Type one diabetes is a chronic condition that is characterized by autoimmune destruction of beta cells that are responsible for the production of insulin in the body (American Diabetes Association, 2019). As a result, the amount of insulin produced in the pancreas is reduced leading to the insufficient synthesis of blood glucose. It is important to individualize diabetes care for each patient to achieve the best health outcomes. One of the ways of realizing optimal diabetes care is through a patient-centered approach. This approach to care helps in creating nurse-patient partnerships that can be used to promote the exchange of information and work towards a common goal (Powell et al., 2015). In patient-centered care, the nurse should appreciate the choices of the patient even if it is not the nurse’s first choice. For example, in the provided case study, Joel expresses his desire to cease treatment for a while. In patient-centered care, the nurse is encouraged to accept the choice of Joel and support him in implementing an intervention that may suit his current needs (Powell et al., 2015). This enhances empowerment and self-management of the condition.
Another way of realizing optimal care in type 1 diabetes is through a holistic approach to care. In holistic care, the focus is on treating the spirit, body, and mind of the patient (Likitmaskul et al., 2016). Holistic care encourages patients to maintain a positive attitude and engage in activities such as arts, physical activities, and music to keep a healthy mindset to cope with their condition (Likitmaskul et al., 2016). Like in the provided case study, providing holistic care to Joel should involve encouraging Joel to participate in activities such as sports, parties, and camps in school. His mindset should be changed to prevent him from thinking that he is different from other students. This can help in improving health outcomes and enhancing Joel’s quality of life.
Powerlessness may be defined as the tendency of a patient to perceive that their actions may not bring significant changes in health outcomes. They, therefore, surrender control of the situation to the health care system and clinicians (Sheridan et al., 2012). Empowerment is the process through which patients gain greater control of the decisions and choices that affect their care (Wakefield et al., 2018). Self-management can be described as the process by which patients actively participate in their care (van Smoorenburg et al., 2019). The influence of individualized diabetes self-management on health outcomes cannot be overstated. Empowering patients to take control of their care is essential in the management. Self-management and empowerment are important tools that can be used to enhance the patient’s ability to act autonomously and take charge of their health (?uczy?ski et al., 2019). One of the ways of facilitating empowerment and self-management is through patient education. According to Haas et al. (2012), patient education on diabetes self-management is essential in preventing diabetes-related complications. It is important to adapt the education according to the patient’s capabilities to take care of themselves. This helps in meeting health care goals and improving health outcomes (?uczy?ski et al., 2019).
Patient education on self-management of type 1 diabetes may involve nutritional counseling, exercises, monitoring blood glucose, and how to deal with psychological stress associated with type 1 diabetes. Nutritional counseling is a crucial aspect of diabetes self-management. This intervention empowers the patient to daily manage their condition through healthy eating plans (Abdelghaffar, 2015). Self-management also involves empowering patients to understand the significance of physical exercises on their health and wellbeing. Exercising is important in lowering blood glucose levels thus enhancing the management of diabetes (Abdelghaffar, 2015). Healthy management of type 1 diabetes requires psychological adjustments to manage stress and anxiety (Powers & Marrero, 2016). Like in the provided scenario, Joel should be taught various stress management techniques to ensure that he does not feel powerless about his condition especially now that he is about to join high school.
Another way of facilitating empowerment and diabetes self-management is through shared decision-making in a patient-centered approach. In shared decision-making, the patient and the nurse work collaboratively to enhance care delivery and promote health outcomes. Shared decision-making, especially in Joel’s case, may value the opinions and ideas of his mother who may be responsible for making most clinical decisions regarding Joel’s care. In a study conducted by Powell et al. (2015), the authors established that teenagers preferred being involved in the decision-making process regarding the management of their diabetes. This helps in improving compliance with medication and recommended interventions. Powell et al. (2015) also established that through shared decision-making nurses can comfortably advise clients on how to improve their self-management skills for better health outcomes.
Diabetes care is important in preventing diabetes-related complications. A suitable model of care should be designed to suit the health care needs of the patient and their family. The care model should be patient-centered and should employ holistic approach for better health outcomes. In the case of Joel, it may be important for him and his mother to link up with diabetes groups within the local region for peer support. This kind of support is important in ensuring that patients do not feel alone. In Wollongong, Joel and his mother can get a diabetes support group at Illawarra Diabetes Service Medical Center. At this facility, patient education, exercise services, and dietetics services are also offered. This helps in treating the patient as a whole and not just their physical condition.
Patient education should also be included in the model of care to improve Joel’s health outcomes and quality of life. Diabetes self-management education is provided by a multidisciplinary team to ensure that the patient understands the significance of appropriate management of diabetes (Powers & Marrero, 2016). Education programs must be quality assured and patient-centered to ensure that the needs of the patient are fulfilled. Additionally, the program should be available for the patient and their family. Given that Joel is soon joining high school, it may be important in the future to involve one staff member from the school in the education program to enhance the management of type 1 diabetes. The education program should also involve dietetics education to help the patient in proper nutritional management (Powers & Marrero, 2016). Research has shown that better nutritional management improves glycemic control. This plan of care is available at Diabetes NSW- Wollongong. The model of care should also integrate a mechanism for routine follow-ups, especially in the outpatient setting. The follow-up should be done at least three times every month to check the patient’s progress.
