Diabetes On Family
Impact of Diabetes on a Family
Nursing 231
Impact of Diabetes on a Family
Descriptive Assessment
Family
L.P. is a 59 year old Asian female in the generativity versus stagnation stage of development. This is defined as the stage with a focus on “supporting future generations” and “community involvement” (Potter and Perry, 2009, p. 140). Generativity is evidenced by her willingness to babysit her granddaughter. There is also stagnation as evidenced by her lack of participation within the community and reluctance to leave the house. This can impact her outcome negatively since she does not willingly participate in her own care. She does not leave the house to attend doctor’s appointments or health promotion events unless …show more content…
prodded her family.
The patient suffered a Coronary Vascular Attack (CVA) in 2009 which left her deaf in the right ear. While hospitalized, she was diagnosed with type 2 diabetes, hypertension and hyperlipidemia. The subject is blind in the left eye due to a previous injury and has diabetic retinopathy. She is unable to work due to her condition and spends most of her time at home. She is able to accomplish all of her activities of daily living (ADL) such as cooking, cleaning and self care without complications.
While the family as a whole is aware of the subject’s medical condition, a majority of the family does not participate in her care. The youngest daughter, C.P., acts as her primary caregivers. She keeps the family up to date on the progression of her condition. She also tries her best to educated and motivate subject but most of her attempts have been proven unsuccessful. The family expects her condition to worsen due to her lack of adherence to the recommended plan of care.
Her situation is further complicated by the fact that she is a non English speaking immigrant. This makes it difficult for her to understand the information presented to her by healthcare professionals. It is also difficult for her to accept advice from her own children since she believes that since she is older she is wiser than her children.
This aim of this paper is to explore the effects of a chronic illness on a family. It will also look into the role of the family in the care of a chronically ill patient and the challenges which the family caregiver may face. This will be accomplished by reviewing current literature regarding these issues.
Epidemiology
Smeltzer, Bare, Hinkle and Cheever (2010, p. 1199) describes type 2 diabetes as a disease in which the body develops and insulin resistance and is also secreting inadequate amounts of insulin. This leads to increase levels of glucose within the blood. The increase in blood glucose can lead to many complications including retinopathy, neuropathy and slow wound healing. They also state that it is not uncommon for the disease to go undiagnosed only to be discovered as the result of the patient being admitted for another procedure.
Management of Care
Dynamics
She and her husband, H.P., split their time living in two separate homes. She stays at C.P.’s home most of the week and spends the rest staying at her oldest daughter’s, R.P, home. The only son is in the military so he does not actively participate in her care nor does the second oldest daughter since she lives far away from the rest of the family.
The family considers each other to be very close and communicates regularly via text message and phone conversations. Communication between the subject and her children pose a challenge due to language barriers. The children, with the exception of the eldest daughter, do not speak their native language and the subject has limited English proficiency. There are dyads within the family who see each other more often the rest of the family. The youngest and eldest daughters, who are the caregivers, form one of the dyads. The other dyad consists of the only son and middle daughter. When it comes to the matter of caring for the subject, a majority of the family is disengaged. It is rare for the family to act as a cohesive unit, even when matters relating the wellbeing of the subject are concerned. Most, if not all, of the medical decisions are made by the youngest daughter.
There is triangulation occurring between L.P., her husband and the youngest daughter. L.P lives and a sedentary life and does not have healthy eating habits as evidenced by her affinity for salty snacks and candy. Whenever the daughter tries to explain to her about the risks associated with her habits, L.P. turns to her husband who enables her bad habits by providing the snacks.
Impact
L.P. does not have any source of income and is currently enrolled in Medicaid. Any extra health expenses incurred are paid by her youngest daughter and son-in-law. The youngest daughter has expressed that she taking care of her mother can quite frustrating due to the language barrier and L.P.’s lack of compliance. I have noticed that L.P. is not well informed when it comes to her own health; she deferred most of the health questions to her youngest daughter.
The youngest daughter has stated that she feels responsible for her mother and sometimes feels as though this is holding her back from pursuing her own interests. Other than the C.P. and R.A., the rest of the family seems to lack knowledge related to L.P.’s condition. This lack of knowledge can lead to family to downplay the severity of consequences related to mismanagement of the disease.
