Culturally Safe Health Promotion Strategies for Mr. Ernie Boulia Case Study

This case study analyzes the importance of culturally safe health promotion strategies and effective education strategies for Mr. Ernie Boulia, a 47-year-old aboriginal man suffering from grade-2 diabetic neuropathic ulceration and poor glycemic control.

Running head: MR ERNIE BOULIA CASE STUDY
MR. ERNIE BOULIA CASE STUDY
Name of the student:
Name of the university:
Author note:

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MR. ERNIE BOULIA CASE STUDY
Culturally safe health promotion strategies and effective education strategies have the
capability of altering the attitude and behaviors of patients and helping them to adopt healthy
habits. They help in developing the health literacy of the patients making them understand the
significance of their modified behaviors on their health (Dorresteijn et al, 2014). This assignment
will analyze a case study where health professionals would first identify the care properties and
accordingly adopt education strategies for helping the patient to change his attitudes towards
health and develop better quality life at the same time of maintaining cultural competency and
developing therapeutic relationship.
Mr. Boulia is a 47-year-old aboriginal man who is suffering from grade-2 diabetic
neuropathic ulceration. The patient is in need of proper wound management and antibiotics. One
important risk that should be also cared for by the professional is that the patient is at a risk for
developing heart disorders as his family history shows other members being affected by coronary
heart disorders (Van Netten et al., 2016). He is a smoker and consumes a high-risk diet of sugar
and fat that increases the chance of the heart disorders. However, one important thing that also
needs to be stated here is that he has poor medication adherence with respect to insulin self-
administration that results in poor glycemic control. This would result in fatal consequences on
his health. The nursing professionals need to care for the symptoms that have higher chance of
affecting the individuals and therefore, they need to critically analyze the situations, understand
the urgency and then set up care protocols and education regime (Yazdanpanah, Nasiri, &
Adarvishi, 2015).
One of the most important health concerns that have been identified is the caring for the
grade 2 diabetic neuropathic ulceration. Researchers are of the opinion that grade 2 diabetic foot
ulcer is a kind of wound that penetrates to the tendons as well as the capsule. Foot ulcers are

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indeed one of the most common complications of poorly controlled diabetes. This happens
mainly by the breaking of the skin tissues and exposing the underlying layers beneath them.
They are mainly found to be common under the big toes as well as the balls of the feet. Poor
circulation, high blood glucose sugar, nerve damage as well as irritated and wounded feet are
some of the causes of the ulcers in the foot (Armstrong, Boulton, & Bus, 2017). Mainly poor
blood circulation is a form of vascular disorders where the blood cannot flow to the feet
efficiently causing difficulty for the ulcers to heal. Mainly reduced functioning of the nerves due
to the peripheral diabetic neuropathy results in reduction of pain sensation in the foot making to
prone to get damaged without the individuals feeling it. Very strenuous situation might result in
situations where gangrenes can take place in stage 5 leading to amputation. To prevent such
occurrences, this should be considered as acute problem that needs to be cared.
Another potential problem that is also identified is his poor glycemic control. It is found
that he does not adhere to his medications properly and even is not careful about insulin
administration that he was prescribed in the last visits. Therefore, if he does not maintain his
blood glucose level and it remains high, various types of negative outcomes will result. Long
term complications associated with improperly controlled blood glucose level and untreated
hyperglycemia are cardiovascular disorder, nerve damage, kidney damage, and damage to retina,
feet problems, ulcerations, bone joint problems, teeth and gum issues and others (Bus et al.,
2016). The cellular systems of the organs will not receive any energy and might not work
effectively resulting organ disorders as well. Therefore, glycemic control, insulin administration
and other medication should be managed and adhered to effectively.
The first topic that should be addressed is the effective foot care and wound management
by which the patient named Ernie would be able to reduce the chances of deterioration of the

