The essay aims to provide a critical approach to examine the health-related issues

regarding a patient with a long term condition of type 2 diabetes which has already
affected the patient holistically. The author will critically analyse the role of a
registered nurse while focusing on the understanding and the involvement of care to
a patient that has type 2 diabetes in the community. This will include the government
guidelines related to the management of type 2 diabetes and the responsibilities of
the district nurses within the community. The Code of Professional Conduct
Guidance and The Nursing and Midwifery Council (NMC, 2018) required healthcare
providers to maintain using the Pseudonym of a patient as a form of respect to
individual’s right to confidentiality and protection of his identity.

Mark is a 69-year old Chinese man and has been diagnosed with type 2 diabetes
(T2DM). He lives with his wife, his dog, and 2 children, 1 daughter and 1 son but the
son died 6 years ago. Mark loves to play table tennis and badminton with his friends,
he also goes to church every Sunday with his wife and friends to socialise. Mark falls
most of the time and often feels shaky and trembly. He was brought to A+E with
severe bruises all over his body. He was sweating and has already experienced loss
of consciousness. The recent time he had a fall caused him to have a serious
bruises so he immediately went to A&E hospital with due to suspected fracture. He’s
also been to hospital due to broken arm but has fully recovered from this; however
they found an incidental finding of T2DM. The doctor referred him to district nursing
to monitor his blood sugars where he has been prescribed with insulin that needs to
be administered. In his past medical history Mark has been battling with depression
due to his Son’s death and was a survivor of bowel cancer.

The Department of Health (DOH, 2012) Social Services and Public Safety stated that
long term condition or chronic condition may affect the patients’ life either
psychologically, socially and physically. According to (Kautzky-Willer, Harreiter and
Pacini, 2016) T2DM has increasingly marked in age. It reaches a peak after 60 years
of age with around 10% of the population are aged over 70 years who may positively
have T2DM. This has been proven by Diabetes UK (2018) prevalence refers
between 2017-2018 England, who has been diagnosed with diabetes about
3,222,559 and in the UK estimated around 3.8 million of people. Gov.UK (2016)
agreed that the proportion of patients that have T2DM has already been increasingly
and more likely giving a bigger health impact. It is more common in men 9.6%
compared to 7.6% women. Southeast Asian and black ethnic groups are more
affected, in comparison to other ethnic groups. As you get older, T2DM will increase
after the age of 45 (Kautzky-Willer, Harreiter and Pacini, 2016). Within the local data
Wolverhampton people that has been diagnosed with diabetes have prevalence of
7.7% - 16,043 Diabetes UK (2018).

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The National Health Service (NHS) England has been developing a programme
called NHS Diabetes Prevention Programme (NHS DPP) aimed to help the GP’s
give advice and offer patients who are at the risk of developing T2DM. Diabetes UK
(2018) acknowledges that this will help to tackle the risk of developing T2DM such as
advising people to eat a balanced diet and exercise more frequently.

T2DM refers into the diseases relating to insulin deficiency which can be a result of
insulin resistance (Diabetes UK, 2018). Mark’s physical condition has been affected
by his T2DM due to occasional high blood sugars which is known as hyperglycaemia
(Kirk et al., 2014). According to (Kirk et al., 2014) hyperglycaemic have symptoms of
blurred vision, fatigue and weight loss. (Diabetes UK, 2019) stated that very high
blood sugars can contribute to T2DM.

Mark was worrying to the effects of his condition’s impact on his mood, as the risk of
depression is high in patients with T2DM. Having hyperglycaemia can affect patient’s
emotional conditions that can cause depression (Moulton, Pickup and Ismail, 2015).
According to (Rustad, Musselman and Nemeroff, 2011) agreed that T2DM can
increase the risk of depression. In addition to this some patients may get injection
and needles phobias due to checking the blood sugar levels very often (Hayek et al.,
2017). Additionally (Valentine and Lowes, 2007) has explained about (Kubler-Ross,
1989) model stated that a patient that has been diagnosed with diabetes may
experience stages of grief and this can have a significant impact to the family. In
contrast of (Wilkinson, Whitehead and Ritchie, 2016) stated that some of other
researchers believed that chronic illness may hard to accept for patients. (Worden,
2018) argues that this model stage of grief has controversy due to dying, for example
people do not always experience this stage of grief. This is supported by (Dunning,
2009) these can be able to help the family to understand and acceptance to the
condition of patient that not all patients will face the stage of grief model. It is
relatively common to the family member of the patient to get anxiety and depression
due to chronic illness (Presho, 2008). According to (Diabetes.co.uk, 2019) another
impact of the diagnosis within the family life is the feelings of grief that is being
arising by chronic illness.

