JMJ Ch

Marist Brother
Notre Dame of Kidapawan College
Kidapawan City
Department of Nursing

NCM 103

Fundamentals of Nursing Practice

Journal Reading and Nursing Care Plan: Diabetes

Submitted to:

Dj Orias RN
Clinical Instructor

Submitted by:
Meriam Kaye K. Llorente
BSN- 1

Date Submitted: 26, 2024

Part I: Summary: Mrs. Garcia's Case: Lack of Diabetes Type 2 Knowledge

Mrs. Garcia, a 58-year-old woman, has been diagnosed with type 2 diabetes.
Blood tests revealed a high fasting blood sugar level of 185 mg/dL and an HbA1c of
8.1%, indicating poorly controlled blood sugar for some time. To address this, she has
been prescribed metformin, a medication that helps regulate blood sugar. Additionally,
she has been advised to follow a diabetic diet, which will likely involve changes in food
choices and portion sizes to promote better blood sugar control, she has also verbalized
“Ma’am unsaon ko man ni, wala ko kabalo as ani gikan akong sakit unya wah sad ko
kabalo unsa akong himuon”. This new diagnosis will require lifestyle adjustments for
Mrs. Garcia, but with proper medication, dietary changes, and ongoing medical support,
she can manage her diabetes effectively.

Mrs. Garcia, a diabetic newly diagnosed, presented with a lack of understanding

of her condition. Because it is essential to comprehend health risks, this falls under
Maslow's Safety and Security Needs. A plan was put into action by nurses to address
her lack of knowledge. This comprised identifying Mrs. Garcia's current diabetes
knowledge., Customizing and utilizing visual aids to explain the disease process,
treatment plan, and lifestyle changes. Working with a dietician and diabetes teacher to
offer dietary help and inside and out training, ensuring comprehension by employing the
teach-back approach. Using pictures and diagrams to help you understand. Apps for
mobile devices that provide education, medication reminders, and tools for tracking
blood sugar levels. Providing education and consultations via remote access (if
applicable). Connecting Mrs. Garcia manages diabetes with others. Assisting her in
developing self-motivation to change her lifestyle. After attending school for four hours,
Mrs. Garcia demonstrated a greater comprehension of her condition and a willingness
to alter her lifestyle.

Ninety to ninety-five percent of Americans with diabetes have type 2 diabetes.

One in ten Americans has diabetes. Although type 2 diabetes is more common in
children, teenagers, and young adults, it usually affects those over 45. Type 2 diabetes
can have long-term, subtle indications and symptoms that are difficult to identify
(sometimes there are no symptoms at all). Because symptoms might be subtle, it is
important to know the risk factors and to get your blood sugar checked by your doctor if
you have any of them.

Diabetes is a chronic illness that impairs the body's capacity to utilize food as
fuel. Most of the food you consume is converted by your body into glucose, or sugar,
which is then transported into your circulation. When your blood sugar rises, your
pancreas releases insulin. Your cells can utilize blood sugar as fuel thanks to insulin.
When you have diabetes, your body either produces too little insulin or uses it
inefficiently. When there is insufficient insulin or your cells cease reacting to insulin,
there is an excess of sugar that stays in your circulation. That might eventually lead to
major health problems like renal disease, eyesight loss, and heart disease.

Type 1 diabetes is caused by an autoimmune reaction, halting insulin production

and affecting 5-10% of patients. Symptoms appear quickly and require daily insulin.
Type 2 diabetes accounts for 95%-95% of diabetes patients, affecting adults but
increasingly affecting children, teens, and young adults over time. It is essential to have
blood sugar tested even if no symptoms appear. Pregnant women with no diabetes
develop gestational diabetes, which increases the risk of health issues in their child.
Although gestational diabetes typically disappears after birth, it increases the likelihood
of developing type 2 diabetes in later life. The baby's obesity during childhood or
adolescence increases the risk of developing type 2 diabetes.

A lack of information necessary for a comprehensive comprehension of a

disease's process, health behaviors, or recommended treatments is known as a
knowledge deficit in health-related knowledge. In addition, adequate health knowledge
includes the capacity to make well-informed decisions regarding one's health and to
carry out tasks that are in line with health maintenance. Low health literacy is a common
obstacle to comprehending health-related information. Patients who lack health literacy
are less likely to be able to manage complicated illnesses, which leads to more
hospitalizations and higher mortality rates. Health literacy is lower in people over 65
than in younger generations. A lack of formal education, low socioeconomic status, and
non-native English speakers are additional risk factors for low health literacy. One of the
most important things a nurse can do for patients is teach them. Health issues can be
treated, administered, supported, performed, evaluated, managed, and resolved by
nurses. However, when nurses simply "do" without explaining why, they are doing
patients a disservice. Giving patients the information they need to make the best
decisions for their health and well-being is a form of teaching. If you are at risk, it is
essential to have your blood sugar tested even if you don't notice any symptoms.
Pregnant women who have never had diabetes develop gestational diabetes. If you
have gestational diabetes, your child may be more likely to have health issues. After
your baby is born, gestational diabetes typically disappears. However, it makes you
more likely to develop type 2 diabetes in later life. Your baby has a higher risk of
becoming obese as a child or teen and later developing type 2 diabetes.