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wound preventing the risks of leg amputation. Researchers are of the opinion that when
individuals have poorly managed diabetes control, they might suffer from foot complications like
infections and ulcers which do not want to heal due to poor circulation. This might result in the
loss of the foot or the leg of the individual even with chances of the life of the patient. Even
chances of occurrence of corns and calluses, development of dry cracked skin as well as nail
disorders might also take place (Skafjeld et al., 2015). Hammertoes and bunions, charcot foot
and poor blood flow might also take place if the patient does not care about his feet effectively.
If untreated, infections might occur and this will make the situation much worse with the passing
days unless gangrenous situations take place. Therefore, the patient should be educated about
how to take care of his feet and management the already made wound effectively. This would
prevent the chances of worsening of the feet conditions and amputations. Better he gets educated
better will be his skill of management. When the patient understands about the complications
that diabetes might result and the ways such complications occur, the adherence of the patient
towards foot care would increase (Monami et al., 2015).
Another topic is poor glycemic control. Poor glycemic control can result in various types
of complications. The patient is also seen to be not adhered to the insulin administration
procedures in a discipline manner and he does not monitor his glucose levels effectively.
Improper glycemic control might results in organ failures affecting his quality of life.
Cardiovascular disorders, kidney disorders, retinal issues, neuropathy, improper metabolic
functioning and many other issues might occur. Therefore, it is very important for the patients to
understand the importance of the effective glycemic control and the different interventions that
the patient needs to manage his glucose levels effectively (Crawford et al., 2015). Therefore, the
professionals should educate the patient about ways to manage the glycemic control through diet,

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lifestyle management and other. He should be educated about the ways by which he can take
insulin medication at the disciplined time and use the glucometer to measure blood glucose level
and be self aware effectively.
Researchers are of the opinion that patient education is indeed an integral procedure,
which helps in enhancing as well as changing the knowledge of the patient modifying their
attitudes as well as their skills that help in maintenance and improvement of the health. The
healthcare professionals need to help the patients in indentifying their risky barriers that
contribute to ill health and should help them to develop their health literacy (Bell et al., 2015).
One of the interesting strategies that the nursing professionals can adopt is the using of
the appropriate duration materials and tools for helping the patients to understand the correct
ways of managing the disorders. The patient in the case study needs to develop knowledge about
effective ways of foot care. The best method that would be used here is the teaching of the
patient with pamphlets or brochures as well as with you tube videos that will be conducted in the
primate healthcare centre only. Four important genres need to be covered like that of the
inspection of the foot, washing of the foot, drying the foot as well as the moisturizing of the foot
(Brown et al., 2016). When such steps are written clearly with dot points and are beautifully
decorated with attractive images about the ways of doing the steps, it becomes easier for the
patients to understand and develop a clear idea about what they need to do. The brochures that
should be handed to the patient in the case study would have the above points mentioned along
with attractive images. It would also have different types of healthy foot habits like the use of
antiseptic lotions; never using of the hot water bottle, heat pad as well as electric blanket on feet;
avoiding of walking on bare feet, protecting the feet from heat or cold; not attempting to remove
corns, calluses, warts, or other foot lesions by themselves and others. Besides, all-important

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guidelines to be followed during toenail care, footwear socks and shoes and many others should
be also written in simple words without the use of technical jargons and interesting clear images.
This would make the patient understand the guidelines and follow them effectively (Saffari et al.,
2014). The professional should first describe the handout in details and then help the patient to
get a clearer perspective with the help of a YouTube video. Here, the patient would get a visual
representation about how the steps and the guidelines would be followed and this would help in
creating a visual image. This has positive outcomes helping the patient to develop skills to take
care of the foot effectively.
Another important topic that should be taught to the patient named Ernie is the effective
glycemic control by the lifestyle management, effective adherence of the insulin administration
as well as the proper handling and usage of the glucometer. One of the effective strategies for
educating the patient would be the teach-back strategy that will be conducted in the primate
healthcare centre only. In this form of teach-back strategy, the healthcare professionals should be
first explaining an important concept, procedures as well as self-management technique to the
patient. The healthcare professionals then need to ask the patient in repeating the lesson given to
him and ensuring whether the patient had understood the entire thing or if there is any gaps left
in the assignment (Bowen et al., 2016). The patient in the case study would be told in details
about the different lifestyle management procedures like diet management, physical exercises
regimes and other. Proper discussions regarding the maintenance of insulin administrations
regimes, setting off alarms clocks or reminders in making the patient remember and similar other
tactics should be taught to him so that he does not forget taking insulin. Proper ways of using the
glucometer, ways of handling it, maintaining hygiene and others should be also discussed with
the patient. The professionals should then ask Ernie to synthesize the health information and then