(Feng and Astrell-Burt, 2018) argued that the impact of a chronic illness diagnosis to
a patient may be difficult. This includes the stage of development, personality and
coping styles which can affect the change in patients behaviour. Also the care
required to look after the patient’s condition can be hard to adjust to. The patient’s
social activities may also reduce due to family concerns about safety. They may find
reasons not to go out and this can lead to a loss of freedom or opportunity for Mark
to do things independently. Diabetes UK (2018) argued that depression may give

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prevalence to patient with diabetes in terms of the fact risk factor can lead into grief
over loss of self-care ability to move. (Adriaanse et al., 2015) state that this can
affect the ability to maintain the quality of life. Since Mark found out the diagnosis he
has changed his lifestyle and found that he always wanted to be alone and not want
to go out with his wife and friends. This may affect his wife’s ability to cope with the
chronic illness of Mark. Social isolation makes patients have a hard and difficult time
to cope with chronic illness (Wilkinson, Whitehead and Ritchie, 2016). (Feng and
Astrell-Burt, 2018) suggested that social isolation impacts the lifestyle of many older
adults in society such as the ability to interact with other people. National Institute of
Clinical Excellence (NICE, 2018) argued that social isolation must be managed with
activities such as exercise which helps to prevent diabetes and keep the patient
away from depression. The student and registered nurse advised Mark to do some
exercises and other physical activities. This helps the patient to be normal and avoid
anything that might be affected with chronic illness. NICE (2012) stated that you
need to value the patient’s needs such as encourage and support.

The roles of the nurses in the management of Mark’s chronic illness include working
together with the multidisciplinary team. This includes the details and any concerns
that the patient may have and how they can best support treat and care for Mark
which assists with proving good continuity of care NICE (2017). (Castro et al., 2016)
explained empowerment in the context that the team have the right to access or
continue about the condition of a patient. This includes nurses and other
practitioners working as a team to improve the patient’s condition and play an active
part by making the decision process for health and quality of life.

The STN and RN completed a holistic assessment based on Roper, Logan and
Tierney model (Holland and Jenkins, 2019) which will allow the community level to
set a plan and give guidance of services to improve health. As a result of the
assessment one of the concerns identified was Marks diet. The STN and RN nurse
recorded the results in the notes and encouraged Mark to eat healthy foods to
stabilise nutrition of his body.

The STN and RN have to educate Mark by checking and controlling his blood sugar
level to avoid hyperglycaemia. According to (Adriaanse et al., 2015) the willingness
to adopt the change might be difficult to accept and family needed to support Mark in
managing his chronic illness. Diabetes self-management can be ideal to help Mark
in avoiding becoming hyperglycaemia. According to Diabetes UK (2018) this is
important to understand the development and control diabetes. Therefore, Mark will
have to monitor his T2DM to ensure patient participation and will help avoid
unnecessary hospital admissions, which could increase his anxiety. By being

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included this helps to achieve and maintain his blood sugar becoming stable to
improve his quality of life.

NICE (2018) recommends that patients with chronic illness and their family must be
given structural behavioural intervention strategies which helps to reduce diabetes
and avoid conflict. The STN and RN informed Mark about what kind of actions he
needs to take, such as how to avoid getting hyperglycaemia. Mark has a care plan
which aids him to check and observe the blood sugar levels regularly. This will
monitor if there are any changes. However, Healing is Essential (2013) argued that
other nurses are disagreeing, due to some patients chronic illness might get worse
by not following the instructions properly. For example, not knowing how long the
patient would take the medication.

The pharmacological approach used for Mark was Metformin and insulin (Saisho,
2015). (Diabetes UK, 2019) stated due to his T2DM using with these medications
would help to bring down the blood glucose level and back to normal range.
According to (NICE, 2017), T2DM can experience more episodes of hyper than
hypo. This means that Mark needs to monitor his blood sugar regularly as this will
assist to prevent the diabetic complications that may be harmful to the patient.

