Holistic Care Approach for a Patient with Type 2 Diabetes

In this particular case, what happened during my placement was that patient L who had been admitted in the ward having being diagnosed with depressive disorder and in his medical history, he had earlier been diagnosed with diabetes. He was at one point found having seriously injured himself. He had cut himself on the wrist severally and had had a lot of bleeding by the time it came to our attention and had consequently lost a lot of blood. My team which was comprised of a general practitioner, I being a nursing student, nurses, a social worker, an occupational therapist, dietician, psychiatrist, and a pharmacist, took up the matter and commenced the treatment process according to the (WHO, 2012). Looking keenly at the way he progressed the team was able to detect that he was not properly managing his diabetes condition as it proved to have deteriorated at that time. We were able to find out that it was a result of dietary indiscretion as well as negligence as he had stopped taking the medicine (Nam et al 2011). Digging deeper our team was able to find out that patient L had a lot to deal with as he had previously lost his mother, wife, and children in a fire incident not so long ago. This kind of grief was too much for him to handle and it made him sink into depression and had no hope in life. He did not see the need to continue with diabetes self-care. He never saw the need to be admitted and get treatment as he wanted to die.it took the intervention of his elder sister to get him admitted successfully as he was very agitated.

Feeling

One is supposed to give an account of their feelings about what happened. What they felt at that particular point and even after the incidence without necessarily giving a conclusion. Also what one thinks about the feelings of other people who were present in the scenario (Markkanen et al., 2020). The situation at hand caught my attention as I was fully aware of the intensity of pain that patient L was experiencing having such a huge loss and immediately I knew that when such issues are combined with diabetes it can be so terrible and his mental health was adversely affected. At this point, I wished I could help but my hands were tied given that I am a student and the issue was beyond me as in my profession I am strictly only allowed to take any action within my limits and competence. Nevertheless, I decided to uplift his soul by giving him hope and letting him know that no situation is permanent meaning he would eventually heal from the pain he was going through.

Evaluation

At this point, one is expected to point out very objectively and honestly, what worked and what did not work in the whole situation. This is to get the most out of the reflection as Tawanwongsri et al., 2019 would have it. One answers questions like what went well, what dint go well, and how did they are any other person contribute either negatively or positively to the situation at hand. Here everybody played their part very well. The nurses were very swift especially in the dressing and cleaning of the cut wounds. This was not as easy as the patient was very aggressive at first. We took the initiative to calm him down in a very friendly manner by explaining to him that the treatment was for his good. I deliberately got closer to him in an empathetic manner during the dressing process and this made him feel I care.

Analysis

Tanaka et al., 2019 explain that this is the point where one can extract meaning from all the above details and make sense of what happened. They can see why things went well, alternatively, why did they not go well, and also what knowledge do they have for instance literature and hypothesis that can help them make meaning of the whole scenario. This whole incidence shows clearly that both inter-professional collaboration and service user involvement aim at ensuring that patient safety is paramount as they receive effective care. The healthcare professionals treat the patients with dignity and respect flows on both ends. Any decisions that are made in the whole treatment process are made in unison by both the team and the patients. Any kind of information about the conditions of the patients and treatment is relayed effectively to the patient and their relatives. There are mutual relationships as well as an understanding of roles where every team member knows their duty and undertakes it with all diligence. The care given to patients is person-centered where the patient is allowed to give their suggestions on what works for them and it is accorded for their best interest.

NMC (2018) dictates that at all times the health care professionals are supposed to ensure that the safety of the patient comes first and that treatment should be in the best interest of the patients. In this case, the patient was found bleeding and the nurses rushed to stop the bleeding first to ensure that the patient was safe and commenced treatment immediately. However patient L did not take it positively and did not want to be treated. Although the decisions of the patients should be respected, we found this kind of decision unsafe for him and since his safety comes first we had to go against his wish politely and made him understand that treating the cuts was for his best interest as nurses have to stop harm from happening. Nurses are required to act immediately in the case where the patient is suffering from harm or is about to suffer from harm according to NMS (2018) so this caused the prompt decision of the nurses. It is a professional requirement for the inter-professional team to partner with the service users and ensures they have shared decision making. This is what I experienced in the whole treatment process. Before anything commenced the team had a brief meeting to discuss the treatment and among us were patient L, his elder sister as well as his twin brother. We incorporated them so that we can fulfill the requirement of shared decision-making. Shared decision-making works best in the achievement of the desired treatment goals. It is the systematic approach whereby there is an exchange of evidence-based information that pertains to the treatment proposed to be offered, whereby the patients together with their relatives can decide on their most preferred treatment plan based on the information that has been relayed to them. When we incorporated shared decision-making in the treatment plan we were aiming at empowering the service user with information so that he can be well aware of his condition and this would help him in self-care. We wanted to seek their opinion on what they feel should be done to their kin during treatment since he was not mentally stable to effectively participate in the discussion. Although patient L was not in his right state of mind, we had to keep him in the meeting and let him also be heard as a sign of value and respect. This was also done following the DOH (2012) that states “no decision about me without me” this is to emphasize the need to have patients involved wherever decisions are to be made concerning their treatment plan. We tried to incorporate him as much as we could to ensure that at no point would we give him forced treatment. Bearing in mind that patient L had inflicted self-harm in his body there was a decision that was made as we were planning the treatment process. According to NHS (2012), we decided that patient L should be taken through one-to-one care based on the fear that he might decide to inflict harm on himself again. NICE,2020 explains self-harm as the act of one making a deliberate decision that they are going to cause harm of whichever kind to themselves be it poisoning themselves or probably injuring themselves in any way regardless of their reasons. It is, of course, suicidal and manifests in various ways for example one burning themselves, inserting harmful objects in the body, pulling one’s hair vigorously, poisoning for example with dangerous drugs as well as inflicting wounds that are very serious in one’s body. Bearing this in mind it was decided that there be no sharp or dangerous objects near-patient L at any point and that he would be under surveillance around the clock having known that this kind of harm is normally done when someone is in isolation.

