SCQF Level 9 Critical Appraisal Of Care Assignment Sample

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Introduction of Critical Appraisal Of Care Assignment

Contemporary health issues (CHIs) mean something current or new and revisiting living through public health concerns regarding economic inequality, lifestyle choices, and disease control. This assessment is going to do a critical appraisal of CHIs, which affects the adult population both internationally and nationally. Additionally, it will evaluate some problem-solving processes, which apply to care management of adult patients regarding their condition. In part c, it will critically appraise theoretical concepts regarding adult nursing, and in part d, it will illustrate some evidence-based interventions for meeting diverse needs of individuals. 

Part A- Critical analysis of contemporary health issue

Contemporary health issue

The first part of this assessment is going to analyse the CHIs, which affect the adult population internationally and nationally. In this assessment, the selected CHI is Diabetes. Information has suggested that Diabetes is a huge public health problem, which is globally approaching epidemic proportions. According to WHO (World Health Organisation), the number of diabetes cases has increased exponentially in the past few decades (World Health Organisation, 2021). According to Diabetes UK, approximately 3.9 million individuals have been diagnosed with this health issue.

Additionally, 7% of the UK population live with this health issue, and around 1 million people are still undiagnosed with type-2 Diabetes (Diabetes UK, 2019). Moreover, approximately 700 people per day are diagnosed with Diabetes, which means one person in 2-minutes. Approximately 90% of diabetic people have type-2 Diabetes (T2D), 8% of diabetic people have type-1 individuals, and only 2% of diabetic individuals have rare types of Diabetes (Diabetes UK, 2019). 

Not only in the UK, diabetic patients are present across the world. The report of International Diabetes Federation (IDF) suggested that in 2019, around 463 million adults were living with this health issue globally, and by 2045, the number will increase to 700 million (IDF, 2020). In Diabetes, the majority of the cases are T2D, and 79 percent of Diabetes adults live in low to middle-income countries. Globally, Diabetes causes approximately 4.5 million deaths. Both internationally and nationally, Diabetes has a huge impact on the adult population; for example, it causes heart attacks, blindness, lower-limb amputation, and kidney failure (WHO, 2021).

Patient case study

Since this assessment selects Diabetes as a contemporary health issue, it has considered a patient case study with the selected CHI. The selected patient is a 68-year old male suffering from T2D for the last 10 years. This patient is not associated with regular exercise and does not follow any healthy diet, and he prefers to eat junk food, which affects his BMI level. Additionally, the patient has alcohol consumption habits. This patient has been receiving metformin and DPP-4 (Dipeptidyl peptidase-4) inhibitors for the last 1 year. The patient's BMI (body mass index) is 29 kilograms per metre square, and her renal function is normal.

The patient has low dyslipidemia controlled having statin as well as angiotensin-2 receptor blocker controls hypertension. Due to concern of hypoglycemia, the patient elects to avoid insulin. Because of Diabetes, the patient experiences skin infections such as swollen skin, itchy rashes, sometimes dry scaly skin, and tiny blisters. Davidson et al. (2021) explained that prevalence of Diabetes is higher within the older population, and Diabetes comes with other issues such as shin spots, outbreak of reddish-yellow bumps, red-colour raised bumps, and skins tags. The patient is also suffering from red-colour raised bumps, and studies found that diabetic people are more probable to have granuloma annular on a large area of the skin.

The case study discusses that the patient has been suffering from type-2 Diabetes for the last 10 years. Additionally, the BMI of the patient indicates that he is underweight, and if he cannot manage his lifestyle or healthy diet, then the patient can experience obesity issues. The patient's age is another major risk factor for his Diabetes. Wang et al. (2021) stated that age is a significant risk factor for Diabetes; more specifically, people over 45 years old are more likely to have Diabetes as compared to young population. By agreeing to this, Noh et al. (2018) explained that besides lifestyle and family history factors, age is another significant factor that can lead to Diabetes.

Research has also found that family is a significant risk factor for Diabetes; however, in this case, the patient does not have any family history of Diabetes. That means his lifestyle factors and age contribute to developing Diabetes. Hence, it can be discussed that the selected patient has Diabetes as a contemporary health issue, which can harm him negatively if he does not change his lifestyle factors, for example, unhealthy diet, and physical inactivity. Lastly, this patient also needs to control the limit of alcohol consumption so that it will not increase future complications. In this context, Wu et al. (2021) explained that if a diabetic patient consumes heavy alcohol, it accumulates specific acids within blood, which result in serious health consequences, such as complications in fat metabolism, eye disease and nerve damage. 

