Introduction to Partnerships in Health and Illness

The case study describes a 21-year-old female patient, named Abby, who has diagnosed nine months ago with type I Diabetes Mellitus and is having difficulty in stabilizing her blood sugar levels due to her erratic work schedule. Type I Diabetes Mellitus or T1DM is a chronic disease that is also called autoimmune diabetes occurring due to the loss of beta cells in the pancreas, leading to hyperglycemia (Gastol et al, 2020). Abby notices that she is slowly slipping into depression and is on the higher end of the BMI spectre. She weighs 90 kgs and her height is 189cms. Based on the case scenario, this contemporary paper entails a discussion on tertiary prevention nursing interventions in the case of Abby to reduce disabilities such as poor control of blood glucose level, feelings of depression, and obesity. It also encompasses the role of a nursing professional before referring the patient to another health care professional.

Partnerships in Health and Illness - Part A

Tertiary prevention interventions are those interventions that help in improving the recovery rate of the patient and enhance their treatment outcome by focusing on improvising the quality of life, reducing the level of disability, or the chances of any complications which may occur due to the disease (Kawasaki, 2015). In the case of Abby, she is faced with three main issues, the first is physical, which is newly diagnosed T1DM as well as obesity. The psychological disability includes feelings of depression and her social disability includes poor work-life balance, which has led to poorly controlled blood sugar levels. The tertiary prevention intervention includes primarily to inform and educate the patient regarding the diagnosis of the disease and the care plan. Research conducted by Schwartz et al., (2016), suggests that it is vital to have a balanced diet and meals at a fixed and regular interval to maintain the insulin levels in the body, thus the first nursing intervention would be to advise and encourage Abby for eating her meals at a proper time daily. The research conducted by Martyn-Nemeth et al., (2016).

Also revealed that skipping meals leads to abnormal spike in the level of insulin in the blood and causes severe hypoglycemia, which can result in either collapse/syncope or even death in a few cases. Abby is also suffering from obesity and depression which are both related to an increase in blood glucose levels. The next intervention is to motivate Abby to practice a daily exercise regime. Exercises help in producing the endorphin hormones, which are also called "happy hormones" of the body and will help in reducing the feeling of depression in Abby and also improve insulin metabolism (Litchman et al, 2019). The third tertiary prevention intervention includes routine monitoring of blood glucose levels daily, as per the research conducted Schwartz et al., 2016 stated that, by maintain a self-monitoring journal, increases the feeling of ownership of the treatment in the patient. This will help Abby to actively participate in her care plan and will incline her to have higher compliance for medication. Thus, as a nurse, it is important to focus on the modification of lifestyles such as encouraging a balanced diet, maintaining a daily exercise routine, strict adherence to routine monitoring of blood glucose level and compliance with medication.

Partnerships in Health and Illness - Part B

A nurse is a crucial member of the multidisciplinary team working in education for self-care of diabetic patients (Visentin et al., 2016). It is the duty of the nurse to orienting the patient as well as their families about the disease diagnosis, prognosis, and treatment plan. Nevertheless, it is the joint effort of the various professionals such as the nurse, doctor, nutritionist, and the physical trainer in obtaining positive treatment outcome in a patient. The role and responsibility of the nurse as per the Nursing and Midwifery Board of Australia (NMBA), Standard of Nursing, (2016) Standard 3 includes, to "maintain the capability for practice". The nurse must respond to Abby by understanding her situation and ensuring that all her concerns and anxieties are addressed effectively. In the case of Abby, the nurse must provide information and education related to the disease and the consequences of the skipping meals and the direct relationship between stress and an increase in insulin levels in the body (Pollock et al, 2016). Abby must be informed about self-care techniques such as regular blood glucose monitoring and encouraged about the importance of maintaining a healthy and balanced diet and the role of exercise in her daily routine.

