Nursing: Self-Management of Diabetes and Health Promotion for J.P

This article discusses the self-management of diabetes and health promotion strategies for J.P, including diet, physical activity, and smoking cessation.

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Name of the Student
Name of University
Author’s note

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Part 1
The primary healthcare needs for J.P include self-care for diabetes. According to the case
study, J.P’s current hemoglobin A1c level is 9.5 while his blood glucose fasting range is 135 to
142 mg/dl. He is also under the medication of Metformin. Thus his case history highlight that he
is under the diabetic stage. According to Choi et al. (2013) fasting blood sugar level greater than
126 mg/dL indicates diabetic state. Shrivastava, Shrivastava and Ramasamy (2013) are of the
opinion that effective self-management of diabetes helps in effective control of the blood sugar
level while improving the overall quality of life by promoting healthy lifestyle habits. The self-
management of diabetes for J.P will include weekly monitoring of the blood glucose level by the
use of glucometer, timely medication adherence, regular practice of mild to moderate physical
activity, maintaining proper diet diabetic plan, cessation of smoking along with periodic follow
up with the physicians in order to identify or for the early detection of the complications
associated with diabetes like diabetic retinopathy or diabetic foot ulcer or other renal
complications. Powers et al. (2017) stated that self-management of diabetes is an ongoing
process and can be accomplished in a successful manner only under the training and disease
awareness education provided by the nursing professionals. Thus J.P needs to educated about the
diabetes prognosis before indulging in disease self-management.
The secondary care healthcare needs include effective financial management of J.P so
that he can comprehensively cover his expenses in the domain of medication management, food
or diet and other basic amenities of life (Strawbridge et al. 2015). The case study highlights that
he is under the Medicare and Medicaid coverage and also receives social security as
supplementary income. However, unlike Medicaid, Medicare insurance can only be availed

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under proper submissions of the premiums and effective financial management and planning for
J.P is important to sustain healthy life-style. Medicare also offers self-management training
benefits for diabetes (Strawbridge et al. 2015). Cessation of smoking will help to reduce his
expenses further (J.P at present smokes two packets of cigarettes per day).
Part 2
The health beliefs are defined as personal belief of individuals about the effective
treatment of the disease. For examples, some individuals, mostly the aboriginals rely on
traditional medicines (herbs and shrubs) as the main source of medication for the disease
management (Oliver, 2013). While other people belief that apart from relying on the medication,
bringing change in the life style can be prove to be effective for faster health recovery. The case
study however fails to highlight any specific healthy belief of J.P. However, the case study
shows that J.P is chain smoker for the past 30 years. According to Pan et al. (2015) long-term
addiction towards tobacco smoking increases the predisposition of developing type 2 diabetes
mellitus (T2DM). () stated that smoking is a modifiable risk factors for the development of
T2DM during the later stages of life and the conditions become detrimental for patients who
have family history of heart disease. Moreover, the case study also reveals that J.P is over-weight
and has high BMI. All these cumulates that J.P healthcare belief does not give importance to
healthy style towards maintenance of healthy living even when there is a disease complication
(J.P is suffering from T2DM for the past 2 years). Wang et al. (2013) are of the opinion that
awareness and education in disease management helps to bring change in healthcare beliefs.

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Part 3
According to the American Diabetes Association (ADA) (2018), patients’ with T2DM
must have their HBA1C level less than 7. Mr. Jones’ HBAIC is 9.5. Thus the goal for the
effective management of the blood sugar level will be to reduction of HBA1C within the
permissible limit by 9 months. According to the ADA (2017) effective management of the blood
sugar level and HBA1C can be done with the help of non-pharmacological interventions. Non-
pharmacological interventions like diet, physical exercise and behavioral change is helpful in
reducing BMI and body weight by >5% thereby promoting reduction in the blood glucose level
(ADA, 2018). The diet plan that will be suitable for J.P will be low on carbohydrate and
saturated fat and high lean protein diet (ADA, 2018). Limited intake of saturated fat will help to
regulate the blood cholesterol level of J.P further.
However, J.P states that he prefers to consume rice with every meal only eats two times
per day due to his busy work schedule. However, in order to reduce the dietary calorie intake the
consumption of carbohydrate needs to be reduced. Thus J.P’s diet plan will include small meals
of carbohydrate (one cup of rice, two times a day). In order to manage his appetite, the diet plan
will be enriched with fresh fruits and vegetables and chicken soup. Since J.P is a busy person
consumption of full course meal at least three times a day might be difficult in that case his diet
plan will include consumption of dry fruits, fresh fruits and cream cracker biscuit (as healthy
snacks) within an interval of 3 to 4 hours (3 times) and 3 full course meals. All these raw food
products recommended as snacks for J.P are easy to carry and eat and thus having less chance to
create problem in busy schedule of J.P (Munshi et al., 2016).

