Evidence-Based Patient-Centered Concept Map Analysis
Summary Brief of the Patient
JB is a 54-year-old Black American male with type 2 diabetes who has lived with the condition for 24 years. He had a right leg amputation below the knee five years ago due to wet gangrene and now uses crutches to walk. He was recently brought to the hospital with symptoms of altered consciousness, severe dehydration, and hyperglycemia.
Upon laboratory testing, it was found that JB had hyperglycemia of 32 mmol/L, a high hemoglobin A1c level of 7.9%, and deranged urea and electrolyte levels. He was diagnosed with a diabetic hyperosmolar hyperglycemic state and admitted to the intensive care unit for controlled insulin therapy.
JB was previously a truck driver but lost his job following the amputation and is now unable to work. He is married with one child, who is studying water engineering on a scholarship. JB does not have medical insurance, and his wife works as a supermarket attendant, which does not provide enough income to afford JB’s antidiabetic medications consistently.
As a result, JB has a history of not taking his medications as prescribed due to cost concerns and does not regularly monitor his blood sugar levels. Despite being told that uncontrolled blood sugar and poor diabetes self-care led to the development of wet gangrene in his right leg, JB has not sufficiently improved his knowledge and self-care practices.
Patient Needs Analysis
To ensure that the interventions in the concept map are relevant and appropriate for JB’s beliefs, values, and lifestyle, it is important to consider his health, economic, and cultural needs. JB’s medical needs include diabetes care, physical therapy and rehabilitation to enhance mobility, and mental health assistance to address the psychological burden of amputation and unemployment.
His economic needs may include financial aid to pay medical treatment and prescription expenses, a steady income to support the family’s basic necessities, and assistance in seeking work or training possibilities. Respect for JB’s personal beliefs and values, consideration of his cultural background as a Black American man, support for maintaining cultural traditions and connections, recognition of any cultural barriers or challenges, and provision of interpreters or other language support services as needed are all examples of cultural needs.
Addressing these demands allows the concept map interventions to be tailored to JB’s individual needs, assisting him and his family in managing his health condition and enhancing their general well-being.
To incorporate the patient’s culture, identity, abilities, and beliefs into the plan of care, it is important to consider the specific needs and preferences of the patient and his family. Since lack of knowledge on efficient diabetes self-care led to the complication of wet gangrene causing the subsequent amputation, part of the plan of care involves providing information and education about diabetes management in a culturally sensitive and appropriate manner.
This could involve using culturally relevant materials and resources and incorporating any cultural beliefs or practices that may affect JB’s self-management behaviors, such as his diet, physical activity, and medication adherence. Furthermore, the information will be provided in the patient’s native language (English) to aid understanding.
As a Black American, JB faces significant discrimination in healthcare. According to a review of socioeconomic disparities in lower extremity amputations by Girijala and Bush (2018), comparing amputees to non-amputees, the African American race was more common in amputees (25.1% vs. 12.6%).
In addition, Black American amputees often have limited access to healthcare services due to higher rates of medical non-insurance and difficulty with transportation (Connell et al., 2019). To address these barriers, the care plan for JB includes connecting him to various healthcare providers, including physical therapists and mental healthcare providers, to facilitate access to care and promote a holistic approach. This will allow JB to easily access and utilize these services, improving his overall care and health outcomes.
It is important to follow a few key strategies to communicate with JB and his family in an ethical, culturally sensitive, and inclusive way. First, it is critical to establish open and honest communication with JB and his family. This may include seeking their permission to share health information, explaining the aim of any tests or treatments, and being open about any risks and benefits (Roodbeen et al., 2020).
It is also crucial to provide a secure and inviting atmosphere for JB and his family, as well as actively listen to their worries and questions to foster honest conversation. In addition to encouraging open communication, it is critical to guarantee that only authorized information is exchanged in compliance with data protection regulations. This may involve explaining the limits of confidentiality and obtaining consent from JB or his family before sharing any personal health information.
Finally, it is crucial to make complex medical terms and concepts understandable to JB and his family, regardless of language, abilities, or educational level. This may include utilizing basic and plain language, giving written materials in JB’s native language or a language that he and his family can comprehend, and using visual aids or other types of communication to assist in communicating information.
It may also be beneficial to ask JB and his family if they have any questions or concerns and to carefully explain any information they may not comprehend. Following these principles will allow healthcare personnel to interact with JB and his family in an ethical, culturally sensitive, and inclusive manner.
