In the United States, type 2 diabetes remains one of the prevailing health conditions among elderly adults. As reported by Yakaryılmaz and Öztürk (2017), though more than 1/4 of the American geriatric population is already diagnosed with the disorder, experts in the field anticipate the number to double over the period of twenty years. Current clinical practice does not provide substantial resources to resist the prolongation of population aging and decline in life expectancy associated with type 2 diabetes, increasing the likelihood of comorbid diseases. As further indicated by Nogueira, de Medeiros, Bittencourt, and da Nobrega (2016), lack of nursing intervention at the moment enhances the manifestations of geriatric symptoms in those diagnosed with diabetes mellitus. Examples of such signs include cognitive impairment, urinary incontinence, polypharmacy, and depressive conditions (Yakaryılmaz & Öztürk, 2017). While there currently exists no treatment for type 2 diabetes, there is a need for research on the feasibility of outpatient telemedicine implementation and its ability to improve the overall quality of healthcare. This novel solution serves as an alternative source of patient care in the form of nursing intervention.
The traditional model of healthcare failed to provide accessible treatment of diabetes to vulnerable elderly patients due to the shortage of endocrinologists and the high cost of the services. Therefore, telemedicine, a practice of screening those with diabetes remotely, may be utilized as an evidence-based solution to the issue, which reduces the number of personnel involved in healthcare and significantly lowers the expenditures (Gervera & Graves, 2015). In this case, the nursing intervention will take place through the exchange of medical information via electronic communications, including, but not limited to, emails, texts, voicemail, smartphone messages, with the purpose of improving the patient’s clinical health status (Gervera & Graves, 2015). Such an approach, in combination with conservative clinic visits, is believed to increase the overall quality of nursing practice, relying mostly on the provision of care from home and asynchronous exchange of data at the workplace. Instead of using annual self-reports from patients as the fundamental support for adjusting the treatment, healthcare professionals could take advantage of the daily (weekly or monthly) records generated as a part of the telemedicine intervention.
Consequently, in the geriatric diabetic patient (P), will implementation of telemedicine to communicate cares and concerns (I) compared to traditional clinic visits (C), decrease the concomitant effects of type 2 diabetes through 24/7 monitoring of the syndromes from home (O) over a 12 month period (T)? By monitoring the symptoms of type 2 diabetes regularly, nurses could analyze the prevalence, motivating factors, and origin of the concomitant diseases mentioned earlier in the paper (Gervera & Graves, 2015). Such practice would respond effectively to the patients’ needs for the majority of individuals diagnosed with diabetes mellitus refer to medical support due to the accompanying conditions of diabetes. If proved efficient over the course of six months, telemedicine could be incorporated in the general nursing practice as a constituent of patient-centered care.
Ultimately, the healthcare quality of geriatric patients may be improved with the adoption of the telemedicine technique in the current nursing practice. The evaluation framework for the effectiveness of the technique should be verified by the home healthcare agency responsible for the technological aspect of screening. The anticipated outcomes for patient care are focused on lowering the manifestations of type-2 diabetes syndromes and decreasing the risk of comorbid health conditions.
Nogueira, L. G. F., de Medeiros, A. C. T., Bittencourt, G. K. G. D., & da Nobrega, M. M. L. (2016). Nursing diagnoses, outcomes and interventions to elderly patients with diabetes: A case study. Online Brazilian Journal of Nursing, 15(2). Web.
Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World Journal of Diabetes, 8(6), 278-283. Web.
Diabetes is often referred to as the plague of the 21st century, as it causes massive long-term damage to individuals, communities, and countries. The disease renders a person’s body unable to properly use and store glucose, causing the blood sugar levels to rise too high. High levels of blood sugar can damage organs and blood vessels, causing internal bleeding and cascade organ failures.
There are two types of diabetes: Type 1 (which prevents the body from producing insulin) and Type 2 (which causes a resistance to insulin’s effects) (American Diabetes Association, 2017). Both of these types are the leading causes of kidney failure in the US, with the total number of victims in the country ranging between 1.6 and 2.2 million a year (Centers of Disease Control and Prevention, 2017). The purpose of this paper is to identify diabetes as a health disparity, with the application of health promotion concepts to develop a treatment plan.
Diabetes and the Nine Determinants of Health
Diabetes affects all nine determinants of health as determined by the World Health Organization (WHO) in a negative way. The list of determinants and their relation to the disease is as follows (WHO, n.d.):
Income and social status: Treatment of diabetes requires time and money to treat properly. Families of low social status and below-average income are more endangered by the disease;
Education: The development of diabetes is closely associated with the consumption of certain products, obesity, and a low-mobility lifestyle. Individuals not aware of diabetes and the ways of personal maintenance are more likely to contract or develop complications of the disease;
Physical environment: Research shows that individuals with access to fresh fruits and vegetable markets, gyms, and parks are at 21% less risk of developing diabetes (CDC, 2017);
Social support: The presence of social support groups, community services, and the general influence of health culture can have a positive or a detrimental effect on diabetic patients;
Genetics: Diabetes is more likely to develop in families with a history of diabetes;
Health services: The presence and availability of high-quality health services affect treatment and death rates associated with diabetes;
Gender: Men and women have a different predisposition towards different types of diabetes;
Individual characteristics: Personal lifestyles and food choices can affect the likelihood of development of the disease;
Policymaking: Treating diabetes is expensive, and different countries introduce different policies to help cope with the situation.
As it is possible to see, diabetes influences all 9 determinants of health, making it a major healthcare condition and a matter of concern for individuals, healthcare institutions, and governments alike.
Epidemiology and Incidence of Diabetes at the State and National Levels
According to CDC (2017), almost a third of the entire US population is suffering from diabetes or prediabetes, with the confirmed number of diabetic patients being at 30.3 million since 2015, and steadily rising. Prediabetes, on the other hand, is a condition that, if left untreated, can lead to diabetes. The number of people in the US with that sort of diagnosis is estimated at circa 84 million. The number of new cases in the country is estimated at 1.5 million per year, minus the fatalities (CDC, 2017). A good portion of adults (circa 25%) do not know they have diabetes up until their first visit to the hospital with symptoms pertaining to the condition (CDC, 2017).
Men are found to be more vulnerable to pre-diabetes than women. Additionally, there are racial and ethnic discrepancies in the percentage of diabetic patients based on educational and income levels. Blacks, Latinos, and native Indians are at greater risk of developing diabetes than Asian-Americans and European-Americans.
Although the average for diabetes remains relatively stable across all states, economic discrepancies are associated with the increase in diagnosed and new diabetes cases. Southern states and areas around the Appalachian Mountains have notably higher rates of diabetes than northern and western areas. The average rate of diabetes for adults in states like Oklahoma, Arkansas, Mississippi, and Alabama is between 12% to 15%, whereas in northern states it is between 7% and 10%.
Issues Surrounding Diabetes Healthcare
Cultural Considerations
Black-Americans, Latinos, and Native Indians are all at a higher risk of developing diabetes when compared to the majoritarian white population. Nevertheless, it is important to understand specific cultural considerations coming along with every ethnic, racial, or religious group. Latinos and Black-Americans are historically distrustful of doctors, especially if those doctors happen to be white (Mendenhall, 2016).
They tend to avoid visits to the hospitals, as they are associated with high expenditures. At the same time, black and Latino preferable cuisines tend to contain products high in fat and protein, which increase the chances of developing obesity and diabetes. Ghetto culture, focus on self-reliance, low educational levels, and greater poverty all are associated with the majority of the mentioned minority groups (Mendenhall, 2016).
