The scenario is of a nine years Old Tony care as provided by the registered nurse in a community and primary healthcare setting, whereas a community health care worker within the rural, suburban neighborhood. The scenario happens in during the school day where the teacher to Tony shared her concern for Tony. According to Tony's medical history, he had been diagnosed with Type 1 diabetes mellitus some months back; this has also caused him to be absent in school several times. According to the teacher, she has tried to provide Tony with a lot of support for Tony while he is attending school and check in with him regarding his blood sugar and meal checks, which he has been doing independently (P & Menon, 2013). From the initial assessment, the teacher said that she understood a little about diabetes since her father is also diabetic, meaning that Tony's blood sugar is ‘all over the place.' The teacher has also been providing Tony with more food that is sent from home. However, in my observation, Tony has not been following the diet plan required for diabetics as was advised by the diabetic’s clinic because he and his family are vegetarian and the plan is supposed to include meat.
Tony stays at their home with his three siblings and parents. Apart from him, his mother is also ill and suffers from a nephric syndrome, which has led her to depression since the family moved from Australia three years ago. The teacher has tried to dialogue with Tony’s mother about his diet concerns; however, nothing has changed for Tony. The teacher is also very concerned because Tony has told her that he always does his insulin in the morning as his father leaves for work very early and his mother is often not up yet when he is scheduled to take the insulin (P & Menon, 2013). The teacher also noted that his sibling often has to be absent from school, just like Tony. However, they are in a healthy condition. In this regard, as a nurse, the plan on ensuring Tony follows medication and proper diabetic diet as prescribed in the diabetic clinic.
Nursing Care
After the consultation with Tony's teacher, the specific aspect of nursing care currently required was to admit Tony to the self-management education course since he was still at elementary school age. This is supposed to be organized regarding the structured curriculum and the scheduled time based on international standards. Among the element of care would include behavioral therapy, the primary purpose of providing this type of care approach is to establish a patient-centered, systems-oriented, and highly individualized plan (Jayakumar & Prasanna, 2013). The care approach will primarily focus on Tony’s needs and characteristics. Because he is at the development and growth stage, it will be essential to enroll him in a group of other diabetic children living together in a kind of youth hostel. The atmosphere will be a reaction and shall have child-appropriate activities like leisure time and trips, circus activities, and mimicking healthy daily life. Tony's developmental stage is critical as will affect the way he is going to accept his situation as a diabetic and the fact that he shall have to live with the condition all through his life (Chiang et al., 2018).
However, with the companionship and development of new friends with other diabetic children will positively counter this since it will bring him a sense of normalcy to the condition. Struggling with equal difficulties and having to learn coping skills as a group helps to relieve the isolation feelings in the children. Also, they will be well taken care of by other young adults who are experiencing the same condition and have been able to manage it. Tony must undergo the self-management education since it will provide him with details of the diseases, allow for the blood glucose monitoring and interpretation, physiologic response, calculating and injecting insulin, proper diet intake and other relevant information and skills. All of these will be integrated into normalcy and leisure activities (Chiang et al., 2018). One of the main goals for this care plan is to train Tony to manage the condition unobtrusively; however, inspire him not to make it the focus of his life. The initial point of the training will look at the particular problems that Tony encounters daily, expectations, wishes, and goals. This will also include his social, cultural, and family background. It will be relevant to make excessive use of Tony's useful resources which have to be first discovered. In all the time process of care, Tony will be an active and participating partner.
The principles of child-centered care will be incorporate where each day the individual learning units are going to be well discussed and planned with Tony. For example, the learning consequences of physical activities regarding his glucose control and ways that he can prepare for it like ensuring he has eaten in advance. Whenever Tony learns new skills, he is going to be rewarded. In the times of social gatherings and the evening, Tony will be allowed to choose a small toy out of a box while the other children congratulate him. It will also be essential to avoid punishment (Wolfsdorf, Glaser, & Sperling, 2006). No activity should be forbidden, and everything should be allowed; however, this will be done under high supervision. Apart from the primary nurse caregiver, the training will also entail a team of Pediatric diabetes specialists, diabetes adviser, an endocrinologist, a Pediatric nurse, a dietician, a teacher, and a child and adolescent psychiatrist. It will also be essential to involve Tony's parents and sister’s including close friends as they will be vital in ensuring the implementation of self-management; however, they will not always accompany Tony during the course. The results of the care approach are to ensure that Tony learns to inject herself through various injection sites. Considering is perceptual challenges, he is going to be intensely trained to notice and interpret correctly any hypoglycemia symptoms, to adhere to blood glucose monitoring schedules, handle the metabolic status of activities and to calculate the dosage of insulin (Wolfsdorf, Glaser, & Sperling, 2006).
