Diabetes Self-Management Education

Preparing Nurse Leaders for Expanded Rolf of Diabetes Self-Management Education
Daly, A., Kulkarni, K., & Boucher, J. (2001). The new credential: Advanced diabetes management. American Dietetic Association.Journal of the American Dietetic Association, 101(8), 940-3.

The authors Daly, Kulkarni and Boucher (2001) provide a historical review of the education, experience and certification process for diabetes educators. The review provides insight for the progression of single practice to the expanded role of nurse diabetes educators as members of a multidisciplinary health care team. According to the authors “Prior to the 1970s, most educators practiced solo, doing the best they could to provide quality diabetes care and education. Since then,
the use of multidisciplinary diabetes care teams has steadily increased, and in 1986 certification for diabetes educators became available” (p.13). The authors emphasize the positive impact of diabetes self-management on health care outcomes and the benefits of the team approach to care. The article differentiates between requirements to acquire and maintain one of two educator pathways: the certified diabetes educator (CDE) and the board certified advance diabetes management (BC-ADM).
Both pathways are available to registered nurses, physicians, dieticians and pharmacist the BC-ADM requires a master’s level degree in addition to experience hours providing education. The information provided was unbiased and informative in assisting practitioners in choosing which diabetes educator pathway to pursue. In comparison to following articles the historical review of the diabetes educator highlights the advanced skills required to remain proficient in current practice guidelines and skills required to provide care in an ever increasing population affected by the chronic illness of
diabetes.

Hollis, M., Glaister, K., & Lapsley, J. A. (2014). Do practice nurses have the knowledge to provide diabetes self-management education? Contemporary Nurse : A Journal for the Australian Nursing Profession, 46(2), 234-41.

Hollis, Glasister and Lapsley (2014) discuss the knowledge, education, experience and skills required for practice nurses to provide diabetes self-management education.
The study discussed the role of practice nurses in a primary care setting in Australia to provide diabetes self-management education. Data collected from a 14 item knowledge survey from the National Association of Diabetes Centers were utilized by the authors and was supported with information from The American Association of Diabetes Educators standards for diabetes self-management (DSME), and chronic care model to support the positive outcomes associated with DSME and highlight the need for improvement for nurses to gain the education, knowledge, skill and experience to obtain the credentialing required to perform DSME. Nurses involved in the study varied in education level comprised of one student nurse, one advanced practice degree in nursing and the remaining with a bachelor of nursing. Work and education experience were varied from novice to less than 5 years’ work experience. Education experience consisted of workshops, in services and the advanced practice nurse completing formal DSME training. Work hours spent with diabetic patients varied from random encounters to 9 to 10 hours in direct care of the diabetic
patient.
Focus areas of concern for the nurse’s knowledge were pathophysiology of diabetes, glucose monitoring, and dietary being the areas the nurses felt the most comfortable with providing education and medication management being the least knowledgeable area.
The article in comparison to other articles discussed was useful in focusing on the importance of education and experience in utilizing the expanded role of nurses in diabetes education and management. The outcomes of the study conducted in Australia were similar to the United States in regards to education requirements, skills, experience and opinion of diabetes nursing for the positive patient outcomes associated with nurse led diabetes education and management.
Information provided by the authors was helpful despite the bias intended for the support of the nurse diabetes educator. The article is supportive of diabetes being a worldwide epidemic and the expanded role nurses perform in patient care through the education process and the positive outcomes associated with this education.

Laughlin, C. B., & Beisel, M. (2010). Evolution of the chronic care role of the registered nurse in primary care. Nursing Economics, 28(6), 409-14. Laughlin reported the evolution of the nurse role in a primary care setting as a member of the treatment team for chronic illness. Laughlin summarized “the RN in the patient’s primary care setting is uniquely qualified to assess the broad spectrum of needs that patients with chronic conditions may present, and to determine, in partnership with the patient, a plan of action, coordinating other resources that may be beneficial” (p. 414). The author discusses the methods and outcomes of studies conducted to support the role of nurses in the improvement of care provided for patients with chronic illness. Studies discussed utilizing the chronic care model and patient centered medical home principals. The author pointed out the need for this expanded role of nurses due to health care reform, increased aging population, increase in patients with chronic illness and the decreased number of physicians available due to retirement or less entering the profession.
A pilot study for diabetes care was assisted through the use of a float nurse to fill in for the primary office nurse four hours each week, allowing a focus on high risk diabetic patients not meeting health criteria, understanding of self-management, compliance with medications and coping.
Nurses utilized protocols for management of care and templates for record keeping. Outcomes reported were lacking in sufficient evidence of positive outcomes of the expanded role of the nurses in chronic disease management. Identified lessons learned were patients were more receptive when the nurse were introduced as a member of the care team, the need for a block of time to allow for coverage when identified patients were in the office, time spent on intake were lengthy but important and were gratifying to the nurse, high risk patients presented more barriers than moderate risk patients. The need for a longer time frame for conduction of the study (p. 411-412). This article was useful in the importance of supporting and establishing a clinical program for the expanded role of nurses in chronic disease management and the importance of defining the nurse as a vital member of the care team. The article emphasized the need for quantity and quality of time set aside for the nurse to assist in the management of chronic illness. The article was fair and unbiased in reporting the findings of numerous studies while supporting the need of the expanded role of nurses.

Tschannen, D., PhD., Aebersold, M., PhD., Sauter, Cecilia, MS,R.D., C.D.E., & Funnell,
Martha M, MS,R.N., C.D.E. (2013). Improving nurses' perceptions of competency in diabetes self-management education through the use of simulation and problem-based learning. The Journal of Continuing Education in Nursing, 44(6), 257-63.

“Case management for chronic disease is a growing area of nursing practice as part of the current em¬phasis on outcomes and patient-centered care.” Tschannen et al (2013). In the article Improving nurses' perceptions of competency in diabetes self-management education through the use of simulation and problem-based learning, the author discusses a pilot use of wrote education, simulation and problem-based learning to improve nurses competency and ability to provide diabetes self-management education. Learning objectives were focused to improve the nurses’ ability to provide diabetes self-management education and focused on the pathophysiology of diabetes, treatment and strategies to engage patients and use of educational material to perform diabetes education (p. 3). Resulting evaluation survey upon completion showed a satisfaction rate of 76 to 100% for components of the education program with 100% being unbiased presentation of material and 76% for course material supporting the objective. This article was supportive for the importance and impact of standardized education programs to prepare the nurse as team members providing education of chronic illness. The material was unbiased and with the impact for nurse and patient empowerment in chronic illness management. The authors varied background as a Clinical Assistant Professor School of Nursing, Senior Project Manager for Ambula¬tory Care Services, and Associate Research Scientist, Department of Medical Education provide a combined effective evaluation team across the spectrum for chronic disease management and the education process required to prepare nurses for this expanded role.