Promoting Adherence discussion post

I am submitting three discussion post and I need three individual responses to provide constructive and insightful comments that go beyond that of agree or disagree. 1)This post is from Sanghee: Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin. Type 1 diabetes requires regular blood sugar monitoring and treatment with insulin. Treatment, lifestyle adjustments, and self-care can control blood sugar levels and minimize the risk of disease-related complications. Type 1 diabetes usually begins in childhood or young adulthood, but can develop at any age. The aim of treatment is to achieve a level of metabolic control which reduces the risk of acute complications such as severe hypoglycemia and diabetic ketoacidosis, and chronic complications such as blindness, renal failure and amputations, while promoting normal growth and development and allowing patients to lead as normal a life as possible. I believe that the nurse needs to assess the patient's knowledge about diabetes type 1 and self management level of the disease. The nurse also needs to ask the patient about his/her concerns about it. Using therapeutic communication technique is essential in building a trust between the nurse and patient. Nurses are in a position to create long-term therapeutic relationships with patients with a chronic illness such as diabetes mellitus by providing health education and social support that enables the patient to create a fulfilling life. The diagnosis of a chronic illness has considerable impact, not only on the patient, but also on the patient's family, friends, employment and social support networks. Nurse's role is to recognize this impact and provide support, education and encouragement to the patient and their family. Factors that the nurse needs to consider would be if patients understand their medications, self-monitor their blood glucose level, adjust insulin levels accordingly, and actively participate in health screening to avoid or delay any diabetic complications. Some other factors that the nurse needs to consider would be the age of patients, barriers of learning, cultural beliefs, and influencing factors such as social and cultural influences. The nurse should have assessed the patient's emotional and spiritual needs and concerns. Education on diabetes type 1 might have performed in the past, but the teaching was ineffective. Patient knowledge of diabetes needs to be frequently assessed and reinforced at different stages of development. It is important to ask questions regarding the focus, values, and goals of practice, which can enable the measurement of health activity. Diabetes education for the patient is crucial toward effectively and economically reaching the ultimate goal of preventing long-term complications of diabetes. The nurse needs to educate the patient on diabetes type 1 including how regimen works, why insulin is needed, demonstration of pen device and self-injection, carbohydrate counting etc. Nursing interventions that include health education and continued promotion of a healthy lifestyle are very important for patients with diabetes type 1. 2)This post is from Angela: The RN should use an educational approach to assist this patient with adherence to the medical regimen. According to Smeltzer, Bare, Hinkle & Cheever (2010) patient and family education is a key component of diabetes treatment. It is important that the patient understand what Type 1 diabetes is, the disease process and the goals of treatment. The nurse must emphasize the importance of self monitoring of blood glucose and insulin injections to successful treatment of Type 1 diabetes. When patients are well informed about their diagnosis, treatment rationale, medication regimen, and the benefits of compliance, they are more likely to comply (Taylor, Lillis, LeMone & Lynn, 2011). Monitoring and pharmacologic therapy are both crucial components of diabetes management (Smeltzer, 2010,). The role of the nurse is to educate the patient about the different approaches to insulin therapy and the patient should be included in the decision as to which insulin regimen to use. I think including the patient in the decision making process will promote adherence. If necessary the nurse should refer the patient to a diabetes specialist or education center for further education. The nurse must take into consideration the patients age and developmental level, family support and financial resources, cultural influences and language deficits, and health literacy level (Taylor, 2011). The RN also needs to consider the patients readiness to learn before initiating diabetes education. Patients first diagnosed with diabetes may go through stages of the grieving process. The patient may feel shock, denial, anger, depression, negotiation, and acceptance when first diagnosed. The patient may also be having feelings of helplessness, guilt, altered body image, loss of self- esteem, and concern about the Future (Smelter, 2010). The nurse should inform the patient that these feelings are normal. It is important that the nurse ask about fears and concerns to find out if misconceptions may be causing anxiety (Smeltzer, 2010). Other factors that the nurse should consider include neurological deficits, and other disabling conditions (Smeltzer, 2010). In this situation I think that the following steps of the teaching-learning process were not employed by the nurse: 1. Assess learning needs and learning readiness- the nurse should assess for factors that may affect the patient's ability to learn. 2. Diagnose the patients learning needs-Identify learning needs and validate through conversations, questionnaires, and checklists. 3. Develop learning outcomes- identify specific, attainable, measurable and short term outcomes for patient learning. 4. Develop a teaching plan- select appropriate teaching strategies/activities, relate teaching content to patient's learning style, formulate a written or verbal contract with the patient (Taylor, 2011). The nurse should have completed a nursing assessment of the patient's learning needs, ensured that healthcare instructions were understandable and designed to support patient goals. The nurse should have also included the patient and family as partners in the teaching- learning process and use interactive teaching strategies to promote patient compliance (Taylor, 2011). 3)This post is from Nash: . The registered nurse is caring for a patient who was just diagnosed with Type 1 Diabetes Mellitus. As the RN begins to teach the patient about self monitoring of blood glucose and insulin injections the patients states “I am not going to do this, stick myself with needles every day for the rest of my life.” Type 1 Diabetes Mellitus, or Juvenile Diabetes, is usually characterized by an acute onset with patients before the age of 30 and affects approximately 5-10% of the population (Taylor, Lillis et al 2011). Discuss an approach the RN can take to assist this patient with adherence to the medical regimen. Make the connection between daily activities and just adding in another part of that routine. If a patient already gets up and makes coffee or a smoothie in the morning, while they wait the can measure blood sugar and/or administer insulin. Or after each meal, when cleaning up their dishes, add monitoring and administration as part of the task. The RN should also inquire why this patient feels this way about taking medication daily. What factors would the RN need to consider? If the patient is under 30 and is beginning treatment, that patient may be scared and daunted by the task of daily insulin administration (Taylor, Lillis et al 2011). Also, an uneducated patient is very dangerous in terms of not following instructions on treatment. Discuss which steps of the teaching-learning process were not employed. Tuning to the patient was not completed. The RN needs to educate the patient with specifics that will help that individual patient learn what they need to to be successful with their treatment regiment. Clarification on all points and especially the administration of medication and the reason for the medication will help with having the patient understand the importance of taking the medication at the appropriate times, daily. What might have been done differently? I'm always about collaborating with other services. Perhaps a social worker following up with the patient to make sure they're needs are being taken care of. A RN that makes house calls periodically until the patient is able to successfully administer medication and understand the reason why and when administration is important.