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Medical Malpractice – Wrong Medication

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Medical Malpractice – Wrong Medication

Introduction

Medical malpractice in nursing constitute professional negligence which maybe as a result of an act or omission intended, or unintended by a nurse or a care giver where the treatment received falls below the required or accepted standard of nursing practice in medical community and which may result in death or injury to the patient. The most common medical malpractice in nursing is medication errors.

Approximately 1.3 million patients are injured in the US every year as a result of wrong medication (Conrad & Marks, 2016). Medical Error occurs when preventable events that cause or may lead to wrong or inappropriate medication in the control of a patient’s medical condition.

Medication errors make it mandatory for nurses to follow a defined pattern of administering drugs to patients. Following several incidences of nurses administering wrong medication some hospitals allow nurses to administer certain medical procedures and treatment under the supervision of doctors only (Caron, 2011).

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The scrutiny of academic qualification documents and other professional qualification that are required for nursing practice in the US take a longer period to ensure thorough scrutiny of nurses papers and their backgrounds including the institution of training number of years and the experience gained and the hospitals worked in.

The high rate of medication errors has made it very difficult for nurses to serve patients on their own except under supervision in large hospitals.

References

Conrad, M. S. & Marks, J.W. (ed) (2016) The Most Common Medication Errors retried March 21, 2016 from http://www.medicinenet.com/script/main/art.asp?articlekey=55234

The website source from Conrad and Marks (2016) outlines the most common medication errors that are prevalent in the medical spheres. The website defines a wide range of medical malpractices some that originate from the drugs manufacturing companies while others from negligent medical practitioners and care givers including nurses. The source also provides preventive measures that can be applied to reduce medication errors.

Caron, C. (2011) Nurse Gives Patient Paralytic Instead of Antacid, abc news, retrieved March 21, 2016 from http://abcnews.go.com/Health/nurse-patient-paralytic-antacid/story?id=14997244

The article provides the details of medical malpractice concerning a nurse who mistakenly administered a drug to a patient who later died as a result of the drugs complications from and which later turned out to be that are related to other conditions that

Croke et al (2003) Nurses, Negligence and Malpractice, Uppincott Nursing Center eNews, American Journal of Nursing, AJN, September, Volume: 103, Number (Page 54 -57) retrieved March 21, 2016 from http://www.nursingcenter.com/journalarticle?article_id=423284

The article that first appeared on the American Journal of Nursing details and tracks malpractice in Healthcare Organizations. The article defines malpractice as unethical or improper conduct or unexplained lack of skill among professionals which border on negligence or gross incompetency. The article outlines the different kinds of malpractices that nurses experiences in the normal cause of duty.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, D.M. and Silber, J.H. (2002)Hospital nurse staffing and patient mortality, nurse burn out, and job dissatisfaction. Journal of the American Medical Association 288(16):1987–93.

The article suggests that the high mortality rates that have been recorded in US health Institution are mostly related to understaffing among the nurses, burnouts and job dissatisfaction.

American Association of Critical-Care Nurses (2005) AACN Standards for Establishing and sustaining healthy work environments.www.aacn.org. American Nurses Association Code of Ethics Project Task Force .A New Code of Ethics for Nurses. American Journal of Nursing 100 (7):69–72.

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This article that was published by AACN outlines the ethics that guide nurses in their stations of work. The malpractices are having a negative effect on Americans.

Treadwell, H.M., and M.R. O. (2003) Poverty, race, and the invisible men, American Journal of Public Health 93:705–7.Veatch, R.M.2003. The Basics of Bioethics, Seconded. Upper Saddle River, NJ: Prentice Hall.

The journal describes the challenges faced by the poor and their quests for treatment and the basis for Bioethnics which refers to the treatment of such issues like abortion and euthanasia.

Volbrecht, R.M. (2002) Nursing Ethics: Communities in Dialogue. Upper Saddle River, NJ: Prentice Hall. Weston,

The book outlines the new nursing standards in the year and compares them to the current changes in medical fraternity including in such areas as bioethical isssues,

Weston, A. (2002) A Practical Companion to Ethics, 2nded. New York: Oxford University Press.