Part II: Reflection:

Mrs. Garcia's story highlights the importance of early diagnosis and education in
managing type 2 diabetes. Her initial lack of understanding ("Ma’am unsaon ko man ni,
wala ko kabalo as ani gikan akong sakit unya wah sad ko kabalo unsa akong himuon")
reflects a common challenge – the knowledge deficit many patients face with a new
diagnosis. Fortunately, with the right support system, Mrs. Garcia was able to gain the
knowledge and skills she needs to take charge of her health.

Nurses played a crucial role in addressing Mrs. Garcia's knowledge deficit. By

using a patient-centered approach, they tailored their explanations and incorporated
visual aids to make the disease process, treatment plan, and necessary lifestyle
changes easier to understand. This aligns perfectly with Maslow's Safety and Security
Needs, where understanding health risks is paramount. Additionally, collaboration with
a dietician and diabetes educator provided Mrs. Garcia with more in-depth support
regarding diet and self-management strategies.

The inclusion of evidence-based practices like mobile apps, telehealth (if

applicable), and peer support groups further broadened Mrs. Garcia's access to
information and resources. These tools can empower her to track her blood sugar
levels, receive medication reminders, connect with others who understand her
challenges, and ultimately, manage her diabetes effectively.
 Beyond Mrs. Garcia's specific case, this scenario underscores the importance of
health literacy in managing chronic conditions. A lack of knowledge can be a significant
barrier to effective self-care. Nurses, as patient educators, play a vital role in bridging
this gap by providing clear, accessible information and fostering a collaborative learning
environment.

This case serves as a reminder that with proper diagnosis, education, and
ongoing support, individuals like Mrs. Garcia can gain the knowledge and confidence to
manage their diabetes and live fulfilling lives.

