A case study of a patient diagnosed with type 2 diabetes

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While at district nursing, I encountered an event where I was to attend to a patient diagnosed with Type 2 diabetes 14 years prior and had developed several complications including high level body swelling, multiple chronic wounds.. Before discharge for home care, the patient refused a proposed dressing procedure which included two debridement before being placed in the VAC. My mentor Nurse K asked me to change the dressing on the wound during a home visit.

In the interest of giving the best care to my client as required by the medical professionalism, I decided to use another therapy since the previous treatment did not work well (Jasper 2001). As medical professional, I suggested the medical intervention as it had the best interest of my patient (NHS UK 2018).Since I worked under close supervision, I consulted with my mentor nurse and other physicians to determine suitability of the method (Papathanassoglou 2012). Inter- professional team work in health care promotes social care (Reeves, 2011). In addition, team-work analysis has indicated that it promotes quality care in nursing (Van Bogaert, 2013).  Lack of team work has been considered as a barrier to long-term home care (McGilton, 2016).

However the patient vehemently refused the new treatment method and also taking the painkillers to lessen the pain which undermined the physical discomfort of the patient (Delaney 2017). I had to involve the family members who contributed to the patience perception about the new method as the intervention contributes to patient-centred care (Delaney 2017). To promote the patients’ autonomy, I provided the patient a room to express his views about his condition and the proposed new intervention (SJU 2018). I had to first value the patient’s unique choices and values since they are important in the overall patient care (Oakley 2018).

To provide room for effective interaction and intervention, I maintained a positive attitude and initiated a friendly communication (Ghadiriran 2014).  As my professional responsibility, I provided counselling to the patient on the need for a better treatment approach to manage his worsening situation.  I also explained to him the benefits and side effects of the new intervention (Grace and DRN 2017). In addition, I consulted with my mentor and supervisor and collaborated with the patient to come up with an informed and sustainable solution (Fredericks, Lapum, and Hui 2015). After the collaboration and intervention, the patient accepted the dressing. Lastly, would care requires more than just wound dressing. For instance, efficient patient safety strategies must be in place (Sood 2014). I therefore offered nutrition therapy and counselling to integrate the treatment (Evert 2014).



Evert, A.B., Boucher, J.L., Cypress, M., Dunbar, S.A., Franz, M.J., Mayer-Davis, E.J., Neumiller, J.J., Nwankwo, R., Verdi, C.L., Urbanski, P. and Yancy, W.S., 2014. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), pp.S120-S143.

Delaney, L. (2017). Patient-centred care as an approach to improving health care in Australia. The Australian Journal of Nursing Practice Scholarship and Research, vol. 25, no. 1, pp. 119–123.

Fredericks, S. L. (2015). Examining the effect of patient-centred care on outcomes. British Journal of Nursing, vol. 24, no. 7, pp. 394-400.

Ghadiriran, F. S. (2014). Nursing professionalism: An evolutionary concept analysis. Iranian Journal of Nursing and Midwifery Research, vol. 19, no. 1, pp. 1-10.

Grace, P.J. and DRN, P. eds., 2017. Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning

Jasper, M. R. (2001). Reflective Model.

McGilton, K.S., Bowers, B.J., Heath, H., Shannon, K., Dellefield, M.E., Prentice, D., Siegel, E.O., Meyer, J., Chu, C.H., Ploeg, J. and Boscart, V.M., 2016. Recommendations from the international consortium on professional nursing practice in long-term care homes. Journal of the American Medical Directors Association, 17(2), pp.99-103.

NHS UK. (2018). Principles and values that guide the NHS. Retrieved 2018, from NHS UK: https://www.nhs.uk/using-the-nhs/about-the-nhs/principles-and-values/

Oakley, C. R. (2018). Holistic patient-centred care. British Journal of Nursing, vol. 27, no. 4, pp. S3-S4.

Papathanassoglou, E.D., Karanikola, M.N., Kalafati, M., Giannakopoulou, M., Lemonidou, C. and Albarran, J.W., 2012. Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses. American Journal of Critical Care, 21(2), pp.e41-e52.

Reeves, S., Lewin, S., Espin, S. and Zwarenstein, M., 2011. Interprofessional teamwork for health and social care (Vol. 8). John Wiley & Sons.

SJU. (2018). How the Four Principles of Health Care Ethics Improve Patient Care. Retrieved 2018, from Saint Joseph University: https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of-health-care-ethics-improve-patient-care

Sood, A. G. (2014). Wound Dressings and Comparative Effectiveness Data. Advances in Wound Care, vol. 3, no. 8, pp. 511-529.

Steven, J. (2016). Reflective learning, reflective practice. Nursing 2018, vol. 46, no. 5, pp. 62-64.

Van Bogaert, P., Wouters, K., Willems, R., Mondelaers, M. and Clarke, S., 2013. Work engagement supports nurse workforce stability and quality of care: nursing team‐level analysis in psychiatric hospitals. Journal of Psychiatric and Mental Health Nursing, 20(8), pp.679-686.

October 13, 2023

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