Prioritisation Of Care For Patients With Chronic Conditions: A Case Study

Patient Background

Patient Peter Mitchelle is 52 years old male diagnosed with type II diabetes. He has a a previous history of  obesity ventilation syndrome, and sleep apnoea. The reason for the patient referral to the GP entailed presentation of shakiness, diaphoreses, increased hunger, high blood glucose levels and breathing difficulty while sleeping. The patient has been smoking for the last 30 years with an approximate of 20 cigarettes per day. He has been attended by dietetic and advised on LEHP (low energy, high protein diet). The patient social status reveals that he is unemployed and receives a government stipend. He lost his job three years ago. Patient Peter is experiencing difficulties with management of his weight and is affecting his self image.  He is contemplating on losing weight and quitting smoking. In light of these two key issues presented by the patient, offering a nursing plan for weight management guide and empowering the patient on smoking quit plan forms key nursing care priorities for the patient. Thus this assessment offers an in-depth overview of these two care priorities for the patient.

Weight reduction management

A weight management plan is key for obese patients. The patient weight assessment and evaluation reveals that his weight exceeds Body Mass Index above 24, signifying obesity status. Currently, the patient faces a lot of challenges performing daily activities causing immense fatigue while undertaking daily activities. The patient generally feels uncomfortable with his size and he feels isolated due to his state. Further, the patient is having breathing problems during sleep, indicating excess weight load on his body. The key aspect for identification as a care priority for the patient entails his willingness and showing an interest in changing the status. The patient feels that he needs to change sickness the weight increase has limited him in performing various activities coupled with increased patient fatigue and being socially isolated. Failure to address this care issue for the patient is likely to cause the patient to fall into depression and eventually suicidal thoughts come (Teixeira et al., 2012). Further, the patient is likely to develop further much worse complication such as the development of kidney diseases and cardiovascular problems which might are increased by his risks of smoking. Weight management for the patients is a crucial aspect for care which needs attention. Studies have shown that obese patients often get the motivation to engage in weight management through positive social setting and elements of joy (Sand, Emaus  & Lian 2017). The patient is motivated to ensure that he reduces weight which has often given his lack of physical activeness and feelings of seclusion form his close family and friends. Thus as a community nurse, there is a need to support the patients towards addressing this identified care need through a proper weight management plan.

Key Priorities of Care for the Patient

Goal setting has been identified as an effective way of focusing on behavior change to achieve expected outcomes (Yang, Maher  & Conroy, 2015). Weight management goal for the patient will entail engagement in exercise activities for 2 hours for 5 days each week and to follow strictly low energy high protein diet in the next one month till another review assessment is undertaken. The underpinnings of the social cognitive theory state that behavior can be changed through behavioral change role. This perspective has informed the choice of these two goals for the patient (Kaiser, 2011). The outcome expected to be achieved on his goals entails identification and changes on inappropriate behavior but he patient with issues associated with lack of exercise and overeating behaviors, showcase eating patterns changes and engagement on sustained individual physical exercise. Key nursing intervention on this aspect will entail carrying out a review of daily dietary intakes and amounts of foods eaten and the eating habits for the patient. Key rational for the patient entails providing an opportunity to focus on a realistic picture of food consumed and amounts of food taken with corresponding patterns that need to be changed (Samdal et al., 2017). Further, a key fundamentals intervention for the patient entails formulation of an eating plan using patient information based on body mass index status gender, age and nutrient requirements. Further an assessment of strategies on diets which have been undertaken and factors associated with their success. Basic rationale entails focussing on foods which offer low fat intake and adequate protein which is crucial in aiding protein intake (Zhou & Yang, 2016).

The proposed interventions will be implemented with the cooperation of the patients with respect to his age, financial resources, and budget. Providing the patient with extra reading and educational materials to aid in the plan will benefit those materials will entail diet sheets, health information, sample menus for low-fat diets and sample lists for shopping. As part of an evaluation plan, a regular review will be undertaken for the patient depending on the patient. Regular weight management at home is key. Weight measurements for the patient will be crucial in assessing and evaluating the effectiveness of the two goals implemented.  The use of a balanced diet plan with range and levels of exercise will be crucial as the patient progress will be regulated and monitored effectively.