The National Health Service (NHS) has increased the responsibilities and duty of
nurses for management of patients with chronic illness (DOH, 2018). Registered
nurses work closely with general practitioners who have the responsibility to deliver
care and treatment of patients. Within the community, nurses including district
nurses, have the responsibility to perform an assessment and care planning to aid
when delivering health and social care for adult patients. (DOH, 2018) stated that
aside from specialists’ nurses, most of nurses such as district nurses have limited
assistance for self-care management to patients. In contrast, realising the Value
(2016) suggested that there are alternative programs for patients to self-manage
their condition. This can be effective with other patients in the community to
encourage self-management such as monitoring blood glucose level.

The STN and RN have to assess and deliver care by setting up a plan, making sure
Mark is involved in decisions and documenting the outcomes and needs of the
patient. This can be provided in an educational model to approach health promotion
and to empower the personality of Mark’s rights (Golden et al., 2015). According to
DOH (2018), RN has the right to advocate patients into a care setting environment
with their families and carers and to acknowledge the importance of control, conflict
and power. Also, DOH (2018) stated the advocate criteria to take into account are
4
frequency of GP visits, to check the patient appointments and number of medicines
that are needed to be taken and the prescriptions.

In addition, non-pharmacological interventions may offer alternative options of

treatment. The STN and RN made a referral for Mark’s chronic illness by contacting
the dieticians. Therefore, dieticians will have to visit and assess and give advice
about Mark’s nutrition diet. (Hassanein, 2015) suggested that having a meal plan will
be helpful to the patient to improve his lifestyle. According to (Diabetes UK 2018;
Wang and Hu, 2018; Forouhi et al., 2018) nutrition and exercise are important to
treat diabetes by preventing patients from getting hyperglycaemia. Patients may
have tendency to treat hyperglycaemic reactions by doing some exercise and to
have balance diet. Hyperglycaemia can be prevented if patients and their family
have been adequately educated to check and monitor the blood glucose levels and
to record if any there are any changes in routine. In addition to this NICE (2012)
stated that dietary recommendations must be reinforced which may help to maintain
body weight. Regardless to (Diabetes.co.uk, 2019) argued that this can be
challenging to the patient and they may find it hard to cope with. Although patients
with T2DM may also have to face fears which affect their social relationships and
lifestyle. The non-pharmacological intervention that is suitable for Mark’s chronic
illness is doing some exercises, such as aerobic exercise, which is ideal for T2DM
patients that doesn’t put pressure on the joints (Young et al., 2015).

There’s an alternative approach for T2DM management, this is Cognitive

Behavioural Therapy (CBT). CBT is a kind of therapy that gives you the concept of
physical sensations, actions and feelings that are connected (Dobson and Dobson,
2017). CBT helps individuals to think about the situation and how this may affect the
way patient’s move. According to (Royal College of Psychiatrists, 2017) CBT aids
the patient in acting on their problems and focusing on the concern that may face.
CBT has been proven in the treatment of depression, anxiety disorder and diabetes
Mental Health Foundation (2019). The STN and RN gives support to Mark to change
the patient’s thought process. This approach helps Mark to be empowered by giving
him confidence when monitoring his T2DM. CBT can be as effective as medication in
a way of treating anxiety and depression issues. The benefits of CBT can be useful
to help patients to cope better in the future rather than facing many difficulties in life.
CBT helps in altering the patient’s behaviours in order on what they feel. Although
this may be true but in contrast of (Dobson and Dobson, 2017) argued that CBT is
not advisable for patients with more difficult mental health needs.

5
In conclusion, working together as a team with MDT gives Mark the importance for
delivering the care that he needs which allows the team to understand about his
condition. Mark has been improved by monitoring his blood sugar and proper diet
which helps to MDT to planning of his care. This requires high levels of
communication skills to deliver the efficient and best possible of service that the
patient’s best interest. The role of the nurse improved the quality of life and patient
satisfactions. As Mark keeps monitoring his blood sugar levels helps him to maintain
the normal range. By doing exercises and with correct balance diet gives him
improvement by controlling taking medications very often. This means that the MDT
gives the right responsibilities to improve patient needs, to promote health and well-
being. Overall, Mark’s has the satisfaction to contribute the health care professionals
by giving the best opportunity to improve the patient’s health and to manage
empowerment with the care and treatment.

6
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