"Clinical Pathway and Nursing Intervention for Type Diabetes

Long term health condition is also called chronic health condition in which the illness cannot be permanently cured but the health implications of the illness can be managed by following the effective medical regimen (Chaudhury et al. 2017). This study will discuss the clinical pathway of a patient in hospital setting who suffers from a long-term heath condition, type 2 diabetes. This study will discuss the epidemiology and pathophysiology of type 2 diabetes. Here a specific nursing assessment model, the Roper et al. (2000) model, will be used to assess the health needs of the selected patient. This assignment will discuss the two activities of the daily living that impact on the overall quality of living and on the care experiences of patient by using relevant evidences. An effective nursing intervention will be discussed in this study which will identify the risk as well benefits of the care plan that designed for treating type 2 diabetes in the patient.

Mrs Jenny, a 36 years old lady has been admitted to the emergency ward with severe hyperglycaemia, ketonuria and fast weight loss of 10 kg in last two weeks. She had been brought by her husband to the hospitals. From the physical health assessment of Jenny, doctors diagnose that she has type 2 diabetes after checking signs and symptoms, Jenny’s fasting and post prandial blood sugar level and GAD and IA2 level. After checking the genetic history of Jenny, it is found that she has a paternal history of type 2 diabetes in which her father and grandfather have this chronic illness. Jenny lives with her husband and 10 years old son in a flat. She is a homemaker and loves to invest all her times in coking, taking care her child and husband and enjoy weekend trip with family. For investing most of her times for her child and husband she is unable to manage proper time for herself. She leads an irregular lifestyle such as skipping of meals, insufficient sleep, high consumption of fast foods and lack of intake of healthy foods and lack of exercise. Her current weight is 74 kg (after the weight loss) and she is diagnosed with obesity. From the last month her health condition begins to deteriorate with frequent urination, feeling of exhaustion and weight loss and the condition worsen in the last two weeks with fast weight loss, fatigue, tiredness and blurred vision.

The case study of Jenny has been selected because her health condition represents the health issues that majority of the middle age people with Type 2 diabetes in the UK face. The physical, emotional and psychological distress that Jenny face due to the diabetic condition are very common in the UK based adult population. PHE (2018) mentioned that, in the UK, NHS has to bear high heath care cost due to the ever-increasing cases of type 2 diabetes in young people [PHE, 2019]. The recent report of the World Health Organisation shows that, more than 12.3 million people in the UK live with type 2 diabetes which impacts adversely on their activities of daily living. As mentioned by (0, type 2 diabetes reduces the quality of living of people by interfering with physical health, decision making and cognition of people. PHE (2018) mentioned that one in ten people belonging to the age group 35-54 years in the UK live with type 2 diabetes [PHE, 2018]. Recent NHS report shows that more than 7% of entire UK population live with type 2 diabetes [NHS, 2019]. PHE (2018) mentioned that young and middle age people in the UK who suffers from obesity and overweight have 15% higher risks of developing type 2 diabetes than the normal weight people [PHE, 2018]. Recent health survey conducted by the Word Health Organisation predicts that, the mortality and morbidity due to type 2 diabetes will increase by 110% in England by 2030 [WHO, 2018]. Out of the adult people in the UK who suffers from type 2 diabetes, more than 23% of the people suffers from ketonuria, hyperglycaemia and polyuria which not only minimise their physical wellbeing but also interfere with emotional, psychological and socioeconomic wellbeing (Foretz et al. 2019). In this context the selection of the case study of Jenny is highly relevant that will assist the learned to gain clear understanding in the types and possible risks of the types 2 diabetes. On the other hand, this case study will assist health care professionals, nursing professionals and health and social care staffs to use evidence-based approach for promoting effective management of type 2 diabetes. Moreover, this case study is highly release which will present the limitations and the benefits of nursing intervention thereby enabling care professionals to know about how to make effective changes in the care plan to promote holistic wellbeing of patients with type 2 diabetes.

