The Patient With Adult-Onset Diabetes - Case Study Example

Information and advice on the patients non-adherence and possible interventions               Introduction Type 2 diabetes, also known as adult-onset diabetes, is a disease in which your body cannot properly use insulin. The patients body is unable to respond to insulin, and therefore cannot store glucose in the cells for energy. The blood is then filled with too much glucose, and the production of insulin cannot compensate the glucose in the blood. This imbalance results in type 2 diabetes. The book, “Medical surgical nursing, Tenth edition” informs us that “the two main problems related to insulin in type 2 diabetes are insulin resistance and impaired insulin secretion.” An article by nlm.nih.gov then tells us that “Most people with the disease are overweight when they are diagnosed.” Important piece information regarding type 2 diabetes is that, more often than not, people develop type 2 diabetes based on their lifestyle or eating habits. One of the other hard parts of this disease is it cannot be cured. According to an article by mayoclonic.com called “type 2 diabetes”, it states “Theres no cure for type 2 diabetes, but you can manage — or even prevent — the condition”. Being that there is no cure, this makes type 2 diabetes a very delicate type of long-term disease, and patients affected by it must follow a set of stern restrictions regarding how much they exercise, what they may or may not eat, and what they need to do on a daily basis. This regimen must be followed to the “T” in order to avoid complications and maintain proper insulin and sugar levels. Diabetes is a very dangerous disease on its own, with complications ranging from nausea, abdominal pain, or shock in acute patients, to glaucoma, nerve damage, impotence, kidney failure, eye complications, gangrene and amputation in chronic patients. (Mathur, 2010) These complications are dangerous enough, but add to that the danger of not following your doctors advice, and the patient doubles or even triples his risk and vulnerability to complications related to diabetes. Some call it non-compliance, others refer to it as non-adherence, but this paper agrees with the statement by Jane Seley, saying “No matter what we call it, the outcome is the same. The patient is not doing what we told them to do.” This makes this disease very alarming in terms of how medical practitioners should educate, guide and respond to their patients needs and actions, and whether or not he follows his medical and health regimen. Our patient, 45 years of age, male, Caucasian, and already has been diagnosed with type 2 diabetes has been observed and reported to not adhere to the diabetic regimen regarding regular physical activity, healthy diet and medication. This papers aim is to provide possible reasons behind the patients neglect of his doctors advice, provide possible risks related to his situation, and list some potential intervention methods that would be most effective for a person in our patients situation. This papers aim is to compile and deliver this information to our patients doctor in order for him to best analyze the situation and best decide on the intervention and action that will be performed on the patient. I aim to provide this information through this paper using these subtopics; Possible reasons for non-compliance Complications of diabetes type 2 related to non-compliance Health intervention options for the doctor to implement Conclusion Possible reasons for non-compliance This section of our paper attempts to address and determine the possible and most likely reasons why our patient does not follow his assigned and advised diabetes regiment. It determines and presents some of the most common reasons for non-compliance to or non-adherence and will relate the ones that are most applicable to our patient’s situation or demographic. The book “Nurses Pocket Guide; diagnoses, Prioritized Interventions, and Rationales, edition 10” (Doenges, M. Moorhouse, M.F., Murr, A. 2006) provides us with reasons for non-adherence and divides them into 3 major categories, namely; individual factors, health system and network factors. In the individual factors, the book includes such factors as the individuals values, spiritual beliefs, health beliefs, knowledge deficit of the patient, a difficulty in changing behavior, and even the individuals thought process. For the health system, the book notes down such things as financial issues, client-provided relationships, convenience or accessibility of care, or even coverage of the patient. As for network factors, our source includes such information as the individuals involved in the patients health plan, or social view of the plan. For our patient, the most applicable reasons for non-adherence are included in the individual and health factors. These factors include things such as the patients belief about the disease. He may not realize that the disease is not as harmful as others say it is, or the patients spiritual beliefs. He may not be allowed to take medicine as per his religion, or he may not be willing to follow his regimen due to his lifestyle or lack of discipline. Lack of trust or hopelessness may also be called into consideration for possible causes. As for the health factors, on possibility could be the patients relationship with the provider, or a lack of teaching skills of the provider. Another issue or cause may be the ease of access of healthcare in their area. The individuals health coverage or financial stability or flexibility may also be a possible factor. Complications of diabetes type 2 related to non-compliance As previously mentioned, diabetes is a very delicate disease and a patient who is affected by diabetes must follow a strict set of rules that must be followed in order to avoid further complications. This section of our paper addresses and identifies some complications or dangers that can affect our diabetes patient should he choose to continue disregarding or neglecting his doctors advised regimen. Doctors provide or prescribe the health regimen to our patient as a compliment to clinical treatments and in order to avoid