Evidence-Based Health Care Priorities for Peter Mitchell

This article discusses two evidence-based health care priorities for Peter Mitchell, a 52-year-old male with multiple health conditions. The priorities focus on improving his health-related quality of life and psychosocial/mental health outcomes. The article also explores the potential causes of his conditions and suggests nursing interventions to address them.

The systematic discussion of two significant evidence-based health care priorities for the
selected ‘Peter Mitchell’ scenario is performed using clinical reasoning cycle (EHA, 2018).
The presented case study reveals the poor health status of a 52-year male Peter Mitchell
affected with obesity, type 2 diabetes, hypertension, sleep apnea, and gastroesophageal
reflux disease (GERD).
Peter experiences clinical signs/symptoms of difficulty breathing (during sleep), poorly
controlled blood glucose level, elevated hunger, diaphoresis, fatigue, shakiness, smoking
addiction. He is also affected by unemployment and social isolation. He also experiences
substantial difficulty in independently undertaking his personal care and ADLs (activities of
daily living). He presently receives insulin, metformin, metoprolol, and dietary interventions to
effectively manage his clinical symptoms.
Peter’s obesity and poorly elevated blood glucose level substantially deteriorate his health-
related quality of life and wellness outcomes (Yousefzadeh, Shokoohi, & Najafipour, 2015).
Peter’s diabetes mellitus substantially increases his risk of cardiovascular disease and
related complications. Peter’s sleeping disturbance and related breathing difficulty is a direct
outcome of his obesity hypoventilation syndrome that substantially elevates the risk of
respiratory and metabolic complications (Katyal & Bollu, 2019). Patient’s GERD status
elevates his risk for pulmonary disease, esophageal adenocarcinoma, Barret’s esophagus,
peptic stricture, and erosive esophagitis (Badillo & Francis, 2014). Peter also experiences a
high risk for the chronic renal disease under the impact of diabetes and hypertension
(Lastra, Syed, Kurukulasuriya, Manrique, & Sowers, 2014).
The probable causes of Peter’s presently reported disease conditions are based on the poor
health-related quality of life, adverse glycemic control, poor mental health, limited physical
activity, smoking addiction, inappropriate diet, limited disease awareness and coping skills,
ineffective self-care capacity, and reduced self-sufficiency.
Peter’s two care priorities will determine the health care goals requiring timely
accomplishment in the context of improving his wellness outcomes in the shortest timeframe.
These care priorities will be based on the enhancement of health-related QoL (Quality of
Life) and psychosocial/mental health outcomes.
The preliminary objective of improving Peter’s health-related QoL is based on the
normalization of his blood glucose level. This step will substantially reduce Peter’s risk of
hyperglycemia-related tissue deterioration and assist in controlling the clinical manifestations
of hunger and fatigue. Peter’s health-related QoL should be improved in a manner to
maintain his premeal and post-meal blood glucose levels within 70-130mg/dl and 180mg/dl
(or less) respectively (DTC_UCSF, 2019). Similarly, the health-related QoL should effectively

