Nutrition and medication adherence

The defining attributes are ranked in order of importance and are described as follows: 1. A helping process, in which the healthcare professional empowers the patient (Rodwell, 1996). 2. Mutual participation (both nurse and patient). Also mutual decision making with the use of resources and opportunities. If both people are not involved, learning cannot take place and goals cannot be met (Ellis-Stoll et al. , 1998). 3. Active listening: Paying attention to what is said and confirming understanding (Ellis-Stoll et al. , 1998).

4. Individualized knowledge acquisition: This is not limited to the patient. The nurse should also continue to learn about the patient, to gain experience assessing the patients’ needs to be able to individually empower him (Ellis-Stoll et al. , 1998). Identify model A model case is an example of how to use the concept, and also applies the defining attributes of the concept (Walker & Avant, 2005). A model case of empowerment will be applied to a diabetic patient.

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Empowerment is a very effective approach to diabetes care and education, as it directs patients to make personal goals related to weight, physical activity, nutrition and medication adherence. A middle age obese woman is diagnosed with early stage diabetes. The nurse practitioner (NP) explains the disease to the patient in understandable terms and informs the patient that diabetes is also closely related to obesity. In addition the NP explains to the patient that proper nutrition and exercise can significantly improve the disease.

After an in depth discussion about diabetes and lifestyle modifications and answering all the patients questions, the NP asks the patient how she feels about the new diagnosis. The patient states she is a little overwhelmed with finding out she is diabetic and is scared because her grandfather went blind with diabetes. The NP decides to not overburden the patient with too much information at once, so she has the patient follow up the next week. The NP gives the patient written patient education material on diabetes and asks the patient to keep a food daily and an activity log for three days.

When the patient returns the following week, the NP asks the patient if she has any more questions about diabetes. After answering a few questions the patient shows her log, which demonstrates the patient leads a very sedentary lifestyle, drinks 2 regular sodas a day, eats around a 3500 calorie diet a day and has a diet high carbohydrate with little produce. The NP reinforces the importance of diabetic nutrition and exercise and asks the patient: “What would keep you from changing a certain behavior at this time? What do you want to work on?

” The NP gives the patient several different goal options of which the patient decides she would like to focus on improving her nutrition. After the patient discusses many different nutritional changes she wants to make, the NP asks the patient for some specific goals. The patient sets the goal “I will not drink soda on Monday, Wednesday and Friday starting tomorrow. ” The provider calls the patient after a week and the patient had met their goal. The patient follows up every 2 weeks for three months, and then every month for the following year.

Every visit the patient would set a new goal. In three months, the patients fasting glucose came down from 180 to 120 and she also lost 10 lbs. After a year of the patient making small lifestyle changes the patient lost 40 lbs and her hemoglobin A1C went down from 6. 4 to 5. 8. In this model the NP works as the facilitator, support and expert resource. However, the patient sets her own goals autonomously and assumes full control over her diabetes care by making informed decisions and setting her own self-management goals (Anderson & Funnel, 2010).

A contrary case would be the NP telling the patient: “You are diabetic; you need to loose a lot of weight and start exercising and eating right. I want you to loose 10 lbs. I’ll have you follow up in one month. ” We can see from this example that none of the critical attributes of empowerment pertain- mutual participation, active listening, and knowledge acquiring. The provider does not offer resources, motivation or support, just facts. The patient would leave completely shocked, but uninformed and unequipped to make lifestyle changes.

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