Living with Diabetes Flashcards
Diabetes in Canada %
29% currently living with diabetes or prediabetes.
Death attribuable to diabetes in Canada?
1 in 10
Qc prevalence compare to others provinces?
Had the lowest prevalence with Nunavut and Alberta.
The impact of Diabetes on the patient?
- 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)
Diabetes Policy and Programs: Canadian Diabetes Charter principles is
- 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.
The Canadian Diabetes Charter outlines responsablities of:
-The governements
-The right and responsabiliies of people living with diabetes
-The right and responsabilities of Health Care Providers
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The backdrop of Diabetes nursing:
- 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
Goals of holistic Self Management Support for Diabetes Patients:
Inspiring patients to learn more about their condition and actively participate in their health care.
One of the biggest challenges for Diabetes nursing:
Ne evidence of true PARTNERSHIPS across the continuum of care due to the “Siloed” mentality of intra/interdisciplinary care teams.
Standards of Practice Diabetes Education:
- 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.
Outcome Standards of Practice Diabetes Education for Patient:
- 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.
The 3 Elements of the Model of Self-Management Competence:
- 4 Domains of Self-Management Competence (Disease Awareness, Healthcare communication, Adherence attitudes and Tx and medication competence)
- Patient-Centered Communication
- Family-Centered Care
The 3 Elements of the Model of Self-Management Competence: the 4 domains are
- Disease Awareness
- Healthcare Communication
- Adherence Attitudes
- Tx and Medication Competence.
The Self-Management Approach to Chronic Conditions (Grady and Lucio Gough, 2014)
- 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.
Self-management education is
-A systemic intervention that involves active patient participation in the self-monitoring and Decision-making
Self-management support is
-A patient-empowering motivational approach for enhancing problem-solving and goal-setting.
Diabetes Self-Management Education Programs (DSME) 2 models:
- Sumano Schellenberg et al. (2013)
- Chrvala, Sherr, and Lipman (2016)
Sumano Schellenberg et al. (2013) Diabetes Self-Management Education Programs (DSME):
- 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.
Chrvala, Sherr, and Lipman (2016) Diabetes Self-Management Education Programs (DSME):
- 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.
Complex Diabetic Patient includes:
- 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.
For complex Diabetic patient, as part of a collaborative and share-care approach should be used and include:
-an interprofessional team with specialized training in diabetes and physician diabetes expert.
Complexity factors for diabetic patient experience:
- Socioeconomic
- Language capability/literacy
- Cultural
- Mental Health
- Family stress
- Work stress
- Employment status
- housing
- education
Assess, validate, educate, teach, empower, motivate and reinforce the knowledge and understanding of diabetes, co-morbidities and current:
- 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?
Basic Knowledge and Skills for Diabetic Patients:
- Monitoring health parameters
- Healthy eating
- Physical activity
- Pharmacotherapy and medication adjustment
- Hypo-/Hyperglycemia prevention/management
- Prevention and surveillance of complications
- Problem identification and solving
Cognitive-Behavioural interventions is know to improve self-management and metabolic outcomes. It may involve:
- Cognitive re-structuring
- Problem-solving
- Cognitive-behavioral therapy (CBT)
- Stress management
- Goal setting
- Relaxation
The patient perspective (Polanski et al., 2011)
-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.
Structure testing strategy is:
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.
5 step approach for the collaborative partnership to “trying to be healthy”: (Polanski et al. 2011)
- Making the Non-visible –> Visible. eg. non-controlled aspects of your care will make you sick.
- Shifting back the power to the patient. eg. Taking meds and following tx most powerful thing patient can do for their health.
- Reframing perceptions. eg. Meds and tx are working despite not feeling it.
- Addressing negative self-blame issues. eg. sense of guilt and self-induced harm.
- Providing information and addressing concerns. eg. taking more meds and progression of the disease.
Patient Perspectives, Hartwell (2006) : tips to HCP that could foster their engagement.
- 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
Diabetic discharge plan recommendations:
- 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.
Difficult patient encounters (Macdonald, 2007)
- 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?
Engaging the patient in their care: (levensky et al., 2007)
With the principle of Motivational Interviewing (MI) and therapeutic skills.
Motivational Interviewing (MI):
- 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.
Motivational Interviewing (MI) therapeutic skills:
- Ask open-ended questions
- Use the ASK/Provide/Ask approach to proving info
- Affirm patients questions and progress
- Summarize
Minimize deficits and maximize strengths: nursing interventions:
- 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)
