[Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care].
A case is presented of a 52 year-old male seen in a Primary Care nursing clinic for a type 2 diabetes mellitus metabolic control. The frequency of the visits increased due to perceived difficulties caused by changing the medical treatment. A focused interview was conducted under functional health patterns framework. The patient was unable to write or read, had not worked for the last 25 years, and expressed a lack of control over his self-care. An action plan was prepared, prioritizing Ineffective Health Maintenance, Powerlessness, and Impaired Social Interaction NANDA-I nursing diagnoses. The goals were set at improving knowledge and control over his disease and participating in leisure activities. To achieve these, the social health resources in the area were contacted, and agreed that the patient could attend activities that could improve his self-care and his quality of life. An improvement in his diabetes control was observed in the following evaluations, with an increase in his level of knowledge and self-care. The Primary Health care nurse should consider available community resources by using a comprehensive approach to chronic diseases for their therapeutic benefit and management, especially in those patients with adverse sociocultural conditions.
Enfermería Familiar y Comunitaria, Unidad Docente Multiprofesional Sur de Atención Familiar y Comunitaria, Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España. Electronic address: luciaperezvico@gmail.com.
Lucía
L
Pérez-Vico-Díaz de Rada
Enfermería Familiar y Comunitaria, Unidad Docente Multiprofesional Sur de Atención Familiar y Comunitaria, Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
Miriam
M
González-Suárez
Enfermería Familiar y Comunitaria, Unidad Docente Multiprofesional Sur de Atención Familiar y Comunitaria, Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
Gonzalo
G
Duarte-Clíments
Investigación de Enfermería Familiar y Comunitaria, Unidad Docente Multiprofesional Sur de Atención Familiar y Comunitaria, Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
Pedro Ruymán
PR
Brito-Brito
D019090:Case Management; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012648:Self Care
Atención Primaria de Salud; Case management; Diagnóstico de enfermería; Gestión de casos; Nursing diagnosis; Primary Health Care; Servicio social; Social work