Diabetes & Obesity Case Study (Case Study Sample)

Case Study:
Care for an Obese Patient
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Case Study:
Care for an Obese Patient
Introduction
The evolution of the field of psychology in the recent years has shown the radical change underwent by the view of the world of medicine and health towards the human person and its healing. Indeed, in addition to evidence-based practice, one other significant inclusion in the curriculum and practice of psychologists is holistic psychology. Holistic psychology involves a specialization in psychology, as well as a newly-promoted principle that involves the administration of psychology care that caters not only to the physical needs of the person, but also his/her social, emotional, spiritual, and other needs CITATION Ame07 \l 1033 (American Nurses Association (AMA), 2007).
Indeed, Dossey and Keegan (2009) noted that holistic psychology involves healing the person as a whole, and not as a sum of its multiple parts. A significant aspect of holistic psychology is then psychological or mental health. Under this concept, care is given not only to address the physical symptoms, but also the possible underlying psychological causes of a disease CITATION Lan06 \l 1033 (Lane, 2006).
In relation, this paper will involve the use of the concept of psychiatric psychology, especially in its application in the care of a patient. More specifically, this paper will involve the analysis of the underlying psychological condition of a patient that prevents her from fully healing and truly changing. This paper will first present an overview of the aforementioned case to be studied. A discussion of the problem from a psychological perspective will then follow. Also, this paper will then explore the history of the patient's case, as well as the different factors that contributed to the patient's problem. Finally, a treatment plan will be discussed, and the said plan will involve the different interventions developed based on the patient's problems that were analyzed earlier.
Overview of the Case
Patient Susan Smith (pseudonym, for purposes of confidentiality), a 41 year old female, was referred to the unit by her current diabetes clinic. The said patient is married, and is now mother to three young children whose ages were three, seven and nine years, respectively. As of the present, patient Susan is unemployed and rarely wanders out of her home. However, before she established her family and before she gave birth to her children, patient Susan worked as an administrative assistant for a lucrative and competitive company. Upon assessment, Susan was found to have a height of 170 centimeters (five feet, six inches), and a weight of 120 kilograms (264 pounds). With these vital statistics, Susan has a Body Mass Index (BMI) of 41.5 kg/m2. In interpreting this finding, the World Health Organization's (WHO, 2000) BMI Classification Table reveals that patient Susan is obese, with a classification of ‘Obese Class III'. The same source also revealed that Susan is morbidly obese, a status which places her in a great risk for major disease, including obesity.
In addition, the patient also revealed a very intact support system, especially since Susan described her marriage as “good”, and she also verbalized that her husband was very supportive. In fact, almost all members of Susan's family are obese, including her husband, and her two eldest children. Still, because of her obesity, she has developed Type II Diabetes and is now ambulating with the help of a cane, because she experiences chronic joint pain. The patient related that she has “tried every diet possible”, but none of these seem to have ever worked. The patient also admitted that she has experienced depression because of her weight gain and her current condition. To make matters worse, Susan also feels that she has felt increasingly powerless to solve her weight problem, especially now that her eldest child has also been teased about his large weight.
Description of Problem (Psychological Perspective)
In assessing the patient, several problems became immediately apparent. Still, before analyzing the patient's problems, it is important to note that one significant and useful basis for assessment is Maslow's Theory of Motivation or Hierarchy of Needs (as cited by O'Connor & Yballe, 2007). According to this theory, man is mainly motivated by different unfulfilled needs, which he fulfills in varying levels or steps that can be depicted in the form of a pyramid.
At the lowest level of the pyramid are the biological or physiological needs, which involve the person's physical demands to survive. Physical needs include food, water, shelter, clothing, oxygen, and numerous others CITATION Mar04 \l 1033 (Milliken & Honeycutt, 2004). After physical needs comes the safety and security needs, which include the person's need for actual and perceived security, such as in the case of a safe community (actual) or of a medical insurance (perceived). Upon fulfilling his/her security needs, the person is next motivated by his/her needs for love and belonging. This level of motivation involves the person's need to develop meaningful relationships with other individuals, as evidenced by the person's friends and family CITATION The08 \l 1033 (Tulchinsky & Varavikova, 2008). Still, after the person's social needs (love and belonging), there are two more needs that serve as motivation for the individual. These needs include the person's self-esteem and self actualization needs. Self-esteem involves the person's perception of his worth as a human being and a member of the community, while self-actualization involves the capacity to realize one's fullest potential CITATION Car08 \l 1033 (Rosdahl & Kowalski, 2008).
Using now this model in analyzing Susan's case, it can be seen that in the physiological realm, the patient has a problem with his diabetes type II. The patient's eating habits, as well as other physical aspects need to be developed, including the patient's leg, since she was experiencing chronic pain. Her security and social needs, on the other hand, seem to have been fulfilled rather well, since she has a home and a supportive family, even though she no longer has a job. However, some issues can be seen in the patient's social needs as well as her self-esteem needs. Ironically, though, these issues with her self-esteem can be seen as among the causes of her continued unhealthy lifestyle and weight gain. Thus, given that the patient was unable to meet her self-esteem needs, then she would have been most certainly hard up in meeting her self-actualization needs. Moreover, in looking in the said hierarchy, a problem can already be seen in the patient's lifestyle and cognition. In fact, Maslow stated that in order to move to a higher level of need or motivation, one must first be able to fulfill the lower levels of need CITATION Bar081 \l 1033 (Kozier, Erb, Berman, Snyder, Lake, & Harvey, 2008). Thus, since at the first level (physiological) alone there was already a problem, it can be rather expected that Susan will have a problem transcending the higher levels of need CITATION Act00 \l 1033 (Acton & Malathum, 2000). Thus, in order to help the patient change her way of thinking, she must be assisted to properly address the physiologic and social (love and belonging) levels of need. Still, in addition to this possible problem, another cognition that can be related to the hierarchy of needs and is also observed in Susan is the fact that although she has a strong support system, the said support system itself is rather problematic, since the individuals concerned are also overweight or obese.
If we add to the said problems the issue of the patient's self-esteem, then it can be better understood why the patient's previous attempts to diet did not work. Since Susan did not have sufficient trust in her capabilities, she may have already subconsciously doubted at the beginning of every attempt the effectiveness of a certain diet CITATION Mor021 \l 1033 (Moran & DuBois, 2002), causing some sort of self-fulfilling prophecy that leads to the failure of the attempt CITATION Sti09 \l 1033 (Stinson, Cameron, Wood, Gaucher, & Holmes, 2009). Thus, treatment should address both physical and psychological needs of the patient.
Case History & Contributing Factors
Given the said motivations for the patient's current behavior discussed in the earlier chapter, a change in the patient' behavior and way of thinking is therefore needed. In order to do this, the Health Belief Model (HBM) can be used to assist the patient in behavior modification. The said model posits that health promotion or changes in health habits can only be achieved through the realization of six significant factors: the patient must feel that she is susceptible to a condition (perceived susceptibility), that the condition or threat is severe (perceived severity), that there are possible impediments to the behavior change (perceived barriers), but that the change in behavior can very much help the person (perceived benefit). More importantly, Susan must also realize that not taking an action can cause further damage (perceived threat) and that she can take control of her health (perceived control) CITATION Nat05 \l 1033 (National Cancer Institute, 2005).
However, in looking at the earlier discussion on the patient's motivational (hierarchy of needs) problem, it can be seen that the major contributing factors to her continued obesity and diabetes problem is her perceived lack of control (low self-esteem), her high perceived barriers, her perceived benefits that were low (lots of diet did not work) and her perception that she can somehow still handle being obese since the diets do not work anyway (...