Introduction and Rationale
This paper contains the description and analysis of vulnerability and an appropriate holistic care plan for a 50-year-old male with type 2 diabetes. According to the Nursing & Midwifery Council (NMC) (2018, p. 9), a nurse has a duty of confidentiality to those who receive care, so the patient will be named Jack. Today, millions of people are aware of diabetes mellitus and the inability to cure this disease. In Scotland, the number of diabetic patients has dramatically increased in the past decade, and approximately 5.6% of the population of all ages live with type 2 diabetes (Scottish Diabetes Data Group, 2018, p. 8).
About 27,500 individuals with type 1 diabetes were registered in 2008 and 32,800 individuals in 2018 (Scottish Diabetes Data Group, 2018, p. 8). Diabetes is a chronic disease caused by a failure to produce insulin in pancreatic cells or respond appropriately to insulin (Galicia-Garcia et al., 2020). This metabolic condition challenges people whose bodies cannot make the necessary hormone, resulting in a high glucose level in the blood (Scottish Public Health Observatory, 2019). Diabetes is managed by taking insulin regularly and never missing blood sugar check-ups.
One of the main rationales to use this particular long-term condition is that despite the intention to manage diabetes, it remains a leading cause of death among people of all ages. According to the World Health Organization (2021), in 2019, 1.5 million deaths were directly related to diabetes, while 2.2 million deaths were indirectly related (high glucose levels). Therefore, the goal of choosing diabetes is to enhance an understanding of this condition and develop an effective care plan for diabetic patients. People who have diabetes spend more time in hospitals and require improved inpatient and outpatient care (Nikitara et al., 2019).
Personal and healthcare needs are increased due to diabetes, and nurses have to pay attention to patient education, holistic care, and support. Nurses work with diabetic people to examine facilitators and barriers in care, promote health, manage the disease process, prevent complications, and explain self-management basics. This paper focuses on a particular person with diabetes to investigate this vulnerability and introduce a holistic approach to care.
Vulnerability and Resilience
Vulnerability is a commonly used but not adequately defined term in health care. Many scholars and researchers have recently demonstrated their interest in understanding vulnerability and its relation to care quality. Clark and Preto (2018, p. 308) explain vulnerability as a characteristic of the human condition of being harmed physically or emotionally. Illnesses and diseases like diabetes prove people’s physical vulnerability and lead to emotional instability (Boldt, 2019). Jack has diabetes and needs to monitor his blood glucose level regularly. Risk factors of diabetes vary, depending on the type of the condition.
For example, in one-third of diabetic cases, diabetes vulnerability is due to genes, while two-thirds are due to environmental factors (Masharani, 2021). The genetic risk is recognised in the HLA locus (type 1 diabetes) and TCF7L2 (type 2 diabetes) (Masharani, 2021). Several relatives in Jack’s family have already been diagnosed with diabetes, which increased the risk of having the same diagnosis with time.
Genetic factors are not the only risks for Jack and people with a similar condition. Many healthcare providers could identify diabetes at an early stage, examining environmental factors. If humans cannot change their genes and natural predisposition to a disease, environmental causes of diabetes are recognised and managed to reduce the chances of developing diabetes at an early stage (Angi and Chiarelli, 2020). The food environment and feeding habits are related to weight changes and obesity-related problems from childhood (Angi and Chiarelli, 2020). The quality of physical activities also contributes to obesity and the likelihood of adverse cardiovascular outcomes and uncontrolled hypertension (Dendup et al., 2018).
Jack does not control his feeding habits and eats fat and high-calorie products. His body mass index is already above the normal, but Jack does nothing to change the situation but lives with obesity and body-related changes. However, increased thirst and appetite, frequent urination, weight changes, and fatigue are the early symptoms of diabetes (Kahanovitz, Sluss and Russell, 2017, p. 37). Jack could not differentiate between the outcomes of obesity and the signs of insulin deficiency because of poor knowledge about diabetes.
Despite examining early signs, genetic factors, and the environment, the current life-long condition is impossible to cure, and individuals need additional support to improve resilience and develop appropriate self-management and lifestyle modifications. In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges (Barasa, Mbau and Gilson, 2018, p. 496).
Resilience proves the necessity of diagnosing a disease, following a treatment plan, managing the condition, and not initiating new problems and complications. Jack does not want to give up on his life, and he tries not to forget about the basics of his treatment and cooperation with the hospital staff when he was diagnosed with diabetes. Jack neglected the necessity to evaluate family history because of limited knowledge about diabetes management, which is a significant protective factor in a care process (Lv et al., 2020). Jack’s resilience lies in his family support and the improvement of individual behaviours linked to microenvironments like his colleagues and neighbours (Angi and Chiarelli, 2020). The elimination of junk food and communication with family members are resilient protective factors for Jack.
Many theories may promote positive changes in managing the person’s diabetes, and one of them includes Erikson’s stages of psychosocial development. This theory was introduced in the middle of the 1900s to reflect Freud’s development theory and the role of social dynamics in human life. The theorist proved that it was possible to achieve positive development by learning specific outcomes at a particular age, like confidence at school or care for middle adults (Erikson and Erikson, 1997, p. 57).
Adults aged between 40 and 65 years should be ready to take care of people or thoughts at this period and contribute to their well-being by any possible means (Erikson and Erikson, 1997, p. 67). If diabetes is a chronic condition that contributes to the person’s disability status and makes him vulnerable, the chosen theoretical framework allows understanding adults’ capabilities for self-management (Perry et al., 2015, p. 254). Diabetes is a challenging condition for all individuals, and the application of eight stages of psychosocial growth should help create a holistic care approach.
