Example of Diabetes and Amputation Care Plan

 Scenario:
A 60 year old, Charles Patel Singh came to the Diabetic resource center and met with the community nurse to learn about how to properly manage their newly diagnosed diabetes. When looking at their health history the nurse learned that the client was South Asian, with a history of hypertension, recently diagnosed with type 2 diabetes, had a below elbow amputation due to a workplace injury in a construction site five years ago, has a BMI score of 39 and states that they have not been as physically active as they were in the past before their amputation. After the amputation they went into a depression and a change of how they perceive themselves. They explain that while exercising outside years ago, after they recovered from their amputation, a group of children got scared of them as they were running and started pointing at them. From that day on they have avoided going outside unless absolutely necessary.  They also identify as non-binary, using “they” pronouns, and are a part of the 2SLGBTTQQIAAP+ (2 spirit, lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual) community. After talking to Charles you learn that they were kicked out from their house at a young age, because their family did not approve of their way of life. They currently have no connection with anyone in their family, however they do have a small support group of friends, which they keep contact with online. They usually get their food delivered from delivery apps such as uber eats and door dash, since they do not feel like going outside for groceries unless necessary. However, they now want to have a change in their lifestyle due to this new diagnosis of type 2 diabetes.

 Care Plan:

Learning Outcomes (short and long term) S.M.A.R.T	Learning Objectives*	Content	Teaching Strategies, Instructional Materials	Time	Evaluation
Through educating the patient, the patient feels confidence in assessing as well as managing their diabetes. This goal will be achieved by assessing the knowledge the patient already has about their condition, answering their questions as well as identifying and addressing gaps in their knowledge. Their confidence in their ability to manage their condition will be measured through a 5 point likert scale (Symeonaki, et al., 2015). After 3 months the goal is to achieve at least a score of 3, in their confidence in understanding and managing their diabetes.	-The patient will learn how to check their blood sugar with the new diabetic monitor and how often they need to check it, it needs to be checked at least once a day, and can also be checked before meals or before exercise. -The patient will improve in their understanding of type 2 Diabetes. -The client will understand how and when to take their medication. The patient will also understand what the medication they are taking does. The patient will be taking metformin so they understand the function of metformin.	-Information regarding Type 2 Diabetes -Information on the medication such as metformin	The patient will be given both synchronous and asynchronous resources which they can use to gain information (Sirbu,2020). These asynchronous sources such as the website will help them in learning this information on their own time, while the synchronous methods such as meetings over zoom can help them have time specific learning where they can ask any questions they may have.	3 months	-Likert Scale Evaluation Tool (Symeonaki, et al., 2015)
Self-evaluation of self perception after injury, the patient feels more comfortable with their body image will score at least at positive 1. This will be measured through a self evaluation utilizing the Self-Perception and Relationships Tool (S-PRT). This will be attainable as there will be interprofessional collaboration with the psychological support, counselling services are paid by the company Charles worked for. This will be measured over a 6 month period (Atkinson, et al., 2004).	-The patient will have psychological support, through therapy and counselling provided in working through any issues or fears. -The patient will be able to talk to and work collaboratively with support groups and other amputees. - The patient will take control of his plan to start exercising and diet, this will enable them to feel more in control of their image - The patient will also focus on DASH which stands for dietary approaches to stop Hypertension.	-The patient will be given resources, regarding psychological support and connection with support groups such as other amputees who they can communicate with.	-There will be resources and contact information on how to reach as well as communicate with support groups on the website.	6 months	-Self evaluation The Self-Perception and Relationships Tool (S-PRT) (Atkinson, et al., 2004).
Establishing a physical activity plan with the patient and incorporating prosthetics into the exercise plan. The satisfaction of the exercise plan will be measured through a 5 point likert scale (Symeonaki, et al., 2015). This exercise plan will be established with collaboration with the physiotherapist. This will be accomplished over the next 4 months.	-Patient creates a individualized physical activity plan with the physiotherapist, learning different exercises they can do -Patient learns about the effectiveness of incorporating prosthetics into the physical activity plan (MCOP Team, 2019)	-The patient will be given information on different exercises they can incorporate into their fitness plan and how to use prosthetics	-There will be information given on different exercises people with upper body amputation can include into their fitness routine with and without prosthetics (MCOP Team, 2019)	4 months	- Likert scale evaluation tool (Symeonaki, et al., 2015)
Long Term Goal: The patient will develop confidence as well as competence in managing their diabetes through adhering to an individualized diet and exercise plan. This will be measured through a calendar based system where they document how they achieved their activities and see their progress over time. This will be attained through collaboration with the interprofessional team, the dietician will assist in constructing a diet plan with the patient, while a physiotherapist will aid in constructing appropriate exercise routines. The patient will utilize the teaching and resources provided to adhere to their care regimen over the next 5 years.	Utilizing tools and resources we provide they will adhere not only to the medication regimen but also diet as well as exercise.  -The patient will collaborate in their care, and will be excited to progress in their care journey. -The patient will develop confidence and competence in managing their diabetes, through understanding the appropriate levels for their blood glucose, and appropriate interventions needed to ensure positive health outcomes	-The patient will be educated on Diabetes management, including, Medication management, DASH diet, and exercise routines -	-There will be both asynchronous and synchronous methods of education, involving the website and other online resources which the patient can use to study on their own time, this will be the asynchronous portion, while time specific education will occur on zoom, or in person, where the health care team can meet the patient at their own home and work together with the interprofessional team to discuss and contribute to the care plan (Sirbu,2020).	Over 5 years	-Calender based documentation - In person check in every 10 days for the freestyle change. Zoom meeting to address any questions or concerns monthly.

                                                                                  References

Atkinson, M., Wishart, P., Wasil, B., & Robinson, J. (2004). Health And Quality Of Life Outcomes, 2(1), 36. doi: 10.1186/1477-7525-2-36

MCOP Team. (2019, September 4). Upper Extremity Amputee exercises: Tips & ideas. MCOP Prosthetics. Retrieved from https://mcopro.com/blog/upper-extremity-amputee-exercises/. 

Sîrbu, A. (06/01/2020). Basic andragogy-oriented strategies and communication in online education. doi:10.2478/kbo-2020-0103

Symeonaki, M., Michalopoulou, C. & Kazani, A. (2015). A fuzzy set theory solution to combining Likert items into a single overall scale (or subscales). Qual Quant 49, 739–762.  Retrieved from https://doi-org.ezproxy.lib.ryerson.ca/10.1007/s11135-014-0021-z