Analyzing Type 2 Diabetes: A Community Nurse's Role & Strategies

This case study examines the role of a community nurse in assisting a 45-year-old unemployed single mother, Susan, with type 2 diabetes. The analysis identifies social determinants of health, such as unemployment, food insecurity, and stress, as well as behavioral determinants like lack of exercise and poor dietary choices, that contribute to Susan's condition. The study emphasizes the importance of motivational interviewing by the nurse to encourage Susan to adopt healthier behaviors and improve self-management of her diabetes. By addressing these factors and utilizing motivational interviewing techniques, the community nurse can help Susan improve her quality of life and prevent further complications from her chronic condition. The case study highlights the development of care plans addressing social and biological determinants and the implementation of motivational interviewing to foster self-care and management.

Introduction:
Susan is a 45-year-old woman living in the rural areas and is a single parent to her two
children of age 13 and 15. She is not employed now. She is mainly living on unemployment
benefits scheme. This makes her live on a very tight budget. She is suffering from type-2
diabetes and is currently gaining on weight. She does not like exercise due to lack of motivation
and frequently needs to go to the toilet. Susan eats processed foods. This is mainly because they
are cheap and she does not have to cook. The assignment will mainly portray the various roles
that will be played by the community nurses in assisting her to cope with the disorder effectively.
Moreover, the social and behavioral determinants of the health would be identified and
accordingly the nurses will incorporate motivation interviewing in the care plan. This would be
helping Susan to overcome the various issues she is facing due to her disorder, helping her to live
better quality life.
Impact of diabetes type-2 in Australian women and its effects on Susan:
Reports provided by the Australian Institute for Health and Welfare (AIHW) had shown
that there were about 16,400 deaths in the nation of Australia with about half of the patients
accounting for about 55% mainly due to tupe-2 diabetes (Diabetes snaphot, AIWH, 2018). About
1 million hospitalizations had been associated with type 2 diabetes in the year 2015 to 2016
(Boyle, Saunders & Drury, 2016, pg: 1986). The rates were found to be similar among males and
females with slight differences of males being at 6% and females being at 5%. Age specific rates
for the females were found to be higher than the males for those above 55 years and above
(Rawal et al., 2015, pg: 205). Insulin treated type-2 diabetes were seen to be 1.5 times higher in

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males than that of the females accounting for about 74 in comparison to 49 per 100000
respectively. Some of the immediate impacts of the disorder are increased thirst as well as
frequent urination, increased hunger, fatigue, blurring of the visions, slow healing of wounds as
well as areas of the darkened skin. Often long-term complications are also seen like the
damaging of the large blood vessels of the heart, brain as well as the legs increasing chances of
cardiovascular disorders. It might also affect the smaller blood vessels causing diabetic
retinopathy, kidney disorders (Fenwick et al., 2018, pg: 667). It also causes neuropathy and foot
ulcers. Susan has already started getting complications like excessive fatigue, frequent urination,
stressed as well as others. Therefore, it is extremely important for Susan to take measures by in
order to prevent any form of complications in the upcoming days as that would result in further
suffering of the patient and more expenditure and financial outflow. As she is a single mother,
her children would be also affected, and they would be stressed by the occurrence of such
disorder. Hence, the community nurse needs to provide her comprehensive care that would help
Susan to prevent deterioration of the condition and helping her to cope with the disorder.
Social determinants of health that increase Susan’s risk of developing the disorder:
As per the definition provided by the world Health organization, social determinants of
health are the conditions in which people survives like they are take birth, grow, live, work and
age. They determine the wider set of the forces as well as the systems that help in the shaping of
the conditions where people live (Smith et al., 2016, pg: 360). Out of different 10 social
determinants that had been put forward by the WHO, it has been seen that unemployment is the
main social determinant that had partly affected the occurrence and deterioration of the situation.
She has been unemployed and she has to live under very tight budget. Studies have shown
unemployment to be intricately associated with diabetes stating that unemployment may be one

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of the social determinants that influence many factors which directly causes diabetes (Volaco et
al., 2018, pg: 321). This social determinant is indirectly associated with two other determinants
out forward by WHO these are food and stress. Poor quality food results in increase in calorie
intake as well as lessens the chances of nutritional intake in the individuals. Moreover, poor
quality foods also increased chances of microorganism infection. All these result in poor quality
health. Moreover, lower income and unemployment creates huge amount of stress among the
affected individuals and this stress thereby acts as another social determinants of health for the
development of various chronic disorders. In case of the patient, it was seen that she was
unemployed, and she had to live on tight budgets (Patel et al., 2016, pg: 796). Moreover, she
could not afford quality organic food and only bought processed foods. Processed foods are low
in nutrition and higher in calories and this aspect results in huge calorie gain in the individuals
(Type 2 Diabetes Management GP Guidelines, 2016). Such amount of calorie gain thereby
increases the chance of obesity that is also one of the risk factors for diabetes type-2 (Walker et
al., 2014, pg: 30. Therefore, similar situation might have happened for Susan that had made her
develop the disorder. She is already gaining weight, and this supports the rationale of her
developing chances of obesity and diabetes. Stress is another social determinant that is associated
with diabetes. When individuals develop stress, the blood sugar levels rise. Stress hormone like
cortisol and epinephrine starts acting vigorously to boost energy. Therefore, all these
determinants might have made Susan develop the disorder.
Behavioral determinants that increase Susan’s risk of Type 2 Diabetes:
Researchers are of the opinion health is determined by the complex interactions between
the different social as well as economic factors along with contribution of the physical
environment and the individual behaviors. One of the most important behaviors that is often

