Evidence-based Education Plan for Client Recently Diagnosed with Type 2 Diabetes Mellitus - Case Study Example

RUNNING HEAD: EVIDENCE BASED EDUCATION PLAN FOR CLIENT RECENTLY DIAGNOSED WITH TYPE 2 DIABETES MELLITUS Evidence based Education Plan for Client recently diagnosed with Type 2 Diabetes Mellitus Name: Course: Institution: Date: Introduction The aim of this education plan is to provide a client recently diagnosed with DMT2 Mellitus (DMT2) and his family with information or knowledge about the disease, current evidence based treatment strategies to manage DMT2 and any Diabetes self management issues that arise from the client assessment. The focus of the education plan is to identify the required lifestyle changes such as a healthy diet and regular exercise as the most appropriate evidence based approaches to the management of Diabetes for the client and his family. The rationale for this focus is that evidence based approaches significantly determine a client’s attitude towards treatment for chronic complications such as Diabetes and the use of the most appropriate educational strategies would significantly affect the response of the client and his family to treatment and management of the disease. Objectives of the Plan 1. To improve the client and his family’s health literacy on DMT2. 2. To inform the client and his family on evidence based approaches to the management of DMT2. Background The client is Jamil Usta, a 47 year old Muslim Turkish man who works as a taxi driver and has recently been diagnosed with DMT2. He is married and has two children aged 14 and 12. He is overweight and does not smoke. Pathophysiology of DMT2 DMT2 is caused by insulin resistance- a metabolic syndrome where the body’s cells have a diminished ability to respond to the action of insulin which in normal conditions prevents or suppresses the release of glucose into the blood (Surampudi et al 2009, Nolan et al 2011). Consequently, insulin resistance leads to high glucose blood levels as glucose is released into the blood which signals the pancreas to secrete even more insulin (and to compensate for the insulin resistance) leading to high levels of insulin in the blood (Poretski 2010). Some of the symptoms of DMT2 include polydypsia, polyuria, fatigue, blurred vision, weight gain and recurring bladder, skin and kidney infections (Nolan et al 2011). Chronic symptoms of DMT2 include increased risk of cardiovascular disease, stroke, Charcot foot, vision impairment or blindness, renal dysfunction or failure, hypertension, Alzheimer’s disease, sexual dysfunction or impotence, loss of protective sensation in the lower extremities, foot injuries leading to amputation and emotional stress (Surampudi et al 2011). Impact of Diagnosis Coping with the diagnosis of Diabetes has often been compared to experiencing grief or bereavement as the patient normally displays many of the physical and psychological symptoms similar to those who are grieving the loss of a loved one (Yu et al 2010). Patients diagnosed with Diabetes usually exhibit emotional reactions ranging from anger, guilt, anxiety, shock, despair and helplessness to concern, fear, sadness, confusion or even disbelief (Stanton et al 2007, Rustad et al 2011). The client’s age (47) and obesity are risk factors which are likely to exacerbate fears over his health and cause even more anxiety among the family. The family of the client is also expected to experience anxiety and grief at the diagnosis which may never be resolved since Diabetes is a chronic or permanent condition (Stanton et al 2007, Yu et al 2010). The diagnosis will also lead to stress as the family contemplates the social, financial and emotional burden of lifelong treatment for Diabetes and the disruption of their normal lives as they care for the client such as adjusting their dietary and lifestyle habits to support the client’s management of the condition (Hall 2009). Evidence Based Treatments for DMT2 Current evidence based treatments for DMT2 normally includes non-pharmacological treatments such as making lifestyle changes and self management measures and pharmacological treatments in the form of medication to control blood sugar and insulin levels (Levesque 2011). Lifestyle changes include changes in diet to avoid foods high in cholesterol and sugars which would also help in addressing obesity for the client as a risk factor for cardiovascular disease and regular exercise to improve blood sugar control (Poretski 2010, Siram et al 2010). Medication may also help diabetic patients control blood sugar and insulin levels by taking insulin injections or oral pills such as Metformin, sulfonylureas, thiazolidinediones, DPP-IV Inhibitors and alpha-glucosidase inhibitors (Levesque 2011). Client Self-Management Issues The diagnosis of DMT2 imposes additional responsibilities for the client in terms of watching their diet, exercising, frequent blood sugar testing, frequent visits to the doctor and adhering to medications. The client should also be aware of risk factors such as family history with Diabetes, smoking, weight (obesity), an unhealthy diet and physical inactivity. The client’s obesity implies that they have to prioritize diet and exercise in addition to following evidence based Diabetes management principles in fulfilling their religious obligations during the holy month of Ramadan (Siram et al 2010, Bravis et al 2010, Hui & Devendra 2010). The client should also seek encouragement and support from family and friends in managing Diabetes. This may include reminders to take blood tests or medicines, supporting a healthy diet by preparing food low in sugar and cholesterol or an active lifestyle through an exercise or activity plan (Hall 2009, Poretski 2010). In addition, the client should seek