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Further exploration of the diet preference of J.P must be done under the presence of nurse
and professional dietician in order to identify foods that are congruent with suggested diet and to
frame the dietary requirements of J.P based on his BMI and daily physical activity.
Part 4
The main health promotion model that will be suitable for J.P includes Nola Pender’s
Health Promotion Model (NPHPM). It focuses on three main domains namely: the
characteristics of the individuals, behavior specific cognition of the individual and behavioral
outcomes. According to this theory, each person has an unique characteristics and set of
experiences that affects a set of actions. This set of behavior or expression helps in modulating
the motivational significance. NPHPM mainly makes four assumptions. First assumption is
individuals seek to regulate their own behavior actively. Second behavior includes all the
biopsychological complexicity interacts with the surrounding environment and gets transformed
over time. The third assumption is nursing professionals constitutes an important part of this
inter-personal environment that cast a significant influence over the healthcare service users. The
fourth assumption include self-initiated reconfiguration of the surrounding health environment is
important to bring change in the health behavior (Khoshnood, Rayyani & Tirgari, 2018). This
model was selected for J.P because, as per the case study, J.P leaves alone at home. Thus in order
to indulge J.P into a healthy lifestyle self-realization and self-motivation and self-initiates are of
prime importance. In NPHPM, the service user and his or her role in changing the external health
environment and behavior is given prime importance and thus this model will be suitable for J.P.
The main concern of J.P in this case is his high body mass (BMI), smoking habits and unhealthy
meal plan which is increasing severity of type 2 diabetes mellitus. According to the study
conducted by Khodaveisi et al. (2017) change in life style and feeding habits helps to reduce the

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BMI and thereby helping to reduce the blood glucose level. The quasi experimental study
conducted over over-weight and obese women highlighted that NPHPM-based training help in
improving the nutritional behavior of the women and thus Khodaveisi et al. (2017) recommended
the use of the NPHPM by the healthcare providers to improve the nutritional value of the diet
and at the same time will help to reduce the calorie intake. The NPHPM mainly stress over the
perceived self-efficacy, commitment to action and improvement in the interpersonal and
situational influences and behavior-related affects in order to promote healthy lifestyle habits
(Khoshnood, Rayyani & Tirgari, 2018). J.P loves to eat rice but prefers to have meals only two
times a day thus in order to improve his nutritional quotient NPHPM will be effective. NPHPM
theoretical statements highlight that, a person can modify cognitions, affects along with
interpersonal and physical environment in order to create incentives for health related actions.
J.P is a chain smoker and thus in order to improve his self-management skills for diabetes
management; he needs to cease smoking all together. The interpersonal communication skills by
the nursing professionals and improvement in the surrounding environment like fighting against
the smoking withdrawal symptoms will help J.P overcome his smoking habits (Alaviani et al.,
2015). Alaviani et al. (2015) stated that application of NPHMP will help to overcome loneliness
and thereby helping to reduce the smoking rates.
Part 5
Strategy: 1
Increase in the Physical Activity
The daily physical activity of J.P will include exercise of 30 minutes per day. However,
J.P is of the opinion that he takes bus to work. Thus in order to promote the healthy lifestyle of

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J.P by making modifications in the surrounding environment as per the NPHPM, J.P can be
asked to get down from the bus one stop before followed by taking stairs to office. NPHPM also
promotes self-motivation in bringing change in the healthcare beliefs. Self-motivation in
conducting the physical exercise can be done by the use of the fit band. The accurate calories
burnt and the steps taken per day (step count) will help to motivate J.P to indulge in physical
exercise. Coughlin and Stewart (2016) are of the opinion the use of the wearable devise helps to
increase the physical activity among the older adults and obese people by increasing the sense of
self-motivation and self-efficacy.
Improvement in dietary habits
In order to promote a healthy life style habits in J.P, he will be asked to reduce his intake
of carbohydrate and replace it with fresh vegetables and fruits. Preparation of the tasty
vegetables will help to increase the tang of the dishes and thereby helping to increase the
indulgence of J.P into vegetable diet while shifting his focus from the carbohydrate rich rice. J.P
mainly relies on Home Health Aide for his food. Such that consultation is required to be done
with Home Health Aide professionals along with J.P in order to bring a positive change in the
dietary regime. Fidanci, Akbayrak and Arslan (2017) stated that families, peers and the
healthcare providers are regarded as an important source of the interpersonal influence that has
been found to modulate the level of commitment and engagement in the health-promotion
behavior as highlighted in the NPHPM. Indulging the Home Health Aide professionals in the
dietary regime under the active supervision of the professional dietician will help to increase the
adherence of J.P in the healthy dietary regime. However, it is recommended to assign personal
dietitian and personalized cook for J.P for getting better output but level of expenses must be
taken under consideration. The three course complete meal plan must be assisted with small

