Healthy People 2020 Goal: The goal of interest for me is to expand the well-being, function, and value of the life of older adults with diabetes. Diabetes is one of the chronic conditions that can lower quality of life for older adults and contribute to the principal causes of death among this population. However, avert sickness or support to detect sickness early, when treatment is extra effective. Notably, the risk of such comorbid conditions increases as the population ages. Therefore, health professionals should assess and implement strategies to reduce related complications. According to research, lifestyle change is an important factor in preventing and delaying the onset of diabetes among individuals with a high-risk profile. In addition, according to the objectives, researchers should increase the sensitivity of laboratory tests to facilitate early diagnosis of the disease among community members. Agreeably, timely diagnosis ensures early management to curb the disease’s pathophysiology, thus reducing the risk of developing complications.
Clinical Objectives: There are numerous specific goals for the diagnosis and management of diabetes as discussed below:
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To lower the death rate associated with diabetes and co-morbid diseases.
Implement strategies to prevent the development of complications and manage diabetes through pharmacologic and non-pharmacologic interventions.
To encourage patients to control their carbohydrate intake, stay hydrated, and to keep active.
To educate the patients on the importance of reducing salt, sugar, and alcohol intake, as a way of reducing diabetes risk.
Aggregate Risk: it is not clear why some people get diabetes while others do not despite studies showing that development of diabetes results from the interaction of hereditary and environmental aspects. Age and family history are also risk factors related to diabetes where family history may lead to inherited diabetes. It occurs when ones immune system for fighting infection attacks and destroys pancreases producing insulin. There is variety of risk factors which increases the chances of developing this condition. They include; being obesity, living a sedentary lifestyle, increase in age, and bad diet. Consuming food which is rich in carbohydrates and added sugar increases the risks of developing diabetes.
In 2015, there was a positive validation of family structure with a value of 98.7%. A family history of diabetes was associated with a relative risk of 95%. It is therefore consistent with thesis that a family with diabetes history is a reflection of genetic and behavioral factors where women are more predisposed to an increased risk of gestational diabetes mellitus. In 2016, Patients with first, second, and third degree has a high risk of developing type two diabetes which has a risk, 1.7(1.5-2.0) as the third degree ( Dall, et al., 2010) .
Economics: in the US, 2017, the study shows that the economic cost of diabetes was commissioned by the Association and increased financial burden. The cost of diagnosing diabetes in 2017 amounted to $327 billion which entailed $237billion covering medical cost and $ 90 billion covering reduced productivity ( Haas, et al., 2012) . Therefore, the cost of managing diabetes is likely to rise and new and more costly treatments emerge and become the culture in health care.
Healthcare Issues: diabetes has become a health concern in the United States where it has affected 29 million of its citizens. It is the main leading cause of new cases of blindness among adults in US as well as in across the world ( Dall, et al., 2010) . It is also the main cause of end-stage of renal failure among the aged. Getting old is associated with risk of diabetes and heart failure as well. There is nothing one can do to stop growing old but eating healthy and managing weight is the best strategy. Reducing cholesterol, blood sugar level, and blood pressure since these condition are associated with old age. Despite having a lot of prevention and treatment strategies, diabetes is the seventh leading cause of deaths in America. Treatment of glucose, increased lipid levels, and unstable blood pressure in people living with diabetes reduces the risks of developing complications which are related to diabetes. Notably, consistent with previous trend, there is increased cause of diabetes although it is lower as compared to previous years. It is therefore a contributing factor to a significant number of other health conditions. Therefore, addressing diabetes we are limiting and curbing other health issues like nerve and kidney failure, vision impairment, stroke, as well as, heart failure.
