Health Promotion - Blood Glucose Monitoring - Essay Example

Health Promotion in type 2 diabetic patient This assignment is about how to plan and conduct a health promotion advice on an individual patient to improve patient’s quality of life. In this essay, I will first outline how government policies, which are National Service Framework (NSF) for long-term conditions and the NSF for diabetes, were developed. To respect confidentiality, all names have been changed to meet the Nursing and Midwifery Council (NMC) Code of Conduct (2008). John is a 57 year old taxi driver, who is newly diagnosed with type II diabetes mellitus (T2DM), married with two teenage children. He frequently works during unsocial hours and has a very unhealthy life style as he relies on fast foods from cafes for his meals. He is overweight with Body Mass Index (BMI) of 30 and is finding it challenging to maintain a normal blood glucose level. He is also concerned that he may lose his job should he be commenced on insulin. John stated that his weight and little exercise might have been a contributing factor for his newly diagnosed diabetes. Diabetes is a condition that occurs when the body can’t use glucose, a type of sugar which isnormally the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin which is made by the pancreas & which helps glucose to move from the blood into the body’s cells. Diabetes is caused when there is resistance to or deficient production of insulin.When the body does not produce or use enough insulin the cells cannot use the glucose for energy and the blood glucose level rises. This means that the body will instead start to break down its own fat and muscle for energy Aryangat, AV. Gerich, JE. (2010).There is two primary types of diabetes: Type 1 diabetes occurs when the immune system destroys the beta cells in the pancreas that create insulin. As a result the body makes very little or no insulin of its own, which means that people with type 1 diabetes must take insulin daily. Type 2 diabetes occurs when the pancreas does not make enough insulin or the body cannot properly use the insulin it does create. Eventually the pancreas may stop producing insulin altogether. Type 2 diabetes can affect people at any age. In men and women, the more overweight an individual is the greater the risk of developing type 2 diabetes (Jarrett, RJ. et al. 1976). The purpose of this paper is to discuss health promotion in nursing practice, the evolving roles and responsibilities of the nurse in health promotion and the implementation of these roles. Health promotion has been defined by the World Health Organisation (WHO) as ‘the process of enabling people to increase control over their health and its determinants, and thereby improve their health WHO (2005). The incidence of diabetes is increasing worldwide, and in England 1.3 million people have the condition. Diabetes affects physical and psychological well-being as well as lifestyle, income and life expectancy, and the financial implication are significant: 5% of the total National Health Service (NHS) budget and 10% of acute sector resources are spent on diabetes which is supported by the department of health (2001a). One of the popular proverbs amongst health care professionals is: ‘An ounce of prevention is worth more than a pound of cure’. In this day and age of budget cuts, cost reduction and staffing shortages, health promotion makes sense. If we can preserve wellness, we reduce the number of times people need to enter the health-care system, thus reducing cost. The goal in health promotion and diabetes management is aimed at controlling the disease with the main emphasis on primary prevention. There are the medical, behavioural and educational assessments that can be done to make health promotion more effective (Patterson, 2011). Medical screening focuses primarily on prevention and premature death. This behavioural model assesses a person’s willingness to change and adopt a healthy lifestyle. Educational approach is used to give the person more information about their particular condition. One of the aims of NSF 2001 was to maximise the quality of life of all people with diabetes and to reduce their risk of developing the long-term complications of diabetes. The aim was that all patients with diabetes will receive high quality care throughout their lifetime, including support to optimise the control of their blood glucose. There is robust evidence that meticulous blood glucose control can prevent or delay the onset of microvasular complications and may reduce the risk of developing cardiovascular disease. However, this requires effort and dedication on the part of the person with diabetes and the health professionals working with them. For people with type 1 diabetes, insulin is the mainstay of blood glucose management and is essential for survival. For patients with newly diagnosed type 2 diabetes, the majority of whom are overweight, weight loss and increased physical activity is the first intervention, followed by the addition of medication, as appropriate. There is supporting evidence that self-glucose monitoring can help reduce the complications of long-term diabetes as it inadvertently empowers the patient to take an active part in their management and helps to self-educate the patient