Dm_Type_2_Case_Study

A Case Study on a Female Client with Diabetes Mellitus Type – 2 NURS11153 (Health and Behaviour) Term 3 – 2010 COORDINATOR: MS. Loretto Quinney STUDENT: Jennifer Manzo, S0194234 WORD COUNT: 2,726 Abstract Type 2 diabetes mellitus has become a highly prevalent threat to human beings, mainly caused by having inactive lifestyle habits and increasing obesity. With this case study the attempt is to understand how physical and emotional ignorance becomes a risk factor for developing this disease. This paper is investigating a case of a migrant Filipino lady in Australia, known as Karla, who has Type 2 Diabetes Mellitus which she acquired when she moved to Australia. The client’s lifestyle, environment, cultural constraints and the strategies to cope with this disorder have been studied to understand the role of developing and managing Type 2 Diabetes Mellitus. Along with the presence of diabetes in Karla’s family history, the client has been surrounded by many major risk factors for developing diabetes. Though indirectly, these risk factors such as inaccessible health services, ignorance of body over cultural norms and lack of awareness prove to be a great hindrance in coping with the disease. Troubled emotions, however, which are not given much acknowledgement, play a great role in developing and managing diabetes. Therefore, strategies which can actively reach the belief system of different cultures and spread the awareness of latest advancements to deal with the disease are required. Table of Contents Introduction 1 Case Study 2 Personal, social and health information 2 Health perception and client health belief model 3 Impact of social influences 5 Pain management 6 Decision making criteria 6 Suggestion for health promotion activity 8 Conclusion 8 Reference 10 Introduction A recent WHO report (Diabetes Australia 2011) revealed diabetes has roughly affected 246 million people worldwide, with more than one million sufferers within Australia, however, approximately 60 percent of this chronic disease is preventable through practicing a healthy diet and undertaking an exercise program (Department of Health and Ageing 2010). Type 2 diabetes is also known as ‘adult-onset diabetes’, as its development is associated with lifestyle, age or genetic factors. It is caused by the body’s inability to efficiently use the hormone insulin, which functions to convert sugar into energy. The disease is chronic and incurable and may result in disability and even death. According to National Health Survey data (Australian Institute of Health and Welfare 2006), diabetes is detailed as the sixth leading cause of death in Australia. It is more prominent in age groups above 35 years old and more than 70 percent of the adult population with Type 2 diabetes die of heart attack or stroke (AIHW 2006). Filipino communities are the third largest growing Asian immigrant group in Australia, but the prevalence of diabetes in Filipinos is still unknown. This is the reason why this study has taken a case of Filipino woman with Type 2 diabetes on her role of developing and managing the disorder. This paper undertakes with the objective to understand the psychological and social foundations of health and illness and how this contribute to each person’s unique illness and health experience. It highlights in identifying the role that emotion plays in health and illness to the client. The information gathered is analysed with the factors that contribute to health and illness behaviours. These include the developmental stage and cognition of the client and the strategies used in facilitating change in health behaviour through the healthy ageing model, and lastly, recognising the influence of culture on health practices. Case Study Personal, social and health information Karla is a 68-year-old Filipina widow, who is currently unemployed and has three children. She migrated to Australia 20 years ago and now lives alone in a unit. Her father died at the age of 80 from a massive stroke and her mother died at the age of 78 from kidney failure. Her mother was found to have diabetes at age 51, which was followed by kidney complications. Both her parents were overweight and two of her siblings also have diabetes. Karla used to work in a laundry company and at present she is depending on the monthly pension from the government. She does not smoke but consumes alcohol occasionally. She is not the type of person who used of taking medications, vitamins or any herbal remedies, but concedes when in pain or when there is a serious reason. Karla was diagnosed with Type 2 diabetes through the oral glucose tolerance test performed at the age of 52. At that time, she was obese, weighing 160 pounds at 5 feet and 2 inches tall with a BMI of 30. Karla confided that because of the lifestyle she adopted in Australia, this contributed to making her an obese person. She gradually lost weight by following a strict diet and exercising daily and had to do a daily blood sugar check to help control her diabetes. Health complaints consist of pain in both legs and occasional experience of eyes blurring. She has been hospitalized once because of wounding her hand in an accident, which caused her to lose a significant amount of blood and also contributed to a slow recovery. Physical examination reveals the following: Height – 157 centimetres, Weight – 78 kilograms, BMI – 30.3 kg/m2, Pulse rate – 76 beats per minute, Blood Pressure – 130/70 mmHg. Laboratory evaluation: TSH – 3.8 (0.9-5.5), Fasting Glucose – 283 mg/dl, HB – 9.5% Lipid Profile: Triglycerides – 336 mg/dl, Total Cholesterol – 243 mg/dl, HDL – 20mg/dl. Health perception and client health belief model Karla has only been admitted once in the hospital and had rarely felt acutely ill. Common ailments had been frequently occurring, but she either ignored them or used some homemade remedies to mask the complaint. The client’s culture believes in maintaining equilibrium in the body through humour along with dietary and food balance; this is known as ‘Timbang’. This belief involves a complex set of fundamental principles in which emphasis is given on side effects of rapid change from ‘hot condition’ to ‘cold condition’ (Anderson 1983, p. 815). Karla leads her and her family life on these principles, based on maintaining body temperature and dietary balance. Along with this, the Filipino community has several theories of illness, which they believe cause any disease. Karla wears an amulet which reflects the evidence of her faith in these