Enlightenment of metabolic syndrome nursing work

The core of metabolic syndrome care has never been to follow the guidelines and issue standardized diet and exercise prescriptions, but to implement "stratified adaptation, multi-agent collaboration, and individualized intervention that takes into account the triple attributes of physiology, psychology, and society." This is my most profound conclusion after working in a community chronic disease nursing position for 6 years and following more than 200 patients.

When I first started working, I was particularly superstitious about the "standard answers" in the guide. When I saw the 52-year-old taxi driver Brother Zhang for the first time, I looked at his 98cm waist and the critical blood sugar, blood lipids and blood pressure. I followed the guide and prescribed the prescription: the number of steps per day should be no less than 10,000, the daily fuel consumption should be controlled within 25g, and late-night snacks should never be eaten. As a result, he came for a follow-up visit two weeks later, scratching his head and saying that it was impossible to do it: he worked the day shift to catch up with the morning and evening rush hours, and he didn't even have time to find the toilet. How could he find time to walk? After working the night shift, I'm stuck on the elevated highway in the middle of the night. I can't bear it without eating a meat bun with soy sauce. You can't starve yourself to the point of catching up just to control sugar, right? It was then that I realized that the unified care plan was like the one-size-fits-all gloves sold in supermarkets. They seemed to be fully functional, but they were either too loose and slipped off, or too tight to fit in, and could not be integrated into the real lives of ordinary people.

In fact, the academic community has always had two different ideas on intervention directions for metabolic syndrome, and there is no absolute right or wrong. One type is the "indicator-first group". The team I contacted when I went to the endocrinology department of a tertiary hospital for further training had this idea: they believed that only by pulling the intensity of intervention to a threshold that can quickly affect metabolic indicators can the course of the disease be reversed. Otherwise, small efforts are useless. The goals they set for patients are very clear. They are to reduce body fat by 3% and waist circumference by 5cm in 3 months. If they cannot achieve this, they will adjust the plan and increase the dosage. Indeed, there are many retired patients with ample time and strong self-discipline who have brought all abnormal indicators back to the normal range after following the plan for half a year. But back to our community care scenario, this method is a bit "acclimated": We looked at the data last year and found that for patients who were given a full-intensity intervention plan at the beginning, the compliance rate at the 3-month follow-up was only 21%, and most of them simply gave up because they thought the requirements were too high. Therefore, the other school of "compliance first" view is more suitable for grassroots scenarios: regardless of whether the goal is "scientific" or not, the first priority is to enable patients to persist. Even if it only takes 10 more minutes to walk every day and half a spoonful of less salt in cooking, it is better than having a perfect plan but leaving it aside to gather dust.

To give a very impressive example, the 62-year-old Aunt Wang who received the diagnosis last year was very panicked when she was first diagnosed with metabolic syndrome. She did a lot of popular science research, ate multigrain rice, and danced for two hours a day. As a result, she suffered from acid reflux for half a month, and her knees hurt so much that she couldn't go downstairs. She simply broke the jars and picked up all the cakes and milk tea. We later changed the plan for her: replace the multigrain rice with soft rice with 1/3 rice added. You can also eat white steamed buns if you want, as long as you don’t exceed one at a time. ； Start exercising by standing against the wall for 15 minutes after meals every day, and slowly add 10 minutes of walking in the neighborhood. You don’t have to get enough exercise. She felt no pressure and could do it every day. After three months of reexamination, her glycosylated hemoglobin dropped from 6.3 to 5.8, and her waist circumference was 4 centimeters smaller. The effect was much better than before when she had to do it hard.

Speaking of this, I also think of a middle school teacher I followed up last year. He ate a very light diet and took time to run every day, but his blood pressure could not be lowered. It took three conversations to figure out the reason: She led the graduating class of junior high school and changed homework until 12 o'clock every day. The students in the class were so worried about their further studies that they often lay in bed and tossed and turned until 2 or 3 o'clock before falling asleep. We later collaborated with a psychological counselor from the street to give her 4 times of stress relief and taught her to do 5 minutes of abdominal breathing meditation before going to bed. We did not change her diet and exercise plan. One month later, her systolic blood pressure dropped by 12mmHg. Do you think it is magical or not? Many people always think that metabolic syndrome is caused by "eating too much and moving too little". They forget that long-term stress and sleep disorders themselves will aggravate insulin resistance. Just focusing on eating and moving is simply treating the symptoms rather than the root cause.

Our colleagues at the private nursing station often say that the care of metabolic syndrome relies on "three-thirds of professionalism and seventy-seven of empathy." You have to really squat down to see what the patient's life is like, and you can't just sit in the clinic and make demands for granted. When giving guidance to a delivery boy, you can’t ask him to go home and cook every day. You have to teach him how to choose meals with less sauce and more protein in the delivery, and how to do a few small movements like tiptoeing and breast expansion while waiting for an order. ； When giving guidance to a stay-at-home mother, you can't let her take 1 hour to go to the gym every day. You have to teach her to do 10 minutes of home resistance while her child is taking a nap, and just take an extra 10 minutes of detour when shopping for groceries. To put it bluntly, nursing is not about giving patients a ticket that they "must do", but giving them steps that they can reach.

In fact, I have been doing chronic disease care for so long, and I have not come up with any universal formula that is applicable to everyone. The biggest revelation is nothing more than this: Don’t treat patients as a bunch of abnormal indicators that need to be corrected, treat them as ordinary people with their own difficulties and preferences. The solutions you give can be seamlessly integrated into their original lives, and only those solutions that are truly useful will be effective.