Case Background
Mr. Juan Duran is a 60-year-old patient who has been attending the diabetes clinic at the VA for several months. One day, the clinic director, Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes, but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the advanced practice nurse and diabetes educator, Jenny, and asks her to schedule an unscheduled appointment for Mr. Duran.
Jenny starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years, and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin.
Patient Assessment
Sixty-year-old Mexican-American patient is exceedingly polite and respectful of health care personnel (and does not like to interrupt or ask too many questions). He has been in the United States for more than 50 years; he is a Navy veteran. Married; lives with wife in a comfortable apartment in California. Mr. Duran speaks fluent English, but his wife’s English is limited. They speak Spanish at home.
Because Mr. Duran has limited vision, his wife has to administer the insulin. Had one daughter, who died less than 2 weeks ago, leaving Mr. and Mrs. Duran to care for her child. Mr. Duran seems befuddled by the insulin and syringes and is stoic when he talks about the loss of his daughter.
Theoretical Approach
One of the relevant theories in this case is the Modeling and Role-Modeling theory, developed by Erickson, Tomlin, and Swain. The primary reason for selecting this theory is that it emphasizes the patient as an individual with their unique needs, experiences, and cultural background (McEwen & Wills, 2023). Here, as a Mexican-American and Navy veteran, Mr. Duran’s unique circumstances are vital in assessing the psychosocial aspects of care. This theory acknowledges the importance of being culturally competent, which is particularly crucial in cases involving diverse patients, such as Mr. Duran.
One of the additional pieces of information that can be gathered about Mr. Duran is his diabetes management and overall spiritual well-being. The loss of his daughter and emotional response to it, as well as cultural beliefs towards overall medication, also stand as factors considered when assessing Mr. Duran. His overall beliefs regarding health and illness issues can be crucial in deciding further treatment plans for Mr. Duran.
To initiate a plan of care or education, Ms. Jenny should establish a trusting and empathetic nurse-patient relationship. According to the given theory, it is essential to provide education and support tailored to individual needs and preferences (McEwen & Wills, 2023). In the case of Mr. Duran, it is possible to involve his wife in the diabetes management process and provide her with specific educational materials. She can also be taught how to address the trauma from their daughter’s death.
In case there is a need for a different theory, it is possible to use the General Systems theory in the case of Mr. Duran. The difference will be in the focus of the treatment plan and care procedures. General Systems theory concentrates on understanding the interconnectedness of different elements gathered from communication (McEwen & Wills, 2023). It will also consider facilitating collaboration within the system. Although this method will bring a more family-centered approach, it can fail in ignoring Mr. Duran’s cultural background and personal circumstances.
Humanistic Nursing Theory, which is an example of a unitary theory, can be considered. If Jenny applied this idea, she may focus on holistic care, prioritizing Mr. Duran’s physical, emotional, and spiritual well-being. One of the key advantages of this theory is its positive impact on both patients and nurses (Zamaniniya et al., 2021). However, because this theory does not provide specific recommendations for addressing cultural factors, there is a need for additional treatment strategies.
References
McEwen, M. & Wills, E.M. (2023). Theoretical basis for nursing (6th eds.). Wolters Kluwer.
Zamaniniya, Z., Khademi, M., Toulabi, T., & Zarea, K. (2021). The outcomes of humanistic nursing for critical care nurses: a qualitative study. Nursing and Midwifery Studies, 10(2), 114-120.