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Diabetes mellitus

Address the comparison of collaborative care for a patient with a mental health
disorder versus a patient with a medical disorder in the acute care setting. The paper
consists of three (3) parts and must be submitted by the close of week six. Each part must
be a minimum of two (2) pages in length.

The comparison of collaborative care for a patient

Part One
Diabetes mellitus is a lifelong condition that affects the patient ability to regulate glucose levels.
When a person ingests food, the body breaks down the food into carbohydrates and glucose. The
glucose is used to fuel the cell activity. This process requires the use of insulin in order for a
cell to convert glucose into energy. With diabetes mellitus, the body does not secrete enough
insulin or the receptors become faulty and are unable to absorb the insulin. This causes glucose
to build up in the blood, which causes damage to the other parts of the body including kidney,
eyes, heart and the nervous systems (Standards of Medical Care in Diabetes—2014, 2013). The
signs and symptoms of diabetes mellitus include reduced appetite, increase urine output and
general body weakness or fatigue. The diagnosis of this disease is done using glucose tolerance
test and also testing of the glycosylated hemoglobin (Standards of Medical Care in
Diabetes—2014, 2013).
According to NICE, patients diagnosed with diabetic are three fold likely to be diagnosed with
depression. Depression is a mental disorder that affects a person’s health and their ability to self
manages their healthcare condition. Research indicates that depression have great risk to
suffering from episodes of diabetic burnout, which can effect their health adversely. Depression
is the medical term that is used to describe people with the following symptoms. To start with,
they have persistent anxiety, sadness and a prolonged feeling of hollowness. The patient feels

The comparison of collaborative care for a patient
helpless, powerless and hopeless. This makes them lose interests of activities that they perceived,
insomnia, memory problems and weight changes (Ennis & Bunting, 2013).
The relationship between depression and other health complications is not fully understood.
However, the rigors of managing the disease is not easy and could cause the condition to get
worse, leading to more health complications. Depression can cause poor management of lifestyle
decisions resulting to less exercise, drug use and binge eating. This affects the person abilities to
perform their duties or even to perform their tasks as they used to. The non-therapeutic
resources used to manage diabetes mellitus and depressions are similar. For instance the
programs used to manage the two conditions include activities that will improve lifestyles, such
as increase of fitness, weight management strategies, nutrition balance and exercises. These
programs help the patient remain in good shape, which improves their self esteem and the patient
diabetic condition (Ennis & Bunting, 2013).
The major difference is in therapeutic management process. This is because diabetes mellitus is
managed using glycemic control including drugs such as Biguanides, Thiazolidinediones
(TZDs), Meglitinide derivatives and insulin’s among others. The management of depression
takes time but it can effectively be managed. The common treatments includes the Cognitive
behavioral Therapy (CBT), a type of psychotherapy that helps change the negative mentality, as
well as lifestyles that contribute to depression. The use of Selective serotonin reuptake inhibitor
(SSRI) is a therapeutic management that involves the use of antidepressants including the Celxa,
Sertraline (Zoloft) and Prozac. Other types of antidepressants that can be used include the
Serotonin and norepinephrine reuptake inhibitor (SNRI) among others (Ennis & Bunting, 2013).
Generally, mental health is more debilitating than the acute diseases. Research indicates that
person diagnosed with depression is 50% likely to become disable than patients suffering from