normalize Peter’s systolic and diastolic blood pressures to 120mmHg-140mmHg and
70mmHg-90 mmHg respectively (Lin et al., 2016).
The community health nurse will need to actively coordinate with Peter in the context of
enhancing his autonomy, positive emotions, resiliency, social ties, healthful diet, and
physical activity pattern (CDC, 2018). The substantial improvement of these attributes will
actively enhance Peter’s overall well-being and treatment outcomes. Health-related QoL
enhancement measures will also focus on improving peter’s mood and energy level (i.e.
mental and physical health perceptions), social support system, and functional status. The
community health nurse will enhance Peter’s knowledge of various physical activities in
accordance with his interest level and weight management requirement. Daily brisk walking
activity with a speed of 5.6km/hr for a duration of 40 minutes will effectively enhance Peter’s
catabolic activity and assist his weight-reduction process to a considerable extent
(Hamasaki, 2016). The nurse will motivate Peter in the context of undertaking an aerobic
exercise to effectively improve his diabetes control while increasing the scope of weight loss
through insulin sensitivity improvement. The aerobic exercises including walking, treadmill,
and cycling will elevate Peter’s glucose uptake level across the skeletal muscle while
effectively improving the process of glucose transporter translocation (Thent, Das, & Henry,
2013). Furthermore, the nurse will also guide peter to undertake resistance training in the
context of improving his quality of life, daily energy expenditure, and insulin sensitivity.
The informed food choices in Peter’s case will assist in controlling his body weight, lipid
level, blood pressure, and glycemic control. The nurse will enhance Peter’s knowledge and
awareness related to the recommended dietary pattern in the context of reducing his risk of
cardiometabolic manifestations. The dietary administration of olive and fish oils will
substantially assist in enhancing Peter’s overall glucose metabolism (Sami, Ansari, Butt, &
Hamid, 2017). Similarly, the utilization of the Mediterranean diet will minimize Peter’s risk of
diabetic retinopathy and related clinical complications. The community health nurse will
guide Peter in the context of consuming a high fiber diet not only to improve his glycemic
control but also to overcome the clinical symptoms of gastrointestinal reflux disease. The
high-fiber diet in Peter’s case will include whole grains, legumes, nuts, fruits, and green leafy
vegetables (MFMER, 2019). The biweekly consumption of fish, including tuna, mackerel,
and salmon will improve Peter’s omega-3 fatty acid level and reduce the risk of
cardiovascular disease. Furthermore, the administration of peanut, olive, canola oils and
avocados will assist in improving Peter’s HDL (high-density lipoprotein) level to a
considerable extent. The community health nurse will guide Peter in the context of avoiding
the consumption of saturated fats, trans fats, cholesterol, and sodium to reduce the risk of
arterial clogging and related cerebrovascular accident (Duman, 2013). The nurse will also

enhance Peter’s awareness related to the need for a salt-restricted diet to effectively control
his systolic and diastolic blood pressures. The reduced consumption of saturated fats, meat,
sweet, and snacks will also help in stabilizing Peter’s blood pressure. The nurse will
effectively monitor Peter’s diet and accordingly facilitate the consumption of vegetable-
based/milk-based proteins along with dietary fibers, fish oil, calcium, and potassium for
minimizing the hypertension manifestations (Duman, 2013).
The community health nurse will require initiating cognitive counseling sessions for Peter in
the context of enhancing his awareness regarding the adverse effects of tobacco addiction
(Chen et al., 2014). The utilization of self-help materials and face-to-face individual
consultation will motivate Peter in the context of quitting the smoking habit and reducing the
extra pounds. The cognitive behavior therapy in Peter’s care will effectively challenge his
smoking behavior while minimizing negative apprehensions related to the relapse of tobacco
addiction. The community health nurse will perform a therapeutic alliance with Peter through
the systematic utilization of motivational communication to foster his desire of quitting the
smoking habit. The community health nurse will compassionately enhance Peter’s autonomy
while providing him several psychosocial strategies for overcoming tobacco addiction.
Nurses’ empathetic attitude and active listening will substantially improve Peter’s trust and
confidence in the recommended cognitive behavioral approach regarding smoking cessation
(Efraimsson, et al., 2015). The cognitive behavioral intervention will enhance Peter’s
problem-solving and coping skills against the reported clinical manifestations and passive
environmental circumstances. The community health nurse will motivate Peter in the context
of modifying his thinking pattern related to tobacco abuse. The enhancement of Peter’s
knowledge regarding smoking withdrawal symptoms will also help him to minimize the
tobacco addiction pattern to an unprecedented level. The utilization of motivational cues and
aversion therapy will also enhance Peter’s unpleasant feeling towards tobacco utilization
(VMC, 2018). The utilization of cognitive behavioral therapy for weight reduction through the
enhancement of focussed exercise and eating habits will not only minimize Peter’s smoking
addiction but reduce is the risk of anxiety, depression, and other adverse mental health
outcomes.
The community health nurse will need to utilize therapeutic communication in the context of
evaluating Peter’s level of compliance with the recommended pharmacotherapy (Popa-Velea
& Purcărea, 2014). Therapeutic relationship establishment in Peter’s case will effectively
facilitate the genuine exchange of emotions and enhance his psychological support system
to a considerable extent. The assertive communication strategy will motivate Peter to share
his personal attitudes, emotions, opinions, and health-related expectations with the
community health nurse. This attempt will facilitate the customization of psychosocial

