Primary Health Care for Diabetes Treatment

• Ashley Suy

Molly is a married 82-year-old woman who is diagnosed with Type II Diabetes and has developed a leg ulcer on her lower left leg. The effects of having leg ulcers impacts Molly’s physical, mental and social health. Physically, Molly’s mobility has declined. She is unable to walk as with every step she takes it causes pain. A lack of physical activity, such as walking has led to weight gain as she has been advised to sit with her leg up as much as possible to speed up the healing process.

Molly’s mental well-being would be negatively impacted as she will be mentally stressed from dealing with the leg ulcer and having no mobility to do day-to-day tasks. This disenables her to have independence as she relies on Pat, her husband, to do simple tasks for her as she is immobile – which may lead to guilt for relying on him to assist her with daily tasks.

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The leg ulcer along with immobility will inflict negative effects on Molly’s social health. Not being able to go out to see her friends and her loved ones or spend time outside of home with Pat will cause an abundant amount of stress which will gradually lead to depression.

The issues that will be primarily focused on are, Primary Health Care relating to Molly’s Leg ulcer, Principles of Wellness, the Wellness Model, Type 2 Diabetes in regards to Molly’s condition and how an Enrolled Nurse will support Pat through a time of distress of grieving and bereavement.

Primary Health Care (PHC) is the primary contact of accessing health care and it is based on the needs of individuals and the country. It focuses on practical, scientifically sound and socially acceptable methods and resources that are made universal for people and families at an affordable cost that individuals and the country can afford to assist with their individual growth and development to maintain a healthy life (Koutoukidis, Stainton, & Hughson, 2013, pp. 85-86).

Since PHC is based on providing appropriate resources for individuals, Molly should be educated on the different types of services that will allow her to treat her health problem effectively. Some services include, home carers, community service, counsellors and online websites such as Diabetes Australia. As Molly suffers from a Leg ulcer she is evidently unable to participate in her regular community activities like she once use too. PHC encourages services that are scientifically sound and socially acceptable – as well as, relevant to the client. A way that PHC can be beneficial for her is through a home visiting service or physiologists that is subsidised by Medicare. PHC supports the involvement of a multidisciplinary team – integration of services that will assist Molly in the healing process. Nurses, dieticians, physiologist, podiatrists and GPs are the most appropriate types of multidisciplinary members. This team will educate her, Pat and her family with information of diabetes, leg ulcers, proper nutrition, appropriate exercises and activities to promote her health as well as preventing future hospitalisation or illness exacerbations.

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‘Wellness’ according to Student Health and Counselling Services (SHCS) (https://shcs.ucdavis.edu/wellness/) ‘is an active process of becoming aware of and making choices towards a healthy and fulfilling life’. The wellness model is a framework that individuals use to become aware of the interconnectedness of each dimension of the wheel and how they play a significant factor to healthy living. The Wellness Model consists of six dimensions: physical, social, intellectual, spiritual, emotional and occupational (Hettler, 1976).

A principle of wellness is ‘the self is the only true healer’. This refers to the health professionals assisting individuals during the healing process. However, it is primarily up to ones’ body and mind to heal– as well as allowing time for full recovery. (Hoppers Institute, n.d). Another principle of wellness is ‘Prevention eliminates the need for treatment’. This simply means that the prevention of wellness should predominantly be focused on a solution or an outcome to eliminate the problem so there would not be a need for treatment.

These principles apply to Molly as she has health professionals that help facilitate the healing process with dressing the wound three times a week and advising her to recover at home which is allowing time to pass by to allow full recovery. Prevention eliminates the need for treatment principle relates to Molly because she needs to limit the chances of leg ulcers from reoccurring again in the future. So, with a mixture of moderate exercise and a healthy diet it would minimise leg ulcers from occurring again. Another effective way to limit the chances of developing leg ulcers again is by using compression socks or hosiery to allow adequate blood circulation in the leg, thus preventing leg wounds. (Kenny, 2013)

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Type 2 Diabetes is insulin that is either, unable to produce what the body needs or the cells in the body are unable to use the existing insulin effectively (also known as, insulin resistance). (Falvo, 2014)

According to Diabetes Australia (http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia/) an estimated 280 Australian’s develop Diabetes every day. It is the most common form of diabetes, affecting 85 – 90% of all people with diabetes. Although it usually affects adults over the age of 45, it is now affecting younger people even children as young as 3. Research has shown that women over the age of 45 and overweight are more susceptible to getting diabetes. Molly has been diagnosed with type 2 diabetic for 17 years. What happens in the body of a diabetic person is that the pancreas which controls glucose in the body makes less insulin (a hormone). However, if the existing cells in the body are unable to effectively use insulin, it makes it difficult to keep blood glucose levels (BGL) in an optimum range. The pancreatic cells cannot use existing insulin effectively thus, why she has been prescribed oral medication to control her blood glucose level.

