The paper aims to provide health promotion for a 15-year old child, Ms. Lee, who has been diagnosed with Type 1 Diabetes. In addition, the paper will provide the education suggested for the client on the chosen issue and the way both the nurse and the client could work together to address it properly. In providing health promotion strategies, the paper will first conduct a review of the literature to identify the works that have been done in this field. Type 1 Diabetes occurs majorly in adolescents and hence, it is also called Juvenile Diabetes. The illness causes the sufferer’s immune system to weaken as it destroys the cells in the pancreas known as beta cells that make insulin. A hormone, insulin helps transfer glucose or sugar to the tissues in the human body and it is also used as fuel by the cells. Due to Type 1 Diabetes, the insulin could not be formed, which results in the weakening of the immune system. Although diabetes might be diagnosed at a young age, it continues to affect the sufferer throughout life. Proper care and treatment help reduce the risks of other illnesses caused due to it.
Ms. Lee is a high school student and is a First Nations citizen. She has had episodes of dehydration since she was 7-years old. Her parents decided to have her diagnosed after severe weight loss and incidents of fainting. However, the intervention strategies proved difficult for the family to follow, as they had to travel long distances to take insulin. Ms. Lee is concerned about the complications of her illness and wants to follow a routine that could be easy to follow. Considering her concerns, it has been decided that she must be given education on injecting insulin as well as maintaining a strict diet. The client developed Type 1 Diabetes owing to the autoimmune disease she developed that caused her pancreas to weaken. Apart from that, her family history also indicated that she would develop this illness as her father had Type 1 Diabetes too.
With the help of Gordon’s Functional Health Patterns, a holistic assessment of the client’s health has been conducted. The client stated that she has never had any other issue other than fainting quite often and weight loss although, she held that it was due to her weakness and not diabetes. Ms. Lee stated that she has had a head injury in the past and believed this could be one of the reasons for her weakness. She states that she got to know about her illness only during one of the sessions with the nurse.
The client’s nutritional metabolic pattern revealed that Ms. Lee has had inadequate nutrition and resulted in deficient fluid volume. Client’s weight loss is indicative of the nutritional metabolic pattern. Chronic weight loss has been an issue for the client. In terms of eating habits, junk food intake has been on the rise especially after entering high school. The urinary elimination pattern of the client is not as per normal pattern as it is very frequent and discomforting as per the client.
In the Activity-exercise pattern, the client stated that she often feels exhausted and could not gather sufficient energy to do usual activities. The sleep-rest pattern of the client is also disturbed. The client stated that she finds it difficult to sleep immediately after going to bed. Irregular sleeping patterns have also been identified. In terms of cognitive-perceptual pattern, the client only has issues with her vision and hence, wears glasses. While describing herself, the client demonstrated positivity despite physical illness. However, some level of frustration and anger was also visible. The client lives with family and has a peaceful home environment although she demonstrated some level of anger towards the father. When asked, the client stated that because her father had Type 1 Diabetes, it got into her as well and she thinks it is her father’s fault.
In Canada, the occurrence of Type 1 Diabetes, also known as ‘juvenile diabetes’ is most prevalent in adolescents aged between one to 19 years (Canada.ca, 2018). Although research also suggests that the Type 1 Diabetes occurs most commonly in children hailing from northern European descendant, cases in Indigenous population is on the rise as well. As Patterson et al. (2014) notes, with the global rise in both Type 1 and Type 2 diabetes, there has been a gradual rise in the incidences of both types of diabetes among Indigenous population. Turin et al. (2016) conducted a research on the risks of diabetes amongst First Nations and non-First Nations population and found that the First Nations people have a greater risk of diabetes than the non-First Nations have. The research found that about 8 to 10 people amongst First Nations between the ages of 18 years and older have the risk of developing diabetes in their lifetime. In contrast to this, the rate amongst the non-First Nations is low with only 5 to 10 young people developing the risk in their lifetime.