Culture, Legal, and ethical issues : cultural background information is a vital issue in giving diabetes care among patients. Culture which entails human behavior such as ones language of communication, values and beliefs are significant in health care. In addition, legal and ethical issues are of great importance in patient care. In some cultures, the patient is not allowed to know the kinds of disease they are suffering; therefore, the patient is not involved in making decisions concerning their healthcare ( Haas, et al., 2012) . Diabetes patients are not treated towards their last days of living. They are informed of their disease and do not receive more treatment though they receive treatment a family level since their worsening situation may affect them psychologically. Moreover, clinicians have both legal and ethical responsibilities which they use to evaluate and educate those suffering from diabetes and eventually educate them on the associated risks reduction. In legal and ethical issues, once the patient is dead, the clinician tries to enquire from the family members if they are willing to give out the corpse to be used in science studies ( Haas, et al., 2012) . Therefore, these are vital states which need deep understanding of one’s culture, ethics, and wishes.
Community Resources : National Diabetes Educational Program (NDEP) resources in the United States help in reducing the burdens which are associated with diabetes through giving culturally and linguistically diabetic education. NDEP materials and resources are distributed through a joint effort of the centers for Disease Control and Prevention and he National Institute of Health ( Stellefson, Dipnarine, & Stopka, 2013) . The American Association of Diabetes Educators (AADE) helps patients in managing diabetes condition through lifestyle monitoring, teaches them to add physical activities in their lifestyle, and giving diabetes education which is offeed through accredited diabetes education program to the patients. They also advocate for modification in lifestyle and diabetes self-management through be careful on one’s diet and regular exercise ( Stellefson, Dipnarine, & Stopka, 2013) . Therefore, these community resources campaigns for complex undertaking, changing health system practices to incorporate community based resources which represent a change in lifestyle thus meeting patient’s requirements in local community setting.
Level of prevention : the goal of any healthcare facility is to reduce the burden of diabetes in people and enhance the quality of life for all people who are at risk to develop diabetes. Losing a small pound of weight by those who are overweight and having regular exercise lowers the risk of developing diabetes. Having lifestyle changes like physical exercise, taking a healthy diet can lead to a gradual weight loss ( Haas, et al., 2012) . Healthy diet means having meals which has a lot of vegetable and fruits and minimizing the amount of carbohydrates intake and also reducing soft drinks with added sugar. These lifestyle changes are vital because they also minimize other risk factors associated with blood pressure, and high blood cholesterol which have severe effects on diabetic patients ( Schmittdiel et al., 2013) . Checking on health diet is the primary level of prevention which cubs the onset of diabetes. Medication should also be introduced to control the glucose levels in blood, blood pressure and cholesterol. Therefore, diabetes can easily be managed by monitoring critical health issues which includes; blood pressure, weight, blood sugar level, and blood cholesterol level. Taking medication is a tertiary level of prevention which reduces negative effects of already developed diabetes condition.
Wellness Plan : the diabetes Wellness Program is used in giving a supervised exercise, education, as well as, support throughout one’s life by executing lifestyle changes which controls health. Wellness programs are designed to give positive cultural changes thus lowering diabetes health risks. Patients are advised to visit their doctors in a regular basis which leads to rehabilitative care ( Spencer et al., 2011) . The wellness plan need to be adhered to thus giving the patient a chance to share their perspectives about their illness. The wellness plan consists of what the patient should do and what should be avoided. This wellness plan will help the patient to reduce the risks associated with diabetes. It is also designed to help patients in weight management healthy eating habits; thus having a reduced health risks and enhancing the quality of their life.
Nursing Theorist: A nursing theorist that relates to the Healthy People 2020 goal of minimizing this disease is Imogene King’s hypothesis of goal attainment. To develop this study, we required to build on the Imogene King’s Theory of Goal Attainment. This defines the nature of nurse patient connections that lead to goal accomplishment, in which nurses decisively interrelate with patients to commonly establish goals, explore and reach agreement on ways to accomplish them. Common goals are founded on the identification of complications, changes in health, and perceptions of complications and distributing of information in order to realize goals.
