Comprehensive Care for Long-Term Conditions

Slide 1:- Introduction

The story narrative will critically and analytically present the following:

A description of the way of development and effect of ageing and Long-Term Condition (LTC) on individual and their family

The evidence-based care for meeting the need of individual with LTC

A presentation of legal, ethical and professional principles that are to be followed in developing the practice

Analysis of the role of the nurse for promoting well-being and good health of the individual with LTC

An identification of the pharmacological and non-pharmacological intervention to be used for health management of a patient with LTC

The incorporation of the Biopsychological model in determining biological, psychological and sociological views in relation to the LTC suffered by the patient

Slide 2:- confidentiality

The NMC Code of Conduct mentions that it is the duty of the nurses to ensure the privacy and confidentiality of the patients to avoid them from harm or abuse or disrespect due to leakage of personal information in public (NMC, 2018). Thus, the pseudonym J is to be used to indicate the patient so that the patient’s personal identity remains confidential.

Slide 5:- Long term condition

Long-Term Condition (LTC) is referred to chronic health condition in which the disease extends for long period of time and requires combination of different therapies and intervention for management of the health condition as it has no permanent cure (Elliott et al., 2017).

According to Age UK, in 2019, nearly half of the people of 65-74 years are found to be suffering from at least on LTC which increased to 2/3rd among the elderly ageing 85 years and above (ageuk.org.uk, 2019).

Facts:

59% individuals living with LTC are current working (ageuk.org.uk, 2019)

72% of people with LTC requires specific care plan in managing their health (ageuk.org.uk, 2019)

LTC accounts for 50% of the current GP appointments, 64% of hospital admission, 70% of healthcare cost spent of NHS is spent for LTC management and 70% of hospital bed days are related to treatment of LTC (ageuk.org.uk, 2019)

64% with LTC require additional support for their well-being and 5.4% of people with LTC are mentioned to have written care plan in detail (ageuk.org.uk, 2019)

Slide 4:- presenting complaint and past medical history of patient

J (pseudonym) is a 78-year-old male who is presented to the hospital due to complaint of increased thirst, unintentional weight loss, and urination.

J was admitted to the medical ward with the history of type-2 diabetes been detected 10 years ago and alcoholism with presence of type-2 diabetes been reported in the family history. However, he ignored to access care for diabetes as always felt his health would not be affected by the condition in any way.

He has been married for 40 years and currently lives along after his wife died 8 years ago. He worked as an accountant in a financial firm and is currently living on retirement money.

Slide 5:- the biopsychosocial model

The Biopsychological model is referred to inter-disciplinary model which considers that health is influenced by interconnecting factors such as biological, sociological and psychological. Thus, the model argues that interplay of genetic development of the people along with their mental behaviour and cultural and social context determine the course of their health management and outcomes (Bajwa and Kalra, 2014).

Slide 6:- biological need ( definition, cause, diagnoses, surgery, pharmacological, non pharmaceutical, impact on patient, impact on family.

Type-2 diabetes is a long-term condition in which the body express irregularity in managing normal level of blood glucose due to impaired functioning of muscles, fat and liver by becoming resistant to insulin use that helps in keeping the blood glucose level under control. the impaired functioning of the cells and liver leads increased blood sugar level to be present which the pancreas is unable to control by producing enough insulin (Roden and Shulman, 2019).

Diagnosis

Fasting blood glucose test in which blood sugar between 100 to 125 mg/dL is considered as prediabetic state and above 125 mg/dL is considered as higher diabetes level (Jin et al., 2017)

J’s fasting blood glucose was recorded to be 230 mg/dL

Impact of Type-2 diabetes on J

Increased pain in the legs with hindrance in movement

Fatigue

Unexplained weight loss

Increased thirst and urination

Impact of Type-2 diabetes in the family of J

Feeling of increased risk to develop the health issue as type-2 diabetes is seen to be genetically linked and it runs in family

According to Ali (2013), the lifetime development risk of type-2 diabetes through hereditary factor is 40% for individuals who have single parent been affected by the disease and 70% for individual who has both parents affected by type-2 diabetes

In case of J, it is revealed that his father and mother both suffered from type-2 diabetes, but his wife was not affected by the disease and died due to cardiac arrest

This indicates that the genes inherited from the mother and father by J were responsible in making him be at increased risk to suffer from the condition

1 in 10 people who are above 40 years of age are living with type-2 diabetes (diabetes.org.uk, 2019)

Nearly 4.9 million people in the UK who are middle-aged, and elderly are suffering from diabetes with 3.8 million been diagnosed with the condition and 90% of them are diagnosed with type-2 diabetes (diabetes.org.uk, 2020)

Nearly 850,000 individuals are presently living in the UK who are suffering from type-2 diabetes (diabetes.org.uk, 2020)

It is predicted that by 2030, the number of people affected by diabetes in the UK would reach 5.5 million (diabetes.org.uk, 2020)

Nearly £2.3billion to £2.5 billion each year is spent by the NHS England for providing inpatient care to the patients suffering from type-2 diabetes which is nearly 11% of the total expenditure made by NHS for delivering inpatient care (diabetes.org.uk, 2014).

