borderline diabetes

borderline diabetes

This scenario is about a patient who has borderline diabetes. This means that her diabetes can still go away if there is a proper diet in place (diet controlled). Avoiding eating sugary food and drinks is advised to the patient to promote her health. Patient D lives in a Nursing Home where a Nurse Practitioner comes to see her every month to check her blood sugar. Every day, there is a ‘resident of the day’ which means that they check their Observations as well as their weight and BMI. So, every month of the 28^th, the Nurses are able to check patient D’s weight as they record it in the diary. The staff have noticed that patient D’s weight has been increasing each month. She is 4 foot 4 inches in height with a weight of 60.50 kilograms, her BMI is 34.2, which falls to ‘obese category.’ Patient D always has snacks in her room, like biscuits, sweets, and chocolates. She has a friend that always visits with lots of snacks that she gives to patient D. One afternoon before the tea trolley comes, patient D asked me where her biscuits were as they are usually kept in her room, but she struggled to find them. She always has her biscuits with tea. I went to her room to look for them, but I did not find them either. I asked the nurse politely whether she knew where patient D’s biscuits were. She replied, “We put them on the top of the shelf because we are hiding all the sweets from her. Every month her weight is increasing, and her blood glucose level is always in a dangerously high range from 17-18 mmol (millimoles). We are trying to keep them all away from her for her benefit.” I went back to patient D, sat with her, and explained to her the risks of her constant snacking and how this will impact her health. I told her that the nurses are trying to reduce her snacking on biscuits and sweets because of her high blood sugar most of the time. I noticed that she looked very upset about it as she loves biscuits and sweets a lot. I asked her open discovery questions such as ‘how does that make you feel?’. Patient D said that she enjoys snacking as it gives her a sense of comfort. I then asked, ‘would you be happy to try diabetic snacks, and what kinds would you be willing to try?’. So, I offered her some alternative options.  I asked her if she wanted some diabetic ice cream or diabetic carrot cake, she replied: “no, I want my biscuits. I have always had it.”

Introduction

This paper will explore the concept of health promotion based on the scenario I was involved in, which included a patient with borderline diabetes. I will focus on such things as communication skills from nurses, empowerment, and the effectiveness of open-ended questions. I will be incorporating the medical approach, The Behaviour-Change Approach, The Client-Centred approach. These will enable me to critique whether good health promotion was applied in this scenario. According to NMC (2018), a person’s privacy and confidentiality should be protected.  Based on NMC guidelines to maintain confidentiality, the patient will be referred to as patient D.

Empowerment

Patient empowerment has become a proactive strategy in improving the quality of life and health outcomes among patients with chronic diseases (Neuhauser, 2003). Empowerment is perceived as a strategy meant to enable patients who do not have the power to gain some degree of control and become powerful over their health and live. Empowerment can be defined as the technique of gaining power, where powerless people acquire the ability to control events that determine their health and lives (Laverack, 2006). From the scenario above, it is clear that patient D is powerless to stop taking sugary diets. The patient, therefore, needs to be given the power to stick to the right diet that will help her improve her life and avoid diabetes. Empowerment strategies should involve individuals, communities, and organizations. Those with power or access to empowerment, such as health practitioners and those who need empowerment such as patients, must collaborate to create an environment where empowerment is possible. In our scenario, the nurses have the responsibility of empowering patient D. Empowerment strategies involve educational opportunities, support groups, advocacy efforts, patient decision-making, and changes in health care services (Howorka et al., 2000). These techniques have been actively adopted in chronic disease care, including diabetes, cancer, renal disease, mental disorders, and osteoporosis.

