nduced Peripheral Neuropathy (DPN) on admission. In relation to confidentiality, this case study will use an alias name ‘Patient A’ when referring to the patient (NMC 2015). Considering the recommendations by the Department of Health (2013), consent was sought from patient A to use any information about her care. However, although the R-L-T Model of care encompasses 12 activities of living, this case study focusses on three which are specific to patient A. These are Eating and drinking, Maintaining a safe environment and Communicating.However, new research shows the R-L-T Model is reputable in most general Hospitals and widely used during assessments to determine a patient’s abilities during the stages of care planning. Moreover, it is generally used in Europe and America and nurses have become familiar with its application (Williams, 2015). On the other hand, one major issue that was identified was the lack of pain management and self-care. Guided by the RTL Model’s problem-solving principles, this case study aims to discuss these problems and provide recommendations from a health promotion perspective. At least one study by Percy & Richardson, (2018) acknowledges that nursing practice is a multidimensional and complex realm and it can be difficult to appraise it using a single model.Client profileFirstly, patent A has never been married or employed, lived in isolation in a council house in one of the community neighbourhoods. Secondly, patient A survived on fast foods, she is over-weight and has never been motivated with any healthy-lifestyle activities. Thirdly, Patient A has been estranged from her family, dropped out of school at an early stage and has no social connections. Also, patient A was diagnosed with type 1 diabetes at the age of 16 and she has been on disability benefits allowance. Lastly, patient A has been in and out of the hospital for failing to keep her goal indicators under control (Al-Tamimi et al, 2018).For this reason, the care planning team considered the biopsychosocial model to incorporate physiological, psychological and social aspects in patient A’s care plan. Hence, the focus of the assessment was to empower patient A with the knowledge and skills necessary to self-manage her condition. However, patient A’s background suggests a lack of all the biopsychosocial factors and yet, health and illness are a consequence of the interaction of all three factors. Besides, the National Institute for Health and Care Excellence (2015) (NICE) document explains the link between the biopsychosocial approach and self-management strategies. For instance, healthcare professionals adopt this approach to treat diabetes patients by implementing a care plan that involves a change in lifestyle. Patients are encouraged to eat a balanced diet, exercise frequently, adhere to their medication and to always check the levels of blood sugar.PrognosisIt is estimated that about one in every three people with diabetes has developed Peripheral neuropathy. DPN is caused by high blood sugar and too many fats (triglycerides) in the bloodstream which affects the small blood vessels that carry nutrients to nerves. However, people describe the symptoms using different terms, but the most common ones are feeling numb, tingling and burning. Procedurally, all patient A vital signs including her blood pressure, oxygen level, pulse rate, respiration rate, and temperature were checked and returned within a normal range. Furthermore, a urine test was ordered to examine the presence of bacteria, blood, and pus, and this revealed the patient had developed Pyelonephritis due to bacterial infection in the bladder. Kidneys are susceptible to tissue inflammation when the urinary tract becomes contaminated with bacterial infection according to (NICE 2015).Owing to the R.L.T Model guidelines, Health care professionals can design interventions that are tailor-made to help patients to be independent in difficult situations and encouraging results from these interventions are beginning to emerge. However, research reveals that among 18 million Americans affected with diabetes, almost 15 percent have been diagnosed with a foot ulcer. When conditions develop to a foot ulcer, the healing process is very slow and in other cases, it becomes untreatable and patients may end up their feet being amputated (Ruben et al, 2015). Also, factors that affect the wound healing process include blood glucose Levels and poor circulation. However, when the body fails to manage the glucose levels, this affects the body nerves resulting in patients losing sensation, and at this stage, they are diagnosed with diabetic neuropathy. Similarly, debates illness can influence the effectiveness of the immune system which leaves the body prone to infection. For instance, the assessment determined that the patient lacked balance and movement coordination subjecting her to falls and injuries. According to diabetic studies, DPN can affect balance, which makes it difficult for a patient to maintain a safe environment (Al-Tamimi et al, 2018).However, a physical (neurological) examination was done on patient A’s foot to observe the blood flow and sensation. Firstly, a monofilament test to ascertain feeling on patient A’s feet was performed. A Monofilament is a plastic fibre which is rubbed gently against the patient’s feet. Secondly, a rotating fork was placed at the bottom of the patient’s feet to establish if the patient could feel the vibration. Nonetheless, the view that the monofilament test is widely used in testing for DPN presence does not guarantee that the results are particularly correct (Unmar, Zafar & Gao., 2017). Presently, there is a wide