theories. According to Mc Bride (1983), these theories can be explained in three models namely: mystical belief system, personality belief system and naturalistic belief system. Mystical belief system is designed on the premise that experiences or behaviours occur due to supernatural reasons such as retribution from ancestors for unfulfilled obligations or wandering of souls during sleep. Personality belief system is the belief of obtaining an illness as the result of some punishment or retribution by Karma. Naturalistic belief system is a range of factors from natural events, for instance, thunder, storm, famine or flood, to unbalance elements like excessive stress, incompatible food and drugs, infection or familial susceptibility causing illness (Mc Bride 1983). Nonetheless, these theories, Karla’s cultural belief system basically emphasises two things, namely, prevention and moderation. Karla has full faith in these theories, but also depends on modern medicine for this particular disease. Thus, her belief system co-exists between the traditional and modern medicine system for her overall well-being. In addition to these belief models, health for Karla is the ability to move freely, without pain and not depending on any external source of remedy like medication. As for Karla, taking medicine is the evidence of illness; consequently, diabetes for her is a major chronic illness which cannot be cured as it requires regular medication. Dietary management is part of the client’s culture, though diabetes requires different strategies, but this is easily understood by the client, due to her traditional knowledge (Lirussi 2010). Karla always perceived herself susceptible to diabetes and after acquiring diabetes she now believes that she will not attain proper health in life. Furthermore, she thinks she will be disabled for the rest of her life. This perception is formed by the situation experienced when her mother had diabetes at around almost the same age at which she is now. This above stated belief of Karla’s reinforced by her symptoms of having frequent leg pain and trouble in eyes such as blurring. Karla’s subjective perception, however, showed less awareness but great willingness to adopt a healthy behaviour. Focusing on her knowledge of these symptoms attributable to diabetes, the client is trying to work on the disease management. Her first concern is not sustaining kidney damage, the same as happened to her mother which could be genetically inherited. As explained by her doctor during her initial diagnosis, the client had been associated with risk involving behaviour contributing to the onset of the disease, not to mention, having less physical activity or getting more obese. In exploring another aspect, however, the client has emotionally exploited herself through emotional eating. Being a widow and the eldest of the siblings, she was always the expected breadwinner in her family and all the exhaustions, restlessness from work go to the over-consumption of food. The food became a transient source of comfort and alleviating all the negative emotions she felt. Thus, on doctor’s advice the client has been trying to care of her own health through following the diet regimen, working on her anxiety level, taking a walk as a means of exercise and trying to balance her emotion to remain happy. At her age now, she confided that her happiness lies in her children and the social support for geriatric care. In this way, the constant social support system promotes an inclination to change and prolong the quality of life (Vallis et al. 2003). Impact of social influences The Filipino culture involves intact family values and bonding, wherein there is lower divorce rates and broken families in their community. Karla’s family shares similar traditions with close bonding among family members. But this tradition sometime creates problems when it comes to managing individual health. Karla recalled when she still lived with the kids; she was having a hard time dealing with preparing food. Karla’s diet plan involves adjustments to sugar free or carbohydrate balance food plan, but the family cannot follow the same diet, thus she tries to cook different meal at the same time. She is finding this very difficult to be disciplined. Aside from the fact of a challenging world of Karla, diabetes patients generally feel lethargic if their glucose level is not balanced, which ultimately negatively impacts their productivity. This development also correlates to Erickson’s psychosocial stages (Jones & Creedy 2008), Karla belongs to the ego integrity versus despair, in which is described as a feeling of unproductiveness, and a hopelessness that would lead to disappointment. Whereas, looking back to past achievements would lead to contentment and happiness in life (Trueman & Parker 2006). Consequently, this tendency of stigma relating to the disease has been developed in the social circle of hers, which believes that Karla is not able to produce or work up to the optimal level. But Karla’s culture demands a close bonded family, and as a consequence, she tends to have increased but shared stress levels with her children and friend’s support. Pain management Karla usually uses some faith healing or natural remedies to manage pain, especially when she visited the Philippines; she directly went to the faith healer for some relief. The use of special oils and herbs were experimented without much success. Karla tried alternative medicine like acupuncture and naturopathy to cure her symptoms of pain. Her decision to try various health remedies is influenced by information of relief received in similar cases by these methods. The source of information has been her fellow community members and close Filipino friends from other suburbs who claimed to have experienced a positive response from alternative medicine. The client ‘already has strategies at hand and has self-knowing and expertise in living with their chronic condition’ (Giddings, Roy & Predeger 2007, p. 564). Similarly, in managing stress she follows a discipline of regular physical activity and depends on doing things which makes her feel warm and light; for instance, playing with her pet dog, cooking, long conversations with friends on the phone, and praying or meditating (De Guzman 2009). Since she lives alone, it has become challenging for Karla to deal with her stress. In spite of this, Karla has adapted a more spiritual method to control her stress. For keeping herself warm, Karla depends on her society, and