Diabetes Education E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 467

Veröffentlichungsjahr: 2012

Beschreibung

Diabetes education is a process, the key to which is establishing a therapeutic relationship with the individual.  The overall goal of diabetes education is to enhance the individual’s health capability, including their ability to solve problems and apply the learning to self-care.  Thus, diabetes education is an interactive process of teaching and learning where information is co-generated.  This innovative and thought-provoking new book explores the ‘how’ of diabetes education, rather than the ‘what’ and the ‘why’.

Diabetes Education: Art, Science and Evidence helps healthcare practitioners teach diabetes effectively from diagnosis onwards and ensure people living with diabetes receive individualised support and information. It enables practitioners and educators to examine and reflect on their practice when managing the person with diabetes.  Bringing together all the thinking and experience of the diabetes journey in one text, this book is essential reading for all practitioners and students involved in diabetes care.

SPECIAL FEATURES:

• Features short stories, case studies, illustrative quotes, practice points and reflection points throughout
• Edited by an internationally renowned expert in the field
• Contributions from some of the world’s leading diabetes educators

This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.

Leseprobe

Contents

List of Contributors

Foreword

Preface

Acknowledgements

List of Tables, Figures and Boxes

Tables

Figures

Boxes

List of Abbreviations

1 Brief Overview of Diabetes, the Disease

Introduction

Overview of diabetes

Prevalence of diabetes

Overview of normal glucose homeostasis

Signs and symptoms of diabetes

Diabetes management and management aims

Long-term diabetes complications

Summary

2 The Journey of the Person with Diabetes

Introduction

Psychological factors: the role of beliefs and attitudes

Psychological factors: emotional reactions to diabetes

Social factors: influence of personal situation

Factors that affect illness/wellness behaviours

Summary

3 Teaching and Learning: The Art and Science of Making Connections

Introduction

Purpose of diabetes education

Principles of learning and teaching

Learning theory

Laws of learning

Knowledge

Nudging

Learning and the brain

Memory

Keeping the brain fit: brain training

Brain training: mind-body fitness

Sleep: vital for learning and memory

His brain, her brain

Technology

Helping people learn: proactive strategies are more effective

Summary

4 Making Choices, Setting Goals

Introduction

Why don’t people do what is best for them?

Self-regulation, goals and values

Behaviour-serving goals

Limited resources

SMARTER

Sleep

Summary

5 The Teacher: Moving from Good to Exceptional

Introduction

Healing

Who is a teacher?

Attributes of a ‘good’ teacher

Moving from good to exceptional

Philosophy of diabetes care and education

Factors that influence philosophy

Therapeutic relationship

Listening

Know yourself

Wounded healer

Reflection

Being present in the moment

Self-care

Summary

6 People Do Not Always Speak the Same Language Even When They Speak the Same Language

Introduction

What is language?

Components of language

Learning a language

The power of language

Body language

Culture

Exchanging information: a complex process

Language and attitude change

‘Voices’