Weston (2002) describes the various practical ways of ensuring that all interdisciplinary ethical standards are all followed and put into practice to the letter.

Mercy, J.A., Krug, E.G. Dahlberg, L.L. and Zwi. A.B. (2003) Violence and health: The United States in a global perspective, American Journal of Public Health 92:256–61.

The Public health journal traces the sources of violence in health care industry and relates the rate of violence in hospitals as associated with inadequate training, lack of dedication and discipline.

Milio, N. (2002) Where policy hits the pavement: Contemporary issues in Communities, In Policy and Politics in Nursing and Health Care, 4^th ed., pp. 659–68.St.Louis, MO: Saunders.

The article describes the difficult situations that the nursing industry has been exposed to and the current challenges facing the situation.

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Side effects of using corticosteroid to treat Addison’s disease

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Side effects of using corticosteroid to treat Addison’s disease

Patients diagnosed with Addison’s disease needs to take up their medication daily in order to replace the inadequate hormones. This normally helps the patients to live a normal life. Treatment mainly involves use of corticosteroids (steroid therapy) to replace hormones lost and those not produced by the aldosterone. Although these medications are effective, corticosteroids are associated with short term and long term side effects (Bentley, 2011)

The short-term side effects includes stomach upset, increased irritability, weight gain due to water retention, increased fat on the face, unusual hair growth , high blood pressure, and risk of other infections. The long-term side effects include muscle weakness, brittle bones, and stunted growth among the children. To minimize such side effects, people taking the drugs should be watched carefully and of necessary, their doses reduced as low doses can be effective and have minimal side effects (In Arieti, 2014).

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Factors that make it problematic for management Addison’s disease in adolescents

The process of diagnosing Adrenal insufficiency is usually a challenge. This is because most of clinical manifestation are nonspecific, and tend to vary according to the underlying causative agent and extent of disease progress. It is important to make early diagnosis as the disease can be life threatening if not diagnosed early enough. The signs and symptoms and management of the diseases are the main challenges faced by the adolescents diagnosed with Addison’s disease. These include issues such as fatigue, malaise, and general muscle weakness. This negatively impacts on quality of life and their daily activities (Helms, 2015).

Importance of inter-professional team for treatment of Addison disease

Team-work in management of Addison disease is important as it aids in improving patient quality of life, reduce mortality, improve communication, reduce errors, and increase patient satisfaction. In this case study, healthcare staff from the following disciplines should work together when delivering care to Addison’s patients. These include physicians, nurses, nutritionists, pharmacists, and physiotherapists. This will help in developing a detailed case related information, which facilitates the decision making processes (Bar, 2013).

References

Bar, R. S. (2013). Early diagnosis and treatment of endocrine disorders. Totowa, N.J: Humana Press.

Bentley, P. J. (2011). Endocrine pharmacology: Physiological basis and therapeutic applications. Cambridge [England: Cambridge University Press.

Helms, R. A. (2015). Textbook of therapeutics: Drug and disease management. Philadelphia,

Pa: Lippincott Williams & Wilkins.

In Arieti, S. (2014). American handbook of psychiatry. New York: Basic Books.

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Sports Medicine Practices: Reflective Essay

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Sports Medicine Practices: Reflective Essay

In this exercise, I had an opportunity to observe sports medicine practices at the clinic. Watching the Professor deliver various treatment services to athletes was an informative experience. This facilitated the transition of knowledge gained in class into practice. A basketball player had come to the clinic for her follow up clinical measures. The patient had suffered from knee injury during a tournament and had undergone surgical process three weeks ago.

According to the Professor, her condition had improved and needed therapeutic exercise to improve function and performance. During this exercise, the Professor was tapping muscle to recruit muscle with isometric exercises. This was interesting and it gave me the desire to explore and learn more about isometric exercises.

The athlete was made to practice the following exercises; in prone position and sandbag on the athlete ankle, she was asked to move her body up and down for five minutes. In supine position, she was asked to move up and down with her legs straight for five minutes.

