NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

Microvascular Complications 

Effect On Patient

The effects of diabetes mellitus are long-term multi-organ dysfunction.  Consistent hyperglycemia and diabetes lead to the development of a proinflammatory microenvironment that causes various microvascular complications (Nguyen et al., 2012). The most commonly observed microvascular complications are neuropathy, retinopathy, and nephropathy. The initial unmanaged diabetes symptoms with poor glucose control and dietary management lead to later development of microvascular complications. It is predominantly evident at places where the glucose concentration is equal to the normal blood glucose (Khalil et al., 2017). 

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

It can be present in every age group mainly significant with the longer duration of diabetes. In patients with a long duration of diabetes type 2, onset at a young age, an increased tendency to develop microvascular complications is observed (Zoungas et al., 2014). The quality of health of patients reduces because of the health impact associated with microvascular complications. Diabetic retinopathy is the most common complication causing disruption of the blood vessels of the eyes eventually leading to blindness (Zhange et al., 2011). Diabetic neuropathy is associated with the risk of foot ulcers, gangrene, amputations, and several gastrointestinal tract disorders. It also causes other microvascular complications as well (Hotta et al., 2012). Diabetic nephropathy damages the blood vessels of the kidneys thus patient has to limit the dietary options (Jakhotia et al., 2018). The complications of microvascular damage disturb the normal quality of life of the patients.  The overall health status of the patient causes additional stress and disturbs the sleep and eating patterns. Obstructive Sleep Apnea (OSA) is mostly observed in diabetes type 2 patients (Antza et al., 2021).  The long hospital stays isolated with multiple health issues enhances the stress and mortality fear in patients (Nikmat et al., 2015). 

Effect On Family 

The family members find it difficult to see their loved ones in pain and deteriorating health. The selection of intervention strategy is a shared decision for the patient and family. Often family members have to make decisions for the patient’s benefit (Ahmed and Yeasmeen, 2016; Ivers et al., 2019)). The long-time adherence to the medication and intervention guidelines becomes a problem for the family members and patient as well. The patient feels lonely and stressed over the medication regimen and dietary restrictions (Kusaslan, 2018). 

Scope of the problem

According to the 2016 Global Survey Report of the World Health Organization (WHO), the total number of diabetics reached 422 million. The rapid increase in the past years has been highest in the developing and under-developing countries. It increases the risk of comorbidities and mortality rate. Most diabetic patients with microvascular complications are at risk of cardiovascular diseases, stroke, blindness, hypertension, chronic kidney diseases (CKD), peripheral artery diseases, and amputations (Jakhotia et al., 2018). The prevalence of amputations is 10 to 20% of the diabetics per year (Boyko et al., 2018).  The most common lower extremities complications, foot ulcers, are common in diabetics. 

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

Foot ulcers are identified in 6.3% of the global population as a complication of diabetes. As reported by the International Diabetes Federation, annually around 9.1million of foot ulcers are reported among 26.1 million diabetics. The United States alone has a history of more than 3.5-million-foot ulcers reported in diabetics. This complication is lifetime and accounts for 15 to 25% of the risk of developing foot ulcers (Armstrong et al., 2017). 

Leadership Role 

It is the role of health care professionals as a stakeholder of the health industry to provide efficient, safe and effective health care provisions and treatment strategies to the patients (Conway et al., 2019). The multifactorial implications of the disease on the physical health of the patient and mental health as well would require a holistic leadership ability. Situational leadership model provides leaders to act differently following the challenge or situation faced. The situational leadership role is centered around the patient care. The framework of this leadership model reflects the core attribute of the leader that is gathered around patient care. The leader will have a broad predictive vision with harmonizing to the patient care and needs. Such a leader will have compliance with the patient-centered actions. Connection with the other, family members, or the patient himself, facilitates personal involvement in the care practice. Such a leader is an enthusiast and motivates the patient to work for his health. Develops an emotional connection with the patient, listening, collaborating, and appreciating the effort patient is putting into the task (Lynch et al., 2018).  

Several hypotheses have been formulated to elaborate on the possible process of developing microvascular complications. It requires addressing multiple factors to start the mitigating and management strategy, including, lifestyle, dietary habits, pharmacological, disease intervention (Khalil et al, 2017). High-quality diabetic care requires self and family intervention adaptations. The consumption of high cholesterol runs in families. The goals should be pharmacological and non-pharmacological interventions as well (Ivers et al., 2019). 

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

Intervention Strategy 

Globally diabetic care management requires patient and family-provided self-management. Diabetes self-management education enabling the patient about medication adherence, blood glucose monitoring, crucial changes in dietary and exercise patterns (Pamungkas et al., 2017).  Education about the outcomes of the physical health, psychological and behavioral wellbeing of the patient and his family (Pamungkas et al., 2017). The education of family members is also important regarding dietary and medication measures, controlling, cholesterol and glucose concentrations. Insulin administration education reduces the load of hyperglycemia. (Zaharieva, D.P. and Riddell, 2017).

Policy Requirement 

Implementation of a screening program is necessary to prevent the early detection of disease. The high prevalence of diabetes and its microvascular complications in the younger generation has put an alarming need of the policy. The health sectoral early detection of the possible future risk can mitigate the disease before its progression (Khalil et al., 2017).  Technology-enabled diabetic self-management and assessment with self-management education of the patient and family members are required (Greenwood et al., 2017). 

