Decision Making in Nursing Care: A Case Study of Mr. Jameson

This case study delves into the complexities of managing a 63-year-old patient, Mr. Jameson, who suffers from a combination of chronic conditions, including Type 2 Diabetes (T2D) and hypertension. The assignment explores the critical role of decision-making in nursing care, emphasizing the importance of a systematic assessment, planning, and the delivery of interventions. It highlights the need for a patient-centered approach and collaborative care to address Mr. Jameson's health issues, including his elevated blood glucose levels, high blood pressure, and developing vision problems. The essay examines the significance of shared decision-making, the utilization of various health models, and the integration of therapeutic interventions to improve the patient's health outcomes. The discussion covers the background of Mr. Jameson's conditions, the assessments made by the nurse practitioner, and the interventions proposed, such as dietary modifications, exercise recommendations, and medication management. The evaluation of the care plan is also considered, emphasizing the need to refine the approach if necessary, ensuring that the patient is actively involved in setting achievable goals for improved health management. The case study underscores the importance of multidisciplinary team collaboration and the role of the local community in supporting patients with complex chronic conditions.

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DECISION MAKING
by (Name)
Class (Course)
Professor (Tutor)
School (University)
City and State
Date

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DECISION MAKING
Introduction
Improving the health conditions of patients and the elimination of risks associated with complex
chronic conditions is vital. To achieve the advanced improvement, use of practical assessment,
person-centred and collaborative nursing care plan is essential (Chrvala, Sherr and Lipman,
2016). Therefore, the essay will discuss a case scenario of Mr. Jameson, a 63-year-old African –
Caribbean man who has chronic complex conditions that include T2D and hypertension. Besides,
the patient has a significant and gradual increase in B.G. levels which is currently at 17mmol/l.
Thus, he has poor glycemic control. Additionally, Mr. Jameson who has high B.P. of 190/100
mmHg has also developed vision problems. However, Mr. Jameson has frequently missed
clinical appointments with no medication for his past 15 years of T2D infection. Mr. Jameson is
married to a wife who is also suffering from T2D, but he has a reasonable glycemic control.
Hence, Mr. Jameson’s complex conditions can be improved through the use of various health
models suitable for hypertension and T2D along with effective care plan and patient-centered
care to minimize health deterioration and reduce risk probability on the patient. Therefore, the
essay will firstly focus on the background, which will highlight how Mr Jameson's complex
health needs will be met through conducting of a systematic assessment, planning and
interventions delivery as well as evaluating the care provided for the patient. Consequently, the
recommendations and goal determination will be made to realize a general improvement of the
patient’s health status.
Finally, through the proper decision making alongside patients with complex chronic conditions
such as Mr Jameson, various health models will be utilized including the therapeutic
interventions necessary for handling complex situations (Batalden et al., 2016). Collaborative

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health treatment and care will also ensure that patients do not receive treatment services without
involving them as part of the whole process (“American Diabetes Association,” 2016).
Therefore, achievements can be made on proper health of patients with complex chronic
conditions if we improvise on appropriate decision-making mechanisms.
Background
Powers et al. (2017) hypothesize involved chronic complications subject the patient to a risk of
infections or other related diseases. For instance, HTN in people with diabetes multiplies the
chances of cardiovascular disease infections which is usually supported by lower HBA1C levels
in the patient’s body. The risk can further lead to stroke infections, thus, increasing the mortality
rate in patients. Nevertheless, research conducted by the American Diabetes Association (2015)
illustrates that the presence of HTN for patients with T2D develop a weak glycemic control
mechanism such as Mr. Jameson. Besides, uncontrolled T2D has following effects that start from
mild to severe among the patients as in the case scenario where Mr. Jameson has started
developing vision problems as well as a significant increase in weight (Marso et al., 2016). Most
importantly, the complex chronic conditions are not only responsible for related infections but
also responsible for neural effects such as anxiety and depression.
Moreover, in the treatment of diabetes, especially the advanced T2D minimizing glucose levels
may not be a strategy in all patients for all cases (Pullon et al., 2016). Additionally, treatment
alone may not be the best approach for patients with complex chronic conditions. Thus, the
active involvement of patients in their healthcare decisions is paramount to make a positive
impact on their health outcomes. The positive effect can be achieved through the use of essential
factors such as shared decision making and ACA (Beck et al., 2018). Practically, complex
chronic conditions can only be managed under the presence of the multidisciplinary team and the