Narrative medicine

The value of reading fiction

Using writing in diabetes care

Education materials

Winnie the Pooh has the last word

7 Role and Use of Creative Arts in Diabetes Care

Introduction

Medical identity

The four cardinal axes of healthcare delivery

Listening to patients and modes of self-expression

Promoting creativity

Painting as a process of transformation

The theatre of lived experience

Artistic expression favours communication

Two examples

Key learning

Art and therapeutic education

Summary

Recommended reading

8 Turning Points and Transitions: Crises and Opportunities

Introduction

The seven ages of man

Common major life transitions

Neutral zone

A new beginning

Major life transitions

Signs a person may be entering or is in a life transition

Strategies to help people manage life transitions

Building resilience

9 Sharing Stories of the Journey: Peer Education

Introduction

Empathy and sympathy

Empathy and social support

Empathy and patient relationships

10 Diabetes: A Lifetime of Learning

Introduction

The clinical experience

Learning styles

Be honest

Consistent and correct terminology

Simplifying complex concepts into easier to understand concepts

Using the individual’s knowledge and experience

‘Catchy’ phrases

Visual aids

Asking the right questions

Health literacy

Group education

Educating people with disabilities

Being flexible about where diabetes education is delivered

Cultural sensitivity and diabetes education

Be aware of language

Where to start

Chapter summary and key points

11 Medicine Self-Management: More than Just Taking Pills

Introduction

Medicine self-management

Complementary and alternative medicines and therapies

‘Compliance’: to use or not to use, that is the question

People with diabetes’ perspective

HPs, especially prescribers and educators perspectives

Carers, particularly family members

Extent of non-compliance

Is there a relationship between medicine compliance and optimal health outcomes?

Factors that influence medicine compliance

How is compliance assessed/measured?

Quality use of medicines

QUM, diabetes educators and medicine management

Summary

12 The Advance of Health Information Technology: Travelling the Internet Superhighway

Introduction

Internet and networks

Diabetes education

Diabetes management tools

Personal health tools and self-care

Summary

13 Leadership—Know Yourself: Influence Others

Introduction

Leadership: a brief historical perspective

What is leadership and what/who is a leader?

Leader functions

Leadership philosophies, theories and models

Leadership styles

Leadership competencies and attributes

Leadership education and care of people with diabetes

Leadership in diabetes clinical care

Leadership in diabetes education

Leadership in diabetes research

What do diabetes educators think about leadership?

How can we grow diabetes education leaders?

Summary

Acknowledgements

Appendix

Index

Education is not the filling of a pail but the lighting of a fire.

(W.B. Yeats 1865–1939)

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Library of Congress Cataloging-in-Publication Data

Diabetes education : art, science, and evidence / edited by Trisha Dunning.p. ; cm.Includes bibliographical references and index.

ISBN 978-0-470-65605-1 (pbk. : alk. paper)I. Dunning, Trisha.[DNLM: 1. Diabetes Mellitus–therapy. 2. Diabetes Complications–prevention & control. 3. Patient Compliance. 4. Patient Education as Topic–methods. 5. Self Care. WK 815]616.4′62–dc23

2012022778

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: iLexx/iStockphotoCover design by Garth Stewart

List of Contributors

Jean-Phillippe AssalPresidentFoundation for Research and Training in Patient EducationGeneva, SwitzerlandTisiana AssalFoundation for Research and Trainingin Patient EducationGeneva, SwitzerlandTrisha Dunning AMChair in Nursing and Director Centre for Nursing and Allied Health ResearchDeakin UniversityandBarwon HealthGeelong, Victoria, AustraliaMillie GlinskyIndiana Regional Medical CenterIndiana, PA, USAKari HarnoLKT Dosentti FHIMSSKerava, FinlandRhonda LeeUniversity of Pittsburgh Medical CenterPittsburgh, PA, USAGretchen A. PiattResearch InstructorDivision of Endocrinology and MetabolismSchool of MedicineUniversity of PittsburghandDirector of EvaluationDiabetes InstituteUniversity of PittsburghPittsburgh, PA, USAMichelle RobinsNurse PractitionerCorio Medical CentreCorio, Victoria, AustraliaandBarwon HealthGeelong, Victoria, AustraliaNorma RyanUniversity of Pittsburgh Medical CenterBrownsville, PA, USAHarsimran SinghDepartment of Neurobehavioural SciencesBehavioral Medicine CenterSchool of MedicineUniversity of VirginiaCharlottesville, VA, USATimothy SkinnerDirector Rural Clinical SchoolUniversity of TasmaniaBurnie, Tasmania, AustraliaJane SpeightThe Australian Centre for Behavioural Research in DiabetesDiabetes AustraliaMelbourne, Victoria, AustraliaandCentre for Mental Health and Well-being ResearchSchool of PsychologyDeakin UniversityGeelong, Victoria, AustraliaandAHP ResearchHornchurch, Essex, UKHelen ThomasicUniversity of Pittsburgh Medical CenterPittsburgh, PA, USA

Foreword

Trisha Dunning and her co-authors have compiled a book that knits ­state-of-the-art research findings with best clinical practice and good ­common sense to produce a most readable book of everyday application to clinicians and healthcare professionals in diabetes, as well as to the more enquiring person with diabetes seeking quality information. They are to be warmly congratulated for the many recommendations and ­helpful tips in the book, which derive from their lifetime in professional practice.

