According to a Ministry of Health 1997 article, of the premature deaths among adults in an average of over 400 individuals per year in the period between 1992 to 1994 were primarily from diabetes. The article further indicates that between 1991 and 1995 there was an average of 296 hospitalisations per year for diabetes in the 0 to 14 year age group which is an average annual rate of 36.8 hospitalisations per 100 000 population. Among the hospitalized the females’ rate was higher than the males’ rate with the difference of 6.8 in the respective population.
Risk factors.
The Ministry of Health 1997 article concluded that among the diabetic there is a complex mixture of genetic and environmental factors. From the genetic factors 20 percent of identified children and adolescents in the Canterbury region had a family history of diabetes while 80 percent were considered to be environmentally triggered due to nutritional practices associated with the consumption of smoked/cured mutton, high dietary nitrosamimes and high nitrate in water supplies. However other factors that can affect the blood sugar levels are stress, and fatigue as well as exercise and any changes in normal schedule.
As far as genetics is concerned, Diabetes may be inherited for example if someone in the family has or previously had diabetes, there is a chance that any member of the family may get it too. Reece, Coustan and Gabbe (2004) suggest that diabetes can also be triggered through infection because the immune system can over react and attack the pancreas which is the manufacturer of insulin. If the pancreas doesn't work properly, it can’t make enough insulin and the glucose levels will be abnormal. Therefore eating healthy and exercising can really help the glucose levels and could help to prevent getting diabetes.
Information from relevant practice settings and the role of social workers.
The literature shows that diabetes is listed as one of the most complex conditions that many people have been managing either individually or with the help of their families. According to Reece et al (2004) a multidisciplinary team management approach has become increasingly accepted as an effective and efficient alternative for the provision of the multidimensional care and support that is required for diabetes patients especially those that are pregnant. This team includes General Practitioners, diabetes nurse educators, dietitians, podiatrists, social workers and diabetes medical specialists. Krentz and Bailey (2005, p. 56) argues that a “care plan should be negotiated and agreed with the patient concerned so that the patient is suitably empowered with the limitations of the plan as it is essential that the patient views the plan as a conjoint effort and loose contract and it is the responsibility of the practictioner to emphasize this point”. I agree with this notion because a client will be encouraged to be committed and will comply as well as taking ownership in self-management of their health. Social work in health care helps people who are dealing with a medical problem to function within their situation. The social worker who specializes in health care works with clients and their families to provide services necessary to make their lives easier for the duration of the client's illness and help them to deal with the consequences directly related to that illness. However the primary focus of the social worker is to assist the client and the client's family in coping with their health care situation, assessing the problems, identifying their immediate and long-term needs, and finding resources to supply the needs. These resources may include encouraging them to attend classes about diabetes, reading about diabetes, accessing diabetes information on the web, or seeing a diabetes nurse educator or dietitian one to one. Further to this the Social worker may act as an advocate to secure the client's rights, directly counsel the client and the client's family, and refer the client to other social agencies, community resources, or facilities that can meet the client's immediate and long-term needs. Living with diabetes is a lifelong journey of learning as the affected will be making choices about their diabetes management everyday. Williams and Pickup (2001) argue that 99.9% of adults with diabetes are efficient or competent on self medication as they always make choices without the immediate help of their diabetes care team. Living with diabetes has far better outcomes when they understand how the glucose tissue shuts down the blood circulation. Therefore the key to managing diabetes is developing self-care skills and this includes learning about diabetes, what it is and how to manage it as a permanent condition although in few situations such as gestational diabetes, it can be short-lived. It also involves developing confidence in the choice making process. However people diagnosed with diabetes need to know that they are not alone and there is lot of community support around the country. Diabetes Auckland which is affiliated to Diabetes New Zealand has grown to become the country's largest educator and provider of support for people affected by diabetes through partnerships with those in the health system. This organisation has been training, providing awareness and assisting with patient management, support and research.
Informed practice
Mertig (2006) postulates that the presence of any chronic or severe illness, including diabetes may increase an individual’s risk factor for development of a depressive disorder. The transition in health status from being a healthy person to a person with a chronic illness can cause a wide rage of emotional reactions. Feelings of anger, denial, sadness and distress may be evoked. According to Watkins, et al (2003) it is becoming increasingly accepted that for diabetes care to be more effective, it is necessary to focus on the psychosocial needs of the person with diabetes as well as the pathophysiology of the condition. It is not easy to manage this kind of change as some of the feelings mentioned above may or may not, result in a process of adjustment and acceptance of the condition. Bruce and Schultz (2001) suggest that individuals in this predicament are out of their comfort zone and in a state of emotional disequilibrium. It is paramount that individuals are helped to understand the facts about diabetes and educate them on what they need to do to manage this chronic disease. Further to this Watkins et al. (2003) argues that a holistic management plan should encompass psychological, social and cultural factors as well as physical status.
Mertig (2006) claims that the day parents discover their child has diabetes is one of the worst days of their lives as they may be eclipsed with fears and all sorts of questions around new diet, medication, regular sugar tests and sugar intakes. I agree with Talbot (2002) who claims that coming to an acceptance of the reality of the change and loss takes time since it involves not only an intellectual acceptance but also an emotional one.