The athlete was also made to balance using one leg. I think these activities are neuromuscular re-education aimed at ensuring that her gait and posture is improved. All this time, I was reflecting on muscle actions as taught in class, which helped me understand better the importance of evaluating the level and strength of therapeutic exercise based on the athlete’s needs.

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The professor asked the athlete to have brace on her ankle throughout. This is important because there are many unexpected situations and her injured knee needs to be protected. I also observed many other athletes in taking therapeutic exercises in the clinic. One practice I observed is that after every training session, they did some stretching to relax the muscles so as to prevent injuries and to reduce soreness. Other preventive measures they used included TENS, hot pack, ice pack, and whirlpool. This was a great experience as I got to observe how these techniques worked practically.

This was a great opportunity to learn the responsibilities and practices in the sports medicine clinic. I realized that treating people is not easy task as perceived theoretically in sports medicine publications. There are many decision making processes that requires one to be adequately informed in sports medicine practices. I will continue studying hard to acquire adequate knowledge. This will ensure that I apply appropriate treatment measures that are patient centered in the future. I am grateful to the Professor for giving this opportunity.

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Chronic Asthma: Pathophysiology

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Chronic Asthma

Maslan & Mims (2014) define asthma as an inflammatory condition of the airway that arises due to hyperactivity to a stimuli causing obstruction of airflow, development of fatal exacerbations, and other respiratory complications. Some of the common allergens that have been citied to trigger asthma include mold spores, grass pollen, and animal dander. Medications such as aspirin, industrial materials such as toluene diisocynate, and indoor air pollution are other common triggers of asthma. Asthma can either be acute or chronic both having significant commonalities and differences.

Pathophysiology of Acute Asthma

Research has reported that exposure to inflammatory allergens triggers reactions in the respiratory system. For instance, Cardinale et al., (2013, March) reports that the onset of acute asthma involves an increased invasion of neutrophils into the respiratory system as well as tumor necrosis factor (TNF), mast cells, and eosinophils. These inflammatory mediators and cells cause increased secretion of respiratory mucous which in turn obstructs the airways, over-inflation of lungs, thickening of the basement membrane, and destruction of the epithelial membrane.

Narrowing of the airway limits inhalation and exhalation exercises of an individual. Consequently, a mismatch in the ventilation-perfusion ration arises. This means that an increase in deoxygenated blood occurs; an event that is quite fatal especially when quick medical attention is not sought.

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Pathophysiology of Chronic Asthma

Just like acute asthma, chronic asthma develops as a result of inflammation in the respiratory system. The allergens initiate the production of inflammatory mediators such as cytokines, histamines, and leukotrines (Maslan & Mims, 2014). These mediators trigger increased contraction and relaxation of the bronchial smooth muscles. Consequently, bouts of airway constriction develop generating the classic symptom of asthma; wheezing.

The narrowing hinders effective exhalation and inhalation. As a result, hypoxia develops and there is increased levels of carbon dioxide in the blood which affects important organs in the body especially the heart, brain, and the kidneys. A number of changes usually occur in patients suffering from chronic asthma. First, there is an increase in eosinophils in the blood supplying the respiratory system and thickening of the lamina reticularis.

The number of mucous secreting cells also increases as well as the size of the bronchial smooth muscles. If medical attention is not sought urgently, patients start presenting with lactic acidosis, hypercapnia, and an unproportional level in the acid-base level in the body. Moreover, in chronic asthma there is an increased degree of hyperactivity to stimuli and an irreversible loss of lung function due to remodeling of respiratory structures. Smooth muscle hypertrophy and hyperplasia are also common occurrences.

Risk Factor

According to Tai et al., (2014), age is one of the leading risk factor that has a significant impact on the pathophysiology of both chronic and acute asthma. Unlike adults, children are usually highly susceptible to suffering from both acute and chronic asthma. This is mainly because adults have cells that are more resistant to the inflammatory agents compared to children. Normally, adults who have previously been diagnosed with asthma can tolerate the condition for a number of weeks unlike children who can easily die within a short time after experiencing an asthma attack just as it is reported in the case of Dynasty Reese and Bradley Wilson.

