Family Care Plan for a Diabetic Child

Subject: Nursing
Pages: 7
Words: 1767
Reading time:
7 min
Study level: College
The focus of Situational Interaction (Either patient/client concern or nurse concern):

The client is a Japanese boy aged 7 years and a school-going child. The boy was recently diagnosed with Type I diabetes. The client and his mother were referred to a pediatric clinic for advice on the type of diet the boy should follow and other measures that should be taken to manage the illness.

Assessment

Developmental Environment

Biological Subsystem

1. The Nurse:

  1. The nurse has worked in the pediatric department for the last fifteen years and is therefore knowledgeable about different diseases that affect children including diabetes.
  2. The nurse is skilled and has experience in preparing family care plans that include special diets and exercises for children with Type I diabetes.
  3. Although the nurse has worked with clients from a different ethnic backgrounds, she has never had a Japanese American patient.

2. The Patient:

  • The patient was diagnosed with Type I diabetes one week ago.
  • The patient experiences frequent thirsts and hunger and urinates frequently.
  • Because of the patient’s young age and the fact that the diabetes diagnosis was done recently, the patient does not understand the implications of the disease means to him.

Psychosocial Subsystem

  • The Nurse:
    • The nurse understands child psychology and is, therefore, able to relate well with children.
    • The nurse is warm, caring, motherly, and patient.
  • The Patient:
    • The patient is smart, bold, and communicates easily without fear
    • The patient has a strong bond with his mother and his two older sisters
    • The patient and his family live in a close-knit Japanese American community that provides social support to its members
    • The patient’s father passed away when he was three years old and therefore his mother is both a mother and a father figure to him.
    • The patient’s mother is the sole breadwinner and the sole caretaker of the home.
    • Diabetes is a rare disease in the community in which the patient lives and therefore the community resources available to help the patient manage the illness are limited.

Spiritual Subsystem

  • The Nurse:
    • The nurse is a Christian and values her relationship with God.
    • The nurse values human beings and sees them for who they are irrespective of differences in ethnic orientation, race, gender, color, and language.
  • The Patient:
    • The patient, his family, and community members are Buddhists.
    • The patient attends regular meetings with his family community members to practice their religion.
    • One of the beliefs of Buddhism is that suffering exists and that suffering is not eternal and will end at some point. This belief, according to the patient, has been his source of hope. The patient believes that his illness will end one day. He is therefore optimistic about his illness.
    • The small close-knit Japanese American community is a source of strength, encouragement, and support for the patient as he tries to come to terms with his illness.

Situational Environment

Intrasystem Analysis of Patient/Client Intrasystem Analysis of the Nurse
Detector Function: Knowledge
What does the patient/client know about the problem?
The patient lacks any knowledge about the problem. He only knows that he feels thirsty and hungry frequently and urinates frequently. He has never heard of the term diabetes before.
Detector Function: Knowledge
What do I know about the problem?
I know a lot about diabetes, its causes, prevention strategies, management strategies, treatment, symptoms, and symptom management. I have worked with diabetic children before and therefore I am knowledgeable about the disease.
Selector Function: Attitudes and Values
What are the patient/client’s attitudes and values about the problem?
Although the patient has only learned about his illness, his religious orientation has helped him to have a positive attitude about his condition and believes that his illness will be cured in time. He is willing to learn about his illness and how to manage it.
Selector Function: Attitudes and Values
What are my attitudes and values about the problem?
Having helped other children manage their diabetes, I strongly believe that the patient will succeed in managing his illness and in keeping his blood sugar levels under control thereby preventing diabetes-related complications. My only worry is that the patient needs constant care to ensure control of his blood sugar levels but his mother is always busy trying to make ends meet for her family. I, therefore, believe that the family needs to hire a caregiver who will follow up on the patient when his mother is not at home.
Effector Function: Behaviors
What skills or resources does the patient/client have to deal with the problem?
The patient only has a supportive family and community members to help him deal with his illness.
Effector Function: Behaviors
What skills or resources do I have to deal with the problem?
I have skills in treating and managing diabetes as well as a wide range of literature about diabetes in children which can be of great help to the patient, his family, and community.