A nurse must keep these factors in considerations, and seek to win the patient’s trust, and engage in information campaigns when facing individuals from the historically-vulnerable groups. Another aspect of cultural sensitivity when treating diabetes revolves around respecting religious practices. Some groups denounce modern medicine and do not wish to take drugs to prolong their lives (Mendenhall, 2016). In these situations, the nurse must focus on preventive tactics to reduce the chances of developing diabetes, and provide herbal alternatives to the standard drugs.
Healthcare Literacy Challenges
Healthcare literacy in relation to diabetes is comprised out of several subfields of expertise, which include the general knowledge about the disease, the symptoms associated with it, the factors that may increase or decrease the prevalence of disease development, and the commitment to following whatever course of treatment is prescribed. As it was already stated, nearly 1 in 4 Americans with diabetes are not aware of their diagnosis prior to a major healthcare accident. This indicates that healthcare literacy in the US suffers significant challenges, especially in rural and minority locations. Some of these challenges are as follows:
A lack of personnel dedicated to population education and advocacy. The medical industry in the US is currently suffering from a shortage of primary and secondary healthcare specialists, with nearly 15% of all vacancies being unoccupied (Johnson, Butler, Harootunian, Wilson, & Linan, 2016). This leaves hospitals and major healthcare organizations unable to dedicate enough workforce to working with the communities;
Financing and material discrepancies. Diabetes education and literacy programs require money and materials to distribute to vulnerable populations, reminding them of the various factors that may lead to the development of the disease and an increase in its severity (Younis, 2017);
Cultural differences. Due to cultural and economic gaps between different communities, the poor and minority groups of individuals are less likely to receive the necessary education regarding diabetes (Brunk, Taylor, Clark, Williams, & Cox, 2017). Poor communication and understanding of cultural barriers reduce the effectiveness of diabetes information campaigns;
Language barriers. This challenge is particularly prevalent in illegal migrants and first-generation Americans, who migrated from poorer countries and did not understand the English language well. Nurses fluent in English, Spanish, and other foreign languages are few, reducing the number of potential candidates for educational roles (Brunk et al., 2017);
Political barriers. Financial cuts to healthcare motivated by political reasons hurt healthcare organizations and non-profitable groups dedicated to promoting the knowledge of diabetes to the masses.
As it is possible to see, there are numerous issues that explain why healthcare literacy regarding diabetes remains at a relatively low level. Should some of these problems be completely or partially resolved, the number of new cases of diabetes is bound to go down, as a result of increased awareness and preventative measures.
Health Promotion Theory and Treatment Plan
In the light of major challenges outlined in the section above, the most appropriate health promotion theory for increasing diabetes awareness would be the social-cognitive theory. This theory promotes self-efficacy, establishes expectations, and promotes reinforcement and self-control through the means of engaging local communities (Ghoreishi, Vahedian-Shahroodi, Jafari, & Tehranid, 2019).
In a situation where nurses are in short supply, expenditures are often cut due to political reasons, and communities are split based on economic and racial boundaries, the social-cognitive theory would encourage community leaders and organizations to undertake the task of educating their members and improving the knowledge of symptoms, predicators, and treatment methods available to the population. The proposed educational intervention plan is as follows (Ghoreishi et al., 2019):
Implement nurses to get in touch with various non-profit organizations at the community level, such as charities, churches, schools, etc.;
Provide the organizations with the information, education, and materials to distribute to their intended populations, such as church visitors, students, and beneficiaries;
Provide information on various healthcare organizations available in the area;
Give these organizations the authority to promote and distribute diabetes-related information;
Provide frequent updates and supervision in regards to healthcare agenda, offer reasonable expectations and expectancies as a result of behavioral change.
This strategy is in line with various nursing theories as well, namely Orem’s healthcare theory, which claims that individuals wish to be independent and capable of taking care of themselves (Kant, Khapre, & Singh, 2017). The involvement of community effort would solve the issues regarding a lack of nurses, the lack of cultural consensus, and, to a degree, the problem of insufficient funding while making patients active actors in the process of their own recovery.
Conclusions
Diabetes is a serious healthcare issue that affects all countries around the world. The US has a significant prevalence of diabetic patients due to socio-economic factors, poor knowledge distribution, and a predisposition towards fat-enriched cuisine. Due to the increase in the percentage of elderly individuals, the increased turnover of nurses in hospitals, and the reduction in healthcare budget, the issue of diabetes ought to exacerbate, causing more than 2.2 million deaths a year on average. The proposed solution to the problem involves an educational intervention based on social-cognitive theory as well as Orem’s theory of care.
It would help get the communities involved and increase social awareness of the problem. However, such a solution will not solve the long-term problems plaguing the healthcare system in the US. Only the recruitment of more nurses, expansion of the healthcare budget, and the reduction of inter-racial, social, and economic barriers will enable information campaigns to be effective.
References
American Diabetes Association. (2017). Classification and diagnosis of diabetes. Diabetes Care, 40(1), S11-S24.
Brunk, D. R., Taylor, A. G., Clark, M. L., Williams, I. C., & Cox, D. J. (2017). A culturally appropriate self-management program for Hispanic adults with type 2 diabetes and low health literacy skills. Journal of Transcultural Nursing, 28(2), 187-194.
Ghoreishi, M. S., Vahedian-Shahroodi, M., Jafari, A., & Tehranid, H. (2019). Self- care behaviors in patients with type 2 diabetes: Education intervention base on social cognitive theory. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(3), 2049-2056.
Johnson, W. G., Butler, R., Harootunian, G., Wilson, B., & Linan, M. (2016). Registered nurses: The curious case of a persistent shortage. Journal of Nursing Scholarship, 48(4), 387-396.
Kant, R., Khapre, M., & Singh, A. (2017). Cognitive effect of standardized group education programme in diabetic population. Journal of Diabetes and Endocrinology Association of Nepal, 1(1), 8-11.
Mendenhall, E. (2016). Beyond comorbidity: A critical perspective of syndemic depression and diabetes in cross‐cultural contexts. Medical Anthropology Quarterly, 30(4), 462-478.
World Health Organization (WHO). (n.d.). The determinants of health. Web.
Younis, M. Z. (2017). Healthcare reform in the Middle East and the USA. Journal of Comparative Effectiveness Research, 6(1), 13-14.
Type 2 diabetes is a dangerous but treatable disease that manifests as high blood sugar, low insulin, and general insulin resistance. It results from living habits rather than any form of a pathogen, and people can develop it spontaneously as long as they are in a risk group. It generally does not require hospitalization unless the issue is severe, and most patients continue their daily lives. However, its symptoms are not immediately apparent to an untrained observer and can come on slowly, preventing the person from noticing. People can be trained in noticing and measuring their symptoms, but they remain fallible and can fail to see a potential cause for alarm. As such, medical workers are trying to develop more reliable and efficient methods of monitoring patients with the condition.
Problem Statement
Most patients with diabetes live their lives with some specific accommodations that manage the condition, such as lifestyle and diet changes alongside specific medications. However, their symptoms require monitoring, and professionals are preferable to the patients for the purpose. Currently, this matter is being resolved through regular clinic visits, with specialists receiving the patients and assessing their condition. However, the procedure takes considerable time and effort on the part of both medical workers and patients. The former have to take time away from their other patients, and the latter have to travel to the clinic and wait to be assessed. With the recent advancements in technology, such an inefficient approach may be outdated and require a replacement.
Purpose of the Change Proposal
Telemedicine is emerging as an alternative approach to the monitoring of remote patients whose issues do not warrant hospitalization. It can take a variety of forms, from regular videoconferences that confirm the patient’s condition to specialized medical tools that link with a smartphone app and submit data to the hospital automatically. Its primary advantage is that the patient no longer needs to come to the clinic physically, which is particularly relevant for seniors. The patients can also be more independent, with the medical workers supporting their judgment with their expertise. Telemedicine has already been successfully applied to various aspects of type 2 diabetes management. As such, it may be prudent to adopt it as a standard and outfit care institutions with telemedicine facilities to improve outcomes.