interventions in the context of minimizing Peter’s risk of experiencing disappointment,
frustration, alienation, anger, hopelessness, and depression. Nurse’s therapeutic alliance
with Peter will enhance his capacity of sharing the deepest emotional state, treatment
complications, and overall health care expectations. A nurse-based therapeutic relationship
will also help Peter to enhance his Pharmacotherapeutic compliance in the context of
reducing the clinical manifestations of the reported diagnoses.
The community health nurse will require evaluating Peter’s functional balance through the
assessment of POMA (Tinetti performance-oriented mobility assessment) and IADL
(Instrumental Activities of Daily Living) scores (Hong et al., 2017). The nurse will accordingly
administer appropriate ADL support with the core objective of improving Peter’s self-
determination self-sufficiency, and self-care capacity. The nurse will need to promote shared
decision-making with Peter while evaluating his cultural/psychosocial requirements and
administer appropriate culturally-sensitive health care interventions for improving the
wellness outcomes (Peterson, 2012). The nurse-based psychological counseling will
motivate Peter to improve his social connectivity through extended interaction with peers,
friends, neighbors, and relatives while concomitantly exploring better employment
opportunities for self-engagement (Klinenberg, 2016). This attempt will categorically motivate
Peter for enhancing his social interaction pattern in the context of improving mental health
outcomes.
The evaluation of Peter’s care priorities and related nursing interventions will be based on
the thorough assessment of his overall physical, spiritual, and psychosocial well-being.
Furthermore, the improvement in Peter’s activities of daily living, pharmacotherapeutic
compliance, social connectivity, physical activity, dietary pattern, and smoking addiction will
be testified through his health-related perception improvement, glycemic control, blood
pressure control, weight reduction, sleeping pattern improvement, and accomplishment of
individualized requirements. The evidence-based accomplishment of Peter’s reported health
care priorities will require generating the desired wellness outcomes in Peter’s case within a
span of 6 months following the utilization of the recommended nursing care strategies. The
community health nurse will need to fill-in the reported gaps in the selected care priorities
based on therapeutic/health care outcomes.
The presented clinical reasoning cycle in the context of Peter’s care priorities substantiate
the requirement of administering person-centered and holistic health care strategies for
effectively accomplishing his clinical, therapeutic, health care and social care requirements. I
understand the requirement of the extended engagement of community health nurse with
the chronically ill patient in the context of evaluating his entire health and wellness aspects

through the utilization of person-centered strategies. Indeed, the administration of
multifactorial health care interventions is the presented scenario is highly needed for
effectively improving Peter’s recovery phase and overall wellness outcomes. In summary,
the improvement of health-related QoL and psychosocial outcomes of the chronically ill
patient is paramount to the enhancement of his overall well-being and therapeutic outcomes.