One of the prime causes of diabetes in children is their dietary patterns and eating habits. Being heavy on junk food is one of the prime sources for incurring diabetes. Although the indigenous people are known for their healthy eating habits, a change in lifestyle has caused them to fall prey to diabetes as well. The indigenous people used to have an active lifestyle and their eating patterns were devoid of junk food. Their lifestyle changed due to the colonization of Canada and consequently, the risks of diabetes increased. Research in the area of Aboriginal health especially focusing on their dietary patterns in Canada has been limited. Most of the studies concerning the food habits of the Aboriginal peoples have been epidemiologic. Little discussion has been made regarding “determinants that contribute to health status” (Graham & Stamler, 2013). To be able to prepare a complete health promotion plan for the client, it is important to learn about the dietary pattern of the Aboriginal people. Prior to the advent of the Europeans, the Canadian Aboriginal people used to have food that came largely from local animals and plants. These were high in nutrients and minerals such as protein and had low fat. The European influence caused a transition to diets that were high in sugar and fats. Owing to this, the Aboriginal children’s food consumption has become heavy on snacks and extremely low on fruits, vegetables, and milk.
Johnson-Down et al. (2015) while investigating the pattern of diabetes in Northern Quebec’s Cree tribe identified three dietary outlines – coastal, junk food and inland. The inland and coastal dietary was found to be heavy on traditional foods while high-sugar and high-fat food characterized junk food eating pattern. The dietary patterns, found the author, was the top contributor for diabetes amongst Cree population in Quebec. Oster, Grier, Lightning, Mayan, and Toth (2014) on the other hand, conducted a mixed method study on the Alberta indigenous population. The results revealed that crude diabetes amongst the First Nations prevailed due to lack in self-determination due to serious lack of cultural continuity. The author also found that individuals who “appeared to have more cultural continuity had significantly lower diabetes prevalence” (Oster, Grier, Lightning, Mayan and Toth, 2014). This tendency has, in turn, caused the Indigenous children to adopt a lifestyle that is inclined more towards unhealthy eating habits. The divergence from cultural and traditional dietary eating habits has caused a visible increase in Type 1 Diabetes among younger people.
The Type 1 Diabetes causes the immune system to weaken because the immune system destroys all the beta cells that make insulin. Insulin helps move glucose or sugar throughout the body. For this reason, patients are prescribed to inject insulin on their own to fight the illness by strengthening the immune system. Educating patients especially children on the technique to inject insulin thus becomes crucial. Research on the importance of educating insulin injection amongst children is however very rare. Little attention has been given to this area of study. According to Lange, Swift, Pa?kowska, and Danne (2014), the chief reason behind the limited researches on educating patients for insulin injection is the focus on treatment rather than on the one requiring the treatment. Most studies have focused on the treatment of the illness from the perspective of the practitioner.
Danne et al. (2014) focused their study specifically on the treatment of Type 1 Diabetes amongst children and adolescents using insulin injection. The authors suggested that since children have no knowledge about the illness, the insulin treatment at the early stages after diagnosis is extremely important. Wherrett, Huot, Mitchell, and Pacaud (2013) further raise awareness regarding the importance of insulin treatment in the early stages of the illness because children do not possess the seriousness like adults. The authors state that adolescents are the most difficult to handle because the practitioner cannot treat them as children and neither as mature adults. The adolescents think that they are strong and immune to everything and that they do not require any treatment.
Wherrett, Huot, Mitchell, and Pacaud (2013) discuss in detail about the need to refer children to diabetes education, psychosocial support and ongoing care with someone having expertise in pediatrics. The authors laid emphasis on education for children regarding diabetes. According to them, “children with new-onset Type 1 Diabetes and their families require intensive diabetes education to provide them with the necessary skills and knowledge to manage this disease”. Further, the topics of education must include insulin action and supervision, dosage adjustment, nutrition therapy and exercise amongst others. Hilliard, Wu, Rausch, Dolan, and Hood (2013) however, found that the management of Type 1 Diabetes amongst adolescents is deteriorating. Although the individual trajectories vary as clinical evidence suggest, the deterioration is largely visible. Their study revealed that poor management of Type 1 Diabetes is found in subgroups of family conflict, ethnic minority status, and longer diabetes duration.
