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Chronic & Palliative Care > Living with Diabetes > Flashcards

Living with Diabetes Flashcards

1
Q

Diabetes in Canada %

A

29% currently living with diabetes or prediabetes.

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2
Q

Death attribuable to diabetes in Canada?

A

1 in 10

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3
Q

Qc prevalence compare to others provinces?

A

Had the lowest prevalence with Nunavut and Alberta.

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4
Q

The impact of Diabetes on the patient?

A
  • Cardiovascular disease
  • End-Stage Renal disease
  • non-traumatic lower limb amputaitons
  • Foot ulceration
  • Depression (30%)
  • Average cost for tx, medication, devices and supplies is around 1500$/year. (57% of patients cannot adhere to prescribed tx due to the high cost)
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5
Q

Diabetes Policy and Programs: Canadian Diabetes Charter principles is

A
  • to ensure people are treated with dignity and respect
  • To advocate for equitable access to high quality diabetes care and supports.
  • Ehance the health and quality of life.
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6
Q

The Canadian Diabetes Charter outlines responsablities of:

A

-The governements
-The right and responsabiliies of people living with diabetes
-The right and responsabilities of Health Care Providers
-

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7
Q

The backdrop of Diabetes nursing:

A
  • Hospital (acute) diabetes Care (Disease-centered, tx focus, reactive, symptom driven managed care)
  • Diabetes patient number increasing (older pop., co-morbidity and lifestyle issues, recruitment/retention issues)
  • Efficient patient flow (time constraints, large workload)
  • Complexities of management support (Increasing demand for services vs limited resources)
  • DB specialized nursing staff and required knowledge/competencies and expetize
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8
Q

Goals of holistic Self Management Support for Diabetes Patients:

A

Inspiring patients to learn more about their condition and actively participate in their health care.

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9
Q

One of the biggest challenges for Diabetes nursing:

A

Ne evidence of true PARTNERSHIPS across the continuum of care due to the “Siloed” mentality of intra/interdisciplinary care teams.

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10
Q

Standards of Practice Diabetes Education:

A
  • Based on ongoing patient-centred needs assessment
  • Diabetes education are ongoing and centred around the patient, facilitates behaviour change, problem solving and active participation.
  • Programs partner with services and utilize resources
  • Effectiveness and quality education program regularly review.
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11
Q

Outcome Standards of Practice Diabetes Education for Patient:

A
  • Understand to the best of their ability and the implications for healthy living
  • Informed decisions and take action towards healthy living, in the context of spiritual and cultural valyes, socioeconomic needs and desired quality of life
  • works with partners in our community and haad our communities aware of the support.
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12
Q

The 3 Elements of the Model of Self-Management Competence:

A
  • 4 Domains of Self-Management Competence (Disease Awareness, Healthcare communication, Adherence attitudes and Tx and medication competence)
  • Patient-Centered Communication
  • Family-Centered Care
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13
Q

The 3 Elements of the Model of Self-Management Competence: the 4 domains are

A
  • Disease Awareness
  • Healthcare Communication
  • Adherence Attitudes
  • Tx and Medication Competence.
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14
Q

The Self-Management Approach to Chronic Conditions (Grady and Lucio Gough, 2014)

A
  • The goal is: Maintenance of Wellness and management of illness across lifespan
  • Include primary, secondary and tertiary prevention.
  • Nursing science at the forefront in deepening reseach, knowledge translation and clinical practice of self-management.
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15
Q

Self-management education is

A

-A systemic intervention that involves active patient participation in the self-monitoring and Decision-making

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16
Q

Self-management support is

A

-A patient-empowering motivational approach for enhancing problem-solving and goal-setting.

17
Q

Diabetes Self-Management Education Programs (DSME) 2 models:

A
  • Sumano Schellenberg et al. (2013)

- Chrvala, Sherr, and Lipman (2016)

18
Q

Sumano Schellenberg et al. (2013) Diabetes Self-Management Education Programs (DSME):

A
  • Systematic Review and Meta-Analysis of Lifestyle Interventions in Type 2 diabetes patients.
  • Comprehensive lifestyle interventions effectively decrease the incidence of Type 2 DB in high-risk patients.
19
Q

Chrvala, Sherr, and Lipman (2016) Diabetes Self-Management Education Programs (DSME):

A
  • Systemic Review of the effect of glycemic control.
  • A combination approach to delivery to program (individual, group, combo or other)
  • Notably significant improvements (A1C% decrease) who received DSME for higher or equal to 10 weeks.
20
Q

Complex Diabetic Patient includes:

A
  • Children with diabetes
  • Type 1 diabetes
  • Women with diabetes who require pre-conception counseling
  • Women with diabetes in pregnancy
  • Individuals with complex (multiple diabetes-related complications underlying co-morbid conditions) Type 2 diabetes who are not reaching targets (Blood glucose control, BP and LDL) or whos as 1 or more risk factors.
21
Q

For complex Diabetic patient, as part of a collaborative and share-care approach should be used and include:

A

-an interprofessional team with specialized training in diabetes and physician diabetes expert.

