Person And Family-Centered Care For Diabetic Complications

According to Aveyard, Sharp, and Woolliams (2011), the six questions for critical thinking are where, what, how, who, when, and why.

Critical Appraisal of the Article

Person-centered care is where the caregivers allow the client to assume an active role in their medical treatment (Entwistle, and Watt, 2013). However, family-centered care is when the caregivers involve the relatives of the patient in decision-making towards the health and well-being of the patient (Rose et al., 2017). Person-centered care and Family-centered care coexist and depend on one another for holistic function. The case scenario presents a 32-year-old Afro-Caribbean woman who has type 2 diabetes mellitus. Anne Baptiste is showing non-proliferative diabetic retinopathy signs. The diabetic condition has made the patient experience microaneurysms. Additionally, Anne complains about blurred vision in her right and left the eye. The patient also suffers from bilateral neovascularisation. The diabetic interference with visual acuity prevents the client from performing her work-related duties. She is unable to read the dentist notes at work. This essay will critically appraise an article that discusses care towards diabetes. It will also apply the Dahlgren and Whitehead model to suggest solutions to Anne's situation.

According to Aveyard, Sharp, and Woolliams (2011), the six questions for critical thinking are where, what, how, who, when, and why. The article is assessed through a systematic research. The researcher, Jean Maydalyne Gumbs found out that, African-American women with diabetes mellitus do not embrace self-care behaviors and self-management education. Gumbs, (2012), arrived at the conclusion after a conclusive research. Jean Gumbs, who is a PhD graduate, wrote the article in the year 2012.  The author wrote the article to enlighten the diabetic African-American women about the essence of self-care behaviors and self-management education.

One of the individual factors in the Dahlgren and Whitehead Model is diet. Therefore, the first approach of decreasing the severity of diabetes is to ensure that the patient takes a healthy diet (Gumbs, 2012). The family should seek the help of an experienced dietitian to suggest the appropriate meals to the patient. The foods consumed by diabetic patients should maintain the level of blood sugar at the acceptable limits. The diet should also achieve a lipoprotein and a lipid profile that decreases the chances of getting vascular complications. In the case scenario, Anne admits that she is struggling to maintain the diet recommended by her dietitian. A key nutritional recommendation for diabetic patients involves adjusting the doses of insulin to match the intake of carbohydrates. The patient should also ensure that she maintains the level of carbohydrate intake on a daily basis. Excessive carbohydrate intake worsens the symptoms of the complication insulin resistance. The client should increase her fiber intake and limit taking meals having trans-fats. Taking fatty foods can lead to obesity which is a risk factor for diabetes (Micha et al., 2017). The family members should monitor Anne to ensure that she lowers both sodium and cholesterol intakes per day. On the other hand, the patient should increase her consumption of vegetables, fruits, legumes, and lean meats which lower the symptoms of diabetes.

Person/Family-Centered and Holistic Approach

According to the model by Dahlgren and Whitehead (2006), a sedentary lifestyle is a risk factor for complications like diabetes. Therefore, Ann should conduct a regular physical exercise to reduce the severity of complications like blurred vision. Physical activity controls diabetes and maintains the levels of blood sugar at acceptable limits (Hansen et al., 2018). Furthermore, managing the amounts of blood glucose prevent long-term complications like kidney diseases and nerve pains. When an individual is conducting the physical exercise, the muscles rely on the blood glucose for the provision of energy. Therefore, the conversion of glucose to energy lowers the levels in circulation. Exercise also improves the effectiveness of insulin thereby reducing insulin resistance. Physical activity also assists an individual in maintaining the amounts of good cholesterol in blood circulation (Duignan, and Duignan, 2017). Exercise helps a diabetic individual to relieve stress and lower the levels glucose in blood circulation. Physical exercise also strengthens the bones, muscles, and the heart. An individual who exercises regularly develops an improved mood and quality sleep. Physical activity also decreases the blood pressure of a diabetic patient.

