Medication Adherence and Health Challenges

In this assignment, a case study will be presented giving comprehensive details of the chosen patient, including their personal characteristics and medical history. The evidence-based professionalframeworks that underpin the patient’s care will be critically examined to identify whether they are up to date and have met the needs of the patient. The approach to care will be discussed, and this approach and the care given will be critically analysed. Furthermore, the interprofessional care activities and principles of teamwork involved in delivering the patient’s carewill be critically examined and discussed, as well as the challenges of delivering the collaborative patient care. For those seeking to enhance their work, healthcare dissertation help can offer valuable insights into best practices and evidence-based approaches in patient management.

In order to maintain patient confidentiality in accordance with the Nursing and Midwifery Council (NMC, 2018) and The General Data Protection Regulation (GDPR, 2018), the patient in the case study has been given the pseudonym name of Doris. Doris is a 60-year-old woman, who was admitted to a rehabilitation hospital ward with reports of type-2 diabetes, hypertension and the recent development of a leg ulcer. Type-2 diabetes is thea chronic health condition, which involves an increase in blood sugar levels as the body develops a resistance to insulin (NICE, 2019). Type-2 diabetes mayalso cause serious problems with the eyes, heart and nerves (NICE, 2019). This is because thehormone insulin, which helps glucose to be transferred to the body ’cells to be used for energy, is resisted by the body. (Diabetes UK, 2019). Type-2 diabetes canoften led to peripheral neuropathy, venous insufficiency or peripheral occlusive disease due to an increase in blood glucose(Nicola et al., 2019). Therefore it can be determined that the development of Doris’ leg ulcer was due to her poorly controlled type-2 diabetes.

Doris also has a medical history of kidney failure and depression, and lives with her 65-year-old husband. Doris has no children and currently, her husband is supporting her needs. The pain caused by her leg ulcer has limited her mobility, which has challenged her ability to manage personal everyday care and the household.Additionally, it is reported by Doris on hospital admission that she has not been adhering to her medication schedule. Poorly controlled diabetes can lead to the development of leg ulcers (Nice 2019a; Diabetes UK, 2020)due to high blood levels stiffening arteries, which in turn restricts their ability to expand and deliver blood. This restricted blood flow can disrupt the natural healing process of wounds and subsequently leg ulcers may develop.Doris has full mental capacity; no hearing issues and speaks fluently in English. Thus, the complex health needs of Doris include effectively controlling her type-2 diabetes, hypertension and the management of her leg ulcer,so that she can take care of her everyday needs and household responsibilities. Furthermore, in managing the household and personal chores, Doris’s family need a social carer who would help her husband.

The ASPIRE framework is to be used in developing care for Doris which is an evidence-based framework that helps nurses know what to do when care planning. The ASPIRE framework stands for Assessment, Systematic Nursing Diagnosis, Planning, Implementation, Recheck and Evaluation (Lambert, 2020). In Assessment, the physiological, emotional, social and spiritual status of the service user is determined by the nurse (Lambert, 2020). In thecase of Doris, the health assessment identifies that she is psychologically less resilient as she is mentioned to have history of depression and currently experiencing stress. It is recognised that individuals suffering from long-term conditions are susceptible to developing stress and depression (NICE, 2019) as they find coping with the impact of their limited physical performance an emotional challenge. In relation to Doris, her experience of long term kidney failure and type-2 diabetes may have contributed to her suffering from depression and increased stress, which in turn may have contributed to her developing hypertension.

The assessment of Doris also identified that she is suffering from physical weakness, which has had an impact on her emotional state. The physical weakness has impacted upon her ability to self-care and perform daily chores, and has led to her need for support from her husband. Indeed, it has been shown that Type-2 diabetes can lead to physical weakness in an individual, causing fatigue when performing personal activities (Olson et al. 2016). This is because those with Type-2 diabetes produce an inadequate level of glucose and subsequently, their body cells are provided with insufficient levels of energy, leading to ineffective functioning and the development of muscle weakness (Rosenstock et al. 2019). If poorly controlled, Type-2 diabetes can lead to leg ulcers, which can cause pain and issues with mobility, and in turn an inability to self-care. This can cause individuals to have low self-esteem and develop depression (Ahmad et al. 2018).