22
Q

Complexity factors for diabetic patient experience:

A
  • Socioeconomic
  • Language capability/literacy
  • Cultural
  • Mental Health
  • Family stress
  • Work stress
  • Employment status
  • housing
  • education
23
Q

Assess, validate, educate, teach, empower, motivate and reinforce the knowledge and understanding of diabetes, co-morbidities and current:

A
  • Glucose monitoring
  • Insulin TX or oral tx, other rx
  • Immunizations
  • Nutrition, weight, activities, smoking, ETOH and drugs..
  • Screening feet, dental, vision, hearing, renal function test, mental health, social support, functional status of ADLs/IADLs, instrumental and peripheral support, ressources ($$, insurance plans, RAMQ, immigration statuts)
  • CLSC appointment?
24
Q

Basic Knowledge and Skills for Diabetic Patients:

A
  • Monitoring health parameters
  • Healthy eating
  • Physical activity
  • Pharmacotherapy and medication adjustment
  • Hypo-/Hyperglycemia prevention/management
  • Prevention and surveillance of complications
  • Problem identification and solving
25
Q

Cognitive-Behavioural interventions is know to improve self-management and metabolic outcomes. It may involve:

A
  • Cognitive re-structuring
  • Problem-solving
  • Cognitive-behavioral therapy (CBT)
  • Stress management
  • Goal setting
  • Relaxation
26
Q

The patient perspective (Polanski et al., 2011)

A

-The issues of engagement and adherence to care are not because of lack of motivation, but because of the lack of perceived value/benefits of self-care due to Burdensome, Pointlessness, discouraging, patient beliefs and their perceived efficacy.

27
Q

Structure testing strategy is:

A

Small test of change to build-up self-efficacy (little steps)
eg. for one week try doing X then we will discuss together how it went.

28
Q

5 step approach for the collaborative partnership to “trying to be healthy”: (Polanski et al. 2011)

A
  1. Making the Non-visible –> Visible. eg. non-controlled aspects of your care will make you sick.
  2. Shifting back the power to the patient. eg. Taking meds and following tx most powerful thing patient can do for their health.
  3. Reframing perceptions. eg. Meds and tx are working despite not feeling it.
  4. Addressing negative self-blame issues. eg. sense of guilt and self-induced harm.
  5. Providing information and addressing concerns. eg. taking more meds and progression of the disease.
29
Q

Patient Perspectives, Hartwell (2006) : tips to HCP that could foster their engagement.

A
  • Provide a vision for the future
  • Add some variety/spontaneity to the usual routine
  • Engage the patient in the care plan
  • Assist the patient and family in developing goals and actions plans
  • Develop realistic measurements that indicate success
  • Active listening and eliciting questions from the Pt/F
  • Encourage
30
Q

Diabetic discharge plan recommendations:

A
  • Initiation of insulin administration at least ONE day before the discharge
  • Provide both written and oral instruction
  • Identification of resources in the community for continuing diabetes self-management education after discharge.
31
Q

Difficult patient encounters (Macdonald, 2007)

A
  • The “Difficult patient” constructed and influenced by what is happening in the context of care.
  • Refocussing of the lens on What is influencing the difficulty?
32
Q

Engaging the patient in their care: (levensky et al., 2007)

A

With the principle of Motivational Interviewing (MI) and therapeutic skills.

33
Q

Motivational Interviewing (MI):

A
  • Counselling approach that engages patient and HCP in collaborative partnerships centered on goal setting and self-management
  • Help explore beliefs and reasons that either positively and or negatively affect ability to engage in change behaviors for health and healing.
  • Enables patient to address ambivalence that hinders ability to engage in change.
34
Q

Motivational Interviewing (MI) therapeutic skills:

A
  • Ask open-ended questions
  • Use the ASK/Provide/Ask approach to proving info
  • Affirm patients questions and progress
  • Summarize
35
Q

Minimize deficits and maximize strengths: nursing interventions:

A
  • Reduce stress (active listening, presence, availability, comfort measures)
  • Symptom management (Alternative therapies such as medication, TENS, reflexology, deep-breathing)
  • Support healing (wound healing through wound care, pain control, comfort measures, assessment nutrition)

Chronic & Palliative Care (12 decks)

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