What particularly struck me was the vein of empathy with the person with diabetes that runs throughout the book. Those with diabetes so often fear that disappointing results at their clinic visit will earn ­disapproval or judgement, but the most welcome standpoint of the authors is to be non-judgemental and thoroughly supportive of those whom they serve, those with diabetes. For that reason, people starting their journey of ­diabetes and their carers would also profit from reading this book. Although learned, it contains a wealth of valuable information that can support them in the daily challenge of living with a chronic disease whose complications can, indeed, be life-threatening.

Although it is now over 25 years since I carried my comatose five-­year-old daughter Kate into hospital with diabetic ketoacidosis, I shall never forget the sense of bewilderment and anxiety that engulfed me and the brutal realisation that this little child now faced a lifetime of insulin ­injections. How it would have helped to put everything in perspective for my wife, Naomi, and myself had we encountered at the outset, health practitioners of the sensitivity of the authors! That said, Kate was well cared for, and I can testify to the continuing gratitude parents and carers feel for those who care for their dependent child with diabetes. Together in Glasgow’s Royal Hospital for Sick Children, a ‘triangle of care’ was formed between the caring professionals, my daughter Kate as the person with diabetes, and Naomi as the principal carer. When that triangle of care works well, there are immense benefits for all, and there are frequent ­references in the book to that potential for successful and mutually ­beneficial relationships between professionals and patients.

Without in any way denying the impressive support of the paediatric diabetologist, the key professional in that triangle of care was the Diabetes Nurse Specialist. As unflappable as she was caring, she was indeed the educator, the source of advice, the encourager, the soother, the reassurer. She was the embodiment of all the fine attributes of the educator to which there is frequent implicit reference in the book. Without the ready access to such support, as carers we could easily have felt isolated and helpless when problems arose. It will come as no surprise that, to this day, I carry a standard for the nurse educator professionals.

This book is additionally welcome because not only does it summarise the best of diabetes care but it ‘encourages educators to reflect on their philosophy of diabetes education and how they teach’. Educators are encouraged to excel and the myriad of practical recommendations—together with a vast anthology of references and research—should satisfy the most enquiring mind. Writing in my capacity as the incoming Global President of the International Diabetes Federation, I know instinctively that better informed, more accomplished educators will succeed in ­helping their patients to maintain better control of their diabetes.

It is not, however, just clinicians and healthcare professionals who can benefit from this book. As the information revolution advances inexorably, people with diabetes can inform themselves in a way that would have been unthinkable a generation ago. Kari Harno’s compelling chapter on the Internet superhighway highlights the many exciting opportunities now opening up to harness technology to help those with diabetes to obtain optimal outcomes. It set me thinking of the many imaginative ways in which diabetes care and self-management could be revolutionised and improved. The ‘quest for a better way’, intrinsic in the human spirit, will bring undoubted benefits in the future to people with diabetes, reminding and supporting them to do the basic things that help maintain good ­control and a healthy life.

As a non-clinician, I found this book enjoyable to read but could not help relating the observations and anecdotes to the experiences of Kate, Naomi and myself in years past. I particularly liked Chapter 2 where Jane Speight and Harsimran Singh describe the journey of the person with ­diabetes and their observation that ‘overcoming emotional reactions is likely to be one of the most important steps a person can take to manage their diabetes successfully. Yet, it is singularly the most overlooked aspect of diabetes care. Time and money are spent on screening for retinopathy and other complications of diabetes, and yet, very little effort is put into screening for emotional distress’. The authors of this chapter are right to highlight the imperative for health professionals to understand the role of the individual’s family context in their diabetes management.