PICOT
Geriatric patients who have type 2 diabetes are the population for this proposal. The use of telemedicine to monitor symptoms is the intervention, and it is compared to the standard practice of regular clinic visits. The expected outcome is a decrease in the concomitant effects of the condition as a result of continuous monitoring. The time is 12 months, which should be sufficient to see a significant change without taking overly long. With these aspects outlined, it is possible to create the following PICOT question:
In geriatric patients who have type 2 diabetes (P), will the implementation of telemedicine to communicate cares and concerns and conduct continuous symptom monitoring (I) instead of traditional regular clinic visits (C) reveal a reduction in the concomitant effects of the condition (O) over a 12-month period (T)?
Literature Search Strategy Employed
The author searched several platforms that host peer-reviewed scholarly nursing literature: Google Scholar, JSTOR, and NCBI PubMed. The process focused on the keywords ‘type 2 diabetes,’ ‘symptoms,’ and ‘telemedicine.’ Only articles that had been published in the last five years were eligible due to the requirement for relevance. Overall, the search yielded approximately 3,000 articles, not all of which applied to the purpose of this proposal. Some were rejected because they did not discuss the relevant topic but mentioned it. Most were omitted due to time concerns, as this proposal only needed several supporting works and was not intended as a literature review. Ultimately, three articles that discuss the advantages of telemedicine and its applicability to various symptom categories passed the inspection.
Evaluation of the Literature
The three articles selected for this paper discuss various aspects of telemedicine and their relevance to the ultimate choice of one approach or the other. Rasmussen, Lauszus, Lokke, and Jensen (2017) claim that the new method is more cost-effective than clinic visits and yields better results, particularly with regards to blood glucose. Fox, Kronenberg, and Weiskopf (2019) highlight the relationship between diabetes and preventable blindness and propose a telemedicine strategy to screen patients for the issue. Finally, Huang, Tao, Meng, and Jing (2015) show a significant improvement in patient glycemic control as a result of telemedicine usage. Overall, the literature appears to promote the view that the new method can improve the quality of current diabetes care and create opportunities for new treatments that enhance patient quality of life further.
Applicable Nursing Theory Utilized
Martha E. Rogers’s Theory of Unitary Human Beings is the most applicable for this proposal, as it discusses both scientific progress and the application of the findings in ways that help patients. Past findings have demonstrated that telemedicine is appropriate to nursing as a whole, helping medical workers manage various conditions. Now, nurses should use the art of nursing to find creative applications of the approach that help diabetes patients improve their well-being. As the literature review demonstrates, it is possible to use telemedicine to address various aspects of the condition and prevent side complications. Medical workers should work on ways to further enhance health by using the new tool at their disposal for various purposes and choosing the best ideas for implementation.
Proposed Implementation Plan
The implementation will consist of three separate parts: planning, purchase and installation, and training. First, the nursing staff will determine the specific devices and software they will use for telemedicine and outline the requirements. Second, the facility will purchase the necessary equipment, construct a telemedicine room, and configure it so that it becomes operable. Third, the staff will be trained in the operation of the telemedicine equipment and in teaching seniors how to use the tools to communicate. The three steps will have to happen successively because a plan is necessary before purchase and because the room will be required for practical staff training.
Potential Barriers and Answers
Some seniors may not be able to afford the equipment required for successful telemedicine usage. The nursing staff should find inexpensive devices that have the required functions and are easy to use. They can then suggest these options to the people in question as cheaper alternatives that still have the benefits. Additionally, seniors may not be receptive to the new technology and its usage, especially if the method chosen requires their active participation. They will require extensive explanations and reminders before they get used to the regular communication or other monitoring methods used.
Huang, Z., Tao, H., Meng, Q., & Jing, L. (2015). Effects of telecare intervention on glycemic control in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. European Journal of Endocrinology, 172(3), R93-R101.
The understanding of medical terminology, as well as the ability to interpret new terms with the acquired knowledge of word parts, namely word roots, suffixes, and prefixes, is a vital part of the educational process for every future medical professional. The article “Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes” published in The New England Journal of Medicine in June 2017 uses the terminology on the subjects of treatment of diabetes and cardiovascular disease, various treatment effects, and outcomes. The authors of this article explore the effects of canagliflozin treatment in patients with diabetes, focusing on complications connected to renal conditions, such as albuminuria and diuresis, and cardiovascular conditions, like myocardial infarction and hypoglycemia. Neal et al. (2017) conclude that the use of canagliflozin may have positive effects, as it lowers the risk of hospitalization and death from cardiovascular conditions and reduces the intensity of albuminuria and the necessity of amputation. The purpose of this paper is to locate various medical terms and define them and their possible constituents such as word roots, prefixes, and suffixes.
The first group of medical terms, which can be defined in this paper, is a number of words with a word root album, which means protein. The article contains multiple words with this root such as albumin, albuminuria, macroalbuminuria, and microalbuminuria. First of all, Martin (2015) defines albumin as a type of protein that is “soluble in water and coagulated by heat” (p. 20). The suffix –in in the word albumin contains the meaning of a material substance. Secondly, the words albuminuria, macroalbuminuria and microalbuminuria also share the suffix –uria, which relates to urine and more specifically to various diseases of the urine (“Common medical terminology,” 2017). Consequently, the term albuminuria has the meaning of the presence of protein in the urine. Finally, the last two terms mentioned above contain prefixes macro– and micro-, meaning large and small respectively. Therefore, these terms bear the meanings of having high or low levels of albumin in urine.
There are other medical terms, found in this article, that are related to the word urine. For example, such words as urinary and genitourinary have the word root urin and the suffix –ary, which indicates the connection to something, in this case, to urine. Furthermore, prefix genito– pertains to reproductive organs, pointing out that conditions described with the adjective genitourinary have a connection to both urinary and reproductive systems. The term diuresis describes a condition when the amount of urine that is produced by the kidneys is too large (Venes, 2017). The word root here is diure, meaning to urinate, and the suffix –sis denotes a motion or a process (“Common medical terminology,” 2017).
Words containing the word root ren define every condition connected to kidneys (Cohen & DePetris, 2013). For instance, in this article, the authors use the adjectives renal and intrarenal that consist of the word root ren and the suffix –al, meaning that the words preceded by these adjectives are related to kidneys. The term intrarenal that can also be found in the article contains a prefix intra-, which denotes that the condition is located inside the organ, in this particular situation meaning that something is located inside the kidney. The authors use the adjective intrarenal with the noun hemodynamics, which is also a medical term (Neal et al., 2017). The prefix hemo– means blood, and the word dynamics has a word root dynam which means strength and movement. Venes (2017) writes that hemodynamics is a science branch that explores blood circulation and its metrics.
Vascular is another term that can be found in the article as a separate word and as a part of a word. It consists of a word root vascul, which means a blood-containing vessel and a suffix –ar, which shows the affiliation of the root with something, making it an adjective (“Common medical terminology,” 2017). Consequently, describing a noun with an adjective such as cardiovascular shows the connection of this noun to the circulatory system of the body, because the prefix cardio– means “pertained to heart” (Martin, 2015, p. 149).