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patients who mutually interact to improve the patient’s health status. Hence, Mr. Jameson's
chronic conditions will lead to determination and a discussion of the interlink and corporations
between the nurses and other members in eliminating deterioration of Mr. Jameson's health.
Thus, through the use of fundamental factors that will enhance proper decision making for
patients with complex chronic conditions, different recommendations and strategies to improve
the patient’s health conditions will be facilitated (Bendelow, 2018). Besides, effectively shared
decision making will ensure that the patient is subjected to different appropriate medications and
appropriate self-monitoring which are likely to improve the patient’s overall health status
(Bendelow, 2018). Also, Proper decision making will ensure proper dietary and exercise
modifications for Mr. Jameson to be in a position of managing T2D, HTN, and their associated
complications. Nonetheless, for appropriate management of Mr. Jameson's complex conditions,
social care needs and healthcare needs, several approaches are required. The several strategies
needed start from identifying the patient's carer who will perform different roles with other
multidisciplinary teams in decision making — using of primary nurses and doctors who will be
providing assessment, medications and the necessary education that is essential for improving
the patient’s health status. Therefore, through the interaction of the patient and other
multidisciplinary teams, shared decision making, collaborative treatment, and effective centred
care will be met. Finally, through the employment of sufficient decision-making identification of
care priorities, goal assessment and evaluation will be enhanced. The role of the local community
on patients with complex chronic conditions will also be recognized in the decision-making
process that targets at contributing to patient health status recovery.
Discussions

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Based on Mr. Jameson's medical, personal and social history as well as the clinical review,
several assessments can be made by the N.P. However, according to the research conducted by
Berkowitz et al. 2016, the evaluation done on patients with complex chronic conditions and
other comorbidities should be restricted in the identification of care priorities. Through
identification of priority, cares will make the N.P efficiently deliver interventions and evaluate
the assessment made on the patient. Mr. Jameson presently has a poor glycemic control as there
has been a rise in glucose levels for the past two days, a condition that has led to uncontrolled
T2D with HBA1C of 9%. Besides, Mr. Jameson is obese as indicated by his BMI that reads
36kg/m² and the report from his wife that the husband is gradually increasing his weight
recently. Additionally, Mr. Jameson has hypertension conditions as demonstrated by previous
examinations as he takes ACE and has little self-care management skills or life deficits as he
conducts limited exercises since he is inactive while at home.
Furthermore, Mr. Jameson has high carbohydrate intakes since he goes to the pub to enjoy fried
food with friends which he overeats on most occasions. Finally, regarding the assessment, Mr.
Jameson has a poor understanding of diabetes as well as hypertension conditions. Overseeing
diabetes could confirm to be very troublesome particularly going along with the determinations
of the specialist. There are some days that the patient does without checking their glucose level,
and there are additionally times that he does not pursue the prerequisites for her eating routine
and eats anything he desires.
Although the patient's primary concern is to get his diabetic condition to be treated, it is the role
of the N.P. to select the most pressing issues and address them by prioritizing medical care. For
instance, Mr. Jameson's elevated glucose levels need to be treated as well as hypertension.
Besides, the gradual weight increase should also be given priority as it will lead to obesity.

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Concerning preferences, Mr. Jameson and his wife should be referred to a dietician as the
priority. Thus, the information from the dietician will help Mr. Jameson loss weight and
recognize the foods that are cause a corresponding increase in blood glucose and B.P. when
taken. Besides, Mr. Jameson should avoid overeating at any time, thus, should instead focus on
reducing the portion size. An extensive analysis conducted by Berkowitz et al. (2016), indicates
that loss of weight among the HTN patients creates a corresponding reduction in B.P.
Moreover, the N.P. should ensure that Mr. Jameson is subjected to therapy assessment. The
therapy assessment should focus on weight reduction and improved diabetes control. The
dieticians should intervene by providing that Mr. Jameson records the food intakes in a food
journal as well as ordering the patient to estimate portion sizes.
On the other hand, the nurse should provide primary education to Mr. Jameson using the
biopsychosocial model regarding the importance of moderate physical exercises on losing weight
and diabetes control. Fiscella and McDaniel (2018) illustrate that physical activities improve the
rate of metabolic reactions, hence, promoting a healthy condition among patients with
hypertension and obesity. Since Mr. Jameson is usually inactive while at home, it means that
conducting of physical exercises is sporadic, the N.P. should order Mr. Jameson and his wife
who assists him to the clinic to make walks each morning after eating breakfast. The N.P. should
then ask Mr. Jameson on the duration he could manage to walk per day. Besides, using the
Telehealth model, the patient can use a treadmill at home The N.P. will then conduct discussions
with Mr Jameson and his wife on the importance of performing exercises on glucose control and
weight loss.
According to Gomez-Batiste et al. (2017), patients should be treated with medications that only
focus on glucose control without affecting weight gain. Therefore, through the use of the

