Description
John is a 70 years old man with a history of type 2 diabetes for 5 years. He has recently (2 years ago) shown symptoms of hyperglycemia. His blood glucose level is at 166mg/dl. John has been previously advised to lose weight but presently shows an increased weight gain of 181 pounds with 32.6 kg/m2 BMI. He says that he has tried losing weight for the last one year by engaging in exercises but that has borne no success. That gives him emotional distress as he fears that his condition might worsen. He also complains of foot pains and dizziness (caused by the 2.5 mg glyburide he takes every morning). John takes atorvastatin (10mg every day) for his hypercholesterolemia. He adheres to medication but argues that testing his blood glucose level at home is not helpful. Even with this presenting condition, John insists that he has not been sick even a single day of his life. It has also been discovered that John’s both parents had diabetes mellitus. John has a weak knowledge about self-care diabetes management and is irritated by the fact he has it and does not take sugars. He is married to one wife and has 4 children. John is an active member in volunteer organizations.
During the consultation, I had some feelings regarding John’s condition. The first was a feeling of sympathy for him because out of his condition he looked utterly distressed especially with the increased weight. John’s was disgusted by having to engage in exercises day in day out without success. In a study, Al-Goblan, Al-Alfi, and Khan (2014) explain that body mass index increases the resistance to insulin by cytokines increasing substances such as hormones, nonesterified fatty acids, glycerol and cytokines among others. I also have a feeling of hope as John is responsive to medications such as those for his elevated cholesterol, triglycerides, and low HDL cholesterol. The hope is however limited by the fact that John questions the importance of testing his glucose every day yet that does not heal or make the situation better. This brings worry as John has to know the level of his blood sugar often so as to seek medical intervention or perform self-management (with insulin) before the situation is worse. I felt a little bit of guilt not to refer John for emotional counseling for his stress. I, however, felt proud of John as a member of charitable organizations. I also felt happy that John was now willing to submit to care despite his negative attitudes to certain practices in self-management.
Upon evaluation, John’s event was good in numerous ways. My experience as a student nurse in coping with elderly patients approaching the end of life was expanded. This was my first time to be involved in palliative kind of care and it formed the foundation of the preceding activities I have been involved in. I was able to appreciate my own career choice as for the first time I felt I had saved a life. I was also able to understand the importance of ethical considerations in providing care. John, being an elderly person is a sensitive subject. I understood the value of respect in the use of language as one ethical consideration (Seaman & Erlen, 2013). I noted that John was distracted by me using informal language I use with people of the same age as myself. John made me also to be able to value confidentiality as he disclosed some information that was sensitive to his own privacy. That way I felt appreciated that even a 70-year-old man could share with me some of his secrets. One negative issue that could be improved was the duration of consultation. I felt that the time I spend with John was not enough for consultation and administration of care. As John was against some self-management practices, the importance of his family came in (Nayeri, Gholizadeh, Mohammadi, & Yazdi, 2015). I found that involving John’s wife and some of his children would help in the administration of medicines, insulin and conducting the blood glucose check and social support (Miller & DiMatteo 2013).
Feelings
According to Kalyani, Golden, and Cefalu (2017), in older adults (like John), diabetes can be a heavy burden especially form their weakened glucose intolerance. John’s burden is not only physical (from the implications of disease), but also emotional in that he is stressed by his increased weight. These burdens probably affect John’s lifestyle and they could also impact how he interacts with activities he likes. In the analysis, the ability to relate to the patient in the right professionalism helped me in dealing with the condition effectively. I have always thought the only important factor in care for a sick patient’s is medication but my interaction with John has changed my mind. John’s submission to care could have been influenced by many factors like professionalism, the value of confidentiality, and ethical considerations in the use of language. The ability to connect with patients is pivotal in the success of a specific care program for the aged (Zamanzadeh, Jasemi, Valizadeh, Keogh, & Taleghani, 2015). I approached John’s care holistically since a holistic approach is the center of the science of nursing. According to Zamanzadeh et al. (2015), a holistic care involves multiple approaches like medication, education, self-help, communication, and complementary treatment. John’s care was influenced by a consideration of all of his aspects and their impact in on the treatment process. By looking closely at John’s thoughts, emotions, cultures, opinions and attitudes, his happiness and satisfaction were triggered. This was in a way John’s self-dignity was preserved. It is good to note that the relationship between providers and clients is based on respect, openness, equality, mutuality, and involvement of the patient in the decision making. There is a relationship between T2DM and hereditary components according to (Ali, 2013). Therefore, it is not coincident that John developed the same considering his parents also were suffering from the same before they died. The designation of John’s care to incorporate his family is guided by the theory that a learning healthcare system recognizes the importance of patients and families being at the center (Smith, Saunders, Stuckhardt & McGinnis, 2013).
