• Subject Name : Nursing

Diabetes Mellitus Case Report

Introduction to Implementation of Therapeutic Communication

Metabolic disorders are the major burden over the health care sector and one of the metabolic disorders is the diabetes mellitus. Diabetes mellitus is a lifelong illness that occurs due to the insulin function lead to increase blood glucose level (Animaw & Seyoum, 2017). The care needs to be reframed to decrease the risk of the patient to acquire diabetes and improve the lifestyle of the population living with diabetes (Crangle et al., 2018). The care process for the diabetic patient should be holistic to address all the aspects that are important for the overall wellbeing of the patient. The nurses are expected to improve the clinical practice to cover all the different aspects which are important to deliver quality care (Blaslov et al., 2018). Different nursing care models are framed as per the patient health status and disorder prognosis. The important nursing care models are total patient care, functional nursing, team nursing and primary nursing (Fairbrother et al., 2015). The report will be discussing the different care aspect are necessary to address the population at risk for diabetes or living with diabetes.

Description Your Current Clinical Practice

The nurses are expected to be the central players in the care process of the patient thus there action should be justifiable to the professional role. The clinical practice should consider all the different aspect that is important for the care of the patient. There are different clinical practice guideline concerning the need and demand of care to address the gap in the health care services (Kredo et al., 2016). The current clinical practice is based over the phenomena of equality and it treats every patient considering the same parameters of the care. The current clinical practise lacking the right approach to address the different issue related to the population at risk for diabetes or living with diabetes. These discrepancies in the clinical practise are directly associated with decrease patient health outcome which leads to an increased hospital stay. One of the studies presented by Choudhary et al. (2015) state that for diabetes there is need to reframe the care as it not only increase health-related issue to the patient during hospital setting but it is lifetime issue that leads to increased risk for complication. The care for the patient risk for diabetes or living with diabetes should initiate with a proper assessment followed by addressing the issue with the right intervention and educating patient concerning the issue to provide holistic care. 

The priority population for the clinical practise setting are population at high risk to acquire diabetes or population having fluctuated blood glucose level and living with diabetes. The population at risk to acquire diabetes associated with the increased exposure to the different risk factor for diabetes. The article presented by Aravind (2019) discussed that the different risk factor that is associated to increase susceptibility toward diabetes includes increase age, poor dietary pattern, sedentary lifestyle, persistent high blood pressure, obesity, family history and high cholesterol level. Thus there is a need to improve the knowledge of the patient concerning the risk factor so that they can be aware and take precautions accordingly.

The population with diabetes and having an issue with managing it needs to be addressed by the different intervention concerning the clinical practise. The article presented by Strategies for Improving Care. (2015) indicate that people living with diabetes need to improve their lifestyle to accurately manage the fluctuated blood glucose level. The different intervention includes physical activity intervention, dietary intervention and self-management intervention.

2 Key Aspects of Care Need to Be Optimized

The first care aspect that needs to be optimized is the person-centric care that is directly associated with an increase the accessibility due to favourable clinical practice. The person-centred care is directly associated with better patient outcome as it improves the care to be tailored as per the patient issue. The person-centred approach allows the health care professional to improve patient participation in the care which increases the shared decision making concerning the care process (Santana et al., 2018). The current clinical practice follows the traditional approach in the care that allows the health care professional to provide the same care as per the symptoms and disorder. One of the studies presented by Zhao et al. (2016) indicates that traditional clinical practise approach considered patient as a passive that is no involvement in the care they are the recipient. On the other hand, the person-centred approach considered to be the patient has an active role and they work as a partner during the treatment process. The traditional approach includes the dominancy of the health care professional in the care moreover in the person-centred approach health care professional collaborates with the patient. 

The second aspect that needs to be optimizing in the care is the therapeutic communication of the health care professional to improve patient understanding concerning the care to improve the self-management skills of the patient. The health care professionals are expected to utilize the interpersonal skills to improve the conversation with the patient that is important for the exchange of necessary information. Therapeutic communication includes the verbal and non-verbal communication method to improve patient expression concerning the issue and care process (Abdolrahimi et al., 2017). Therapeutic communication improves the active listening skills of the health care professional to improve the rapport with the patient. The therapeutic communication helps the health care associates to improve the health care associates concerning the issue and need of the patient. Therapeutic communications also help the nurse to maintain the professional boundary with the patient that is necessary to justify the professional role. Therapeutic communication is important in clinical practice to improve the goal of the care that is important to improve clinical practice (Blake & Blake, 2019). 

