Discussion

This paper evaluates a case study where a patient has a chronic illness. For this paper, type 2 diabetes is selected and applied this illness to the case of Kathleen. This paper aims to identify the current treatment procedures and self-management procedures of type 2 diabetes. In this study, the South Eastern Sydney Local Health District has been chosen to analyse the available resources that can help in the implementation of nursing care and treatment of type 2 diabetes. It has evaluated the key factors, empowerment, challenges, local resources and nursing actions to obtain better health outcomes of type 2 diabetes.

 Type 2 diabetes has been chosen for this paper.

In the case study of Kathleen, Kathleen is a 55-year-old lady who has been diagnosed with type 2 diabetes. Recently she has experienced fatigue and blurred vision. She has noticed that any kind of wound is taking a long time to heal and mostly vital symptom is an increased frequency of urination. Kathleen smokes almost ten cigarettes a day which is one of the major causes of type 2 diabetes. According to Chatterjee et al., (2018), a person who is consuming 1 to 2 cans a day may have a greater risk of developing type 2 diabetes. The patient intakes seven cans of soft drinks in a day which is not normal. It might be the cause of her being overweight. Obesity is associated with type 2 diabetes.

Type 2 diabetes refers to the impairment in the way the body uses and regulates glucose like a fuel. It results in excess circulation of glucose in the bloodstream. This condition can impact the nervous, circulatory and immune systems (Chatterjee et al., 2018). In Australia, almost 1 million adults were diagnosed with type 2 diabetes from 2017 to 2018. In order to provide successful diabetes care, there is required a systematic approach for supporting the changes in the behaviour of the patients (Eid et al., 2017). The factors that are affecting the delivery of proper care are including healthy lifestyle changes such as smoking cessation, management of weight, healthy diet and physical activity. Another aspect is self-management of disease via taking medication and self-monitoring the level of blood glucose.

Figure 1: Optimal patient care

(Source: Eid et al., 2017)

The most important factor is the good infrastructure of healthcare for taking preventive actions of diabetes complications such as actively screening renal complications, eye, foot, self-monitoring of the foot health. In addition, there is a need to encourage health professionals to provide education for high-quality diabetes self-management (Lambrinou, Hansen & Beulens, 2019). This education covers that how patients can involve in self-management, glucose control and satisfaction. However, for delivering quality care there is a need for proper planning and strategies that can be applied to reduce the barriers. The care team needs to be appropriate and need to have proper knowledge about pharmaceutical therapy and other devices that are used in the care of type 2 diabetes.

Chosen chronic illness

According to Settineri et al., (2019), self-management of a patient is the ability of the patient for dealing with all the chronic entails, including treatment, signs, physical and consequences of society and lifestyle changes. Empowering a patient is the procedure through which people can gain greater control over the actions and decisions that are affecting their health. In nursing, diagnosis powerlessness is described as a state in which an individual perceives the lack of control over the events and his actions have not influenced the outcome.

Figure 2: Self-management and empowerment

(Source: Lambrinou, Hansen & Beulens, 2019)

 In order to facilitate self-management for the patients and their families, the nurses need to make therapeutic relationships and instruct them about how to make choices regarding lifestyle. As per Lambrinou, Hansen & Beulens, (2019), in order to facilitate the self-management of chronic diseases the way of delivering patient care needs to be collaborative. This collaborative relationship between the nurse, family and patient shows the result of patient satisfaction. It is adhered to treatment plans and can improve health outcomes. It is stated by Lambrinou, Hansen & Beulens, (2019), that nurses can motivate the patients and families to make changes in leading lifestyles. The empowerment-based strategies may involve the plan of self-management and identifying how diabetes affects the patient personally.

Figure 3: Self-management and empowerment of the patients

(Source: Settineri et al., 2019)

In this case study, the nurse can facilitate education and support for Kathleen and her family members to understand why lifestyle modifications are needed. This education may increase her knowledge that gives her empowerment to reduce the level of HbA1c, make better the psychological status and endorse behavioural changes (Settineri et al., 2019). However, the nurse can use the patient-centred empowerment programme by involving Kathleen and her family. The nurse or health professionals can demonstrate the disease experience of others and can gain the characteristics of the disease.

Figure 4: Self-management educatio

n in diabetes

(Source: Chatterjee et al., 2018)

Those people who are getting better results after changing lifestyles such as regular exercising, adequate diet plan can share their experiences with Kathleen. However, the patient needs to understand the physical limitation, social factors, family support and finances of their own to understand how she can facilitate her self-management process. The nurse is encouraged to stop the smoking habit and replace it with nicotine replacement therapy. The nurse is advised to stop consuming excess levels of soft drinks in a day and guided to drink once or twice a month.  

