Management of Postpartum Diabetes Mellitus

CASE STUDY
INSTRUCTION:
Assessment 1 Instructions: Diabetes Patient Concept Map
Create a concept map graphic and write a 2-4 page narrative on the patient scenario presented in Assessment Case Study: Evidence-Based Patient-Centered Concept Map. Base your report on the information provided in the case study and your own research of 3-5 evidence-based resources.
Evidence-based practice is a key skill in the tool kit of the master's-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, 2019). In essence, evidence-based practice is all about ensuring quality care.
In this assessment, you will apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. The concept map that you will create is an example of a visual tool that you can use for patient and family education.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Apply evidence-based practice to plan patient-centered care.
Analyze the needs of a patient, and those of their family, to make sure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient's specific health, economic, and cultural needs.
Competency 3: Evaluate outcomes of evidence-based interventions.
Propose relevant and measurable criteria for evaluating the outcomes the patient needs to achieve.
Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
Determine the value and relevance of evidence used as the basis of a patient-centered concept map.
Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.
Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.
Reference
Godshall, M. (2019). Fast facts for evidence-based practice in nursing (3rd ed.). Springer Publishing Company.
Scenario
The charge nurse at the wellness center has sent you an email to request that you review a patient file before the patient arrives at the clinic. She has asked you to put together a concept map for your patient’s care plan. The concept map is intended to help you think through the best strategy for your patient’s care and for subsequent use for patient education. In addition, the nurse needs a narrative report that describes your patient with up to five diagnoses, in order of urgency.
Your Role
You are a nurse at a community wellness center who has received a request for patient case review and preparation for an upcoming appointment.
Instructions
Review the Assessment Case Study: Evidence-Based Patient-Centered Concept Map media activity.
Create your concept map and narrative as separate parts of your document. Be sure to note where you must include your evidence-based support and clarify your strategies for communicating information to the patient and the patient's family.
Integrate relevant evidence from 3-5 current scholarly or professional sources to support your assertions.
Part 1: Concept Map
Develop a graphical concept map for the patient based on the best available evidence for treating your patient's health, economic, and cultural needs.
Many organizations use the spider style of concept maps (see the Taylor and Littleton-Kearney article for an example).
The Assessment Case Study: Evidence-Based Patient-Centered Concept Map, which includes an example of a concept map, may help you prepare your assessment.
If a particular style of concept map is used in your current care setting, you may use it in this assessment.
Part 2: Narrative Report
Develop a narrative (2-4 pages) for your concept map.
Analyze the needs of a patient and his or her family to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Consider how your patient's economic situation and relevant environmental factors may have contributed to your patient's current condition or could affect future health.
Consider how your patient's culture or family should inform your concept map.
Determine the value and relevance of the evidence you used as the basis of your concept map.
Explain why your evidence is valuable and relevant to your patient's case.
Explain why each piece of evidence is appropriate for the health issue you are addressing and for the unique situation of your patient and the family.
Propse relevant and measurable criteria for evaluating the outcomes the patient needs to achieve.
Explain why your proposed criteria are appropriate and useful measures of success.
Explain how you will communicate specific aspects of the concept map to your patient and the family in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
Promote honest communications.
Facilitate sharing only the information you are required and permitted to share.
Are mindful of your patient's culture.
Enable you to make complex medical terms and concepts understandable to your patient and his or her family, regardless of language, abilities, or educational level.
Additional Requirements
Organization: Use the following headings for your Diabetes Patient Concept Map assessment:
Concept Map.
Patient Needs Analysis.
Value and Relevance of the Evidence.
Proposed Criteria for Patient Outcome Evaluation.
Patient and Family Communication Plan.
Length: Your concept map should fit on one page (possibly a horizontal layout) and your narrative report will be 2-4 double-spaced pages, not including title and reference pages.
Font: Times New Roman, 12 points.
APA Format: Your title and reference pages must follow current APA format and style guidelines. The body of your paper does not need to conform to APA guidelines. Do make sure that it is clear, persuasive, organized, and well written, without grammatical, punctuation, or spelling errors. You also must cite your sources according to APA guidelines.
Scoring Guide: Please review this assessment’s scoring guide. The requirements outlined above correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance-level descriptions for each criterion to see how your work will be assessed
Assessment Case Study: Evidence-Based Patient-Centered Concept Map
Introduction
Supervisor Email
Diabetes Patient
Concept Map
Results & Conclusion
Introduction
Concept maps are an important tool in patient–centered care planning. A concept map helps to synthesize facts about a patient's health needs and personal circumstances with available evidence and analysis. Such a tool becomes more useful when a patient has complex health, economic, and cultural needs.
Supervisor Email
You continue in your role as a nurse at the Uptown Wellness Clinic. You receive an email from the charge nurse, Janie Poole.
Email
Frm: Janie Poole
Subject: Patient Profiles
Good morning,
We have a new patient coming in today.
Her name is Carole Lund. Carole is a new mother who had gestational diabetes during her pregnancy. She has continued to track her blood glucose postpartum, and is worried that it does not appear to be stabilizing.
It probably will be helpful to create a concept map for Carole to show her this care plan in a visual way. Talk to your patient and start planning her care. Thanks!
— Janie Poole
Diabetes Patient
Reason for Referral:
Carole Lund is a 44–year–old woman of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.
Situation:
Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis, and it shows 150–200 fasting, over 200 following meals.
What diabetes treatments did you receive during your pregnancy?
Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don't think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.
Did your obstetrician advise you to take insulin during your pregnancy?
She did, yeah, and we talked about it. I don't like the idea of being dependent on a drug. I called my mother. She's still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it's made in a laboratory somewhere, and I'm not sure that's any better.
By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn't, and I know you have to be careful having a baby at my age. I want to do what's best, but I don't want to believe that insulin is my only option.

Are there any challenges in your life which you think may be interfering with your ability to follow a treatment plan?
It's harder now than it was before she was born. It's just the two of us in the apartment, which is wonderful, but I don't remember the last time I had a good night's sleep. A lot of my work is freelance, so I make my own hours, but that also means if I'm not working I don't get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it's all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.
Do you have any other concerns you'd like to have addressed?
I worry about Kassandra. She's healthy and perfect, but I know that she's at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself.
Concept Map
Well, it sounds like this is a more complex case than we thought at first. I'm going to need you to put together a concept map for your patient's care plan.
I need a brief description of your patient, and then up to five diagnoses (there may not be that many). Go in order of urgency, and make sure you list the professional or scholarly evidence you used to formulate the diagnosis. Just use in–text citations, please; we want to keep this short and sweet.
You may use the template provided in the assignment, another template, or your own concept map format for your final map.