range of different methods being used and other writers have criticized the approach as making patients uncomfortable (Craig et al., 2015).Body System (The urinary system)The urinary system comprises of the kidneys, ureters, bladder, and the urethra and its main function are to eliminate nitrogenous waste products in the form of urine. In addition, the urinary system regulates a variety of internal conditions to maintain a conducive and consistent internal environment. These include controlling the blood volume and blood pressure through the process of osmoregulation. Kidneys have a vital role in the process of homeostasis by keeping the level of water consistent. On the other hand, the urinary system work in conjunction with other organs of the body that include skin, lungs, and intestines to eliminate waste from the body. However, in the case of infection to the urinary system organs, this will disrupt the elimination process which often results in health issues and accumulation of toxic elements within the body (Stevens et al, 2017). Nevertheless, it is estimated that about 25% of diabetes patients living in the US have developed urinary tract infection UTI. Similarly, recent investigation shows 22% of diabetes patients have developed Chronic Kidney disease (CKD) (Malde, 2018). However, kidney damage is a result of the interaction of risk factors such as obesity, insulin resistance, and hypertension, causing damage to nerves, kidneys and the heart. Though not all diabetes patients develop UTI, however those that are obese, and they lack control of goal indicators have a high risk (Al-Tamimi et al, 2018). UTI can affect any of the urinary system organs and it is usually the lower part of the urinary tract (pyelonephritis) or the upper part (Cystitis) which patient A exhibited during the assessment. About patients with DPN, some of their urinary system organs become infected and once the nerves that help with the contraction of the bladder are compromised, the results are most patients become incontinent (Baptista et al., 2016). In conclusion, a recent publication by the American Diabetes Association and the National Kidney Foundation reveal that evidence-based treatment strategies have been introduced. Yet, some patients are still on a waiting list to be considered for advanced treatment according to the Mayo Clinic, (2015). Evidence by the Mayo Clinic (2015) suggests that some patients have reached the point where their kidneys cannot maintain the body and they will be needing a transplant or dialysis. However, despite exhibiting symptoms such as fatigue, swelling, and nausea to indicate the malfunction of their kidneys, they remain not on advanced treatment. Health & Social Care Agenda The Health and Social Care Delivery Plan (2016) objectives state that patients should be supported to live in a community environment with little or no risk of being re-admitted. Also, it stresses the importance of self-management among patients with chronic diseases and to continuously evolve the healthcare sector to embrace the new technologies of care. Furthermore, the plan would incorporate the health and social care services to cater to patient needs from a holistic perspective and to make healthcare providers accountable if these services are not to standard. However, the Health and social care delivery plan (2016)’s main objective was to make provision for healthcare providers to give precedence to the needs of patients rather than to the demands of organizations. Patient A suffers from a chronic illness DPN and her background entails that she lived in the community with minimal help to self-manage her condition. The Health and social care delivery plan (2016) was legislated to form a system that would give patients such as patient A the skills they would require to manage her diabetes mellitus and periphery neuropathy condition. However, despite some favourable findings of the Health and social care delivery plan approach, evidence suggests that there is a need to utilize resources effectively to integrate all the health and social care serves (Nam et al 2011). The complexity of diabetes care has raised serious concerns on how patients have failed to access the urgent care services they prefer despite the recent reforms. However, a recent study reveals that there has been improved coordination between hospitals and GPs after the delivery plan was implemented (Earl, 2019). According to Earl, (2019), before the Health and social care delivery plan (2016), information sharing was one major issue among different parts of the system. Arguing in support of the delivery plan, in their observational study, Baptista et al, (2016) acknowledge that the idea would help those with chronic illnesses and disabilities to stay at home and live as independently as possible. The feasibility of this is evident in the aims of the delivery plan, better health, better value, and better care. In summary, the delivery plan aims to provide a service with high expectations of supported self-management, prevention promotions, and early detection. In addition, patients needing treatment are expected to be attended to the same day and released, a system that the plan expects to be standard. To conclude, for the Health and social care delivery plan (2016) to fulfill all its aims, there should be at least an understanding that not only much attention should be paid to physical and mental health, but the importance of eliminating the fundamental conditions that affect health.However, critiques of the plan argue that the healthcare system remains fragmented, arguing that the plan was implemented without proper consideration of the