The iDEAL group shares their thoughts on invigorating education for today’s diabetes care professionals
It’s essential that healthcare practitioners in the field of diabetes stay current and deliver evidence-based care wherever they practice. To do that, they need accessible education.
The challenges of diabetes care are becoming more diverse
For someone living with diabetes, self-managing the condition can be very challenging. The characteristics of diabetes, potential unpredictability and variation over the person’s life span can all pose difficulties in maintaining safe blood glucose levels. They need individualised support, based on confidence, motivation and potential behaviour change, to manage their condition effectively.
At the same time, diabetes care is becoming increasingly complex. As the needs of people living with diabetes become more diverse, more healthcare practitioners are sub-specialising in their knowledge and care delivery. For those healthcare practitioners, it’s essential they can base individualised support on some core proficiencies.
It’s clear there are healthcare practitioner shortages too, as especially in general practice, recruiting and retaining enough doctors has proven difficult. Allied healthcare practitioners and nurses are rapidly developing their own roles and removing traditional boundaries between them.
Although each professional will bring a different perspective to their role in diabetes care, there are no recognised distinctions between healthcare practitioners from different professional backgrounds, nor are there articulated differences in their scope of practice.
The increasing reliance on unregistered healthcare practitioners, especially in primary care, requires clear core proficiency and competency frameworks for safety and access to informed education for unregistered healthcare practitioners when working with people living with diabetes.
An over-reliance on unregistered healthcare practitioners with little or no access to ongoing diabetes education raises safety and quality of care concerns regarding information giving and knowledge gains for people living with diabetes. Therefore, access to ongoing learning and support is essential for safe care delivery for increasing numbers of Health Care Assistants and Assistant Practitioners (RCN, 2019). An example of this is Ruth Miller’s 10-point diabetes training, endorsed by Diabetes UK.
NHS England and Getting It Right First Time (GIRFT) both demonstrate considerable variations in the delivery of diabetes care across CCGs in England, although they also promote areas of good practice for other healthcare practitioners to model themselves on in their service improvement, especially with the advent of Primary Care Networks (PCNs).
Education for healthcare practitioners is key to addressing these challenges
An educated healthcare practitioner can go above and beyond the delivery of diabetes care. They can facilitate the development of other healthcare practitioners to deliver higher quality, more informed, individualised diabetes care and use language more appropriately in conversations with patients. This makes a real difference in individual, personal interactions with patients and develops the abilities of healthcare practitioners, in particular, enabling practitioners to grow within their roles, supported by access to CPD.
Historically, training healthcare practitioners focused more on teaching them the facts about diabetes, rather than emphasising the principles of person-centredness and choice. Healthcare practitioners who support people living with diabetes must use a blend of art and science in diabetes care, along with humility too. Effective practice relates as much to the humanity of the healthcare practitioner as it does to his/her technological knowledge or expertise. At the heart of the therapeutic relationship, is person-centred communication and the healthcare practitioner’s ability to fully engage with each individual and his/her needs.
The art of diabetes care can be articulated through recognising and appreciating the unique and unassuming role of practice nurses. As Fitzpatrick (2016) recognised, the therapeutic relationship formed ‘oils the wheels’ and facilitates any therapeutic intervention. The evolution of the practice nurse’s role in diabetes care has been fundamental as practice nurses do work with the majority of people with Type 2 diabetes and some with Type 1. Precision in practice, which is current, evidence-based and delivered in partnership reflecting ‘making every contact count’ is efficient, effective and indubitably fiscally responsible.
Davis (2015) suggested that understanding how diabetes weaves into the complexity of an individual’s life is crucial to optimise self-management, as well as recognising factors which may prevent effective self-management. These may include health literacy, the experience of comorbidities, employment/unemployment, psychological consequences of diabetes and, potentially, the age and cultural beliefs of the people living with diabetes. Understanding of these influences is a core skill of diabetes-aware healthcare practitioners and one that is also gained with working with people living with diabetes and through CPD.
Attridge et al, (2014) suggested that diabetes care for people living with diabetes, that have been culturally tailored or is culturally appropriate can bring significant greater improvements in risk factor reduction, diabetes knowledge and self-efficacy. McGregor et al’s (2019) work in the U.S. demonstrates the growing appreciation for the need to have a culturally competent healthcare practitioner workforce.
The nature of diabetes care delivery and the need for growth in accessible diabetes healthcare practitioner education for both generalist and specialist practice is vital. Educated healthcare practitioners enable knowledgeable people living with diabetes, so each is mutually inclusive to each other. As the iDEAL Group highlighted in its 2018 White Paper, ultimately, the aim is to reduce variation in care delivery and raise the standards of care received by everyone living with diabetes.
The iDEAL Group is supported by an unrestricted educational grant from Ascensia Diabetes Care.
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