Tool
C.P. was screened using “The Preparedness for Caregiving Scale”. This tool is an eight question survey which the caregiver rates their level of preparedness on a scale of 0 to 4 in a variety of categories (Zwicker, 2010). The mean of the scores is used to determine the caregiver’s readiness with 0 being the lowest and 4 being the highest. The mean of C.P.’s score was 1.38. The score shows that she believes that she is not well prepared to administer care for her mother. She rates herself as somewhat prepared on emotional needs, scheduling, and overall preparedness. She was not too prepared in the areas of physical needs, stress, information gathering. She states that she wants to “learn how to communicate and educate in a compassionate and entertaining manner” and to “enforced best practice in maintaining a healthy lifestyle” (C.P., personal communication, October, 15, 2012)
Genogram
It was not possible to obtain a genogram which extended back two generations. This is due to that fact that most of the government’s documents in Cambodia were destroyed by Khmer rouge, a radical communist regime. The information I was able to gather was only anecdotal. L.P.’s father was killed by the Khmer rouge in 1974 at the age of 46. L.P. lost contact with her mother around the same time. This was quite common due to the nature of the war. To the best of her knowledge, L.P. states that both of her parents were free of any chronic illnesses. Her husband, aged 62, suffers from HTN. Her children do not currently suffer from any known chronic illnesses. See appendix A.
Evolving Knowledge
Literature Review
There are many strategies which can be taken to improve the patient outcomes in chronic illness. Integrating the family into the care of the patient can lead to more positive outcomes. According to Coffman (2008), she states that “family members were a preferred source of support” due the fact that they had “a vested interest” in the patient. It would also be helpful for the patient to have a family member present during doctor’s appointments to “provide an extra set of ears” (Osborn,Cavanaugh, and Kripalani 2010). If the family does get involved with the patient’s care, there is always the possibility for increased stress and role strain. Newell, Allore, Dowd, Netinho, and Asselin (2012) states that, the experience can “be extremely demanding and stressful”.
In L.P.’s situation, cultural and language barriers can have a negative impact. According to Stiles (2011), minorities generally have “reduced levels of health literacy”. Herman and Wills (2011) also make the point that, language barriers can make it difficult for the patient to obtain quality health care. Therefore, it is important to offer the patient and her family relevant health information but it must also be presented in a simple manner.
Priority Problem
The family has knowledge deficit regarding the disease process, treatments, and signs and symptoms of diabetic complications. This is evident by the family’s lack of participation in her care. They are unfamiliar with the signs and symptoms of hypoglycemia and hyperglycemia. The father allows and sometimes encourages the subject to eat foods which go against her prescribed diet.
Interventions
The nurse will educate the family about the diabetes using materials which are easy to understand. This will include materials such as visuals aids and brochures with written in a simple easy to understand manner. Osborn, Cavanaugh and Kripalani (2010) recommend the use of materials which are written in a simple manner. Including the family in the teaching is also very important. Stiles (2011) states that, “Relatives or carers often play an important role in the management of the patient’s diabetes. The nurse will refer the patient and her spouse to the Penn Asian Senior Services Inc. (PASSi) to obtain in home health services by a health professional who speaks their native language. According the Heerman and Wills (2011), “limited English proficiency is another major barrier to high-quality health care” and that even though family members are readily available to act as translators there are many issues that can arise such as “omission of pertinent information, and unfamiliarity with medical terms”. By referring L.P. and her family to this organization, they can obtain low cost nursing care from an individual who can explain things in their native language. This can help to improve the family’s overall health literacy and improve the patient’s potential outcome.
Evaluation
Achievability/Barriers
Simple, culturally relevant health information is readily available through many community based Asian organizations.
The main barrier for this intervention would be gathering the family for teaching. It is difficult to organize the family as a single unit so multiple teaching sessions will have to be done to ensure the entire family is well informed. Teach backs to determine the effectiveness of teaching may also be difficult due to language issues.
