Question

Julie is 45 year old mother and lives on a cropping farm, run as a family business, with her husband and his brother. Julie has three children same, aged 14; Katie, aged 12 and James aged 8.The two older children attend boarding school and return home for holidays. James is at home and attends the local primary school 50 km away.
Both Julie's boys have type 1 diabetes that she manages.
Julie has lived with her diabetes for 37 years and has many comorbidities due her both her diabetes and celiac disease. which she developed as a teenager. Julie has stage 3 chronic kidney disease, poor eyesight and osteoporosis. She is currently tryinģ to give up smoking after having smoked since of 16.
Julie currently sees her endocrinologist in large metropolitan hospital every three-month at outpatient clinic. It take her five hours to drive by car to the appointment in the city a journey that she takes with her husband. Her nephrologist is based at the regional hospital about 2 hours drive from home.Julie engages with a diabetes educator via phone and face to face monthly . The local hospital is 50 km away and is small, rural hospital. with a locum doctor and regular nursing staff, who cover the acute inpatient ward, and community registered nurse. She attends a community chronic diseases self management program at the local church hall run by the community registered nurse once a week in town and does her weekly groceries. Julie has expressed to the diabetes educator that she need more assistance with managing her own condition. She is concerned that her son who have type 1 diabetes, may end up with the same comorbidities as her because she has an autoimmune chronic condition

Question

Collaboration between interdisciplinary team members is a dynamic process reliant on effective communication and shared-decision making. Students must recognise and understand that individuals with chronic and complex conditions require interdisciplinary management to ensure quality patient outcomes.

1.Using the case study provided , you are required to verbally execute a clinical handover to a relevant interdisciplinary health professional using the ISBAR (Identify, Situation, Background, Assessment and Recommendations) format.

2.You are required to provide written rationale for your chosen interdisciplinary healthcare professional. This rationale must demonstrate your understanding of the importance of collaborative care in relation to the patient.

Answer 1

1.

• Identitiy:Me name is (xxxxx) , Iam a community nurse in a diabetic ward . My patient's name is Julie , female 45 years and Dr (xxx) is the attending Physician.
• Situation: Iam calling you since my patient is suffering from a chronic and complex type of medical complications that needs your urgent care. My patient finds it really difficult to treat her conditions the right way since her treatment requires a combinations of different interdisciplinary attention.
• Background: My patient was first dignosed with type 1 Diabetes followed by another autoimmune condition , Celiacdisease at the age of 37 years.She has stage 3 chronic kidney disease, poor eyesight and osteoporosis. She is currently tryinģ to give up smoking after having smoked since of 16.She currently sees her endocrinologist in large metropolitan hospital every three-month at outpatient clinic. It take her five hours to drive by car to the appointment in the city a journey . Her nephrologist is based at the regional hospital about 2 hours drive from home.Julie engages with a diabetes educator via phone and face to face monthly . The local hospital is 50 km away and is small, rural hospital. with a locum doctor and regular nursing staff, who cover the acute inpatient ward, and community registered nurse. She attends a community chronic diseases self management program at the local church hall run by the community registered nurse once a week in town .
• Assesment: As a diabetic educator , i have assesed her condition and i think its pretty complicated .I have helped her with her diabetes for almost 5 years now and i think because her condition consists of other conditions iam not that well versed with , Its difficult for me to treat her further.
• Recommendation: As you are are well versed with auto immune conditions and the conditions rooting from it i would like you to review this patient and come up with a management plan by which her quality of life can be improved Also two of her sons also suffer from Type 1 diabetes . She is worried that they also will reach the same fate as she is doing right now . Suggest some recommended guidelines and treatments.