Examine a contemporary social issue (which may or may not have been covered during the module) paying particular attention as to why this issue has become problematic and for whom. Also, consider what should be done about your chosen issue and any role that nursing/social work might have in dealing with it. A social issue can be defined as ‘social conditions identified by scientific inquiry and values as detrimental to human well-being’ (Manis 1976). I believe that a social issue can be anything that affects a person in a bad way and affects their standard of living.
It could be something from a health problem to something to do with a financial issue within someone’s home. I am going to focus on the health of the public and have chosen to pay attention to the social issue of diabetes type 2. I am going to pay particular attention to why diabetes has become problematic in the community and for who it is causing a problem to. Type 2 diabetes occurs when the pancreas does not produce enough insulin to maintain a normal blood glucose level, or your body is unable to use the insulin that is produced (NHS Choices).
You are likely to develop type 2 diabetes if you are over the age of 40, have a relative with the condition or are overweight. A person is normally thought to have type 2 diabetes if he or she does not have type 1 diabetes (insulin-dependent) or monogenetic diabetes (WHO). Patients that suffer from type 2 diabetes generally are given dietary guidance so that they can manage their blood sugar and they are also advised to take their blood sugar once a day to make sure that it is regular. Patients should also increase physical activity and control their weight.
It is important that diabetes type 2 is controlled so that it doesn’t progressively get worse and lead to diabetes type 1 diabetes which would mean the patient would become insulin dependent. Diabetes type 2 is problematic for the patient as during everyday living they have to make sure they are aware of what they are eating and doing to make sure they control their own blood sugar to keep themselves healthy. A patient suffering from type 2 diabetes might feel self conscious at meal times as they may have to eat something different to the people they are dining with.
This can cause the person’s self esteem to be decreased and they could be embarrassed to eat around other people as they might feel like they are being segregated from the group. A patient also has to exercise regularly which they might find difficult to fit into their lifestyle but in order to control their blood sugar effectively it should become an important part of their everyday life. It can also be problematic on the health costs. Current estimates suggest that direct health cost of diabetes accounts for 5% of the UK health cost (Payne, Barker 2010).
This percentage doesn’t even include the full cost of the problem. There are also costs related to sickness from work, disability and more than 10% of hospital bed days. Since 1996 the number of people diagnosed with diabetes has increased from 1. 4 million to 2. 9 million. Most of these cases will be Type 2 diabetes, because of our ageing population and rapidly rising numbers of overweight and obese people. This suggests to us that the demands on the health service are going to increase which will therefore cost more money. These statistics also tell us that an increase in obesity is going to affect diabetes.
Obesity is increasing in the UK such that over half the population are now overweight or obese. This has significant health consequences, causing an increase in the risk of diabetes (Payne, Barker 2010). The government have suggested that obesity is resulting in health costs increasing and life expectancy decreasing. One of the social consequences for a person that is obese or overweight is that they are seen negatively upon and discriminated against. This can happen in all situations in social environments and can affect a person in many different ways such as low self-esteem and depression.
Obesity is causing an increase risk of diseases that are associated with it. This will also increase health costs as well as making the health of the public worse. If type 2 diabetes is not controlled then type 1 diabetes can develop. This is worse because the patient becomes dependant on insulin. It usually develops in the teenage years of someone’s life. This has to be given my subcutaneous injection (Payne, Barker 2010), this makes sure that the insulin levels are regular and forms the basis of dietary management. They will also have to regularly check their blood sugars.
They will often need monitoring, assessment and treatment of cardiovascular risk factors because they have many features of metabolic syndrome. There are many different complications that are caused by diabetes. If you have diabetes, you are up to five times more likely to develop heart disease or have a stroke (WHO). When the blood glucose levels are increasing it results in the furring and narrowing of your blood vessels which may result in a poor blood supply to the heart. This can lead to a heart attack or a stroke. This doesn’t only put the patient’s life at risk but it also results in a huge cost on the NHS.
It can also affect the patient’s family a friends hugely emotionally but also physically if they are in need of care after the event. It can change the patient’s life style dramatically. It is not only the blood vessels near the heart that are affected it is also the blood vessels in the nerves. This sometimes causes a tingling sensation in your limbs. If the nerves in the digestive system are affected a patient may experience nausea, vomiting, diarrhoea or constipation. This will make the patient’s life very uncomfortable.
Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents the light from fully passing through to your retina. If it is not treated, it can damage your vision (NHS Choices). If a patient doesn’t control their blood sugar levels they are very likely to develop serious eye problems. Having an annual eye check up with a specialist, an ophthalmologist, can help to see the signs of an eye problem sooner so that it can be treated. Another problem that diabetes can lead to in a blockage of the blood vessels in the kidney, this makes the kidneys work less efficiently.
In very rare cases this can lead to kidney failure and the need for dialysis or even a kidney transplant. Another reason why diabetes affects people’s health and health costs is because 1 in 10 people with diabetes get a foot ulcer (WHO). Damage in the nerves of the foot can mean that small nicks and cuts are not noticed. They will not be noticed because the nerves are damaged the patient with these small cuts won’t feel the pain from them. If these small cuts are not noticed a serious infection can occur and it can lead to the development of a foot ulcer.
