Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and is now insulin dependent. In 2012 the company she worked for downsized, and Ms. Jackson lost her job. As a result she was unable to pay her mortgage and became homeless. Since then she has been staying with various family members and friends because she has not been able to afford her own apartment. She has been working as an office temp from time to time but has not been able to find full-time work. She arrived at the emergency department (ED) with a blood sugar of 322 (normal range is 80 to 120) and a hemoglobin A1C of 11% (normal is approximately 5%). Sam is a 23-year-old nursing student assigned to care for Ms. Jackson. After Sam reads Ms. Jackson's chart, she notices that she has come to the ED on several occasions over the past 6 months with the same issue. She also notices that health care providers who took care of Ms. Jackson during the previous visits documented that she verbalized an understanding of how to manage her diabetes but has been nonadherent with her treatment plan. After Sam conducts a cultural assessment using an explanatory model with questions, she learns that Ms. Jackson fears that she will eventually die because her mother died of diabetes. She also learns that Ms. Jackson cannot get her medications filled because she doesn't have health insurance. After obtaining this information, Sam consults with a social worker, who tells Sam about a community health center within eight blocks of the place where Ms. Jackson is currently living. This health center has a diabetes management program and can offer ongoing support to Ms. Jackson. Sam spends time with Ms. Jackson explaining that people do not die from diabetes if they manage it effectively. Sam also discusses with Ms. Jackson some realistic ways to manage her diabetes given her challenging circumstances. In addition, she escorts Ms. Jackson to the social worker's office so they can discuss possible housing and unemployment resources. Sam realizes that there is an opportunity for her to learn more about the social determinants of health that affect Ms. Jackson's ability to manage her care. She also realizes that by gaining skills in cultural competence she will be more confident in providing culturally competent care to her patients. 1. List some of the social determinants of health that Sam most likely discovered while conducting a cultural assessment with Ms. Jackson. 2. On the basis of a cultural assessment, Sam discovers that Ms. Jackson believes that she may die. Select the C-LARA communication mnemonic listed in this chapter and plot a discussion that might help Ms. Jackson understand that diabetes is a manageable chronic illness that does not have to result in death. 3. Ms. Jackson is discharged and returns to the ED several months later because she is having difficulty managing her diabetes again. You are assigned to care for her. How will her weight, history of nonadherence, and past visits to the ED possibly affect your treatment? How could these factors trigger biases and assumptions that will get in the way of providing quality care? How could self-awareness help you reduce the effect of bias on the quality of care you provide?
1, Homeless patients predisposed to more health outcomes due to
poor living condition,food insecurity,unstable housing and limited
resources of self-care..Ms. Jackson with diabetes have difficulty
managing her condition without an appropriate place to store
insulin and access to nutritious food..they have very transient and
have no transportation facilities..
2, people with chronic disease have complex and interacting needs
and require treatment and care from professional and services
concurrently..Nurses in place with communicate and coordinate care
and in providing self-management education to patients can help
manages their chronic illness..chronic disease management includes
patient self-management support and organization support..patient
with chronic illness need long term support to overcome multiple
challenges..education and supportive intervention help patients to
change their risky behavior..
3, Behavioral health medications nonadherence associated with poor
health outcome it is common with homeless people..Factors including
sociodemographic health-related factors, Behavioral health
conditions associated with this nonadherence more with this
people..several barriers like homeless,no prescription insurance
coverage,financial instability, lack of space for storing the
medication associated with chronic illness..Nonadherence can affect
the patient previous treatment, self-reported treatment need
multifactorial,multidisciplinary and patient-focused
strategies..Maintaining treatment adherence to multiple illness is
a complex issues ..Due to nonadherence most of the people do not
achieve optimal disease control..Medication taking behavior and
traditional method like pill count,maintaining clinical
report,prescription refills ,self measures like diet regulations
are some acceptable way to provide medication adherence way to
provide treatment adherence information..Harm from medication error
occurs when the patient unintended consequences like wrong
medication ,doses, etc..lack of knowledge about the medication and
the effect the structure or any function of the
body..Self-education about dispensing and preparation and uses of
medication can help prevent bias and improve quality of care..
Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and...
Cultural Awareness Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and is now insulin dependent. In 2012 the company she worked for downsized, and Ms. Jackson lost her job. As a result she was unable to pay her mortgage and became homeless. Since then she has been staying with various family members and friends because she has not been able to afford her own apartment. She has been working as an office temp...
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