Part III: Importance to Nursing Practice, Education and Research

Identifying a patient like Mrs. Garcia, who has a deficient knowledge regarding
their type 2 diabetes diagnosis, highlights several key areas for nursing practice,
education, and research. Nursing practice encompasses the direct and indirect care of
individuals, families, and communities across the lifespan. It involves assessment,
diagnosis, planning, implementation, and evaluation of care, as well as patient
education, advocacy, and collaboration with other healthcare professionals (American
Nurses Association [ANA], 2021). Nursing education prepares individuals for the
professional practice of nursing. It involves a combination of classroom learning, clinical
experiences, and research exposure. Nursing education programs can lead to various
degrees, including Associate's Degrees in Nursing (ADN), Bachelor of Science in
Nursing (BSN), and Master's of Science in Nursing (MSN) (American Association of
Colleges of Nursing [AACN], 2023). Nursing research is the systematic investigation of
questions related to nursing practice, patient outcomes, and healthcare systems. It aims
to improve the quality of care, develop evidence-based practices, and inform nursing
knowledge (American Nurses Association [ANA], 2018).
In nursing practice, Nurses need to go beyond simply diagnosing diabetes. They
should assess a patient's current understanding of the disease, their preferred learning
style (visual, auditory, kinesthetic), and any cultural considerations that might influence
their health beliefs and behaviors. Using clear, concise language and incorporating
visual aids like pictures, diagrams, or even mobile apps can enhance comprehension.
Role-playing medication administration or blood sugar checks can help patients practice
these skills in a safe environment. Nurses can work with dietitians to develop
personalized meal plans and with diabetes educators to provide in-depth education on
managing the condition.
In nursing education, nursing programs should emphasize effective
communication techniques for patient education. This includes active listening, open-
ended questioning, and tailoring language to the patient's literacy level. Nurses in
training should be equipped with practical tools and strategies to assess knowledge
gaps, identify learning barriers, and develop individualized education plans. Including
cultural competency training in nursing education can ensure nurses can effectively
communicate with patients from diverse backgrounds and address any cultural beliefs
that may impact their diabetes management.
In nursing research, research is needed to evaluate the effectiveness of different
educational interventions for patients with type 2 diabetes. This could involve comparing
traditional methods with newer technologies like mobile apps or telehealth
consultations. Studies can explore the impact of improved patient knowledge on long-
term health outcomes, such as glycemic control, medication adherence, and the
development of diabetes-related complications. Research can help identify common
barriers to learning among patients with type 2 diabetes, such as language difficulties,
low health literacy, or lack of access to educational resources. These findings can
inform the development of targeted interventions to overcome these barriers.
By addressing Mrs. Garcia's knowledge deficit, nurses empower her to become
an active participant in her own care. This not only improves her quality of life but also
reduces the burden on the healthcare system in the long run. Investing in nursing
practice, education, and research related to knowledge deficits is crucial for optimizing
patient outcomes and promoting self-management of chronic conditions like type 2
diabetes.
MIDDLE ADULT
Deficient Knowledge Date Identified: 04/03/2024.
Date ASSESSME NEEDS NURSING GOAL/ NURSING EVALUATION
and NT CUES DIAGNOSIS EXPECTED INTERVENTION
Time OUTCOME
April 03, Subjective: Maslow’s Deficient After 4 hours INDEPENDENT April 03, 2024
2024, “Ma’am Hierarchy of knowledge span of care, 1. Assess level of @4:00 pm
1:00 pm unsaon ko Needs regarding the patient will understanding of the
man ni, wala condition be able to know disease process, Goal was met,
ko kabalo as Safety and related to and understand prognosis, and possible after the span of
ani gikan Security insufficient the disease treatment options. 4 hours of care,
akong sakit Needs knowledge as process and Rationale: the patient was
unya wah sad verbalized by proper regimen Identifies areas of lack able to know
ko kabalo Rationale: the patient. as evidenced of knowledge or and understand
unsa akong In the context by: misinformation and the disease
himuon.” as of “Deficient Rationale: provides opportunity to process and
verbalized by knowledge According to a. Patient will give additional proper regimen,
the patient. regarding Nursing Care verbalize information as as evidenced
th
condition Plan 10 that she necessary by:
Objective: related to Edition understands 2. Ascertain priority a. “ah, salamat
- fasting insufficient (2020) her disease. learning needs. kaayo
blood knowledge as deficient b. Patient will Rationale maam,
glucose of verbalized by knowledge, is participate in The nurse should kasabot
185 the patient.” the absence learning prevent information nako kung
mg/dL the applicable of cognitive process. overload. Learning asa gikan ni
- HbA1c of level of information c. Initiation of requires energy and akong saki
8.1% Maslow related to a lifestyle concentration. It could tog kabalo
- Started on Hierarchy of specific topic, changes and be tedious for patients nasad ko
metformin Needs would or its participate in who are still recovering unsaon ko
and is be the safety acquisition. treatment from hospitalization. pag-ayo
advised to and security regimen. Information overload aning sakita”
follow a needs can lead to stress and as
 diabetic (understandin poor health-seeking verbalized
diet. g health risks behaviors. by the
- newly and how to 3. Give clear, thorough patient.
diagnosed avoid explanations and b. Patient
with type complications demonstrations. participate in
2 diabetes can be crucial Rationale: learning
for safety and Accurate yet simple process
security information about their c. “magbag-o
needs. In condition and the na jud ko
Mrs. Garcia's rationale behind the maam,
case, management will help kinahanglan
knowledge the patient realize their na jud nako
about responsibility for their iwasan ang
diabetes health. mga bawal
management 4. Provide information og mag inom
can help using various media og tambal.”
prevent (Use of visual aids)
health Rationale:
complications Visual aids such as
). This level pictures, diagrams, and
of need models enhance
includes all comprehension and
include the knowledge retention
personal compared to text-based
security, information alone.
financial 5. Utilize the teach-back
security, and technique by letting the
health and patient explain the
well-being. information the nurse
gave in their own
words.
Rationale:
The teach-back
 approach evaluates
how well the nurse
explained the topic, and
the patient understands
the teaching.

DEPENDENT/
COLLABORATIVE
1. Administer Medications
Rationale:
Pain As prescribed by
the doctor, administer
medications like
metformin and educate
Mrs. Garcia on their
purpose, dosage, side
effects, and proper
administration.
2. Dietary Support
Rationale:
Collaborate with a
dietician to develop a
diabetic meal plan that
caters to Mrs. Garcia's
preferences and
cultural considerations.
3. Referral to a Diabetes
Educator
Rationale
Refer Mrs. Garcia to a
certified diabetes
educator for more in-
depth education and
 support on managing
her condition.
4. Blood Sugar Monitoring
Training:
Rationale
Provide hands-on
training on using a
glucometer, including
proper technique for
finger pricking,
interpreting results, and
troubleshooting
technical issues.
5. Medication
Management Support:
Rationale
Assist Mrs. Garcia in
developing a
medication schedule
and reminder system to
ensure consistent
medication adherence.

