Developing a Health Promotion/Learning Plan for Self-Injecting Insulin in Diabetic Patients

Overview of The Client and Implications of The Disease on The Future Health of The Person

Develop a Health Promotion/Learning Plan On How To Self-Inject Insulin For a Newly Diagnosed Diabetic Client.

The main purpose of this report is to develop a learning plan on overall management of diabetes for a newly diagnosed client with Type 2 Diabetes (T2D). To prepare an effective learning plan for this, a client from the community will be used to assess his holistic health care pattern. The Gordon’s Functional Health Pattern will be used to identify holistic health needs of the client and a health promotion plan will be developed based on client’s expressed desire to learn about type 2 diabetes. The main rationale for selecting learning needs of newly diagnosed diabetes patient is that diabetes is the most chronic disease and recently diagnosed patients often lack the knowledge about the disease leading to frustration and stress (Gardsten et al., 2018). Hence, it would be beneficial to learn about the challenges faced by this people and increase their abilities to mobilize their own strength.  The paper will first give an overview of the client and then engage in development of a plan to manage the issue.

 The client for whom the assessment is completed is Mr. Y, who is twenty two year college student recently diagnosed with T2D. Currently, Mr. Y seems very distressed by the new diagnosis and he is very confused about how to deal with the disease. He feels reluctant to take any help from this friends or parents too. Before conducting the assessment on patient to know his learning needs, understanding the implication of T2D diagnosis on his future health is important. T2D is a chronic disease condition that affects the way the human body metabolizes glucose, an important source of fuel for the body. It either impairs the effect or function of insulin on the human body or it affects the way insulin is produced for the maintenance of normal glucose levels (Chaudhury et al., 2017). Unless and until Mr. X learns to self-manage the disease, he is at risk of other complications too. This is said because T2D will damage his small and large blood vessels which can increase the risk of other disease conditions such as heart attack, stroke, kidney problem, eye problem like retinopathy and nerve problem like diabetes nephropathy (Government of Canada, 2018). Pecoits-Filho et al. (2016) supports that diabetic kidney disease is one of the most frequent complications of T2D which affects about one-third of the patients. According to the World Health Organization (2018) report, the global prevalence of diabetes is increasing and it is the major cause behind blindness, kidney failure, heart attack and lower limp or foot amputation. In 2016, diabetes was the reason behind 1.6 million deaths. As health diet, physical activity and maintaining normal body weight is vital to manage the disease, identifying health education strategy to increase knowledge and self-management of T2D for Mr. X is important.

Assessment of Client’s Health

To understand overall effect of T2D diagnosis on Mr. X health outcome, assessment has been completed using Gordon’s functional health assessment patterns. The significance of this framework is that it helps to evaluate an individual perception or impact of any disease by 11 categories of health patterns. These 11 health patterns include health perception, nutritional, elimination, activity, cognitive, sleep, role, self-perception, coping, sexuality and value (Mahnaz, Shahin & Shahdoust, 2019). Current Mr. X’s health perception about diabetes is low and he is not consuming adequate diet for the management of his blood sugar level. Due to emotional burden, he has stopped engaging in recreational activities. As currently he has very low self-esteem due to lack of knowledge about T2D and effective ways to self-manage it at home, there is a need to identify best method to increase his knowledge about overall management of diabetes in accordance with his age and learning needs. The functional health pattern that is important for newly diagnosed patient includes nutritional patterns, activity patterns and coping-stress tolerance pattern. The learning plan will be developed focusing on this pattern.

Based on Mr. X’s health pattern assessment, the most important health needs for him is that he lacks proper knowledge about T2D and the way to self-manage the disease on his own. In his learning plan, self-management education will be prioritized and all support will be given to him to ensure that he could adopt all behavior needed to improve health outcomes. According to Chrvala, Sherr and Lipman, (2016)., Diabetes Self-management education (DSME) and support provides the foundation to enable people with diabetes to navigate their decisions and activities for better health outcomes. It is the process of building knowledge and skills necessary for diabetes self-care. While designing the learning plan, it is important to address current health beliefs, cultural needs, emotional concerns, health literacy and other factors that could influence Mr. X’s ability to meet the challenges of self-management. The educational plan differs for a recently diagnosed diabetes patient compared to more experienced T2D patient.  As Mr. X is overwhelmed with feelings of uncertainty and confusion, he needs to absorb a large amount of information and develop skills to manage blood glucose level on a day to basis (Gardsten et al., 2018). Hence, it is necessary to provide learning in a way that is easily understood and grasped.