It is for this reason that parents should be highly educated on the symptoms of asthma as well as the approaches they should undertake in the event a child presents with the symptoms. Moreover, parents should be enlightened about the risk factors of asthma and how they can safeguard their children from being exposed to the asthma triggers.

Diagnosis

For effective diagnosis of asthma, physicians begin by determining the chief complaint followed by the history of the presenting illness (HPI). Asthmatic patients usually complain about wheezing, coughing, tachypnea, shortness in breath just as it is reported in the case study of Dynasty Reese and Bradley Wilson. Spirometry has been tipped to be an effective approach in the diagnosis of asthma.

This technique is used in identifying the differential diagnosis by determining the FEVI of a patient. For instance, the test is positive for asthma when the FEV₁increases by about 12% while the FVC increases by about 200mL (Killeen & Skora, 2013). Chest X-rays can also be used in the diagnosis of asthma as well as the patient’s family history.

In management of asthma, patients are first given maintenance medications such as inhaled corticosteroids which include fluticasone and betamethasone. Rescue medications are then prescribed. They include bronchodilators such as salbutamol and levalbuterol. For adults with asthma, the most suitable medications are the anti-inflammatory agents such as inhaled steroids where as in children, oral medications like prednisone are recommended (Alexander et al., 2012).

References

Alexander, A. G., Barnes, P. J., Chung, K. F., Flower, R. J., Garland, L. G., Goldie, R. G., … & Lulich, K. M. (2012). Pharmacology of asthma (Vol. 98). Springer Science & Business Media.

Cardinale, F., Giordano, P., Chinellato, I., & Tesse, R. (2013, March). Respiratory epithelial imbalances in asthma pathophysiology. In Allergy and Asthma Proceedings (Vol. 34, No. 2, pp. 143-149). OceanSide Publications, Inc.

Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nursing Clinics of North America, 48(1), 11-23.

Maslan, J., & Mims, J. W. (2014). What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngologic Clinics of North America, 47(1), 13-22.

Tai, A., Tran, H., Roberts, M., Clarke, N., Gibson, A. M., Vidmar, S., … & Robertson, C. F. (2014). Outcomes of childhood asthma to the age of 50 years. Journal of Allergy and Clinical Immunology, 133(6), 1572-1578.

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Mammary Duct Ectasis: Case Study Overview

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Mammary duct ectasis

Case study overview

A 60-year-old Latina female is concerned about the thick green discharge on her left breast, a situation she has experienced for the past month. The discharge happens spontaneously causing pain and burning around the breast. She reported to have breastfed all her children; she was not on any medication. However, occasionally she used Tylenol for treating arthritis.

The mammogram test done 14 months ago is within the normal limits. Physical examination indicates that there are slight redded and edematous around the left breast. A greenish-black is seen when palpation is done; there is an ovoid which is smooth, very mob that is not tender at 1cm nodule in the RUIQ at 11.00 5cm from the nipple. The patient is worried that she might be at risk of developing breast cancer.

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Diagnosis

Women over 50 years are likely to suffer from mammary duct ectasis; this is a condition that occurs when the breast dust becomes wider making its walls thicken causing fluid build-up around the breast (Stanford School of Medicine, 2016). Sticky and thick black or green discharge is an indication of mammary duct ectasis. In addition, the nearby tissues around the breast and the nipple will become tender and red. The hard lump caused by this condition is often confused with breast cancer (Patel, et al, 2015).

Treatment and management plan

The patient needs antibiotics for 10 to 14 days to treat the infection; pain medication includes acetaminophen or, ibuprofen, other drugs are Advil, Motrin IB among others. Acetaminophen is commonly prescribed to reduce the pain ,an adult dosage includes is 2 regular strength 325 mg after every four hours or 2 extra-strength of 500mg after every six hours but the maximum dosage should not exceed 4,000 mg in a day.