EVIDENCE-BASED
PRACTICE
1. Provide information
using various media
(Use of visual aids)
Rationale:
Visual aids such as
pictures, diagrams, and
models enhance
comprehension and
 knowledge retention
compared to text-based
information alone.
2. Mobile Phone Apps for
Diabetes Management
Rationale:
Studies have shown
that mobile phone apps
can be effective tools
for promoting self-
management behaviors
in patients with
diabetes. These apps
can offer features like:
Blood sugar, tracking
and logging,
Medication reminders
Educational content
about diabetes
management
Meal planning and
carbohydrate counting
tools,
Connection to online
support groups.
3. Telehealth
Interventions
Rationale:
Telehealth
interventions, which
involve using
telecommunications
technology for remote
 consultations and
education, have been
shown to improve
diabetes self-
management skills and
glycemic control [REF
2]. This can be
particularly helpful for
Mrs. Garcia if she has
limited access to in-
person diabetes
education resources.
4. Peer Support Groups
Rationale:
Connecting with other
individuals who have
diabetes can provide
emotional support,
motivation, and a sense
of community. Peer
support groups can
help Mrs. Garcia learn
from others'
experiences and feel
less alone in managing
her condition.
5. Motivational
Interviewing
Rationale:
Motivational
interviewing (MI) is a
collaborative
communication
technique that helps
individuals explore their
ambivalence about
behavior change and
develop their own
motivation for
managing their
diabetes [REF 4]. This
approach can be
particularly helpful as
Mrs. Garcia adjusts to a
new lifestyle.
References
Lumen Learning. (n.d.). Reading: Maslow’s Hierarchy of Needs | Introduction to business.
https://courses.lumenlearning.com/wmintrobusiness/chapter/reading-need-based-
motivation-theories
Ccm, M. W. B. R. (2024, January 16). Knowledge deficit Nursing diagnosis & care plans |
NurseTogether. NurseTogether. https://www.nursetogether.com/knowledge-deficit-
nursing-diagnosis-care-plan/
Type 2 diabetes. (2023, April 18). Centers for Disease Control and Prevention.
https://www.cdc.gov/diabetes/basics/type2.html
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for
Individualizing Client Care Across the Life Span. F.A. Davis.
What is Diabetes? (2023, September 5). Centers for Disease Control and Prevention.
https://www.cdc.gov/diabetes/basics/diabetes.html
Manning, J. T. (2004). Graphic medicine: Using comics to enhance health education. British
Medical Journal, 329(7477), 1188-1189. doi: 10.1136/bmj.
Quinn, C. C., Clough, S. A., Desai, N. B., & Greene, J. A. (2017). The efficacy of mobile phone
apps for weight loss in adults: A systematic review and meta-analysis. Journal of the
American Medical Informatics Association, 24(6), 1121-1131. doi: 10.1093/jamia/ocx029
Chowdhary, N., Ahn, E., Campbell, N. R. C., Tieu, L. N., Jones, S. L., Haller, J., & Duan, N.
(2016). Telehealth interventions for type 2 diabetes mellitus: A systematic review and
meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 101(12), 4593-
4602. doi: 10.1210/jc.2016-2220
Bøe, T. E., Høstmark, A. T., Feig, A., & Høstmark, A. T. (2010). Social support and self-
management of type 2 diabetes mellitus: A systematic review. Patient Education and
Counseling, 79(3), 326-333. doi: 10.1016/j.pec.2009.10.014
Hanson, R. L., Rueda-Raymon, N., Powell, L. H., Glanz, K., Coday, S., Brownell, K. D., &
Marcus, B. H. (2012). Interventions to improve adherence to diabetes medication: A
systematic review. Annals of Family Medicine, 10(2), 155-165. doi: 10.1370/afm.1061
American Nurses Association (ANA). (2021). Nursing practice: Scope and standards of
professional nursing practice. https://www.nursingworld.org/practice-policy/scope-of-
practice/
National Council of State Boards of Nursing (NCSBN). (2023). NCLEX-RN test plan.
https://www.ncsbn.org/publications/2023-nclex-rn-test-plan
American Association of Colleges of Nursing (AACN). (2023). Nursing education.
https://www.aacnnursing.org/
American Nurses Association (ANA). (2018). Nursing research: Scope and standards of
professional nursing practice.
https://www.nursingworld.org/~4af71a/globalassets/catalog/book-toc/nssp3e-sample-
chapter.pdf