help from a psychotherapist as psychotherapy has been proven to help cope with the stress or anxiety of managing diabetes and improve blood sugar control by reducing depression (Gonzalez et al 2007: 2008, Rustad et al 2011). Education Strategies 1. Motivational Interviews Motivational interviews will be conducted with the client and his family. This strategy is based on the theory of planned behavior and behavioral change motivation theories with the objective of supporting and encouraging behavior changes for the client such as diet and exercise and to reduce resistance to treatments (Blue 2007, Omondi et al 2010). The focus of motivational interviews will be to understand the client’s state of mind about Diabetes, the treatments they are facing and their readiness to make lifestyle changes (Loveman et al 2008). The discussions will emphasize on healthy lifestyle choices such as diet and exercise to mitigate risk factors such as the client’s obesity, how they can resume a normal life with treatments and the importance of constant blood sugar monitoring (Poretski 2010). 2. Face to Face Sessions Face to face practice based education sessions on diabetes will also be conducted with the client and his close and extended family. This strategy is based on dual process theory which encourages patients and their families to take an active role in learning about Diabetes management (Davies et al 2008, Nutbeam & Harris 2004). During these sessions, family members will be informed of the various treatment options for Diabetes, the importance of lifestyle changes such as healthy diet and exercise and best practice guidelines on how to prevent Diabetes as well as to provide support for the client as he manages Diabetic symptoms and complications. 3. Visual and Audio-Visual Media To supplement the motivational interviews and face to face sessions, the client and his family will also be provided with a variety of visual and audio-visual material with information on current best practice in managing Diabetes such as how to administer insulin injections and proper foot care (Wallace et al 2009, White et al 2010). The use of audio visual material is based on the theory of reasoned action and social learning theories which argue that patients are more likely to have positive attitudes towards and to adhere to self management principles for Diabetes after exposure to videos or pamphlets which contain information about diabetes and demonstrations on how to manage it (Hall 2009). The videos and pamphlets would significantly influence the client and his family’s attitudes and intention towards the treatment or lifestyle changes (Loveman et al 2008, Kandula et al 2011). The client would also be provided with educational pamphlets on how to manage their blood sugar levels during Ramadan. Challenges facing the Client As indicated in the background, there are several challenges facing him in management of diabetes. The client is overweight (obese), a risk factor that compounds the risk of developing diabetic and cardiovascular complications (Siram et al 2010). The client is also a Muslim which implies that they have to be educated on the appropriate management of Diabetes during the holy month of Ramadan when they are fasting (Hui 2010). The nature of the client’s job (taxi driver) is also challenging as they may not be able to perform effectively due to some Diabetic symptoms such as blurred vision which may impede their driving or polyuria which may necessitate frequent visits to a urinal. Impact of Adaptations Due to changes in lifestyle such as watching their diet and dependence on insulin injections, the client and his family may be susceptible to feelings of anxiety, loss of control and self esteem. The client’s career will also be affected, exacerbating low self esteem and depression as driving is considered dangerous due to blurred vision as a symptom of DMT2 (Yu et al 2010). In addition, the client’s behavioral changes may be visible to the society contributing to feelings of helplessness when shown sympathy by friends and loved ones on disclosure of the diagnosis. Conclusion The education plan aims to improve the client and his family’ health literacy about DMT2 or provide the client and his family with specific knowledge on the required lifestyle changes to support the management of Diabetes such as a healthy diet and exercise, how to monitor blood glucose levels, how to identify symptoms of hypoglacemia/hyperglacemia and how to perform skin and foot examinations. The evidence based education strategies to be used in the plan include motivational interviews and face to face sessions with the client and his family which will be supplemented using audio visual materials. Recommendations 1. The client should be started on Metformin medication immediately to help cope with the symptoms of DMT2. 2. A personal one on one interview between a clinician and the client should be scheduled to discuss treatment for DMT2 as well as a face to face session with the client’s immediate family since they share the risk factors for DMT2. 3. The client should be assigned a psychotherapist or counselor to help them cope with the emotional and psychological impact of diagnosis as well as to provide support for treatment. References Blue, C.L. (2007). Does the theory of planned behavior identify diabetes related cognitions for intention to be physically active and eat a healthy diet? Public Health Nursing 24(2):141- 150. Bravis, V., Hui, E., Salih, S., Mehar, S., Hassanein, M. & Devendra, D. (2010). Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with Type 2 diabetes who fast during Ramadan. Diabetic Medicine 27: 327-331. Davies, M.J., Heller, S., Skinner, T.C. et al (2008). 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