Patient Needs Analysis

One of the needs that the patient has is support from family or loved ones and the healthcare providers. Currently, she does not have the appropriate support she needs to both care for her 10-weeks-old baby and manage her diabetic condition or adhere to the recommended treatment. The overwhelming care demands for her 10-week-old child and her diabetic condition and the lack of adequate financial or social support expose her to high risks for caregiver role strain. While her economic situation and family relations remain unknown, the patient’s prevalent circumstances reveal that the family has not been as supportive as is expected from her Native American culture. It is this lack of family support, and the perception of little support from health providers, that has contributed to her current predicament. As Mulligan et al. (2017) indicated, support from the family members and health providers would be of great help in enhancing her ability to manage her condition and care for the child. The providers could offer their support through electronic monitoring and communication once the patient is discharged.

Value and Relevance of the Evidence

The North American Nursing Diagnosis Association (NANDA) (2019) handbook provides the details of the nursing diagnoses associated with the patient’s conditions and was used to arrive at the diagnoses. The article by Mulligan et al. (2017) details the risks and barriers to effective self-management for diabetic patients, and also provides strategies for enhancing self-management. The authors explained that patients who receive support from their families and health care providers have an enhanced opportunity for improving their self-maintenance (Mulligan et al., 2017). Thus, helping the patient to identify and deal with the barriers to self-management helps in the process of addressing the first nursing diagnosis. Rogers et al. (2017) presented the evidence that the most common cause of lack of adherence to medications among discharged patients is the lack of medication indications, meaning that patients often do not know why they should take prescribed medications. The solution, as part of the patient support solution for enhancing self-management in the first nursing diagnosis, is to have an electronic monitoring and dosing system to help the patient to improve the management of the medications (Rogers et al., 2017). 

The American Diabetes Association (ADA) (2017) recommends the referral of patients with a risk for unstable blood glucose levels receive individualized medical nutrition therapy (MNT). They can obtain the MNT instruction from a registered dietician, a strategy that is associated with an A1C decrement of between 0.5% to 2% for individuals with type 2 diabetes (ADA, 2017). The article by ADA (2017) also details other critical elements of the care for patients with gestational diabetes. The National Prescribing Service (NPS) (2017) provided evidence for the evaluation of the patient’s medication regimen to identify those that affect blood glucose levels, eliminate medications that can worsen the condition, substitute them with appropriate ones, and prescribe medications for hyperglycemia. 

The article by Evangelista et al. (2016), based on social support for heart failure patients, presented evidence of the positive effects of support group interventions on caregiver burden, confidence, depressive symptoms, and preparedness. The study findings helped provide evidence for including social support as an intervention for the patient as a means of reducing the risk of caregiver role strain. Schellekens et al. (2017)’s study, on the other hand, provided evidence for the use of mindfulness stress reduction interventions to improve patients’ quality of life, self-compassion, relationship satisfaction, and ease caregiver burden. It supports the use of mindfulness techniques as a psychological intervention for the patient in view of the third nursing diagnosis.

Proposed Criteria for Patient Outcome Evaluation

There are three major outcomes that the patient needs to achieve as a result of the proposed interventions. They include an improved knowledge of diabetes self-care and adherence to treatment, maintenance of glucose levels of 180 mg/dL or less, feelings of being supported by family and health providers, and reduced feelings of burdens and distress. The first outcome measure will be evaluated through the administration of the Adherence to Therapeutic Regimen, designed by Nesari et al. (2010) for evaluating patients’ adherence and self-care for diabetes medications, exercise, diet, and SMBG. This Likert-scale type of measure will be administered to the patient on a monthly basis to evaluate her progress in self-care and adhering to the therapeutic regimen. Improvements in the scores will be appropriate measures of success for the intervention. 

NURS FPX 6011 Assessment 1 Diabetes Patient Concept Map

The second outcome measure will be blood glucose tests, taken every day during her inpatient stay and weekly after discharge to check progress. Success will be reached when the levels are below 180 mg/dL. The final means of evaluating outcomes will be the patient’s self-reported Likert-scale score on how much the family and assigned health providers support her and her feelings of burden and distress. Improvements in these self-reported measures will provide evidence for the success of the interventions.

Patient and Family Communication Plan

The patient and family communication plan will involve the assignment of a provider or case manager to the family after the patient’s discharge. The provider will help in identifying family members who can support the patient and provide them, along with the patient, the appropriate information at the time of discharge. This education strategy at discharge helps in preventing a dangerous gap in care (ADA, 2017). The information at discharge will include the diagnosis of gestational diabetes, an explanation of the desired glucose levels, the recommended diet, how to use the electronic monitoring system, and when to call a provider or visit the emergency department. 

Since the patient has a Native American background, the involvement of both the nuclear and extended family will be appropriate in the communication with providers after discharge. As such, the assigned provider or case manager will work closely with a representative of the family to pass information to the patient post-discharge. This representative, along with the other family members, needs to be informed on how to use a glucagon kit for cases when the patient would be unable to swallow. The information includes consistent nutrition habits, 150 minutes of physical activity per week, when to take medications and self-administer insulin, how to use and dispose of syringes where necessary, and the management of sick days (ADA, 2017). Finally, the post-discharge care will include referring the patients to individual or group Diabetes Self-Management Education (DSME) and Diabetes Self-Management Support (DSMS) programs that run for at least 10 hours.

References

American Diabetes Association (ADA). (2017). Clinical practice recommendations. Diabetes Care, 40(Suppl. 1). 

Evangelista, L.S., Strömberg, A., & Dionne-Odom, J.N. (2016). An integrated review of interventions to improve psychological outcomes in caregivers of patients with heart failure. Current Opinion in Supportive and Palliative Care, 10(1), 24-31. https://doi.org/10.1097/SPC.0000000000000182.

Mulligan, K., McBain, H., Lamontagne-Godwin, F., Chapman, J., Haddad, M., Jones, J., Flood, C., Thomas, D., & Simpson, A. (2017). Barriers and enablers of type 2 diabetes self-management in people with severe mental illness. Health Expectations, 20(5),1020–1030. https://doi.org/10.1111/hex.12543

North American Nursing Diagnosis Association (NANDA). (2019). Nursing diagnosis handbook: An evidence-based guide to planning care. Elsevier.

National Prescribing Service Limited. (NPS). (2017). Medicines that affect blood glucose levels. Retrieved from https://www.nps.org.au/medical-info/consumer-info/medicines-and-type-2-diabetes

Nesari, M., Zakerimoghadam, M., Rajab, A., Bassampour, S., & Faghihzadeh, S. (2010). Effect of telephone follow-up on adherence to a diabetes therapeutic regimen. Japan Journal of Nursing Science, 7, 121-128. https://doi.org/10.1111/j.1742- 7924.2010.00146.x 

Rogers, J., Pai, V., Merandi, J., & Catt, C. (2017). Impact of a pharmacy student-driven medication delivery service at hospital discharge. American Journal of Health-System Pharmacy, 74, S24–S29. https://doi.org/10.2146/ajhp150613Schellekens, M.P.J., van den Hurk, D.G.M., Prins, J.B., Donders, A.R.T., Molema, J., Dekhuijzen, R., van der Drift, M.A., & Speckens, A.E.M. (2017). Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial. Psychooncology, 26(12), 2118-2126. https://doi.org/10.1002/pon.4430

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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