Diabetes contribute to leg ulcers as fatty substances called atheroma develops on the inside lining of the arteries reducing blood flow to various parts of the body. The most commonly affected area is the arteries in the legs – causing a decrease in blood supply to the feet (Kenny, 2014). Diabetic retinopathy is the most common diabetic eye disease. It is caused by changes in the blood vessels of the retina. Blood vessels in the eye may swell, or leak fluid. In some people, abnormal new blood vessels grow on the surface of the retina.

A learning program for Molly’s Leg ulcer is a crucial factor in educating her on the prevention of reoccurring leg ulcers. Some teaching methods that would be used are verbal discussions about Diabetes, her eating habits, exercising routine and lifestyle. Since she has put on weight, she feels tired and unwell.

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A dietician and a local GP will work together to review current blood and other tests that will be mixed together to come up with a suitable diet plan. The dietician will then provide Molly with written information that she will be able to take home to follow, thus achieving her physical health. (Dieticians Associated of Australia, 2014)

Another method of teaching is through a physiologist who can demonstrate various low to mild exercise routines where the activities are suitable and safe to follow as well as assist with Molly’s current immobility (Allied Health Profession Australia [AHPA], 2010). As mental health for Molly is a risk factor, beyond blue encourages that maintaining connections with friends, family and the community can prevent feelings of loneliness and isolation and help to stay mentally healthy (Beyond Blue, 2013).

This first link is a publication regarding leg ulcers and how to care for them, thus educating Molly on Leg ulcers. Molly will need to read this publication to understand it or have a relative or health professional explain it to her.

• http://www.awma.com.au/publications/vlu_patient_info_a4_2012-08-21.pdf

The second resource that Molly can learn from is the Leg Ulcer Prevention Program (LUPP) which is an electronic multimedia client education package for people receiving care regarding leg ulcers. The program is delivered at home via a nurse’s personal computer, so Molly will not have to move too much. Also, she can listen and watch the multimedia. (Kapp, S; Miller, C; and Donohue, L, 2010)

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Grief and loss are two major feelings that Pat has encountered as Molly passed. Grief is a response to loss. People experience grief differently; some may go through sadness, anger, anxiety, disbelief, panic, relief or even numbness. (Healey, 2010)

To relieve Pat’s grief, an Enrolled Nurse would offer basic reassurance that he is not alone, an opportunity for him to talk about the loss of his wife, encourage him to seek help from other resources if he needs, such as psychologists, counsellors, or mental health services.

The Australian Centre for Grief and Bereavement (ACGB) offers support groups that will help participants in many ways. Some of the groups that they offer are Bereaved Partners, Death of a Parent, For Men, Pet Loss and many more. ACGB also shares stories of other people that have gone through loss (Australian Centre for Grief & Bereavement, n.d). Another service available is the ‘Compassionate Friends Victoria’, a group that offers ‘men’s space’ where bereaved men go along and discuss issues together. (Compassionate Friends Victoria, 2014)

Primary Health care along with the Wellness Model play a major role in the quality of life that Molly has experienced. Type 2 Diabetes has a major affect on Molly’s health, thus contributed to leg ulcers. Pat will gradually move on from grieving over the loss of his wife with the help of support groups.

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Word Count: 1591

References

Donna R. Falvo.(2014). Medical and Psychosocial Aspects of Chronic Illness and Disability (Ed. 5) (p.377)

Beyond Blue (2013). Older People and Depression. Retrieved from: http://www.beyondblue.org.au/resources/for-me/older-people

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hopperinstitue.com. (n.d.).Principles of wellness. Retrieved from http://www.hopperinstitute.com/wellness.html

Diabetes Australia (2013). Type II Diabetes. Retrieved from: http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia/

Bill Hettler, MD. (1976). The Six Dimensions of Wellness Model. Retrieved from http://c.ymcdn.com/sites/www.nationalwellness.org/resource/resmgr/docs/sixdimensionsfactsheet.pdf

Gabrielle Koutoukidis., Kate Stainton., Jodie Hughson. (2013). Health promotion, education and wellness. In Elizabetch Coady& Jane Coulcher (Ed.6), Tabbner’s Nursing Care (pp. 85-86).

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Tim Kenny. (2013).Venous Leg Ulcers. Retrieved from: http://www.patient.co.uk/health/venous-leg-ulcers-leaflet

shcs.ucdavis.edu (n.d) Wellness. Retrieved from: https://shcs.ucdavis.edu/wellness/

compassionatefriendsvictoria.org.au.(2014). Retrieved from Compassionate Friends Victoria: http://www.compassionatefriendsvictoria.org.au/

grief.org.au. (n.d.).Grief.Retrieved from Australia Centre for Grief & Bereavement: http://www.grief.org.au/grief_and_bereavement_support/understanding_grief/about_grief

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Justin Healey. (2010). Coping with Grief and Loss: Vol. 319.Coping with Grief and Loss. Australia: The Spinny Press.

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