Applying chronic illness on the case study

Prince of Wales Hospital is the available resource within South Eastern Sydney Health District that provides diabetes services (seslhd.health.nsw.gov.au, 2022). Their diabetes centre provides education as well as medical management to the patients of the hospital and to the people who are living with Type 2 diabetes. This hospital is working collaboratively with general practitioners, health care professionals and the family carer.

Figure 5: Model of Diabetes management

(Source: slhd.nsw.gov.au, 2022)

These people are responsible for managing diabetes. These people can provide particular advice on lifestyle changes and medicines that helps the patients to learn to live with diabetes (Pamungkas, Chamroonsawasdi & Vatanasomboon, 2017). This resource or hospital also makes appointments to the dietitian, doctor and podiatrist for preventing the complications of diabetes. This resource takes part in the arrangement of types of equipment such as blood glucose level testing devices, insulin devices. This service can be recommended for diabetes patients to get appropriate care from this resource (Wu et al., 2018).

However, there is an online information portal named health pathways which supports health professionals and GP to assess and manage diabetes. On the other hand, My Health Record is another secure online summary of the health information of a person. The Sydney District Nursing community also provides care to people at community-based clinics (seslhd.health.nsw.gov.au, 2022).

Recommending patient care in both primary and acute healthcare settings

Figure 6: Strategy of Diabetes

(Source: slhd.nsw.gov.au, 2022)

During pre-diabetes state, people get support from the Sydney local health district providers. In primary care, the CESPHN and District have provided advice and support for setting up diabetes-related resources and programs (Cesphn.org.au, 2022). In this care, the toolkit of diabetes is used by GP and health assessment has been done in this primary health care setting. In South Eastern Sydney Health District, type 2 diabetes is mostly managed in the primary healthcare setting through the GP of the patient with a multidisciplinary team (seslhd.health.nsw.gov.au, 2022). This team includes the dietitians, practice nurses and podiatrists. In this delivery of care, the GP is developing care plans that facilitate the subsidised visits to the services. Those patients who are getting serious symptoms of type 2 diabetes can be referred to specialist diabetes services. In secondary diabetes care, the patients have been followed up appropriately. In this secondary care, a team needs to collaborate with health professionals according to the need, situations and preferences of the patient (Davies et al., 2018).

Key factors: key factors for optimal care delivery to people with type 2 diabetes

The chronic care facility of South Eastern Sydney Health district has frequently identified issues such as limited communication skills, complex treatment regimes. The patients within this health district people are lack awareness about diabetes and may prone to develop more complexity (McGill et al., 2017). They can develop heart diseases, hypertension, stroke and other chronic health issues which make it critical to deliver the appropriate patient care. Moreover, in this district, most of the population are ageing and increasing the demand for health services (Reach et al., 2017). It increases the hospital admission number and the longer time to wait for accessing healthcare services in this district.

The nurses play the main role to deliver patient care of chronic illness effectively as they can involve certain types of actions such as

Educating the patient how to use medical devices: Nurses can explain to the client how the patient can check parameters of blood glucose level at home and can manage the glucose variation. The nurse will make aware the client of the ideal glucose level.

Observing viability of insulin: The nurse is responsible to manage the medications of the client. Checking of expiration dates of the medications is one of the most important things in the intervention of nursing (Davies et al., 2018). Health professionals can inspect the insulin whether it is clear or not and check the storage and make preparation as these affect the absorbability of insulin.

Figure 7: Three nursing actions

(Source: Davies et al., 2018)

Encouraging client for reading labels: The client can maintain diet as it is described by the nurse by checking the low glycemic index, high fibre and foods of low content fat. The nurse can encourage the patient to check the labels before buying the foods.

However, the learning process in nursing practice helps the student nurses to get the idea that how diabetes develops and how it affects the body. They can acquire the skills of diagnosis of the patient by observing their behaviour with diagnostic tools (Davies et al., 2018). They have learnt to use a new advanced type of strategies that can help in reducing the number of diabetic patients.

Conclusion

It can be concluded that type 2 diabetes is a chronic disease that increases day by day. The rate of cases is getting higher in this 21st century. For this reason, the nurses and health care systems need to involve the digital technologies and new strategies that help them to prevent the complications of diabetes. However, self-management and empowerment to the patients are key tools for treating diabetes. There is a need to overcome the barriers or communication issues to educate the patients. Local staff involvement and increasing expenditure on healthcare can help to make the world diabetes-free.

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