The person-centered approach during care stood out as part of service user involvement and I was able to identify it in this scenario. Person-centered care means being fully aware of what the service user needs and wants during the treatment and fully incorporating it during the treatment planning and execution. This is normally done with a lot of respect and putting the patient’s best interest forward. In this case, patient L had two conditions that affected each other which took a toll on his health in a big way. Diabetes made him have high blood sugar levels and affected his mental condition and since he was mentally not okay he did not prioritize taking care of himself since the mental disorder lost his hope and got him into despair. Our inter-professional team was able to put all this into serious consideration and unanimously agreed to deliver care that puts patient L’s needs as paramount. We had to make sure that we control diabetes as quickly as we could as well as help him with the depression that came along with the condition to be able to help him most effectively. According to Fazio et al., 2018 when applying person-centered care to patients, the professional team ought to be extremely understanding to whatever the patient does be it good, bad, or harmful to themselves or any other person. The professionals are supposed to be able to understand the patient’s condition fully, understanding why they are doing things in a certain way, and not be judgmental towards them at any point. In this particular incident, patient L was handled with all respect and was never judged or condemned in any way by our inter-professional team when it was found out that he was deliberately cutting himself and not taking his diabetes medicine. Another aspect that came out strongly in the inter-professional collaboration that we had in the incidence was role understanding. In our strong team, every member had their unique skills and expertise that they were bringing on board. We also understood each other’s role and no one could have tampered with the other's responsibility at any point. According to Pollard et al., 2012, we embraced each other’s skills and responsibilities in the whole process and it highly contributed to our effectiveness. We also shared our skills and knowledge in the entire process.

In this case, the general practitioner was able to assess patient L at first because he handles different illnesses, he examined him then leased with the psychiatrist for proper physical and mental examination, and it is when the treatment for his diabetes and depression was prescribed.

The psychiatrist monitored the outcomes of the treatment and how his mental health was progressing as well as advising him on what to do from time to time. The dietician also came in handy to guide patient L on what to each, how to eat, when to eat because of the blood sugar regulation. Nurses also took part in the administration of drugs, carrying out specific tests, injections as well as monitoring the patient’s progress during the treatment. It was also the duty of the nurses to also ensure that the needs expressed by patient L were addressed. The nurses were the link between the patient and the inter-professional team. For me being a student nurse, I was assigned several duties by my supervisor which included ensuring that the patient is okay at all times, administering medication to him, I also carried helped in checking his sugar levels as well as assisting him in changing his clothes, and monitoring vital signs.

Conclusion

In most cases, the healthcare professionals are often faced with serious and complex matters with the patients and this is where inter-professional collaboration comes in achieving patient-centered treatment as one or two health workers may not be as effective. This paper has depicted how effective it is to incorporate inter-professional working for the wellbeing of the patients. It has also emphasized that for there to better result in the team there has to be person-centered care, good communication and relationship, shared understanding and decision making as well as having each member understand their role and that of other teammates.

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Personal Action Plan

Here one summarizes what they have learned through the whole experience and thereafter looks at what they would do better or how they can change their actions to influence better outcomes in the future. This is the stage, as illustrated by Dhaliwal et al. (2018) that ought to be taken with utmost seriousness for on to develop themselves in the practice and for them to benefit through their personal experiences. Here a clear action plan is made (Harerimana, 2018) depicting what one is currently doing and what they are going to do in the future to improve in their practice.

Based on what I have learned in this experience, I have deliberately decided to be keen with all the patients I encounter during my practice and put more emphasis on being compassionate to those that have gone through serious life issues that could lead them to be so depressed to a point of attempting to harm themselves. I have come to learn that self-harm is suicidal and patients with these tendencies need to be handled with a lot of care, mores they need to be shown a lot of concern and constantly given hope (Zhao et al., 2016). I will be very deliberate in giving the patients a shoulder to lean on to reduce the distress they are going through. I have also taken it as a challenge to make sure that I am always up to date with any emerging issues concerning mental health. Taking part in pieces of training and sessions that will help me learn more and more to sharpen my skills and also seeking all the help I can get from my colleagues who are more experienced to professionally handle any patient I come across.

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