Type 2 diabetes is the chronic health illness that occurs due to the insufficient insulin production or the insulin resistances inside the body. Insulin hormone plays crucial roles on maintaining the normal range of glucose in the blood stream (Thrasher, 2017). Beta cells that are located in the Islets of Langerhans of pancreas are involved in production and secretion of sufficient insulin hormones into the circulation. In normal people, if there is a rise in the blood glucose level then brain transfers the signal to the pancreas to activate beta cells for producing and secreting sufficient insulin hormone (Bellou et al. 2018). Insulin hormone work on the excess glucose and convert it into glycogen which is then stored into the muscles and tissues for future use. Pathophysiology of type 2 diabetes shows that the two possible conditions are associated with this disease. One is that, a peripheral insulin resistance developed inside the body which leads to reduction in the insulin utilisation by the body system. The inability of body to utilise the sufficient insulin interfere with the glucose homeostasis thereby increasing glucose level in the blood stream (Kato et al. 2019). In other condition, some structural and functional changes occur in beta cells which leads to reduction in the production and secretion of insulin from the beta cells thereby making het body unable to maintain normal glucose level in the blood stream. The actual reason behind development of insulin resistances and the reduction in the production as well as secretion of insulin are still unknown due to lack of proper evidences.

As mentioned by Kenny and Abel (2019), while it comes to make an effective assessment of health condition of type 2 diabetic patients, care professionals must use best suited assessment tool that would be highly relevant to determine to that health needs of patients. In case of Jenny, Roper et al. (2000) assessment model has been used that assist nurses to make clear assessment of the different aspects of activities of daily living (ADLs) of Jenny. This assessment model is also known as Roper-Logan Tierney model. This model had been developed in 2000 to assist the care professionals to make a clear as well as effective assessment of patient’s health condition based on which an effective care plan can be developed (Okemah et al. 2018). Roper et al (2000) mentioned that the Roper-Logan Tierney model must not be used as the checklist by the nurses rather it needs to be used as guidelines to promote cognitive development of people who suffer from critical health condition. Roper-Logan Tierney model is widely used assessment tool that the nursing professionals use in everyday nursing (Henning, 2018). In case of Jenny, through using this model, nurses can conduct effectives clinical interventions that help them to develop highly realistic and relevant care plan for preventing and managing type 2 diabetes. This assessment tool enables the nursing professionals to assess and analyse the factors that impacts on the activities of daily living of patients which suffer from type 2 diabetes. In case of Jenny, through using the Roper-Logan Tierney model nurses’ area able to determines the current physical, social, emotional, spiritual health needs of Jenny that nurses need to considers while developing the care plan for her health management.

Thet Roper-Logan Tierney model presented 12 activities id daily living such as maintenance of safe environment, communication, breathing condition, eating and drinks, elimination of body waste, personal cleansing and dressing, controlling the body temperature, playing and working, mobilising, sleeping, expressing sexually and dying (Sacerdote et al. 2019). While assessing the health condition of a patient suffering from type 2 diabetes, care professionals need to consider all activities of daily living. By analysing all these ADLs in case of Jenny, nurses are able to detect her current holistic needs. By analysing all these ADLs, nurses can determine whether there is any improvement in health condition of Jenny after the implementation of the treatment process such as whether her blood sugar level reduces, or whether there is any improvement in her ketone bodies. Many theorists mentioned that, Roper-Logan Tierney model needs to be used for developing effective care plan and clinical intervention by care professionals that can assist them to meet social, cognitive and physical needs of patients. On the contrary, critics argued that, the Roper-Logan Tierney mode can help the nursing professionals to assess the ability of patients to perform their activities (Mazidi et al. 2017). In case of Jenny, nurses are not only able to determine the social, psychological and physical health needs of jenny by using the Roper-Logan Tierney model, but also, they can evaluate the impacts of the lifestyle, dietary habits, unhealthy eating on the diabetic condition. One of the biggest advantages of this Roper-Logan Tierney model is it helps nurses to assess the holistic needs of patients that impacts on patient’s activities of daily living. In case of Jenny, this health assessment tool us highly beneficial in relation to determines her social, emotional, psychological and physical needs that assist the nursing professionals to develop effectives clinical intervention for meeting these needs accordingly thereby managing type 2 diabetes in Jenny (Hemmingsen et al. 2017). Along with the benefits there are also some drawbacks or limitation of this Roper-Logan Tierney model in the health care context. This model assists nurses to be only confine to detect the ADLs of patients but it fails to assist nurses to use innovative strategies for effective’s pain management, proper medicine administration and effective medicines administration that are also associated with effective management of type 2 diabetes (Sacerdote et al. 2019). In case of Jenny the use of Roper-Logan Tierney model although assist nurses to determine her social, physical and psychological needs, it fails to assist nurses to consider the other important factors such as improvising her self-management skill and empower her by providing the stress management training.

