Running Head: EDUCATIONAL REFLECTION PAPER

Educational Reflection Paper Dianne Bettick Johns Hopkins University School of Nursing

On my honor, I pledge that I have neither given nor received any unauthorized assistance on this assignment. ___Dianne Bettick____

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Working in an acute care facility, I see a growing number of patients with new diagnosis of type II diabetes as well as complications from uncontrolled type II diabetes. Unfortunately I am not sure if this model is used at all for inpatient education to address this population. For example, when a client comes to the hospital with an HgA1C of 15, we try to educate these clients on how to better control their disease and the extent of possible complications. Unfortunately, in not using a model such as the Health Belief Model, I don't think there is enough focus on assessing their perceived susceptibility or perceived severity. These patients in turn leave the hospital without having made the connection between what we are telling them and what could happen to them. Down the road we see these patients return to the hospital when diabetes has destroyed their body. For example, one client had suffered a below the knee amputation, loss of eyesight, and a loss of toes on the remaining intact leg. He was in a depressive state and regretted not having listened when people told him the importance of controlling his diabetes. Several months ago I was presented with a situation in which the use of the Health Belief Model would have proven useful. I had a patient with a new diagnosis of type II diabetes and although he was very eager to learn how to control his illness, his knowledge level was so that he required extensive education, specifically nutritional education. Nutritional education is a crucial part of diabetes control. According to The Effectiveness of Nutritional Education on the Knowledge of Diabetic Patients Using the Health Belief Model, in using this model the responsibility of making the right choice with regard to care is placed on the patient. (Sharifirad et al, 2009) This can be done only after they are given the resources necessary to motivate this behavior. I was prepared to educate my patient on his susceptibility to complications and the severity of not following through with regular glucose checks and insulin control. In addition, I had prepared a handbook that gave the patient a resource to keep track of necessary

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appointments and trends in his glucose levels. Finally I was prepared to work with him on his glucometer to better assess his self efficacy, or confidence, in using the machine and how the readings relate to insulin control. Despite my efforts he was discharged before I felt I was able to provide him with the full extent of the education necessary to properly control his diabetes. Because patients diagnosed with type II diabetes may not fully comprehend the severity of their illness as well as understand their susceptibility to complications from the disease, the Health Belief Model is a resource that allows the provider to better understand what is driving the behavior of the individual and how to best approach the patient in order to successfully alter that behavior. (Park et al, 2010) Furthermore, this model allows the provider to break down the necessary education into various categories and individualize that education to the patient. One focus of the Health Belief Model that proves beneficial to improving patients adherence to disease control is self efficacy. Self efficacy, or confidence in managing a disease or illness, has been found to impact medication adherence. Higher self efficacy leads to significantly higher adherence to medication. (Park et al, 2010) Similarly, when a patient lacks self efficacy they may avoid taking medications all together. Obviously because of the importance of following through with insulin administration in controlling diabetes this is an important part of diabetes education. A good way for me to integrate this theory into my practice setting is to use the Health Belief Model to understand my patients level of: perceived susceptibility with regard to possible complications from uncontrolled diabetes; perceived severity with regard to the effects of the disease on the organs of the body; self efficacy with regard to their ability to check their glucose and administer insulin; and perceived barriers that may prevent them from following through after discharge. In using this model I can better understand my patient and what I can do to motivate healthy behavior.

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References Sharifirad, G., Entezari, M. H., Kamran, A., & Azadbakht, L. (2009). The Effectiveness of Nutritional Education on the Knowledge of Diabetic Patients Using the Health Belief Model. Journal of Research in Medical Sciences, 14(1). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129063/ Park, K., Kim, J., Kim, B., Kam, S., Kim, K., Ha, S., & Hyun, S. (2010). Factors that Affect Medication Adherence in Elderly Patients with Diabetes Mellitus. Korean Diabetes Journal, 34. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879904/