The comparison of collaborative care for a patient
the chronic diseases angina, arthritis or even diabetes mellitus. This is because mental pain is real
that and more severe than the physical pain. The hustle for mental illness is real as most of the
mentally ill patients are not accessing care as compared to those with medical conditions.
Approximately, three quarters of these individuals are not able to access care. This is especially
so, because the NHS commissioners have not commissioned mental health appropriately. For
instance, when people suffering from physical condition undergo treatment, their treatment
usually include the treatment psychological therapy. Psychological therapy in physical treatment
especially in chronic diseases is emphasized than in the mental disorders treatment (Standards of
Medical Care in Diabetes—2014, 2013).
The main issues that arise during the management of these health disorders are financial burden.
This is because diabetes and depression are long term diseases that require a lot of resources
including attending of the lifestyle modification programs. This is a challenge considering that
chronic disease and mental disorders are inadequately covered by the public medical covers. This
could be costly to both the patient and the family (Ennis & Bunting, 2013). The other issue that
could arise is lack of effective training on how to handle the patients. In most of the public
hospitals, patients and the care givers are not trained on how to manage the transition from the
healthcare facility. There are not told about what is available for their management of care and
what is not. This miscommunication between the patients, caregivers/ families and healthcare
providers is a huge challenge that must be addressed (Barr, 2010).
Part 2 Registered Nurse Ethical and legal implications
In these healths setting, the registered nurses have ethical and legal guidelines used during their
practices. There are six ethical principles applied by RN when making ethical decisions about

The comparison of collaborative care for a patient
their care. These include respect for the patient. RN is expected to support the patient. This
includes empowerment and respecting patient’s choice (Autonomy) (Perreault, 2011).
The decision made by the registered nurses must be with the aim of improving patient’s
condition by doing well (beneficence) and with the aim of avoiding harm (nonmaleficence). The
ethical decision must be made with fairness, truthfulness and equitably (justice). The registered
nurse must remain veracious and faithful to their commitment. The registered nurse is expected
to make their decisions during care as indicated by the American Nurses Association’s nurse’s
code of ethics. These standards are delineated registered nurses across the settings (Barr, 2010).
Some of the ethical concerns that arises these care is balancing the nursing attitude care with
compassion, and simultaneously recognizing as well as sustaining the patient-healthcare
boundaries. Another ethical concern for registered nurses is to ensure that these patients can
access care. The registered nurses have the responsibility of acting as patients advocates,
especially in ensuring that their care directives are respected and also in elimination of the
healthcare hindrances (Barr, 2010).
End of life care is also an ethical concern for the registered nurses. The registered nurses have
the responsibility of ensuring that their patients die with dignity.
The legal implications of nursing include the issues of licensure as stipulated by the federal and
states laws. These licensures have delineated registered nurse scope of practice as well as the
public expectations. The nurse level of education and the licensure gives the framework by
which the registered nurse is expected to practice. These frameworks are to ensure that their
practice does not fall below the accepted and expected standards of nurse care, which could
expose the RN to litigation (Perreault, 2011).

The comparison of collaborative care for a patient
There are no differences in the ethical and legal implication for RN for the physical disorder
(diabetes mellitus) and the mental disorders (depression). The basis for RN litigation is if the
patient can prove that the nurse’s actions were due to negligence to perform what is expected of
them by the ANA code of ethics and nurse practitioners standards. These includes acts of
omission and commission could subject the RN to have their licensure reviewed and to litigation
(Perreault, 2011). Regardless of the method or approach of care, the RN has legal as well as
ethical obligation to respond to patient’s demands. This implies that the RN should attend to the
patient, assess the patient’s demands and the magnitude of care demands. The RN should
conduct the family health assessment and cultural health assessment to ensure that the care
provided is culturally sensitive. Based on the data generated from the assessment of the patient,
then the RN can determine the level as well as the type of interventions are required, develop a
care plan and implement it. The RN should contact higher level of healthcare where necessary,
including offering referrals (Barr, 2010).