The review of research literature related to the type of education given to T2D patient with diabetes suggests that understanding patient’s perspective and working in a mutual way is important to encourage patients during self-management. Empathetic and individual ongoing support is also crucial to inspire Mr. X to self-manage the disease and develop the perception that the disease is controllable (Powers et al., 2016). This is supported by Gardsten et al. (2018) too as the authors argue that personalized and comprehensive approach to DSME is necessary to share the information required by diabetes patient to promote effective coping and self-management. Patient-centered approach can fulfill both current and future needs. In addition to this, it is planned to utilize interactive teaching strategies with the use of information and communication technology (ICT) to ensure that smooth sharing of information takes place. Use of internet based education minimizes barriers related to distance and limit access to diabetes care services. There are many examples of studies which achieved positive results with the use of ICT to promote self-management of diabetes. Booth et al. (2016) investigated about the impact of a computer based program for people recently diagnosed with T2D and assessed diabetes knowledge and goal setting post the intervention. The computer program resulted in a statistically significant improvement in diet related knowledge. Another advantage of using ICT or web based tool for diabetes education is that this resource is most commonly accepted by patients and this tool can complement outpatient visits too (Shibuta et al., 2017).

Learning Plan for Management of Diabetes

The next vital part of the learning plan is designing appropriate teaching content. This has been developed based on exploration of challenges faced by Mr. X in dealing with blood sugar level currently. All the initial questions and concern of the client will be addressed by starting with basic information about T2D, its causes, risk factors, preventive steps, medications and technique to control the blood sugar level. The patient will be introduced to the fact that his role is most important in controlled the disease. This will help in receiving the mutual support to engage in self-directed goal setting (Powers et al., 2016). Similarly, based on his current concerns, education will focus on self-care behaviors like health eating, being active and monitoring blood sugar level regularly.  Short term recommendations related to physical activity will be provided and a food plan will be made based on his cultural preferences. The initial process of change is most challenging and supporting patient to cope with the burden of diabetes will be crucial too (Powers et al., 2016). Hence, it is planned to be in touch with patient to review behavior change and develop their problem solving skills so that they can easily manage the challenge associated with diabetes. Psychosocial support by means of motivational interviewing can be provided to Mr. X so that he could be motivated to sustain the change and get access to positive information on diabetes management. Counseling for promotion of the use of problem-oriented coping strategy is crucial for successful management of patients with diabetes early during the course of the disease (Parildar, Cigerli & Demirag, 2015).

Conclusion

Based on the above learning plan, the educational session was started with Mr. X. Since the focus was to identify initial concerns and personal challenges for patient, various general questions about the disease was asked. I patient was a bit uncomfortable in the beginning. However, due to use of empathetic approach, he eventually became comfortable and honestly made me aware about his main concerns post diabetes diagnosis. I am satisfied that focused on holistic concerns of client instead of focusing on the physical health concerns only. This helped to empower the client and convince him that he can actually take control over his health. Since, he was a newly diagnosed patient, I started with broad information on disease, medications and other self-care behaviors. However, one aspect that I could not identify was that why he did not contacted anyone to get help. Exploring about this was important to identify any stigma related issues and plan educational strategies accordingly.

References

Booth, A. O., Lowis, C., Hunter, S. J., Dean, M., Cardwell, C. R., & McKinley, M. C. (2016). Development and evaluation of a computer-based, self-management tool for people recently diagnosed with type 2 diabetes. Journal of diabetes research, 2016.

Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., ... & Kuriakose, K. (2017). Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Frontiers in endocrinology, 8, 6.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient education and counseling, 99(6), 926-943.

Gardsten, C., Blomqvist, K., Rask, M., Larsson, Å., Lindberg, A., & Olsson, G. (2018). Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study. Journal of clinical nursing, 27(19-20), 3666-3678.

Government of Canada (2018). Diabetes in Canada. Retrieved from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/diabetes-canada-highlights-chronic-disease-surveillance-system.html

Mahnaz, K., Shahin, T., & Shahdoust, M. (2019). Effects of applying a patient assessment form based on the health functional patterns on nursing student's attitude and skills in developing nursing process. International Journal of Nursing Sciences.

Parildar, H., Cigerli, O., & Demirag, N. G. (2015). Depression, Coping Strategies, Glycemic Control and Patient Compliance in Type 2 Diabetic Patients in an endocrine Outpatient Clinic. Pakistan journal of medical sciences, 31(1), 19–24. doi:10.12669/pjms.311.6011

Pecoits-Filho, R., Abensur, H., Betônico, C.C., Machado, A.D., Parente, E.B., Queiroz, M., Salles, J.E.N., Titan, S. and Vencio, S., 2016. Interactions between kidney disease and diabetes: dangerous liaisons. Diabetology & metabolic syndrome, 8(1), p.50.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … Vivian, E. (2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical diabetes : a publication of the American Diabetes Association, 34(2), 70–80. doi:10.2337/diaclin.34.2.70

Shibuta, T., Waki, K., Tomizawa, N., Igarashi, A., Yamamoto-Mitani, N., Yamaguchi, S., Fujita, H., Kimura, S., Fujiu, K., Waki, H. and Izumida, Y., 2017. Willingness of patients with diabetes to use an ICT-based self-management tool: a cross-sectional study. BMJ Open Diabetes Research and Care, 5(1), p.e000322.

WHO (2018). Diabetes. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/diabetes