After assessing the client’s condition, it has been found that the client needs education on insulin injection and dietary habits. Devising a health promotion program for the client would require extensive research on the programs that have been conducted previously for similar patients. In this regard, the nurses’ role becomes crucial because the client opens up with the nurse in the initial stage. Kemppainen, Tossavainen, and Turunen (2013), while focusing on the role of the nurses in health promotion practices state that nurses engage in practices that help patients change their perspective and behavior towards their illness. Nurses have to deal with various types of patients dealing with various sorts of illnesses. In contrast to this study, • Vivienne Wu, Tung, Liang, Lee and Yu (2014) found that the perceptions and ideas of nurses and patients often conflict. “The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful” at the same, found the authors (Vivienne Wu, Tung, Liang, Lee and Yu, 2014). It was also found that the nurses valued the need for health education more than the patients did. In the case of Ms. Lee, it can be stated that the scenario is similar because she perceives her capability of self-care is enough and that no health promotion is required. Davies et al. (2013) suggested in their research that such situations could be tackled if the nurses do a holistic assessment of the client. The holistic assessment would help the nurses understand the social and ethnic background of the client, which often shapes their behavior. In Ms. Lee’s case, the nurse is aware of the fact that she comes from an Indigenous background and her values about self-care and health are different.
Schabert, Browne, Mosely, and Speight (2013) diverted their attention towards the need for a “comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice”. They found in their study that people especially adolescents have been stigmatized in various places due to their illness. Ms. Lee also has been stigmatized in a few occasions although not severely. The client shared her primary school experience when she was bullied for frequenting the school washroom. Further, during her high initial high school days, Ms. Lee was body shamed for being underweight.
Quirk, Blake, Tennyson, Randell and Glazebrook (2014) suggested physical intervention for adolescents suffering from Type 1 Diabetes. According to the authors, “people with Type 1 Diabetes have at least twice the risk of developing cardiovascular disease compared with those without diabetes” (Quirk, Blake, Tennyson, Randell and Glazebrook, 2014). This fact reveals that Ms. Lee will have a future risk of developing cardiovascular disease. The authors suggest that physical activity could largely contribute towards reducing the risk amongst Type 1 Diabetes diagnosed adolescents. Delamater, de Wit, McDarby, Malik and Acerini (2014) however assert that children and adolescents need psychological care more than anything does because “young people with diabetes appear to have a greater incidence of depression, anxiety, psychological distress, and eating disorders compared to their healthy peers”. Adolescents with recurring diabetic ketoacidosis (DKA) have more chances of incurring psychological problem than younger people with good metabolic control. Ms. Lee has demonstrated a weal metabolic control and episodes of psychological distress and hence, it is important for the nurse to plan a health promotion practice that takes into account the client’s psychological issues as well.
The review of literature helped bring forth certain points with which, the nurse could approach Ms. Lee. Most importantly, the importance of educating children about the importance of injecting insulin on their own, engaging in physical activity and following strict dietary pattern has been established from the review. The client in question, Ms. Lee is also an adolescent, as has been established earlier and observing her closely has also revealed similar tendencies associated with adolescents. Nonetheless, Ms. Lee is more cautious regarding her diabetes condition and wants to “get rid” of it as soon as possible. The nurse now has the challenge to convince the client to undertake the said interventions in order to reduce the symptoms. The review of academic work in the field of Type 1 Diabetes in adolescents’ health promotion also reveals that the nurse needs to provide psychological assistance as well to the client.
Conclusion
The analysis that was conducted in order to provide health promotion practice for the client revealed important information regarding the education of insulin injection and dietary patterns. In addition, the analysis also found that the client needed to be given physical and psychological intervention as well. The nurse met with the client after conducting the analysis and discussed the health promotion with her. The client seemed satisfied with the health promotion plan as it encompassed all the aspects including social, psychological and physical including medical. The health promotion plan focused mostly on educating the client on how to take insulin injections on her own. Apart from that, the plan also included dietary patterns that the client needed to avoid and follow. In addition, the nurse was able to convince the client about the benefits of following the plan. However, the plan needed to be more comprehensive and easy to understand for the client. For example, a detailed diet plan needed to be provided. The client also seemed satisfied with the plan’s focus on an acknowledgment of her Indigenous background. The plan also comprised physical intervention because Type 1 Diabetes increases the risk of cardiovascular disease and physical exercise helps in reducing the risk.
Nevertheless, the client seemed dissatisfied with some aspects of the plan where she had to visit regularly the nurse to have her condition checked. The client argued that she could check her condition by herself with the help of the measuring scales available. The plan also lacked in providing clear and concise physical exercise routine for the client and much attention was given to the benefits and importance of physical exercise. The nurse however assured the client that the visits would be short and that she needed to visit to ensure complete benefit. The nurse also brought in additional learning plan for the client that included routines for physical exercise and psychological improvement.
References
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