Implementation of Mindfulness in 66-years-old Female with Diabetic Post Surgery: A Case Report to Inform Nursing Role to Deliver Holistic Care

Ida Widaningsih; Titis Kurniawan; Kusman Ibrahim; Nursiswati Nursiswati

doi:10.37287/ijghr.v6iS6.5291

Ida Widaningsih Universitas Padjadjaran
Titis Kurniawan Universitas Padjadjaran
Kusman Ibrahim Universitas Padjadjaran
Nursiswati Nursiswati Universitas Padjadjaran

DOI: https://doi.org/10.37287/ijghr.v6iS6.5291

Keywords: mindfulness, nursing, post surgery

Abstract

Currently, there are no suggested psychological interventions or outcomes in the diabetic management guidelines. This case report presents the management of a 66-year-old female patient, Mrs. R, with diabetes mellitus, hypertension, and gastroesophageal reflux disease (GERD) who underwent exploratory laparotomy for retained stone exploration in the common bile duct (CBD). This Case report aimed to explore the implementation of mindfulness in patients post-operative. The patient experienced significant hyperglycemia, with blood glucose levels peaking at 436 mm Hg. Psychological assessment revealed a severe anxiety score of 31, which likely contributed to her unstable glycemic control. Throughout her unstable glycemic control. Throughout her severe condition, the patient was managed with total parenteral nutrition (TPN) due to fasting and green gastric contents, as part of the nursing intervention. Comprehensive nursing interventions, including regular blood glucose monitoring, insulin administration, and psychological support were employed. Mindfulness techniques such as guided meditation and breathing exercises have been introduced to alleviate hospital-induced distress and manage blood glucose levels. Following these interventions, her blood glucose level decreased to 167 mmHg, and the patient reported feeling calmer and more spiritually connected (Hamilton Rating Scale/ HARS 18). This case describes the management of post-surgical diabetic patients, highlighting the benefits of integrating psychological interventions to improve glycemic control and overall patient outcomes. Therefore, psychological interventions, particularly mindfulness, are needed for integration in diabetes management, especially in hospitals.

References

American Diabetes Association Professional Practice Committee. (2024). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care, 47(Suppl 1), S158–S178. https://doi.org/10.2337/dc24-S009

Böhm, A.-K., Jensen, M. L., Sørensen, M. R., & Stargardt, T. (2020). Real-World Evidence of User Engagement With Mobile Health for Diabetes Management: Longitudinal Observational Study. JMIR MHealth and UHealth, 8(11), e22212–e22212. https://doi.org/10.2196/22212

Davis, G., Fayfman, M., Reyes-Umpierrez, D., Hafeez, S., Pasquel, F. J., Vellanki, P., Haw, J. S., Peng, L., Jacobs, S., & Umpierrez, G. E. (2018). Stress hyperglycemia in general surgery: Why should we care? Journal of Diabetes and Its Complications, 32(3), 305–309. https://doi.org/10.1016/j.jdiacomp.2017.11.010

Duncan, A. E. (2012). Hyperglycemia and perioperative glucose management. Current Pharmaceutical Design, 18(38), 6195–6203. https://doi.org/10.2174/138161212803832236

Ee, C., de Courten, B., Avard, N., de Manincor, M., Al-Dabbas, M. A., Hao, J., McBride, K., Dubois, S., White, R. L., Fleming, C., Egger, G., Blair, A., Stevens, J., MacMillan, F., Deed, G., Grant, S., Templeman, K., & Chang, D. (2020). Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study. Frontiers in Endocrinology, 11, 570777. https://doi.org/10.3389/fendo.2020.570777

Ferdian, D., Hikmat, R., Anshor, A., Irwan, I., & Triyanto, T. (2024). Overview of Nutritional Status Among Female Students. Indonesian Journal of Global Health Research, 6(2 SE-Articles). https://doi.org/10.37287/ijghr.v6i2.2943

Ford, D. M., Budworth, L., Lawton, R., Teale, E. A., & O’Connor, D. B. (2023). In-hospital stress and patient outcomes: A systematic review and meta-analysis. PLoS ONE, 18(3 March), 1–17. https://doi.org/10.1371/journal.pone.0282789

Frisch, A., Chandra, P., Smiley, D., Peng, L., Rizzo, M., Gatcliffe, C., Hudson, M., Mendoza, J., Johnson, R., Lin, E., & Umpierrez, G. E. (2010). Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care, 33(8), 1783–1788. https://doi.org/10.2337/dc10-0304

Greco, G., Ferket, B. S., D’Alessandro, D. A., Shi, W., Horvath, K. A., Rosen, A., Welsh, S., Bagiella, E., Neill, A. E., Williams, D. L., Greenberg, A., Browndyke, J. N., Gillinov, A. M., Mayer, M. Lou, Keim-Malpass, J., Gupta, L. S., Hohmann, S. F., Gelijns, A. C., O’Gara, P. T., & Moskowitz, A. J. (2016). Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery. Diabetes Care, 39(3), 408–417. https://doi.org/10.2337/dc15-1817

Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597

Hikmat, R., Rahayu, U., Pebrianti, S., Cahyani, E. M., Sari, C. P., & Afrilia, G. (2022). Post-operative pain management with non-pharmacological interventions in patients undergoing breast cancer surgery: A systematic scoping review. The Journal of Palembang Nursing Studies, 1(3 SE-Review), 125–133. https://doi.org/10.55048/jpns.v1i3.24

Hikmat, R., Yosep, I., Widianti, E., Suryani, S., Sriati, A., & Susanti, I. (2024). Stuart Stress Adaptation and Nola Pender’s Model on Mental Nursing Care of Patients Schizophrenia: Case Study. OBM Neurobiology, 08(04), 249. https://doi.org/10.21926/obm.neurobiol.2404249

Holubová, A., Vlasáková, M., Mužík, J., & Brož, J. (2019). Customizing the Types of Technologies Used by Patients With Type 1 Diabetes Mellitus for Diabetes Treatment: Case Series on Patient Experience. JMIR MHealth and UHealth, 7(7), e11527–e11527. https://doi.org/10.2196/11527

Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian Journal of Endocrinology and Metabolism, 22(5), 696–704. https://doi.org/10.4103/ijem.IJEM_579_17

Kian, A. A., Vahdani, B., Noorbala, A. A., Nejatisafa, A., Arbabi, M., Zenoozian, S., & Nakhjavani, M. (2018). The impact of mindfulness-based stress reduction on emotional wellbeing and glycemic control of patients with type 2 diabetes mellitus. Journal of Diabetes Research, 2018, 6–11. https://doi.org/10.1155/2018/1986820

Komariah, M., Ibrahim, K., Pahria, T., Rahayuwati, L., & Somantri, I. (2023). Effect of Mindfulness Breathing Meditation on Depression, Anxiety, and Stress: A Randomized Controlled Trial among University Students. Healthcare (Switzerland), 11(1). https://doi.org/10.3390/healthcare11010026

Lean, M. E. J., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Welsh, P., Kean, S., … Taylor, R. (2019). Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The Lancet. Diabetes & Endocrinology, 7(5), 344–355. https://doi.org/10.1016/S2213-8587(19)30068-3

McCowen, K. C., Malhotra, A., & Bistrian, B. R. (2001). Stress-induced hyperglycemia. Critical Care Clinics, 17(1), 107–124. https://doi.org/10.1016/S0749-0704(05)70154-8

O’Brien, C. L., Ski, C. F., Thompson, D. R., Moore, G., Mancuso, S., Jenkins, A., Ward, G., MacIsaac, R. J., Loh, M., Knowles, S. R., Rossell, S. L., & Castle, D. J. (2016). The Mental Health in Diabetes Service (MINDS) to enhance psychosocial health: study protocol for a randomized controlled trial. Trials, 17(1), 444. https://doi.org/10.1186/s13063-016-1561-4

Pereira, M. da G. (2017). Changing the mind: hypnosis and diabetes. Revista Latino-Americana de Enfermagem, 25, e2868. https://doi.org/10.1590/1518-8345.0000.2868

Saslow, L. R., Mason, A. E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H., Daubenmier, J., Hecht, F. M., & Moskowitz, J. T. (2017). An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial. Journal of Medical Internet Research, 19(2), e36–e36. https://doi.org/10.2196/jmir.5806

Vedantam, D., Poman, D. S., Motwani, L., Asif, N., Patel, A., & Anne, K. K. (2022). Stress-Induced Hyperglycemia: Consequences and Management. Cureus, 14(7), e26714. https://doi.org/10.7759/cureus.26714

Yaribeygi, H., Maleki, M., Butler, A. E., Jamialahmadi, T., & Sahebkar, A. (2022). Molecular Mechanisms Linking Stress and Insulin Resistance. EXCLI Journal, 21, 317–334. https://doi.org/10.17179/excli2021-4382

Yosep, I., Hikmat, R., & Mardhiyah, A. (2023). Types of Digital-Based Nursing Interventions for Reducing Stress and Depression Symptoms on Adolescents During COVID-19 Pandemic: A Scoping Review. Journal of Multidisciplinary Healthcare, 16, 785–795. https://doi.org/10.2147/JMDH.S406688

Yosep, I., Mardhiyah, A., & Sriati, A. (2023). Mindfulness Intervention for Improving Psychological Wellbeing Among Students During COVID-19 Pandemic: A Scoping Review. Journal of Multidisciplinary Healthcare, 16, 1425–1437. https://doi.org/10.2147/JMDH.S411849