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NURS6621 Clinical Practice A Questions:  John is a 69 year old gentleman of Italian heritage, who has come into hospital for a below knee amputation due to complications from his Type 2 Diabetes (18 years post diagnosis). He is retired and lives with his wife of 40 years and his daughter, son in law and their three young children in a three bedroom house in the outer suburbs of Melbourne. He has failing eyesight and has not had a job for the past 15 years due to his health problems. He is currently taking the medication to help manage his blood sugar (Metformin), however his blood sugars continue to be very high. John does not like taking his medication as he finds it expensive and does not believe it helps him maintain his blood sugars within a healthy range. He believes there is nothing he can do to manage his blood sugar levels and that the amputation was a natural progression of the disease state. He infrequently takes his blood sugars, and does not see the point in attending frequent doctor appointments again due to the cost. John’s son in law is the only one who brings an income into his household, and this must support John, John’s wife, his daughter and their children. With limited resources, it is important that John keeps his medical bills as low as possible. The family does enjoy spending time together and enjoy celebrating and connecting over meals. His son-in-law usually joins John in an evening after the family meal to drink wine and smoke cigars. Both men find this an important time to connect and relax after a long day. John socializes very infrequently with anyone else outside of his family, as his failing health and eyesight prevents him from being able to drive anymore. Section A: Referring to the case study, identify the seven dimensions of patient centered care and how you could utilize the dimension/s to provide holistic, therapeutic care to John. Section B:  Compare and contrast to the biomedical model of health and explain how John’s psychosocial health could benefit applying a social model of health care. Answers: Introduction In the 21st century, patient-centred-care plays a major role between patient, nurses and other health workers. Patient-centred care is a major contemporary healthcare reform that is designated to build an integrated relationship that provides quality, preferential, respectful and effective care to the patient. A professional nurse who employs the Patient-centered care dimensions through the appropriate model of health is able to maintain the patient’s personal values in the improvement of healthcare organization and foster health outcomes of non-communicable diseases like diabetes. This essay will demonstrate how a nurse can apply the patient-centred care technique and be of much benefit to John and his/her family in controlling diabetes through meaningful and valuable dimensions and proper models of health. The essay also explains how the patient-centred care technique help nurses to cope with the situation of old people who have chronic illness. Section A Dimensions Of Patient Care Respect For Patient’s Preference The client is treated with respect and dignity and recognition of the cultural value and autonomy. In providing care to John, I could listen and respect his family’s decisions. However, I could warn both John and his son in law of the dangers of smoking and taking wine to heath especially to a diabetic patient (Kelley et al, 2014). Coordination And Integration Of Care Well-Integrated and coordinated care is essential for the patient where they express vulnerable and powerless feelings due to their illness condition. John believed that his blood glucose is uncontrollable. However, I could encourage him to keep on taking and monitoring his blood glucose level frequently and also organize on how he could get a specialist to give more advice and recommend for more advanced diabetic medication (Inzucchi et al, 2014). Information And Education The health professionals have to focus on the disease progress information, clinical status, the caring process and the disease prognosis that could help in relieving the patient’s worries and fears. As the care provider of John, I could offer much education to John, his family and his son-in-law on how to take care of John’s health regarding the eating habits and frequent monitoring of the glucose level (Inzucchi et al, 2015). Physical Comfort In the hospital environment, Physical comfort is crucial to a client who is in situations such as personal daily activities and pain management. John requires physical assistance due to his eyesight problems, knee amputation, and his failing health. I could ensure physical support to John due to his knee complication by paying more attention when he is walking and also assist him by driving him to the hospital for doctors’ appointments (Pulvirenti, McMillan & Lawn, 2014). Emotional Support Emotional support is a very important intervention to the patient of diabetes, especially in John’s situation to relieve his fear and anxiety feelings. As the caregiver of John, I could pay attention to John anxiety over illness’s impact, prognosis, treatment, and financial status (Neal et al, 2015). John requires emotional support to counter anxiety and fears caused by his family’s financial status which makes him think of halting medication. John seems anxious over his high blood glucose level which failed to respond as per the doctors’ medication. Participation Of Family And Friends Friends and family contribute in the provision of patient-centred care through encouraging the patent to strengthen his hopes, offering physical support, socializing and interactions to give the company, in decision making and creating of a humble environment. To strengthen the close relationship in John’s family, I could holistically participate in their daily activities as a community nurse while involving them in a decision that could improve John’s health for example in food decisions (Evert et al, 2014). Continuity And Transition  The health practitioner providing care should be understandable concerning the dietary needs, physical limitations, medication details, and patient’s appointment plans. I could give clear and appropriate information to John about medication and inform him on the significance of adhering to doctor’s appointments that could offer a solution to his complaints about the lack of improvement on his medication.  