Myocardial is a term that is predominantly used as a part of a phrase myocardial infarction throughout the article. The word root cardio means heart, the suffix –al shows a connection to the word root and the prefix myo– means muscle. As a result, the term myocardial means a process or condition related to the heart muscle. The other part of the phrase, namely the term infarction, has a word root infarct, which, according to Venes (2017), means the death of tissue due to blood deprivation, and a suffix –ion that denotes a process. Therefore, the phrase myocardial infarction means the death of heart muscle tissue because of an “interruption of its blood supply” (Martin, 2015, p. 496).
One of the main terms of this article is diabetes, also known as diabetes mellitus. American Diabetes Association (2017) writes that diabetes is a group term for diseases connected to the incorrect production of insulin in the human body. They also note that one of the terms related to diabetes is hyperglycemia (American Diabetes Association, 2017). The authors of the article, considered in this paper, also mention the terms glycemia and hypoglycemia. Glycemia is a general term that means that blood contains glucose or sugar (American Diabetes Association, 2017). Hyperglycemia has a prefix hyper– which points to an extensive quantity of something, in this case, a high level of glucose in the blood. Hypoglycemia, on the other hand, means that the blood contains low levels of glucose. The prefix hypo– means that the quantity of something is deficient. Another condition connected to diabetes is ketoacidosis. Ketoacidosis is a type of acidosis, more precisely the lowering of the blood pH, which occurs because of the high number of ketone bodies in the blood (Venes, 2017). Acid id a word root, –sis is a suffix showing a particular state, and keto– is a prefix pertaining to ketones.
Other research problems, discussed in the article include the use of such words as cholesterol, hemoglobin, lipoprotein, and creatinine. Cholesterol is a sterol that is produced in the liver of animals and humans. According to Venes (2017), cholesterol plays a significant role in the process of metabolism, acting as an initiator for various hormones. The prefix chole– means gall or bile and the word root sterol describes a group of solid alcohols in a plant or an animal system (“Common medical terminology,” 2017). Hemoglobin is a red pigment, the main function of which is to carry oxygen to the tissues of the body from the lungs. Hemo– is a prefix that means blood, and globin is a word root synonymous with the word protein (“Common medical terminology,” 2017). Lipoprotein is a protein connected to fat. Protein is a word root and lipo– is a prefix that means fat. Finally, creatinine is a product of metabolism that is usually found in blood and urine. Word root creatine describes an organic acid and the suffix –ine means that the word is pertaining to something.
The term dialysis denominates the process of cleaning the body of a patient with a kidney disease from toxic chemicals (Venes, 2017). Prefix dia– means to go through; and the word part –lysis means separation. The adjectives systolic and diastolic find their place in the article in relation to the phrase blood pressure. These terms describe two different phases in the movement of the blood through the heart. Blood pressure is systolic when the ventricles are contracting and diastolic when they are relaxing. Word root systol means contraction, while the word root diastol comes from the word diastole that is a process of blood filling in the chambers of the heart (Venes, 2017).
25 medical terms were located in the article “Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes”. The terms were defined according to the latest medical dictionaries and separated into word parts, such as word root, suffix, and prefix. Word parts were defined as well. It is necessary to point out, that the definitions of the word parts significantly affect the final understanding of a word as a whole, as their meaning is usually interpreted literally. Word roots, suffixes, and prefixes have equally important roles in constructing the meaning of the final word, as they all have their own distinct meanings.
References
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(1), S81-S90.
Cohen, B., & DePetris, A. (2013). Medical terminology: An illustrated guide (7th ed.). Baltimore, MD: Lippincott Williams & Williams.
Common medical terminology. Suffix, prefix, and root words. (2017). Web.
Martin, E. (Ed.). (2015). Concise medical dictionary. New York, NY: Oxford Quick Reference.
Neal, B., Perkovic, V., Mahaffey, K. W., de Zeeuw, D., Fulcher, G., Erondu, N.,… Matthews, D. R. (2017). Canagliflozin and cardiovascular and renal events in type 2 diabetes. New England Journal of Medicine.
Venes, D. (2017). Taber’s cyclopedic medical dictionary. Philadelphia, PA: FA Davis.
It was a regular day. My dad and I were at Superdawg. We were eating our food then all of a sudden my dad started to hold his head in acute pain. It looked like he had a brain freeze, but he wasn’t drinking or eating anything cold. I knew what was wrong, he needed sugar. I gave him some of my lemonade, but it did not help. My dad’s whole body was completely tense. It looked like he was cramping up and it would not go away. I now went to the register and asked the worker at the counter for some sugar. When I got it, I had to hand feed it to my dad because he could not move. Eventually, he finally was able to move and comprehend what was going on. My dad has diabetes Type 1. He has had it since he was 31 years old and will have it for the rest of his life unless a cure is found.
Diabetes: Investigating a Disease
Diabetes is a serious metabolic disease that leads to the hindrance to the production of insulin in the body. Insulin is a hormone produced by the pancreas and is responsible for controlling blood sugar. Insulin accomplishes this task by breaking down glucose in the body. Therefore, the absence of insulin in the body allows a dangerous build-up of sugar in the body which, if unchecked, is fatal (“Diabetes”, par. 1). Generally, diabetes is often manifested through frequent urination, unusual hunger, strange weight loss, and extreme fatigue, and irritability (“Diabetes”, par. 4). Type 1 diabetes is characterized by frequent infections, blurred vision, slow-healing cuts and bruises, and frequent numbness in hands and feet (“Diabetes”, par. 4).
There are three types of diabetes; type 1 diabetes, type 2 diabetes, and gestational diabetes. Type 1 diabetes is caused by insulin deficiency in the body. The insulin deficiency is brought about by the loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas. Type 1 diabetes is further dichotomized as immune-mediated or idiopathic. Most cases of type 1 diabetes are of the former category, in which the beta cell loss is T cell-mediated autoimmune attack (Rother, p. 1500).
Doctors are yet to determine preventive measures against Type 1 diabetes. Type 1 diabetes was traditionally associated with children but is now common among adult populations as well. Most victims lead healthy and normal lives as their response to insulin injections are usually normal, particularly in the early stages.
The second type of diabetes is Type 2 diabetes. In this case, the body does not produce enough insulin or the cells in the body fail to recognize the produced insulin. If the diabetic patient only produces a little insulin, then that patient can sometimes control the disease with proper exercise and healthy eating habits. Some Type 2 diabetics do not need to inject insulin into their bodies. Whereas type 1diabetes is common among Americans and Europeans, type 2 diabetes is prevalent in African-Americans, Native Americans, and Asians (“Type 2”, par. 1).
The third type of diabetes is gestational diabetes. It is characterized by high blood sugar levels during pregnancy. This type goes away after pregnancy but requires proper medical attention during this period (Lawrence et al., p. 900). It has been noted that about 20% to 50% of women affected by Gestational diabetes develop Type 2 diabetes later in life (Lawrence et al., p. 902).
Gestational diabetes is temporary, but if untreated may harm the fetus or the mother. It interferes with the normal development of the fetus may hamper normal delivery of the affected baby; hence the need for cesarean section (Lawrence et al., p. 904).
It is worth noting that some minor categories of diabetes have been identified as well. One such type is pre-diabetes characterized by slightly high blood sugar that cannot be diagnosed as type 2 diabetes. It is, therefore, considered a precursor to type 2 diabetes.
There is also the latent autoimmune diabetes that afflicts the adult population. This is a condition that leads to the development of type 1 diabetes. Latent autoimmune diabetes is usually confused, in its initial stages, with type 2 diabetes. There are various causes of diabetes. Type 1 diabetes is partly inherited although the Coxsackie B4 virus has been identified as a possible contributor. Type 2 diabetes is attributed to lifestyle and genetic factors. Genetic defects are manifested in beta cell functions, mitochondrial DNA mutations, and insulin processing (Rother, p.1500). Insulin action may experience defects in pro-insulin conversion, insulin gene mutations, and insulin receptor mutations (Rother, p.1500).
