Needs Assessment of a Diabetic Patient - Essay Example

Needs Assessment of the Diabetic Patient You're Needs Assessment of the Diabetic Patient Introduction Diabetes can be a severely crippling and dehabilitating disease. Of course research has determined that there are two types, Diabetes I and Diabetes II. These two different forms have similarities as well as differences the main difference being that diabetes II can not be treated with insulin therapy while Diabetes I can be treated in this way. In light of this fact, Diabetes II is the more serious of this form of illness as it can result in more pronounced complications within the physiological workings of the human body (Rubin 1999). Diabetes II commonly occurs in adulthood which has been found to be even more complicated that Diabetes I due to the fact that the adult human body can not combat this type of disease as succinctly as a younger individual can manage a diagnosis of Diabetes I (Cryer 1997). Diabetes II finds that insulin is produced by the pancreas but it is ineffective in carrying out total body functions where the insulin is desperately needed to be regulated (Rubin 1999). Furthermore, just as this current patient faces issues of obesity, many adult patients who suffer with Diabetes II are quite regularly classified as being moderately overweight to points of morbid obesity as well which again is an issue that further complicates the treatment process. Since insulin therapy is ineffective in the treatment and management of Diabetes II and also because the majority of people with this form of diabetes are obese the most popular and beneficial treatment regimens that have been implemented into the care of patients has been an appropriate exercise routine with proper diet and nutrition mapped out for them. Seemingly this would be the appropriate guidelines for the current patient. Therefore the two main goals of the management plan for this patient will be to decrease his weight with an exercise program and to monitor his dietary and fluid intake on a weekly basis as well. Appropriate Management Care of the Diabetes II Patient with Obesity Firstly, before an in-depth management program can begin with this patient there needs to be an initial development of a good interpersonal relationship between the primary care manager and the patient himself. Because patients with Diabetes II are sometimes severely obese the medical provider needs to have the clear awareness that this patient might suffer with depression and anxiety due to his physical appearance. Therefore, it should be the goal of the care giver to build a position of trust and faith between him or herself and the patient in order to provide a high quality care plan to manage the Diabetes (Aggleton & Chalmers 2000). Nurses who use an interpersonal approach have been found to be able to correctly assist patients in planning a strategic alternative to gaining control over a disease such as Diabetes II. This is due to the fact that an interpersonal approach utilizes techniques that are more thorough than a traditional nurse/ patient evaluation. For instance, the skills used are normally observing, questioning, examining, and testing and measuring to ascertain whether the patient will be able to meet the set goals being designed for them (Roper et al 1996). It is believed that this type of approach will be best for this patient in that it will build the proper relationship in order to work as a joint team in the management of the patients' illness. Furthermore, with regard to correctly acquiring this patient's information so that medical treatment and evaluation can be carried out, nurses and all medical care providers have to be careful not to tread over the stipulations that the NMC has specified when working with patients. This specific code states that, "nurses should protect all confidential information concerning patients obtained in the course of professional practices and make disclosure only with consent" (NMC 2002). This of course draws on the ethical and legal aspects of properly caring for patients in a medical environment as they have a right to privacy and their information should only be divulged if they have given their consent as the code of the NMC directly points out. As is being shown there is more to facilitating the proper care of this particular patient which is being found to be more complex than simply laying out a nutrition plan and lifestyle management plan. All of the issues do lead off into other medical areas which is why strong interprofessional relationships are imperative to patient care management as well (Hogg & Armstrong & Brown 1997). Monitoring and Assessing the Patients Needs Since this patient is already in a medically facilitated environment it will be easier on those in charge of his care to monitor his glucose levels and sugar intake to prevent adverse reactions from possibly occurring. Also, ensuring adequate exercise in the plan that has been designed for him will be effectively implemented as well due to the fact that he can be observed and monitored in his behaviors on a daily basis (Alexander 1994). For this patient some of the most detrimental areas that will be evaluated and monitored have to do with the symptoms that are often associated with the disease. Often if a specific symptom lasts for to long of a period it can alert a caregiver to a possible complication that might be potentially arising. These typical symptoms are, thirst, excessive urination, loss of appetite, weight loss with an increased appetite, fatigue, nausea, vomiting, blurred vision, frequent infections, tingling, and numbness (HinchCliffe et al 1993). Also, those in charge of this patients care need to make certain that the hormones are regulated properly as well even though in most cases of diabetic patients these vary from person to person. The nurse managing this patient's care however should have a clear comprehension of where the normal range should be if they have evaluated him correctly. This is of course based on the individual plan that has been designed for this patient as well. There are a number of different responses from the treatments that can develop, therefore it is crucial to utilize close observation skills in the management care of this individual (Ewles & Simnet 1999). Furthermore, the meal and exercise plan that should be structured for this individual should provide great benefits in controlling his weight, blood sugar