Part 3
The inter-professional teams refer to the collaborations between the various healthcare staffs,
with the aim of attaining the common goals of delivering quality and safe care. This is beneficial
as the healthcare staffs divide their chores according to the scope of their practice. This reduced
the events that the healthcare staffs become burnout. Additionally, inter-professional team
facilitates the sharing of information. This coordination and supports ensures that the
interventions proposed are ethical and legitimate (Axon et al., 2008).
Inter- professional team faces many barriers. This includes lack of understanding of the major
roles, which reduces respect between the healthcare team. The nurses have a key role in

The comparison of collaborative care for a patient
collaborating between the healthcare inter-professional team. They are required to possess
facilitation skills to ensure that they work collaboratively with the patients and the healthcare
staff. This is to ensure that the teams have updated information about the patient and their
preferences. For example, the nurses are the healthcare professionals who spend most time with
the patients. Therefore, the nurses are expected to deliver around the clock care and record the
observations (Pope & Casarett, n.d.).
The nurses are also responsible in ensuring that the physician’s directives are implemented.
These include administering of medications and assessment of patients responses to the treatment
plan. The nurses is also responsible for the evaluation of the patients medical plan efficiency and
safety. They should interpret patient’s information to help the healthcare providers to make the
appropriate decisions. Therefore, the nurses roles in the inter-professional team is to assess
patient psychological, social, cognitive as well as spiritual needs , and to advocate for the
patients wellness as well as facilitating optimal health for the patient. They are also responsible
for patient education (Axon et al., 2008).
Through patient education, the patient understands the importance of adherence. There are five
interacting factors if medication adherence that have been described by the World Health
Organization (WHO). These include factors related to therapy, patient’s behaviors,
socioeconomic factors and medical condition factor. Evidence based research identifies
strategies to improve the medication adherence. The social and economic factors that can be
addresses include lack of health literacy, communication barriers, low socioeconomic status and
lack of medical cover. The nurse must learn the cultural beliefs to ensure that they can assist the
patients (Axon et al., 2008).

The comparison of collaborative care for a patient
Therapy related factors include complexity in therapy such as mastery of various techniques
such as use of inhalers or injections. The unpleasant benefits, prolonged use and interferences
are other causes of poor medication adherence. The patient related factors include the cognitive
impairment and swallowing difficulties. The nurses need to address psychological issues such as
confidence in following treatment, as well as making the patient understand the benefits of
medication. Empowering the patient improves their confidence as well as the ability to follow
their treatments despite the perceived risks (Pope & Casarett, n.d.).
Evidently, team effectiveness questionnaire is a tool that can be used to evaluate the
effectiveness of working as a team. This tool consists of about 25 items which evaluates the
effectiveness of the interprofessional team I relation to four main dimension including
communication, organizational efficiency, healthcare practices such as staff development, EBP
and patient centered care. The interprofessional collaboration scale may also be used to assess
the interprofessional’s perceptions including the nurses, physicians and the other relevant
healthcare professionals. This tool is a 13 item scale that is adapted from the Nurses Opinion
Questionnaire. Other evaluative techniques include the evaluation of quality healthcare
indicators such as readmission rates, patient’s falls, hospital acquired infections and the length of
hospitalizations. These strategies will help identify the gap in inter-professional team, leading to
effective interaction between the healthcare staff (Axon et al., 2008).

The comparison of collaborative care for a patient
Axon, A., Hassan, M., Niv, Y., Beglinger, C., & Rokkas, T. (2008). Ethical and Legal
Implications in Seeking and Providing a Second Medical Opinion. Dig Dis, 26(1), 11-17.

Barr, H. (2010). Understanding Interprofessional Working in Health and Social Care. J Interprof
Care, 24(4), 470-471.
Ennis, E., & Bunting, B. (2013). Family burden, family health and personal mental health. BMC
Public Health, 13(1), 255
Perreault, K. (2011). BOOK REVIEW Interprofessional Teamwork for Health and Social
Care. Scott Reeves, Simon Lewin, Sherry Espin and Merrick Zwarenstein, Wiley-Blackwell
(2010), 191 p. Physiotherapy Theory And Practice, 27(8), 595-596.

Pope, T., & Casarett, D.(n.d.). Ethical and Legal Obligations of Hospice Staff When Their
Patients Receive Aid in Dying. SSRN Electronic Journal.

Standards of Medical Care in Diabetes–2014. (2013). Diabetes Care, 37(Supplement_1), S14-

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