The provision of patient-centered care to suit the health needs of the patient is important but may be faced with challenges, thus jeopardizing health care delivery. One of the challenges that could be experienced in the delivery of patient-centered care based on the available services mentioned above is financial issues (Powell et al., 2015). Joel’s mother works as a part-time administrator at the local council and the money she gets from her part-time job helps with making ends meet. It may, therefore, be financially straining for her to pay for the health care services at Diabetes NSW- Wollongong. Another potential barrier to access to care could be time limitations. Limitation of time on both the part of the patient and the provider may make it difficult for the patient and their family to access educational programs due to other commitments. Time limitations can also affect follow-ups, thus making it difficult to track the progress of the patient (Powell et al., 2015). Poor motivation may also affect Joel’s ability to access the health care services mentioned above. The case study provided indicates that Joel is tired of taking his medications. This attitude may affect his motivation for other interventions such as education and dietetics services thus affecting the quality of care.
Conclusion
Effective and efficient care provision is very significant in the management of chronic conditions like in Joel’s case. For care delivery to be effective and efficient, nurses must employ patient-centered and holistic care. These are some of the most important nursing aspects that will inform my future practice. In future practice, I intend to educate my patients on the importance of nutritional balance to help in glycemic control. Education regarding nutritional balance will involve teaching the patient how to count carbohydrates and the types of food to avoid (Powers & Marrero, 2016). To ensure the successful implementation of this nursing action, I will involve the input of a dietician to ensure that the patient understands what they should or should not consume.
I also intend to empower my patients in the future to take charge of their care plans and enhance the promotion of wellness. This action will involve giving patients the power to manage their conditions and improve health outcomes. Self-care will revolve around self-administration of insulin as directed to ensure that blood glucose is maintained below 180 mg/dL. Studies have revealed that patient empowerment helps in promoting adherence to mediation and compliance with nursing interventions, thus leading to better health outcomes (Wakefield et al., 2018). I will, therefore, encourage my patients to take a central role in their care and make decisions that suit their health needs.
Another nursing action that I intend to undertake in my future plan is actively involving the patient and their family in care. Family involvement, especially in pediatric care is important in ensuring that the long-term health needs of the child are fulfilled. Studies have shown that family-centered care improves coping mechanisms, improves health outcomes, promotes consumer satisfaction, and reduces the cost of care in some instances (Festini, 2014). This approach to care can be integrated with patient-centered care to ensure optimal delivery of care. I believe that the nursing actions discussed in this section of the paper will ensure that I deliver quality and safe care to my patient and improve their quality of life.
References
Abdelghaffar, S. (2015). Nutritional Management of Type 1 Diabetes. Major Topics in Type 1 Diabetes, 121.
American Diabetes Association. (2019). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement 1), S13-S28.
Festini, F. (2014). Family-centered care. In Italian journal of pediatrics (Vol. 40, No. 1, p. A33). BioMed Central.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & McLaughlin, S. (2012). National standards for diabetes self-management education and support. The Diabetes Educator, 38(5), 619-629.
Likitmaskul, S., Sahakitrungruang, T., Numbenjapon, N., Sriussadaporn, P., & Nitiyanant, W. (2016). Outcomes of holistic care for patients with type 1 diabetes (T1D) by multidisciplinary teams in Thailand. Diabetes Research and Clinical Practice, 120, S123.
?uczy?ski, W., ?azarczyk, I., Szlachcikowska, I., Kiernozek, ?., Kaczmarek, A., Szylaj, O., … & Bossowski, A. (2019). The Empowerment of Adolescents with Type 1 Diabetes Is Associated with Their Executive Functions. BioMed research international, 2019.
Powell, P., D Corathers, S., Raymond, J., & Streisand, R. (2015). New approaches to providing individualized diabetes care in the 21st century. Current diabetes reviews, 11(4), 222-230.
Powers, M. A., & Marrero, D. (2016). 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. Diabetes Care 2015; 38: 1372-1382. Diabetes Care, 39(1), e17.
Sheridan, N., Kenealy, T., Kidd, J., Schmidt-Busby, J., Hand, J., & Raphael, D. et al. (2012). Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study. Health Expectations, 18(1), 32-43. https://doi.org/10.1111/hex.12006
van Smoorenburg, A. N., Hertroijs, D. F., Dekkers, T., Elissen, A. M., & Melles, M. (2019). Patients’ perspective on self-management: type 2 diabetes in daily life. BMC health services research, 19(1), 1-8.
Wakefield, D., Bayly, J., Selman, L. E., Firth, A. M., Higginson, I. J., & Murtagh, F. E. (2018). Patient empowerment, what does it mean for adults in the advanced stages of a life-limiting illness: A systematic review using critical interpretive synthesis. Palliative medicine, 32(8), 1288-1304.
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