While referring the subject to PASSi will be simple to do, the issue will lie within the cost. Even though the organization offers low cost home nursing, L.P. has no source of income and this financial burden will fall on C.P. That is unless the family shares the cost of this service. This will require some communication on each family member’s part to ensure that the cost is evenly shared. Risk/Benefit The risks are that the teachings will go unheeded and L.P will continue mismanaging her illness. Judging from past experiences, this seems a very real possibility. Since the entire family will be given this information, it may increase L.P.’s compliance. With more than one informed family member watching her, it will be easier for family members to recognize unhealthy behaviors and …show more content…
intervene. Home nursing services hold a financial risk. If the financial aspect cannot be sorted, the burden may fall on a single person or in the worst case scenario the services will be too expensive for the family. The benefits of this service is that it offers the patient a chance to speak with a health professional who can explain her medical condition in a language which she can understand. This may increase health literacy and may also increase self-efficacy.
References
Brunner, L.
S., Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and suddarth 's textbook of medical-surgical nursing. (12 ed., Vol. 1). Hubsta Ltd.
Chandra, Y. O., Cavanaugh, K., & Kripalani, S. (2010). Strategies to address low health literacy and numeracy in diabetes. Clinical Diabetes, 28(4), 171-175. Retrieved from http://search.proquest.com/docview/817780796?accountid=9969
Coffman, Maren J,PhD., R.N. (2008). Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing, 34(4), 32-9. Retrieved from http://search.proquest.com/docview/204153122?accountid=9969
Newell, R. A., Allore, S. M., Dowd, O. P., Netinho, S., & Asselin, M. E. (2012). Stress among caregivers of chronically ill older adults: Implications for nursing practice. Journal of Gerontological Nursing, 38(9), 18-29; quiz 30-1. doi: http://dx.doi.org/10.3928/00989134-20120807-06
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing. (7th ed.). St. Louis, MO: Mosby Elsevier.
Stiles, E. (2011). Promoting health literacy in patients with diabetes. Nursing Standard, 26(8), 35-40. Retrieved from
http://search.proquest.com/docview/902801597?accountid=9969
William, J. H., & Morgan, J. W. (2011). Adapting models of chronic care to provide effective diabetes care for refugees. Clinical Diabetes, 29(3), 90-95. Retrieved from http://search.proquest.com/docview/888059786?accountid=9969
Zwicker, D. (2010). Preparedness for caregiving scale. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_28.pdf
Nursing 231
Impact of Diabetes on a Family
Descriptive Assessment
Family
L.P. is a 59 year old Asian female in the generativity versus stagnation stage of development. This is defined as the stage with a focus on “supporting future generations” and “community involvement” (Potter and Perry, 2009, p. 140). Generativity is evidenced by her willingness to babysit her granddaughter. There is also stagnation as evidenced by her lack of participation within the community and reluctance to leave the house. This can impact her outcome negatively since she does not willingly participate in her own care. She does not leave the house to attend doctor’s appointments or health promotion events unless …show more content…
prodded her family.
The patient suffered a Coronary Vascular Attack (CVA) in 2009 which left her deaf in the right ear. While hospitalized, she was diagnosed with type 2 diabetes, hypertension and hyperlipidemia. The subject is blind in the left eye due to a previous injury and has diabetic retinopathy. She is unable to work due to her condition and spends most of her time at home. She is able to accomplish all of her activities of daily living (ADL) such as cooking, cleaning and self care without complications.
While the family as a whole is aware of the subject’s medical condition, a majority of the family does not participate in her care. The youngest daughter, C.P., acts as her primary caregivers. She keeps the family up to date on the progression of her condition. She also tries her best to educated and motivate subject but most of her attempts have been proven unsuccessful. The family expects her condition to worsen due to her lack of adherence to the recommended plan of care.
Her situation is further complicated by the fact that she is a non English speaking immigrant. This makes it difficult for her to understand the information presented to her by healthcare professionals. It is also difficult for her to accept advice from her own children since she believes that since she is older she is wiser than her children.
This aim of this paper is to explore the effects of a chronic illness on a family. It will also look into the role of the family in the care of a chronically ill patient and the challenges which the family caregiver may face. This will be accomplished by reviewing current literature regarding these issues.
Epidemiology
Smeltzer, Bare, Hinkle and Cheever (2010, p. 1199) describes type 2 diabetes as a disease in which the body develops and insulin resistance and is also secreting inadequate amounts of insulin. This leads to increase levels of glucose within the blood. The increase in blood glucose can lead to many complications including retinopathy, neuropathy and slow wound healing. They also state that it is not uncommon for the disease to go undiagnosed only to be discovered as the result of the patient being admitted for another procedure.