Another causal agent of diabetes is exocrine pancreatic defects such as chronic pancreatitis, pancreatectomy, pancreatic neoplasia, cystic fibrosis, hemochromatosis, and fibrocalculous pancreatopathy (Rother, p.1500). Other causes include endocrinopathy, infections, and the use of some prescription drugs.
Several diagnostic procedures are available for the diagnosis of diabetes. First, urine tests can be conducted to check the blood sugar level in the body. If it is higher than 200 mg/dl then there is a good chance of diabetes. The second approach is to take a blood test. The three blood tests that are done are; fasting blood glucose level, Hemoglobin A1c test, and the oral glucose tolerance test (“Diabetes”, par. 5).
Once a person is diagnosed with type 1 diabetes, they have to cope with it for the rest of their life because there is no cure. Diabetes can be managed through regular insulin injections. However, it may be hard to know how much insulin is required by the body. Diabetics will usually need to check their blood pressure and put in a certain amount of insulin to have normal blood sugar levels. If a person puts in too much insulin, then the person can suffer a diabetic shock.
A diabetic shock occurs when the person’s blood sugar levels are really low. If the person is not given some sugar immediately, they will go into a coma or die. The rapid change of high and low blood sugar can cause a lot of damage to the body. Insulin is supposed to be absorbed by the body slowly throughout the day. Diabetics have to inject themselves three times a day, but this is still putting too much insulin at one time.
There are several dangers associated with diabetes. First, diabetes may lead to heart diseases. Diabetic adults are two to four times more likely to die of heart disease than regular adults (Jost, p. 188). The risk of stroke is two to four times as likely. Sixty to sixty-five percent of diabetics have high blood pressure. Secondly, diabetes is the leading cause of blindness between 20 and 74-year-olds. Thirdly, two-thirds of diabetics have nervous system problems. Diabetes is also the leading cause of lower amputations (Jost, 194).
Diabetes Type 1 is hereditary and cannot be prevented. Type 2 is, however, prevented by healthy eating and exercising normally. For a diabetic, it is also important to have a good diet and a healthy lifestyle because that will reduce the risk of amputations and blindness. The more a diabetic can control their blood sugar levels, the less at risk they are for all the damaging factors that come along with diabetes.
However, the control of diabetics is hampered by some challenges. For instance, Gregg Gierke, a diabetic for 21 years, explains how difficult it is to control and manage diabetes: “I have low blood sugar two to three times every day. The brain isn’t able to function with low sugar. Then, I eat sweets with lots of sugar so I can function. This makes my blood sugar high, which causes me to become tired. It is very difficult to keep blood sugar in a safe range.”
Over time, there have been new ways to control diabetes. Before 1921, there was no way of controlling diabetes. This made the disease fatal. In 1921, Banting and Best came up with a substance that regulated blood sugar levels, which was called insulin. Consequently, they were honored for their discovery with the Nobel Prize. At first, when people tried to use the insulin it was not effective. This was because they were using insulin from pigs and cows, which created immune problems for humans. So, the gene for human insulin was cloned and this was achieved in 1971.
Diabetes in the past has usually been controlled by taking a shot of insulin using a needle and a syringe. This is a mediocre way of controlling diabetes. The newest way of controlling diabetes is the insulin pump. The pump is made up of a pump reservoir, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being pumped into the body. This pump gives the diabetic continuous amounts of insulin instead of a lot of insulin at one time. Over 50,000 diabetics worldwide now use the pump (Mathur, par. 9). The next step for the pump is to get a reading of the person’s blood sugar level instead of having the patient prick their fingers. Tests are being done to see if insulin can eventually be inhaled (Mathur, par. 11). But for now, patients have to do with the pump.
Conclusion
Currently, many foundations are trying to help and find a cure for diabetes. One of them is the JDRF foundation. JDRF was found in 1970 by parents of children with type 1 diabetes. JDRF has funded more than 1.5 billion dollars in research. In 2010, they donated $107 million for Type 1 diabetes research (JDRF, section 1). The goal of JDRF is to stop type 1 diabetes, reverse diabetes, prevent diabetes, and improves the treatment of type 1 diabetes, and to have tighter glucose control (JDRF, section 1). JDRF is one of the leading foundations today to help stop and prevent diabetes. In early October, they had a “walk to cure diabetes,” which was very successful.
With this comprehensive information, I conclude by stating that diabetes is a deadly disease. If not controlled properly it can lead to serious side-effects. It is important to eat healthily and exercise to prevent diabetes. Foundations are leading the way to try to come up with a cure. If a cure is eventually found, it will change the lives of millions of diabetics across the world. This vastly improves the quality of healthcare.
JDRF. Juvenile Diabetes Research Foundation International. n.p., 2011.
Lawrence Jean M. et al. “Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/ethnically Diverse Population of Pregnant women, 1999–2005”. Diabetes Care 31.5 (2008): 899–904.
Mathur, Ruchi. “Insulin Therapy for Diabetes Past, Present, and Future.” MedicineNet. n.p., n.d. Web.
Rother, Kristina I. Diabetes Treatment—Bridging the Divide”. The New England Journal of Medicine, Vol. 356.15 (2007): 1499–501. Print.
“Type 2.” American Diabetics Association. American Diabetes Association, n.d. Web.
Glycemic control is a crucial component of type 2 diabetes management. Surgery may impair normal glucose metabolism and during the recovery period. Furthermore, diabetic patients are at a higher risk of postoperative complications such as surgical site infections and delayed wound healing (Akiboye & Rayman, 2017). Therefore, it is important to ensure proper glycemic control in the course of the perioperative period. This paper reviews the literature on the management of blood sugar levels in patients with type 2 diabetes before and after surgery. The PubMed and Google Scholar databases were searched using the key terms type 2 diabetes, blood sugar control, and surgery. The search was narrowed down to articles published within the last five years. A total of ten relevant articles were selected and evaluated.
The recommended first-line treatment for type 2 diabetes is metformin and combination therapy (American Diabetes Association [ADA], 2020). Oral agents such as glucagon-like peptide 1 receptor agonists are preferred to insulin if the first treatment is ineffective. Therefore, insulin should be used as a last resort when all other options do not yield the glycemic targets. Nevertheless, different patient groups have been reported to have varying patterns of insulin use (Kong et al., 2020). However, additional precautions are needed during the perioperative period. First, preoperative assessment of blood sugar levels is the first step towards the proper management of glucose levels. Patients with type 2 diabetes should be assessed a few days before the scheduled surgery to establish other parameters such as ketones and electrolyte standing in addition to glycemic control (Jefferies et al., 2018). Akiboye and Rayman (2017) recommend the treatment of hyperglycemia during the perioperative period. The normal target is fasting blood glucose levels of 5.0 to 8.0 mmol/L. Ferrera et al. (2019) demonstrated that subjecting patients to a carbohydrate reduced hospital diet containing 135 grams of carbohydrates per day resulted in improved glycemic control post-surgery.
Patients on insulin treatment should continue with the treatment at a reduced dose to prevent ketoacidosis. Their blood sugar levels should be monitored every hour before, during, and after surgery to identify and address hypo or hyperglycemia (Ferrera et al., 2019). The type of insulin can also influence blood glucose outcomes. Pasquel et al. (2020) observed that treating hospitalized patients with glargine U300 and glargine U100 produced comparable glycemic control. However, glargine U100 is linked to a lower incidence of hypoglycemia and can be considered in the prevention of hypoglycemia.