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he should repeat it in his own words. This will help in understanding whether the patient truly
comprehends the health information. If the patient is not able to do so, then the professionals
have to think of other ways to help the patients to understand (Coppola et al., 2016).
The first step of reflection is description of the event. While caring for the client, I would
get the opportunity to interact with a patient of another cultural background. The next step is
called the feeling stage. Initially, I was quite apprehensive and nervous thinking how I would
perform in caring of a patient with different backgrounds. Then I self regulated my feeling and
developed the confidence that the openness of my cultural background and the cultural
awareness that I had developed in my university classes would help me to handle the case
effectively. The next step is the evaluation phase. From the very early childhood, my cultural
traditions had always taught me to be open-minded and accept all other cultures openly without
developing any negative feelings for the other. My parents have always taught me to be
culturally sensitive and asked me to mix with people of all cultures just as I mix with people
from my own culture. This would be helpful in handling the patient and educating him more
successful.
The next step is analysis stage. People are of the opinion that more one remains
transparent and accepting to other cultural norms and traditions, the lesser remain the chance of
being culturally biased. I do not like judging other cultures according to the viewpoints exercised
by my own culture. This helps me to be respectful for other cultures as well. The patient named
Ernie is of the aboriginal background that has its own cultural traditions, preferences and
inhibitions. I should respect all their cultural sects, values and beliefs and accordingly develop
therapeutic relationship with him. I would communicate with him with verbal and bon vernal
communication skills in ways that align with their culture and make him feel respected. The next

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stage is conclusion and action plan stage. In my future also, I might need to handle more such
cases. Therefore, I would ensure that my cultural knowledge, cultural sensitivity and unbiased
behavior would help me providing culturally competent care to them. I would go through more
trainings and evidence based studies to become more competent in provide care to culturally
different patients.
From the above discussion, it is seen that the patient was suffering from diabetic
foot ulcer. He was not maintaining the glycemic control and was not adhering to the insulin
administration. He was also having improper diets high in sugar and fats. Therefore, it was
important for the professionals to educate him on these topics to help him develop better quality
life. Education with proper materials and tools and by adopting the teach-back methods, for ulcer
management and glycemic control management need to be taken. Moreover, it is extremely
important for professionals to have cultural awareness, cultural sensitivity and cultural
competence so that they can effectively care for the patient ensuring person centered care and
development of therapeutic relationship.

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References:
Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their
recurrence. New England Journal of Medicine, vol 376 no(24), pp 2367-2375. DOI:
10.1056/NEJMra1615439
Bell, K. J., Smart, C. E., Steil, G. M., Brand-Miller, J. C., King, B., & Wolpert, H. A. (2015).
Impact of fat, protein, and glycemic index on postprandial glucose control in type 1
diabetes: implications for intensive diabetes management in the continuous glucose
monitoring era. Diabetes Care, vol 38 no(6), pp 1008-1015.
https://doi.org/10.2337/dc15-0100
Bowen, M. E., Cavanaugh, K. L., Wolff, K., Davis, D., Gregory, R. P., Shintani, A., ... &
Rothman, R. L. (2016). The diabetes nutrition education study randomized controlled
trial: a comparative effectiveness study of approaches to nutrition in diabetes self-
management education. Patient education and counseling, vol 99 no(8),pp 1368-1376.
https://doi.org/10.1016/j.pec.2016.03.017
Brown, S. A., García, A. A., Brown, A., Becker, B. J., Conn, V. S., Ramírez, G., ... & Cuevas, H.
E. (2016). Biobehavioral determinants of glycemic control in type 2 diabetes: a
systematic review and meta-analysis. Patient education and counseling, vol 99 no (10),
pp1558-1567. https://doi.org/10.1016/j.pec.2016.03.020
Bus, S. A., Van Netten, J. J., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., ... &
International Working Group on the Diabetic Foot (IWGDF). (2016). IWGDF guidance