on the effects that diet has on blood glucose. Delivery of health promotion, Told the patient should check more regular blood glucose, at least once a day but if possible twice. Change to a healthier diet. Getting more exercise, and taking more of a management for his condition. The delivery of health promotion towards John was to make small lifestyle changes that would help reduce the risk factors of complications with diabetes. After talking with John I explained that short term complications can happen quickly such as hypoglycaemia, hyperglycaemia, and ketoacidosis. Also the long term complications of diabetes such as: heart disease, kidney disease, neuropathy and diseases of the eyes. I furthered to explain that a healthier diet and regular exercise can help control blood pressure and blood glucose. John was eager to take an active part in his treatment and management of his diabetes. Since John was a newly diagnosed diabetic I explained to him that self-monitoring can be done at home with home testing kits which would provide information daily on his blood glucose. At first John was unsure about the home testing kit because of financial reasons I therefore explained to John that these home testing kits are provided free to diabetic patients by the manufacturer and the testing strips can be provided by a NHS prescription along with his other medications at no extra charge. There is currently a great deal of debate about the need and frequency of Self-monitoring of blood glucose(SMBG) in type 2 diabetes. The debate is focused on the balance between the high and rising NHS expenditure on blood glucose monitoring and the importance of the involvement and empowerment with self-care of people who have diabetes (Gray, A. et al. 2000). Glucose meters are not prescribed by the NHS as they are provided free to patients by the manufacturers on the basis that their profit is made from the testing strips which are prescribed at NHS expense. In addition it is worth mentioning that each type of testing strip is specific to each monitor. Routinely, patients who have been diagnoses with diabetes mellitus (DM) have regular HbA1c blood test, which assesses the control in most patients, except when the patient has frequent hypoglycaemic events. SMBG is a way of testing the concentration of glucose in the blood (Davis et al 2006). A SMBG is performed by piercing the skin, typically on the finger to draw blood, then applying the blood to the chemically active disposable test-strips. Using a blood glucose monitoring machine then provides a reading which determines the glucose level in the blood (Diabetes UK 2009) and therefore detecting both hyperglycaemia (a condition that happens when there is too much glucose circulating in the blood) or hypoglycaemia (when the blood sugar level drops too low). The Diabetes Control and Complications Trial (DCCT) was the first study to show the benefit of making efforts to keep blood glucose levels within tight limits. The results have had a significant effect on the directions of new diabetes management research (DCCT 1993). The DCCT was a 10-year study involving 1,441 people with insulin-dependent diabetes throughout the United States and Canada. It compared the effects of two different levels of insulin monitoring and blood-glucose control on the development and progression of diabetic complications. The results proved that tight blood glucose control prevents or delays the onset of complications and showed that even minor improvements in diabetes control reduce the risk of complications. Making tight blood glucose control is imperative for those who already have complications & will prove to be worthwhile. Another study that shows SMBG clearly correlated with improved life expectancy and reduced long-term complications in people with type 2 diabetes is The Retrolective Study: Self-monitoring of blood glucose and Outcome in people with type 2 diabetes (ROSSO). This study shows that people with type 2 diabetes who self-monitor have a 51% lower risk of death and a 32% lower risk of complications like heart attack, stroke, blindness and amputation (Martin, S. et al 2006). This study was published in the Journal of Diabetes Nursing (Hicks D 2005). The study compared people who self-monitor their blood glucose with those who do not. It found that people who self-monitoring were more aware of their blood glucose levels and sought advice sooner from their health care professional (HCP) when their levels were outside the target range. The ROSSO study, conducted at the well-known German Diabetes Centre, Düsseldorf, collected data from 3268 people with type 2 diabetes. The research panel involved in the study stated that patients who monitored their blood glucose levels were more aware of their optimum levels and more inclined to alert their HCP when they were outside their range. This lead to more frequent adjustments in their medication. ROSSO highlights the importance of patient education alongside regular blood glucose monitoring so that results can be interpreted and acted upon. From 2006 all Primary Care Trusts (PCTs) in England and Wales must by law provide people with diabetes a structured patient education (NICE 2008b). Currently, Diabetes Education and Self-Management for On-going Newly Diagnosed (DESMOND), is the only national programme for people with type 2 diabetes, meeting National Institute for Clinical Excellence (NICE) recommendations and the National Service Framework (NSF) for Diabetes standard 3 (Department of Health. 