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observed among diabetes patients is their lack of motivation to exercise (Goyal et al., 2016,
pg:100). Physical inactivity is associated with occurrence of obesity and this directly increases
the chance of the diabetes. Moreover, the case study has shown that Susan has been increasing
body weight due to her lack of motivation in being physically active and undertaking of
exercises. Researchers are of the opinion that when individuals exercise, muscles are seen to
become more sensitive to insulin and thereby absorb glucose from the blood. However, Susan is
seen to completely lack motivation and does not show any proactive behavior in being physically
active and overcome sedentary lifestyle. He is often seen to prefer processed foods as it saves her
from cooking (Ouyang et al., 2015, pg: 430). Such behaviors need to be changed and she needs
to be highly proactive in taking up self-management interventions for coping with the symptoms
of diabetes and overcoming the barriers (Walker et al., 2016, pg: 363)). Susan is also seen not to
cook food and tries to escape from the job of cooking by in taking of processed foods. Such
processed foods are the highest contributors to conditions of being overweight or obese as the
calories contained by such foods are high and results in weight gain and increase in the blood
glucose level (Namadian et al., 2016, pg:93). Eating of the carbohydrates with low glycemic
index is indeed significant for the maintenance of the blood sugar levels. However, Susan is not
following such diet as she is having carbohydrates high on glycemic index. This increases the
chance of diabetes or high blood glucose levels in the individuals (Feinman et al., 2015, pg: 12).
These kinds of behaviors need to be changed where Susan needs to be encouraged to pick up
healthy behaviors and thereby prevent the chances of deterioration of the situation.
Principles of motivational interviewing:
Motivational interviewing can be defined as the collaborative goal oriented style of
communication that associates with the particular attention for strengthening of the personal

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motivation for and commitment towards meeting a particular goal. This is done by eliciting as
well as exploring the reasons of the change for the person within an atmosphere for acceptance
as well as compassion. This is mainly applied for the diabetes patients for encouraging them in
discussion of their behaviors that remain associated with their self-management. It also remains
associated with assisting patients in their motivation as well as confidence for making different
types of changes that will help in the improvement of the diabetes control (Christie et al., 2014,
pg: 381). Therefore, while interacting with Susan, the nurse needs to undertake this procedure to
help Susan change her behaviors and make her more motivated to lead a healthy lifestyle to cope
with the symptoms of the chronic ailments of diabetes type-2. The spirit of motivational
interviewing is effective collaboration and partnering of the nurse with the patient. The second
one is evocation where the nurse needs to elicit the desires as well as reasons for change in the
patients. The nurse should give advice only with the permission of the patient. The third one is
autonomy where nurses need to respect and honor the autonomy of the patient (Pladevall et al.,
2014, pg: 136. The nurse needs to allow Susan to be in control of her own desires. The fourth
aspect is compassion where the professional need to promote the welfare of the patient actively.
The main principles that the community nurse should follow while undertaking motivational
interviewing for Susan are to based as RULE formula. “R” for resisting the righting reflex, “U”
for understanding the motivation of the patient, “L” for listening to the patient and “E” for
empowering of the patient is the principles to be followed (Elwyn et al., 2014, pg: 270). The
nurse should take the counseling strategy to engage Susan in the patient centered communication
by asking her open-ended questions and probes, for affirming Susan in sharing her information,
reflecting on what she says and providing statements and summarizing the nature of the
discussion. It would help in assessing her confidence, ability as well as commitment for

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achieving the agreed goad that are mainly the key components of the successful behavior
changes.
Conclusion:
From the above discussion, it is seen that the diabetes is a chronic condition and is
affecting many individuals in the nation of Australia. Different types of social determinants and
behavioral determinants of health can result in development of this disorder. It is seen that often
management of such determinants of health are an important criterion for nurses. In order to
change the behaviors for ensuring better self-management of the disorders, nurses can undertake
motivational interviewing. The nurse in the case study would first develop care plans for
realizing the social and biological determinants of health and then undertake motivational
interviewing for helping Susan change her behaviors and be more motivated in self-care and
management.

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