Deficient knowledge depicts a lack of understanding of the underlying health problem. Lack of patient awareness on how to engage in behavior change hinders a smoke behavior change strategy. Patient Michelle is an active smoker spanning over 30 years of smoking. His deteriorated health state has forced to initiate health behavior change. Health belief theory suggests that when the severity of the disease or a health problem, an individual seeks cues to action and seek an avenue to change the behavior. The patient believes that his health state is stake has led him to initiate change though he is unsure where to start. Difficulty in breathing and negative self-image coupling the state of the patient is crucially hampering the self-esteem of the patient.  Effects of smoke have been linked to damage to respiratory diseases which causes damage to the airways leading to the development of lung cancers. Exacerbation of the obesity state coupled with lung diseases is likely to lead to other diseases development such as hypertension and diabetes. Smoking behavior is risking factor for the development of this state of the patient. The patient has been an active smoker for a long period of time and coupling the issues faced with obesity is likely to develop to other complications thus affecting his already worsening health state (Schoeppe, et al., 2016). Evidence suggests that cigarette smoking is one of the key factors which are causing morbidity and mortality (Kovac, Khanna & Lipshultz, 2015). Hence as a community nurse providing care to the patient, necessitates priority care for the patient so as to ensure that the negative effects for the patient are lowered.

Weight Reduction Management

The aim of any smoking plan is to ensure that there is a reduction in the number of people or smoking episodes for individual facing the problem. The main goal is to initiate smoking cessation for the patient through a smoke cessation plan. The patient lacks the crucial information which will aid in implement this plan. This nursing issue is further evidenced by the lack of verbalization of weight reduction. Lack of awareness of strategies for behavior change has often hindered many patients willing to change. Key interventions to be implemented for smoking cessation plan for the patient entail, drawing a plan for the slow withdrawal of smoking through a gradual reduction in the number of cigarettes consumed per day (Gould et al., 2017). There is a need to draw a plan on how the patient can withdraw from smoking gradually. Further engaging in pharmacotherapy approach is key in ensuring that patient urge for smoking is reduced significantly thus aiding in adapting to the plan. Managing the intervention willed ensure that goals for the smoking outcome are reduced significantly.  Research undertaken has demonstrated that a combination of medical treatments and behavior counseling are essential in ensuring successful smoking cessation plan (Hollis, Konrad & Whittaker, 2015). Thus combining these two methods are essential for ensuring that patient achieves his goal of quitting smoking and improve his overall health status.

Evaluation of the plan will entail assisting the patient gain knowledge on his goals and management plan towards smoke cessation. Assessing patient beliefs and perceptions will be essential in understanding whether there is improved knowledge with regard to smoking cessation plan. Patient assessments will entail close assessments on any learned behavior change strategy towards smoking cessation.

Conclusion

As a community nurse, undertaking a nursing priority care plan for the patient is essential in identifying his needs and offering guidance so as to achieve the nursing desires. This case assessment has reflected two key nursing priorities for patient Peter Mitchelle. Key nursing priorities for the patient entails engaging in weight management and assisting the patient to gain more understanding towards health care information. Enhancing patient cognitive information is essential for health restoration preservation. Knowledge will play an influential part in aiding the patient enhance smoke cessation and improve overall recovery. Thus as a community nurse, helping the patient achieve these key care priorities is essentials.

References

Gould, G. S., Bar-Zeev, Y., Bovill, M., Atkins, L., Gruppetta, M., Clarke, M. J., & Bonevski, B. (2017). Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implementation Science, 12(1), 114.

Hollis, V., Konrad, A., & Whittaker, S. (2015, April). Change of heart: emotion tracking to promote behavior change. In Proceedings of the 33rd annual ACM conference on human factors in computing systems (pp. 2643-2652). ACM.

Kaiser, S. (2011). A Social Cognitive Theory based examination of the behavioural change role played by Let’s Move’s website and social media applications.

Kovac, J. R., Khanna, A., & Lipshultz, L. I. (2015). The effects of cigarette smoking on male fertility. Postgraduate medicine, 127(3), 338-341.

Samdal, G. B., Eide, G. E., Barth, T., Williams, G., & Meland, E. (2017). Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 42.

Sand, A. S., Emaus, N., & Lian, O. S. (2017). Motivation and obstacles for weight management among young women–a qualitative study with a public health focus-the Tromsø study: Fit Futures. BMC public health, 17(1), 417.

Schoeppe, S., Alley, S., Van Lippevelde, W., Bray, N. A., Williams, S. L., Duncan, M. J., & Vandelanotte, C. (2016). Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 127.

Teixeira, P. J., Silva, M. N., Mata, J., Palmeira, A. L., & Markland, D. (2012). Motivation, self-determination, and long-term weight control. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 22.

Yang, C. H., Maher, J. P., & Conroy, D. E. (2015). Implementation of behavior change techniques in mobile applications for physical activity. American journal of preventive medicine, 48(4), 452-455.

Zhou, K., & Yang, S. (2016). Understanding household energy consumption behavior: The contribution of energy big data analytics. Renewable and Sustainable Energy Reviews, 56, 810-819.