Chronic Condition Diabetes
It is a difficult task caring for people living with chronic diseases bearing in mind that the process focuses more on management of symptoms as opposed to the treatment. The result of healthcare also depends on different factors including psychological and social factors. There are other additional factors (as causes and consequences) involved and they need to be given consideration including quality of life; sick/illness role, social isolation, symptom management, stigma, patient empowerment, social support, sexuality and body image.
We look at the factors in relation to diabetes below.
Social isolation can be a challenge in the care of people living with diabetes. This is in relevance Diabetes Self-Management Education (DSME) question. Suhl and Bonsignore (2006), refer DSME as a significant part of diabetes care ‘for all individuals with diabetes who want to achieve successful health-related outcomes’’ (p. 235). In other words, DSME aims at ensuring that management of the disease is simple.
This also involves different variables (having diabetes-related knowledge, nutritional assessment and physical activity assessment) and operational variables (cognitive dysfunction, depression and physical disability). All patients are expected to take part in their care. Even so, the importance of having people (family, friend and healthcare staff, for instance) should not be overlooked.
Social isolation as it were can lead to complications making it difficult to manage the condition. The two DSME parts imply two types of social isolation or its two causes including cognitive and physical. The physical aspect refers to the patient’s ability to move around and perform different tasks required as part of DSME.
The cognitive aspect on the other hand has more to do with the ability of a patient to perceive and comprehend their illnesses as well as how long one should go in its management (Suhl & Bonsignore, 2006; Steptoe, et al., 2013). Nonetheless, these issues can lead to social isolation if there is no one to help them.
Additionally, studies reveal that patients who do not get DSME are at high risk of developing major complications of the disease compared to those who do not. Social isolation can prevent effective DSME. In this regard, it is essential to note the prevalence trend of social isolation in patients with chronic conditions across all ages. Research also shows that the challenges mentioned above (physical and cognitive inabilities) are common among elderly patients compared to younger ones.
Quality of Life
Hernandez, et al. (2000) defined the focus on quality life as concerning ‘the reduction in expenses, to reduce mortality and complications’’ (p.50). Despite being sick in other words, there are standards set within which a patient with diabetes can be said to receive satisfactory care. This is where the issue of quality of life arises.
Therefore, serious complications of diabetes, increase in psychiatric conditions and worsening metabolic control are known to worsen the quality of life of a patient living with the condition. According to Huang, et al. (2007), it is essential to understand how the sick perceive and evaluate the quality of life (in relation to complications and treatments) because it helps to assess the diabetes patient’s economic value and to ‘’provide insight into treatment adherence’’ (p. 2478).
Diabetes weakens the immunity system of a patient. Patients are more susceptible to a wide range of cardiovascular and micro vascular diseases. A study carried out by Hernandez, et al. (2000) for instance, revealed several complications in patients living with diabetes mellitus. 35.2 percent of the patients involved had hypertension, 31.1 percent were overweight and 19.4 percent suffered ischemic cardiopathy.
Other patients in the study had diabetic foot ulcers as well as secondary chronic renal failure. Some also had gone blind and had amputations. Even so, the complications and risks can be reduced significantly via all-inclusive as well as exhaustive care (Huang, et al. (2007). Hernandez et al. (2000) for instance found out that such complications were related to the failure of a patient to keep appointments with the doctor (59.5 percent of the patients failed to visit chiropodist, 57.3 percent did not visit their dentists).
Despite the fact that 55.8 percent of patients lived sedentary lives, those who smoked made up 24.3 percent and 17.8 percent failed to visit their family doctors. It is therefore essential to note and understand the factors that define the quality of life of a patient (related to age and type of diabetes, among others) based on the fact that it determines the attention needed by a patient.
The healthcare system like other structures includes the role of vital agents. In the modern healthcare system, being patient is accompanied with different social expectations; ‘’what it means to be a ‘‘patient,’’ how one gets the condition and, especially, what one is to do when he or she becomes a patient’’ (Emke, 2002, p. 81). According to Talcott Parsons (quoted in Emke, 2002), ‘‘illness is not merely a state of the organism and/or personality but comes to be an institutionalized role’’ (p. 82).
In other words, even though patients have rights, they also have responsibilities as well as obligations in their healthcare process. This is what is known as sick/illness role and it lies on the patient’s ‘‘lay beliefs on the condition and treatment’’ (Davies, 1999, p. 119) which affects a patient’s behavior.
In respect to rights, according to Talcott Parsons (cited in Emke, 2002), once one becomes a patient, they have a lawful right to withdraw into dependency: they are exempted from normal social responsibilities and from carrying out the full responsibility of getting well. the sick in other words have the right to assistance. Even so, a patient has responsibility to ensure those who care for them have an easy time. They should ensure cooperation with nurses, physicians and supporting members of the family.
