Chronic Illness Management

Introduction

Health education is a crucial field in promoting a culturally safe environment for people with chronic diseases. Promoting health education is the role of registered nurses in accordance with the Nursing and Midwifery Board of Australia. Nurses are expected to understand, address and manage the needs of these patients. Cultural competence is the most important requirement for nurses when undertaking this role. Health education promotion programs should be conducted in preference of the patients by providing training sessions for them. These could be conducted at a patient, family or communal level with the sole objective of promoting ultimate healthcare. One of the chronic illnesses portrayed by a client in the Aboriginal Community Controlled Health Organization (ACCHO) is hypertension and type-2 diabetes. Mr. David Bonner, the patient in consideration, has a lot to learn on person-centered care for ultimate self-management. Below is an overview of the two coexisting diseases, a possible health concern and health promotion education strategies aimed at promoting self-care.

Overview and Health Concern

Hypertension and diabetes are two fatal conditions that coexist together and often result in heart diseases. They are associated with genetic factors and contributing environmental factors (Rosa, Arcidiacono, Chiefari, Brunetti, Indolfi, & Foti, 2018). For instance, David Bonner has a family history of coronary heart disease. For the former, glucose intolerance and insulin resistance are contributing and sustaining factors for both chronic diseases. Further studies reveal that the renin-angiotensin-aldosterone system (RAAS) inhibits proper glucose utilization thus creating a favorable environment for the illnesses. In the management of hypertension, a blood pressure level of less than 130/80mmHg is recommended. Hence, for a diabetic patient like David, a blood pressure level of 150/90mmHg is high and could easily result in death or disability. Effective health practices for hypertensive diabetic persons involve eating healthy diets, adapting bodyweight-loss strategies, and living an alcohol and smoking free life. Recommended diets should comprise minimal sodium and fats while maximizing on potassium and fiber foods. To adhere to these practices, David should basically adopt a new lifestyle to manage or even stop hypertension. Unfortunately, being a smoker and a consumer of high sugar and saturated fats diets, he is not doing any attempt in preventing the progression of the diseases. In support of a healthy hypertensive diabetic lifestyle, several drugs are administered to help maintain a disfavoring environment for the chronic conditions.  These drugs are mostly designed to boost the sensitivity of insulin and inhibit RAAS. A perfect medication for the client, who is 47 years could be the CCBs or ARBs whose long-term usage ultimately minimizes the risk of developing new diabetes in hypertensive patients. A major health concern for Mr. Bonner is the possible risks of Cardiovascular and renal disease as well as developing new-onset diabetes. The traditional factors contributing to cardiovascular diseases (CVD) are hypertension and diabetes (Schiffer, Isermann, Huber, & Anders, 2018). The impact of these illnesses on cardiovascular diseases is very strong as it causes a reduction in life expectancy by 3 years on mid-aged patients (Asiri, 2015). More specifically, a patient suffering from hypertension and type-2 diabetes will more likely contract chronic kidney diseases (CKD) which in turn increases the exposure to CVD (Said & Hernandez, 2014). To address this health concern, hypertensive diabetic patients should strictly adopt healthy and therapeutic lifestyles as well as seek early medications.

Topic for Health Promotion Education Session

To address the potential risks for CVD and CKD in a hypertensive diabetic patient, a health promotion education session would effectively serve to manage these chronic illnesses ( Correia, Lachat, Lagger, Chappuis, Golay, & Beran, 2019). The main topic or aim of the education program should be on how to manage diabetes, hypertension, and potential health concerns by adopting healthy lifestyles to promote self-management and optimization of health. Education programs should be conducted at an individual, family, and communal level to promote the ultimate healthcare for the patient (Ngoc, Lin, & Ahmed, 2020). One of the major areas of concern that should be addressed is a lack of awareness. Different people have different understandings of the said control and preventive measures relative to their cultural or economic backgrounds. For instance, Mr. Bonner ignores the restricted diet plan and believes that strict adherence to his medications is enough. He strictly visits his general practitioner every six months for the renewal of medication prescriptions. What is controversial is that he smokes, consumes sugar and other unhealthy meals which endanger his health thus putting him in the risk of potential health concerns. He needs to be educated properly on the clinical facts behind the control and preventive measures to be applied in curbing the chronic diseases. Also on the same topic, Mr. Bonner should be educated on the complications that could result from his conditions. This will actually motivate him to strictly adhere to the prescribed requirements without monitoring. Recognizing and learning of the potential risks and adversity of CVD and CKD will encourage the client to ultimately adjust his lifestyle ( Hien, Tam, Tam, Derese, & Devroey, 2018 ).

A Culturally Appropriate Health Promotion Education Activity

The nurse should incorporate the most appropriate and culturally accepted process in addressing the hypertensive diabetes health issue. Mr. Bonner is among the Aboriginal people who are more predisposed to the risks and prevalence of hypertension and diabetes. Unlike the non-indigenous people, health-care services employed on aboriginal people have to be strictly culture sensitive. A health promotion education activity focusing mainly on family intervention should be implemented. The activity will aim to integrate the indigenous cultural values and address the preventive and control measures at a family level. Family intervention will entail education programs by the nurses where the health concern and multiple health risk factors of the patient and his family are highlighted and explained. Understanding both the modifiable and non-modifiable risks will influence the esteemed behavioral changes in addressing the issue and adopting healthy lifestyles.

