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Q1. Identify the risk factors for Mr James Storey and clearly explain why these are risk factors for him?
Answer. Various risk factors which contribute to the poor health status of Mr James Storey include behavioural risk factors, such as poor diet. Since he is taking more of pasta and bread, even though they have a high glycaemic index. They contribute to his condition of diabetes mellitus and obesity. His daily consumption of beer, also places him at high risk of poor glycaemic control. He is also an occasional smoker and has limited physical activity which has led to increased weight gain. As per research conducted by Chang et al., (2012), smoking is directly linked to poor treatment outcomes in patients with obesity and diabetes mellitus. Other risk factors include biomedical risk factors, such as increased blood pressure (National Strategic Framework for Chronic Conditions Standard 1.1, 2020), glucose intolerance and stress. All these factors are inter-related and act as triggers to cause risk for the occurrence of other factors. The non-modifiable risk factor includes age and genetics. As per the case study, it has been found that Mr James Storey's father also had diabetes, hence making him more vulnerable to the disease. Furthermore, he is 40 years old, and it is a well-known fact that as the age increases, the risk of comorbid conditions also increases such as hypertension and cardiovascular disease (Pes et al., 2019).
Q2. Using the best available evidence, identify the nursing assessments that are required to be conducted for Mr James Storey and the rationale for these.
Answer. Nursing assessment for Mr Storey's would include, history taking, objective and subjective examination. As per the case study, Mr Storey has a history of multiple comorbidities such as hypertension, cardiovascular disease and type II diabetic Mellitus. His family history is also positive for type 2 diabetes mellitus, which is an indication that the disease has been genetically transferred to him as per the research of Khan et al., (2020), the genes play a vital role in determining the health status of an individual. The increase in susceptibility of carrying a high risk of developing T2DM is through the gene TCF7L2. Furthermore, the research also stated the impact of other factors such as gender, age and BMI. In the objective nursing assessment, it is noted that the BMI of Mr Storey falls into the obese category. The finding also suggests poorly controlled blood pressure. The rationale for conducting the subjective, objective assessments in nursing is to rule out the cause of the disease as well as the current health status of an individual and to understand the pathophysiology of the impact of the chronic conditions on patient’s physical and mental health. It forms the basis of the treatment protocol (Sulaiman et al., 2017).
Q3. Using the best available evidence, discuss the self-management priorities that would be developed in collaboration with Mr James Storey. These should consider health promotion and reducing the risk of complications (Strategic Priority Area 1.1).
Answer. Various self-management techniques can be deployed for improving the healthcare outcomes in the case of Mr Storey. The primary management technique includes adherence to medication, the patient should be encouraged to stick to the medical treatment, regular monitoring of glucose or SMBG (self-monitoring of blood glucose). Mr Storey must maintain a journal of blood glucose monitoring as well as blood pressure monitoring at home. Various researches reveal that importance of journaling in increasing accountability in the patients to take responsibility of their health and help in making well-informed decisions for their health (Archer & Aria, 2019; Kim et al., 2019). The second technique encompasses lifestyle modifications and dietary changes. Research conducted by Balducci et al., 2017 reported that behavioural interventions such as healthy eating habits and playing games helps in controlling sugar levels in the body, reduce stress and manage obesity as well as hypertension. Therefore, group exercises and activities must be encouraged to motivate Mr Storey to make modifications and losing weight (National Strategic Framework for Chronic Conditions Standard 1.1, 2020).
Q4. Utilising the SMART acronym (Specific, Measurable, Achievable, Relevant and Timely) identify and describe one goal that will be set in collaboration with the patient from the self-management priorities identified in Q3. Explain why this goal was selected.
