney Diabetes Plan 2019 recommends implementing primary prevention strategy by improving food consumption, increasing physical activity and building healthy environment. In addition, for secondary prevention and management, the Western Sydney government has implemented services for HbA1c testing, lifestyle coaching, GP support line, integrate, in-hospital care, community eye program and in-hospital health clinic (NSW Government, 2015). They have tried to adapt a whole of district approach by connecting several types of diabetes services together. Several eHealth technologies have been implemented to provide comprehensive diabetes services and education to patient. Such services are likely to provide all support needed by Jean to provide optimal care and control risk of complications (NSW Government, 2019).

The advantage for people with diabetes living in Western Sydney is that they can get access to multi-sector services for promotion of health and improving lifestyle. This includes preventive strategies aligned to address social determinants of health, implementation of lifestyle coaching, enhanced management by GPs and specialised consultation and care. In case of Jean, her diet pattern is a concern as she is consuming soft drinks per day and has very few fruits and vegetables (NSW Government, 2015).. Her increase in weight gain is an indication too that she needs support in the management of diet. Some of the local resources in that can be useful for Jean to improve her food consumption pattern includes Get Kids Cooking, OzHarvest and various kitchen gardens in Black town school. The advantage of services like OzHarvest is that it finances cooking classes for people with social disadvantage. Due to weight gain and diabetes, Jean is at need of physical activity too. Jean can get the activity to engage in physical activity by using Parklands in Great West Walk. RunWest and Lions Club community forums are also aimed at increasing activity of residents (NSW Government, 2019). Smoking is one health behaviour that can be associated with detrimental outcome for Jean. The local resources in Western Sydney that can support her to quit smoking include the WSLHD Tobacco Control Program that gives education to diabetic people about the benefits of quitting smoking. The staffs of this program work to create smoke-free environment and improve ability of health care staffs to work on tobacco control (WSLHD, 2019).

Challenges:

The care recommendation proposed for supporting diabetic patient included controlling glycemic level and reducing the likelihood of complications. To achieve this goal, the local resources in Western Sydney mainly focused on engaging in multi-sector partnership and increasing access to appropriate food, physical activity, life style intervention and secondary prevention related support. However, some of the challenges or barrier to the utilization of resource might include cultural barriers and motivation related barriers. This is said because Jean has different cultural values and ways to socialize. She likes cooking traditional meal. Hence, there is a possibility that these services might fail to adhere traditional or cultural needs of patient. Motivation related issue can act as a barrier as it can affect participation in diabetes prevention program. According to Edelman (2017), motivation is the key to adherence to any primary or secondary prevention strategy.

Conclusion:

From the discussion regarding the evaluation of person-centred care and holistic care for Jean, it can be concluded that patient with diabetes are vulnerable to poor outcome if there health behaviour is not appropriately managed. Certain negative health behaviours like poor diet, smoking and consumption of aerated drinks are factors that can leads to increase in hyperglycemia and further increase risk of microvascular and macrovascular complications. From the analysis, it has been found that patients with diagnosis are not only in need of pharmacological intervention, but also non-pharmacological intervention to meet holistc care needs and promote quality of life. In future practice, three nursing actions that will be vital to optimize health of diabetic individuals include empowering patient, educating patient on self-management skills and implementing lifestyle intervention. The first nursing action of empowerment is crucial because newly diagnosed diabetic patient mostly suffer from feelings of powerlessness and confusion. They are in need of support and guidance to raise their morale. Secondly, in future nursing practice, it is planned to implement self-management education that focus on holistic well-being of clients. Nursing action is this area will be implemented with a patient-centred focus and the main rationale behind this intervention is  that diabetes is a lifelong disease and self-management skill is the key control exacerbation and better self-control on the disease. Thirdly, lifestyle intervention will be prioritized because issues like hyperglycemia and poor blood glucose control occurs because of poor lifestyle. Prioritize lifestyle change in diabetic patient will lead to control of diabetes related outcome, reduce health cost and better quality of life too.

References:    

Campagna, D., Alamo, A., Di Pino, A., Russo, C., Calogero, A. E., Purrello, F., & Polosa, R. (2019). Smoking and diabetes: dangerous liaisons and confusing relationships. Diabetology & metabolic syndrome, 11(1), 1-12.

Castro, E. M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W., & Van Hecke, A. (2016). Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient education and counseling, 99(12), 1923-1939.

Edelman, S. V. (2017). Taking Control Of Your Diabetes: An Innovative Approach to Improving Diabetes Care Through Educating, Motivating, and Making the Connection Between Patients and Health Care Providers. Clinical Diabetes, 35(5), 333-339.

Gomez-Velasco, D. V., Almeda-Valdes, P., Martagon, A. J., Galán-Ramírez, G. A., & Aguilar-Salinas, C. A. (2019). Empowerment of patients with type 2 diabetes: current perspectives. Diabetes, metabolic syndrome and obesity: targets and therapy, 12, 1311.

Hollrah, D., Dawson, K., Kennedye, P., & Palmer, P. (2017). Question: In patients with type 2 diabetes, does diet soda consumption contribute to decline in blood sugar control?. The Journal of the Oklahoma State Medical Association, 110(4), 206.

NSW Government (2015). Western Sydney Diabetes Prevention and Management Initiative. Retrieved from: file:///C:/Users/User00/Downloads/WSLHD_Diabetes_PreventionManagementBook_FA.pdf

NSW Government (2019). WESTERN SYDNEY DIABETES PLAN 2019. Retrieved from: https://www.westernsydneydiabetes.com.au/themes/default/basemedia/content/files/WSD_Plan_2019.pdf

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Tol, A., Alhani, F., Shojaeazadeh, D., Sharifirad, G., & Moazam, N. (2015). An empowering approach to promote the quality of life and self-management among type 2 diabetic patients. Journal of education and health promotion, 4.

WSLHD (2019). Smoke Free: Health promotion action to prevent smoking related-harm in our community. Retrieved from: https://www.wslhd.health.nsw.gov.au/Population-Health-Services/Services-and-Programs/Smoke-Free