Part B- Evaluating problem-solving processes

The previous part discussed the CHI and, based on that, and it has illustrated a patient's case study who is suffering from Diabetes. According to the NHS, Diabetes is a progressive and chronic disease, which affects almost every aspect of life. It comprises a set of disorders having various causes that are associated with raised blood glucose levels. The UK government developed the NSF (National Service Framework) programme for improving services through setting national standards for driving up service quality in diabetes care. The National Service Framework for Diabetes sets some standards and key interventions for Diabetes (Government of UK, 2017). In order to manage on-growing cases of Diabetes in England, NHS has developed the NHS Diabetes Prevention Programme (NHS DPP), whose goal is to deliver a systematic approach regarding decreasing risk of individuals developing this health issue (NHS England, 2018). According to information, in England, 5 million people are at higher risk of developing T2D. Thus, NHS DPP identifies the significant risk factors and then referred those patient appropriate behaviour change programmes.

According to the American Diabetes Association (2020), behavioural interventions that support people in maintaining a healthy lifestyle and weight can remarkably reduce risk of Diabetes. Besides this, NHS has launched NHS RightCare Pathway: Diabetes that defines optimal disease services regarding people who have or who are at high risk of having Diabetes, which delivers better value regarding cost and outcomes (NHS England, 2018). This pathway was developed by collaborating with NHS DPP. It allows commissioners to think about the existing services for Diabetes and compares those services with the optimal ones. Additionally, local healthcare can utilise the products to structure the local improvement to make RightCare decisions. NHS RightCare Pathway supports CCG (Clinical commissioning group) for working with physicians for increasing participation within Diabetes audits as well as ensuring that diabetes-related education is increasing so that people are more aware of this healthcare issue and their health. Moreover, NHS England has financed approximately 42 million pounds and collaborated with STPs (Sustainability and transformation partnerships) and CCG to improve people's care and treatment.

Since Diabetes is a global issue, besides the UK government, other global organisations take several approaches to manage Diabetes. In order to respond to the rising burden of Diabetes throughout the world, WHO has come up with the Global Diabetes Compact (WHO, 2021). Aim of this Compact is to reduce diabetes risk and ensure that diabetic individuals have access towards comprehensive, high quality, affordable and equitable treatment and care. This Compact will support prevention of T2D from a healthy diet, physical inactivity, and obesity. Additionally, the CDC (Centers for Disease Control and Prevention) has developed National DPP, the partnership of private and government organisations working to prevent or delay T2D (CDC, 2020). The partners make this easier for people at severe risk of Diabetes. An important feature of this program is a lifestyle-change program, which is a research-based program that pays attention to physical activity and healthy eating. It shows that people having pre-diabetes participating in structured lifestyle-change programmes can reduce risk of T2D developments. Lastly, IDF has mentioned diabetes prevention. According to them, T1D still cannot be prevented; however, different factors are present that influence T2D developments (IDF, 2019). It has been seen that lifestyle behaviours are the most influential factor for development of T2D. That is why they highlight some recommendations related to a healthy lifestyle, such as a lot of water, tea, or coffee, instead of cold drinks and fruit juice and consuming three servings of fresh fruits and unsweetened yoghurt.

Thus, it can be stated that by considering these policies of diabetes prevention, this contemporary health issue can be prevented or managed. Additionally, these policies and programmes are proven effective for achieving contemporary health targets. 

Part C- Critical appraisal of theoretical concepts

The above part discusses the different policies and programmes in order to prevent Diabetes as well as treatment care of Diabetes. This part is going to critically appraise theoretical concepts about adult nursing. In other words, it will discuss nursing practice, assessment, and skills required to treat a diabetic patient.

Nursing assessment

In order to take care of diabetic patients, nurses have to assess the following things.

  • Assessing patients’ history

For determining the existence of Diabetes, nurses need to first assess the medical history of the patient as well as the history of symptoms in relation to a diabetes diagnosis. Additionally, they will monitor blood glucose. Additionally, they will consider patients’ cultural, lifestyle, economic and psychological factors, and diabetes effects upon functional status.

  • Assessing physical condition

Next, nurses assess the patient's blood pressure level during standing and sitting to detect orthostatic changes. Additionally, assess the symptoms and signs of hyperglycaemia, such as whether there is an insufficient amount of insulin or not.

  • Laboratory examination

Related to the selected case study, nurses can assess patients' blood glucose levels before meals and during bedtime.