If patients develop nerve damage they should check their feet every day and report any changes to a nurse or doctor. When a nurse is visiting a patient with diabetes they should look out for sores and cuts that do not heal as well as puffiness and swelling. There are always going to be other side effects to having diabetes but these are the most common. Another problem that diabetes can cause is an increased risk of a miscarriage or stillbirth. It is important that women that are pregnant are aware that they have diabetes so that the blood sugar level can be carefully controlled during the early stages of pregnancy.
If it is not carefully controlled there is also an increased risk of the baby developing a birth defect (NHS Choices). Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetic clinic. As a nurse it is important we make sure pregnant women with diabetes are aware of this. This allows the care team to keep a close eye on the patient’s blood sugar levels and control your insulin dosage more easily, if you regulate your blood sugar using insulin. They will also be able to monitor the growth and development of your baby.
Pregnant women are also at risk of having larger babies than normal which causes problems during the birth of the baby as well as the late stages of pregnancy. It can cause other problems to the mother during the birth such as ripping on the vagina or even to the stage they have to go through with a suzerain. All of these side affects cost the NHS money. This can be reduced by people eating healthier and exercising so that they do not form the illness of diabetes in the first place. One example of how much diabetes can cost health services is the Lucentis injection.
This is a shot that helps to prevent people with severe diabetes going blind but it costs ? 1000. This is a huge amount of money when you put it into proportion to the amount of people that have diabetes in the UK. With around 5,000 new cases a year, NICE is reluctant to recommend the use of Lucentis for treating DMO, diabetic macular oedema (Global Diabetes Community). ‘A report by the NHS entitled Prescribing for Diabetes in England reported that over the last 5 years, the cost of drugs and treatments alone in order to treat people with diabetes had risen by 40% from ? 458. 6 million in 2004/5 to ? 649. 2 million in 2009/10’.
These statistics tell us that the number of people in the UK with diabetes has risen. This could be due to the fact that the number of people that are obese in England has risen. The UK is the ‘fattest’ country in Europe. The number of obese adults is forecast to rise by 73% over the next 20 years from to 26 million people, resulting in more than a million extra cases of type 2 diabetes, heart disease and cancer (Global Diabetes Community). The cost of diabetes in 2010 was 13. 750 billion pounds just for the year on the NHS.
This cost includes the treatment, drugs, inpatients and outpatient appointments for diabetes type 1 type 2. There is also other services that are included into the treatment such as the social service. The amount of money that is spent on each type of diabetes for each different area of expenditure can be seen in appendix 1. The cost of in patients with diabetes is the greatest. This is due to the fact when diabetes gets so severe people need time in hospital to recover and be treated for other illnesses that diabetes has caused them.
Type 1 diabetes cost 1. 802 billion pounds in 2010 where as diabetes type 2 diabetes cost 11. 718 billion pounds. This is due to the fact type 2 diabetes is more common in the UK. Although it can be controlled by changing your lifestyle it is not always diagnosed and therefore can cause more problems than if the patient was aware they had this condition. There should always be actions in place to try and decrease the number of people in the UK that have diabetes.
Published in 2001, The National Service Framework for Diabetes contains nine standards for the provision of high quality diabetes services in what it recognised as a growing area of need. The prevention of type 2 diabetes will play a major part in this because if people are eating healthier and exercising more they are less likely to form diabetes type 2 but if they do people should be able to identify that they have diabetes in order for them to control their own condition. By controlling their own blood sugar they will be less likely to end up in hospital with another illness related to this condition.
In order to do this the NHS want to see public awareness campaigns to communicate the seriousness of diabetes and its complications, the risk factors of type 2 diabetes (Young 2011) This should hopefully point the public in the right direction to whether they have diabetes so that they can seek help and advice in order to keep as healthy as possible in their everyday life. It is important that as nurses we give advice to our patients they importance of NHS checkups and healthy living so that patients with diabetes reduce the risk of illness.
As a nurse health promotion is always important for any condition. Health promotion has evolved into an extremely broad sphere of activity encompassing health education, lifestyle and preventative approaches (Scriven, Orme 2001). As nurses we have to concentrate on improving the health of our patients and the public. One way in which we can promote health to our patients is while we are working alongside them in hospital is to provide structured information in preparation for stressful events (Macdonald, Bunton 1992).
When a patient has diabetes it could mean that we give the patient information about how to manage this condition at home so that they live a healthy lifestyle. There is a lot of substantial evidence that suggests passing on information to the patient and communicating with them reduces anxiety and speeds up recovery time. More recently, the need to adopt more individualised, patient-centred approaches, incorporating a recognition of the importance of self-efficiency beliefs and the wider barriers to taking health action, has been widely recognised (Norton 1998).
This could suggest that one patient may just need the advice to be told to them while another patient needs instructions on how to use this advice at home, maybe written down or extra support at home depending on the health and well-being of this particular patient. While I was on placement it was an important job to help the patients chose what they would like to eat the next day by filling in a menu. For a diabetic they would have different choices and then a pudding with less sugar in to the other patients.
It was important that as a student nurse helping them I helped to promote the healthier options to all patients in order for them to eat a healthy balanced diet. This would not only mean that they would eat healthier while in hospital but it would also give the patients an idea of what to eat at home to have a balanced diet. The department of health also help to ensure that the public with diabetes are cared for to reduce health costs and to improve the public’s health. One way that they do this is to ensure that local authorities commission a fully funded health check programme and a follow-up action.
Courtney from Study Moose
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