she tried to be more and more part of the community. Even her close friends encourage her to join activities in the community. There were times Karla became lonely at home, felt physically and socially isolated when her stress level increased which would result in an imbalance of blood glucose level once she checked her blood glucose. Decision making criteria In understanding the behavioural change of the client, it highlights sensible decision-making which is influenced by the complexity of previous behaviours and habits (Davies 2006). The awareness of behavioural change evolves on social cognition and the health belief of the individual. The client is not a frequent visitor to any hospitals and health centres in Australia, instead she has more faith in cultural health belief, which she refers to first before consulting a health practitioner. As per her individual health belief which is influenced by a cultural belief system, she considers the onset of diabetes symptom as an act of evil eye or some devilish intervention by some devil soul. When symptoms of diabetes like polyuria or excessive urination, polyphagia or excessive hunger, polydipsia or excessive thirst and unexplained weight loss, started to occur, she thought she had been attacked by some evil eye or spirit. For this reason, Karla used a medium in her country to go to the faith healer who sent her some religious materials, to protect her from the evil action. But she started feeling weak and symptoms of neuropathy started emerging. Karla was told by her children to consult a doctor. On consultation with a doctor, Karla was found to have diabetes mellitus Type 2, which is quite common at her age. She was advised to have a proper diet which includes vegetarian foods as well in order to fulfil nutrients which she is not getting by her non-vegetarian food. The doctor has emphasised to slowly change the situation through changing her own behaviour. But due to her cultural constraint, she decided to stick to her vegetarian chart. Instead, the doctor prescribed her some pills as supplement. It is really a concern if an individual is not ready to change, or to try to change any unfavourable behaviour. As long as Karla has the idea on how to manage the disease, it is up to her to decide what is best for her. Suggestion for health promotion activity Karla’s community, the Filipino Asian community who are a large group in Australia, is known to be very culturally intact community. Due to their traditional health belief system, they have less contact to any health care system for common ailments. As a result, Karla on occurrence of the signs and symptoms of diabetes did not visit the clinic; rather she looked for alternative health remedies for relief. This makes modern health advancement difficult to reach this kind of behaviour in the community. Health promotion activity which has an outreach program to women like Karla has to penetrate their belief system. This can be done by introducing the healthy ageing model with activities that motivate the older ones to understand and manage chronic disease, goal setting and coaching techniques of their illness (Potempa et al 2010). Nursing has an essential role in the delivery of care and education of people with diabetes. As the patient’s advocate, the nurse practitioner can choose the most important health issues of the client that needs to be addressed (Meetoo, McGovern & Safadi 2007). Since Karla is of Asian descent and was consuming a higher level of carbohydrate and fatty foods, the nurse practitioner can refer the client to a dietician for a thorough nutritional therapy assessment. Although the client does not have any maintenance medication at present, she needs to have a glycaemic goal for maintaining the right weight, enhance physical mobility through daily exercise and the right food to eat. The nurse also would make recommendations with the client to join any healthy groups in the community that will focus on the importance of health and wellness especially the Asian people in Australia. Likewise, such activities like attending regular health checkups as chronic illness management or producing natural techniques in combating symptoms of diabetes would be beneficial. Propagation of natural techniques to manage diabetes should also be included as it is more acceptable by Asian community to be more aware the health system could offer. Conclusion Karla, an older lady with diabetes mellitus Type 2, which is associated with her age factor and slightly obese condition, is trying to work on this disease management in her everyday living. She is closely bound to her Philippine culture, whose health belief system is quite different than modern medicine systems. She believes in holistic healing through visiting her doctor and at the same incorporates her illness with religious healers so to balance the cure. Her motivational level to live a healthy life is quite low, but due to familial experiences Karla is willing to adopt strategies to manage the disease. She undergoes the daily challenge of proving her worth and ability as stigma related to this disease creates a perception of not able to perform to her optimal level. This increases pressure on her emotions resulting in increased stress level, which ultimately results in deterioration of her health. Therefore, with available knowledge and experiences, Karla is managing the disease but has some misconceptions and societal challenges to lead a quality healthy life. This can be removed by penetrating better awareness of this disease in her health belief system and by making knowledge of latest advancement within her reach. *** The End *** Reference Anderson, J 1983, ‘Health and illness in Pilipino immigrants’, Cross-cultural Medicine, viewed 25 January 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1011010/pdf/westjmed00196-0041.pdf Australian Institute of Health and Welfare 2006, Australia’s health 2006, viewed 25 January 2011, http://www.aihw.gov.au/publications/index.cfm/title/10321 Davies, K 2006, ‘Health promotion: what is effective intervention: using theories of health promotion’, British Journal of Nursing, vol.15, no. 5, pp. 252-256, (online EBSCOHost). De Guzman, A 2009, ‘Spirituality in nursing: Filipino elderly concept of, distance from, and involvement with god’, Educational Gerontology, vol. 35, pp. 929-944, (online EBSCOHost). Department of Health and Ageing 2010, Diabetes, Commonwealth of Australia, Canberra. 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