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Diabetes Research And Clinical Practice Assessment Answer



As per the case study of Gulcin, the major health problems identified are Diabetes type 2, social isolation and urinary incontinence. Social isolation is the primary heath determinant observed in her case. After migrating from Turkey, she has settled in Melbourne and badly wants to meet her parents and siblings. She has also lost her uncle who has sponsored her family a few years ago and lived without any relatives in Australia. Thus, her life revolves around her husband and four children. She is longing since years to visit Turkey to meet her parents and siblings but in vain. According to Browne et al., (2015), social isolation is the absence or a lack of meaningful social contact. There is a difference between those who are socially isolated and those who prefer to be alone. The later is the loneliness and is the absence of the contact of an individual with another human.

She was diagnosed with Type 2 diabetes after some medical tests. She felt exhausted and drained of energy. Diabetes is the chronic illness and is the primary challenge faced by the public health authorities (Tay et al., 2014). Across the world, it is recognized to be the fastest growing disease in the human history (Greenwood & de Leeuw, 2012). Type 2 diabetes mellitus is the complex disease and requires substantial effort from the patient to manage or cope with the comorbidities. Stress, anxiety, and depression are additional common problems associated with T2DM and is observed in 41% of the diabetic people (Britt et al., 2013). There is a need for effective communication and collaboration between the care providers and the patients so as to assist them in coping with the disease.

Gulcin is profoundly worried about her urinary incontinence and feels awkward to discuss it with her general practitioners. She is afraid of experiencing more "waterworks accidents" while moving and going out. Therefore, she restricts herself to home and saves money for a trip to Turkey by making more lampshades. International Continence Society defines “urinary incontinence” (UI) as involuntary leakage of urine which can be described severity of the problem, frequency, hygiene, quality of life and other social aspects (Australian & New Zealand Continence Journal, 2014). Chronic conditions and UI is highly likely to occur in the community of elder population. There is a need for identifying and minimizing barriers to early diagnosis and treatment of chronic diseases and UI. It is essential to improve the quality of life of the patients and decrease the burden of cost (Avery et al., 2014). The essay will discuss the health determinants in the subsequent sections and summarize the conclusion.

The experience of living conditions greatly shapes the health status of the Canadians. It has more influence than lifestyle choices and medical treatments. The term social determinant explains this phenomenon which reflects thinking beyond the medical aspects of the disease. It refers to taking into consideration other factors contributing to illness or health. The majority of the Canadians are unaware of this evidence-based information. According to the Canadian Model of the determinants of health involves education and literacy, social support networks, income, social status, Social Inclusion, Employment / working conditions, Social Environments, Healthy child development, physical environment, personal health practices and coping skills, gender, Biology and Genetics endowment, health services and culture (Britt et al., 2013).

There are seven health determinants identified in the case study of Mrs. Gulcin. Social support and Networks is the first health determinant identified. Better health outcomes are achieved when patients receive adequate support from families, friends, and communities. Social support is essential to address people’s problems and help them to cope with their adversity. It is important to help people in gaining control over their life and control the circumstances (Paul et al., 2013). I will arrange community support services for Gulcin as she has no relatives except her husband and children. She and her family can utilize a variety of programs organized by Brimbank City Council (Redfern & Chow, 2013). It includes various services that relate to this health determinant including migrant services which is useful for Gulcin as they are from Turkey. Also, government support, as well as support at a professional level, is also provided by this council. Gulcin can also avail playgroup programs for her children from this council. It is a very relaxed environment for the children involving the participation of the children, parents, grandparents, and babies meet, caregivers in informal sessions. Children choose the range of activities from the playgroup as per their needs. These are the cost effective method, and playgroups can be set up by the parents anywhere in a community and the neighborhood centers, kindergartens, church halls, health clinics, and women’s centers as per the safety conditions. Smalltalk in Supported Playgroups helps parents meet their needs, allow their children to enjoy with other children and teach them strategies to promote their children’s learning and development. These parenting strategies are delivered by the trained facilitators who aim for improved learning, wellbeing and development outcomes for children (City of Brimbank, 2016). They achieve this by providing the early home learning environment to the children and ensuring effective parent-child interaction. These are highly beneficial for the parents as they learn and develop effective parenting skills, confidence to meet their children’s developmental needs (Roe, Flanagan & Maden, 2015). Families can use or transit to other community support services that provide more intensive or specialist early childhood services along with Turkish interpreters.