Management of Care
Dynamics
She and her husband, H.P., split their time living in two separate homes. She stays at C.P.’s home most of the week and spends the rest staying at her oldest daughter’s, R.P, home. The only son is in the military so he does not actively participate in her care nor does the second oldest daughter since she lives far away from the rest of the family.
The family considers each other to be very close and communicates regularly via text message and phone conversations. Communication between the subject and her children pose a challenge due to language barriers. The children, with the exception of the eldest daughter, do not speak their native language and the subject has limited English proficiency. There are dyads within the family who see each other more often the rest of the family. The youngest and eldest daughters, who are the caregivers, form one of the dyads. The other dyad consists of the only son and middle daughter. When it comes to the matter of caring for the subject, a majority of the family is disengaged. It is rare for the family to act as a cohesive unit, even when matters relating the wellbeing of the subject are concerned. Most, if not all, of the medical decisions are made by the youngest daughter.
There is triangulation occurring between L.P., her husband and the youngest daughter. L.P lives and a sedentary life and does not have healthy eating habits as evidenced by her affinity for salty snacks and candy. Whenever the daughter tries to explain to her about the risks associated with her habits, L.P. turns to her husband who enables her bad habits by providing the snacks.
Impact
L.P. does not have any source of income and is currently enrolled in Medicaid. Any extra health expenses incurred are paid by her youngest daughter and son-in-law. The youngest daughter has expressed that she taking care of her mother can quite frustrating due to the language barrier and L.P.’s lack of compliance. I have noticed that L.P. is not well informed when it comes to her own health; she deferred most of the health questions to her youngest daughter.
The youngest daughter has stated that she feels responsible for her mother and sometimes feels as though this is holding her back from pursuing her own interests. Other than the C.P. and R.A., the rest of the family seems to lack knowledge related to L.P.’s condition. This lack of knowledge can lead to family to downplay the severity of consequences related to mismanagement of the disease.
Tool
C.P. was screened using “The Preparedness for Caregiving Scale”. This tool is an eight question survey which the caregiver rates their level of preparedness on a scale of 0 to 4 in a variety of categories (Zwicker, 2010). The mean of the scores is used to determine the caregiver’s readiness with 0 being the lowest and 4 being the highest. The mean of C.P.’s score was 1.38. The score shows that she believes that she is not well prepared to administer care for her mother. She rates herself as somewhat prepared on emotional needs, scheduling, and overall preparedness. She was not too prepared in the areas of physical needs, stress, information gathering. She states that she wants to “learn how to communicate and educate in a compassionate and entertaining manner” and to “enforced best practice in maintaining a healthy lifestyle” (C.P., personal communication, October, 15, 2012)
Genogram
It was not possible to obtain a genogram which extended back two generations. This is due to that fact that most of the government’s documents in Cambodia were destroyed by Khmer rouge, a radical communist regime. The information I was able to gather was only anecdotal. L.P.’s father was killed by the Khmer rouge in 1974 at the age of 46. L.P. lost contact with her mother around the same time. This was quite common due to the nature of the war. To the best of her knowledge, L.P. states that both of her parents were free of any chronic illnesses. Her husband, aged 62, suffers from HTN. Her children do not currently suffer from any known chronic illnesses. See appendix A.
Evolving Knowledge
Literature Review
There are many strategies which can be taken to improve the patient outcomes in chronic illness. Integrating the family into the care of the patient can lead to more positive outcomes. According to Coffman (2008), she states that “family members were a preferred source of support” due the fact that they had “a vested interest” in the patient. It would also be helpful for the patient to have a family member present during doctor’s appointments to “provide an extra set of ears” (Osborn,Cavanaugh, and Kripalani 2010). If the family does get involved with the patient’s care, there is always the possibility for increased stress and role strain. Newell, Allore, Dowd, Netinho, and Asselin (2012) states that, the experience can “be extremely demanding and stressful”.
In L.P.’s situation, cultural and language barriers can have a negative impact. According to Stiles (2011), minorities generally have “reduced levels of health literacy”. Herman and Wills (2011) also make the point that, language barriers can make it difficult for the patient to obtain quality health care. Therefore, it is important to offer the patient and her family relevant health information but it must also be presented in a simple manner.