The systematic nursing diagnosis element of ASPIRE, involves making a clinical judgement regarding the health problems of the service user (Lambert, 2020). In the case of Doris, it was decided that a blood test was required to determine her current blood sugar levels. This was in order to analyse how much her condition had deteriorated so that the appropriate actions needed to care for Doris could be identified. Moreover, thermal imaging of diabetic leg ulcer for T is to be made by the nurses. Thi8s is because thermal imaging in diabetic leg ulcer leads to determine the size of ulcer an healing trajectory compared to conventional methods (Fraiwan et al. 2017). The planning involves identifying interventions to be provided to patients based on diagnosis of their health condition (Lambert, 2020). In these stages, the nurses caring for Doris will determine the most appropriate intervention(s) based on her diagnosis and then implement the intervention(s).

According to health condition of Doris, nurses would arrange pharmacological intervention of administering Metformin in appropriate dose to Doris. This is because Metformin is the approved pharmacological drug mentioned by the NHS to be used in effective management and control of type-2 diabetes (NHS, 2018). Moreover, the study by Foretz et al. (2019), mentions that Metformin in type-2 diabetes patients acts to reduce the amount of glucose released by the liver. This, in turn, contributes to lower deposition of increased sugar in the blood and avoids raising the glucose level as seen in case of type-2 diabetic patients. The nurses are also required to plan using antibiotics for Doris to cure her leg ulcer. This is because antibiotics avoid development of bacteria on the wounds as well as support faster wound healing by boosting the immune system of the body (Huang, 2020). At the recheck stage, the nurses involved in Doris’ care revaluate the care they have provided to determine if any further changes are to be made and in evaluation stage, the current care provided are examined to determine to what extent they are effective in support health of the patients (Lambert, 2020). Thus, the care provided to Doris as per planned is revaluated to determine if any changes are required. However, it was assessed tat no further changes are required in the care as she is responding well to te already arranged care intervention.

Democratic leadership is a style of management that involves leaders encouraging input and communication with individuals in order to make decisions about the patient’s care (Xu, 2017). In relation to Doris, the nurses used democratic leadership in order to obtain informed consent and choice of care. According to the NMC Code of practice (2018), nurses are required to involve patients in making choice of clinical intervention for their care and ensure they provide informed consent (NMC, 2018). Thus, nurses are to ask choice of care intervention from Doris regarding the management of her health issues such as type-2 diabetes, leg ulcer and hypertension to ensure providing her effective quality healthcare as per demands.

The 12 activities of living mentioned in Ropert-Logan-Tierney Model are breathing, managing safe environment, communication, eating and drinking, washing, controlling body temperature, mobilisation, working, expressing sexuality, sleeping and death (Holland and Jenkins, 2019). The activities of daily living (ADLs) were used by the nurse caring for Doris to determine the activities she was facing difficulty in achieving and needed subsequent support with. According to Malhi et al. (2017), diabetic leg ulcer patients develop issues with mobility and physical activity due to the swelling and pain caused by the unhealed wound. For Doris, the ADLs assessment showed that Doris’ immobility was due to her suffering from a diabetic leg ulcer, which in turn was hindering her ability to complete daily tasks, leaving her feeling a burden on her husband as she relied on him for support.

An adequate dietary intake is essential for type-2 diabetes patients so that the blood sugar remains controlled and the adverse impact on the body is reduced. This is because intake of simple carbohydrates leads the body to easily break them into simple sugar in the form of glucose to be readily available in the blood leading to create dangerous level of blood sugar (Mancini et al. 2018). An assessment of Doris’ dietary intake identified that she does not maintain an adequate diet to keep her blood sugar levels under control and subsequently this has led to adverse health conditions.As argued by Brandão-Lima et al. (2018), people suffering from type-2 diabetes are unable to execute strenuous work activities, due to the inability of their body cells to use glucose from the blood in providing energy to the body to execute strenuous activities. Thus, the working efficiency of Doris is assessed to determine to what extent she is able to perform strenuous activities. This revealed that she is experiencing fatigue along with muscle weakness which has led her being unable to work and requiring extensive support.