In mild cases, patients are advised to conduct warm compresses to help to manage the disease, however in severe cases, surgery will be recommended whereby an incision will be made at the edge of the colored tissue to release the built up fluids (Chougule et al, 2015).

Mammary duct ectasis is often confused with breast cancer, therefore women especially those that are above 50 years need to be educated about the differences in the presentation between the two conditions and urged to seek urgent medical attention whenever they have sysmptoms related to mammary duct ectasis.

References

Chougule ,A., Bal A, Das, A., Singh, G ( 2015). IgG4 related sclerosing mastitis: expanding the morphological spectrum of IgG4 related diseases. Pathology 47 (1): 27–33

Patel, B. K., Falcon, S., & Drukteinis, J. (2015). Management of nipple discharge and the associated imaging findings. The American journal of medicine, 128(4), 353-360.

Stanford School of Medicine (2016).Mammary Duct Ectasia .Retrieved from http://surgpathcriteria.stanford.edu/breast/mammductectasia/

ACUTE ASTHMA: PATHOPHYSIOLOGY

Asthma

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Pathophysiology of Acute Asthma

Pathophysiology of Chronic Asthma

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Risk Factor

Normally, adults who have previously been diagnosed can tolerate the condition for a number of weeks unlike children who can easily die within a short time after experiencing an asthma attack just as it is reported in the case of Dynasty Reese and Bradley Wilson. It is for this reason that parents should be highly educated on the symptoms as well as the approaches they should undertake in the event a child presents with the symptoms. Moreover, parents should be enlightened about the risk factors and how they can safeguard their children from being exposed to the triggers.

Diagnosis

For effective diagnosis, physicians begin by determining the chief complaint followed by the history of the presenting illness (HPI). Asthmatic patients usually complain about wheezing, coughing, tachypnea, shortness in breath just as it is reported in the case study of Dynasty Reese and Bradley Wilson. Spirometry has been tipped to be an effective approach in the diagnosis of an asthmatic patient.

In management of the disease, patients are first given maintenance medications such as inhaled corticosteroids which include fluticasone and betamethasone. Rescue medications are then prescribed. They include bronchodilators such as salbutamol and levalbuterol. For adults, the most suitable medications are the anti-inflammatory agents such as inhaled steroids where as in children, oral medications like prednisone are recommended (Alexander et al., 2012).

References

Alexander, A. G., Barnes, P. J., Chung, K. F., Flower, R. J., Garland, L. G., Goldie, R. G., … & Lulich, K. M. (2012). Pharmacology of asthma (Vol. 98). Springer Science & Business Media.

Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nursing Clinics of North America, 48(1), 11-23.

Maslan, J., & Mims, J. W. (2014). What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngologic Clinics of North America, 47(1), 13-22.

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Viruses: Structures and their Functions

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VIRUSES

Virus Structures and Their Functions

All viruses are made of two main constituents, the nucleic acid genome, and the protein capsid. These structures create up the nucleocapsid but in animal viruses, the nucleocapsid has an additional structure called the lipid envelope (Zimmer, 2015). The genome can either be DNA or RNA but not both which may be single or double stranded. The function of the genome is to encode for proteins present on the protein coat/capsid.

The genome is also responsible for multiplication of the virus particle. The protein capsid covers the viral genome protecting it from nucleases and attaches the virus particle to specific receptors on prospective host cells during infection. The lipid envelope found in animal viruses, and it enables the virus to enter or exit host cells through endosomal membranes and protects the virus from the extracellular environment.

Diversity in Animal Viruses

The diversity of animal viruses is as a result of structural differences present in different viruses including the structure of the genome. Some viruses have DNA both single or double stranded as their genome; papillomavirus is a DNA virus which causes warts while others have RNA either single or double stranded an example is Influenza virus which causes the flu. Other viruses differ in their virus particle structure; some are icosahedral such as Adenovirus, others such as the rabies virus are helical or rod-shaped, while others are pleomorphic or irregular. Viruses can also be differentiated by the presence or absence of the lipid envelope, and based on this criteria animal viruses are classified into different families, for instance, the herpes simplex virus has an envelope while others do not (Villarreal, 2005).