The main goal of nursing is to support the patient in the fight against a health problem or concerning well-being. As soon as the nurse and patient classify goals to be attained, the exchanges are fixated on these areas and a helpful interpersonal relationship begins. The health variability observed and assessed during the study permit us to encourage the rationality of Theory of Goal Attainment as the basis for nursing care for patients with diabetes in the milieu of Primary Health Care.
Imogene King's theory of goal attainment aligns with the 2020 objectives. It describes a relationship whereby health professionals empower patients to achieve specific health goals. One of the primary propositions of the theory is that the quality of the interaction between the patient and the healthcare provider determines the value of the transaction, goal attainment, and satisfaction.
Furthermore, the postulation supposes that the relationship between a nurse and a patient is essential for the realization of healthcare objectives. In this context, a healthcare professional should ensure that his or her goals agree with those of the patient to help facilitate collaborative compliance in developing the appropriate care plan. Since the theorist describes health as the outcome of the interaction of the person and the environment, nurses should prioritize communication and patient education. Consequently, this will create a suitable environment for diabetes management.
Imogene also states that the quality of interaction between the healthcare professional and the patient is a determinant of the transaction value, goal attainment, as well as satisfaction. Imogene’s theory illustrates how human beings are open systems that interact with the environment constantly and are, therefore, action and goal-oriented (Caceres, 2015). The goal attainment concept has reportedly helped many Diabetes patients gain more knowledge about setting proper healthcare goals and working to achieve them. Furthermore, self-management measures such as behavioral changes also enable Diabetics to adopt healthy habits for controlling blood sugar levels (Schrivastava, Schrivastava & Ramasamy, 2013). Therefore, communication and patient education is a crucial tool for motivating patients to improve their health, provided guidance from their caretakers.
The aim of AADE (American Association of Diabetes Educators) investigation is to judgmentally examine the value that diabetes instructors and diabetes education add to enhanced clinical procedures, enhanced patient outcomes, and condensed medical expenses. The association pursues examination openings to contribute to the evidence base, enlarge openings for diabetes coaches, and improve member awareness, comprehension, and study of pertinent scientific data.
The importance of physical activity in the control of diabetes but its adherence is still slowly achieved by the patients. According to the theory under analysis, although each human being is unique, a group of people can observe the same event, but each one can perceive it differently. However, patients’ problems in implementing this practice may be linked to lack of motivation or even accommodation. The theory planned by Imogene King for the achievement of goals is feasible to be applied in the Family Health Strategy, since the patient impressions co-responsible for his or her treatment, and performances with significant power in the probable variations for better observance to the projected care.
References
Caceres, B. A. (2015). King’s theory of goal attainment: exploring functional status. Nursing Science Quarterly, 28(2), 151-155.
Dall, T. M., Zhang, Y., Chen, Y. J., Quick, W. W., Yang, W. G., & Fogli, J. (2010). The economic burden of diabetes. Health affairs , 29 (2), 297-303.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., ... & McLaughlin, S. (2012). National standards for diabetes self-management education and support. The Diabetes Educator , 38 (5), 619-629.
Healthy people 2020. (2019). Diabetes. Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes/objectives.
Schmittdiel, J. A., Brown, S. D., Neugebauer, R., Adams, S. R., Adams, A. S., Wiley, D., & Ferrara, A. (2013). Peer Reviewed: Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study. Preventing chronic disease , 10 .
Schrivastava, S. R., Schrivastava, P. S., & Ramasamy, J. (2013). Role of self-care management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 12(1), 14.
Spencer, M. S., Rosland, A. M., Kieffer, E. C., Sinco, B. R., Valerio, M., Palmisano, G., ... & Heisler, M. (2011). Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. American journal of public health , 101 (12), 2253-2260.
Stellefson, M., Dipnarine, K., & Stopka, C. (2013). Peer reviewed: The chronic care model and diabetes management in US primary care settings: A systematic review. Preventing chronic disease , 10 .