Access To Care I could organize with John’s family for an easier way to get a specialist who could understand his diabetic condition to offer more knowledge to him and his family on how to control such a diabetic situation. Section B Comparison Of The Models Of Health Many health professionals when diagnosing a diabetic patient start with the biomedical model of treatment to enable them to note and monitor the disease progression in their clients (Chiauzzi, Rodarte & DasMahapatra, 2015). The biomedical model of health focuses on the physical and biological phases of the disease such as the medication, treatment and diagnosis while the social model address aspects such as environmental, social and cultural elements of providing healthcare services. The social model of health recognizes the relationship between the health determinants, disease status and considerations of vital concepts like ,socio-economic status, health accessibility and social connectedness to improves the patients’ health. On the other hand, the biomedical model involves mainly the medications, x-rays and body parts replacement. The biomedical model is appropriate to improve the quality of lives with chronic illnesses while the social model improves the overall wellbeing, focusing on vulnerable populations through campaigns and programs in the community to improve and maintain the health of Australian. The Benefits Of Applying The Social Model Of Care To John The social model of care promotes good health, helps in the overall wellbeing and focuses majorly on vulnerable populations. When the client’s disease condition exceeds the biomedical model, the doctor now recommends for the social model of health (American Diabetes Association, 2017). This model would be of much benefit to John considering the drugs did not respond to his expectations in lowering his blood sugar as well as his background financial status which influenced his psychological health (Nelson et al, 2014). The programs that are involved in the social model could help John to change his negative beliefs by interacting with other people who have experienced such diabetic conditions. The social model of health is very helpful especially through sharing of the health responsibilities, for instance collaborating with the family of John in taking care of him by educating them and advising more on the nutrition for a diabetic patient (Elwyn et al, 2014). Through diet consultation with family including the son-in-law will assist John to stop taking wine and also cigars which are very harmful to his health. The social model of health could enable John’s family and other caregivers to express empathy, trust love and tangible caring services to John which could give him encouragement and motivation to get well. The model involves suggestions, advice and information that is helpful for self-evaluation that strengthens a person to cope many psychosocial issues such as anxiety, depression coping skills like adhering to medication, giving up to smoking and other social support (Kahn, Cooper & Del Prato, 2014). Conclusion In conclusion, the concept of employing knowledge of patient-centred-care practice in the effective management of type 2 diabetes has to be built by nurses. This essay has clearly shown how the concept of patient-centred-care can be significance for effective care to a diabetic patient. The essay has also discussed the dimensions and the models of health that could be applied for effective outcomes of the diabetic condition, especially to the less informed population. The essay has explained how lack of proper follows up of the patient-centred-care dimensions while monitoring a diabetic patient could be ineffective to the patient. Finally, the essay has discussed how the application of the two models of health, social and the biomedical model of healthcare of great advantages towards treating the type 2 diabetic patient. References American Diabetes Association. (2017). 8. Pharmacologic approaches to glycemic treatment. Diabetes Care, 40(Supplement 1), S64-S74. Chiauzzi, E., Rodarte, C., & DasMahapatra, P. (2015). Patient-centered activity monitoring in the self-management of chronic health conditions. BMC medicine, 13(1), 77. Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., … & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), S120-S143. Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.  Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-149. Inzucchi, S. E., Lipska, K. J., Mayo, H., Bailey, C. J., & McGuire, D. K. (2014). Metformin in patients with type 2 diabetes and kidney disease: a systematic review. Jama, 312(24), 2668-2675. Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083. Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207. Neal, B., Perkovic, V., de Zeeuw, D., Mahaffey, K. W., Fulcher, G., Ways, K., … & Jiang, J. (2015). Efficacy and safety of canagliflozin, an inhibitor of sodium–glucose cotransporter 2, when used in conjunction with insulin therapy in patients with type 2 diabetes. Diabetes care, 38(3), 403-411. Nelson, K. M., Helfrich, C., Sun, H., Hebert, P. L., Liu, C. F., Dolan, E., … & Sanders, W. (2014). Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA internal medicine, 174(8), 1350-1358. Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self?management. Health Expectations, 17(3), 303-310.

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