Reflections on Standard of Care

Reflections on Standard of Care

Reflections on Standard of Care

Evidence-based practice (EBP), clinical practice guidelines (CPG), and standards of care are essential components of psychiatric care as the frameworks enable mental health providers to deliver high-quality, consistent, and holistic care grounded in empirical research and patient values. However, clinicians may have divergent therapeutic approaches to similar patient scenarios; all are intended to benefit patients and achieve quality care outcomes (Wang et al., 2025). This assignment presents a reflective assessment of clinical care with contrasting treatment interventions between my preceptor and me during my practicum. The paper presents the case, contrasts the treatment approaches, and justifies the interventions based on research evidence. In its final part, the paper explores lessons learned for future clinical decision-making in care delivery.

Patient Case Summary

During my practicum, I encountered a patient with Type 2 Diabetes Mellitus (TDM). The patient was an African American male who presented with poorly controlled blood glucose levels. The patient also had a history of hypertension and hyperlipidemia, consequently placing him on medication. The assessment findings revealed elevated blood glucose and blood pressure levels. As such, the patient required immediate and effective interventions to improve both conditions, especially ensuring the right blood sugar levels and blood pressure to avoid any exacerbation and its implications.

Treatment Plans

Based on the diagnoses, providers can implement divergent treatment plans to improve a patient’s condition. For instance, high blood pressure requires immediate stabilization using pharmacological interventions, especially first-line medication such as angiotensin-converting enzyme inhibitors (ACEi) or Angiotensin receptor blockers (ARBs). During the clinical rotations or rounds, my preceptor’s treatment plan entailed adjusting medications, especially the dosage.

My preceptor’s plan entailed increasing the dosage of Metformin, initiating a GLP-1 receptor agonist, and establishing regular follow-ups to closely monitor the blood sugar levels for further interventions as well as modifications. The preceptor’s proposed treatment plan also included immediate insulin injection to lower HbA1c. As a psychiatric nurse practitioner who adheres to evidence-based and clinical practice guidelines, I propose that we should have a holistic or integrated treatment plan that incorporates pharmacological as well as non-pharmacological approaches (Galindo et al., 2023). My proposed plan entailed maintaining the Metformin dosage as the first line of treatment for T2DM, but not having the insulin injection since the blood levels may shoot unexpectedly. I also proposed the introduction of dietary changes, especially a low-carbohydrate diet, encouragement of regular physical activity, including at least 30 minutes of moderate exercise daily, and integration of patient education on self-monitoring of blood glucose levels. The integration of non-pharmacological interventions will lower the possible side effects of medications, especially due to the patient’s comorbidity status.

Justification based on Evidence, Clinical Practice Guidelines, & Care Standards

Managing comorbidities that involve type 2 diabetes mellitus (T2DM) and hypertension requires an integrated and patient-centered approach. Clinical guidelines recommend ensuring blood pressure control to an acceptable range of <140/90 mmHg (or <130/80 mmHg, in case there is protein in the urine) and utilization of ACE inhibitors or ARBs as the first-line drugs (Melichova et al., 2023). Further, the approach requires rigorous glycemic control, lifestyle modifications, change, and management. The American Diabetes Association (ADA) supports effective medical care standards for individuals with diabetes. At the core of these guidelines are appropriate lifestyle activities and interventions alongside medications for optimal management of type 2 diabetes mellitus. The ADA guidelines recommend a holistic approach that integrates patient education and lifestyle modifications as important aspects of managing diabetes. In their article, Wang et al. (2025) assert that diabetic patients who suffer from hypertension require a comprehensive life change to reduce risk factors, including effective monitoring that enables providers and patients to set blood pressure targets. Key risk factors entail genetic predisposition, aging, obesity, gender, and unhealthy lifestyle. Additionally, Samson et al. (2023) emphasize the importance of effective type 2 diabetes management to lower the risk of risk factors. The guidelines from the article emphasize the importance of having a complication-centric approach that goes beyond glucose levels and frames decisions on the first-line pharmacologic treatment interventions. Through the algorithm, the study offers a holistic approach to diabetes management, especially for individuals with other comorbidities like high blood pressure.

Again, the Diabetes Prevention Program (DPP) (CDC, 2024) recommends lifestyle modifications as an evidence-based practice to reduce the risk of prediabetes and diabetes. According to the program, lifestyle modifications help to improve glycemic levels in patients with type 2 diabetes (Andreae et al., 2026). More fundamentally, regular physical activity can improve insulin sensitivity and enhance blood glucose management. The implication is that the proposed approach is founded on clinical guidelines, evidence-based practice, and recommended standards of care for individuals with type 2 diabetes mellitus and suffering from hypertension.

Reflection on Differences

A comparison of the two plans shows a notable difference in the approaches between my preceptor and me. My preceptor’s approach mainly focused on medication change, an evidence-based practice in the management of T2DM. According to my preceptor’s plan, all interventions should involve medication with limited integration of non-pharmacological activities. Conversely, at the core of my plan is to attain long-term sustainability of the patient, especially by addressing the root causes of the patient’s comorbidity status. Evidence shows that while a pharmacological approach is essential, providers should not consider it as the only remedy for individuals presenting with T2DM (Andreae et al., 2026). The ADA clinical guidelines are explicit that a comprehensive or holistic approach is optimal as it entails patient education and lifestyle modifications (ADA, 2026. Again, dietary changes and exercise can help control T2DM as opposed to medications. Again, the patient suffers from hypertension, a condition that requires effective monitoring.