Health Promotion Education Session Structure and Justification

The health promotion education session structure explains the role of the registered nurse in promoting change in the patient’s lifestyle (CHOW, et al., 2018). The education activity session structure will comprise of two family intervention steps; education and monitoring. Under education, a one on one lesson of the nurse with the patient and the extended family will be adequate to promote awareness. It is this education that will drive behavioral and lifestyle change enabled by both Mr. Bonner and his family. Under monitoring, a self-monitoring habit will be emphasized. With little intervention from the nurse to offer counseling on diets, physical activities, and the general lifestyle improvement, the patient should be self-restricted. This will actively optimize home-based care and the esteemed long-term survival of the patient. Diabetes and hypertension education programs will require an input of resources (Ma, Lorig, Greenberg, DeVries, & Turner, 2018) on the training of family members. These people could be having little or no experience in dealing with a hypertensive diabetic patient. Consequently, they should be properly trained to address such issues and deal with the patient directly. Also, client motivation is part of the education session. Adhering to the strict rules on therapeutic and healthy lifestyles involving restricted diets and smoking cessation is not easy. Such patients, therefore, need motivation which has to be done to their preference. While some will want to listen to their nurses, doctors, local health officers, or physicians, others will prefer their relatives and family. As for Mr. Bonner who lives with his extended family, he most likely will choose to listen to one of his family members. As a result, any advice directed to the patient should be done in the presence of the family member with the role of motivating the person. To justify the two-step health promotion education program facilitating home-based care, it is important to note that only self-assessment and self-monitoring can promote the desired outcome. A change in lifestyle is more of a personal decision where the client has to clearly understand the consequences and repercussions of his actions. Besides, the patient has to understand the need for consuming little or no sugar rather than just making it as a command.

Conclusion

Promoting health promotion education programs that advocate for self-monitoring is the most effective client-centered approach for Mr. Bonner and similar chronic disease patients. The strategy optimizes individual self-management and promotes active participation of the patient and extended family in diabetes and hypertension management. Empowering people with chronic diseases to self-manage themselves should be done in a culturally accepted way where the patients feel motivated and encouraged to adopt new lifestyles. It is a major role of nurses to provide health education to affected and potential individuals, families, societies and communities. To the many people who lack awareness, this will help provide a widespread knowledge on the control of preventive measures to take in curbing chronic illnesses. Finally, a constant follow up with one’s nurse is critical to ensure that the patient properly adheres to the ultimate and preferred self-care management practices. Different clients could have different ways of managing their hypertensive diabetic condition. As a result, besides self-monitoring, regular physician monitoring is recommended to ensure chronic illnesses’ management in the best way possible (Hughes, Wibowo, Sunderland, & Hoti, 2017).

References

Correia, J., Lachat, S., Lagger, G., Chappuis, F., Golay, A., & Beran, D. ( 2019). Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries: a scoping review. BMC Public Health, 1542.

Hien, H., Tam, N., Tam, V., Derese, A., & Devroey, D. ( 2018 ). Prevalence, Awareness, Treatment, and Control of Hypertension and Its Risk Factors. International Journal of Hypertension, 12 pages.

Asiri, S. (2015). Client Education Plan for Improving Diabetes Management during Primary Health Care in Saudi Arabia. Austin J Nurs Health Care, 2.

CHOW, S., Lam, K.-M., LIE, S.-H., MAK, K.-C., MONG, K.-C., SO, C.-M., et al. (2018). Do demographic factors and a health-promoting lifestyle influence the self-rated health of college nursing students? BMC Nursing, 50.

Hughes, J., Wibowo, Y., Sunderland, B., & Hoti, K. (2017). The role of the pharmacist in the management of type 2 diabetes: current insights and future directions. Integrated Pharmacy Research and Practice., 15–27.

Ma, Q., Lorig, K., Greenberg, J., DeVries, A., & Turner, R. (2018). Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost. Journal of Medical Internet Research, Vol 20.

Ngoc, N., Lin, Z., & Ahmed, W. ( 2020). Diabetes: What Challenges Lie Ahead for Vietnam? Annual Global Health, 86.

Rosa, S., Arcidiacono, B., Chiefari, E., Brunetti, A., Indolfi, C., & Foti, D. (2018). Type 2 Diabetes Mellitus and Cardiovascular Disease: Genetic and Epigenetic Links. Frontiers in Endocrinology, 28-32.

Said, S., & Hernandez, G. (2014). The link between chronic kidney disease and cardiovascular disease. Journal of Nephropathology, 99–104.

Schiffer, M., Isermann, B., Huber, T., & Anders, H.-J. (2018). CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nature Reviews Nephrology, 361–377.