Barriers To Strategy 

Patients with microvascular compilations often have long hospital stays for neuropathy and nephropathy complications. The intervention and strategy of treatment are often multifactorial. The health care providers ahs reported that they find certain barriers in the incorporation of the appropriate strategy. The main barrier observed is the lack of communication and decision-making ability of the family members (You et al., 2015). Often a crossroads is reached, the family members cannot make the tough decision. The implementation of appropriate measures requires communication and efficient decision-making ability. The provision of educational reinforcements and efficient technological tools has been a barrier in generating awareness and providing self-management diabetes alleviation guidelines (Adu et al., 2019).

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

References

Khalil, H.,(2017). Diabetes microvascular complications—A clinical update. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11, pp.S133-S139.

Zoungas, S., Woodward, M., Li, Q., Cooper, M.E., Hamet, P., Harrap, S., Heller, S., Marre, M., Patel, A., Poulter, N. and Williams, B. (2014). Impact of age, age at diagnosis, and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia, 57(12), pp.2465-2474.

Zhang, W., Liu, H., Al-Shabrawey, M., Caldwell, R.W. and Caldwell, R.B. (2011). Inflammation and diabetic retinal microvascular complications.

Ivers, N.M., Jiang, M., Alloo, J., Singer, A., Ngui, D., Casey, C.G., and Catherine, H.Y. (2019). Diabetes Canada 2018 clinical practice guidelines: key messages for family physicians caring for patients living with type 2 diabetes. Canadian Family Physician, 65(1), pp.14-24.

You, J.J., Downar, J., Fowler, R.A., Lamontagne, F., Ma, I.W., Jayaraman, D., Kryworuchko, J., Strachan, P.H., Ilan, R., Nijjar, A.P. and Neary, J. (2015). Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA internal medicine, 175(4), pp.549-556.

Ahmed, Z. and Yeasmeen, F. (2016). Active family participation in diabetes self-care: a commentary. Diabetes Manag, 6(5), pp.104-107.

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

Nguyen, D.V., Shaw, L. and Grant, M. (2012). Inflammation in the pathogenesis of microvascular complications in diabetes. Frontiers in endocrinology, 3, p.170.

Hotta, N., Kawamori, R., Fukuda, M., Shigeta, Y. and Aldose. (2012). Reductase Inhibitor–Diabetes Complications Trial Study Group.  Long‐term clinical effects of epalrestat, an aldose reductase inhibitor, on the progression of diabetic neuropathy and other microvascular complications: a multivariate epidemiological analysis based on patient background factors and severity of diabetic neuropathy. Diabetic Medicine, 29(12), pp.1529-1533.

Kusaslan Avci, D. (2018). Evaluation of the relationship between loneliness and medication adherence in patients with diabetes mellitus: a cross-sectional study. Journal of International Medical Research, 46(8), pp.3149-3161.

Jakhotia, S., Sivaprasad, M., Shalini, T., Reddy, P.Y., Viswanath, K., Jakhotia, K., Sahay, R., Sahay, M., and Reddy, G.B. (2018). Circulating levels of Hsp27 in microvascular complications of diabetes: prospects as a biomarker of diabetic nephropathy. Journal of Diabetes and its Complications, 32(2), pp.221-225.

Antza, C., Ottridge, R., Patel, S., Slinn, G., Tearne, S., Nicholls, M., Cooper, B., Ali, A. and Tahrani, A.A. (2021). The impact of sleep disorders on microvascular complications in patients with type 2 diabetes (SLEEP T2D): the protocol of a cohort study and feasibility randomized control trial. Pilot and feasibility studies, 7(1), pp.1-11.

Boyko, E.J., Monteiro-Soares, M. and Wheeler, S.G. (2018). Peripheral arterial disease, foot ulcers, lower extremity amputations, and diabetes. Diabetes in America. 3rd edition.

Nikmat, A.W., Hashim, N.A., Omar, S.A. and Razali, S. (2015). Depression and loneliness/social isolation among patients with cognitive impairment in the nursing home. ASEAN Journal of Psychiatry, 16(2), pp.1-10.

Conway, A., O’Donnell, C., and Yates, P. (2019). The effectiveness of the nurse care coordinator role on patient-reported and health service outcomes: A systematic review. Evaluation & the health professions, 42(3), pp.263-296.

Lynch, B.M., McCance, T., McCormack, B. and Brown, D. (2018). The development of the Person‐Centred Situational Leadership Framework: Revealing the being of person‐centredness in nursing homes. Journal of Clinical Nursing, 27(1-2), pp.427-440.

NURS FPX 4900Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations PS

Pamungkas, R.A., Chamroonsawasdi, K. and Vatanasomboon, P. (2017). A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences, 7(3), p.62.

Armstrong, D.G., Boulton, A.J. and Bus, S.A. (2017). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376(24), pp.2367-2375.

Zaharieva, D.P. and Riddell, M.C. (2017). Insulin management strategies for exercise in diabetes. Canadian journal of diabetes, 41(5), pp.507-516.

Greenwood, D.A., Gee, P.M., Fatkin, K.J. and Peeples, M. (2017). A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. Journal of diabetes science and technology, 11(5), pp.1015-1027.

Adu, M.D., Malabu, U.H., Malau-Aduli, A.E. and Malau-Aduli, B.S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one, 14(6), p.e0217771.