magnitude of the vast majority of patients (Dantic, 2014). On the other hand, the concept integration carries with its risks and challenges, particularly in the provision of the correct skill mix to deliver the appropriate standard of care. Currently, there are new concerns regarding the prevention of a health crisis, the reduction of admissions and coordinating the discharge process. Dinh, (2013) argues that there was an increase in readmissions of elderly patients following their failure to adapt after their release. Besides, Dinh, (2013) reveals that elderly patients must endure long periods of waiting to be discharged due to inconsistencies between hospitals and social care. A phenomenon that has caused the NHS to incur costs worth millions. To summarise, for a long time of austerity, the healthcare system was left to languish in extraordinary difficulties and this was more apparent within the NHS with its financial discrepancies and long waiting periods for appointments and treatment. However, it is now relevant to note that the health and social care agenda has made the healthcare system sustainable by incorporated principles of empowerment and accountability. Evidence now suggests that the multidisciplinary approach and the health service integration forms a framework that is conducive to effective inter-professional healthcare delivery. Finally, the most fundamental benefit of smooth coordination is the financial gain and when integration is well-coordinated, the health and social care system will operate with less spending and yet delivering quality care. Though, it remains a priority to put more work for future certainty. Health Promotion activitiesResearch states that health promotion provides individuals with the aptitude to self-care and to be in control of their care. It entails a well-co-ordinated range of interventions that are aimed at improving the wellbeing of individuals. Proponents view health promotion not only from a treatment and cure point but as a strategy to address the origins of sickness and disease. However, critiques have warned that Health promotion is not a straightforward undertaking (Nam et al 2011). Except for the theory behind Health promotion is fully measured, the risk of launching inconsistent interventions is highly likely.However, according to the WHO (1986), the context of promotion denotes to the prioritization of health agendas that affect individuals either on a personal or public level. Yet, socioeconomic determinants of health can necessitate positive or negative outcomes to these health agendas depending on individual circumstances (Earl, 2019). Evidence suggests that in high -income economies, social intervention programs do not favour the health of less privileged individuals. Hence, it will be difficult to offset the health agendas for the socioeconomically less privileged. However, the health promotion strategy intends to empower all individuals to have more autonomy and the ability to negotiate some of these social determinants (Baptista et al., 2016).Nevertheless, the discourse of social determinants often invokes health-related issues and hence the need for health promotion strategies (Morris, 2012). For instance, diabetes self-management education (DSME) is a strategy that has been implemented to address bio-psychosocial issues that affect diabetes patients. With help from local diabetes groups, the on-going health promotion offers skills necessary to self-manage the chronic disease. Furthermore, the program provides insight into the challenges associated with the enhancement of these skills and how to overcome these challenges. In addition, the program integrates individual values, let the patient make informed decisions on self-care and support them where necessary (Reisenhofer & Taft, 2013).The scope of health promotion for diabetic patients.The objectives of the DSME strategy are to ascertain the realization of a patient’s desired goals. Proponents of this strategy have called it problem-based learning (PBL) as it allows the patient to negotiate solutions to self-identified issues. Furthermore, the PBL intervention method encourages self-directed learning which resonates with the Self-determination theory (Patrick & Williams 2012). The Self-determination theory claims that patients have the highest probability to acquire the necessary skills to take care of their illnesses. However, in the framework of diabetes, autonomy motivation necessitates the point at which a patient can feel they have taken every precaution to conform to diabetes self-management activities (Dinh, 2013).On the other hand, for families and patients living with diabetes can be an overwhelming experience (Rodgers et al, 2013). However, local diabetes support groups such as the Camden Diabetes UK Support Group or the Global Diabetes Community Group can provide much-needed comfort. Not only do they support those who are affected by diabetes with community-led information, families, and patients can connect with families who share the same predicament and share their experiences. Most of these diabetes groups have volunteer employees who are compassionate about campaigning for activities and events that help to improve lives for diabetes patients. They do this by providing fundraising projects, advocating for the development of diabetes services and organizing outreach events. In addition, diabetes groups also offer specialist services for children and families with diabetes. The Scottish Government, (2010) commended these diabetes groups and called them respect for people’s values, which makes them extremely important to patient A and diabetes health promotion.