+
Motivation in
Health Behavior
of the Non-
Compliant
Adolescent with
Type I Diabetes
KIM FORBES
UNIVERSITY OF CENTRAL FLO...
+ Background of the Problem
Adolescence is a time of transition into adulthood that presents its own
unique set of challen...
+ ProblemState
ment
Adolescents with type I
diabetes experiencing
increased emotional stressors
such as depression and lac...
+
Significance of the Problem
According to data collected in 2010 by the Centers for Disease
Control and Prevention (2012...
+
Specific Aims
To identify and analyze specific barriers to successful self-
management of the adolescent with type I di...
+
Theoretical Framework/Model
Cox’s (1982) Interactive Model of Client Health Behavior (IMCHB)
was developed to explain th...
+Application of (IMCHB) to the Care Plan of
an Adolescent with Type 1 Diabetes
Cox (1982) states that for nursing consider...
+ IMCHB
nursing interventions cont.
Once risk factors are identified, the nurse should encourage
family involvement throu...
+
Summary
The care of the adolescent with type I diabetes is
proven to be a difficult task for healthcare providers.
The...
+ References
Cox, C. L. (1982). An interaction model of client health behavior: Theoretical
prescription for nursing. Adva...
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Final theory powerpoint

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Final theory powerpoint

  1. 1. + Motivation in Health Behavior of the Non- Compliant Adolescent with Type I Diabetes KIM FORBES UNIVERSITY OF CENTRAL FLORIDA
  2. 2. + Background of the Problem Adolescence is a time of transition into adulthood that presents its own unique set of challenges. For the adolescent that must deal with a chronic disease like type I diabetes, this period of emotional instability can be especially difficult. 50% of adolescents with a chronic disease do not comply with care recommendation (Kyngas, 2000). It is important to understand the relationship between daily emotion and stress and how it relates to health and health behaviors (Larsen & Kasimatis, 1991). The risk for poor treatment management and medical intervention increases in those adolescents with depressive symptoms and family conflict. This “at risk” subgroup averaged a HbA1c of 11.2% and only 2.9 blood glucose checks per day (Hilliard, Yelena, Rausch, Dolan & Hood, 2013).  Depression has a direct negative impact on diabetes self- treatment and perceived quality of life. Furthermore, parental and health care staff support and encouragement is critically important in regard to treatment compliance (Grey, Davidson, Boland& Tamborlane, 2001).
  3. 3. + ProblemState ment Adolescents with type I diabetes experiencing increased emotional stressors such as depression and lack of family or healthcare provider support are more likely to be non-compliant to prescribed healthcare regimes increasing the need for medical intervention.
  4. 4. + Significance of the Problem According to data collected in 2010 by the Centers for Disease Control and Prevention (2012) an estimated 215,000 children ages 19 and under have diagnosed diabetes.  Diabetes contributes to premature mortality and many of these deaths are preventable with the proper self-care management.  Complications such as nephropathy, neuropathy or retinopathy developed much earlier in those with poor blood glucose control. The long-term health complications that arise from non- compliance of the diabetic treatment regime and consequential lack of metabolic control increase the need for medical intervention and/or hospitalization.  Patients with a HbA1c greater than 8.5% are likely to have a diabetes-related hospitalization. In contrast, those with better metabolic control were found to have decreased hospitalizations and lower overall direct medical costs.  The overall medical costs for patients with poor diabetes management averages $356 more than for patients with good control. (Ying et al., 2011)
  5. 5. + Specific Aims To identify and analyze specific barriers to successful self- management of the adolescent with type I diabetes and to create nursing interventions that can be used to promote better overall metabolic results by applying Cox’s theory of motivation in health and Interactive Model of Client Health Behavior (IMCHB).  Improved blood glucose control and overall long-term health for the adolescent patient with type 1 diabetes.  Decreasing the need for preventable medical intervention by establishing a supportive and trusted client-provider relationship that encourages individuality, autonomy and knowledge of proper self-care.  Ensuring long-term compliance to the diabetic medical regime via the constant and enduring emotional support of family.
  6. 6. + Theoretical Framework/Model Cox’s (1982) Interactive Model of Client Health Behavior (IMCHB) was developed to explain the relationship between the patient’s personal and environmental variables that may affect health care behaviors and the client-provider relationship that influences these outcomes. The Model has three components: Singularity – the client’s background variables, expression of motivation, estimation of the health care concern and the emotional response to that concern. Elements of client-professional relationship - provision of health care information to the client, affective support that considers the client’s singularity and assesses for health care barriers, decisional control, and professional- technical competencies. Elements of health outcomes – utilization of health care services, clinical health status indicators, severity of health problems, adherence to the recommended- care regimen and satisfaction with care. (Cox. 1982)
  7. 7. +Application of (IMCHB) to the Care Plan of an Adolescent with Type 1 Diabetes Cox (1982) states that for nursing consideration there are three specific areas of this model that are operational, measurable and open to use for intervention: (1) provision of health information (2) affective support and (3) decisional control. The ultimate goal of these three guides of intervention is the motivation of good self-care and better health care outcomes. Nursing Interventions  Education of both client and family centering on the disease process and expectations of healthy outcomes through adherence to medical regime can give the adolescent a sense of empowerment and self-awareness that may aid in motivating better self-care. Identify risk factors of non-compliant behaviors that can affect metabolic control through a comprehensive history and assessment and by using tools such as the Family APGAR.
  8. 8. + IMCHB nursing interventions cont. Once risk factors are identified, the nurse should encourage family involvement through family focused support groups or therapy guided family interaction. It is necessary that follow-up assessments be made in the area of family support and emotional wellbeing to ensure longevity of good health behaviors. It is necessary that follow-up assessments be made in the area of family support and emotional wellbeing to ensure longevity of good health behaviors. In an adolescent patient, the power to participate in making health care decisions is imperative to the success of motivating proper self-care and therefore good metabolic control outcomes. Decisional control gives the adolescent feelings of empowerment that encourage self-efficacy and therefore increase self-esteem.
  9. 9. + Summary The care of the adolescent with type I diabetes is proven to be a difficult task for healthcare providers. The high risk of both short and long-term complications in adolescents with decreased compliance and poor metabolic control not only increases healthcare costs by preventable medical interventions and hospitalizations; it lowers the patient’s overall quality of life as well. With so many outside factors that influence the adolescent’s sense of wellbeing and emotion state during a vulnerable developmental stage, there must be proper consideration given to this in concordance with treatment of the disease process itself. Addressing the emotional needs of adolescent patients creates an environment of caring that affects self-esteem and increase feelings of empowerment that lead to better compliance, better quality of life and fewer hospitalizations.
  10. 10. + References Cox, C. L. (1982). An interaction model of client health behavior: Theoretical prescription for nursing. Advances in Nursing Science, 5, 41-56. Grey, M., Davidson, M., Boland, E. A., & Tamborlane, W. V. (2001). Clinical and psychosocial factors associated with achievement of treatment goals in adolescents with diabetes mellitus. Journal of Adolescent Health, 28(5), 377-385. Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013). Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28-34. Kyngäs, H. (2000). Compliance of adolescents with chronic disease. Journal of Clinical Nursing, 9(4), 549-556. Larsen, R. J., & Kasimatis, M. (1991). Day-to-day physical symptoms individual differences in the occurrence duration and emotional concomitants of minor daily illnesses. Journal of Personality, 59(3), 387-424. Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M. W., & Heptulla, R. A. (2011). Predictors of direct costs of diabetes care in pediatric patients with type 1 diabetes. Pediatric Diabetes, 12(3), 177-182.

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