Diabetes: Living with Fears, Stress, and Burnout (PDF)

Unit 9. Diabetes: Living with Fears, Stress and Burnout Social Work in Health Settings Min Ah Kim Sungkyunkwan University Department of Social Welfare Unit 9. Diabetes: Living with Fears, Stress and Burnout  Chronic Illness  What is Diabetes?...

Unit 9. Diabetes: Living with Fears, Stress and Burnout Social Work in Health Settings Min Ah Kim Sungkyunkwan University Department of Social Welfare Unit 9. Diabetes: Living with Fears, Stress and Burnout  Chronic Illness  What is Diabetes?  Diabetes Burnout  Interventions for Patients with Diabetes What is a Chronic Illness?  Chronic illness is one that lasts for an extended period, usually 6 months or longer, and often for persons' life  Chronic illnesses are slowly developing diseases that cannot be cured but rather are managed by patients and health care providers.  Long-term treatments and observations are required due to the late effects.  Chronic illnesses are the main contributors to disability and death worldwide. What is a Chronic Illness?  Almost half of general population has chronic illness.  Most chronic diseases increase as individuals get older.  7 in 10 people age 65 and older will need chronic illness care.  Chronic diseases have significant health and economic costs. Definition of Chronic Illness Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both WHO. Noncommunicable Diseases. (2016). Available from: http://www.who.int/topics/noncommunicable_diseases/en/ Definition of Chronic Illness Chronic illnesses are not passed from person to person. They are of long duration and generally slow progression. The four main types … are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes Types of Chronic Illness Diabetes Alzheimer disease Arthritis Asthma Cancer Chronic Obstructive Pulmonary Disease (COPD) Crohn disease Cystic fibrosis Cause of Chronic Illness  Health Risk Behaviors Long-Term Condition  Chronic diseases can be transitioning: from terminal diagnosis to chronic disease, or from acute to chronic  Chronic diseases continue throughout the patient's entire life and are greatly affected the patient's and family's daily lives.  Chronic illnesses affect family functioning, including relationships with a partner or children. Stress and Anxiety  Chronic disease causes stress and anxiety as symptoms and complications continue to fluctuate.  Chronic illnesses may require medication use and self- monitoring of symptoms.  Psychological stress can cause or result from chronic diseases.  It is easy to be isolated from social relationships due to side effects of disease or treatment. Psychological Challenges Emotional Distress Treatment Diabetes ⚫ Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. ⚫ Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells. ⚫ Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues. https://www.idf.org/aboutdiabetes/what-is-diabetes.html Types of Diabetes It can develop at any age, but occurs most fre quently in children and adolescents. Type 1 Diabetes Your body produces very little or no insulin. It is more common in adults. Your body does not make good use of the ins Type 2 Diabetes ulin that it produces. Symptoms of Type 1 Diabetes ⚫ Abnormal thirst and dry mouth ⚫ Sudden weight loss ⚫ Frequent urination ⚫ Lack of energy, tiredness ⚫ Constant hunger ⚫ Blurred vision ⚫ Bedwetting Symptoms of Type 2 Diabetes ⚫ Excessive thirst and dry mouth ⚫ Frequent urination ⚫ Lack of energy, tiredness ⚫ Slow healing wounds ⚫ Recurrent infections in the skin ⚫ Blurred vision ⚫ Tingling or numbness in hands and feet Risk Factors for Type 2 Diabetes ⚫ Family history of diabetes ⚫ Overweight ⚫ Unhealthy diet ⚫ Physical inactivity ⚫ Increasing age ⚫ High blood pressure ⚫ Ethnicity ⚫ Impaired glucose tolerance (IGT)* ⚫ History of gestational diabetes ⚫ Poor nutrition during pregnancy Treatments ⚫ Insulin: taking insulin to control their blood glucose levels. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. ⚫ Healthy nutrition: Knowing what and when to eat ⚫ Physical activity: keeping blood glucose levels under control ⚫ Self-monitoring: Checking their blood glucose levels regularly to inform insulin dosage Complications of Diabetes ⚫ Cardiovascular disease ⚫ Nerve damage (neuropathy) ⚫ Kidney damage (nephropathy) ⚫ Eye damage ⚫ Foot damage ⚫ Skin conditions ⚫ Hearing impairment ⚫ Alzheimer's disease Psychosocial Reactions Shock Denial Anger Guilt Anxiety Psychosocial Reactions ⚫ Denial: Denial interferes with the patients’ ability to monitor their condition, take initiative in seeking treatment, and manage their illness ⚫ Anger: a strong feeling of resentment, displeasure. Psychological counseling is needed to control anger and reduce depression ⚫ Guilt: It could be a realistic or unrealistic. ⚫ Anxiety: Need training to provide accurate information; Motivation is required to avoid desperation ⚫ Acceptance: Adjust to disease and receive active treatment  Psychosocial Impact of Diabetes Individual Family Community Guilty for genetic Stigma towards people Denial, fear, anger, guilty, Impact of Disease predispositions, anger with diabetes, depression, acceptance management inappropriate treatment -Difficult to understand diet -Difficulties in building social -Preparing meals -Prejudice on eating relationships -Balance with other restrictions Eating -Not eating out family members' needs -A lack of various -Difficulty in changing eating (eating out, etc.) alternative foods habits -Seek support Self- -Difficulty in self-control care manag -Difficulty in managing time Physical -A lack of resources for ement -Preference and burden for -Seek support Activity physical activities exercise -Support for BG Blood -The fear of needles measurement Glucose -Response to measurement -Support of Levels results measurement results Psychosocial Impact on Children Diabetes negatively affected the child’s life, such as personality, physical well-being, schooling, and emotional well-being. Children and adolescents with diabetes are at a greater risk for emotional and behavioral problems. School-aged children and adolescents with diabetes often feel different from their peers. They often adopt risky or haphazard behaviors while they perceive that they are still able to do. They often experience conflicts with parents. Families play the key role in the adjustment of children and adolescents to diabetes. Importance of Self-Care ⚫ Approximately half of individuals with diabetes do not follow treatment or attain target glycaemic control ⚫ Sustaining self-care behaviours is challenging ⚫ Demanding self-care decisions into daily life  Diabetes Distress and Depression  Diabetes distress is related to Worry and fear regarding health Financial and behavioral burden of living with diabetes Onset of complications Impact on lifestyle of self-management demands Lack of support in managing diabetes  Depression is more prevalent in individuals with diabetes than in the general population.  