1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.

Clinical Journal

Identify the clinical experience and describe the events noting four areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. Intake:

Open Cities Health Center covers families facing challenges, such as poverty, violence, no insurance, unemployed, and inmates, undocumented immigrants, the homeless, the retired senior citizens, and the children without health insurance. Chronic care has always been the highest priority in the Open cities Health Center. Clients who have chronic diseases like diabetes and hypertension are given the best attention possible. Majority of the clients who attend the Open cities are lower class clients who have either high school or GED as their highest level of education. The two most important chronic diseases covered by the Open Cities Health Center are; diabetes and hypertension.

During my clinical experience , I was able to offer some education about diabetes with the help of the wonderful medical assistants. I had an opportunity to interview diabetic patients and most of them were African Americans. A disproportionate number of African American are affected by type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC; 2012) it is estimated that by the year 2050 as many as one third of all Americans will be diabetic or at a high risk of developing the disease. ("CDC Press Releases", 2012) Type 2 diabetes is the most common and it is characterized by an inability of the body to produce or appropriately metabolize insulin. ("Current Approaches to Support the Psychosocial Care of African American Adults with Diabetes: A Brief Review", 2012)

Diabetes is the seventh leading cause of death in the United States, and currently 8% of the U.S. population or nearly 26 million people are affected by this condition; the Centers for Disease Control and Prevention (CDC; 2012) estimates that by the year 2050 as many as one third of all

Americans will be diabetic or at high risk of developing the disease. ("CDC Press Releases", 2012)

During my interview with three diabetic patients, I found out that most of them have diabetes related complications. Most of these patients are non- compliant and this has led to them having diabetic related complications. I asked them if they got education about the diabetic disease. The response I got was that they are frustrated with the diabetes self-care routines, they feel overwhelmed by disease related lifestyle changes and the perceived loss of control among the newly diagnosed adults has greatly contributed to their being non- compliant. Most of the clients when they are newly diagnosed with diabetes, they tend to monitor their blood sugar, get involved in more intense exercise routine, administer insulin as needed and follow up appointments with primary doctors.

With time, the diabetic patients experience psychosocial distress and depression usually associated with poor adjustment to a diabetic diagnosis and the new life style changes. This is usually aggravated by lack of family, community and professional support. (Mitchell & Hawkins, 2014). As a result this leads to Poor management of Type 2 diabetes which can result in disabling complications that include a lower life expectancy, increased risk of heart disease, lower limb amputation, kidney failure, and adult-onset blindness. (Mitchell & Hawkins, 2014)

The diabetic related complications make it critical to continue to develop clinical

Strategies for social workers and other health care providers working with this population. Clinical strategies need to be developed in order to reduce and control the high rate of type 2 diabetes among African Americans. Effective strategies need to be implemented towards African American with type 2 diabetes.

Most of the diabetic patients do not have confidence about diabetes management and this is usually mistaken for medication non- compliance. As previously discussed, receiving emotional, social, psychological, material, and educational support (i.e., psychosocial care) can have a significant impact on successful diabetes management, particularly among populations with high rates of psychological distress related to diabetes diagnoses and management such as African Americans. (Mitchell & Hawkins, 2014). Social workers can play a critical role in providing services and support to individuals with diabetes.

After my interaction with the diabetic patients, some strategies need to be applied to help them manage the disease so as to avoid secondary complications. Some of the strategies include encouragement

Community based psychosocial care: Diabetic patients should be encouraged to join diabetic community groups. Community-based participatory strategies are among the most well studied methods of addressing psychological, social, and educational barriers to diabetes self-management in African American communities. Diabetic patients should be encouraged to express their feelings about diabetics, the struggles they go through trying to adhere to the diabetic diet, financial struggles of getting insulin. Community based diabetic groups have greatly benefitted the diabetic patients. For example in Michigan, the racial and ethnic approaches to community health (REACH) program was an innovative study in Detroit that targeted 150 African Americans and Latinos with diabetes. This intervention was arranged with vital input from local community members on form of focus groups and a community advisory board. With the help of the intervention, local residents were trained as “ family health advocates” to deliver education focused on stress reduction, depression, health eating habits, physical activity and the use of social support to maintain life style changes. A number of family health advocates were also trained to empower the diabetic patients. According to Two Feathers et al., 2005, participants experienced tremendous improvements in their blood sugar control, improved knowledge about self-care and diabetes management. As a result, the participants were provided with non- judgmental environment where they could express themselves without any fear.

In conclusion, African American diabetic patients should be encouraged to join diabetic community groups in order to address their fears as far as diabetic management is concerned.

References

CDC Press Releases. (2019). Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Mitchell, J., & Hawkins, J. (2014). Current Approaches to Support the Psychosocial Care of African American Adults with Diabetes: A Brief Review. Social Work In Public Health, 29(6), 518-527. doi: 10.1080/19371918.2014.888533

Two Feathers, J., Kieffer, E., Palmisano, G., Anderson, M., Sinco, B., & Janz, N. et al. (2005). Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults. American Journal Of Public Health, 95(9), 1552-1560. doi: 10.2105/ajph.2005.066134