In_What_Way_Has_Care_for_Long-Term_Conditions_Such_as_Diabetes_Changed_over_the_Last_Thirty_Years_and_Why__K101

Part A: Essay Option Number: 1 Title: (It was) my very first day as a consultant back in February 1978. The clinic was typical of hospital-based care at that time. There was no diabetes team, and I was expected to see about 45 patients in three hours. (Sue Roberts, national Director for Diabetes. (England) In what ways has care for long-term conditions such as diabetes changed over the last thirty years and why' Healthcare, has changed dramatically for long-term conditions such as diabetes, over the past thirty years. The bio-medical, ' doctor's surgery' approach, having been replaced by a more patient and team-based ' expert patient ' approach, where patients' are more in control of decisions concerning their condition, and are encouraged to manage their own treatment. Basically, health-care, in the community and with support, has become ' normal '. In the UK, healthcare is divided into ' primary ' and ' secondary, with primary being the first port of call, generally the G.P.'s surgery. Unlike thirty years ago, a patient presenting with diabetes, would not now simply be given medication and dismissed. In the current day, patient's such as the ficticious Anwar Malik, would have regular consultations at a diabetes clinic, with specialist staff. They would then be referred to hospital if any symptoms (such as vision or foot problems), became especially problematic or in fact, seemed as though problems may develop. Diabetes care, as with other conditions, in modern timés, involves a large network of health-care specialists, including podometrist, opticians, dieticans and psychologists', who all work towards :- --- "Concordance..(which is) based on the notion that the work of prescriber and patient in the consulation is a negotiation bewteen equals.... (the) aim is a therapeutic alliance " Basically, effective health care, is now believed to involve engaging with, educating, informing and supporting people, so that they can be instrumental in managing their own treatment programme. In addition, in our increasingly multi-cultural society, the service users' cultural, social and religious background needs to be considered and respected, with the health care programme, or plan, suitably attuned. Anwar, for example, would need re-assurance and advice, on how to incorporate his insulin medication, into his traditional asian cuisine. Similarly, sensitivity would in modern times, be shown to his cultural beliefs concerning things such as, stripping to her underclothes in front of medics of the opposite sex. A noticable example of the change's over the past thirty years, refers back to the title, where Sue Roberts' informs us that : --- --- " My first experience ...on my very first day as a consultant back in February 1978 ...there was no diabetes team...I was expected to see 45 patients in three hours " Ms. Roberts, continues to tell us : --- --- " Patients' were clearly self - managing because they had no other option - but didn't have the knowledge and skills to do this safely " Sue Roberts gives an example of a middle-aged gentleman who had presented with a ' sudden loss of vision in his left eye ' , who wondered if there was a correlation to his diabetes. Sadly, had the gentleman presented thirty years later, his condition would not have progressed to such devasting ends, as he would have been far more self - aware and educated about his condition ! By now ' prevention ' is seen as fundemental to care and his eyes would have been regularly checked and monitored by Primary Health Care Teams', who would have referred him to seconday / acute care specialists at hospital, should the need have arisen. D.A.F.N.E (Dose Adustment for Normal Eating), came into existence, following realisation that only 60 - 70 per cent of diabetics' were not achieving the expected results, regardless of increased knowledge and encouraged self-management. D.A.F.N.E, gives people the skills through an education programme, to match insulin with the amount of food eaten. This is in contrast to the bio-medical approach which forced people to change their eating patterns, and has been a break-through for those with Type 1 diabetes. Passivity has been replaced by an active role in their health-care plan. Engaging and empowering patients, was further praised by 47 year old, Leicester patient Tim Taylor, who was recently diagnosed with type 2 diabetes, following an un-related visit to his G.P. Tim, on diagnosis, was convinced he would go blind or need a limb amputation and was on the verge of a deep depression. He however, got in touch with D.E.S.M.O.N.D ( Diabetes Education and Self Management for Ongoing and Newly Diagnosed ), where he found support and learned the necessary skills to manage his condition and says : -- --- "It was very personal, in my home town and it has made a real difference to my life... ...I don't ...( fear ) ... diabetes anymore. " Tim has touched upon, another recent change from thirty years ago. In modern times, the tendency is for the specialists to ' come to the patients' locality ', making them more relaxed and the medic, more ' approachable '. Dr. John Dean, a consultant diabetologist in Bolton, says : --- --- " Physically taking specialists out of the hospital has made a major difference...Patients' find us more approachable.... primary care staff are happy to be trained by us...( and ) .. Simply by coming outside the hospital we've removed a major barrier to team working. " ( team work being thematic in the progressive changes ) Support groups, are also, plentiful in modern times, to the point where, South Warwick- shire Primary Care Trust, became involved with the ' Aphnee Sehat ' ( Our Health ) project. This is an asian support group involving the ' Temple to Table ' initiative, and has lead not only to changes to cooking thoroughout the asian diabetic community, but in resturants too. In conclusion then, health-care for long-term conditions, including diabetes, has changed phenomenally in the past thirty years. Long gone are the days of the ' passive ' patient being diagnosed by over - worked physicians. Patient education, empowerment and multi- perspective treatment, including psychological services, are now the standard practice. Patients are actively encouraged to ask questions, seek support and be more ' in control' of their own health and welfare. Team - work being the key. ( word count = 1028. ) References Part B Developing care relationships Please read the guidance for Part B in the Assessment Guide. Principles Your observations of Sue’s practice with Julie Your observations of Maria’s contrasting practice with Lyn 1 Supports in maximising potential Sue fails to encourage Julie to be an active participant in the meeting. She takes over the planning of Julie’s trip and doesn’t encourage her to get involved and feel it’s her trip. She doesn’t help Julie to enjoy imagining it and thinking what she’d like to take. Maria holds back, leaving space for Lyn to make the decisions throughout the trip. Lyn decides where they’ll go and what she’ll buy. Maria quietly suggests where something is, rather than bustling about showing that she knows the shop better than Lyn does. 2 Supports in having a voice and being heard 3 Respects beliefs and preferences 4 Supports rights to appropriate services 5 Respects privacy and rights to confidentiality Self-reflective notes 1 What have you enjoyed most and why' 2 What have you liked least and why' 3 What have you found most difficult and why' 4 How well do you feel you are getting on with your K101 studies' 5 Are there things you would like support with' Marks Tutor comments Possible Actual Part B 8 Self-reflective notes 4 Participation in online forums 3 Sample answer to Part B