Analysis

Identification of Stressors

  1. Financial strain because the mother is the sole breadwinner and does not earn much
  2. Lack of knowledge and information about diabetes
  3. Lack of community resources to assist in managing the illness such as diabetic clinic and resource persons
  4. No caregiver to assist the patient’s mother in taking care of the home and children

Coping Resources

  1. Strong family bond and support
  2. Strong community bond and support
  3. A positive attitude towards the illness
Scoring on Situational Sense of Coherence (SSOC)
(high=3, medium=2, or low=1)
Score Discussion
Comprehensibility:
About what the patient/client needs to know about the situation, how much is known?
1 The patient knows little, if any, about diabetes and how to manage it.
Meaningfulness:
About motivation, how much effort is the patient/client willing to put into resolving this problem?
2 The patient is eager to learn about his condition and to take all the measures possible to manage it. However, the patient seems distressed about the insulin injections he will be required to administer to himself.
Manageability:
About resources, what is available to manage this problem?
2 The only available resource is willing human resources in form of family and community members who are willing to help the patient manage his condition.
Nursing Diagnosis:
There is a need to educate the patient, his family, and the community about diabetes and how it can be managed by diet and exercise (Hanas, 2007). This is evidenced by the low levels of information and knowledge about diabetes in the patient’s community.

Implementation (Intervention)

Mutual Patient/Client–Nurse Goals (made when patient/client and nurse agree) or
Nursing Goals(made only if there is no agreementbetween client and nurse)
  1. The patient, his family, and community members will demonstrate knowledge of identifying low blood sugar and high blood sugar levels.
  2. The patient, his family, and the community will gain knowledge in diets for diabetic patients.
  3. The patient, his family, and the community will gain knowledge in insulin administration.
Intersystem Interaction
Patient/Client-Nurse Interaction
Communication of Information
Information will be transmitted through different modes: face-to-face interactions between the nurse and the patient, family, and community.
The nurse will also give brochures to the patient, family, and community that have information about diabetes, management, and prevention of complications. The brochures will also be translated into Japanese to ensure that everyone in the community understands the information therein.
Organization of Behaviors (a mutual plan of care)
  1. Organize family-specific and community-wide education programs. Rationale: The education programs will educate the patient and community about managing diabetes. This will help to involve all family and community members in the care of the patient and will prove useful especially when the mother is not available to monitor her child.
  2. Educate the patient and his family on how to use an insulin pump. Rationale: An insulin pump is a more effective and easier way of insulin administration compared to insulin injections. The patient will only be required to wear the pump throughout the day thereby avoiding incidents of forgetting to take the insulin injections.
  3. Educate the patient on the importance of diabetic diets and train the family and community members on how to prepare such diets. Rationale: The importance of this intervention is that the patient is still a child and may therefore not like some of the foods recommended for diabetics. It is also important for the family and community members to learn what foods are good for the management of diabetes to help the patient manage the condition (Loring, 1999).

Evaluation

Scoring on Situational Sense of Coherence (SSOC)
(high=3, medium=2, or low=1)

Rescoring on SSOC Score The scientific basis for nursing interventions:
Comprehensibility:
About what the patient/client needs to know about the situation, how much did they learn?
3 I prepared to learn brochures for the patient, family, and community and translated them into the Japanese language. This is because the patient comes from a different ethnic community and therefore it is important to adopt cultural-competent strategies to enable the patient, family, and community to accept the strategies more easily. This intervention was very effective in instilling knowledge in the patient, his family, and the community about all aspects of diabetes.
Meaningfulness:
About motivation, how willing was the patient/client to accept the challenge of the problem and work to overcome it?
3 I conducted several education and training programs for the patient, family, and community members to sensitize them on diabetes management strategies. The involvement of all community members was a motivating factor for the patient because the exercises were fun activities. The family and community members also offered support to the patient and encouraged him to do his best to manage his condition. This intervention was also very effective.
Manageability:
About resources, how adequate were they to manage this problem?
3 The resources I provided to the patient, his family, and community including the brochures, insulin pump, diet, and exercise plans were effective in managing the patient’s diabetes. This is because due to the resource scarcity in the patient’s community, I opted to take the resources to the community instead of making them visit the clinic for the resources. This proved to be effective because the majority of community members were able to gain access to the relevant resources. The patient also did not have to make the long-distance to the clinic.

Comments

In managing diabetes in a small child like the one presented in the above scenario, there is a great need to involve other members of the patient’s family and community. Information also plays a key role in managing diabetes because diabetics need to monitor their blood sugar levels frequently, special diets, and exercises.

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Without such information, it would be difficult to manage the illness and the illness may lead too other complications that affect other organs of the body. Educating the patient, his family, and community is therefore an important intervention strategy.

Reference List

Hanas, R. (2007). Type 1 diabetes in children, adolescents, and young adults: how to become an expert on your diabetes. London: Class Publishing.

Loring, G. (1999). Parenting a child with diabetes: a practical, empathetic guide to help you and your child live with diabetes. New York: McGraw-Hill Professional.