levels, and also help in reducing the possibility of needing any additional medications also. Therefore, the diet constructed should limit his sugar intake; it should have the inclusion of foods that are low in fat but rich in fiber. The meal plan should also be regulated so that he is served on a consistent basis, at least three times a day to regulate blood sugar levels (Bower 1977). The approach that would help the most would obviously be a holistic one as the plan is seemingly following a path that is consistent with a holistic type of framework (Bower 1977). Within nursing home care, the diabetic nurse visits the patient quite often, documenting their meals and what they have consumed on a regular basis to see how the varied diet sets with them and to articulate the response from the patient about their diet as well. This type of activity is often carried out before meals and the last thing at night then documented in the patients chart (Russell 1999). Following release from an intensive medical environment and then being allowed to return back to the main nursing care area within a nursing home environment, these various interactions that have been mentioned ensure that the patient will feel positive enough to attempt to stick with the regimented plan designed for them of which they had a part in. So, by monitoring correct carbohydrate intake, glucose levels, and other food products that might affect the natural insulin levels in the body, the patient can feel at ease and secure in knowing that those in charge of his or her care will safeguard his or her wellbeing and plan out the best strategies to keep their health in optimum shape. Furthermore, the underpinning of holistic care guarantees that the patient does not feel neglected or left out of any of the decision making surrounding the individual care plan that they need. By proper communication through interpersonal relations with the patient the nurse and other care practitioners can promote a positive experience for the diabetic patient and help them facilitate their own needs in the best way possible (Abramms 1996). Ensuring exercise is beneficial to the patient as well. This is due to the fact that exercise for any diabetic can help to keep the proper muscle tone and improve upon physical fitness. Not only this but regulated exercise for this patient will help his blood circulate more fluidly to allow for his organs to get enriching oxygen which otherwise could be restricted (Cryer 1997). It is highly likely that this patient will have a positive reaction to exercise and begin to feel better about himself both physically and mentally as well. Good physical health is important but strong mental health is what regulates a person in trying to combat a disease that is severe such as Diabetes II. The exercise will also prove to be effective in lowering his blood pressure which is elevated due to his obesity and this will promote a positive influence on his overall health condition. Exercise plans have also been found to ward off serious complications such as Arteriosclerosis which is a major problem for people who suffer from any form of Diabetes. If this were to occur with this patient he could suffer from strokes, heart attacks, and very poor circulation as well (Bertie 1991). If the nurse does not ensure that the patient has adequate blood circulation then another complication that could arise in his condition could be relative to his feet where damage to the vessels and nerves could initialize and thus increased chances of infection could take place as well (Bertie 1991). Often Diabetes II patients have been known to lose limbs due to this adversity so this has to be carefully monitored at all times in order to protect this patients well being and sustain a decent quality of life for him. All of the aforementioned medical areas have to be assessed, monitored, and critically evaluated on a daily basis to ensure that the patient will continue to have a sense of normalcy in their life and also so they will start to feel more positive in their care and in the control they have over their treatment as well. The Role of Cultural and Social Diversity within the Health Care of the Diabetes II Patient Depending upon what cultural background a patient has the more complex the management of the patients care can become. However, interpersonal skills will help in overcoming many of these obstacles if the structure of patient care is handled correctly (Ewles & Simnet 1999). Here again, in this area of diversity holistic health care works far more effectively than trying to maintain the traditional type of care because often a traditional method is not going to blend well with a patient of a Latin background or a background that clashes with the main cultural entity within a country such as England, or even Canada. Therefore, holistic methods could be implemented in a way to where they would meet patients' individual social and personal needs, improving upon their own participation in the management of their health care regimen as well (Ewles & Simnet 1999). For instance, this patient's situation shows that he is suffering emotionally and it could be assumed his obesity issues are stemming from some of these past emotional problems. Thereby, the holistic approach could work to help the patient open up and confide in the care provider on how his obesity initially started and what he feels was the cause of it occurring. This issue is extremely important because obesity complicates the treatment process for type II Diabetic patients. Therefore the nurse in charge of this patients care needs to determine the main cause of the weight gain and provide any necessary counseling to assist this patient in overcoming the root cause to his weight dilemma. Many diabetic patients suffer in this area and often the weight gain stems from depression for various reasons. In this patient's case it is obviously the loss of his spouse and his own independence dwindling. With proper intervention his weight problem can be corrected, again with holistic forms of medical therapy. Abramms (1996) claims that agencies such as the NCCH (National Center for Cultural Healing) can bring about a concentrated effort to fluidly understand the cultural diversity that often enters into the treatment phases of a diabetic patient. The resources that centers like this offer help the nurse in particular gain a comprehension on how to directly approach gender issues in