Susan is a 45-year-old woman living in the rural areas and is a single parent to her two children of age 13 and 15. She is not employed now. She is mainly living on unemployment benefits scheme. This makes her live on a very tight budget. She is suffering from type-2 diabetes and is currently gaining on weight. She does not like exercise due to lack of motivation and frequently needs to go to the toilet. Susan eats processed foods. This is mainly because they are cheap and she does not have to cook. The assignment will mainly portray the various roles that will be played by the community nurses in assisting her to cope with the disorder effectively. Moreover, the social and behavioral determinants of the health would be identified and accordingly the nurses will incorporate motivation interviewing in the care plan. This would be helping Susan to overcome the various issues she is facing due to her disorder, helping her to live better quality life.
Reports provided by the Australian Institute for Health and Welfare (AIHW) had shown that there were about 16,400 deaths in the nation of Australia with about half of the patients accounting for about 55% mainly due to tupe-2 diabetes (Diabetes snaphot, AIWH, 2018). About 1 million hospitalizations had been associated with type 2 diabetes in the year 2015 to 2016 (Boyle, Saunders & Drury, 2016, pg: 1986). The rates were found to be similar among males and females with slight differences of males being at 6% and females being at 5%. Age specific rates for the females were found to be higher than the males for those above 55 years and above (Rawal et al., 2015, pg: 205). Insulin treated type-2 diabetes were seen to be 1.5 times higher in males than that of the females accounting for about 74 in comparison to 49 per 100000 respectively. Some of the immediate impacts of the disorder are increased thirst as well as frequent urination, increased hunger, fatigue, blurring of the visions, slow healing of wounds as well as areas of the darkened skin. Often long-term complications are also seen like the damaging of the large blood vessels of the heart, brain as well as the legs increasing chances of cardiovascular disorders. It might also affect the smaller blood vessels causing diabetic retinopathy, kidney disorders (Fenwick et al., 2018, pg: 667). It also causes neuropathy and foot ulcers. Susan has already started getting complications like excessive fatigue, frequent urination, stressed as well as others. Therefore, it is extremely important for Susan to take measures by in order to prevent any form of complications in the upcoming days as that would result in further suffering of the patient and more expenditure and financial outflow. As she is a single mother, her children would be also affected, and they would be stressed by the occurrence of such disorder. Hence, the community nurse needs to provide her comprehensive care that would help Susan to prevent deterioration of the condition and helping her to cope with the disorder.
As per the definition provided by the world Health organization, social determinants of health are the conditions in which people survives like they are take birth, grow, live, work and age. They determine the wider set of the forces as well as the systems that help in the shaping of the conditions where people live (Smith et al., 2016, pg: 360). Out of different 10 social determinants that had been put forward by the WHO, it has been seen that unemployment is the main social determinant that had partly affected the occurrence and deterioration of the situation. She has been unemployed and she has to live under very tight budget. Studies have shown unemployment to be intricately associated with diabetes stating that unemployment may be one of the social determinants that influence many factors which directly causes diabetes (Volaco et al., 2018, pg: 321). This social determinant is indirectly associated with two other determinants out forward by WHO these are food and stress. Poor quality food results in increase in calorie intake as well as lessens the chances of nutritional intake in the individuals. Moreover, poor quality foods also increased chances of microorganism infection. All these result in poor quality health. Moreover, lower income and unemployment creates huge amount of stress among the affected individuals and this stress thereby acts as another social determinants of health for the development of various chronic disorders. In case of the patient, it was seen that she was unemployed, and she had to live on tight budgets (Patel et al., 2016, pg: 796). Moreover, she could not afford quality organic food and only bought processed foods. Processed foods are low in nutrition and higher in calories and this aspect results in huge calorie gain in the individuals (Type 2 Diabetes Management GP Guidelines, 2016). Such amount of calorie gain thereby increases the chance of obesity that is also one of the risk factors for diabetes type-2 (Walker et al., 2014, pg: 30. Therefore, similar situation might have happened for Susan that had made her develop the disorder. She is already gaining weight, and this supports the rationale of her developing chances of obesity and diabetes. Stress is another social determinant that is associated with diabetes. When individuals develop stress, the blood sugar levels rise. Stress hormone like cortisol and epinephrine starts acting vigorously to boost energy. Therefore, all these determinants might have made Susan develop the disorder.
