problem solving assessment flow chart diabetes activecare

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Source: Adapted from The Art and Science of Diabetes Self-Management Education, American Association of Diabetes Educators, 2010.

Problem Solving Assessment Flow Chart Diabetes ActiveCare

• Recurrent DKA

• Frequent hyperglycemia

• Frequent hypoglycemia

• A1C > 9%

Level 1: Referral ProblemClinical Markers and Emergencies:FIRST

Identify the reason the patient has been referred.

• Unhealthy eating

• Physical inactivity

• Difficulty taking medications

• Not monitoring as prescribed

Level 2: Self-Care Behavior Concerns

NEXTWhat are the

behavior problems related to clinical

markers?

Level 3: Barriers by Self-Care Behavior

THENWhat barriers

for self-care can the patient identify?

Barriers to Monitoring• Pain• Inconvenience• Interference with lifestyle• Testing skills• Fear of the numbers

(high and low)• Cost/expense

Barriers to Taking Medications• Needle phobia• Fear of hypoglycemia• Costs• Forgetting to take• Complexity of the regimen• Medication side effects• Understanding the regimen• Perceived treatment benefits• Not taking medications

in the presence of others• Medication knowledge

Barriers to Physical Activity

• Unwilling• Lack of appropriate/

safe place

• Weather• Poor conditioning• Cost of facilities• Lack of support• Competing time priorities• Fear of hypoglycemia• Pain• Unpleasant physical

responses – sweating, feeling ill, shortness of breath

Barriers to Coping• Lack of skills• Lack of support• Social pressures• Unmanaged stress• Time management

skill deficit• Emotional distress• Cognitive barriers

Barriers to Healthy Eating

• Eating out• Time pressure• Portion sizes• Nutrition/meal

planning deficit

• Feeling deprived• Competing priorities• Cost of healthy foods• Cultural preferences/

knowledge deficit on incorporation into meal plan

• Food craving• Eating at social events

or school• Snacking when bored

or alone

Barriers to Risk Reduction

• Lack of knowledge• Lack of adequate

medication taking• Cost of medications• Medication side effects• Fear of hypoglycemia• Unhealthy eating

• Lack of confidence in self-efficacy

• Lack of motivation

• Limited understanding of vulnerability

Use in conjunction with My Action Plan to Solve a Problem.

FINALLYContinue with planning and

implementation.

• ER visits

• Preventable hospitalizations

• Emergence or progression of diabetes complications

• Inadequate control: BP, lipids, glycemia

• Trouble coping

• Difficulty reducing risks

• Unable to problem solve