Pharmacological

J is to be prescribed taking Metformin to immediately control his blood sugar level which has been drastically raised due to hindered control of the condition. This is because Metformin helps in inhibiting the hepatic glucose production which reduces the intestinal absorption of glucose in the blood leading to improved glucose uptake and utilisation (NICE, 2020)

J is also to be administered sulphonylureas as pharmacological intervention. This is because sulphonylureas acts as insulin secretagogues which causes the body to create enhanced secretion of insulin for controlling blood glucose level (Webb et al., 2019)

Non-pharmacological

The inclusion of low-calorie diet is required for J in controlling type-2 diabetes with increased intake of complex carbohydrates. This is because it leads the body to take increased time in developing blood glucose level through breakdown of complex carbohydrates and low-calorie food ensures enhanced weight management which is important in controlling the condition (Lewgood et al., 2021)

Physical exercise is needed to be included for J because increased activity leads the body to be capable of using increase amount of glucose from the blood, in turn, helping to keep the blood glucose level under control (Rodriguez‐Mañas et al., 2019).

Impact of pharmacological intervention

Support immediate control of raised blood sugar level in J

Lower fatigue

Control thirst and urination

Impact of non-pharmacological intervention

Cost-effective

Improved lifestyle change

Long-term support

Slide 7:- Psychological

Impact on J

Low mood

Anxiety and stress

Worrying regarding personal care

Impact on Family

Fear of risk of the disease

Possibility of burden of care for the patient

Coping Strategies

Accept new way of leading life with self-management as it would make the patient being lower burden of care on the family as well as develop self-efficiency along with empowerment in taking own care that would boost their respect and emotional health (Wu et al., 2019).

Positive reframing of care

Delivering cognitive behaviour therapy to J and his family for resolving depression and anxiety regarding the condition. This is because the therapy helps in understand the cause of the distress and manage appropriate action to overcome the condition to lead an enhanced life (Whitehead et al., 2017).

Sociological

Impact on J

Controlled lifestyle and diet to be maintained

Withdrawal from alcohol for socialisation

Social Intervention

J is to be referred to counselling to access advice regarding the way to avoid further drinking habit as it is necessary to control blood sugar level to normal. This is because increased alcohol intake leads the body to be incapable of controlling enhanced functioning to absorption glucose and release insulin for blood sugar management (Zhang et al., 2017).

Slide 8:- nurse role and impact

Nurses caring for J are to work in collaboration with the multi-disciplinary team which would include dietician, physical trainer and psychiatrist

This is because dietician would assist in developing proper diet chart for the patient to maintain the individual’s blood sugar under control (Early and Stanley, 2018). Moreover, the psychiatrist would assist in controlling mental health of the patient and the physician would help in improving J’s physical activity required for enhanced control and management of type-2 diabetes in long term.

Relevant policies and legislations

The Care Act 2014 mentions that it is duty of the caregivers to develop person-centred approach to safeguard vulnerable adults and ensure their good health and well-being (legislation.gov.uk, 2014). In case of J, effective person-centred approach is been taken as he is involved in all the care decision made to ensure his good health.

The NMC Code mentions that the nurses are to work in best interest of the patient and provide them care in meeting all their need (NMC, 2018). In case of J, the NMC Code is appropriately followed as all his care need are identified and according care plan is developed to holistically meet all his need and ensure him enhanced health.

Slide 9:- Conclusion

The above discussion mentions that J is been admitted to the hospital after being suffering from a relapse type-2 diabetic condition which caused due to his negligence in acing care for controlling the condition. His key needs included support to lower his blood sugar, improve his diet, and resolve depression.

The use of Metformin and fast-acting insulin is to be used for immediate treatment of J as per NICE guidelines. A diet chart is to be developed to control type-2 diabetes in J and Cognitive Behaviour Therapy (CBT) is to be provided to J to lower his depression. The Care Act 2014 and NMC Code are to be followed in delivering care to Mr J.

Take a deeper dive into Comprehensive Analysis of Care Provision for James with a Complex Health Condition with our additional resources.

References

ageuk.org.uk 2019, Briefing: Health and Care of Older People in England 2019, Available at: https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health--wellbeing/age_uk_briefing_state_of_health_and_care_of_older_people_july2019.pdf [Accessed on: 17 July 2021]

diabetes.org.uk 2020, Diabetes Statistics, Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics [Accessed on: 17 July 2021]

diabetes.org.uk 2014, The Cost of Diabetes, Available at: https://www.diabetes.org.uk/resources-s3/2017-11/diabetes%20uk%20cost%20of%20diabetes%20report.pdf [Accessed on: 17 July 2021]

diabetes.org.uk 2019, Diabetes Statistics, Available at: https://www.diabetes.org.uk/about_us/news/new-stats-people-living-with-diabetes#:~:text=One%20in%20ten%20people%20over,of%20those%20with%20Type%202. [Accessed on: 17 March 2021]

legislation.gov.uk 2014, Care Act 2014, Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents/enacted [Accessed on: 17 July 2021]

NICE 2020, Type 2 diabetes in adults: Management, Available at: https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493 [Accessed on: 17 July 2021]

NICE 2019, Insulin Treatment, Available at: https://www.nice.org.uk/bnf-uk-only#:~:text=Insulin%20aspart%2C%20insulin%20glulisine%2C%20and,usually%20given%20by%20subcutaneous%20injection. [Accessed on: 17 July 2021]

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 17 July 2021]

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Whitehead, L.C., Crowe, M.T., Carter, J.D., Maskill, V.R., Carlyle, D., Bugge, C. and Frampton, C.M., 2017. A nurse‐led education and cognitive behaviour therapy‐based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial. Journal of evaluation in clinical practice, 23(4), pp.821-829.