Conclusion
From John’s reflection, there certain things I learned. One is the importance of ethics of language in addressing care for the elderly (Seaman & Erlen, 2013). I also learned to value confidentiality as a legal and ethical concern in nursing. The experience also helped me to understand that healing is not just medically influenced. There is a need to observe other factors like the opinion of the patient. I was also able to value the effort of the family in the care of a patient especially an elderly one. This event could better incorporate legal and ethical considerations by ensuring making sure that the patient is taken care of as per the nursing standards of practice and that confidentiality between us is observed even more.
Various plans can be deduced from this case scenario. One is ensuring that there is more time for consultation for elderly patients who are at time slow in speech and cannot cohesively express themselves. Patient education on the importance of some self-management practices is important (Powers et al., 2015). This would entail educating on why it is important to test glucose at home and doing that frequently. Another future consideration is being culturally sensitive while addressing the age. This would require a mastery of the appropriate language when addressing different people to avoid embarrassments (Seaman & Erlen, 2013. I would also assure the aged of the preservation of confidentiality and one way of doing that is asking them to sign confidentiality forms (Zahedi et al., 2013). I would also consider expanding my knowledge of working with the elderly with complex needs.
References
Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 587. doi: 10.2147/DMSO.S67400
Ali, O. (2013). Genetics of type 2 diabetes. World journal of diabetes, 4(4), 114. doi: 10.4239/wjd.v4.i4.114
Baig, A. A., Benitez, A., Quinn, M. T., & Burnet, D. L. (2015). Family interventions to improve diabetes outcomes for adults. Annals of the New York Academy of Sciences, 1353(1), 89-112. doi:10.1111/nyas.12844
Kalyani, R. R., Golden, S. H., & Cefalu, W. T. (2017). Diabetes and aging: unique considerations and goals of care. Diabetes care, 40(4), 440-443. doi:10.2337/dci17-0005
Miller, T. A., & DiMatteo, M. R. (2013). Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, metabolic syndrome and obesity: targets and therapy, 6, 421. doi:10.2147/DMSO.S36368
Nayeri, N.D., Gholizadeh, L., Mohammadi, E., & Yazdi, K. (2015). Family involvement in the care of hospitalized elderly patients. Journal of Applied Gerontology, 34(6), 779-796. doi: 10.1177/0733464813483211
Powers M.A., Bardsley J., Cypress M., Duker P., Funnell M.M., Fischl A., …& Vivian E. (2015). Diabetes Self-Management Education and Support in Type 2 diabetes: a Joint Position Statement of the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics. doi:10.2337/dc15-0730
Seaman, J. B., & Erlen, J. A. (2013). “Everyday Ethics” in the Care of Hospitalized Older Adults. Orthopaedic Nursing, 32(5), 286-289. doi: 10.1097/NOR.0b013e3182a3019d
Smith, M., Saunders, R., Stuckhardt, L., & McGinnis, J. M. (2013). Engaging Patients, Families, and Communities. Retrieved 23rd October 2018 from https://www.ncbi.nlm.nih.gov/books/NBK207234/
Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., … & Dastgerdi, M. V. (2013). The code of ethics for nurses. Iranian journal of public health, 42(Supple1), 1. Retrieved 23rd October 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712593/
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: a qualitative study. Indian journal of palliative care, 21(2), 214. doi:10.4103/0973-1075.156506
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