Based on tote health condition of Jenny, nurses have used two elements of activities of daily living of Roper-Logan Tierney model. These two elements are, ‘communication’ and ‘eating and drinking’. As Jenny suffers from type 2 diabetes, in her case, nurses must maintain an transparent and effective communication that can enable them to gain clear report on heath condition of Jenny and any health improvement in her sugar level. As mentioned by Oguntibeju (2019), nurses must develop an effective communication with patients and doctors thereby transferring all the valuable information between them. In case in Jenny, nurses have use two types of communication such as synchronous and asynchronous communication. In synchronous communication is the real time communication in which the care professionals and nurses are able to make direct communication to each other regarding the health condition of patients (Tumminia et al. 2018). On the other hand, in case of asynchronous communication, different health care professionals, nurse and health and social care staffs can communicate to one another at different time. In case of Jenny, nurses and doctors use synchronous communication that involves the video conferencing with senior health professional regarding Jenny’s current health condition, official conversation between nurses and doctors and ward rounding (Verma et al. 2019). Asynchronous communication that are performed in case Jenny are formatting drug chart, providing written report on currented glucose level, ketones bodies and glomerular filtration rate of Jenny to doctors (Jehan et al. 2018). Another important ADL that is used by the nurses in case of Jenny is eating and drinking, in this context nurses analyse the regular eating habits, food choices, dietary routines and lifestyle of Jeny that she used to follow in ger daily life before admitting into the hospitals. As Jenny uses to lead a highly irregular dietary routine and unhealthy food habit, she needs modification in her eating and drinking pattern. Here nursing professionals must take Jenny to the nutritionist to guide her about the prescribed dietary routines that she needs to follow throughout her life. Through following prescribed of dietary routine and healthy lifestyle, it is possible to manage type 2 diabetes (Pan et al. 2018). In case of Jenny’s nurses must ensure that she is provided with the prescribed food every day with prescribed quantity of water and other fluids. Jenny must be provided with such a diet that will have low amount of carbohydrates and fats and high amount of protein. Nurses must check the blood sugar level before and after the meal, to determine whether prescribed dietary routines are useful for Jenny to improve her diabetic condition.

In Jenny’s case, nurses have used MUST (Malnutrition, Universal Screening Tool) to detect whether Jenny is at the risk of the malnutrition. MUST tool involves five steps process in terms of detecting three different biological parameters such as Body mass index (BMI), weight loss in the last six month and acute illness effect (Pan et al. 2018). The higher the score of MUST the more the patients would be at the risks of malnutrition. In case of Jenny her MUST score is 3 which shows that she is under the moderate risk of malnutrition. The assessment of her BMI, weight loss and the impacts of acute illness show that she has a BMI which is higher than the normal BMI rate for her, severe weight loss of 10 kg in last two weeks and adverse heath implication of type 2 diabetes on her physical and psychological wellbeing (Jehan et al. 2018). Based on this health assessment by using MUST, dietician prescribes that Jenny needs to follow an irregular and healthy nutritional regimen that to have a healthy weight and good physical as well as psychological health condition (Tumminia et al. 2018). Based on the MUST score for Jenny, the health professionals suggest her to follow clinical regimen in which she needs to take regular medicines, take timely food that are prescribed by the dietician, and do regular exercise as recommended by the physiotherapist. An fluid balance chart is used by nurses to promote the sufficient intake of fluid into Jenny’s body to maintain a healthy balance of intracellular fluid. Additionally, the stool chart is also used by nurses to check the bowel movement of Jenny.