  • Assess feet regarding pulses, sensation, and temperature

For monitoring neuropathy and peripheral perfusion, the nurses can assess the feet of this patient regarding temperature, sensation, and colour.

  • Monitoring albumin and creatinine

Since diabetic people have higher chances of having renal failure, thus, nurses can monitor creatinine of the patient because renal failure can cause >1.5mg/dL, and microalbuminuria is the first symptom of diabetic neuropathy.

Nursing practice

Nursing practice is a care-based practice where treatment and diagnosis processes are applied towards people who are experiencing disease or illness (Independent Nurse, 2020). The fundamental goal of nurses is to help diabetic people to manage their illnesses. Some major nursing practices regarding Diabetes are mentioned below.

  • Prevention advises utilising health coaching techniques and behaviour change techniques.
  • Screening, preventing and early detecting diabetes
  • Promoting self-care
  • Urine monitoring
  • Oral therapies (Diabetes UK, 2019)
  • Monitoring blood glucose level
  • Injectable therapies

Nurses are crucial in supporting diabetic people, and they are the individuals whose support is most important for diabetic care. They not only help for administering medication, they also offer crucial physiological and health advice for helping people tackle daily challenges, which any life-long severe condition can bring. Nurses build community support networks, which defines that Diabetes relies upon reassurance and guidance. Nikitara et al. (2019) stated that nursing practice includes supporting diabetic people. It also incorporates valuable lifestyle and dietary advice, which help people who are at significant risk of diabetes development. Nursing practice also incorporates raising awareness about Diabetes by providing information about its risk factors, symptoms, diagnosis, and treatment. In addition, Funnell and Freehill (2018) explained that nurses majorly play educators, motivators, and caregivers’ roles. By considering the provided patient's case study, it can be stated that nurses can check blood glucose level of the patient, promote self-care, and do urine monitoring to detect renal failure due to Diabetes.

Nursing skills

Communication skills

A nurse requires having appropriate nursing skills while treating any patient. The most important skill is communication, and it is required to treat any patient (Kaya and Karaca, 2018). For example, in this case, nurses need to build effective communication with the patient so that nurses can collect information about his medical history, lifestyle, and eating behaviour. 

Problem-solving skills

Additionally, they need to have problem-solving skills because diabetic patients have a huge risk of developing other major health issues. If the diagnostic procedure exposes that patient to have developed other medical complications, nurses' problem-solving skills help deal with that issue by utilising appropriate interventions. 

Networking

Besides these two skills, they also need to have networking skills. Professional networking regarding nurses allows professionals are exploring the field and develop a strong support system for the medical community. For example, regarding the selected patient, nurses can use their network to effectively treat the patient and ensure that the patient receives high-quality care.

Part D- Devise evidence-based interventions

Interventions for improving diabetes results can be directed at diabetic people, health systems, and healthcare providers. Some evidence-based interventions of Diabetes have been stated below.

Lifestyle management

  • Healthy eating

Research has found that lifestyle management is crucial for managing Diabetes because having an unhealthy lifestyle is a significant risk factor for Diabetes. Regarding diabetic people, there is no specific diet; however, people can consider some major aspects in their daily routine. For example, they can schedule healthy snacks and meals and consume high-fibre foods, including whole grains, non-starchy vegetables, and fruits. Since the selected patient is overweight, he needs to have an appropriate diet that will not only help him to manage blood sugar levels it will also help him maintain perfect body weight. Marín-Peñalver et al. (2016) stated that dietary fibre, especially, which gave natural resources, has significant improvement in managing Diabetes. Additionally, the case study highlights that the patient has alcohol consuming habits; however, consuming heavy amounts of alcohol can have adverse effects. Therefore, physicians can recommend quitting drinking, or they can suggest him not to take more than two drinks per day (Bailey and Day, 2018).

  • Physical activity

Since the patient is overweight, exercise is important for him and losing and maintaining weight is crucial for diabetic patients. Tahrani (2017) explained that exercise and physical activities are some of basic strategies in diabetes treatment. An appropriate exercise plan can provide multiple benefits. For example, it improves glycaemic control, increases insulin sensitivity, loses weight, and improves psychological weight. Blaslov et al. (2018) agreed that exercise and physical activities bring improvement within metabolic parameters as it helps in preventing risk factors of cardiovascular disease. Thus, physicians can recommend appropriate exercise routines, including both resistance and anaerobic exercise.