The principle of person-centred care is the provision of care which promotes patient individuality and independence (Ballard et al. 2018).This indicates that patient such as Doris is to be provided freedom of choice in deciding care intervention for her current health condition which could individually resolve her health complication. As stated by NICE (2019a), effective education regarding care intervention to the patients is one of the principles of person-centred care. This is because education allows the patient to develop independence in making choices about their care.In order that person-centred care could be provided for Doris, she was educated in the limitations and strengths of each intervention available to support her health condition so that she could make an informed choice and effectively participate in quality care planning for her own well-being. According to theRCN(2020), the principle of person-centred care includes providing respect to the preferences and expressed needs of the service users. This is because it makes the patient's feel valued as their concerns are cared by the nurses, which in turn, leads them to develop trust over the nurses to avail care without creating any hindrance. Thus, to deliver person-centred care to Doris, the nurses require respecting her choice and preferences regarding interventions to be made for type-2 diabetes and leg ulcer.

In family-centred care, the nurses and family members of the patients are to work in partnership in managing and delivering care to the patients. One of the principles of family-centred care is recognition and respect towards one another knowledge and expertise (O'Connor et al. 2019). This indicates that nurses and family members of Doris that is her husband are required to respect each other's knowledge and expertise in supporting her care to ensure effective partnership is built between them for successful delivery of care to Doris. However, a lack of recognition of each other's knowledge in family-centred care can lead to a lack of trust between a patient’s family members and nurses, which can cause poor collaboration between them (Lee et al. 2018). According to the NMC(2018), alack of executing two-way communication leads to hindered family-centred care. This is because the family members and the nurses are unable to understand which roles and responsibilities are played by whom and the progress in care for the patients. Thus, while delivering family-centred care for Doris, it is importantthat effective two-way communication between her husband and nurse are formed so that each of them systematically provides successful care to Doris for improving her health condition regarding type-2 diabetes and additional health issue. In delivering family-centred care to Doris, the nurses are to educate her husband regarding the way to regularly check her blood sugar level, provide her assistance in coping depression due to long-term health condition and manage enhanced healing of leg ulcer.

Working in partnership with other professionals is essential to provide the best possible care. It involvesthesharing ofopinions and skills of experts from a variety of fields in order to decide on the bestquality care plan for the patient (Glasby, 2017). This is evident as while planning evidence-based practice care for Doris, to effectively improve her type-2 diabetes, leg ulcer along with manage hypertension the nurses by working in partnership with dieticians, tissue viability nurse, physiotherapist, vascular specialists, endocrinologist and psychiatrist would be able to gather specific information regarding dietary regulations, the ulcer and physical activity. However, lack of communication and shared ideas of expert opinions in partnership working leads nurses fail to determine specific and enhanced care delivery to patients (Wiltjer, 2017; and NMC, 2018). This is because in case of Doris the dieticians and physiotherapist would have better knowledge compared to the general practice nurses in determining the specific dietary inputs and physical exercise to be included in managing Doris’s health complications.

An endocrinologist is an expert involved in the treatment of hormone imbalances caused by a dysfunctioning endocrine system (Davidson et al. 2018). Patients with uncontrolled type-2 diabetes are often referred to an endocrinologist for a reassessment of their medication regimeand to be educated on how best to manage their diabetes (Escaladaet al. 2016). In this condition, the nurses caring for Doris are required to work in partnership with endocrinologist to reassess her medication and identify potential care plan to be developed to ensure effective control of her type-2 diabetes.This is because it would lead the nurses have specialist advice regarding the way blood sugar level in Doris can be effectively normalised. According to endocrinologist, the Metformin is the most effective medication in controlling blood sugar level for patients suffering from type-2 diabetes as previous determined by the nurses on following NHS guidance. Thus, working in partnership with endocrinologist, the nurses caring for Doris are required to provide Metformin in controlling her condition.