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snacks that will be easy to carry for J.P in his office like dry fruits, fresh fruits and biscuits.
Fidanci, Akbayrak and Arslan (2017) stated that situational influences in the external
environment can help to increase the level of commitments and level of participation in the
healthcare regime as per the assumptions cited by the NPHPM. Easy to carry food in office in
order to accomplish the small snacks need will help to increase the situational influence of J.P.
Smoking Cessation
Pan et al. (2015) are of the opinion that smoking is one of the modifiable risk factors
behind the development of T2DM and cardiac complications during the later stages of life.
Smoking cessation program for J.P will include replacement of cigarettes with the help of the
electronic cigarettes. Regan et al. (2013) are of the opinion that the electronic cigarettes fall
under the category of the nicotine replacement therapy which helps the tobacco addicted
individuals to gradually withdraw themselves from smoking habits via fighting with the
withdrawal symptoms. Here the use of the e-cigarette under the influence of the nicotine
replacement therapy can be cited under. As per the assumption of the NPHPM, the perceived
barriers can constrain individual’s commitments to action towards the health promotion behavior
(Fidanci, Akbayrak and Arslan, 2017). Bullen et al. (2013) stated that cessation of smoking can
create psychological and physical constraints by increasing the rate of the withdrawal symptoms.
Use of the nicotine replacement therapy, helps to fight effectively against the withdrawal
symptoms and thereby helping to quit smoking habit. However, consultation must be done with
N.P in order to discuss the expenditure of using E-cigarettes for smoking cessation as Medicaid
and Medicare do not cover these aspects of the health promotion or therapy.

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Increasing commitment
The last intervention for N.P will to increase health awareness. According to NPHMP, a
lower commitment towards a specific plan decreases the overall outcome of the health promotion
plan. Here the perceived barrier for N.P includes lack of motivation due to lack of disease
awareness and disease prognosis. Powers et al. (2017) are of the opinion that educating the
patients about the process of the disease prognosis and how healthy lifestyle habits will help to
improve the healthcare condition will lead to adherence of health lifestyle. Thus N.P must be
educated about the disease progression under the guidance of the community health nurse.
Part: 6
Goal: 1
Reduction in the level of glucose in the fasting condition and reduction in the level
HBAc1: The level of fasting blood glucose and HBAc1 will be monitored weekly in order to
denote reduction in the glucose level in blood. Proper maintenance of diabetic diet will help to
reduce blood glucose level. According to Ettehad et al. (2016) normal blood glucose level is 100
mg/DL and normal level of HBAc1 is between 4 to 5.6%.
Goal 2
Reduction in the level body weight and body mass index: Regular practice of the physical
activity for about 30 minutes a day will help to reduce the BMI level and body weight of NP.
The weight of N.P will be monitored on a weekly basis. A digital weight measuring machine will
be installed in the house of N.P and he will be used to monitor his weight on weekly basis. The
increase in the weight of N.P will promote modification in the diet plan with restricted intake of
calorie or increase in the rate or duration of the physical activity (Powers et al., 2017).

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Goal 3
Reduction in smoking: Reduction in the rate of smoking will be monitored through self-
reported data. N.P will questioned on monthly basis in order to record his cigarettes intake per
day. An absence of smoking reduction will promote mental counseling as this will help to
highlight his psychology behind smoking. Since J.P lives alone, quitting smoking can be
challenging such that proper assistance with mental health nurses like counseling will prove to be
helpful (Babb, 2017).
Goal 4
As per the NPHPM, the level of satisfaction level of NP will be monitored based on his
personal experience. In order to increase his level of comfort and satisfaction person-centered
care plan can be used.

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