cultures, body size and weight issues, individual beliefs and values, and acculturalation directly so that a better supportive network can be established. Medical providers have come to realize that understanding different ethnic groups and cultural classes plays a detrimental role in facilitating proper medical care. If medical staff can not become comprehensible to the needs of culturally diverse patients then the NHSS could be criticized and stated to be incompatible with the needs of other cultures both internationally and nationally as well (Abramms 1996). As Jackson (1993) defines, holistic treatment in diabetic care focuses on the lower order of physiological needs initially because it is understood these needs must be met first to meet the higher levels of needs in the patients care as well. As has been stated this would be extremely beneficial for this patient as he is dealing with psychological issues as well as his disease at the same time so his treatment is a little more complex than other patients might be. For instance, although this patient has not lacked warmth, etc he has lacked emotional support and has recently lost his spouse so his emotional state is out of balance. For other patient their social and physiological needs might be simply associative with a lack of warmth, shelter, and food which would complicate their medical treatment due to their emotional state and their feelings of insecurity, lack of feeling safe, and a lack of feeling cared for as well (Jackson 1993). This of course shows that in regards to the culturally diverse areas and social areas in the patient care regimen, information is needed about the individual patients physiological and social functioning as it has been inherently found that each patient is different and their symptoms of disease might slightly vary from other patients due to their individuality and social differences. Therefore, when each patient's problems or needs are dealt with efficiently then it avoids the depersonalization that can often come from the traditional framework of care. In holistic care the person is treated as a whole person and not just as a diagnosed illness but someone with a cultural background, and who has varied social needs just like any other human being does (Jackson 1993). When a diabetic patient is treated more exclusive they develop a positive attitude and are more willing to follow the necessary nutritional plan and lifestyle assessment plan than if their personal needs were ignored and no acceptance of their cultural or social differences were given. Therefore, again holistic medicine has made great improvements in a wide range of services for diverse patients who suffer with type II Diabetes. Hinchcliffe et al (1993) define how this type of alternative to traditional healthcare has transformed the field of nursing into one more devoted to the care of the individual patient instead of grouping them all into one category. Quite naturally this form of care will fit well with this patients needs and in understanding his emotional and psychological needs as well, not just basic health care needs. Conclusion Patients want to have a part in structuring the life changes that are going to be necessary to regulate their health and safeguard their over all physical well being. Therefore, for this patient I feel that holistic medicine is the best option available to him and will be great at achieving these types of feelings and promoting positivism in the patient/nurse relationship. Furthermore, the realization that every diabetic patient is different and this idea is also one of extreme pertinence for the primary care giver for this individual to keep in mind. While some will have to have routine checks on their glucose and insulin levels others will not so making certain that the proper nutrition plan and exercise plan is established is a very important part of the patient care as well. All of these issues carried out in a positive manner and with the patient in mind at all times lead to a positive and fulfilling nursing experience for both the nurse and the patient that he or she has under their care as well. Care for a diabetic patient can be confusing but care for a type II Diabetic patient can be confusing and time consuming thereby it takes the necessary strategy to fulfill the needs and expectations of each individual patient. As the research has pointed out every patient is totally different and therefore the patients themselves need to be treated, not just the disease. So as has been theorized, proper communication, understanding, sharing knowledge, and allowing for decision making by the patient are all necessary factors in achieving a positive patient experience in nursing, with particular emphases on the individual patient. The patient management care of a type II diabetic individual can be hard yes; but it is not impossible with the right implementations and the correct attitude. Notes 1. Aggleton, P & Chalmers, H, "2nd Edition Nursing Models and the Nursing Process," London: Palgrave Publications Limited (2000). 2. Alexander, S, "Nursing Practice Hospital and Home-The Adult," Churchill: Livington Publications (1994). 3. Bertie, O & et al, "Rediscovering Nursing," London: Chapman and Hall Publications (1991). 4. Bower, FL, "A Model for Planning Holistic Nursing Care: A Model of Practice," (2nd Edition) Journal of Advanced Nursing, 11, (1977). 5. Cryer, Philip, "American Diabetes Association: Complete Guide to Diabetes," New York, (1997). 6. Ewles, L & Simnet, I, "Promoting Health: A Practical Guide," (4th Edition) London: Balliere Publications, (1999). 7. HinchCliffe, S & Norman, S & Schober, J, "Nursing Practice and Healthcare," (2nd Edition) Journal of Advanced Nursing, 11, (1993). 8. Hogg, T & Armstrong, V & Brown, B, "The Importance of Good Keeping," Nursing Times, 93, (1997). 9. Jackson, L, "Understanding, Eliciting, and Negotiating Patients' Multicultural Health Needs." Nurse Practitioner, 18, 30-34, (1993). 10. NMC, "NMC Code of Conduct," [online] Available from: http://www.nursing-standard.co.uk/professionaldevelopment/nmc-code.asp (2002). 11. Roper, N & Logan, W & Tierney, a, "The Elements of Nursing: A Model for Nursing Based on a Model of Living (4th Edition) London: Churchill Livington Publications (1996). 12. Rubin, Alan, "Diabetes for Dummies," Hungary Minds Incorporated (1999). 13. Russel, G, "Essential Psychology for Nurses," London: Routledge Publications (1999). Read More