co-morbid long term conditions

This essay will focus on the management of co-morbid long term conditions and the case study for this essay on co-morbid long term conditions will be 57 years old Abdulla. The medical history of Abdulla showed that he was first diagnosed with type 2 diabetes mellitus when he was 42 years old. Since his diagnosis, he has suffered from multiple complications of type 2 diabetes mellitus particularly leg ulcers which had been constantly recurring and vascular insufficiency. Several attempts had been made by doctors to treat these complications through surgeries but these attempts were unsuccessful and as a result, the patient had to undergo a medical procedure to have his left leg amputated below the knee. Further analysis of his medical history showed that the patient also suffers from cardiovascular complications associated with type 2 diabetes and he suffered from his first myocardial infarction when he was 50 years old. He is regularly inconvenienced by recurrent symptoms of angina, another cardiovascular comorbidity associated with type 2 diabetes mellitus. The patient’s healthcare provider subsequently prescribed nitro-glycerine for him. This prescription was required in order to ameliorate the symptoms of angina experienced by him. The patient has been prescribed medications which he has to take daily and he appear to wholly adhere to his medication regimen. The patient is a married man whose wife also doubles as his carer and provides constant care and support for him. The patient is also a small-business owner and he does the company’s administrative and accounting work. The student met Abdulla at a local healthcare facility where he was referred to for proper assessment and treatment of co-morbid type 2 diabetes. The student was tasked with utilising the concepts of behavioural change theories to develop an effective treatment plan that would encourage the patient to play a more active role in the management of his long term condition. The student had to assess the patient’s ability to perform the activities of daily living and was required to employ the use of emerging management techniques to help improve the quality of life of the patient. Since self-management is vital aspect of living with this long term condition and can be a complex process, the student had to provide evidence-based recommendations on how to encourage and support the patient in the self-management of his condition. The student also had to employ the expertise of an interprofessional team in order to develop a care plan that was individualised and patient-centred. The student had to consider the needs of the patient in respects to the physical, psychological and educational aspects of living with type 2 diabetes and its associated co-morbidities while also assessing the impact of living with this condition on the patient and his family. It was also important for the student to maintain active communication with the patient in order to continuously provide information needed by the patient to avoid the risk of developing further complications or worsening of the patient’s condition as a result of poor self-management. Living with type 2 diabetes and its co-morbidities can be quite demanding and therefore it affects several areas of the patient’s life including the physical and psychological areas. In essence, the patient has several needs which need to be met in order for him to effectively live with his condition. One of such need pertains to education. Education is an important factor in the self-management of co-morbid type 2 diabetes and it is necessary in order to avoid mismanagement of the condition which can result in further complications. It is important to note that whilst the patient would have received some information during assessment and treatment of his condition by a healthcare professional, education of the patient should be a continuous process rather than a one-time affair. The psychological wellbeing of the patient is also important. Living with co-morbid type 2 diabetes can take a toll on the psychological health of the patient as a result of this, the patient is prone to other mental health problems such a depression and anxiety. Evidence has shown that the psychological health of type 2 diabetes patients living with associated co-morbidities such as angina is markedly low when compared to the psychological wellbeing of those living with only type 2 diabetes (Naess et al., 1995). Sexual dysfunction is also an underlying psychological issue that can be difficult for the patient to discuss with his carer or healthcare provider and as such, it is imperative that this handled with great care and respect (Debono and Cachia, 2007). The patient may also be prone to constant fatigue due to the severity of his condition and might also experience some difficulties relating to weight control and exercising. Furthermore, the presence of diabetes-related complications can contribute to a significant reduction in the quality of life when viewed from both individual and societal perspectives (Hahl et al., 2004).As earlier mentioned, living with type 2 diabetes and its co-morbidities can be demanding and self-management of this condition is often a complex process. However, the demands of living with this condition does not affect only patient but also has a significant impact on his wife who also acts as his carer. Usually, family members see the severity of a chronic condition more intensely than the patient themselves and this can lead to the feeling of anxiety, uncertainty of the future and fear of early widowhood but can also induce other behaviours such as nagging or smothering which will have an adverse effect of the self-management behaviours of the patient. Also, the amount and quality of care provided by the patient’s family is directly proportional to their general wellbeing. In order words, the psychological and physical wellbeing of the carer usually worsens as the amount of care increases (Smith et al., 2014). Due to the complexity of managing the patient’s condition alongside its associated co-morbidities, the challenges of caring for the patient are not restricted to the psychological aspects alone but also have financial and social importance (Carers Trust, 2014). Interpersonal relationship between the patient and his healthcare providers is an important factor that contributes to the development of patient-centred care. In the care of co-morbid type 2 diabetes, it is essential for the healthcare providers to maintain a good interpersonal relationship with the patient that fosters effective communication so that the patient that learn about and acquire the self-management skills needed to properly manage his condition (Mulder et al., 2015; Schöpf et al., 2017). Such self-management skills include activities relating to nutrition, exercise and constant blood glucose monitoring, In essence, communication between the patient and his healthcare providers has the potential to encourage good self-management practices and can also affect the patient’s perception of his quality of life. Interpersonal communication between the patient and his healthcare providers can also help the healthcare provider to assess if the patient is facing any difficulties