An intravenous infusion should be considered for surgical procedures lasting 2 hours or less. For longer surgeries, dextrose should be included in the infusion and adjusted appropriately to ensure that the blood glucose level is between 5 and 10 mmol/L. The normal diabetes regimen should be continued as soon as the patient resumes oral nutrition. However, higher doses of insulin may be required immediately after surgery because of stress, pain, and inactivity. Therefore, blood glucose levels should be checked frequently within the first two days following surgery. Statins can minimize the risk of cardiovascular events in diabetic patients undergoing hemodialysis. Genser, Wanner, and März (2020) have developed a score that can be used to forecast the precise effects of statins in diabetic patients undergoing hemodialysis, thereby minimizing their adverse effects in this patient group.
Dietary interventions can also be used to manage blood glucose levels for hospitalized patients with type 2 diabetes post-surgery. Skalkos, Moschonis, Thomas, McMillan, and Kouris-Blazos (2020) established that taking lupin biscuits as a mid-meal snack resulted in a significant reduction in postprandial glucose after dinner. In an outpatient setting, the administration of sodium-glucose cotransporter 2 (SGLT2) inhibitors, which work by reducing the kidney retention of glucose, can also be used for glycemic control (Mazer et al., 2020). Surgical interventions can also aid glycemic control. For instance, van Baar et al. (2020) observed that duodenal mucosal resurfacing can enhance glycemic control in people with type 2 diabetes notwithstanding their body mass index.
References
Akiboye, F., & Rayman, G. (2017). Management of hyperglycemia and diabetes in orthopedic surgery. Current Diabetes Reports, 17(2), 1-11.
American Diabetes Association. (2020). 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2020. Diabetes Care, 43(Suppl 1), S98-S110.
Ferrera, H. K., Jones, T. E., Schudrowitz, N. J., Collins, J. E., Lichstein, P. M., Shaner, J. L., & Fitz, W. (2019). Perioperative dietary restriction of carbohydrates in the management of blood glucose levels in patients undergoing total knee replacement. The Journal of Arthroplasty, 34(6), 1105-1109.
Genser, B., Wanner, C., & März, W. (2020). A scoring system for predicting individual treatment effects of statins in type 2 diabetes patients on haemodialysis. European Journal of Preventive Cardiology, 2047487320905721.
Jefferies, C., Rhodes, E., Rachmiel, M., Agwu, J. C., Kapellen, T., Abdulla, M. A., & Hofer, S. E. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Management of children and adolescents with diabetes requiring surgery. Pediatric Diabetes, 19(Suppl 27), 227-326.
Kong, A. P., Lew, T., Lau, E. S., Lim, L. L., Kesavadev, J., Jia, W., & Yoon, K. H. (2020). Real‐world data reveal unmet clinical needs in insulin treatment in Asian people with type 2 diabetes: The Joint Asia Diabetes Evaluation (JADE) Register. Diabetes, Obesity and Metabolism, 22(4), 669-679.
Mazer, C. D., Arnaout, A., Connelly, K. A., Gilbert, J. D., Glazer, S. A., Verma, S., & Goldenberg, R. M. (2020). Sodium-glucose cotransporter 2 inhibitors and type 2 diabetes. Current Opinion in Cardiology, 35(2), 178-186.
Pasquel, F. J., Lansang, M. C., Khowaja, A., Urrutia, M. A., Cardona, S., Albury, B., & Vellanki, P. (2020). A randomized controlled trial comparing glargine U300 and glargine U100 for the inpatient management of medicine and surgery patients with type 2 diabetes: Glargine U300 hospital trial. Diabetes Care, 43(6), 1242-1248.
Skalkos, S., Moschonis, G., Thomas, C. J., McMillan, J., & Kouris-Blazos, A. (2020). Effect of Lupin-Enriched Biscuits as Substitute Mid-Meal Snacks on Post-Prandial Interstitial Glucose Excursions in Post-Surgical Hospital Patients with Type 2 Diabetes. Nutrients, 12(5), 1-15.
van Baar, A. C., Holleman, F., Crenier, L., Haidry, R., Magee, C., Hopkins, D., & Mertens, A. (2020). Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: One year results from the first international, open-label, prospective, multicentre study. Gut, 69(2), 295-303.
The title is accurate enough since it describes the diagnostic area of focus, the stage at which patients are, and the fact that the study means to be no more than descriptive.
Researcher Qualifications
As a diabetes nurse specialist with the metabolic unit of University Hospitals Coventry and Warwickshire NHS Trust/Holbrooks Health Centre, Coventry Primary Care Trust, Anne Phillips is not only a medical-care practitioner but also a specialist in diabetes. UHC Warwickshire is a new, very large (1,250 bed) hospital with facilities not to be found outside London. Being an NHS facility with 27 operating rooms and, at last count, 250 specialists (NHS, 2008), UHW specialists like Phillips presumably work to high standards of peer review.
Methodology
The author employed the qualitative approach of phenomenology, one of the more rudimentary techniques available for first-time research into a subject area. It is fairly straightforward and easy to learn because it involves merely collecting feedback in unstructured depth interviews and reflecting on the same through the lens of medical praxis.
One inspects the phenomena from different perspectives – in this case, the feedback of patients who have just started on insulin administration – and essentially lets the information take us where it might. There is no working hypothesis as we know it other than the determination to discover as many elements of the condition as one can. Like every other qualitative technique, phenomenology trades scientific rigor for insight (Boeree, 1998). After all, qualitative methods uncover a wide range of insights and examples but have no predictive value.
Idea of Interest
The author sets out to discover how diabetes type 2 patients cope with needing to have insulin administered, now that the syndrome has progressed to the point where oral medication no longer effectively controls blood glucose levels.
Sample Size and Adequacy
The sample comprised just eight patients who had been on insulin therapy for at least a year. While there is no hard and fast rule on what makes for reliability in qualitative research, one is concerned that the author accounted for four patient variables: gender, age, frequency of insulin administration, and the period since starting insulin therapy. To the extent that these classificatory variables are relevant or moderating factors and could have produced some hint of inter-group variation, one would have wished for at least twice or three times that number.
Data Collection/Clarity of Analysis Steps
Interviews took place in privacy to allow patients maximum leeway for expressing their distress or other feelings. To make sure nothing was missed, the author recorded all proceedings. In addition, she made notes of her observations, particularly about non-verbal phenomena, immediately after each interview. Lastly, the transcripts were content-analyzed and coded. This is all painstakingly listed and recommended procedure for qualitative research (Oka and Shaw, 2000).
Discovery and Implications
The author brought to the fore the shock of the initial diagnosis and the concern of patients for at least informing other family members about the disease lest unhealthy habits lead them down the same path.
Prior biases that patients on insulin must be “different” aggravated the shock at learning that they now had to undergo insulin treatment. Fellow-patient group support alleviated their distress somewhat but brusque treatment by physicians and the sinking feeling they were getting due punishment for “neglectful” behavior made the prescription to go on insulin akin to a life sentence.
Once they had started on the course of taking insulin, patients detailed eight other themes of behavior, taking comfort or feeling even more negative about their “deteriorating condition”:
Coping by learning more (but getting dismayed at perceiving that some health care professionals they encountered were not as up-to-date about diabetes) and seeking like company.
Adjusting by adhering to a healthier eating regimen. It would seem going on insulin sharply increased patient compliance.
Taking heart from the apparently active lives and “sporting achievements” of celebrities who had their condition.
Dismay about the awful inefficiency of NHS staff calling for repeated glucose level tests.
Discrimination on the job and on having to forego more privacy when hiring a car, taking out insurance, or renewing their licenses.
Increased concern and hypochondriac-type anxiety that new symptoms they suffer herald a severe hypoglycemic episode. On the other hand, there were patients who reported enhanced quality of life after going on insulin.