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MR. ERNIE BOULIA CASE STUDY
on the prevention of foot ulcers in at‐risk patients with diabetes. Diabetes/metabolism
research and reviews, 32, 16-24. https://doi.org/10.1002/dmrr.2696
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for
adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic
control. Patient education and counseling, vol 99 no (6), pp 926-943.
https://doi.org/10.1016/j.pec.2015.11.003
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A., & Gazzaruso, C. (2016). The role of patient
education in the prevention and management of type 2 diabetes: an overview. Endocrine,
vol53 no (1), pp 18-27. https://doi.org/10.1007/s12020-015-0775-7
Crawford, F., Cezard, G., Chappell, F. M., Murray, G. D., Price, J. F., Sheikh, A., ... & Young,
M. J. (2015). A systematic review and individual patient data meta-analysis of prognostic
factors for foot ulceration in people with diabetes: the international research collaboration
for the prediction of diabetic foot ulcerations (PODUS).
https://www.ncbi.nlm.nih.gov/books/NBK305602/
Dorresteijn, J. A., Kriegsman, D. M., Assendelft, W. J., & Valk, G. D. (2014). Patient education
for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews, (12).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001488.pub5/full
Ferguson, S., Swan, M., & Smaldone, A. (2015). Does diabetes self-management education in
conjunction with primary care improve glycemic control in Hispanic patients? A
systematic review and meta-analysis. The diabetes educator, vol 41 no (4),pp 472-484.
https://doi.org/10.1177/0145721715584404

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MR. ERNIE BOULIA CASE STUDY
Lee, Y. J., Shin, S. J., Wang, R. H., Lin, K. D., Lee, Y. L., & Wang, Y. H. (2016). Pathways of
empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to
glycemic control in patients with type 2 diabetes mellitus. Patient education and
counseling, vol 99 no (2), pp 287-294. https://doi.org/10.1016/j.pec.2015.08.021
Monami, M., Zannoni, S., Gaias, M., Nreu, B., Marchionni, N., & Mannucci, E. (2015). Effects
of a short educational program for the prevention of foot ulcers in high-risk patients: A
randomized controlled trial. International journal of endocrinology, 2015.
http://dx.doi.org/10.1155/2015/615680
Pickup, J. C., Reznik, Y., & Sutton, A. J. (2017). Glycemic control during continuous
subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes:
individual patient data meta-analysis and meta-regression of randomized controlled
trials. Diabetes Care, vol40 no (5), pp 715-722. https://doi.org/10.2337/dc16-2201
Saffari, M., Ghanizadeh, G., & Koenig, H. G. (2014). Health education via mobile text
messaging for glycemic control in adults with type 2 diabetes: a systematic review and
meta-analysis. Primary care diabetes, vol 8 no (4), pp 275-285.
https://doi.org/10.1016/j.pcd.2014.03.004
Skafjeld, A., Iversen, M. M., Holme, I., Ribu, L., Hvaal, K., & Kilhovd, B. K. (2015). A pilot
study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers
in patients with diabetes–a randomized controlled trial. BMC endocrine disorders, vol
15 no (1), pp55. https://doi.org/10.1186/s12902-015-0054-x
Van Netten, J. J., Price, P. E., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Jubiz, Y., ...
& International Working Group on the Diabetic Foot (IWGDF). (2016). Prevention of

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MR. ERNIE BOULIA CASE STUDY
foot ulcers in the at‐risk patient with diabetes: a systematic review. Diabetes/metabolism
research and reviews, vol 32, pp84-98. https://doi.org/10.1002/dmrr.2701
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of
diabetic foot ulcer. World journal of diabetes, vol6 no (1),pp 37.
doi: 10.4239/wjd.v6.i1.37