Value and Relevance of the Resources
A variety of resources were employed to develop a meaningful concept map for JB, as well as a critical analysis of his needs. Connell et al. (2019), Girijala and Bush (2018), and Lewis and Van Dyke (2018), for example, discuss the challenges African Americans face in healthcare access and utilization.
The three articles are relevant to JB’s case because he is a Black American amputee without medical insurance who is at a high risk of having difficulty accessing and utilizing healthcare services. Furthermore, the studies are current (published within the last five years), written by medical experts in various health fields, and give accurate findings supported by a variety of research studies.
On the other hand, Demir and Aydemir (2020) provide a comprehensive lower extremity amputation protocol, part of which includes physical mobility and strengthening exercises. This information is useful in caring for JB, an amputee who needs physical mobility and strengthening exercises to keep his joints functioning properly.
A large array of research papers supports the information in the article, and it is current (published within the past five years). Furthermore, Demir and Aydemir (2020) have specialist backgrounds in physical medicine and rehabilitation, which gives them the competence to write about lower extremity amputation protocol.
Furthermore, whereas Roodbeen et al. (2020) investigate the communication and collaborative decision-making during patient care, Silbert et al. (2018) address hypoglycemia in type 2 diabetes patients. The results of Roodbeen et al. (2020) may be valuable in assisting healthcare personnel in efficiently communicating with JB, who has little health literacy, and including him in decision-making about his treatment.
Moreover, Silbert et al. (2018)’s findings on risk factors and preventative measures may be valuable in assisting JB and his healthcare professionals in identifying ways to regulate his blood sugar levels and lower his risk of hypoglycemia. The two studies were written and published within the last five years by medical professionals and communication specialists, and they are supported by a large body of evidence from various research studies, boosting their credibility.
The patient at the center of the concept map is a 54-year-old Black American man with type 2 diabetes who has lived with the condition for 24 years. He is an amputee, uses crutches to walk, and has recently been admitted to the intensive care unit (ICU) to manage a diabetic hyperosmolar hyperglycemic coma.
As a Black American amputee without medical insurance, he faces significant discrimination in accessing healthcare. Therefore, it is important to develop a comprehensive care plan that takes into account the patient’s culture, identity, abilities, and beliefs.
Additionally, the patient will need a strong social support system to help him cope with his physical debilitation and prevent any psychiatric consequences of his condition. The care plan should also address the patient’s economic and cultural needs, which may require extending beyond the hospital to his home. Although healthcare providers may have limited ability to address the patient’s financial needs directly, they can help educate the patient and his family on potential solutions and link them with relevant social and community resources to provide further support.
Connell, C. L., Wang, S. C., Crook, L., & Yadrick, K. (2019). Barriers to healthcare seeking and provision among African American adults in the rural Mississippi Delta region: Community and provider perspectives. Journal of Community Health, 44(4), 636–645. https://doi.org/10.1007/s10900-019-00620-1
Demir, Y., & Aydemir, K. (2020). Gülhane lower extremity amputee rehabilitation protocol: A nationwide, 123-year experience. Turkish Journal of Physical Medicine and Rehabilitation, 66(4), 373–382. https://doi.org/10.5606/tftrd.2020.7637
Girijala, R. L., & Bush, R. L. (2018). Review of socioeconomic disparities in lower extremity amputations: A continuing healthcare problem in the United States. Cureus, 10(10), e3418. https://doi.org/10.7759/cureus.3418
Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the health of African Americans: The potential importance of intersectionalities. Current Directions in Psychological Science, 27(3), 176–182. https://doi.org/10.1177/0963721418770442
Roodbeen, R., Vreke, A., Boland, G., Rademakers, J., van den Muijsenbergh, M., Noordman, J., & van Dulmen, S. (2020). Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers, and suggestions for improvement reported by hospital-based palliative care providers. PloS One, 15(6), e0234926. https://doi.org/10.1371/journal.pone.0234926
Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R., Katabi, A., & McCoy, R. G. (2018). Hypoglycemia among patients with type 2 diabetes: Epidemiology, risk factors, and prevention strategies. Current Diabetes Reports, 18(8), 53. https://doi.org/10.1007/s11892-018-1018-0
Assessment 1 Instructions: Evidence-Based Patient-Centered Concept Map