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HIV Replication Cycle

The first stage of HIV replication is binding, where the virus enters the host immune cells by attaching its glycoproteins to the receptors on target cells (Murphy et al., 2012). After this attachment, the viral casing/envelope then fuses with the membrane of the host cell and releases its capsid into the cell in the process. Once the virus has bound to the target cell, its genome and enzymes, such as reverse transcriptase, integrase, rib nucleases, and protease, are injected into the cell (Murphy et al., 2012).

During the reverse transcription stage, the single-stranded viral RNA is then transcribed into complementary DNA by the enzyme reverse transcriptase. The cDNA and its complement are transported to the cell nucleus as double-stranded DNA and is integrated into a host chromosome by the enzyme integrase. This is referred to as the integration stage. The fourth stage is the transcription step where provirus is transcribed into RNA, which undergoes RNA splicing to form mRNAs (Zimmer, 2015). The mRNAs are the translated into regulatory proteins, and this takes place in the cytoplasm. These proteins are packaged into new virus particles.

Structural Differences and Similarities between PRPc and PrPSc

The main difference between the two prion forms is that PRPc has various amino acids and one disulphide bond giving them an alpha helical structure while PrPSc has a higher β-sheet structure. They are also different in solubility, fibril formation, and other features. There are no obvious similarities in structure between the two forms (Zimmer 2015). The function of the normal prion is controversial because present information indicates many different roles. Normal Function of Pro-Oncogenes

Proto-oncogenes code for proteins that control cell development and differentiation. They also play a role in signal transduction and passage of mitogenic signals (Berns, 2013). Viruses are known to cause tumor development when they integrate close to proto-oncogenes. The nearby integration of viral sequences genetically alters the proto-oncogene causing its RNA to cause cancerous tumor growth (Berns, 2013). Some oncogenic viruses include hepatitis c virus that causes 22% of liver cancers, human papilloma virus that causes cervical and vulvar cancers (Zimmer, 2015).

How Viruses Cause Disease

Viruses can reside in cells without causing any harm. However, when they start dividing inside the host cell, they breach its walls, and this triggers the activity of the immune cells. They invade the host cells and takes over the activities taking part inside the host cells. The virus continues to replicate until it fills up the host cell. At this stage, the host lyses releasing the viral particles which start infecting other cells repeating the replication pattern (Villarrealal, 2005).By this tyme, the host immune cells recognise the antigen and starts fighting and blocking the virus and establishes a disease.

References

Berns, K. I. (Ed.). (2013). The parvoviruses. Springer Science & Business Media.

Murphy, F. A., Fauquet, C. M., Bishop, D. H., Ghabrial, S. A., Jarvis, A., Martelli, G. P., … & Summers, M. D. (Eds.). (2012). Virus taxonomy: classification and nomenclature of viruses (Vol. 10). Springer Science & Business Media.

Villarreal, L. P. (2005). Viruses and the Evolution of Life. American Society of Microbiology.

Zimmer, C. (2015). A planet of viruses. University of Chicago Press.

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Gastrointestinal disorders: Nursing Practicum

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Gastrointestinal disorders

Various gastrointestinal disorders may present with similar symptoms which may make the diagnosis difficult especially when the information provided in the patient history is not sufficient. In the case study presented, the patient presents with the symptoms of weight loss, anorexia, epigastric tenderness, and chronic heartburn. From the information garnered from the patient history, the risk factors included the use of NSAIDS and smoking.

Apart from peptic ulcer disease, gastroesophageal reflux disease, and gastric cancer, the differential diagnosis would include other conditions such as abdominal pain syndrome as well as dyspepsia (Agarwal & Mayer, 2013). The definite diagnosis is difficult to make since the patient did not provide sufficient information regarding the disorder.

For instance, the health care professional ought to ask the patient of the history of the occurrence of such a condition in members of the immediate family so as to rule out any genetic predisposition to the disorder (Agarwal & Mayer, 2013). Also, it would have been important if the patient was asked about having taken opioids or any other related drugs (Talley & Ford, 2015).