The different approaches that my preceptor and I use demonstrate clinical experience and utilization of evidence-based practice interventions. My preceptor’s clinical experience may have informed her choices of the medications and her lack of emphasis on non-pharmacological interventions. However, my selection emanates from the integration of the best available evidence, especially from credible sources such as the American Diabetes Association (ADA) (ADA, 2026). My preceptor may have been keen on stabilizing the patient as opposed to a holistic approach. These variances show how providers influence the implementation of evidence-based practice in their clinical settings.

Lessons Learned

The interaction with the case shows the importance of incorporating evidence-based practice through a holistic approach. The analysis demonstrates that while clinical guidelines provide a robust framework for addressing such issues, professional experience and judgment are very critical. The case shows that while patients may require optimal and immediate interventions, empowering patients through education and lifestyle modifications results in long-term outcomes (Galindo et al., 2023). As a nurse practitioner, I believe this case shows that one should advocate for a balanced approach that integrates lifestyle change and medications. Patient education is essential for patients to understand their condition and implement customized strategies to manage chronic and long-term conditions.

Conclusion

The case shows the importance of implementing a multiple treatment approach, especially in the management of chronic conditions such as T2DM. The integration of evidence-based practice, clinical guidelines, and standards of care ensures that patients with chronic conditions such as T2DM can have better outcomes. A holistic care approach ensures that care providers deliver customized care for better outcomes.

References

American Diabetes Association (ADA) (2026). Summary of Revisions: Standards of Care in

Diabetes—2026. diabetesjournals.org/care/article/49/Supplement_1/S6/163930/Summary-of-Revisions-Standards-of-Care-in-Diabetes

Andreae, S. J., Reeves, H., Casey, T., Lindberg, A., & Pickett, K. A. (2024). A systematic review

of diabetes prevention programs adapted to include family members. Preventive

Medicine Reports, 39, 102655. https://doi.org/10.1016/j.pmedr.2024.102655

CDC National Diabetes Prevention Program (2024 May 15). What Is the National DPP?

https://www.cdc.gov/diabetes-prevention/programs/what-is-the-national-dpp.html

Echouffo-Tcheugui, J. B., Chakkalakal, R. J., & Ali, M. K. (2025). Is the current lifestyle

modification approach to diabetes prevention in the US a success? Diabetes care, 48(6),

863-870. https://doi.org/10.2337/dci24-0040

Galindo, R. J., Trujillo, J. M., Wang, C. C. L., & McCoy, R. G. (2023). Advances in the

management of type 2 diabetes in adults. BMJ medicine, 2(1), e000372. https://bmjmedicine.bmj.com/content/2/1/e000372

Melichova, J., Sivco, P., Rusnak, M., Phuong Truc, P., & Majdan, M. (2023). International

evidence-based guidelines on hypertension and type 2 diabetes mellitus: A systematic

review. Journal of Public Health Research, 12(1), 22799036221146913. https://doi.org/10.1177/22799036221146913

Samson, S. L., Vellanki, P., Blonde, L., Christofides, E. A., Galindo, R. J., Hirsch, I. B., … &

Valencia, W. M. (2023). American Association of Clinical Endocrinology Consensus

Statement: comprehensive type 2 diabetes management algorithm–2023 update.

Endocrine Practice, 29(5), 305-340. DOI: 10.1016/j.eprac.2023.02.001

Wang, W., Wan, Q., Wang, S., Ning, G., Bi, Y., Liu, L., … & Pan, H. (2025). Management

Guidelines for Diabetic Patients with Hypertension. Journal of Diabetes, 17(6), e70093.

DOI: 10.1111/1753-0407.70093

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To prepare:

Select a patient case from your clinical experience this quarter where you and your preceptor approached the treatment plan differently. Reflect on these differences, using relevant and current resources, particularly those outlining standards of care. As you develop your reflection, review the assignment instructions and grading rubric for guidance. Keep your writing concise, using paragraph format, and lists for medications and diagnoses when appropriate. Be sure to include a title page and reference page.

Assignment:

Briefly summarize the case:

• Include relevant patient information, including history, assessment, any testing that might have been done, and medications.

• Presenting symptoms.

• Diagnosis.

Compare Treatment plans:

• Describe your preceptor’s recommended treatment plan.

• Explain the alternative treatment plan you would have recommended as a nurse practitioner.

Justify Your Approach:

• Use evidence-based guidelines, clinical research, and relevant literature to support your alternative plan.

• Discuss why you believe your approach would be effective, considering the patient’s history, condition, and individual needs.

Reflect on Differences:

• Analyze the differences between your plan and your preceptor’s.
• Consider factors such as clinical experience, knowledge, patient-centered care, and the influence of evidence-based practice in decision-making.

Lessons Learned:

• Reflect on how this experience has influenced your clinical practice and approach to treatment planning.

• Discuss how you can apply what you learned to future patient care.
• How might you approach another provider professionally in the future when you find treatment plans differing during collaboration on the patient case?

Submission Requirements: 

• Length: 3-4 double-spaced pages, APA format.
• Cite at least 3 current peer reviewed sources or evidence-based research to support your analysis.

 Evaluation Criteria (also see rubric): 

• Clarity and completeness of the case summary.

• Depth of analysis and comparison between treatment plans.

• Use of evidence-based rationale for your alternative plan.

• Reflection on learning and future application.

• Proper use of APA formatting and references.