Example Of Clinical Question Case Study

Background

The case in hand is about a patient, Mr. Armitage, who is a 50 year old man of aboriginal descent with a 5 year history of poorly controlled type two diabetes mellitus. He was diagnosed with this condition in 2004 after experiencing symptoms suggestive of hyperglycemia for 2 years. He is a married man with two adult children. He is a self-employed man owning and managing a small grocery store in a regional shopping center. He has a family history of coronary artery disease, with his father having died from myocardial infection (heart attack) at the age of 78 years. His uncle too underwent a heart attack at the age of 72 years and died of heart failure several months later. Besides type 2 diabetes, Mr. Armitage also has the following medical history:
- Hypercholesterolemia
- Inguinal hernia repair 10 years ago
- Obstructive sleep apnea, and
- Hypertension
Evidence-based nursing practice is crucial for providing excellent care to patients. Four fundamental patterns of knowledge in nursing, as identified by Carper (1978), include empiric, ethics, personal, and aesthetic patterns. Empirical knowledge refers to factual descriptions, explanations, and predictions. Ethics refers to moral values, obligations, and desired ends. Personal knowledge in nursing refers to transpersonal relation between each patient and nurse. Aesthetic knowledge exhibits the perception of the nurse regarding the particularities of patient's behavior and the nurse's skill of providing care (Thurston and King, 2005). Though all these patterns of knowledge are important for providing care to patients, it is the empirical knowledge, on which evidence-based practice is based, is the most crucial of all. Evidence-based practice by evaluating the research findings closes the gap between the research and practice. It helps nurses explore the reasons behind existing methods and processes to bring improvement in the quality of patient care.

Objective

The objective of this paper is to find effective treatment option for Mr. Armitage, based on evidence available in the literature related to the incidence of type 2 diabetes among people of Aboriginal descent.

What is the connection between Mr. Armitage's development of diabetes 2 with that of his Aboriginal descent?
Rationale
The rationale for selecting Aboriginal descent as the main focus of my research is that the type 2 diabetes is a common disease among Australian Aboriginals. All the research studies analyzed in this paper showcase a higher prevalence of type 2 diabetes among people of Aboriginal descent. Since the patient Mr. Armitage too is a person of aboriginal descent, it will be easier to find effective treatment options for him if the data related to the likely causes of the prevalence of type 2 diabetes in Australian Aboriginals can be found as evidence.

Search of Evidence

I began the search for evidence by looking for data related to the connection between Aboriginal Australians and Diabetes 2. Though most of the research studies available were focused on indigenous people as a whole, encompassing details on both Aboriginal Australians and Torres Strait Islander, which are the two indigenous races of Australia, my primary goal was to cull out data related to the indigenous population of Aboriginal Australians, because Mr. Armitage is of Aboriginal descent. I searched for information on the internet and the college library using the terms "Aboriginal Australian Diabetes" and a list of research studies appeared as results, from where I had to narrow down my resources to mere seven that befit the objective of this paper. I avoided the research papers that did not furnish any exclusive detail about Aboriginal Australians. There were many papers that furnished information on indigenous people of Australia in general without mentioning anything in particular about the race of Aboriginal Australians, and hence, I had to discard them because my primary focus was to find information related to diabetes and Aboriginal Australians. The resources that I have used in this paper have whole or exclusive information about Aboriginal Australians.

Summary of Evidence

The research conducted by Robyn A McDermott, Ming Li and Sandra K Campbell (2010) reveals that the rate of type 2 diabetes mellitus is about four times higher for people pertaining to Australian aboriginal origin than non-Indigenous people. According to them, the rate of type 2 diabetes is 50% higher in Australian aboriginals than what was reported a decade back. The trio conducted a community-based follow-up study of 1,814 Torres Strait Islander and Australian Aboriginal adults between the period of 1999 and 2007. At the beginning of the survey, the participants were free of diabetes. Of 1,814 participants, 554 adults ultimately completed the study, and out of these 554 adults, it is seen that 100 participants developed diabetes over the course of time. It was found that compared to Torres Strait Islanders who have the incidence rate of 48.0% per 1000 person-years (py), Australian Aboriginals have 51.3% per 1000 py (McDermott, Li and Campbell, 2010). It was observed in the study that aboriginal participants had higher level of triglycerides in their blood, but lower BMI and waist circumference than Torres Strait Islanders. Their lifestyle was also sedentary compared to the participants of Torres Strait Islanders. Aboriginal adults who developed diabetes were aged between 22 and 54 years. However, no conclusive evidence as regards the relation of age with the incidence rate of type 2 diabetes among Aboriginal Australians was given in the research paper.
Jennings (2014), in his study on the prevalence of type 2 diabetes and hypertension among indigenous communities, has revealed that the indigenous population of Australia, both Australian Aboriginals and Torres Strait Islanders have the onset of diabetes at a much earlier age between 25-34 years. Even younger people of Aboriginal descent with healthy BMI range between 20-25 have higher prevalence of diabetes. The incident rates of diabetes among Aboriginal adults increases with age, from 2.2 per 1000 (py) for people younger than 25 years to 39.9 per 1000 py for people aged between 45-54 years. The incidence rate drops slightly for those aged 55 years and above (30.5 per 1000 py).
A number of studies have furnished a link between type 2 diabetes and high levels of obesity among Australian aboriginals. The research paper of Aajuli Shukla (2010) reveals that a diet consisting of foods of high saturated fat and low fiber and the lack of fresh fruits and vegetables is linked to the obesity factor of Aboriginal Australians and the prevalence of type 2 diabetes among them. Australian Indigenous Health Info Net (2015) also concurs that the westernization of lifestyle, which has replaced nutritious food with energy-dense diet, high in refined sugars and saturated fat, has contributed to the high level of obesity and the resultant diabetes among Aboriginal adults in Australia. The high consumption of snacks, cold drinks, artificial fruit juices, bread, sugar, and canned meats has been related to the cause of obesity among Australian Aboriginals (Daniel et al, 2002).
Added to obesity, another factor that has led to the rise of diabetes among people of Aboriginal descent is the lack of exercise. National Health Survey (2001) reveals that the percentage of Indigenous people like Australian Aboriginals leading a sedentary life style was far greater than that of non-Indigenous people (AIHIN, 2015). Alcohol consumption has also been related to the cause of diabetes. The report of Australian Institute of Health and Welfare showcases that Aboriginal males in Australia have a propensity to engage in high-risk drinking behavior and that the percentage of Aboriginal Australians in terms of binge drinking is double the percentage of binge-drinking by non-indigenous population (AIHW #1, 2015). The findings of McDermott, Li and Campbell (2010) are also in agreement that the Australian Aboriginals, especially men, had the highest diastolic blood pressure (BP) and the "high-risk" drinking habits.