The Challenges, Strengths and Limitations

The different barriers that are associated with the response toward the person-centred care are individual, health worker and organizational level. The individual level of barriers includes decrease health literacy of the patient decrease the participation in the care and reluctant behaviour of the patient in involving in the care (Moore et al., 2017). At the workforce level, the barriers include the unsupportive attitude of the workforce that decrease the implementation and lack of experience also restrict them to implement person-centric care. The last organizational level barriers are lack of effective policies and supply of right resources decrease the chances of implementation of person-centred care (Moore et al., 2017).

The strength associated with the person-centred approach is improving patient participation in the care that is directly associated with a better health outcome. It also helps to uphold the autonomy of the patient that is important for maintaining the ethical practice in the clinical setting. The person-centred approach also improves treatment perspective by making it more people specific (Kiwanuka et al., 2019). There is only a limitation factor of the person-centred approach that it utilizes the optimistic view that directly increases the power of the individual to implement the change (Bachkirova & Borrington, 2018).

The challenges that directly decrease the right implementation of therapeutic communication in the clinical setting start with the lack of communication skills of the health care professionals. Another challenge that directly decreases the effective implementation of therapeutic communication is nurse perspective toward it has it increase workload. The lack of organizational support is also important to decrease the implementation of therapeutic communication in the clinical setting. The decreased interest of the patient also hampers the health care professional practise concerning therapeutic communication (Popa-Velea & Purcărea, 2014). There are different strengths of the therapeutic communication and one of them it improves the rapport with the patient that is important of the quality care. Therapeutic communication improves the patient understanding concerning the treatment that is important for the participation of the client in care. The last strength of the therapeutic is improving the self-efficacy of the client to manage health by improving the lifestyle (Wilkinson et al., 2017). The one limitation that set back the therapeutic communication is considering that it over advice the patient that influences the decision (Amoah et al., 2018).

Enablers for The Innovation

The innovation is a collective aspect that directly utilizes the contribution of all the health care professional and organization staff to implement the change. The organization climate plays a major role in the innovation and stable climate is preferred to improve the implementation. The stable environment includes a positive attitude toward the innovation that will improve teamwork for the implementation of the change. The working culture of the organization also plays an important role in innovation as a supportive culture help in the easy transfer of the information concerning the change that improves the implementation (Johnsson, 2017). The management team is also an important player in the innovation as their support improves the proper conduction of the innovation that is important of the implementation Team collaboration and understanding also support the innovation that is important for the innovation in the setting. Resources supply and workforce awareness also improve innovation in the setting that is important for improving the working pattern (Kenneth et al., 2015)

These enablers are also important to improve the clinical setting by incorporating the person-centred approach and therapeutic communication that is important to address the specific requirement of the priority population and it also helps to improve the patient participation. The increase patient participation increases the understanding the risk factors and it also improves the use of different approach to managing diabetes to improve the health status.

Reflective Practise for Case Audit

This case audit has been an eye-opener to understand that traditional clinical approach is only able to decrease the issue of the patient but not able to empower patient. After this case audit realise that to improve the safety of the priority population there is a need to improve the clinical practice. I will try to improve my clinical practice in future by incorporating the person’s centred approach that will help to address the specific need of the patient. I have good communication skills but I will try to utilize the evidence-based practice to understand and improve my therapeutic communication. The Case audit also helped me to understand that clinical practice not only affected by the individual efforts but organization and patient are equal contributors to the quality of the clinical practice. Thus, I will collaborate with the organizational staff and patient to improve their understanding concerning the changes that will help to improve the implementation of the changes in the clinical practice. The implementation of the changes will improve the clinical practice make it more personalized that has a positive impact on the health status of the patient that is the major aim of the care.

Conclusion on Implementation of Therapeutic Communication

The report can be concluded by adding that diabetes is a lifelong issue thus the patient with increase risk or diabetes or living with diabetes require holistic care to provide the right care while empowering their skills. The holistic approach demands the person-centred care to improve the personalization of the care and therapeutic communication is added to improve the rapport with the client. These both factors in the care can improve the quality of care that is important for better health outcome. Different barriers are associated with the changes but a positive attitude can help in the innovation that is important for the implementation of the changes. The strength of both aspects has a positive influence over the patient that directly decrease the recovery time and improve their understanding concerning the self-management. The enablers that are required to support the innovation lie at the organization and individual level which lead to improvisation of the practice for better patient outcome. The implementation of these changes in the clinical practise will help the healthy patient to understand precaution concerning the prevalence of diabetes. It also improves the diabetic patient to understand the different method that can be utilized to support the deteriorated health to manage and reduce changes of the complication.