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Again it is important that various tests such as imaging tests be taken on the patients to assist in making the definitive diagnosis (Talley & Ford, 2015). Some further tests that should have been done include virtual colonoscopy and computed tomography to examine the patient intensively for any conditions that could have been causing the disorder. Also, magnetic resonance imaging could also have been used to rule out the possibility of the patient having any malignancies within the gastrointestinal system (Agarwal & Mayer, 2013).

More so it is recommended that endoscopy is conducted on the patient to determine or rule out the occurrence of peptic ulcer disease (Talley & Ford, 2015). Additionally, blood tests should be carried out on the patients to determine if they are suffering from the narcotic bowel syndrome.

References

Agarwal, S., & Mayer, L. (2013). Diagnosis and treatment of gastrointestinal disorders in patients with primary immunodeficiency. Clinical Gastroenterology and Hepatology, 11(9), 1050-1063.

Talley, N. J., & Ford, A. C. (2015). Functional dyspepsia. New England Journal of Medicine, 373(19), 1853-1863.

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Diabetes Self care: PICOT and Literature Review

Diabetes self care us an integral part of diabetes therapy and entails active involvement of family members. Effective self management is associated with positive clinical outcomes in diabetic patients. However, effective self management can be challenging because of the naturally evolving and age appropriate attitudes as well as biological factors in young adults. Several studies have shown low self discipline and management which results into higher hemoglobin A1C (HbA1c) (Jackson, Adibe, Okonta, & Ukwe, 2014).

In addition, standard self care of diabetes management involves prescribing constant drug dosages, which are often titrated based to patients condition during their clinic visits. The clinical visits for most patients are usually 2-3 times every month. Consequently, the patient drug dosage is determined by only these visits, which is not the true representation of daily patient health needs. This is associated with significantly elevated levels of blood glucose and frequent recurrent admission episodes attributed to treatment failure (Hinshaw & Basu, 2015).

In this context, the study aims at investigating whether the use of social network (SocialDiabetes.com) can reduce the incidences of hypoglycaemia in adolescents patients diagnosed with diabetes type 1. The PICOT statement is as follows: In adolescent patients diagnosed with diabetes type 1 (P), is integration of social network (SocialDiabetes.com App) (I), in comparison with standard care (C), reduce hypoglycaemia incidences (O), in a period of eight months?

Literature review

De Jongh, T., Gurol-Urganci, I., Vodopivec- Jamsek, V., Car, J., Atun, R. (2012). Mobile phone messaging for facilitating self management of long term illnesses. Cochrane Database System Rev 12 (12) : CD007459. doi: 10.1002/14651858.CD007459.pub2.

This paper assesses the impact of mobile phone messaging applications in self management of chronic illnesses. The study evaluates the health outcomes and patients capacity to manage their health complication. This systematic review examined randomized controlled trials, quasi controlled studies, interrupted time series (ITS) and controlled before- after (CBA) studies to ass the effects of mobile phone messaging.

The paper found some limited information regarding the implication of integrating technology in improving self management for chronic diseases. However, the study found some significant knowledge gaps regarding long term effects, costs, acceptability and risks associated with these interventions.

Dobson, R., Whittaker, R., Jiang, Y., Shepherd, M., Maddison, R., Carter, K., Cutfield, R., McNamara, C., Khanolkar, M., and Murphy, R. (2016). Text message-based diabetes self management support (SMS4BG): Study protocol for a randomized controlled trial. Trials 17: 179. doi: 10.1186/s13063-016-1305-5.

According to this article, utilization of technology to deliver self management is an effective support strategy that allows people to have patient centered care. The Self- Management Support for Blood Glucose (SMS4BG) is a novel technology that is text message based, and is used to support people diagnosed with diabetes to support self management strategy and to achieve better glycaemic control as well as patient education that is tailored to individual patient needs and preferences.

