Bolg Question 2

    The challenges in implementing the guidelines for managing diabetes, hypertension, and dehydration are

·          Diabetes is a chronic disease needs care from all healthcare professional such as nurses, physicians, dietitians, and pharmacists including the patients (self-care skills). Diabetic patient’s required education, monitoring, and medication to achieve treatment goals. Barriers to support and manage chronic illness is increase in the time and effort in delivering to adequate management needed because health-care system provide care more about acute illnesses and poorly designed to meet the care for complex chronic diseases. Diabetes required care from patients in glucose control, screening to early detect organ damage, self-check for foot or wound to prevent further complications, regular exercise, diet, and educate patient for medication administration and doses.

Barriers to Providing Diabetes Care in Community Health Centers.

·          Hypertension, many ways to manage the blood pressure as pharmacological and non-pharmacological. Some of non-pharmacological measures such as stress control are depend on patient life-style; healthcare providers have no control over patient life. The barrier of implementing hypertension management is poor medication adherence for example hyperglycemia remind the patient about the need to take medications. Moreover, medications have some side effects that are worse than the disease. Medication failure to refill on time delay the medication daily intake that will result in losing blood pressure control.

Barriers to and Strategies for Effective Blood Pressure Control 

Potential barriers to control of blood pressure 

·         Dehydration is more between elderly people result in low blood pressure, dizziness, increased risk of falls, poor skin conditions (e.g. pressure ulcers), and poor oral health. Dehydration: why is it still a problem? The challenges in implementing dehydration management are detecting the symptoms before it becomes worse and fail to care as nursing time at the bedside to ensure the patients are properly hydrated.

In conclusion, this link will provide general points to minimize hospital readmission

Respond on N651 Question 1

The IOM recommended 10 steps to lessening the gap between patient care and healthcare practice. Sharing my personal experience that will show how the hospital used two of the steps addressed in IOM.

1-     Healthcare provider share clinical knowledge and medical information freely with patients or even other healthcare member such as new IV medication or dressing. King Faisal Hospital in Saudi Arabia has mandatory courses, annual courses, and sometimes any update in procedures or hospital system. At the hospital level, they use a computer program to save patient’s data; the hospital made system update and they made schedule for the staff in the unit to attend the course in their off day (with bounce) and share the new update with other staff member. In medical unit, sometime there is meeting every two weeks to address any problems, new procedures or regular procedures, or new cases. At the end of each month, nursing staff make a short presentation to share knowledge or learn new procedure, that also help in staff evaluation and portfolio. One of the presentations that I attend was about pressure ulcer and new dressing that help in different wound stages. Because medical unit have many long term patients who have a higher chance to get pressure ulcers.

2-     Patient is the source of control for his/her own health which is important for healthcare professionals, patients, and their family members for them to choose, accommodate, and encourage shared decisions. As a provider our right from the patient is to take all the information such as patient history, home medications, any previous surgery, etc. Patient right is to be aware, know, and make their own decision about their health and care received. That will achieve by how much shared information and knowledge with patient about his/her condition. Patients are the only one who knows about their body and the care they need. Healthcare provider’s responsibility is to give a full and best care plan to patient and every change is made in treatment plan. I saw different kind of same situation where physician give a background about the case and different opinion in the patient preferences of treatment plan to choose from especially in pediatric unit for the parents to made the best decision for their child. Nurses usually comfort and give extra explanation for any concern about the plan. Other example when the patients or their family sign DNR consent in cancer patients or elderly with many chronic problems. One of the stories I have been through was in a surgical unit when physician and dietitian made a different plan for an obese patient to lose weight by diet or liposuction. They give a full description of the benefits and complications; giving different stories of other cases having the same situation.