References for Implementation of Therapeutic Communication

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M. and Ebadi, A. 2017. Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, vol. 9, no. 8, pp. 4968–4977. https://doi.org/10.19082/4968

Amoah, V. M. K., Anokye, R., Boakye, D. S. and Gyamfi, N. 2018. Perceived barriers to effective therapeutic communication among nurses and patients at Kumasi South Hospital. Cogent Medicine, vol.5, no. 1. https://doi.org/10.1080/2331205X.2018.1459341

Animaw, W. and Seyoum, Y. 2017. Increasing prevalence of diabetes mellitus in a developing country and its related factors. PLOS ONE, vol. 12, no. 11, pp. 1-11. https://doi.org/10.1371/journal.pone.0187670 

Aravinda J. 2019. Risk factors in patients with type 2 diabetes in Bengaluru: A retrospective study. World Journal of Diabetes, vol. 10, no. 4, pp. 241–248. https://doi.org/10.4239/wjd.v10.i4.241

Bachkirova, T. and Borrington, S. 2018. The limits and possibilities of a person-centered approach in coaching through the lens of adult development theories. Philosophy of Coaching: An International Journal, vol. 3, pp. 6-22. https://doi.org/10.22316/poc/03.1.02.

Blake, T. and Blake, T. 2019. Improving therapeutic communication in nursing through simulation exercise. Teaching and Learning in Nursing, vol. 14, no. 4, pp. 260–264. https://doi.org/10.1016/j.teln.2019.06.003 

Blaslov, K., Naranđa, F. S., Kruljac, I. and Renar, I. P. 2018. Treatment approach to type 2 diabetes: Past, present and future. World Journal of Diabetes, vol. 9, no. 12, pp. 209–219. https://doi.org/10.4239/wjd.v9.i12.209

Choudhary, P., Rickels, M. R., Senior, P. A., Vantyghem, M.-C., Maffi, P., Kay, T. W. and Hering, B. J. 2015. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycaemia. Diabetes Care, vol. 38, no. 6, pp. 1016–1029. https://doi.org/10.2337/dc15-0090 

Crangle, C. E., Bradley, C., Carlin, P. F., Esterhay, R. J., Harper, R., Kearney, P. M. & Wallace, J. G. (2018). Exploring patient information needs in type 2 diabetes: A cross sectional study of questions. PLOS ONE, 13(11), 1-19. https://doi.org/10.1371/journal.pone.0203429 

Fairbrother, G., Chiarella, M. and Braithwaite, J. 2015. Models of care choices in today’s nursing workplace: Where does team nursing sit? Australian Health Review, vol. 39, no. 5, pp. 489. https://doi.org/10.1071/ah14091 

Johnsson, M. 2017. Innovation enablers for innovation teams-a review. Journal of Innovation Management, vol. 5, pp.75-121. https://doi.org/10.24840/2183-0606_005.003_0006.

Kenneth, G., Mummassabba, J. & Stanley, M. 2015. Evidencing enablers of innovation capabilities and their effects on organizational performance evidencing enablers of innovation capabilities and their effects on organizational performance.

Kiwanuka, F., Akhavan, S. and Alemayehu, Y. 2019. Enhancing patient and family-centered care: a three-step strengths-based model. International Journal of Health Sciences, vol. 12, no. 584.

Kredo, T., Bernhardsson, S., Machingaidze, S., Young, T., Louw, Q., Ochodo, E. and Grimmer, K. 2016. Guide to clinical practice guidelines: The current state of play. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, vol. 28, no. 1, pp. 122–128. https://doi.org/10.1093/intqhc/mzv115

Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M. and Wolf, A. 2017. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scandinavian Journal of Caring Sciences, vol. 31, no. 4, pp. 662–673.  https://doi.org/10.1111/scs.12376

Popa-Velea, O. and Purcărea, V. L. 2014. Issues of therapeutic communication relevant for improving quality of care. Journal of Medicine and Life, vol. 7, no. 4, pp. 39–45.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H. and Lu, M. 2018. How to practice person-centred care: A conceptual framework. Health expectations: An international Journal of Public Participation in Health Care and Health Policy, vol. 21, no. 2, pp. 429–440. https://doi.org/10.1111/hex.12640

Strategies for Improving Care. (2015). Diabetes Care, vol. 39, no. Supplement 1, pp. S6–S12. https://doi.org/10.2337/dc16-s004

Wilkinson, W. M., Rance, J. and Fitzsimmons, D. 2017. Understanding the importance of therapeutic relationships in the development of self-management behaviours during cancer rehabilitation: A qualitative research protocol. BMJ Open, vol. 7, no. 1, pp. 1-8. https://doi.org/10.1136/bmjopen-2016-012625 

Zhao, J., Gao, S., Wang, J., Liu, X. and Hao, Y. 2016. Differentiation between two healthcare concepts: Person-centered and patient-centered care. International Journal of Nursing Sciences, vol. 3, no. 4, pp. 398–402. https://doi.org/10.1016/j.ijnss.2016.08.009.

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