Priority Problem
The family has knowledge deficit regarding the disease process, treatments, and signs and symptoms of diabetic complications. This is evident by the family’s lack of participation in her care. They are unfamiliar with the signs and symptoms of hypoglycemia and hyperglycemia. The father allows and sometimes encourages the subject to eat foods which go against her prescribed diet.
Interventions
The nurse will educate the family about the diabetes using materials which are easy to understand. This will include materials such as visuals aids and brochures with written in a simple easy to understand manner. Osborn, Cavanaugh and Kripalani (2010) recommend the use of materials which are written in a simple manner. Including the family in the teaching is also very important. Stiles (2011) states that, “Relatives or carers often play an important role in the management of the patient’s diabetes. The nurse will refer the patient and her spouse to the Penn Asian Senior Services Inc. (PASSi) to obtain in home health services by a health professional who speaks their native language. According the Heerman and Wills (2011), “limited English proficiency is another major barrier to high-quality health care” and that even though family members are readily available to act as translators there are many issues that can arise such as “omission of pertinent information, and unfamiliarity with medical terms”. By referring L.P. and her family to this organization, they can obtain low cost nursing care from an individual who can explain things in their native language. This can help to improve the family’s overall health literacy and improve the patient’s potential outcome.
Evaluation
Achievability/Barriers
Simple, culturally relevant health information is readily available through many community based Asian organizations.
The main barrier for this intervention would be gathering the family for teaching. It is difficult to organize the family as a single unit so multiple teaching sessions will have to be done to ensure the entire family is well informed. Teach backs to determine the effectiveness of teaching may also be difficult due to language issues.
While referring the subject to PASSi will be simple to do, the issue will lie within the cost. Even though the organization offers low cost home nursing, L.P. has no source of income and this financial burden will fall on C.P. That is unless the family shares the cost of this service. This will require some communication on each family member’s part to ensure that the cost is evenly shared. Risk/Benefit The risks are that the teachings will go unheeded and L.P will continue mismanaging her illness. Judging from past experiences, this seems a very real possibility. Since the entire family will be given this information, it may increase L.P.’s compliance. With more than one informed family member watching her, it will be easier for family members to recognize unhealthy behaviors and …show more content…
intervene. Home nursing services hold a financial risk. If the financial aspect cannot be sorted, the burden may fall on a single person or in the worst case scenario the services will be too expensive for the family. The benefits of this service is that it offers the patient a chance to speak with a health professional who can explain her medical condition in a language which she can understand. This may increase health literacy and may also increase self-efficacy.
References
Brunner, L.
S., Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and suddarth 's textbook of medical-surgical nursing. (12 ed., Vol. 1). Hubsta Ltd.
Chandra, Y. O., Cavanaugh, K., & Kripalani, S. (2010). Strategies to address low health literacy and numeracy in diabetes. Clinical Diabetes, 28(4), 171-175. Retrieved from http://search.proquest.com/docview/817780796?accountid=9969
Coffman, Maren J,PhD., R.N. (2008). Effects of tangible social support and depression on diabetes self-efficacy. Journal of Gerontological Nursing, 34(4), 32-9. Retrieved from http://search.proquest.com/docview/204153122?accountid=9969
Newell, R. A., Allore, S. M., Dowd, O. P., Netinho, S., & Asselin, M. E. (2012). Stress among caregivers of chronically ill older adults: Implications for nursing practice. Journal of Gerontological Nursing, 38(9), 18-29; quiz 30-1. doi: http://dx.doi.org/10.3928/00989134-20120807-06
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing. (7th ed.). St. Louis, MO: Mosby Elsevier.
Stiles, E. (2011). Promoting health literacy in patients with diabetes. Nursing Standard, 26(8), 35-40. Retrieved from
http://search.proquest.com/docview/902801597?accountid=9969
William, J. H., & Morgan, J. W. (2011). Adapting models of chronic care to provide effective diabetes care for refugees. Clinical Diabetes, 29(3), 90-95. Retrieved from http://search.proquest.com/docview/888059786?accountid=9969
Zwicker, D. (2010). Preparedness for caregiving scale. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_28.pdf