Different clinical interventions have been used by nurses in case of Jenny to improve her ability to perform the activities of daily living. one of this intervention is the SALT (Speech and Language Therapy) therapy (Tumminia et al. 2018). Involvement of dietician is another important intervention to improve the dietary routines of Jenny. Through using SALT, nurses are able to improve ability of Jenny to make clear interaction with nurses thereby sharing her pain, health issues and health needs (Mazidi et al. 2017). through involving dietician, care professionals are able to provide proper guidance to Jenny on what types foods she needs to take on regular wise, how much fluid she needs to intake and what food she must avoid to maintain normal glucose level.

Another important nursing intervention is the involvement of physiotherapist which provides the necessary guidance to Jenny regarding the exercise that she needs to perform on regular wise. as mentioned by Mazidi et al. (2017), regular exercise is important for body to improve the activates of the internal organs. In case of Jenny, physiotherapist must advise to her regarding the type of movement she needs to perform on regular wise which will improve the hormonal production and hormone-utilisation insides the body by improving blood circulation which can reduce the chances of type 2 diabetes.

While it comes to conduct an effectives management type 2 diabetes, care professionals must follow the relevant guidelines for implementing effectives as well as realistic care plan, in case of Jenny, nurses follow the guidelines of National Services Framework (NSF) and Chronic Care Model (CCM) in terms of improving the quality of the entire care delivery (Oguntibeju, 2019). Under NSF, nurses ensure that effective and transparent communication have been maintained with Jenny to detect her psychical, emotional, psychological and social needs. Under NSF nurse must respect the autonomy, dignity and preferences of Jenny throughout the care delivery (Jehan et al. 2018). Under that CCM, nurses and doctors must use the relevant assessment and treatment process based of the current health condition Jenny that are highly relevant to meet her holistic needs.

After implementation of the nursing intervention and care plan in case of Jenny, a follow up has been done by care professionals to check that usefulness and drawbacks of these interventions (Pan et al. 2018). Thet follow up shows that, that nursing interventions that are used are highly useful in case Jenny in improving her physical and psychological health condition thereby improving her abilities to perform the activities of daily living. additionally, the SALT process and the involvement of dietician and physiotherapist assist Jenny to develop a strong self-management skill in her that assists her to have good control on her own health and wellbeing. on the others hand, the effectives change in the dietary routine and lifestyle assist Jenny to have a normal blood sugar level, proper weight and normal BMI (Furtado et al. 2019). The risk associated with the intervention and care plan is negligence of Jenny in following the prescribed medical regime and further leading an unhealthy lifestyle can interfere with the positive health outcomes of above-mentioned clinical intervention.

From the above-mentioned discussion, it can be concluded that, type 2 diabetes is the chronic illness in which body develops a peripheral insulin resistance system which pose r=barriers on proper utilisation of insulin. due to the inability of body to proper utilisation of insulin there is an increase in the blood glucose level. while manging the type 2 diabetes, care professional must use best suited assessment tool based on the curate health condition of the patients. Roper-Logan-Tierny model is widely used assessment model that care professional use to detect the physical and the psychological health condition of patient. After effective assessment of the patients with type 2 diabetes, care professionals need to develop an effective care plan that would be best suited to the health condition of patients thereby assisting care professionals to meet the health needs of patients. effective nursing interventions are important for care professional to implement into care plan to improve the quality of living of the patients by improving their ability to perform the activities of daily living, care professionals must conduct the follow up of the care plan and intervention to check whether their treatment process are effective for managing type diabetes in patients

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