Communication
One of the issue with connection during this care plan was that Tony suffered from dyscalculia, which is difficulty in making arithmetical calculations due to a brain disorder. To address the question thus, specific schemata and tables would be developed with the involvement of Tony's parents. In the tables, the counted carbohydrates will be allocated to a particular factor with respect to multiplication. For example, 30g of carbohydrates x 1.5, this will then be adapted to the blood glucose level. The multiplication factor that will be varied by the child and during the day, all these will have to be adopted by Tony. The schema is also going to enable Tony to determine the right insulin dosage, which is going to ensure his self-management despite having dyscalculia. Other less helpful habits and their potential communication challenges will also be discussed from Tony’s point of view and new arranges are going to be made (Wolfsdorf, Glaser, & Sperling, 2006). Because Tony speaks English as a first language, it will be easy to ensure that adherence and self-management training has been adopted.
There will also be challenges in food intake, as initially observed by Tony's teacher. Tony might end up obese by taking up large food intake in the evening. However, this will be controlled by a food roaster in respect to the dietician. Tony will also be required to participate in all the planning and decisions of all details and all discussions which will take place when Tony felt emotionally comfortable (Jayakumar & Prasanna, 2013). All the self-management goals are going to be written down/ In case the goals are not reached; all the primary reasons will be discussed with the intent recalled. However, this will be done with no hint of blaming and achievement of each intended goal will also be rewarded. This is meant to encourage Tony to adhere to the self-management program.
The principles of family-centered care will also be incorporated in all communication stages, as stated in dealing with dyscalculia. It will also be essential to ensure clear communication and sharing of complete and unbiased information with parents regarding Tony’s condition and self-management development. There will be a sharing of information between the caregiver and Tony's family where the nurse will provide Tony's parents with access to his medical chart. Since tony is still nine years, he may not be required to write on the chart himself but will do this with the help of the nursing caregiver (Jayakumar & Prasanna, 2013).
Conclusion
In summary, the dietary situation, the insulin intake frustration, and stress of the diabetic child and the people in her circles can be substantially improved when the focus of diabetic care is completely changed. In the previous days and despite having a standard medical care, there has often been strong fluctuations in regard to blood glucose levels with a lot of hypoglycaemic episodes and a complete dependence of the child on his teacher even more than his parents, this led to a lot of anxiety, leading to absenteeism in school and social isolation (Jayakumar & Prasanna, 2013). When it comes to diet care, Tony played a passive role. Standardized training and medical information was an important part of care and must be provided in a theoretical, intellectual level, and not specifically accounting for the individual child situation, including her healthy and developmental capacity. The main aspect of the presented intervention was to look at the primary focus regarding diabetic care based on the child and her context, wishes, needs, hurdles and competency and the age-appropriate active collaboration (Jayakumar & Prasanna, 2013). This also entailed the monitoring of laboratory data and other technical factors regarding management that were also removed from the center of focus to become supportive, secondary, and less obtrusive. By providing the systems-oriented care, all the most important factors were well addressed within the similar process. The schedule of self-management training is going to be evolved out of the daily requirements regarding specific requirements of Tony. Rather than maintaining his glucose levels, the main focus of interest will be Tony himself.
References
- Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A.,Schatz, D. (2018). Type 1 Diabetes in Children and Adolescents: A Position Statement by theAmerican Diabetes Association. Diabetes Care, 41(9), 2026-2044. doi:10.2337/dci18-0023
- Jayakumar, R., & Prasanna, A. (2013). Type 2 Diabetes in Children. Diabetes in Children and Adolescents, 30-30. doi:10.5005/jp/books/12092_3
- P, S., & Menon, V. (2013). Diabetes Education in Children with Type 1 and Type 2 Diabetes.
- Diabetes in Children and Adolescents, 150-150. doi:10.5005/jp/books/12092_15
- Wolfsdorf, J., Glaser, N., & Sperling, M. A. (2006). Diabetic Ketoacidosis in Infants, Children, and Adolescents: A consensus statement from the American Diabetes Association. Diabetes Care, 29(5), 1150-1159. doi:10.2337/dc06-9909
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