Risk Factors for Mr. James Storey
James has a poor diet which is majorly comprised of excessive carbohydrates, bear, and smoking. Diet is one of the main causes of James illness. Evidence shows that diet plays a significant contribution in diabetes and increased BMI (Manson et al., 2011). Higher consumption of carbohydrates and alcohol based products enhance the dangers of type 2 diabetes. An examination conducted among smokers found out that they are 45% more prone to the disease than people who do not smoke (Willi et al., 2007). Smoking leads to increased weight and causes hormonal imbalance, leading to abdominal obesity (Shimokata et al., 2009). Additionally, his sedentary behavior has increased. He has become less physically active and he closed his business and has nothing to do. He does not participate in community organizations and he is getting more and more tired. Lack of physical activity increases energy stored in the body as a result of food intake (Ainsworth, et al., 1993). Lastly, James’ family has a history of type 2 diabetes. Diabetes can be inherited in the family has a history of the disease. According to Debra (2018), if a parent had the disease, there is a possibly of the child getting it through gene mutation. Weight gain and high blood sugar may have resulted from gene mutation.
Nursing assessments to be conducted for Mr. James Storey
Health history of the patient
The care provider should seek to understand the health history such as any diseases, surgeries, or family history of diabetes type 2. Additionally, characteristics such as obesity, lifestyle, and diet will be evaluated to determine the risk factors. Also, the nurse will evaluate how James is complying plus coping with his health condition and whether he takes his glucose levels tests as required to monitor his condition. Assessment of the patient’s history enables the nurse to identify the underlying causes of the patient’s condition (Alfadda, 2006).
Physical Examination
The nurse will examine and record James’ physical characteristics such as weight, BMI, and height. His abdominal circumference will be measured to enable the nurse determine if he is obese or not. Inspecting the injection sites is imperative to establish evidence of lipoatrophy plus lipodystrophy. Cardiovascular examinations such as pulse rate and blood pressure to determine his blood flow to the feet and hands which tend to swell regularly. Examination of the legs, ankles, and feet is significant to determine if the patient has diabetic amyotrophy and peripheral neropathy (Downis, 2015).
Urinalysis and blood tests
Blood tests will measure the amount of glucose in the blood while urinalysis will examine substances such as protein, ketones, and nitrates to determine if the patient has any infections (Downis, 2015).
Self-management priorities that would be developed in collaboration with Mr. James Storey
Motivational Interviewing
The approach will facilitate behavioral change by assisting James to examine and determine his attitude towards behavioral change. The aim of the approach is to explore the ways James can change his behavior and improve his motivation to increase physical activities to lose weight. For the approach to be successful, the nurse must identify the patient’s ambivalence to adopt positive change and help the patient to analyze and change it to set his mind in motivation state. Motivational interviewing has proved to improve behavioral characteristics related to diet, weight loss, and positive outlook towards life (Chen et al., 2012).
Coaching
The intervention involves grouping James with other patients with the same condition to establish connections through activities such as trainings and sharing personal journey and experiences. The aim of the intervention is to engage, motivate, and help the patients embrace self-management activities to improve their health conditions (Thom et al., 2013).
Problem Solving Therapy
The approach will enable James to cultivate for positive emotional impulses and eliminate negative feelings and emotional reactions. The nurse will teach James to solve problems in life step by step by identifying, defining, understanding, and setting goals to a given problem. As a result, the patient will solve multiple problems like stress management and disorders related to their condition (Sutherland et al., 2011).
Identification and description of one goal that will be set in collaboration with the patient
| Specific | I will establish a coaching group for my diabetes type 2 patients, including James. The patients will share their experiences and feelings towards their condition. I will guide them of various activities they can participate in to improve personal self-management in a group, and from the activities, they will chose the ones they prefer. Every patient will state what they wish to achieve, for instance, how many kilograms they wish to have lost by the end of the program. |
| Measurable | The goals will be achieved by having a tangible weight loss and positive outlook of life and their health conditions. At the end of the coaching program, the patients will celebrate their milestone through a party in one of the patient’s residence. |
| Achievable | To achieve the goal, a personal trainer, a dietician, and psychologist will be involved to provide a holistic self-management approach. The patient’s family will provide support by ensuring that patient attends to all activities of the program. |
| Realistic | At the end of the program, every patient will have lost 5 kilograms and adopting health diet behavior to keep them motivated that self-management is possible. |
| Time framed | The program will take three months. |
How goal setting may impact on actively engaging patients in their care
Goal setting enables patients to personalize their healing journey. In healing or managing a health condition, patients lack positive momentum, but with help, they can remain focused and take it as their personal responsibility. Goal setting enhances positive motivation when a patient pauses or takes a break from active engagement to resume and work towards achieving their goals. Additionally, it helps in lessening the impacts of their illness. When goals are set, patients put effort to minimize the impacts of their illness. Research found out that program with well designed goals compels patients to actively participate to empower themselves (Saunder et al., 2013).
Consequently, goal setting motivates patients in participating by feeling the need to share their story. When patients share their experience, they relieve the burden of their illness by realizing that there are others who have the same challenge and striving to live a positive life. As a result, they actively engage to explore what can work for them to accomplish a comfortable life. In active engagement programs, patients adopt personalized activities which complement their medication to stay strong and healthier.
References
Ainsworth, B. et al. (1993). Compendium of physical activities: classification of energy costs of human physical activities. Medical Science Sports Exercise, 25(1): 71-80
Alfadda, A. (2006). Assessment of Care for Type 2 Diabetic Patients at the Primary Care Clinics of a Referral Hospital. Journal of Family & Community Medicine, 13(1): 13-18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410072/
Chen, S. et al. (2012). Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. International Journal Nursing Studies, 49: 637-644
Debra, S. (2018). Is Type 2 Diabetes Caused by Genetics? Healthline. Retrieved from https://www.healthline.com/health/type-2-diabetes/genetics
Downis, S. (2015). Type 2 Diabetes: Prevention, diagnosis, and management. Nursing Times, 111(10): 14-15. Retrieved from https://www.nursingtimes.net/clinical-archive/diabetes-clinical-archive/type-2-diabetes-prevention-diagnosis-and-management-02-03-2015/
Manson, J. et al. (2011). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345(11): 790-7.
Shimokata, H. et al. (2009). Studies in the distribution of body fat. III. Effects of cigarette smoking. JAMA, 261(8): 1169-73.
Saunder, R. et al., (2013). Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. National Academic Press.
Sutherland, J. et al. (2011). Evidence-based behavioral treatments for diabetes: problem-solving therapy. Diabetes Spectrum, 24(2): 64-69. Retrieved from https://doi.org/10.2337/diaspect.24.2.64
Thom, D. et al. (2013). Peer coaching to improve diabetes self-management: which patients benefit most? Journal of General International Medicine, 28(7): 938-942.
Willi, C. et al (2007). Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA, 298(222): 2654-64.