In traditional set up, the healthcare system did not give a lot of attention to the role of the patient in the process of healthcare. Even today, many healthcare experts do not recognize the sick role. Luckily, it is not gloom as it was in the past. Many attempts have been made and this is the premise that underlies patient empowerment concept.
Care in diabetes just like in all chronic diseases focuses on symptom management as opposed to treatment. This is in relevance to the quality of life concept, which focuses on ensuring the lives of diabetes patients is bearable. Poor care (symptom management) can enhance the progression of the disease leading to further complications (Harris et al., 2012).
Alwan (1994) outlines basic symptom management principles. To start with, healthcare experts can decide on what to do in diabetes patient care. First of all, they must understand what they are dealing with. This means correct diagnosis should be carried out for efficient symptom management. Since diabetes has no cure, care focuses more on reducing blood sugar level thus, correcting any possible risk factor that could cause more complications (including hyperlipidemias, obesity and smoking among others) and monitoring blood pressure.
In the event where patients of diabetes mellitus do no depend on insulin, care requires team work round the clock. Doctors are required closely with healthcare team, nurses and the patient. Self-monitoring that is enhanced via DSME is also essential as it helps to enhance the quality of life as it ‘‘improves the quality of life and safety of therapy’’ (Alwan, p. 4). In this relevance, the healthcare system should offer patients basic requirements making it easy for them to practice self-care.
Even so, there are no same patients. Therefore, management (including therapy) should be custom to suit individual needs of a given patient. Record keeping is vital to ensure proper follow up and continuity of treatment. Having stated that treatment should be designed towards the needs of an individual, the effect is that there cannot be a general management and standard treatment strategy. These principles are however essential in offering an ideal care framework.
Powerlessness and empowerment
In patient care traditional approach, medics and nurses played I-know-it-all. This means they acted as those who understood everything and those patients but were just recipients of their care. The patients simply had no power to decide on how they wanted the care to be administered to them. However, for the past 20 years, this has changed and it is worth noting.
The empowerment approach gives a patient voice and it has been recognized, accepted and applied in management of patient. Not only does the sick receive care of choice but they also become the ‘‘central figures in the design and implementation of their diabetes care plans’’ (Weiss, 2009, p. 116). This has also been enhanced by different scientific and developmental changes that have taken place over the past years.
The idea of empowering patients rests on key premises listed by Meetoo & Gopaul (2005). First ‘‘patients are the ones who experience the consequences of both having and treating their illness so they have the right to be the primary decision-makers regarding their medical condition” (Weiss, 2009, p. 117). Secondly, patient empowerment takes place within the patient.
As a result, it is not only the duty of healthcare providers to hand it to the sick. However, they (the healthcare professionals), can only create an environment that aids and enhances empowerment of the sick. Thirdly, empowerment leads to trust between the patient and healthcare providers, which is significant ingredient in determining positive healthcare results.
Empowerment of patients also doesn’t give the sick authority to decide how they want to be taken care of. It also enables them to take part in the care program. DSME is an ideal example of empowerment of the sick. Patient empowerment most importantly involves giving them access to facts on their sicknesses as well as alternative care methods available. This means that the sick make informed decisions.
It is therefore essential to clearly understand social and psychological effects of the disease because it advises on strategy and practice to patients. Social issues have also affected the healthcare of patients as well as their quality of life and one of them is stigma. It may not be easy to tell a sick person in the initial stages because the symptoms are not clear. Even so, there are physical and behavioral aspects that may be notable.
The features can lead to undesirable occupational, emotional and social consequences. It is a form of ‘‘living on the outside’’ (Dwivedi, n.d., p.1). When it comes to stigma, theoretical perspectives take three views including social psychological, sociological and interactionist. Sociological perspectives focus more on traits that socially discredit, as well as social features that lead to stigma. For instance, when the sick ‘‘appraise the demands imposed by stigma-relevant stressor, such as injecting insulin in public’’ (Schabert, et al.,2013) it poses identity risk because there are people can mistake them for illegal drug users.
In this respect, management focuses on how the patient or a person perceives and responds to risks to his or her identity socially. Social psychological focuses on how different attributes can lead to unwanted characteristics and stereotypes. On the other hand, interactionist views link social psychological to sociological aspects.
Stigma is also characterized by some assumptions from the general public on their view of people living with the disease (those who exhibit the symptoms). There are negative stereotypes including labeling the sick as lazy. Once such stereotypes are linked with the negative ones, a separation process occurs in what is known as the in-group/outgroup comparison.