Jack’s experience and diabetes management may be considered through eight stages in Erikson’s theory of development. First, regarding his age, Jack is at his generativity vs. stagnation crisis. Generativity is associated with making commitments, developing relationships, and contributing to improved living conditions (Erikson and Erikson, 1997, p. 67). Stagnation is a pathology when a person cannot find an appropriate way to contribute to development and maturity due to a lack of interest, no properly taken efforts, or self-centredness (Erikson and Erikson, 1997, p. 68). Thus, Jack is in his stagnation stage when he does not want to take some steps and change his health.
He demonstrates no interest in developing himself, which means Jack could possibly make some mistakes or failures in the past. Second, it is necessary to investigate each stage of development, starting from trust vs. mistrust and understanding hope (Erikson and Erikson, 1997, p. 60). Sometimes, previous stages of development may be reviewed but never neglected to make sure that all psychosocial skills are used.
Appropriate Care
The development of an appropriate care plan is critical for Jack and his diabetes management tactics. A person with type 2 diabetes is at risk of getting several severe conditions that challenge human health, including kidney failure, cardiovascular diseases, neuropathy, blindness, and mortality (Cole and Florez, 2020, p. 378). At this moment, Jack should be educated on the diet standards to be maintained because obesity contributes to diabetes, challenges blood sugar levels’ monitoring, increases blood pressure, and provokes new heart problems. Physical activities must be improved as well to establish better well-being.
Finally, communication and social support are critical elements in any care plan where nurses cooperate with patients and their families. As such, there are two main aspects of health, obesity and sugar blood levels, that may be affected by diabetes and managed by nursing care (Scottish Intercollegiate Guidelines Network, 2017, p. 9). Lifestyle managements depends on the patient and his readiness to cooperate with the nurse.
According to Erikson’s theory of development, an adult person should properly understand and experience such feelings as fidelity, hope, and confidence in any activity. In case there is a conflict between what has to be achieved and what is achieved at the moment, a person should address an expert and find support to make the necessary improvements (Erikson and Erikson, 1997). In Jack’s case, diabetes cannot be cured for good, and the goal of a care plan is to manage the symptoms, monitor the level of blood sugar, and predict the growth of adverse conditions.
According to Helgeson, Van Vleet and Zajdel (2020), older age is associated with less psychological diabetes distress. In other words, with age, people know how to live with diabetes, what habits to avoid, and what decisions to make. Jack needs education on diet standards like the avoidance of carbohydrates and sugar that slow the absorption process and complicate maintaining glucose levels (Kahanovitz, Sluss and Russell, 2017, p. 39). Drink and food alternatives exist, and Jack could hear about some of them due to his age and diabetic experience.
In addition to individual resilience and responsibility, the role of nurses in a holistic care plan is vital. As a part of a health care team, a nurse works with a doctor and coordinates the patient’s health care needs (National Institute for Health and Care Excellence, 2015, p. 7). Although the nurse is not able to watch what Jack eats all the time, communication helps underline the main aspects of the food environment (Lawler et al., 2019). Some nurses have special degrees that allow them to prescribe medicines and counsel about self-management (Nikitara et al., 2019). However, not all patients trust nurses more than doctors, and oral recommendations and emotional support are expected from nurses in most cases.
From the personal focus, blood sugar monitoring is one of the most important things the patient can do to manage diabetes mellitus. Some people do not know how to make the necessary calculations, and that is how the nurse contributes to a holistic care approach (cited in Nikitara et al., 2019). For example, the HbA1c test shows the average blood sugar level in the last three months, and some tests require people to fast a certain period (Kahanovitz, Sluss and Russell, 2017, p. 38).
In diabetes care, nurses perform the role of educators to help people understand their new condition, the specifics of the disease, possible complications, and complications (Lawler et al., 2019). Doctors usually inform how often to monitor the blood, and nurses remind and motivate not to miss the deadline and report the results. Today, the person can choose among a variety of portable blood sugar meters with respect to personal interests, finances, and even the style of life. Diabetes is a chronic condition, but it is possible to live with it and establish some fashionable trends.
From the environment focus, physical activity is an element of a weight-loss program for the diabetic person. A low level of activity is one of the severe vulnerabilities of a person that is explained by increased television viewing time and reduced sleep (Angi and Chiarelli, 2020; Linder et al., 2018). Therefore, Jack has to be introduced to different physical activities and aerobic exercises that do not contradict other health recommendations (Scottish Intercollegiate Guidelines Network, 2017, p. 17).
Physical activity resources include swimming, running, biking, and walking (Dendup et al., 2018). The role of a nurse, in this case, is not to keep company but to share information and give clear instructions on how exercises are related to diabetes management. Inpatient care depends on nurses and an understanding of their roles. If inadequate information, delays in data exchange, and the lack of diabetes knowledge may prevent self-management success (Nikitara et al., 2019). Jack needs more information about the two concepts, diabetes and physical activity, and the nurse is the most reliable and nearest source.
Conclusion
Personal learning from this task has improved understanding diabetes as a chronic condition that makes an individual vulnerable across the lifespan. A holistic care approach was offered to Jack because it was necessary to combine self-management steps like regular physical activities or blood sugar level monitoring and cooperate with a nurse to be educated and counselled properly. Diabetes may be provoked by genetic and environmental factors, and if Jack cannot resist genetics, he can manage the environment. Although diabetes does not have a cure, certain recommendations may facilitate patients’ conditions and predict adverse outcomes.
In this scenario, a 50-year-old man does not recognise his obesity as a problem for his health and a contributor to diabetes. Therefore, the nurse had to educate and motivate Jack not to neglect physical activity and the necessity of monitoring blood sugar levels regularly. Student nurses could use this case and understand that not all people know enough about diabetes and its monitoring details. Many healthcare practitioners are involved in diabetes diagnosis, management, and treatment, but nurses are the authentic sources of education, communication, and support.
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