Engaging Your Patients -

There is a high degree of importance placed on patient participation when it demands a change in life-style and diet, due to Syndrome X and DM. At each clinical visit, brief the patient on his/or her daily life and ask if the patient has made a change for the better. By probing the issues further you may find room for improvements. Hear are a few interventions in supporting patients in actively responsive health care:

· Have a provision of printed leaflets and health information packages on living with HT and DM.

· Having computer-based internet health information for your patients.

· Having target mass media campaign through the Marketing Dept.

To Improve Clinical Decision Making -

· Provide patient decision aids on HT and DM.

· Provide training for clinicians and nurses in communication skills.

· Coaching and question prompts for patients.

 
To Offer and Improve Self-Care -

· Self management education classes.

· Teach self monitoring and self administered treatments.

· Offer self help and/or group peer support meetings.

· Patient centered tele-care groups (i.e., conference calls).

· Encouraging adherence to treatment regimens.

· Patient reporting of adverse drug events, provide patient with one number or person to call.

 
Relevant outcome -

· Knowledge of condition and long term complications.

· Self care knowledge.

· Knowledge of treatment options and likely outcomes.

· Comprehension of information.

· Recall of information.

Health Behavior and Health Status -

· Health related lifestyles.

· Self-care activities.

· Treatment adherence.

· Severity of disease and/or metabolic disorder.

· Physical functioning.

· Mental functioning.

· Clinical indicator bio-markers.

The Nurse Can Only Teach ‘That What She/he Knows’ -

In both medical and nursing schools, DM is taught as associated with systolic/diastolic HT, and a wealth of epidemiological data suggests that this association is independent of age and obesity. Evidence indicates that the link between DM and essential HT is hyperinsulinemia. [18] It has been shown that the insulin resistance of essential HT is located in peripheral tissues (i.e., muscle mass), and is limited to non-oxidative pathways of glucose disposal (i.e., glycogen synthesis), and correlates directly with the severity of HT. [19] ʹ[20]

Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Insulin, independent of its effects on B//P and plasma lipids, are known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells.

Note: physiological maneuvers, such as calorie restriction (e.g., found in overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower B/P in both normotensive and hypertensive patients. [21]’ [22]

The nurse practitioner should be aware of this highly important study on chronic HT, that insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent DM, obesity, HT, lipid abnormalities, and atherosclerotic cardiovascular disease. In order for the patient to understand that a change in life-style must start now, the practitioner too must have a plain of action for his/her patients.

The Joint Commission on Accreditation of Health Care Organizations have mandated that hospitals and other health organizations provide instruction understandable to patients, assess patients’ knowledge, and document such educational efforts. [23] Set goals of having at least 95% of patients with HT take action to control their B/P, and of having 75% or higher, people with DM receive education on DM. Patients’ functional health literacy must be considered when attempting to reach these goals. It appears that there are no simple methods of identifying low-literate patients and the significant shame or embarrassment associated with comprehension often makes them hide their disability.

As a nurse, using your assessment skills may lead your patients to open up to you, rather than the treating physician. Consider ‘direct involvement’ of the patients in developing educational materials, this action may empower them to improve their health while ensuring that the content effectively educates them. The future of patient education requires ingenuity and commitment of necessary resources to improve the outcome for patients with chronic diseases.

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