Among diabetic patients, self-management education has been proved to produce self-empowerment, treatment satisfaction, enhanced diabetes control, improved knowledge and need for treatment, and self-management skills (Deakin et al., 2005). Studies have shown that empowerment results in improved disease control, dietary habits, and self-management. Evidence has shown that patient empowerment, and empowerment features such as mastery of their condition and patient involvement produce a constructive dialogue and environment, which leads to enhanced health and quality of life among patients (Norris, Engelgau, and Narayan, 2001). Patient D should be educated on the dangers of his dietary choices and his capacity to stop or limit poor diets. The nurses should establish an open dialogue with the patient to help her master his condition. The participation of the patient is very critical so that he makes conscious, voluntary, and informed decisions on his health and life. The lack of proper communication from the nurses will only worsen Patient D’s condition. The decision to hide her snacks behind his back, not helping the situation. One of the aspects of empowerment is asking open-ended questions. These are questions that cannot be answered with a static response or a yes or no feedback. They are classified as good questions since they enable responders to offer more extended responses that show their understanding. The response from such questions can be compared with the data that is already known by the questioner (Ackley and Ladwig, 2010). Asking Patient D open-ended questions will provide a constructive discussion about her condition. It will encourage the patient to participate in discussions about his health and will provide doctors with crucial information, which will enable them to advise her better.

Health promotion

Health promotion is the endorsement of healthy communities, healthcare access, safe homes, nutritious food, transparent healthcare information, and the participation of patients in healthcare policies and care planning (Raingruber, 2014). It includes political, economic, and social changes in creating an environment that is conducive to health. The health of individuals is affected by several factors, such as the community and political climate surrounding them. This explains the role of Patient D’s friends in his health practices. The friends largely contribute to his poor health by supplying her with snacks. The nurses need to talk to the patient and help her understand how his friends are destroying his health rather than enhancing it. Socioeconomic factors may have a more significant effect on an individual’s health compared to individual health practices (Pampel, Krueger, and Denney, 2010). It is crucial to evaluate the socioeconomic factors such as income levels, which may be affecting Patient D’s health practices. It is also essential to determine if the patient has enough funds to buy alternatives such as diabetic ice cream or diabetic carrot cake. Therefore, health promotion should involve health education and related environmental, economic, organizational, and social interventions required to facilitate health (Tones, Tilford, and Robinson, 1990). It requires nurses to educate patients about their health needs. Referring to the scenario of patient D, the nurses are expected to educate the patient about her health and the dangers posed by prolonged sugar intake. The patient should be informed that continuous sugar intake is a risk factor in the development of diabetes. She should be educated about better diets and practices. Health promotion is an essential aspect of nursing practice. By promoting the health of communities, families, populations, and individuals, nurses help transform the health of society and individuals. Nursing is defined as the promotion, optimization, and protection of health and abilities, the prevention of injury and illness, and the relief from suffering through diagnosis and treatment (ANA, 2010). This explains why the nurses are involved in the frequent monitoring of patient D’s blood sugar, weight, and BMI. It helps the nurses promote her health by preventing the development of diabetes. However, from this scenario, poor health promotion was shown by the nurses as they hid all the patient’s biscuits and sweets in an attempt to improve her physical health. Health promotion must involve health education and the participation of patients in decision making. The patient’s unwillingness to stop the intake of snacks may be because he is upset by the decision of nurses to hide his snacks. Patients should be active participants in their care; they must feel that they are knowledgeable individuals whose input is believed and respected and should be involved in decision-making concerning matters on their health (Eldh, Ekman, and Ehnfors, 2010). It is crucial to discuss with the patient to understand why and when he started taking a lot of snacks. Therefore, nursing includes policies that are supportive, inclusive, promotive, and restorative.  In the scenario, Patient D requires support from nurses to restore his health to how it was before he started taking excessive sugars. This support can take the form of empowerment, as discussed before.

Various health promotion approaches can be adopted in the scenario of Patient D. The first one is the medical approach. The purpose of this method is to achieve freedom from illness and disability, including infectious diseases, heart disease, and cancer.  It involves medical intervention in preventing or ameliorating conditions, mainly through persuasive or paternalistic techniques. For Patient D, the medical approach was applied in monitoring and improving the patients’ blood sugar results. The medical approach is comprised of three distinct levels. Primary prevention is the first level and involves preventing the onset of illness through risk education, such as immunization and advocating non-smoking (NurseKey, 2017). The second level is secondary prevention, which involves preventing diseases from progressing through means such as screening and other techniques of early diagnosis. The last level is the tertiary level, and it consists in controlling further suffering or disability in people who are already ill and includes palliative care and rehabilitation. It is clear that Patient D falls at the secondary level. Through medical intervention, borderline diabetes will be prevented from progressing into type 2 diabetes. For instance, metformin is a medication that is used both in treating diabetes and preventing the development of diabetes among those at a high risk of developing diabetes (NIDDK, 2018). The medical approach focuses on preventive medical methods and the responsibility of healthcare practitioners in ensuring that patients follow recommended procedures.