2002). The DCCT trial and the ROSSO study both indicated that the benefit of making efforts to keep blood glucose levels within tight limits. The results have had a significant effect on the directions of new diabetes management research (DCCT 1993). I examined implications of the DCCT study results, which indicated that tighter control of blood glucose levels through more frequent monitoring directly correlates with reduced risk of hyperglycaemia. It was noteworthy that close monitoring of blood glucose will also pre-empt the short-term potential for hypoglycaemia. The end result is that for patients to minimise the risk of both the long term complications and the short-term hypoglycaemia of diabetes they must sustain a strict regimen of blood glucose monitoring, which can become taxing for many patients. This was to ensure a healthier lifestyle by lowering blood glucose risks. Model of reflection What worked well and why? In the secondary health care for this particular case, SMBG worked well especially the diet adjustment. This is a result of controlled glucose intake that impacted the blood glucose level to a healthy level. What did not work well and why not? The adoption of SMBG for patients with type II diabetes, did not achieve optimum results in lowering blood glucose level. This is because it results in major medication adjustments and leads to health complications such as heart attack, stroke and blindness. What will I do the same next time? In case of a secondary health care, I would definitely use SMBG technique to achieve healthy blood glucose level. This is mainly because it works well for both low blood glucose level and high blood glucose level complications. What would I address differently next time? I would consider therapy for patients with type II diabetes to add to SMBG for optimum results unlike the previous technique to avoid health complications. Health promotion activities, such as body weight control, healthy diet, sporting activities, and fresh air are the basic pillars for type 2 diabetes risk prevention. I directed my patient to make some changes, but it was quite a challenge for him. John did settle on eating less rich food, participating in morning exercises bywaking too work. His daily intake was quite minimal in order to facilitate control over healthy body weight. In this secondary care, my patient was motivated by the idea of health promotion, because he did not want to suffer from drastic consequences of diabetes. I convinced him on this cause by providing him with examples from the modern literature illustrating positive changes of self-monitoring. National guidelines and frameworks set the standards of care that people with diabetes should expect and prioritise information, education, training and support to enable people to manage their diabetes themselves (Department of Health. 2002). SMBG combined with education, provides information for people with type 1 and type 2 diabetes to make day-to-day decisions about food, physical activity and treatment to maintain optimum control of blood glucose (Diabetes UK. 2009). Debbie Hicks, Nurse Consultant in Diabetes and author of the review in the Journal of Diabetes Nursing said “Without the ability to self-monitor their blood glucose, people with diabetes may not be aware of increased blood glucose levels until they experience overt symptoms such as a hypoglycaemic episode. Persistently high levels of blood glucose can contribute to long-term complications such as heart attack, stroke and eye damage or even death” Moreover, Debbie Hicks’ article goes on to explain that people who self-monitor are more likely to experiment with their diet enabling them to learn how certain foods influence their blood glucose levels and assess the effect of physical activity on blood glucose levels (Hicks 2005). My patient was quite afraid of a heart attack and stroke and different complications that resulted from experimentation with diet and physical activities were a motivation for him in handling his condition. A wide range of examples from literature publications and emotional support were essential in assisting John to understand and gain motivation to deal with his diabetes. John took the initiative to adopt self-monitoring measures References: Department of Health.(2001a)National Service Framework for Diabetes. London: DH Patti Zuzelo (2010) The Clinical Nurse Specialist Handbook Jones & Bartlett Learning. Melanie Jasper (2003) Beginning Reflective Practice. Nelson Thornes. Robert Schinke, Stephanie J. (2009) Hanrahan Cultural Sport Psychology. Human Kinetics. Christopher Johns. (2009) Becoming a Reflective Practitioner. John Wiley & Sons. Leana E. Callara. (2008). Nursing Education Challenges in the 21st Century. Nova Publishers. Clare Delany, Elizabeth Molloy (2009).Clinical Education in the Health Professions. Elsevier Australia. Kay Mohanna. (2010).Teaching Made Easy: A Manual for Health Professionals. Radcliffe Publishing. Practising Clinical Supervision:John Driscoll (2007). 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