Enlightenment and reflections on metabolic syndrome nursing work

The core conclusion of metabolic syndrome nursing is not to copy standardized diagnosis and treatment paths and blindly pursue short-term achievement of indicators, but to break away from the single evaluation logic of "numerical theory" and build a dynamic nursing system that takes patients' real life scenarios as the core and takes into account clinical evidence-based evidence and patients' long-term compliance. This is the most solid practical conclusion after I have been engaged in chronic disease care in a community health service center for 8 years and dealt with nearly a thousand patients with metabolic syndrome.

Speaking of which, this conclusion was not drawn from the guide. It was a lesson taught to me by Uncle Zhang, an online ride-hailing driver who treated me last month. The 52-year-old Uncle Zhang's abdominal circumference is 102cm, his blood pressure hovers around 145/95mmHg all year round, his fasting blood sugar is 6.7mmol/L, and his triglycerides are twice as high. He just meets the diagnostic criteria of metabolic syndrome "abdominal obesity + hypertension + impaired glucose regulation + dyslipidemia". At first, I gave him a standard prescription according to the guidelines: at least 150 minutes of moderate-intensity aerobic exercise per week, a low-GI diet, and a daily caloric intake of less than 1,800 calories. I also gave him a detailed recipe. After a recheck two weeks later, the indicator showed no movement at all. Uncle Zhang scratched his head and told me the truth: "Girl, I drive 12 hours a day and eat in the service area. How can I have time to cook brown rice for you? It's almost 11 o'clock when I stop driving, how can I still have the energy to run for half an hour?"

After this incident, Corey held a case discussion meeting and argued for a long time. The young nurse from the evidence-based nursing school felt that Uncle Zhang had poor self-discipline. The intervention path clearly written in the guide would definitely be effective as long as it was strictly implemented, and follow-up supervision should be strengthened. The old head nurse from the humanistic nursing school directly responded: "Go and take a 12-hour online ride-hailing test. Try? If you can stand and talk without pain in your back, no matter how good the plan is, it will be zero.” In fact, this is also a controversy that has not yet been fully understood in the field of metabolic syndrome care: should we prioritize ensuring the evidence-based rigor of the intervention plan, or should we prioritize ensuring patient compliance?

I didn’t force Uncle Zhang to follow the original prescription. I followed him for a long time and changed the plan after finding out his schedule: I don’t need to take time to exercise. I walk around the car for 5 minutes after delivering an order. Don’t sit while waiting for the order. Stand up and twist and kick your legs. Just come down and get enough 30 minutes of exercise; you don’t have to eat brown rice for meals. For the lunch boxes in the service area, replace half of the white rice with steamed corn or roasted sweet potatoes, add some cold vegetables, and replace the sweet drinks with the sugar-free oolong tea that comes with you. Don’t eat ham when you are really hungry, buy some boiled corn to fill your stomach. Such a loose plan was implemented effortlessly by Uncle Zhang. Three months later, he came back for a follow-up examination and found that his abdominal circumference had lost 4 centimeters, his blood pressure was stable at 135/85mmHg, and his glycosylated hemoglobin dropped from 6.8% to 6.2%. The effect was much better than the previous standard prescription.

Oh, by the way, there is another misunderstanding that is particularly easy to avoid. Many people think that metabolic syndrome is a "disease of fat people", but in fact it is not at all. Last year, I treated a 28-year-old Internet operator girl who was 165cm tall and weighed only 90 pounds. During the physical examination, it was found that her fasting blood sugar was 6.9mmol/L and her triglycerides were three times higher, which is also a typical metabolic syndrome. After asking, I found out that she stayed up until two or three o'clock every day, drank milk tea instead of water, ate takeaways heavy in oil and salt, and hardly exercised. The exercise prescription I prescribed for her at first was to go to the gym to lift irons. She went to the gym twice and found it too troublesome and never went again. Later, I asked her to get off the subway and walk home two stops early after get off work. I changed her usual milk tea from full sugar to sugar-free and fresh milk. She is really greedy and drinks full sugar at most once a week. I put an egg boiler in the office. When she is hungry, boil eggs instead of puffed food. After two months of this change, the index fell back to the normal range.

In the past few years, I have tried many popular nursing models in the industry. I am not saying that any one is 100% better. For example, a higher-level hospital previously launched a "centralized health training camp", where patients were invited to live there for a week and provided unified meals and exercises. After a week, the indicators dropped very quickly, but many patients rebounded within two months after returning home. Why? The life in the training camp is too unrealistic. No one has time to cook meals with less oil and salt at home every day, and no one can spare two hours of exercise every day. On the contrary, the "peer care group" established in our community is surprisingly effective. It allows old patients with good control to share their experiences with new patients. They are all from the same community, and they buy food at the same vegetable market. The recipes shared are all ingredients that can be bought for a few dollars. They even know which supermarket has cheaper cereals. New patients can directly copy the homework, and the compliance is very high.

In fact, after working in nursing for a long time, I feel that caring for metabolic syndrome is difficult to say and easy to say. Just like maintaining a car, you can't apply the maintenance standards of a sports car to a pickup truck that goes to the construction site every day. It's all about transportation, and the working conditions are different, so the maintenance plan must be adjusted. The guidelines must be adhered to. They are the bottom line accumulated by so many clinical studies, but how to combine the bottom line with the patient's life is our real ability in nursing. Oh yes, there is one more thing I pay special attention to now, that is, don’t label patients as “unself-disciplined” right from the beginning. Many people either don’t want to change, but they don’t know how to change in their own lives. Spending an extra ten minutes asking them what they eat and do every day is much more useful than a ten-page prescription.

Of course, this does not mean that we must completely follow the patient's habits. We must also adhere to the principles that should be adhered to. For example, the bottom line of quitting smoking, limiting alcohol, and drinking less sugary drinks must not be relaxed at all. After all, the ultimate goal of our care is not to let patients live like the standard samples in the guidelines, but to enable them to live their own lives healthily, right?