The second approach is the behavior change approach. The purpose of this approach, as the name suggests, is to alter a person’s attitude and behaviors to adopt healthy lifestyles. In the patient’s scenario, I gave the patient alternatives and suggestions to help initiate a behavior change such as diabetic snacks. The behavior change approach involves encouraging individuals to quit smoking through the smoking cessation program. This approach is used by health practitioners who believe that lifestyle changes are consistent with the client’s interests and will encourage clients to adopt healthy practices. The management of Patient D’s conditions requires both good self-management and good clinical care. Nurses can improve the patient’s self-management if they possess the necessary skills to induce motivation and support the patient’s behavior change. Motivational interview is a useful technique that can be used to make patients adopt lifestyle changes (Resnicow et al., 2002). The idea of motivational interview is that patients need to be ready to embrace changes for positive outcomes, with resistance to change in mind 18 (Swanson and Maltinsky, 2019). For instance, Patient D ought to take healthy diets and reduce sugar intake, but it is also essential to understand that temptations to take snacks are inevitable. Motivational interview adopts several open-ended questions to elicit the values, goals, attitudes, and preferences of a patient. The nurses should have considered this approach to identify and respect the values and preferences of patient D. There are several stages of communication in motivational interview that can be used by nurses in the case of Patient D. They include, engaging her in a discussion, focusing on her goals, evoking change discussions, and establishing strategies for change. The nurses should be supportive and non-judgmental. Through motivation interview, nurses will be able to elicit the patient’s goals, values, and attitudes, challenge ambivalence, and guide her towards decisions to adopt changes that will improve his health. This will help the patient avoid heavy sugar intake and adopt healthy lifestyles such as taking fruits and engaging in regular physical exercise. Motivational interview has been used in several behaviors concerning health such as mental health, pain management, and physical activity. Studies have shown that motivational interview is effective in changing lifestyle behaviors among patients with diabetes and psychological disorders 19. (Knight et al., 2006). The nurses should, therefore, consider applying this approach to Patient D.

The Client-centered Approach is the third approach that can be applied to Patient D’s scenario. The purpose of this method is to collaborate with patients to assist them in identifying what they need to know and take action on and come up with their choices based on their values and interests. The role of the health promoter here is to be the facilitator by assisting clients in identifying their concerns and acquiring knowledge and skills necessary in adopting lifestyle changes. In this approach, the self-empowerment of the patient is crucial (Laverack, 2004). In Patient D’s case, the Client-centred approach was not adopted as the nurses did not involve the patient in making the decision, which caused the patient to feel powerless. Nurses didn’t value the patient’s beliefs and did not respect her input. In the client-centered method, patients are perceived as experts with skills, knowledge, and capacity to contribute and regulate their health. In this approach, Patient D should be placed at the center of decisions and perceived as an expert who is working with nurses to achieve the best results. This is not concerned with just giving her what she desires or providing information. The approach is about integrating her social circumstances, values, desires, and lifestyles in developing the right solutions. This will enable nurses to practice compassion and empathy in promoting the health of Patient D. In the past, patients were required to fit in practices and routines that health practitioners considered appropriate. However, the client-centered approach was introduced to ensure flexibility and meet the needs of patients in ways that work best for them. This approach presents many benefits such as respecting individual values, providing emotional support, and considering people’s choices and expressed needs.