  • Weight loss

Weight is another important intervention for diabetic people, and regarding this patient losing weight is necessary; otherwise, it can lead to obesity issues. In this regard, physical activities can be effective for this patient. Thus, physicians or dieticians can help to set proper weight-loss goals as well as motivate him to change his lifestyle.

  • Monitoring blood sugar

Besides all these approaches, Khursheed et al. (2019) explained that physicians recommend self-monitoring of blood glucose levels so that patients can manage their blood glucose before it leads to major complications. In this case, physicians can advise the patient how frequently they can check sugar level to ensure it is in target range. For example, this patient can check sugar levels once a day after and before exercise.

Pharmacologic therapy

  • Metformin

Besides lifestyle management, pharmacologic or medication is important for managing Diabetes. Metformin is the first-line medication for treating T2D. It helps in lowering sugar production within the liver and improving the body's sensitivity towards insulin so that the patient's body can utilise insulin effectively. This medication comes up with some side effects such as abdominal pain, diarrhoea, bloating, and nausea.

  • Sulfonylureas

Another effective medication for diabetes treatment is Sulfonylureas. This medicine can be used as both first and second-line therapy. It helps in secreting more insulin in the body, and potential side effects are weight gain and low blood sugar. According to Marín-Peñalver et al. (2016), Sulfonylureas is more effective when it is applied as monotherapy or by combined with it other hypoglycemic drugs. A cost-efficient medication can significantly lower the glucose level in the body.

  • Alpha-glucosidase inhibitors

Currently, there are three different agents of Alpha-glucosidase inhibitors such as voglibose, acarbose and miglitol. Both medicines have different properties, and their mode of action is different. For example, acarbose is used for treating hyperglycemia.

  • DPP-4 inhibitors

DPP-4 inhibitors are also effectively used in diabetes treatment. These inhibitors quickly inactivate incretins and induce the active levels of hormones (LeRoith et al. 2019). It is used as monotherapy within patients inappropriately controlled by exercise and diet. However, it is also used in the combination of insulin and metformin. The case study of the patient shows that the patient has already taken DPP-4; however, in order to get better results, physicians can use the combination.

  • Insulin therapy

Min et al. (2017) explained that insulin therapy is used to treat some T2D patients. In the former, this therapy was utilised as the last approach; however, today, it can be prescribed earlier if sugar targets are not met with medications and lifestyle changes.

  • SGLT2 (Sodium-glucose co-transporter-2) inhibitors

It affects the function of blood-filtered in the kidney through inhibiting glucose return towards the bloodstream. As an outcome, glucose is excreted with urine. Min et al. (2017) stated this drug could reduce chances of stroke and heart attack. Similar to other medications, these also have some potential side effects such as infections in urinary tract, high cholesterol, low BP (blood pressure), and risk of bone fractures.

Conclusion 

This assessment has aimed to critically appraise the one case study of a patient who is suffering from contemporary health issues. From the above information, it can be discussed that diabetes patients require both medication intervention and lifestyle management because Diabetes is significantly associated with an unhealthy lifestyle. Therefore, in this case, nurses can consider these interventions, especially the lifestyle management for the selected patient to his their contemporary health issues. By considering these interventions, nurses can effectively deliver high-quality care to the patient.

Reference list

Journals

American Diabetes Association.(2020). 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), pp.S48-S65.

Bailey, C.J. and Day, C. (2018). Treatment of type 2 diabetes: future approaches. British medical bulletin, 126(1), pp.123-137.

Blaslov, K., Naran?a, F.S., Kruljac, I. and Renar, I.P. (2018). Treatment approach to type 2 diabetes: Past, present and future. World journal of diabetes, 9(12), p.209.

Davidson, K.W., Barry, M.J., Mangione, C.M., Cabana, M., Caughey, A.B., Davis, E.M., Donahue, K.E., Doubeni, C.A., Krist, A.H., Kubik, M. and Li, L. (2021). Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. Jama, 326(8), pp.736-743.

Funnell, M.M. and Freehill, K. (2018). Keeping up-to-date with diabetes care and education. Nursing2021, 48(10), pp.22-29.

Kaya, Z. and Karaca, A. (2018). Evaluation of nurses’ knowledge levels of diabetic foot care management. Nursing research and practice2018.

Khursheed, R., Singh, S.K., Wadhwa, S., Kapoor, B., Gulati, M., Kumar, R., Ramanunny, A.K., Awasthi, A. and Dua, K. (2019). Treatment strategies against diabetes: Success so far and challenges ahead. European journal of pharmacology, 862, p.172625.