Reflecting honestly, I can see how daughter Kate’s outcomes could have been improved if she had had access to proper psychosocial support at key times of her diabetes journey in adolescence and young adult life when leaving home weakened the parental influence on compliance. The ­importance of such psychosocial support is emphasised, directly and by implication, in many places in the book. I remain interested in the different ways in which such support can be offered and found myself in strong agreement with Gretchen Piatt’s views on the beneficial effects of peer support. Whatever else, I am convinced that parents—hardwired to be protective—are not the best or right people to counsel when young people find compliance a tiresome burden, not least when they see their peers enjoying the diabetes-free existence they envy.

As with much else in life, effective communication can be the difference between success and failure. Trisha Dunning’s chapter on effective ­communication is essential reading for those who daily interact with patients. Nowhere is there a greater requirement for effective ­communication than in the therapeutic patient education that she rightly identifies as an essential component of equipping the person with diabetes to achieve optimal outcomes. Trisha’s chapters on education are pure gold, coupling practical experience with theory to produce guidance from which all health professionals can benefit. It is perhaps trite, but true, that ­continuing quality professional education is inseparable from good health outcomes, and without the benefits of good recurring education, the latter will be hard to achieve.

I hope that this book will be suggested if not prescribed reading for those who work in diabetes care. I hope too that those who read it, ­reflecting regularly as they do so, will find it relevant and useful and will thereby be empowered to care even more effectively for their patients with diabetes.

Sir Michael HirstJune 2012

Preface

The word ‘education’ is interesting. It is derived from the Latin educare, to bring up, which is related to educere, to bring forth that which is within or bring out potential, and ducere, to lead. Significantly, educare also contains the word care.

There are many scientific books and papers about education including diabetes education—so why write another one? Ancient sages ­commanded ‘physician know thyself’ and suggested ‘physician heal thyself’. Both these sentiments are at the heart of this book. At the end of each chapter is a list of questions to encourage educators to reflect on what they read and what they need to know to develop the courage to really teach, rather than just provide information.

Therein lies an important distinction—educators share their knowledge by providing information. The person who receives the information turns it into knowledge through complicated mental processes and is in control of what they learn and what they do with the information. Thus, an ­effective educator finds ways to develop the skills to ‘sell’ their messages by tailoring them to suit the individual. To do so, the educator must be open to new information sourced from numerous places and must know how to apply the information effectively. Above all, they need to actively cultivate the art of listening and being fully present in each encounter. Sometimes, just being there is enough.

Joslin emphasised the importance of diabetes education in the 1920s, but clear evidence for its value was not documented until the 1970s when Miller demonstrated a link between reduced hospital admissions for ketoacidosis and hypoglycaemia and diabetes education. A great deal of research has been undertaken since then, which suggests knowledge is important; however, knowledge alone is not enough to encourage people to engage in effective self-care. An effective therapeutic relationship is a key determining factor.

Many educators assume people newly diagnosed with diabetes know very little about diabetes and require rigorous detailed diabetes education to overcome their knowledge deficits to be able to undertake self-care. In fact, many people with diabetes have some information about the ­disease, have developed an explanatory model to explain their diabetes and sought ‘facts’ about the disease. These explanatory models and ‘facts’ may be very different from those of educators: in fact they usually are, but they are no less ‘true’. Educators often regard people’s explanatory ­models as myths to be dispelled rather than accepting them as part of the ­individual’s story to be explored, discussed and understood.

Significantly, to the individual, diabetes is not ‘failure of the pancreas to produce insulin’, or ‘insulin that does not work properly’ that needs to be ‘addressed’, ‘managed’, ‘treated’, ‘fixed’ or ‘cured’. It is an emotional as well as physical presence that affects the individual’s whole being for the rest of their lives. Importantly, the physical aspects of people’s ­reactions cannot be separated from their emotional, social, economic and ­environmental ­circumstances. Thus, accepting diabetes and coping with the hard work of self-care for a lifetime has a significant impact and is part of the individual’s personal journey. Most people do not make the journey alone, so involving family and other relevant carers is essential.