This randomized controlled study was conducted in New Zealand Health districts, where one thousand participants were randomized into 1:1 ratio to receive SMS4BG and usual standard care. The study findings indicated that this technology is associated with better glycaemic control (HbA1c), enhanced self efficacy, diabetes distress, and perceived social support and improved health related quality of life.

Hinshaw, L., & Basu, A. (2015). Technology Use for Problem Solving in Adolescent Type 1 Diabetes. Diabetes Technology & Therapeutics, 17(7), 443–444. http://doi.org/10.1089/dia.2015.0175

According to this article, technology and use of social media in adolescent care has been associated with improved glucose control among the adolescents because it provides them with practical platform to solve their therapeutic issues, thereby improving their quality of life. The qualitative study evaluated the relationship between use of modern technology and glycemic control.

The study findings indicated that the modern technologies have significant impact in enhancing self care management because it provides an opportunity for individualized care for a given patient, making it need based and focuses. However, the paper warns that one size fits all approach in this approach may not effective due to unique health demands and preferences.

Jackson, I. L., Adibe, M. O., Okonta, M. J., & Ukwe, C. V. (2014). Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy Practice, 12(3), 404.

This study aims at exploring knowledge of self care practices and factors responsible patients knowledge deficiency in patients diagnosed with diabetes type 2. The cross sectional survey was conducted on patients attending the University of Uyo teaching Hospital, where Diabetes Self Care Knowledge (DSCK-30) was used to assess the self care knowledge.

The study found that nearly 70% of the population had basic knowledge about self care, but it was associated with the level of education, household income and the length the patient has suffered from the disease. The study recommended for further investigations that will help enhance self care and individualize care based on patient’s health needs or demands.

Ng, S. M. (2015). Improving patient outcomes with technology and social media in paediatric diabetes. BMJ Quality Improvement Reports, 4(1), u209396.w3846. http://doi.org/10.1136/bmjquality.u209396.w3846

According to this article, there has been significant increase in the number of people diagnosed with diabetes Type 1 in Europe, but only small percentage of people attain better diabetes control. Recent studies have established novel digital strategies with the aim of improving overall patient health care.

The quantitative study evaluated 3 digital initiatives with the aim of implementing electronic diabetes information system that would help to undertake routine blood glucose values and calculate drug dosages with the aim of improving clinical outcomes. The study concluded that use of digital initiatives is effective in empowering patients, improving efficiencies, satisfaction, communication, reduction on emergency admissions, and to reduce diabetes related complications.

Marques, M.B., da Silva, M., Coutinho, J.V., & Lopes, M.V. (2013). Assessment of self-care competence of elderly people with diabetes. Revista da Escola de Enfermagem da USP, 47(2), 415-420. https://dx.doi.org/10.1590/S0080-62342013000200020

The prevalence rated of diabetes is highest among the USA population. Diabetes self care management is complex as it contains important recommendation for physical activity, nutrition, glucose levels and medications. Young adults and the elderly have issues that uniquely impact self care.

This is because as people age, their health status, mental abilities, nutritionl requirements and physical abilities change. Depression is also common among the diabetic patient is associated with the deterioration of self care behaviors. This descriptive cross-sectional and correlation study assess self care competencies among the population through Scale to Identify Diabetes Mellitus Patient’s Competence for Self Care as well as other factors associated with it.

The study findings indicated that only 6% of the participants had self competence, highlighting the need to integrate other health promotion activities that target this population, assess their skills and to encourage effective self care practices that enhance planning of health interventions.

References

Hinshaw, L., & Basu, A. (2015). Technology Use for Problem Solving in Adolescent Type 1 Diabetes. Diabetes Technology & Therapeutics, 17(7), 443–444. http://doi.org/10.1089/dia.2015.0175

Jackson, I. L., Adibe, M. O., Okonta, M. J., & Ukwe, C. V. (2014). Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy Practice, 12(3), 404.

Weinger, K., Beverly, E. A., & Smaldone, A. (2014). Diabetes Self-Care and the Older Adult. Western Journal of Nursing Research, 36(9), 1272–1298. http://doi.org/10.1177/0193945914521696

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