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biomedical model of health, the N.P. should ensure that Mr Jameson receives medications that
only control glucose rise and not those that, may lead to weight gain. Also, the medicines that
will be prescribed to the patients should be taken with food to avoid G.I. side effects. The N.P.
will ensure there is proper contact by including the time and date of contact and medication
evaluation in Mr Jameson's treatment plan. Additionally, the patient should set goals which can
be short-term and long-term. Short-term goals may involve weight loss, medication, and
exercises. The goals set by Mr Jameson and his wife should be achievable. Thus, the N.P. should
intervene by assisting them in determining goals that are short-term and valid.
Through the transtheoretical model, the N.P. can then refer Mr Jameson to a diabetes educator
who will be responsible for offering fundamental knowledge on how he would manage T2D. The
plan of care developed by the N.P. will be made available to the physician who will work
collaboratively with the patient in discussing procedures and diagnostic tests findings. Chronic
complex conditions can only be managed through a partnership with other multidisciplinary
teams (Goyal et al., 2016). Through the house care model, the N.P. will ensure that there is total
involvement of other relevant members including therapists to reinforce therapies regarding
medical nutrition to improve glucose control, hence, facilitating glycemic control (Fiscella and
McDaniel, 2018). Evaluation can be made through assessing the methods used in bringing
recovery of Mr Jameson. If the ways are found not to be efficient, then the N.P. will be required
to refine the care plan and involve the patient in setting other short-term valid goals. The meeting
results show that the patient needs more training on the dangers that he could be presented to
because of the way of life that he lives (Carter and Kaylor, 2016). The patient likewise
encounters agonies, for example, depression and vision problems and furthermore gaining
weight at recognizable levels that are because of the intake of fatty foods.

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The typical results are that the patient will most likely decide their glucose and likewise decipher
the outcomes. The patient will also have the capacity to name the kinds of nourishment he ought
to eat and physical exercises that he ought to take part in to keep up her wellbeing
(Daskalopoulou et al., 2015). In this manner, the patient must use the house care model and be in
a situation to frame a day by day menu for the nutritious eating routine that he ought to expand
consistently. The patient will likewise show on the best way to effectively oversee insulin
utilizing a syringe and furthermore arrange the needle in a legitimate way (Hanefeld, Powell-
Jackson, and Balabanova, 2017). Toward the finish of the mediation, the patient can likewise
have the capacity to instruct different patients through the assistance of his wife in the network to
expand mindfulness.
Assessment depends on the petitions that are required as distinguished in the meeting results.
The patient requires a great deal of consideration particularly as far as eating regimen and
physical exercise (Carter and Kaylor, 2014). In terms of treatment and organization of insulin,
the patient should be subjected to adequate learning. Additionally, to guarantee that her family
does not strain to help her as far as treatment cost and arrangement of assets, the patient could
join local gatherings that offer free training on the new advancements occurring on the treatment
of T2D (Islam et al., 2015). The people group additionally gives free drug by liaising with the
network wellbeing foundations, so the administrations offered to them are at died down rates to
improve reasonableness.
The nursing analysis should include the intercessions that the medical attendants make when
managing T2D patients to counteract more dangers and diseases (Kaakinen et al., 2018). To
anticipate the threat of the patient having imbalanced nourishment the medical attendant ought to
urge the patient to take an interest in the treatment sessions effectively. Additionally, the medical