Researchers are of the opinion health is determined by the complex interactions between the different social as well as economic factors along with contribution of the physical environment and the individual behaviors. One of the most important behaviors that is often observed among diabetes patients is their lack of motivation to exercise (Goyal et al., 2016, pg:100). Physical inactivity is associated with occurrence of obesity and this directly increases the chance of the diabetes. Moreover, the case study has shown that Susan has been increasing body weight due to her lack of motivation in being physically active and undertaking of exercises. Researchers are of the opinion that when individuals exercise, muscles are seen to become more sensitive to insulin and thereby absorb glucose from the blood. However, Susan is seen to completely lack motivation and does not show any proactive behavior in being physically active and overcome sedentary lifestyle. He is often seen to prefer processed foods as it saves her from cooking (Ouyang et al., 2015, pg: 430). Such behaviors need to be changed and she needs to be highly proactive in taking up self-management interventions for coping with the symptoms of diabetes and overcoming the barriers (Walker et al., 2016, pg: 363)). Susan is also seen not to cook food and tries to escape from the job of cooking by in taking of processed foods. Such processed foods are the highest contributors to conditions of being overweight or obese as the calories contained by such foods are high and results in weight gain and increase in the blood glucose level (Namadian et al., 2016, pg:93). Eating of the carbohydrates with low glycemic index is indeed significant for the maintenance of the blood sugar levels. However, Susan is not following such diet as she is having carbohydrates high on glycemic index. This increases the chance of diabetes or high blood glucose levels in the individuals (Feinman et al., 2015, pg: 12). These kinds of behaviors need to be changed where Susan needs to be encouraged to pick up healthy behaviors and thereby prevent the chances of deterioration of the situation.
Motivational interviewing can be defined as the collaborative goal oriented style of communication that associates with the particular attention for strengthening of the personal motivation for and commitment towards meeting a particular goal. This is done by eliciting as well as exploring the reasons of the change for the person within an atmosphere for acceptance as well as compassion. This is mainly applied for the diabetes patients for encouraging them in discussion of their behaviors that remain associated with their self-management. It also remains associated with assisting patients in their motivation as well as confidence for making different types of changes that will help in the improvement of the diabetes control (Christie et al., 2014, pg: 381). Therefore, while interacting with Susan, the nurse needs to undertake this procedure to help Susan change her behaviors and make her more motivated to lead a healthy lifestyle to cope with the symptoms of the chronic ailments of diabetes type-2. The spirit of motivational interviewing is effective collaboration and partnering of the nurse with the patient. The second one is evocation where the nurse needs to elicit the desires as well as reasons for change in the patients. The nurse should give advice only with the permission of the patient. The third one is autonomy where nurses need to respect and honor the autonomy of the patient (Pladevall et al., 2014, pg: 136. The nurse needs to allow Susan to be in control of her own desires. The fourth aspect is compassion where the professional need to promote the welfare of the patient actively. The main principles that the community nurse should follow while undertaking motivational interviewing for Susan are to based as RULE formula. “R” for resisting the righting reflex, “U” for understanding the motivation of the patient, “L” for listening to the patient and “E” for empowering of the patient is the principles to be followed (Elwyn et al., 2014, pg: 270). The nurse should take the counseling strategy to engage Susan in the patient centered communication by asking her open-ended questions and probes, for affirming Susan in sharing her information, reflecting on what she says and providing statements and summarizing the nature of the discussion. It would help in assessing her confidence, ability as well as commitment for achieving the agreed goad that are mainly the key components of the successful behavior changes.
Conclusion:
From the above discussion, it is seen that the diabetes is a chronic condition and is affecting many individuals in the nation of Australia. Different types of social determinants and behavioral determinants of health can result in development of this disorder. It is seen that often management of such determinants of health are an important criterion for nurses. In order to change the behaviors for ensuring better self-management of the disorders, nurses can undertake motivational interviewing. The nurse in the case study would first develop care plans for realizing the social and biological determinants of health and then undertake motivational interviewing for helping Susan change her behaviors and be more motivated in self-care and management.
References:
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