LeRoith, D., Biessels, G.J., Braithwaite, S.S., Casanueva, F.F., Draznin, B., Halter, J.B., Hirsch, I.B., McDonnell, M.E., Molitch, M.E., Murad, M.H. and Sinclair, A.J. (2019). Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), pp.1520-1574.

Marín-Peñalver, J.J., Martín-Timón, I., Sevillano-Collantes, C. and del Cañizo-Gómez, F.J. (2016). Update on the treatment of type 2 diabetes mellitus. World journal of diabetes, 7(17), p.354.

Min, S.H., Yoon, J.H., Hahn, S. and Cho, Y.M. (2017). Comparison between SGLT2 inhibitors and DPP4 inhibitors added to insulin therapy in type 2 diabetes: a systematic review with indirect comparison meta?analysis. Diabetes/metabolism research and reviews, 33(1), p.e2818.

Nikitara, M., Constantinou, C.S., Andreou, E. and Diomidous, M. (2019). The role of nurses and the facilitators and barriers in diabetes care: A mixed methods systematic literature review. Behavioral Sciences, 9(6), p.61.

Noh, J.W., Jung, J.H., Park, J.E., Lee, J.H., Sim, K.H., Park, J., Kim, M.H. and Yoo, K.B. (2018). The relationship between age of onset and risk factors including family history and life style in Korean population with type 2 diabetes mellitus. Journal of physical therapy science, 30(2), pp.201-206.

Tahrani, A.A. (2017). Novel therapies in type 2 diabetes: insulin resistance. Practical Diabetes, 34(5), pp.161-166a.

Wang, T., Zhao, Z., Wang, G., Li, Q., Xu, Y., Li, M., Hu, R., Chen, G., Su, Q., Mu, Y. and Tang, X. (2021). Age-related disparities in diabetes risk attributable to modifiable risk factor profiles in Chinese adults: a nationwide, population-based, cohort study. The Lancet Healthy Longevity, 2(10), pp.e618-e628.

Wu, X., Liu, X., Liao, W., Kang, N., Dong, X., Abdulai, T., Zhai, Z., Wang, C., Wang, X. and Li, Y. (2021). Prevalence and characteristics of alcohol consumption and risk of type 2 diabetes mellitus in rural China. BMC public health, 21(1), pp.1-10.

Websites

Centers for Disease Control and Prevention. (2020). National Diabetes Prevention Program. [Online] Available at: https://www.cdc.gov/diabetes/pdfs/library/socialmedia/NDPP_Infographic.pdf [Accessed 26 November 2021]

Diabetes UK. (2019). Diabetes Specialist Nurses. [Online] Available at: https://www.diabetes.co.uk/healthcare-professionals/diabetes-specialist-nurse.html [Accessed 26 November 2021]

Diabetes UK. (2019). Diabetes statistics. [Online] Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics [Accessed 26 November 2021]

Diabetes UK. (2019). Number of people with diabetes reaches 4.7 million. [Online] Available at: https://www.diabetes.org.uk/about_us/news/new-stats-people-living-with-diabetes [Accessed 26 November 2021]

Government of UK. (2017). National Service Framework for Diabetes: Standards. [Online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/198836/National_Service_Framework_for_Diabetes.pdf [Accessed 26 November 2021]

Independent Nurse. (2020). The Nurse and Diabetes Care. [Online] Available at: https://www.independentnurse.co.uk/blogs-article/the-nurse-and-diabetes-care/232170/ [Accessed 26 November 2021]

International Diabetes Federation. (2019). Diabetes prevention. [Online] Available at: https://www.idf.org/aboutdiabetes/prevention.html [Accessed 26 November 2021]

International Diabetes Federation. (2020). Diabetes facts & figures. [Online] Available at: https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html [Accessed 26 November 2021]

NHS England. (2018). Diabetes pathway. [Online] Available at: https://www.england.nhs.uk/rightcare/products/pathways/diabetes-pathway/ [Accessed 26 November 2021]

NHS England. (2018). Diabetes treatment and care programme. [Online] Available at: https://www.england.nhs.uk/diabetes/treatment-care/ [Accessed 26 November 2021]

World Health Organisation. (2021). Diabetes. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes [Accessed 26 November 2021]

World Health Organisation. (2021). The WHO Global Diabetes Compact. [Online] Available at: https://www.who.int/initiatives/the-who-global-diabetes-compact [Accessed 26 November 2021]

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