Most telling, perhaps, was the guilt feelings and loss of control owing to the inherent difficulty of managing blood glucose levels. Patients believe it is entirely their fault.
Other than suggesting the possibility of a larger-based study, Phillips painted a rosy picture of her findings and foresaw no need for remedial action.
Ethical Considerations
The researcher ensured that participation remained voluntary and implemented every protection that patient privacy demanded (Medical Research Council, 2000/2003). The latter included showing them interview notes and transcripts and obtaining informed consent at varying stages of the process, a point Bartunek and Louis (1996) stress.
Next Step in Research Process
In reality (see point 9 above), this qualitative study by Phillips opens up new avenues for more robust research. Cartwright et al. (2006), for instance, described a large-scale community-based participatory research in the course of which 172 qualitative interviews had already been conducted in Idaho. Such a wider study is called for because the Phillips exploration had revealed opportunities for improving patient management and even embarking on preventive social marketing designed to hold back the onset of second-stage, insulin-dependent type 2 diabetes. The revelation of patient anxieties and mistreatment at the hands of NHS staff are in themselves matters of import.
Brief Evaluation
Philips evidently knows her facts. This is the virtue of having a practicing specialist carry out any kind of writing or research. This helps explain why she writes clearly, albeit her work could have used the services of a style editor to enhance readability and rhetoric.
Such credibility helps explain why the Phillips research needs to be expanded and, if validated by quantitative research, inform health care practitioners about the opportunities they miss both for alleviating the mental state of patients and perhaps even taking cues on stabilizing those who are still on oral medication.
As to the weaknesses, the reportorial style is dry, confined to a recitation of facts and findings, and more reticent than authoritative. Inexperience at research reporting shows in a disorganized review of the literature.
All in all, the study informs the hapless novice and that is perhaps its primary value. After all, phenomenology yields nothing more than a little case experience by nurse specialists or physicians would ordinarily provide. If that is, they have the heart to pay more attention to their patients.
References
Bartunek, J. M. & Louis, M. R. (1996). Insider/outsider team research. Thousand Oaks, CA: Sage.
Cartwright, E., Schow, D., Herrera, S., Lora, Y., Mendez M., Mitchell D., Pedroza, E., Pedroza, L. & Trejo, A., (2006) Using participatory research to build an effective type 2 diabetes intervention: The process of advocacy among female hispanic farmworkers and their families in southeast Idaho. Women and Health, 43(4).
Medical Research Council (2000/2003) Personal information in medical research. Web.
NHS (2008). One of Europe’s top hospital has opened in Coventry. Web.
Oka, T. & Shaw, I. (2000) Qualitative research in social work. Web.
Coordination of efforts aimed at educating people on the matter
Weaknesses
Additional funds should be allocated
Implementation of the program will take a significant amount of time
Insufficient methodology
External
Opportunities
Governmental support of similar projects
Increase of public’s attention to the issue
Advances in the research
Threats
Insufficient support of the government
Insufficient coverage in media
Insufficient attention of young people
The program aimed at raising awareness of people on diabetes can have a significant impact on the healthcare system as well as the health situation in the USA. One of the major strengths of the program will be a decrease in the development of the disorder as people will be able to pay close attention to their lifestyle, their health, and possible symptoms (Johnson, 2012). There are some programs and websites providing information on the problem but they are still inconsistent and a far-reaching program with significant media coverage may have a positive effect.
Notably, the US government is paying more attention to the problem and allocates funds to similar educational incentives (Shi & Johnson, 2014). People also seem to pay more attention to the issue. Finally, researchers have discovered new ways of treatment, diagnosing, and prevention of the disorder.
At the same time, there are threats and weaknesses. However, they can be mitigated. The program requires allocation of funds but this should not be a burden for the federal or state budget as additional funds may be received from numerous charities. It is essential to obtain the necessary media coverage and the Internet (especially social networks) may help do that as the issue excessively discussed on the Internet eventually appears in media. Social networks will also help draw young people’s attention as they are major networks’ users.
SWOT Analysis and Strategic Planning
SWOT analysis can be used as a starting point of strategic planning for a health administrator. SWOT analysis reveals the basic challenges and opportunities of any project. This type of analysis is rather brief but very precise and comprehensive. It can help come up with an efficient strategy to implement a project.
First, strategic planning is impossible without a SWOT analysis. Strategic planning presupposes the use of strengths of the project and the ability to predict challenges as well as ways to overcome them (Bauer, 2014). SWOT analysis enables administrators to unveil possible challenges (internal as well as external). This is important for the development of tools to address the issues that are likely to arise or prevent problems from occurring.
As has been mentioned above, the SWOT analysis is a starting point of any strategic planning and it is also a basis and an effective checking point during the process of decision-making. An administrator may use the SWOT analysis to make a decision especially when it comes to changes in the project. Clearly, each project should be flexible as new circumstances appear and the administrator has to be ready to respond (Merlino, Omi & Bowen, 2013). A proper SWOT analysis often contains the vast majority of challenges to be addressed and this helps administrators develop the necessary responses to arising issues.
Finally, SWOT analysis also helps allocate funds more effectively. The administrator can allocate funds to facilitate the strengths of the program and mitigate certain weaknesses. The administrator can also effectively allocate funds to address the issues that are likely to arise during the implementation of the project. Hence, it is possible to conclude that a proper SWOT analysis is crucial for efficient strategic planning.
Administrator Interview Synopsis
A Summary of the Interview
The administrator interviewed works for quite a small organization. She reports that they have come up with a strategic plan for five years. This is quite a detailed plan with identified goals and terms. There are a number of major goals and several intermediate ones. The plan includes fund allocation that is quite preliminary and rather flexible. It is noteworthy that the plan includes people responsible for certain minor projects and the achievement of goals. Those are not names of particular people but posts and teams/departments.
The interviewee believes that strategic planning is of paramount importance for any organization and the pressure is quite high. The process is very challenging and it needs the involvement of all employees. The interviewee stresses that they do not have enough funds to hire an effective strategic planner from outside. Hence, they have to come up with the plan using their resources and experience. The head of the organization is responsible for the development of the plan, which is compiled after numerous discussions and meetings.
The interviewee stresses that SWOT analysis is often a basis of the plan as it includes major points. The analysis is held during a meeting where employees come up with ideas. Employees also complete certain research and provide insights on possible goals for the next five years, challenges, and ways to address them. The most challenging part for the interviewee and his colleagues, as reported, is making decisions on major and intermediate goals and potential challenges.
Synopsis
As has been mentioned above, strategic planning is a complex process that needs effective decision-making. Clearly, during the development of this plan, many goals and challenges may seem important but it is important to evaluate the relevance of each goal and each issue (Bauer, 2014).
Effective decision-making is especially important when it comes to resource allocation. Reaching every goal presupposes certain expenditure and it is essential to make sure that a sufficient amount of funds is allocated to achieve this or that goal. The modern world is highly competitive and companies cannot afford to spend too many resources. When it comes to the sphere of public health, tension is increasing as healthcare often lacks sufficient financial support. Hence, resources have to be allocated wisely and efficiently.
It is important to make sure that funds will cover the achievement of the necessary goals and there are enough resources to address challenges that are likely to arise. It is important to prioritize and make sure that relevant processes can be implemented effectively and on time. It is also necessary to remember about possible risks and problems that can occur. There should be a reserve where additional resources can be found if necessary.
Conclusion
In conclusion, it is necessary to note that effective decision-making is crucial for strategic planning when it comes to resource allocation. It can ensure the effectiveness of the plan and the success of the organization in reaching its goals. Of course, this increases the competitiveness of the organization as well. Companies have to pay specific attention to funds allocation and remember that the plan should be flexible as well as resource distribution. It is always important to remember that some additional challenges may occur and resources may be required to address these issues.