Answer. Increased weight is the primary root cause of all other underlying chronic conditions. By adequate weight control and management, the target goal of blood glucose levels, as well as target blood pressure levels, can be achieved (Balducci et al., 2017; Poppe, 2019; Rygg, Lohre & Hellzen, 2017). The SMART goal intervention would encompass S- Specificity of the goal, such as, having a clear vision of the goal. The patient must state an exact amount of weight to be lost. As per the case study, Mr Storey was advised to lose 5 kgs of weight. M- it refers to defining the milestones during the journey of reaching towards the goal, for instance, evaluating weekly progress in the weight loss journey. A- The goal must be achievable, which is to say that the goal must be within the reasonable limits. R- realistic. For instance, in the case study of Mr Storey, the goal is to lose 5kgs initially and not 20 Kgs. T- It refers to the period during which the gaol has to be achieved. For instance, to lose 5kgs weight Mr Storey must commit to a time frame of 2 months.
Q5. Using the best available evidence, explain how goal setting may impact on actively engaging patients in their care (Strategic Priority Area 2.1).
Answer. According to the Strategic Priority Area, 2.1 of the National Framework of Chronic Conditions states that various healthcare stakeholders such as government policymakers, non-profit organizations, environmentalists and healthcare professionals play an active role in facilitating the patients to make healthy and well-formed choices in their lives. Developing Partnerships with academicians, governmental and organizational structures in health promotion and prevention and promotional activities enhances the healthcare outcomes of the individuals (Kim & Jeong., 2019). It addressed the challenges of the community and aim to bridge the socio-economic gaps between the urban and the rural population. It is vital to eliminate healthcare inequity and disparity among various communities by engaging in awareness creating programs, increasing the accessibility of healthcare infrastructure and medical facilities in the remote and rural areas to aid healthy lifestyle in people and to reduce the burden of chronic diseases on the healthcare system (Saito, 2016).
Archer, N., & Aria, R. (2019, May). Reducing risk from chronic illness with lifestyle changes supported by online health self-management. In 2019 IEEE/ACM 1st International Workshop on Software Engineering for Healthcare (SEH) (pp. 73-76). IEEE.
Australian Government Department of Health, (2020). National Strategic Framework for Chronic Conditions. Retrieved from https://www.health.gov.au/resources/publications/national-strategic-framework-for-chronic-conditions
Balducci, S., D’Errico, V., Haxhi, J., Sacchetti, M., Orlando, G., Cardelli, P., ... & Nicolucci, A. (2017). Effect of a behavioural intervention strategy for adoption and maintenance of a physically active lifestyle: the Italian Diabetes and Exercise Study 2 (IDES_2): a randomized controlled trial. Diabetes care, 40(11), 1444-1452.
Khan, S. M., El Karte, N., El Hajj Chehadeh, S., Hassoun, A., Afandi, B., Tay, G. K., & Alsafar, H. (2020). Association between type 2 diabetes mellitus & TCF7L2 gene variants in the Emirati population: Genetics of diabetes in the United Arab Emirates. American Journal of Human Biology, e23434.
Kim, Y., & Jeong, W. (2019). An Analysis on Role of Stakeholders for Security System in Smart Healthcare Environment. Journal of Society for e-Business Studies, 24(1).
Kim, Y., Park, J. E., Lee, B. W., Jung, C. H., & Park, D. A. (2019). Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: A systematic review and meta-analysis. Journal of telemedicine and telecare, 25(10), 587-601.
Pes, G. M., Licheri, G., Soro, S., Longo, N. P., Salis, R., Tomassini, G., ... & Dore, M. P. (2019). Overweight: a protective factor against comorbidity in the elderly. International Journal of Environmental Research and Public Health, 16(19), 3656.
Rygg, L. Ø., Løhre, A., & Hellzèn, P. O. (2017). Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes–The Active Ingredient in the Education. A Qualitative Study.
Saito, M. (2016). Current status of community pharmacies: expectations as a health information hub, the enforcement of revised pharmaceutical and medical device act, and a new role as stakeholders. Yakugaku zasshi: Journal of the Pharmaceutical Society of Japan, 136(2), 245-249.
Sulaiman, I., Cushen, B., Greene, G., Seheult, J., Seow, D., Rawat, F., ... & MacHale, P. (2017). Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 195(10), 1333-1343.
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