Enlightenment of metabolic syndrome nursing work

The care of metabolic syndrome is by no means a copy of the standardized indicator control in the guideline. Instead, it must be based on evidence-based evidence and embedded in the patient's real life scenario to make individualized adjustments. Only by shifting from "requiring patients to cooperate with medical treatment" to "medical treatment adapting to patient needs" can truly achieve long-term effective intervention.

Two years ago, I met Uncle Zhang who drove a taxi. He was 52 years old and had an abdominal circumference of 96cm. His blood pressure, fasting blood sugar, and triglycerides were all on the red line for metabolic syndrome diagnosis. When we first came to set up a profile, we followed the standard plan given in the guide: walk 10,000 steps a day, limit daily salt intake to 5g, quit smoking, and try to cook at home. As a result, after three consecutive re-examinations, the indicators did not drop at all. He even had a quarrel with the front desk nurse, saying that we "stand and talk without backache" - the day shift works for 12 hours, and it is difficult to even find the toilet during the peak period. How can we find the time to take 10,000 steps? If you rely entirely on roadside fast food to eat, how can you get the low-salt and low-oil conditions? Who is responsible for an accident if I quit smoking and get sleepy while driving?

At that time, Corey had many arguments about the management plan for such patients. Nurses with clinical experience believe that the guidelines have been verified by large sample data, and the benefits of meeting the standards are clear. If patients fail to do so, they have poor compliance, so they need to increase their efforts in tutoring and strictly enforce the indicators. ； Our nurses who go to the community for follow-up every day prefer the idea of ​​​​humanistic intervention. They feel that the real difficulty of patients is not that they are "disobedient", but that they really have no conditions to implement. Hard standards will only make people unwilling to come for follow-up, but they will not be able to even perform basic monitoring. Both views are actually valid. The former gives priority to ensuring the professionalism of intervention, while the latter gives priority to ensuring the accessibility of intervention. There is no absolute right or wrong.

Later, we tried to change the plan for Uncle Zhang: instead of adding in 10,000 steps, we parked the car and walked around the parking lot 3 times every shift, which took less than 10 minutes. Two shifts a day took 20 minutes, almost 6,000 steps, and it was enough to reach the basic level of activity.； I said hello to the boss of the fast food restaurant I frequented. I told him not to put half a spoonful of salt every time I served him food. Keep a big kettle in the car to make cornstarch water, and don’t always buy carbonated drinks. ； You don’t need to quit smoking all at once. First reduce it from 12 to 6 cigarettes a day. Then smoke again when you feel really sleepy. Then slowly reduce the amount. After three months of implementation, Uncle Zhang came back for a follow-up check. His blood pressure dropped to 130/85mmHg, his fasting blood sugar returned to 6.2mmol/L, and his abdominal circumference was 3cm smaller. He himself was surprised and said, "This time the requirements are humanly possible."

Last year, we collected data on 372 patients with metabolic syndrome who were enrolled and managed in our jurisdiction. For the group that strictly implemented the standardized protocol, the 6-month follow-up compliance rate was only 21.7%, and the index compliance rate was 14.3%.； For the group that underwent individualized scene adaptation, the six-month compliance rate was 68.2%, and the target compliance rate reached 47.9%. The gap is actually quite astonishing.

A while ago, a 28-year-old Internet operator came to see me. Her physical examination revealed that her triglycerides were over the standard and her abdominal circumference was 87cm, which puts her at high risk for metabolic syndrome. As soon as I mentioned "drink less milk tea," her face fell. She said that she had to work overtime until the early hours of the morning and depended on milk tea to survive. If she stopped, she would have to quit her job. Do you think I can force her to quit? The final plan we discussed was to replace one cup of full-sugar bubble milk tea every day with up to three cups of three-point sugar without any added ingredients per week. When I feel really sleepy, drink black coffee with a spoonful of condensed milk. Get off the subway one stop early after work and walk home slowly for 20 minutes. There is no need to go to the gym. She breathed a sigh of relief and said, "I can do this." A follow-up checkup six months later found that her triglycerides had returned to the normal range and she had lost 4 pounds.

In fact, I used to think that nursing is to clearly explain the guideline requirements to patients one by one. Failure to do so is the patient's problem. After encountering many obstacles in the past few years, I realized that metabolic syndrome care has never been a "standardized test paper". Everyone has the same answer. ； Instead, it's like building blocks. You have to first look at what blocks the patient already has in his hands - whether he is a migrant worker who works 12 hours a day, a mother who is constantly raising her baby at home, a truck driver who travels long distances, or an old man who is retired and has no time at home. Then use these ready-made blocks to build the most stable structure, rather than forcing the patient to use blocks that you think are "correct". He will not be able to catch or build them, and eventually everything will collapse.

Of course, some colleagues do not agree with this idea. They feel that relaxing the requirements is unprofessional and will make patients feel that "it doesn't matter if they don't meet the standards." I think we must first distinguish between the "perfect standard" and the "effective bottom line." For example, the standard for salt control is 5g per day. If a patient usually eats 12g, and you ask him to reduce it to 5g at once and he can't do it, is it okay to reduce it to 8g first? It's also beneficial. It's better than continuing to eat 12g without breaking the pot, right?

Speaking of metabolic syndrome, it is a lifestyle disease. It involves everything from eating, drinking and sleeping. The job of nursing is never to pull patients out of their lives and stuff them into a "healthy template", but to get into their lives and help them find a comfortable and healthy balance. After all, a good plan is a plan that can be adhered to for a long time.