Prescription of insulin and higher demands for self- management increase burden of treatment Gonzalez, J. S., Fisher, L., & Polonsky, W. H. (2011). Depression in diabetes: have we been missing something important?. Diabetes care, 34(1), 236-239.  Diabetes Burnout Diabetes burnout is a contributing factor to the discrepancy between diabetes optimal care and actual care. Diabetes burnout is defined as a state of exhaustion and frustration from the daily demands of diabetes self-care or failure to achieve blood glucose (BG) control. Efforts to maintain diabetes can lead to burnout of patients. If the results are not good compared to efforts, you may feel overwhelmed by the feelings of being defeated, or want to give up on the futility of not managing the disease on your own. Polonsky WH. Diabetes Burnout: What to Do When You Can’t Take It Anymore. Alexandria, VA: American Diabetes Association, 1999. Diabetes Burnout Diabetes lasts 24 hours, 7 days, and 365 days, so it is natural to feel exhausted. Disease management is always inconsistent. The patients must accept that it cannot always be perfect. A reasonable and patient-centered self-care goal should be set considering their energy level. It is appropriate to implement manageable actions that can be solved one at a time. You must celebrate little achievement. You need to form a collaborative relationship with the clinical workforce. If you need help, you should ask your family, friends, acquaintances, etc. for assistance.  Components for Diabetes Burnout Burden of diabetes self-care Lack of achievement in diabetes control Co-occurrence of life events/stages Lack of support system Figure 2. Possible driving factors and key components for diabetes burnout. Abdoli, S., Jones, D. H., Vora, A., & Stuckey, H. (2019). Improving diabetes care: should we reconceptualize diabetes burnout?. The Diabetes Educator, 45(2), p. 223. Why is Diabetes Burnout Important? Diabetes Education  It is one of the most important treatments for diabetes self-care.  It helps people with diabetes learn how to take the best care of themselves.  It helps gain the knowledge, skills, and confidence to thrive with diabetes.  It is important to develop education contents suitable for patient needs.  It helps motivate to maintain continuous behavioral changes.  It is effective for a team of multidisciplinary health professionals to intervene.  Diabetes Camp ✓ Educate, Empower, and Inspire ✓ Peers and dedicated professionals provide motivation and support, as well as acceptance, understanding, excitement and adventure. ✓ Help children affected by diabetes lead healthier, happier and more productive lives ✓ Conduct education on stress management, role play, psychological play, life graph drawing, etc.  Support Groups for Diabetes ✓ A diabetes support group is a vital part of diabetes management. ✓ Support group for people with diabetes provides information about diabetes and help members manage it together continuously. ✓ People with diabetes can check each other’s self-care activities and share information to help manage chronic diseases. ✓ This group is often led by a Licensed Clinical Social Worker or certified diabetes educator. Understanding Diabetes Risk Active and Helpful Eating Diabetes Factors Mindful Lifestyle A Multidisciplinary Team A multidisciplinary team was needed for optimum care of people with diabetes. Physician Nurses Social Workers Nutritionists Diabetes Educators The Role of Social Workers in Diabetes Care Counsellors Educators Advocates Social Work Intervention for People With Diabetes ◼ Psychological Approach: Providing individual counseling on why the patients should control the food and what plans he or she has for it ◼ Family Intervention: Expanding awareness of the importance of the role of the family as a caregiver ◼ Social Intervention: Providing information regarding how to deal with difficulties arising from relationships with peers ◼ Financial support: Providing help in case of economic difficulties ◼ Support group: Providing information about diabetes peer counseling, social skills training, social relationship training, and family education  Psychosocial Assessment Psychosocial screening and follow-up includes: – Attitudes about diabetes – Expectations for medical management and outcomes – Affect or mood – General and diabetes-related quality of life – Available resources: financial, social – Psychiatric history Providers should assess psychosocial issues, such as diabetes distress, depression, anxiety, disordered eating behaviors, and cognitive capacities References  Abdoli, S., Jones, D. H., Vora, A., & Stuckey, H. (2019). Improving diabetes care: should we reconceptualize diabetes burnout?. The Diabetes Educator, 45(2), 214-224.  Abdoli, S., Hessler, D., Vora, A., Smither, B., & Stuckey, H. (2020). Descriptions of diabetes burnout from individuals with Type 1 diabetes: an analysis of YouTube videos. Diabetic Medicine, 37(8), 1344-1351.  Gonzalez, J. S., Fisher, L., & Polonsky, W. H. (2011). Depression in diabetes: have we been missing something important?. Diabetes care, 34(1), 236-239.  Hoover, J. W. (1983). Patient burnout and other reason for non-compliance. Diabetes Educ, 9(3):41-43.  International Diabetes Federation. https://www.idf.org/aboutdiabetes/prevention.html  Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian journal of endocrinology and metabolism, 22(5), 696.  QUESTIONS? [email protected]