The family members should urge Anne to visit the caregivers regularly for check-ups and follow-up care. In the case scenario, Anne admits that she does not check her blood glucose levels due to her busy schedule and forgetfulness.  After being diagnosed with non-proliferative diabetic retinopathy (NPDR), the client failed to visit the diabetic consultant for the second time.  Her failure to honor the specialist's appointment worsened her condition. Initially, the patient had complications in the right eye, but failure to visit the doctor regularly led to vision difficulty in the left eye. After NPDR and Proliferative retinopathy diagnoses, the patient failed to visit the diabetic specialist for follow-up. The failure to visit the caregiver further complicated her situation as she encountered bilateral neovascularisation. Visiting the caregiver for monitoring prevents the severity of diabetic signs and symptoms. The caregiver can recommend a healthy diet that decreases the severity of the complications (Ley et al., 2016). The care provider can also prescribe drugs that prevent the progression of the NPDR. The husband and the daughter of Anne should encourage her to visit the specialists for follow-ups. Additionally, the relatives should accompany the patient to the various health facilities.

The patient should also monitor her glucose level to maintain it at the normal range. The health specialists should train the patient on how to control her sugar levels (Schnell et al., 2017). The health facility should provide the equipment for monitoring diabetes. The family members should ensure that the patient checks her blood glucose levels on a daily basis. After reviewing the standards, the patient should take appropriate actions to bring the sugar levels to the normal range. The remedies include exercising, proper diet among other solutions. Adequate implementation of the remedies leads to a drop in the HbA1C in the blood. Recent research has shown that a 1% decline in HbA1C has numerous advantages to diabetic patients. Firstly, the reduction leads to a 40% decrease in diabetic complications like cardiovascular diseases. In the case scenario, the patient complains of bilateral neovascularisation which can decline with the reduction of blood glucose. The decrease in HbA1C also leads to a 90% reduction in diabetic retinopathy that leads to blindness. The patient has blurred vision in both eyes which can reduce with a decrease in HbA1C levels. The decline in the levels of HbA1C by 1% also reduces renal and vascular diseases by 50% and 40% respectively. The reduction in sugar levels also lowers the mortalities from vascular complications by 40%.

Monitoring and Regular Check-ups

Self-care Management training of diabetic patients is another person-centered care towards the complication. The family members of diabetic patients should urge the patients to seek self-care education to reduce the severity of the difficulty. A recent study has indicated that support and training towards diabetic patients are cost-effective as it decreases hospital admissions (Powers et al., 2017). Self-management education also reduces the amounts of hospital readmissions. Patients who attend the education sessions always learn about the appropriate lifestyles to manage their condition. Such patients tend to adopt a healthy eating pattern which prevents the emergence of risk factors like obesity. An informed diabetes client knows the benefits of regular exercises. Therefore, the education on self-care makes the patients conduct daily physical activities. The management education also empowers the patients and enhances their self-efficacy. An enlightened diabetes patient can adopt a healthy coping with the condition. The training on diabetes management also enables patients to avoid stress due to the complication. Depression is a mental complication that can affect the diabetic patients without proper education on self-care management.

Diabetic patients should attend both regular dilated eye and annual foot check-ups to prevent the emergence of other complications. In the case scenario, Anne admits that she finds it hard to read dentist notes. Her daughter should encourage her to go for the tests to improve her visual acuity. Diabetes mellitus causes blindness to the adults in the US. Therefore, the purpose of the examinations is to detect possible blindness and look for appropriate interventions. Regular eye tests for diabetic patients decreases the chances of developing diabetes-related blindness (Fisher et al., 2016). Anne developed proliferative retinopathy due to lack of dilated eye examination. Annual examination of the foot is an essential exercise for diabetic patients. The test enables the caregiver and the patient to pinpoint high-risk conditions of the foot (Pop-Busui et al., 2017). The test should involve the checking of foot components like skin integrity, vascular status, and foot structure. Individuals with numerous foot conditions require a periodic examination and evaluation. Foot complications can prevent diabetic patients from having an efficient movement.