Education and literacy are the second health determinant identified from the case study of Mrs. Gulcin. People with high level of educational attainment tend to have better clinical outcomes (Hutchings & Sutherland, 2014). Socioeconomic status determines health literacy and corresponding health status. Education informs people about the pros and cons of illness and behavior that affects health. Therefore, education imparts knowledge, problem solving skills and lifelong learning for the maintaining sense of security and job satisfaction. It increases the capability to access health information and enhance protective behavior to keep their health safe (Tay et al., 2014).

Gulcin is suffering from Type 2 Diabetes Mellitus and UI and is highly worried about her healthy consequences. I can help her increase the knowledge about her illness by providing assistance through "ISIS Primary Care Health Community Clinic." I will arrange for diabetes educator, female doctor or nurses so that she can comfortably share her problems without feeling awkward. They provide general practice, diabetes services and support groups for women’s health (Anon, 2016). Health practitioners in this clinic tend to create awareness about health issues. This will broaden Gulcin’s knowledge and increase her coping skills. Therefore, she can better manage her diabetes and UI. As she is not fluent in English, she can avail interpreters who can speak in different languages in this clinic. It is evident from the case study that she gets tired quickly and cannot perform intense physical activities. Therefore, exercise is not a good option for her. Hence I will arrange for physiotherapist. She will be provided with ROHO cushion which has therapeutic benefits. It will help to minimize stress while making lampshades (Redfern & Chow, 2013).

“Personal Health Practices and Coping Skills” is the third health determinant observed in the case study of Mrs. Gulcin. It refers to behavior which can prevent chronic diseases and enhance coping skills, promote self-care, increase self-reliance and make health-promoting choices (Paul et al., 2013). To assist Gulcin with her waterworks problems home care intervention is best suited. Initially, I will collect her history of UI that includes information related to frequency, duration, severity of leakage and other factors influencing the condition. This will help develop the management strategies knowing the causative factors correctly. I will identify best strategies to improve this condition based on supporting evidence. I will perform an assessment of current strategies such as reduction of bladder irritants, change in fluid intake, use of containment devices and prompted or scheduled toileting (Newall & Menec, 2013). I will recommend Gulcin to use disposable or reusable insert pads after explaining her about its advantages in providing relief from UI.

As mentioned in the case scenario, Gulcin is feeling lonely and is longing to meet her parents and siblings in Turkey. She is depressed which is of priority concern as she does not have any relatives in Australia. I will use person-centered approach and encourage her to express her fears and worries. I will use empathetic communication and involve her family for support and accomplish target goals. Empathy and affection increase confidence and security thereby, creating the positive environment (Ignatavicius & Workman, 2015). This will enhance coping skills and decreases anxiety and depression in the patient. Acknowledging will make the patient feel that they are understood, and their needs are addressed. I will suggest Gulcin’s  family to admit her in the "Settlement Support Groups" by Brimbank City Council. These services are meant for migrants in Melbourne and help them to enhance self-esteem and self-reliance by integrating into broader community through physical activities, engagement in arts and sports (Browne et al., 2015). These will provide Gulcin with opportunities to meet other people and friends and share each other’s experience and foster mutual support.

Biology and Genetic Endowment is the fourth health determinant in Gulcin’s case.  It refers to the genetic predisposition of various chronic diseases or health responses that influence health status. Several diseases such as Alzheimer, Diabetes are inherited in the family. According to Redfern & Chow, (2013) T2DM is a “genetically complex and chronic disease." Therefore, it is apparent that Gulcin has inherited her illness in the family. Recent literature on diabetes prevention highlights the need for developing effective strategies to motivate and improve compliance to the medication and disease management. The strategies aim at improving the positive lifestyle changes which have been proved to decrease the risk of T2DM (Paul et al., 2013).

“Health services” is the fifth health determinant observed in the case study of Mrs. Gulcin. Health services refer to primary treatment, secondary treatment, services designed for maintaining health and restore function that was present before the illness (Lee et al., 2013). Brimbank City Council provides several clinics that offer the wide range of services to the diabetic patients I the West Side. I will refer Gulcin to avail services in “ISIS Primary Care at St. Albans” because it has diabetes specialists. These professionals provide health education to the patients. Gulcin can learn to monitor her blood glucose level, take the right dose of insulin and tablets. She can be referred to "National Diabetes Services Scheme (NDSS)" to purchase medicines at cheaper rates as well other diabetes products. Additionally, she will be educated about correct food behavior required to avoid comorbidities associated with diabetes. They also engage patients in supermarket tour. Gulcin can also avail counseling sessions for goal setting and meeting targets. ISIS provides women's health nurses who will be of greater help to Gulcin as she is embarrassed to discuss her issues with GP. These professionals maintain privacy and confidentiality of the patient’s data. These are free services which Gulcin can access to save her money.