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attendant ought to dependably check the patient's load every day to think about their immediate
nourishment consumption what's more, that before (Kurtz, Draper and Silverman, 2016). The
attendant is likewise expected to direct glucose and insulin as required and urge the patient to
take an eating routine comprising of starches and fats and protein.
The executives of type 2 diabetes mellitus are most troublesome with regards to creating systems
to improve the treatment of the illness. Along these lines, in light of the nursing mediations, the
patient ought to be in a situation to self-screen their glucose and translate their outcomes
(Snorgaard et al., 2017). As far as treatment, they ought to figure out how to infuse insulin as
required by the medicinal professionals and figure out how to go to all the treatment sessions to
screen their advancement. To guarantee that the patient does this, the medical caretaker ought to
catch up by making standard telephone considers getting some information about the patient's
improvement and any challenges that they could be encountering (Moore et al., 2017).
Accordingly, this will draw the patient nearer to carrying on with regular life as ordinary people
without facing numerous difficulties. A decision making arises from a decision need which is
usually gotten from a necessity’s evaluation spotlights on a circumstance where various choices
should be thought. Evaluating decisional needs is required to expand great choice help (Crane,
2018). Besides, when the multidisciplinary team is needed to give choice help to a patient proper
decision making will contribute towards the patient's gradual recovery from the chronic
complications. A decision-making appraisal is especially necessary for cases like that of Mr
Jameson, for example, organizing a course of multiple choices that include various patient
conditions that are difficult to decide. Choice help mediations address patients’ decisional needs.
Nurses are a significant piece of the human services framework and are part practical experience
in giving ideal patient consideration, and all-encompassing consideration for the patients with

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perpetual scatters and other perilous disarranges (Reiter, Dobmeyer and Hunter, 2018). Medical
caretakers effectively partake in choosing a compelling routine of the patients. They speak with
the patients and the doctor and advance the prosperity and integrative model of wellbeing
(Sussman et al., 2015). The job of medical caretakers isn't just constrained to emergency clinics,
yet they additionally give nursing care in network homes and other related therapeutic services
settings. For this situation evaluation, the individual is experiencing weight increase, HTN, and
T2D. These conditions have a social, mental and other wellbeing inconvenience for the duration
of their life expectancy. These should be overseen viably to maintain a strategic distance from
the effects like social and psychological breakdown (Wendlandt et al., 2017). HTN and obesity
are firmly identified with one another, and they lead to T2D. Medical caretakers assume a
different job in teaching the general population with diabetes and current scholarly inability.
Medical caretakers participate in in-patient consideration legitimately and furthermore play out
the managerial assignment to streamline the result of these complexities (Young-Hyman et al.
2016). Medical caretakers help the patients to get associated with various exercises, choosing the
fitting system for overseeing T2D. The minding condition and active remedial treatment help the
patient to accomplish distinct results.
Recommendations
According to Purnell et al. (2016), comorbid depression can be treated for people with T2D
under a collaborative care model in a primary care setting. Besides, routine monitoring of
patients with chronic complications is necessary especially for T2D and HTN patients as well as
the impact caused by the diseases on life quality (Munshi et al., 2016). Additionally, patients
with involved chronic complications experience pain which should be managed through referring
the patient to a behavioural health provider and other appropriate interventions for pain

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management strategies. Furthermore, in a primary care setting, the regime of treating HTN and
T2D patients should be reevaluated especially when they present disrupted patterns of eating
(Nerenberg et al., 2018). Above all providers should use validated screening measures to screen
disordered eating especially when B.P. and hyperglycemia do not appear appropriately by
physical activities or mental plan.
Conclusion
To conclude, various health models are essential in the evaluation and assessment of patients
with complex chronic conditions. For instance, a collaborative model plays a vital role in
ensuring that the patient receives treatment and while under-involvement. Besides, setting of
goals for patients with complex chronic conditions also crucial as it helps the providers
determine and evaluate the targets set in recovery and prevention of patient’s health
deterioration. Therefore, a better-shared decision made in helping patients with complex
conditions has a substantial impact on bringing the patient health status than just focusing on
medications that may not apply in all situations.

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Appendices
T2D – Type 2 Diabetes
B.G. -Blood Glucose
B.P. – Blood Pressure
HTN – Hypertension
ACA – Affordable Care Act
N.P. – Nurse Practitioner
ACE – Angiotensin Converting Enzyme
G.I. – Gastrointestinal