Juan Garcia is a 47-year-old, Hispanic male, who lives with his wife and has a full-time job working as a math teacher. He has had to add extra hours from a second job at a department store to make ends meet. The extra work has made it difficult to eat well, to check his blood glucose often enough, and to continue his walking program. His primary job has health insurance, but the co-payment is quite high. Juan’s wife also has health concerns and is on his insurance plan. Juan was diagnosed with type 1 diabetes mellitus at age 10. Three years after Juan was diagnosed with type 1 diabetes, his parents were killed in an automobile accident. He was then raised by his aunt and brother without much support. His wife became involved in his care shortly after marriage over 10 years ago. Juan enjoys weekend barbeques with his neighbors and friends from work. He has no routine physical activity. He occasionally attends his nephew’s soccer games and thinks about being a coach for the team. Juan’s father had type 2 diabetes, and Juan can remember his father taking insulin and battling some eye and kidney problems. He also remembers a time when his father passed out because of a low blood sugar. Juan has been told that he has early background retinopathy. He worries that if his vision gets worse, he will not be able to continue building his model trains. He has also noticed some tingling in his feet and some involuntary leg movement at night, which bothers his wife. He mentions seeing an ad on the television about a medicine for erectile dysfunction and wonders if it will work for him. Juan takes medicine for hypertension. He also takes a basal insulin at bedtime and a rapid-acting insulin at meal times. He admits to missing a meal injection several times a week. Sometimes he forgets the shot, and other times he just does not want to take it. Juan does not adjust his insulin. “I let the doctor do that.” Juan remembers having a class about diabetes when he was a teenager, but has had no updates since then. He believes dietitians and other healthcare providers give him unrealistic goals. “They just do not understand all the stress I am under.” Juan tries to be careful with the amount of carbohydrates and fat in his meals, but he does not really know how to count carbohydrates. He thinks the most important thing on a food label is the carbohydrates. His wife does most of the cooking at home. He has fast food meals 3–4 days a week, takes his lunch to work, and eats out with his wife about once a week. His favorite foods are Mexican, Chinese, and his barbeques. His wife tries to remind him to eat healthy, but he admits to ignoring her sometimes. “There are just times when I always feel hungry.” Juan’s A1c last month was 9.5% and he has been to the ER twice in the past two months for severe hypoglycemia. His wife had to give him a glucagon shot when he passed out three months ago. Juan checks his blood glucose a couple times a week. The strips are expensive and the testing makes his fingers sore. “Besides, what would I do with the number? It is always the same—high.” Juan acknowledges that diabetes is hard to deal with. “I get depressed and want to give up because I have had it too long. I guess I was destined to get this diabetes because my dad had it. Now I am having eye problems like he did. What next?” Cross-Cultural Counseling For this assignment, you will: Create a teaching plan for the patient used in the Juan Garcia case study (see assignment Resources). Include principles from your readings regarding the healthy plate method and cross-cultural counseling for the patient. Consider the patient’s age, gender, and medical-surgical-social history, including culture, habits, religious beliefs, and so on. The teaching plan should include: Principles from your readings regarding the “healthy plate method,” and the following, including the methods of deriving or deciding on the following information. Both subjective and objective data to support your plan. Analyze the Four-Step Process to improve cross-cultural counseling and its relation to patient in case scenario. Purpose of your teaching plan. Overall goals. Short-term goals, long-term goals. Note: The goals must be objective, Specific, Measurable, Attainable, Relevant and Timely. Method for evaluation of goals objective. Specific teaching content, rationale, and documentation. Specific teaching strategies, rationale, and documentation. Teaching materials to consider. Referral, consultations to consider. Write 2–3 pages using APA style and formatting. Support your findings with evidence-based references.