regarding the performance of any of the activities of daily living. However, minimal emotional support and lack of empathy from the healthcare providers during these communications be an impediment to effective self-management (Sohal et al., 2015). Interprofessional collaboration amongst healthcare professional is also essential to the management of the patient’s condition. An interprofessional team usually consists of practitioners from different professional backgrounds working together to provide patient-centred care rather than independently of each other. The complexity of the patient’s condition makes it difficult for the patient to be treated solely by a primary care physician and as such specialists with different medical backgrounds need to recruit into the patient’s care team. Specialists would include professionals such as a diabetes-specialist doctor, a diabetes-specialist nurse, a pharmacist, a cardiologist (due to his cardiovascular complications), exercise professionals, a podiatrist and a dietician (to provide a healthy nutrition plan). Although interpersonal relationship is important between the patient and the healthcare providers, good interpersonal relations between members of the interprofessional team is vital to the delivery of care to the patient. The dynamics of an interprofessional team can be complex as there are a lot of shared roles and this can lead to the poor cohesion among the team members which inadvertently affects the quality of care being delivered. The organisational model of the patient’s care requires that the primary care physician and the members of the patient’s interprofessional care team be in constant communication with each other, through sharing of medical reports, throughout the patient’s journey of care. The patient will also have to visit the healthcare facility several times a year for review. The organisational model is directly linked to the interpersonal and the interprofessional issues of the patient’s care. This link is reflected in the fact that delivery of care in the model is dependent on the presence of good interpersonal relationships between the members of the interprofessional team in order to provide good quality of care in the treatment and management of the patient’s condition. The organisational climate in the healthcare facility should also promote patient-centred care as one of its priorities and also ensure continuity of care.Effective self-management of co-morbid type 2 diabetes can be quite demanding as well as complex however it is necessary for Abdulla to be actively involved in the management of his condition alongside its comorbidities. Interventions based on behavioural change theories can be used to empower the patient to take an active role in the self-management of his condition and one of such theories is the theory of planned behaviour. In the Theory of Planned Behaviour, an individual’s behaviour is majorly determined by their intent and the stronger a person’s intent is, the more easily and faster it is for the individual to carry out a certain behaviour (Akbar et al., 2015). This intent is in turn affected by three factors which are attitude, subjective norms which represents whether or not the individual’s significant other thinks the behaviour is necessary and perceived behavioural control which represents the degree of ease or difficulty in carrying out a certain behaviour (Lee et al., 2017; McDermott et al., 2015). It is a cognitive theory that places emphasis on predicting and identifying health-related behaviours through the use of a set framework (Ajzen, 1991; Armitage and Conner, 2001). The construct of this theory requires the patient to have a certain level of education regarding their conditions. The application of this theory will first of all highlight what lifestyle or behavioural modifications need to be made and then adjust the patient’s attitude to these changes by influencing his beliefs regarding the changes as well as provide means and motivation for the patient to easily carry out these changes. For example, the subjective norms of the patient could be modified by convincing him through role play that his wife would approve of him carrying out certain behaviours thus increasing his intent toward the behaviour. Another behavioural change theory that can be applied is the Health Belief Model. The basis of the Health Belief Model is that when an individual feels a perceived susceptibility to their health and recognises the perceived severity of this complication, the person will adopt a pattern of behaviour that is beneficial to their health (perceived benefits) and eliminate any barriers to the health behaviour (perceived barriers). Since Abdulla is already familiar with the perceived susceptibility and perceived severity of his condition, interventions based on this model will focus on the perceived benefits of behaviour modification and the perceived barriers to this modification. The perceived barriers are not necessarily tangible and can include limited access, financial constraints, or difficulty of the behaviour (Kasmaei et al., 2015; Pender et al., 2006). In order for the interventions based on the Health Belief Model to effective, it is necessary for Abdulla to be properly educated what specific behaviours he should adopt and the benefits of these behaviours should be made known. For example, Abdulla could be advised to monitor and adjust his diet or to partake in a moderate amount of physical activities daily and then be informed of the benefits of these behaviours on his glycaemic control.In order to effectively manage and live with co-morbid type 2 diabetes, it is important for the patient to engage in self-management practices. However, self-management of type 2 diabetes is not necessarily one of the easiest things to do and can be a complex process. Therefore, in order to ensure the involvement of the patient in self-management of his condition and also ensure the efficacy of this process, it is important that the patient receives support from his healthcare provider or through other means. Mobile apps can be a useful tool in providing support for the patient. These apps can assist the patient in monitoring self-management activities and behaviours such as blood glucose monitoring and physical exercises. Arsand et al. (2012) suggests that personal goals set by the patients regarding glycaemic control and behavioural changes are more effectively monitored using smartphone diabetes apps. Support groups are also an excellent way to improve self-management behaviours. Support groups can help improve the patient’s attitude towards self-management by providing a sense of solidarity and also reducing the distress and anxiety associated with the patient’s condition. These groups can also provide needed education regarding proper diabetes self-management. Studies have reported a marked increase in the lifestyle and psychosocial outcomes of patients living with type 2 diabetes (Steinsbekk et al., 2012; Zheng et al., 2014). Research conducted by Cai and Hu (2016) and Fu et al. (2015) highlighted the efficiency of these support groups in improving self-care behaviours when they are family- and community based.

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