Appraisal of the Evidence

Summary of Recommendations
Since sedentary lifestyle, obesity, poor diet, and alcohol consumption are the main reasons for type 2 diabetes, literature suggests that in order to provide effective care to the patient, it is important to remove or modify the behavioral and environmental risk factors prior to the manifestation of symptoms or the onset of the disease (AIHIN, 2015). Since in the case of Mr. Armitage, he has already been diagnosed with type 2 diabetes, it might be too late to apply the primary prevention measures to stop him from having diabetes. However, effective intervention strategies can be applied to lessen the impact of diabetes.
Since diabetes, which is known as the silent killer, can lead to a variety of health problems including kidney failure, vision impairment, peripheral neuropathy, sensory neuropathy and even organ failure, Mr. Armitage must follow a routine lifestyle consisting of healthy diet and regular exercise (AIHW #2, 2015). Along with timely intake of medications, he also must take complete abstention from alcohol consumption as alcohol is likely to deteriorate the condition.
Besides, the risk factors related to diabetes are also common for conditions such as cancers and cardiovascular disease, and hence, the removal of environmental and behavioral risk factors, such as sedentary life style, lack of exercise and unhealthy diet, will reduce the risks of Mr. Armitage's developing coronary heart disease in the future like his father and uncle.

Conclusion

The case study deals with a 50 years old patient Mr. Armitage who has a 5 year history of poorly controlled type two diabetes mellitus. He hails from a family of heart ailments with his own father having died of heart attack and his uncle having died of heart failure. Since evidence based practice in nursing reduces the gap between research and practice, the implementation of evidence based practice is expected to provide effective care to patients. The objective of this paper was to find effective treatment options for Mr. Armitage on the basis of evidence available in the literature and the problem that was scrutinized for research in this paper was the connection between the development of type two diabetes and Mr. Armitage's aboriginal descent. The findings of several research papers reveal that Aboriginal Australians have 6 times higher incidence of type two diabetes than general Australians. In fact, the incidence rate of diabetes among Aboriginal Australians is even higher than the other indigenous population of Australia, Torres Strait Islanders. The risk factors identified to be the likely causes of type two diabetes, among people of Aboriginal descent, include obesity, sedentary life style, unhealthy diet, and high risk drinking behavior. Compared to the rate of diabetes reported even a decade back, the incidence of diabetes has increased by 50% in recent years. All the research studies point to the fact of lifestyle choices of Aboriginal Australians, and therefore, the recommendations for intervention strategies for Mr. Armitage include total elimination of unhealthy lifestyle preferences and a routine life with timely intake of medications, regular exercise and healthy diet.

References

McDermott, R. A., Li, M. and Campbell, S. K. (2010). Incidence of type 2 diabetes in two Indigenous Australian populations: a 6-year follow-up study. The Medical Journal of Australia. 192 (10), 562-565. Retrieved on 30th March, 2015 from <https://www.mja.com.au/journal/2010/192/10/incidence-type-2-diabetes-two-indigenous-australian-populations-6-year-follow>
Jennings, G. (2012). Hypertension and Diabetes in Indigenous Communities. Heart, Lung And Circulation, 21(10), 648. doi:10.1016/j.hlc.2012.07.020
Australian Institute of Health and Welfare (AIHW) #1 (2011). Substance use among Aboriginal and Torres Strait Islander People. Retrieved on 30th March, 2015 from <http://aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418265&libID=10737418265>
Australian Institute of Health and Welfare (AIHW) #2. (2011). Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians. <http://www.aihw.gov.au/publication-detail/?id=10737418878>
Australian Indigenous Health Info Net (AIHIN). (2015) Review of diabetes among Indigenous peoples. Retrieved on 30th March, 2015 from <http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/reviews/our-review>
Shukla, A. (2010). Type 2 Diabetes in Indigenous Communities: A Multifactorial Approach. The Cross Section Journal. VI, 59-71 Retrieved on 30th March, 2015 from <https://eview.anu.edu.au/cross-sections/vol6/pdf/ch05.pdf>
Daniel, M., Rowley, K., McDermott, R., and O'Dea, K. (2002). Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk. Diabetes Research And Clinical Practice, 57(1), 23-33. doi:10.1016/s0168-8227(02)00006-2
Thurston, N., and King, K. (2005). Implementing evidence-based practice: walking the talk. Journal Of Vascular Nursing, 23(2), 54-60. doi:10.1016/j.jvn.2005.04.003