The sixth determinant identified in the Julien's case is gender. It refers to the range of social and cultural characteristics, behaviors, values, socially determined roles, relative power, that are different for males and females (Stellefson, 2013). The practices and priorities of the health system sare influenced by the Gendered norms. The UN Millennium Development Goals practices and promotes Gender equity in all the programs especially low and middle-income countries (Feinman et al., 2015). Special services are designed for women such as family planning, pap smear services, dealing with menopause and continence issues, breast awareness. These services ensure healthy and happy life for women. 

Culture is the last determinant of health in Gucci's case. According to Britt et al., (2013), dominant cultural values lead to conditions such as devaluation of language and culture, decreased access to culturally appropriate health services and stigmatization (Boyle et al., 2016). Cultural inclusion can be enhanced by respecting and ensuring the safety of the culture. Gulcin can benefit from Women Moving Forward groups, Cooking Courses, Career’s support that will strengthen Gulcin’s community engagement as she belongs to Turkey and is socially isolated in Australia.


Conclusively, social determinants are important health-influencing factors. Identifying and addressing them can help improve health outcomes of Gulcin. As a nurse, it is my duty to address health determinant which partakes in health care practice and assist individuals to cope with the disease.


Avery, J. C., Gill, T. K., Taylor, A. W., & Stocks, N. P. (2014). Urinary incontinence: severity, perceptions and population prevalence in Australian women. Australian and New Zealand Continence Journal, The, 20(1), 7.

Boyle, E., Saunders, R., & Drury, V. (2016). A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners. Journal of clinical nursing, 25(13-14), 1977-1986.

Britt, H., Miller, G. C., Henderson, J., Bayram, C., Valenti, L., Harrison, C., ... & O'Halloran, J. (2013). General Practice Activity in Australia 2012-13: BEACH: Bettering the Evaluation and Care of Health (No. 33). Sydney University Press.

Browne, J. L., Nefs, G., Pouwer, F., & Speight, J. (2015). Depression, anxiety and self‐care behaviors of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long‐term Empowerment and Success (MILES) Study. Diabetic Medicine, 32(1), 133-140.

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Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., ... & Nielsen, J. V. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition, 31(1), 1-13.

Greenwood, M. L., & de Leeuw, S. N. (2012). Social determinants of health and the future well-being of Aboriginal children in Canada. Paediatrics & child health, 17(7), 381.

Hutchings, J., & Sutherland, L. (2014). Student nurse understanding of the psychosocial impact of urinary incontinence. Urologic nursing, 34(6), 318-326.

Ignatavicius, D. D., & Workman, M. L. (2015). Medical-surgical nursing: Patient-centered collaborative care. Elsevier Health Sciences.

Lee, C. M. Y., Colagiuri, R., Magliano, D. J., Cameron, A. J., Shaw, J., Zimmet, P., & Colagiuri, S. (2013). The cost of diabetes in adults in Australia. Diabetes Research and Clinical Practice, 99(3), 385-390.

Newall, N. E., & Menec, V. H. (2013). Targeting Socially Isolated Older Adults A Process Evaluation of the Senior Centre Without Walls Social and Educational Program. Journal of Applied Gerontology, 0733464813510063.

Paul, C. L., Piterman, L., Shaw, J., Kirby, C., Sanson-Fisher, R. W., Carey, M. L., ... & Thepwongsa, I. (2013). Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial. Implementation Science, 8(1), 1.

Redfern, J., & Chow, C. K. (2013). Secondary prevention of coronary heart disease in Australia: a blueprint for reform. Med J Aust, 198(2), 70-71.

Roe, B., Flanagan, L., & Maden, M. (2015). Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes. Journal of advanced nursing, 71(7), 1464-1483.

Stellefson, M. (2013). The chronic care model and diabetes management in US primary care settings: a systematic review. Preventing chronic disease,10.

Tay, J., Luscombe-Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G. A., ... & Brinkworth, G. D. (2014). A very low-carbohydrate, low–saturated fat diet for type 2 diabetes management: a randomized trial.Diabetes Care, 37(11), 2909-2918.

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