What’s more, there is still the tendency of placing ‘us’ against ‘them’. These tendencies in some cases become automated reactions and ultimately, stigma leads to discrimination and loss of status. Enhancing the quality of life of people living with diabetes necessitates presence of the people for emotional support. Focusing and addressing the issue of stigma via sensitization of the general public is therefore essential part of healthcare.
In the case of body image, we refer to physical aspects that are notable in diabetes patients. In relation to this, there are questions on eating habits, glycemia in diabetes patients and body mass. Diabetes patients are often known to suffer following disordered eating that affects their body mass.
There are also general eating disorders patterns among patients depending on the type of diabetes they suffer from. Mentioning literature in this field (Davison (2003), states that diabetes type 1 patients often suffer from ‘‘subclinical eating disorders and bulimia nervosa’’ (p.62), while patients with diabetes type 2 often exhibit suffer from ‘‘subclinical and clinical clinge eating disorders’’ (p.62)
There are no direct connections between healthcare results and body image. Even so, body image indirectly can be utilized to determine the quality of life of a patient and consequently, the amount of care needed. Melter et al (2001) notes “eating disorders per se do seem to be associated with poorer glycemic control and increased risk for complications” (p. 678). These affect body image and it can generate other complications affecting healthcare results.
For instance, as mentioned above, body image exposes the illness of a patient to other people and it can easily lead to stigma. This may in the end result in social isolation, loneliness, social isolation and down the line even depression. All these factors are in the same way related and together, they affect the quality of life of a patient. Therefore, body image should be addressed as an element of quality of life and hence, a very crucial element of healthcare.
Besides different psychological and medical complications diabetes can lead to sexual dysfunction. Research offers string evidence of sexual disorders among male diabetes patients. Erectile dysfunction that is quite common in early childhood between the ages of 4-8 is not all but additionally, a revelation of other significant factors. For instance, it has been associated with longer duration of the disease as well as the presence of complications related to the disease.
Studies also point out that there is a possibility that the disease affects more women than men (Enzlin, et al., 2003; Zaiei-Reid, et al., 2010). To start with, sexual dysfunction in patients suffering from diabetes in their study in Iran, Zaie-Reid, et al. (2010) discovered that both genders are affected by sexual dysfunctions. They also found out that the problem is prevalent in patients suffering from type 2 diabetes (91.0 percent).
Even so, as discussed above, the most notable was that women are the most affected compared to men. These findings support early research findings on sexual dysfunction among diabetes type 1 patients by Enzlin, et al. (2003). Additionally, it was found out that 27 percent of women diabetes type 1 had sexual dysfunction compared to 22 percent of men.
However, the question as to whether the sexual condition is more prevalent among diabetes type 1 patients or those suffering from diabetes type 2. Nonetheless, that diabetes leads to sexual dysfunction is not to be doubted. Sexual dysfunction predictors in men are different from these in men (Enzlin, et al., 2003; Zaiei-Reid, et al., 2010). The condition in diabetes patients can be a symptom of the level of the disease in the patient. Therefore, understanding the situation inform the type of the disease as well as the level of care that a patient should receive.
Social and family support
Social isolation (loneliness) can lead to different complications including depression. Therefore, it is essential that a patient receives social support from friends, family and healthcare practitioners as it makes symptom management quite simple. It the realization of this in the past years, social support has been included as a significant part of diabetes self-care. Family members, more specifically are considered essential source of social support for the patients.
Family members can therefore have a great impact on symptom management results. They can easily facilitate (such as filling prescriptions) or interfere (such as buying groceries) with efforts of self-care (Mayberry & Osborne, 2012; Marzilli & College, n.d). Social support also involves different activities on those taking responsibility. They can offer evaluation, informational and emotional support; instrumental support (such as taking care of notable actions that facilitate healthy behaviors).
These types of support have also been realized to have a solid impact on ‘’adherence to self-care behaviors across chronic diseases’’ (Mayberry & Osborn, 2012, p. 1239). Unfortunately, despite the fact that studies offer this significant link, interventions hardly offer serious focus on support of family as a crucial part of enhancing and facilitating self-care trends. For instance, in examining the effect of a person (patient) awareness on glycemic control, interventions do not engage family members in many occasions as part of offering the care.
Even the interventions that have made effort include inconsistency of family members. The situation is even worse in adult patients. Children with diabetes as a matter of fact receive a lot of attention from their guardians or parents. The assumption perhaps is that elderly patients can take good care of themselves but this should not be the case because social support is very essential.
This paper establishes that none of these factors are self-regulating of the others. We rather see a network of interrelatedness of issues surround diabetes patient care. It asserts the responsibility of different agents in this process; family, healthcare experts, friends and patients. Ultimately, this study emphasizes an approach that is quite integrative to healthcare.
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