other complications or permanent damage to our patients body. According to an article called “DIABETICS & NON-COMPLIANCE”, effects that can result from a patients non-compliance can include “complications that affect the eyes, kidneys, heart, nerves, feet and more” and over time, constant non-compliance can result in “permanent damage of these areas as well as stroke, heart disease and blindness.” (Coleman, R. 2010) As with the case of our patient, he either chooses to disregard or forgets his doctors advise and does not adhere or comply to his diabetes health regimen for one reason or another, and although a long span of time has not yet passed, he is already in danger of having too much glucose in the blood, which has immediate effects such as being dizzy, tremors, or weakness, which can and will affect his day-to-day functionality. Health intervention options for the doctor to implement Based from the information above regarding possible reasons for our patients non-compliance and possible effects or complications, both immediate and long-term, that may come from his non-compliance, this section of our paper is dedicated to noting down possible interventions and advice that is aimed at informing our patients doctor about the possibilities and options regarding what can be done in order to further encourage our patient to follow his diabetes health regimen. These intervention suggestions and options for steps to be taken will not include scare tactics and fear-induction as this will not be beneficial to the patient and these will not be able to encourage him to decide to follow his health regimen on his own. Rather, this portion will consist of suggestions in order to increase our patients education regarding his disease and provide him with knowledge on the effects of non-compliance and how his health regimen can be beneficial to his situation or how it can compliment his clinical treatments. Some of the options that are more suited to our patients case are such interventions as, developing a better relationship between him and his doctor. This would encourage him to trust or put more faith into his doctors advice. Another intervention that can be performed is to provide him with much more information on his disease, the effects that he can and will feel in his body, how his lifestyle can affect his disease, and other effects or dangers that can be experienced with his disease, specially if he chooses do disregard his doctors advise. Yet another intervention that must be performed is to educate him and encourage him to begin a positive change in lifestyle such as a change in eating habits, or increase in exercise, as this has a huge effect on his blood-glucose level and therefore, has a huge effect on his disease as a whole. Some more intervention options that his doctor can choose from include providing him with other, healthier alternatives to what his current lifestyle is used to. This is in order to provide substitutes to what he normally does or is used to, so that he does not crave for certain things. As a whole, these intervention options and suggestions serve to encourage our patient to choose the right direction on his own, rather than we, as medical professionals or his doctor, forcing him, or scaring him into following his health regimen. This ensures that he will have a more powerful reason to stay on track and also avoid veering away from what was advised to him. This will also provide him with his own watch-dog type of sense in himself that will tell him to keep his discipline. Conclusion Looking ay all of the information that has been presented in this paper regarding possible reasons for non-compliance, possible complications and effects of non-compliance and intervention options that can be taken by our patients doctor, we can see that at the end of the day, it is still up to our patient to follow his regimen, and choose to go the more health and less dangerous route, even when no one is looking. This is confirmed by an article found in the Journal of the American Medical Association. In states “More than 95% of diabetes care is done by the patient, and health professionals have very little control over how patients manage their illness between office visits. “ (Funnell, M. Anderson, R. 2012) This means it is still left up to the patient to choose what is right for his body even though it may not be as comfortable, as delicious, as satisfying, or as easy as what he is used to. In order to achieve this, it is the job of all the medical professionals around him such as his doctors and nurses to provide him will all of the information, support, alternatives, and care that he may need or require, and encourage him to not only be constant with his clinical treatments, but also be constant, regarding his doctors advice. References Coleman, R. (2010, November 18). Diabetes and Non-Compliance, Retrieved 2012, March 18, from http://www.livestrong.com/article/311411-diabetics-non-compliance/ Doenges, M., Moorhouse, M. F., and Murr, A. (2006). Nurses Pocket Guide. Diagnoses, Prioritized Interventions, and Rationales, Edition 10, 365-369. Eckman, A. (2012, February 28). Type 2 Diabetes. Retrieved 2012, March 18, from nlm.nih.gov Funnell, M., Anderson, R. (2012) The Problem With Compliance in Diabetes, Medical Student JAMA, retrieved 2012,March 20, From http://jama.ama-assn.org/content/284/13/1709.full Mathur, R. (2010). What are the acute complications of diabetes? Diabetes Mellitus. Retrieved 2012, March 18, from http://www.medicinenet.com/diabetes_mellitus/page6.htm Mayo Clinic Staff. (2011, August 2). Type 2 Diabetes. Retrieved 2012, March 18, from http://www.mayoclinic.com/health/type-2-diabetes/DS00585 Selley, J. J. (2009, June 19). Non-compliance vs. diabetes self care: Are we still playing a blame game?. Retrieved 2012, March 18, from http://www.diabeteshealth.com/read/2009/06/18/6248/non-compliance-vs--diabetes- self-care--are-we-still-playing-a-blame-game/ Smeltzer, S. and Bare, B. (2006). Assessment and Management of Patients with Diabetes Mellitus. Medical-Surgical Nursing, Vol. 2, 10th Edition, 1149-1203.http://jama.ama-assn.org/content/284/13/1709.full   Read More