Individuals with diabetes should be supported to make an autonomous decision, not to be forced to follow the doctor’s orders. Redman cited in Mertig (2007) suggest that true client autonomy requires creating new options to meet the patient needs with the right to refuse a treatment option. This means that Social work practice should be informed around a client’s health status and in this case of a client being diagnosed or having diabetes, it is best to use the client centred approach as it increases client’s autonomy in the health care delivery. Mertig (2006) supports this idea as she believes that clients should be able to freely choose which health care providers, care facilities and care management systems best suit their needs and values. However practitioners need to balance the risk factors and client’s autonomy, given that clients may be devastated to learn their diagnosis and this may result in choosing alternatives that are ill advised. Motivational interviewing or assessment may help such people to explore and resolve any hesitancy about treatment options. Watkins et al. (2003) suggests that this is the way of working that is thoughtful and skilful and has been found to be useful and effective in a wide rage of situations. It aims to elicit internal motivation to change and can be used as a prelude to treatment and or integrated with other treatment approaches.
Watkins et al. (2003) suggests that those caring for the affected also require patience and perseverance and an understanding of humanity combined with a cautious optimism to guide those with diabetes through the peaks and troughs of their lives. This is where the family is required to be involved and according to Kissane and Bloch (2002) a family centred model of care is an essential requisite of responsible services seeking to meet the needs of both the patient and family and to maintain support. This approach involves creating a list of coping strategies with the family on what may help them and a list of issues that may appear to be of concern. Bruce and Schultz (2001) suggest that adapting and grieving involves the reworking of personal models of the world that has become redundant following a significant loss and change. This process can be well supported with the concept of support groups, as it is often useful for a group of people with the same problem to get together and talk about their lives.
Key principles and skills of practice
The key to effective social work practice and skills starts with understanding diabetes, as well as an understanding of the concerns of those who live with it. This insight will form the intervention plan which according to Watkins et al. (2003) will address the uncertainty surrounding the symptoms and prognosis, societal and personal stigma, the management of treatment regimens and professional – patient relationships. Watkins et al. (2003) further argues that the ability and skills of professionals to acknowledge and understand these issues greatly influence clinical outcomes such as self care skills, concordance and the level of patient satisfaction with service provision. Principles for a holistic approach includes exploring the client’s beliefs about their diabetes, who do they think caused it, their experience of the condition and adjustment process. The practitioner also needs to look at the social circumstances of their clients’ lives, fears and uncertainties surrounding their condition and finally what they need or want to enable them to manage their condition on a day to day basis. It is also helpful to identify any support groups within their clients areas because the social support they may get from engaging in group training or even sport is good for their emotional well-being and can add significantly to their sense of accomplishment and happiness. After watching and hearing my friends’ testimonies on how they live with diabetes, I concluded that activities such as dancing, cycling, swimming, walking, mountain climbing, or even something as simple as breathing should be incorporated in the management of diabetes as part of their daily life routine. If one can make time for TV, they can also make time for exercise and choose a proper diet and nutrition for a healthier life.
Unique learning and conclusion
People with diabetes can live a normal, regular life by keeping track of their blood sugar levels. However I learnt that the average life span of a diabetic is 15 years less than people that are not diabetic, but this does not mean that they cannot live a normal life. If a diabetic takes care of themselves by exercising and eating right, then their life can be just as happy as anyone without diabetes.
A good diet, exercise, and weight loss can help improve the body's use of insulin therefore the good diet should include low-fat foods, moderate amounts of protein, and lots of foods high in complex carbohydrates, like beans, vegetables, and grains. It is also advisable to do regular exercise as it helps the body to take in glucose. Exercise also lowers glucose levels and plays a major part in treatment as well as losing weight. It can also help the body to use insulin more efficiently. If a healthy diet is not kept up, then life-threatening complications may arise. These life-threatening complications include: blindness; heart attack; kidney failure; stroke; nerve damage; and amputation.
References
Bruce, E.J., Schultz, C.L. (2001) Nonfinite Loss and Grief, Baltimore, Maryland, Brookes Publishers.
Kissane, D.W., Bloch, S. (2002), Facing death, Family focused grief therapy, Buckingham, Open University Press.
Krentz, A.J, and Bailey, C.J., (2005) 2nd edition, Type 2 Diabetes in Practice, London, Royal Society of Medicine Press Ltd.
Mertig, R. G. (2006) The nurse’s guide to teaching diabetes self-management, what nurses need to know, New York, Springer Publishers.
Reece, E.A., Coustan, D.R., and Gabbe, S.G. (2004) 3rd Edition Diabetes in Women Adolescence, Pregnancy, and Menopause, Philadelphia, Maple Press
Watkins, P.J., Amiel, S.A., Howell, S.L. and Turner, E. (2003) 6th edition, Diabetes and its Management, Gosport, Blackwell Publishing Ltd
Williams, G., Pickup, J.C. (2004) 3rd edition, Nurse's guide to teaching diabetes self-management what nurses need to know, Malden, Mass, Blackwell Publishers
http://www.diabetesauckland.org.nz/contact.htm
http://www.phics.org.nz/index.cfm/Quick_Finder/Diabetes