In conclusion, it is clear that the nurses handling Patient D did not adopt an effective health promotion program. They did not empower the patient to observe some behavioral changes. The decision to hide her snacks behind her back is not consistent with effective health promotion. In a good health promotion plan, the patient should be involved in decision making concerning matters of their life. The patient’s input should be considered and respected. The medical approach applied in the scenario was not adequate. The approach did not go beyond monitoring the patient’s blood sugar, weight, and BMI. The medical approach should have been used alongside other interventions such as behavior change approach and the client-centered approach. In the behavior change, I advised the patient to consider some alternatives to snacks to prevent his condition from developing to diabetes. These alternatives include diabetic ice cream or diabetic carrot cake. However, the nurses should have done a better job in this approach by engaging the patient in decision making to discuss some possible behavior changes to improve her health. Motivational interview is an effective approach that can be used. Through motivation interview, nurses can elicit the patient’s goals, values and attitudes and guide her towards decisions to adopt changes that will improve his health. The nurses did not apply the client-centered approach since they did not involve patient D in making decisions about her health. They did not consult her but instead hid her snacks. In the client-centered approach, the patient is seen as an expert who can make competent decisions about their health. The approach is about considering and respecting her social circumstances, values, desires, and lifestyles in developing the right solutions. In sum, the health promotion adopted by the nurses was neither effective nor adequate.

References

1. The Nursing and Midwifery Council (NMC), 2015. The code Professional standards of practice and behavior for nurses and midwives [online]. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed 27 December 2019].
2. Neuhauser, D., 2003. The coming third health care revolution: personal empowerment. Quality Management in Healthcare, 12(3), pp.171-184.
3. Howorka, K., Pumprla, J., Wagner-Nosiska, D., Grillmayr, H., Schlusche, C. and Schabmann, A., 2000. Empowering diabetes out-patients with structured education:: short-term and long-term effects of functional insulin treatment on perceived control over diabetes. Journal of psychosomatic research, 48(1), pp.37-44.
4. Deakin, T.A., McShane, C.E., Cade, J.E. and Williams, R., 2005. Group based training for self‐management strategies in people with type 2 diabetes mellitus. Cochrane database of systematic reviews, (2).
5. Norris, S.L., Engelgau, M.M. and Narayan, K.V., 2001. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes care, 24(3), pp.561-587.
6. Laverack, G., 2006. Improving health outcomes through community empowerment: a review of the literature. Journal of Health, Population and Nutrition, pp.113-120.
7. Ackley, B.J. and Ladwig, G.B., 2010. Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
8. Raingruber, B., 2014. Contemporary health promotion in nursing practice. Jones & Bartlett Publishers.
9. ANA (2010). What is Nursing & What do nurses do? | ANA Enterprise. [online] ANA. Available at: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/ [Accessed 27 Dec. 2019].
10. Tones, B.K., Tilford, S. and Robinson, Y., 1990. Health Education: Effectiveness and Efficiency.
11. Pampel, F.C., Krueger, P.M. and Denney, J.T., 2010. Socioeconomic disparities in health behaviors. Annual review of sociology, 36, pp.349-370.
12. Eldh, A.C., Ekman, I. and Ehnfors, M., 2010. A comparison of the concept of patient participation and patients’ descriptions as related to healthcare definitions. International journal of nursing terminologies and classifications, 21(1), pp.21-32.
13. Ewles, L. and Simnett, I., 1999. Promoting health: a practical guide. London: Baillière Tindall.
14. Laverack, G., 2004. Health promotion practice: power and empowerment. Sage.
15. NIDDK (2018). Insulin Resistance & Prediabetes | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance [Accessed 27 Dec. 2019].
16. NurseKey (2017). Models and approaches to health promotion. [online] Nurse Key. Available at: https://nursekey.com/models-and-approaches-to-health-promotion/ [Accessed 27 Dec. 2019].
17. Resnicow, K., DiIorio, C., Soet, J.E., Borrelli, B., Hecht, J. and Ernst, D., 2002. Motivational interviewing in health promotion: it sounds like something is changing. Health Psychology, 21(5), p.444.
18. Swanson, V. and Maltinsky, W., 2019. Motivational and behavior change approaches for improving diabetes management. Practical Diabetes, 36(4), pp.121-125.
19. Knight, K.M., McGowan, L., Dickens, C. and Bundy, C., 2006. A systematic review of motivational interviewing in physical health care settings. British journal of health psychology, 11(2), pp.319-332.