Vascular specialists are involved in the managementmanaging and treatment of diabetic leg ulcer and provide specialist advice regarding wound management to ensure quick healing (Wennberg et al. 2019). AsDoris is suffering from a diabetic leg ulcer, the nurses are to work in partnership with vascular specialists to develop knowledge regarding wound management in order to promote the healing of Doris’ leg ulcer. The ineffective management of diabetic leg ulcers has been criticised (Majumder et al., 2020), as it causes the build-up of slough and exudate, along with damage of epithelising tissues, which creates increased pain and discomfort. Thus, effective wound management of Doris by the nurses in partnership with vascular specialist would ensure delivering specialist care and enhanced dressing to promote effective healing of leg ulcer.

The psychiatrists are medical practitioners who have specialisation in diagnosis and treatment of mental illness (Martins-Monteverde et al. 2019). In case of Doris, it is seen that she is suffering from hypertension and has long history of depression. As asserted by Schmitt et al. (2017), increased stress regarding any long-term health condition leads individuals to develop hypertension. This is because the stress create surge in the hormone of the body which acts to increase the blood pressure making the heart to beat faster and blood vessels to be constricted. In the case of Doris, it is seen that she had been suffering from long-term health condition such as type-2 diabetes which is not appropriately controlled that may have led her to develop stress regarding her health which has contributed to make her experience hypertension. As asserted by Lyra e Silva et al. (2019), the psychiatrist by performing counselling and involving mentally-ill patients in talk therapies acts to ensure enhanced emotional and mental health condition. Thus, the nurses are to develop partnership with psychiatrist so that specialised mental healthcare can be provided to Doris to resolve her depressed and stressful mental state caused out of prolonged from diabetes. As criticised by Chaudhary et al. (2017), lack of management of hypertension leads to uncontrolled type-2 diabetes as well as creates complications such as kidney failure, heart attack and others. This is because hypertension causes vascular remodelling along with raised body fluid amount which leads to peripheral arterial resistance associated with insulin resistance in the body faced by type-2 diabetes patients. Thus, effective partnership with psychiatrist is required to lower stress that would eventually reduce hypertension for Doris which would support her improved well-being.

The study by Bukht et al. (2019), mentions that physical activity among type-2 diabetic patients helps them to experience effective control of raised blood sugar as well as improvement in overall health condition. This is because during physical exercise the body cells get contracted and develop the need for energy. It makes them use glucose in the blood to meet their need making them show greater sensitivity in reducing blood sugar. As asserted by Shaw Jr and Karami (2017), physical exercise promotes the production of endorphins in the brain. The endorphins are considered as natural pain killer which activate opioid receptors in the brain minimising discomfort and enhancing relaxing ability among individuals (Miller et al. 2016). In the case of Doris, the nurses are to develop partnership with the physiotherapist for making decision regarding the type of physical exercise appropriate to resolve stress regarding long-term suffering from type-2 diabetes in Doris. This is because physiotherapist is health professionals who provide advice through their expert knowledge and training regarding the physical exercise to be performed by individual based on their health condition to ensure better well-being (Nwose and Bwititi, 2016).

In conclusion, the above discussion informs that Doris is living with type-2 diabetes along with hypertension and is in hospital due to difficult mobility as a result of rise of leg ulcer. The use of ASPIRE framework was used to determine ways to provide evidence-based care to Doris. The needs assessment of Doris is to be completed by using the Roper-Logan-Tierney Model of nursing according to which mobility is badly affected for Doris. The low carbohydrate in the body could lead to produce less glucose as well as to control blood sugar level (McArdle et al., 2019). Thus, according to dieticians, Doris is to be provided low carbohydrate diets for managing type-2 diabetes In supporting Doris’s healthcare needs to ensure her well-being the inter-professionals such as endocrinologist, psychiatrist, vascular specialist along with person-centred care and family-centred care are to be included.

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