References
Badillo, R., & Francis, D. (2014). Diagnosis and treatment of gastroesophageal reflux
disease. World J Gastrointest Pharmacol Ther., 5(3), 105-112.
doi:10.4292/wjgpt.v5.i3.105
CDC. (2018, 10 31). Well-Being Concepts. Retrieved from HRQoL:
https://www.cdc.gov/hrqol/wellbeing.htm
Chen, J., Chen, Y., Chen, P., Zhijun, L., Luo, H., & Cai, S. (2014). Effectiveness of individual
counseling for smoking cessation in smokers with chronic obstructive pulmonary
disease and asymptomatic smokers. Exp Ther Med, 7(3), 716-720.
doi:10.3892/etm.2013.1463
DTC_UCSF. (2019). Goals of Treatment. Retrieved from https://dtc.ucsf.edu/types-of-
diabetes/type1/treatment-of-type-1-diabetes/monitoring-diabetes/goals-of-treatment/
Duman, S. (2013). Rational approaches to the treatment of hypertension: diet. Kidney Int
Suppl (2011)., 3(4), 343-345. doi:10.1038/kisup.2013.73
Efraimsson, E. O., Klang, B., Ehrenberg, A., Larsson, K., Fossum, B., & Olai, L. (2015).
Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics
in primary health care. Eur Clin Respir J, 1-13. doi:10.3402/ecrj.v2.27915
EHA. (2018, 01 18). The Clinical Reasoning Cycle: The 8 Phases and their Significance.
Retrieved from http://www.heartassociation.eu/the-clinical-reasoning-cycle-the-8-
phases-and-their-significance/
Hamasaki, H. (2016). Daily physical activity and type 2 diabetes: A review. World J
Diabetes, 7(12), 243-251. doi:10.4239/wjd.v7.i12.243
Hong, X., Chen, X., Chu, J., Shen, S., Chai, Q., Lou, G., & Chen, L. (2017). Multiple diabetic
complications, as well as impaired physical and mental function, are associated with
declining balance function in older persons with diabetes mellitus. Clin Interv Aging,
189-195. doi:10.2147/CIA.S123985
Katyal, N., & Bollu, P. C. (2019). Ventilation, Obesity-Hypoventilation Syndrome. In
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK482300/
Klinenberg, E. (2016). Social Isolation, Loneliness, and Living Alone: Identifying the Risks for
Public Health. Am J Public Health, 106(5), 786-787. doi:10.2105/AJPH.2016.303166

Lastra, G., Syed, S., Kurukulasuriya, L. R., Manrique, C., & Sowers, J. R. (2014). Type 2
diabetes mellitus and hypertension: An update. Endocrinol Metab Clin North Am,
43(1), 103-122. doi:10.1016/j.ecl.2013.09.005
Lin, J. D., Chen, Y. L., Wu, C. Z., Hsieh, C. H., Pei, D., Liang, Y. J., & Chang, J. B. (2016).
Identification of Normal Blood Pressure in Different Age Group. Medicine (Baltimore),
95(14), 1-8. doi:10.1097/MD.0000000000003188
MFMER. (2019). Diabetes diet: Create your healthy-eating plan. Retrieved from Diabetes
diet: Create your healthy-eating plan: https://www.mayoclinic.org/diseases-
conditions/diabetes/in-depth/diabetes-diet/art-20044295
Peterson , K. J. (2012). Shared decision making in health care settings: a role for social
work. Soc Work Health Care., 51(10), 894-908. doi:10.1080/00981389.2012.714448.
Popa-Velea, O., & Purcărea, V. L. (2014). Issues of therapeutic communication relevant for
improving quality of care. J Med Life, 7(4), 39-45. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813615/
Sami, W., Ansari, T., Butt, N. S., & Hamid, R. A. (2017). Effect of diet on type 2 diabetes
mellitus: A review. Int J Health Sci (Qassim)., 11(2), 65-71. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426415/
Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of Exercise in the Management of Diabetes
Mellitus: the Global Scenario. PLoS One, 8(11), 1-8.
doi:10.1371/journal.pone.0080436
VMC. (2018). Cognitive-Behavioural Therapy (CBT) for Quitting Smoking. Retrieved from
https://www.myvmc.com/treatments/cognitive-behavioural-therapy-cbt-for-quitting-
smoking/
Yousefzadeh, G., Shokoohi, M., & Najafipour , H. (2015). Inadequate control of diabetes and
metabolic indices among diabetic patients: A population based study from the
Kerman Coronary Artery Disease Risk Study (KERCADRS). Int J Health Policy
Manag., 4(5), 271-277. doi:10.15171/ijhpm.2015.06