Reference List
Bauer, J.C. (2014). Paradox and imperatives in health care: Redirecting reform for efficiency and effectiveness. Boca Raton, FL: CRC Press.
Johnson, T.D. (2012). Prevention and public health fund paying off in communities: Success threatened by cuts to fund. The Nation’s Health, 42(6), 1-31.
Merlino, J., Omi, J., & Bowen, J. (2013). Lean behavioral health: The Kings county hospital story. New York, NY: Oxford University Press.
Shi, L., & Johnson, J.A. (2014). Novick and Morrow’s public health administration: Principles for population-based management. Sudbury, MA: Jones & Bartlett Learning.
Diabetes prevention and management is an important issue when it comes to dealing with older patients because some of them lack resources, tools, and education to deal with the condition effectively. In rural areas, issues with access to care can be limited to the disease’s prevention due to the low health literacy of residents, shortages of physicians, and low incomes, which is why the topic was chosen for the current discussion (Nielsen, D’Agostino, & Gregory, 2017). The selected source is the article by Luo et al. who focused on studying diabetes-related prevention behaviors among the rural elderly residence of Hunan, China.
The Size of the Problem
Outcome measures for the study included their general information, including age, marital status, family history of diabetes, BMI, education, and the behaviors related to diabetes management. It was found that elderly citizens living in rural areas exhibited a high rate of harmful diabetes-related behaviors. For example, 57.6% of participants completed physical examinations less than once a year, 55.3% did not engage insufficient physical activity, 51.4% paid limited attention to controlling their nutrition, and 41% ate a high-salt and high-fat diet (Luo et al., 2018). The source is therefore essential for pointing out the fact that elderly patients in rural areas do not have sufficient resources and education necessary to ensure the effective management of diabetes.
Conclusion
The research will contribute to personal practice because it encourages healthcare providers to be aware of the limitations rural patients face and be more proactive in their diabetes prevention. It is also imperative to provide education to such patients and engage their families into the process of learning to boost their health literacy (Hash, Jurkowski, & Krout, 2014). Being able to advocate for the needs of underserved populations is also a part of work with older adults as they often cannot stand for themselves.
References
Hash, K., Jurkowski, E., & Krout, J. (2014). Aging in rural places: Programs, policies, and professional practice. New York, NY: Springer.
Luo, B., Zhang, J., Hu, Z., Gao, F., Zhou, Q., Song, S., … Xu, H. (2018). Diabetes-related behaviors among elderly people with pre-diabetes in rural communities of Hunan, China: A cross-sectional study. BMJ Open, 8(1), e015747.
Nielsen, M., D’Agostino, D., & Gregory, P. (2017). Addressing rural health challenges head on. Missouri Medicine, 114(5), 363-366.
Race and ethnicity are the factors that provoke a number of discussions in various fields, including politics, economics, health care, and medicine. In their article, Purcell and Cutchen (2013) defined the incidence of diabetes among African Americans as a serious and complex problem that had to be defined, analyzed, and solved. In this paper, the role of culture and identity will be discussed from the point of view of health and care offered to a particular group of people. The goal is to overview diabetes among the African American population with available statistics and implications for health and describe the population’s cultural identity using the PEN-3 model in the study of Purcell and Cutchen.
Overview of the Health Issue
In the article by Purcell and Cutchen written for the American Journal of Health Education, the issue of diabetes among the African American population is discussed. The authors relied on various scholarly studies to investigate Type 2 diabetes and its disparities in relation to the chosen community (Purcell & Cutchen, 2013). There are many factors that may contribute to the development of this disease. They include age, obesity, family history, impaired glucose metabolism, and a lack of physical activity (Purcell & Cutchen, 2013). Compared to other cultural groups, the high incidence of the disease, as well as diabetes-related mortality rates, is observed in African Americans. The researchers took into consideration the role of social and economic factors that challenge the population. Poverty, lack of insurance, and low levels of education create additional obstacles for African Americans to improve their health compared to the opportunities that are available to the Whites.
Scope of the Problem and Statistics
The necessity to define the scope of the problem means that one should think about what works and what does not work in the chosen situation. African Americans have already been proved as the community with a high incidence of diabetes (Purcell & Cutchen, 2013). Despite the fact that various factors and reasons were recognized, it is hard for healthcare workers to prevent the growth of cases and control diabetes-related problems. According to the Centers for Disease Control and Prevention, approximately 30 million Americans are diagnosed with diabetes, which estimates about 9% of the total population of the United States. Non-Hispanic blacks include about 12% of this number, second only to American Indians (15%) (Centers for Disease Control and Prevention, 2017). Type 2 diabetes accounts for about 90% of all cases of diabetes diagnosis, compared to 6% of Type 1 (Bullard et al., 2018). The Northwestern University proves that blacks gain more weight with time, making obesity as one of the major contributors to the risk for diabetes. Biological and physiological factors, along with racial disparity, provoke new uncontrolled cases of diabetes.
Implications for Health
As well as any diseases, diabetes is characterized by serious implications for health among African Americans. Hypoglycemia and hyperglycemic crisis are the common reasons for emergency department visits for diabetic patients (Centers for Disease Control and Prevention, 2017). Diabetes is the inability to control the level of sugar in the blood, which leads to new cardiovascular diseases, nerve or skin damage, vision or hearing problems, and mental health disorders.
Cultural Identity
The PEN-3 model is a helpful tool to plan, implement, and evaluate healthcare interventions. It aims at identifying and examining the relationship between health and cultural meanings (people’s beliefs, family values, and social contexts). Cultural identity is one of the categories of this model, and Purcell and Cutchen (2013) focused on each component. Their approach helps explain why family-focused intervention is the best solution for diabetic African Americans.
Person
The success of healthcare interventions depends on a person and a clear understanding of their beliefs and values. In the chosen study, African Americans adult men and women have to live with type 2 diabetes (Purcell & Cutchen, 2013). A patient may experience a lack of trust in the healthcare system or be afraid of general recommendations. Although the theme of racism was closed decades ago, biased effects, as the causes of subordination, cannot be ignored.
Extended Family
Being defined as the representatives of a separate minority group, African Americans respect the idea of family support and its role in growth and development. In addition, Purcell and Cutchen (2013) identified coworker support and cooperation with an entrusted physician as the two critical factors in health care. African Americans are not ready to trust every person around, but if the circle of trust is created, diabetes becomes a common problem for a community.
Neighborhood
Finally, the role of community is impressive for African Americans who have serious health problems. Purcell and Cutchen (2013) underlined a high level of spirituality in the population, and the church was defined as a source of social and moral support for people. Diabetes is a challenge, and beliefs in God promote strengths and readiness to manage diabetes. Faith healing may not be effective, but it has to be considered by African Americans to improve their health.
Conclusion
Diabetes is a global burden with a number of consequences for African Americans. It is not enough to say that a black patient has a high level of predisposition to this disease just because of his or her ethnic belonging. Cultural identity is a chance to understand if African Americans are ready to cope with the challenge of diabetes using their beliefs, family support, and the environment.
References
Bullard, K. M., Cowie, C. C., Lessem, S. E., Saydah, S. H., Menke, A., Geiss, L. S., Imperatore, G. (2018). Prevalence of diagnosed diabetes in adults by diabetes type – United States, 2016. Morbidity and Mortality Weekly Report, 67(12), 359-361.
Purcell, N., & Cutchen, L. (2013). Diabetes self-management education for African Americans: Using the PEN-3 model to assess needs. American Journal of Health Education, 44(4), 203-212.