Conclusion:

Diabetic patients deserve person/family-centered care as a holistic approach to decreasing the severity of the complication. The patients should take a healthy diet to manage the severity of signs and symptoms. The patient should take an elevated amount of fruits and vegetable and reduce the intake of carbohydrate-rich foods. The client should also conduct a regular physical exercise. The exercise has numerous benefits that include reducing the levels of blood sugar and increasing the levels of good cholesterol. The patient should visit the caregivers regularly for the check-up and follow-up care. The caregivers can prescribe appropriate medications and advice the patient on the proper diet. The diabetic client should also monitor glucose levels. Afterward, the patient should take appropriate remedies to reduce the glucose levels to the normal range. The clients should also attend self-care education on managing diabetes. Finally, annual foot and eye examination are necessary for the patients.

Self-Care Management Training

References:

Aveyard, H., Sharp, P. and Woolliams, M., 2011. A beginner's guide to critical thinking and writing in health and social care. McGraw-Hill Education (UK).

Duignan, M. and Duignan, O., 2017. Physical activity: is it time for emergency department nurses to step up?. Emergency Nurse (2014+), 24(10), p.23.

Entwistle, V.A. and Watt, I.S., 2013. Treating patients as persons: a capabilities approach to support the delivery of person-centered care. The American Journal of Bioethics, 13(8), pp.29-39.

Fisher, M.D., Rajput, Y., Gu, T., Singer, J.R., Marshall, A.R., Ryu, S., Barron, J. and MacLean, C., 2016. Evaluating adherence to dilated eye examination recommendations among patients with diabetes, combined with patient and provider perspectives. American health & drug benefits, 9(7), p.385.

Gumbs, J.M., 2012. The relationship between diabetes self-management education and self-care behaviors among African American women with type 2 diabetes. J Cult Divers, 19(1), p.18.

Hansen, D., Niebauer, J., Cornelissen, V., Barna, O., Neunhäuserer, D., Stettler, C., Tonoli, C., Greco, E., Fagard, R., Coninx, K. and Vanhees, L., 2018. Exercise prescription in patients with different combinations of cardiovascular disease risk factors: a consensus statement from the EXPERT working group. Sports Medicine, pp.1-17.

Ley, S.H., Ardisson Korat, A.V., Sun, Q., Tobias, D.K., Zhang, C., Qi, L., Willett, W.C., Manson, J.E. and Hu, F.B., 2016. The contribution of the Nurses' Health Studies to uncovering risk factors for type 2 diabetes: diet, lifestyle, biomarkers, and genetics. American journal of public health, 106(9), pp.1624-1630.

Micha, R., Peñalvo, J.L., Cudhea, F., Imamura, F., Rehm, C.D. and Mozaffarian, D., 2017. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. Jama, 317(9), pp.912-924.

Pop-Busui, R., Boulton, A.J., Feldman, E.L., Bril, V., Freeman, R., Malik, R.A., Sosenko, J.M. and Ziegler, D., 2017. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care, 40(1), pp.136-154.

Powers, M.A., Bardsley, J., Cypress, M., Duker, P., Funnell, M.M., Fischl, A.H., Maryniuk, M.D., Siminerio, L. and Vivian, E., 2017. 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. The Diabetes Educator, 43(1), pp.40-53.

Rose, L., Istanboulian, L., Allum, L., Burry, L., Dale, C., Hart, N., Kydonaki, C., Ramsay, P., Pattison, N. and Connolly, B., 2017. Patient-and family-centered performance measures focused on actionable processes of care for persistent and chronic critical illness: protocol for a systematic review. Systematic reviews, 6(1), p.84.

Schnell, O., Barnard, K., Bergenstal, R., Bosi, E., Garg, S., Guerci, B., Haak, T., Hirsch, I.B., Ji, L., Joshi, S.R. and Kamp, M., 2017. Role of continuous glucose monitoring in clinical trials: recommendations on reporting. Diabetes Technology & Therapeutics, 19(7), pp.391-399.

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