According to Hagger et al, (2018), “The Australian Diabetes Association affirms that performing self-monitoring of blood glucose levels permits assessing the response of the patient to the treatment and to modify the dosage of drugs and non-drug interventions for in patients with type 1 as well as type 2 DM.” Furthermore, as per NMBA Standard 4, it is the role of a nurse to analyze and conduct a comprehensive assessment of the patient. The nurse would take a holistic assessment of Abby, including all the basic parameters such as objective and subjective examination, effectively gather all the information and measurement of the vitals, and checking for other complications such as the presence of any sensory issues and observation of the foot for ulcers, which are common in case of T1DM. Standard 4.3 states, “A nurse hones the ability to work in partnership with various health care providers to determining the causative factors, or the factors which can impact the patient’s well-being and health and also determines the priority of action for providing a referral." Based on the assessment of Abby, the nurse must exhibit effective decision-making skills, in deciding to work in partnership with other professionals for obtaining a holistic outcome.

In the case of Abby, it is impertinent that she is referred to as a nutritional therapist for helping her to follow a healthy and balanced diet. The consult should also include a psychologist who will help her assist in managing the level of stress and anxiety and fear of hypoglycemia. She should also be referred to the doctor, her diabetologist, or consultant of change in medication management, if necessary. The multidisciplinary team in the care plan of Abby must also include a physical trainer to help her lose weight, which is essential for controlling diabetes as well as help to eliminate feelings of depression (Pollock et al, 2016).

References for Partnerships in Health and Illness

Gastoł, J., Kapusta, P., Polus, A., Pitera, E., Biela, M., Wołkow, P., & Kieć-Wilk, B. (2020). An epigenetic mechanism in search of the pathomechanism of diabetic neuropathy development in diabetes mellitus type 1 (T1DM). Endocrine, 1-6.

Hagger, V., Hendrieckx, C., Cameron, F., Pouwer, F., Skinner, T. C., & Speight, J. (2018). Diabetes distress is more strongly associated with HbA1c than depressive symptoms in adolescents with type 1 diabetes: Results from Diabetes MILES Youth—Australia. Pediatric diabetes19(4), 840-847.

Kawasaki, E. (2016). Combined intervention for the tertiary prevention of type 1 diabetes. Journal of diabetes investigation7(3), 300-302.

Litchman, M. L., Walker, H. R., Ng, A. H., Wawrzynski, S. E., Oser, S. M., Greenwood, D. A., ... & Oser, T. K. (2019). State of the science: a scoping review and gap analysis of diabetes online communities. Journal of diabetes science and technology13(3), 466-492.

Martyn-Nemeth, P., Farabi, S. S., Mihailescu, D., Nemeth, J., & Quinn, L. (2016). Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention-a review. Journal of Diabetes and its Complications30(1), 167-177.

Martyn-Nemeth, P., Farabi, S. S., Mihailescu, D., Nemeth, J., & Quinn, L. (2016). Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention-a review. Journal of Diabetes and its Complications30(1), 167-177.

NMBA, (2016). Retrieved from file:///C:/Users/vjadl.DESKTOP-PF8AB0C/Downloads/Nursing-and-Midwifery-Board---Standard---Registered-nurse-standards-for-practice---1-June-2016.PDF

Pollock, A. J., Moreno, M. A., Bekx, M. T., & Connor, E. L. (2016). Online Resources for Pediatric Type 1 Diabetes: What Adolescents Want. Journal of diabetes science and technology10(6), 1419-1420.

Schwartz, S. S., Epstein, S., Corkey, B. E., Grant, S. F., Gavin, J. R., & Aguilar, R. B. (2016). The time is right for a new classification system for diabetes: rationale and implications of the β-cell–centric classification schema. Diabetes Care39(2), 179-186.

Visentin, A., de Fátima Mantovani, M., Caveião, C., Hey, A. P., Pereira Scheneider, E., & Paulino, V. (2016). SELF-CARE OF USERS WITH TYPE 1 DIABETES IN A BASIC HEALTH UNIT. Journal of Nursing UFPE/Revista de Enfermagem UFPE10(3).

White, M., O'Connell, M. A., & Cameron, F. J. (2017). Clinic attendance and disengagement of young adults with type 1 diabetes after transition of care from paediatric to adult services (TrACeD): a randomised, open-label, controlled trial. The Lancet Child & Adolescent Health1(4), 274-283.

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