Although research has identified many commonalities in the way ­people react to diabetes diagnosis and their self-care behaviours, ­educators must never assume the commonality fits the person in front of them. They must strive to understand the individual’s unique story and the social and environmental factors that shape their story.

In fact, psychosocial and environmental factors, including culture, ­support, health and other beliefs, fears, locus of control, effective communication and therapeutic relationship, may have a greater effect on ­outcomes than knowledge. Thus, the educator’s social and emotional intelligence is as, or more, important than their knowledge of diabetes, the disease.

Many valid tools are available to measure these parameters—most of them focus on the person with diabetes, and success is largely concerned with whether the individual with diabetes’ knowledge improves, they stay out of hospital and whether their blood pressure, HbA1c and lipids are ‘normal’. Education and clinical care largely focuses on changing the ­person with diabetes. Equal focus must be placed on changing/enhancing, and measuring, the educator’s capacity to communicate, engage, ­empathise and engender hope: that is to effectively combine art and ­science.

Many models describe ways to help people with diabetes and optimal diabetes services. In addition, models such as the Health Belief Model, the Transtheoretical Model of Change and the Chronic Disease Model are widely used as the conceptual framework for diabetes education, ­service planning and research. However, few, if any, of these models help ­educators develop the skills to move from ‘good’ to ‘exceptional’ ­educators.

Diabetes care has come a long way, since it was first described as diabetes maigre (bad prognosis) and diabetes gros (big diabetes). Science and ­technology continue to make major contributions to our understanding of diabetes and produce new management options. However, the prime focus of this book is on exploring effective teaching and learning and ­suggesting how educators can continue to learn and grow professionally and personally, rather than on the disease, ‘diabetes’.

The book is not concerned with what diabetes is, or medical care, and the focus is not on what people with diabetes need to know, or what they should be taught. Such information is clearly documented in many care standards, clinical practice guidelines and other publications. The book aims to encourage educators to reflect on their philosophy of diabetes ­education and how they teach.

Hopefully, the book will encourage educators to read widely, including fiction as well as clinical publications and evidence-based literature. Reading fiction enhances people’s social and emotional intelligence. Debating about and reflecting on a broad range of topics can help ­educators understand themselves as well as people with diabetes. Significantly, ­educators are not immune from illness, including diabetes, which can affect the quality of their lives and how they teach and provide care.

Carl Rogers stated:

Relationships can’t flourish if they do not operate in a climate of listening and non-judgmental acceptance of the other person’s point of view. Empathy is the hallmark of a genuine person.

Rogers (1902–1987)

Trisha Dunning AM

Acknowledgements

Many people were inspirational during planning and writing this book. Most of the inspiration and challenges came from the people with diabetes I have been privileged to know since I began my journey as a diabetes educator in 1984—they were and continue to be my true teachers and a source of inspiration.

I am also grateful to the many fiction/creative writers whose great books help me reflect on how I behave in my personal and professional lives. These include the members of Geelong Writers and Deakin Literacy Society who critique my stories and poetry and share their life experiences and insights through their writing.

Many national and international colleagues shaped my thoughts about diabetes education over the years through formal discussions, committee work, clinical care, casual conversations and their contributions to ­diabetes education research.

I am grateful to my wonderful research team at Deakin University/Barwon Health, Sally, Sue and Nicole, who understood my need to ­constantly scribble ideas in notebooks and endlessly discuss them and who managed to smile as they helped me track down references and sort out the table of contents.

I am, as always, indebted to my publishers, Wiley-Blackwell, for their enthusiastic response to the book proposal and their continued advice and support throughout the publication process. I especially thank Alexandra Mc Gregor who championed the book from the outset, Magenta Styles and Sarah Claridge for their advice and support, SPi Global who typeset the manuscript and the book cover designer, Garth Stewart.

Michelle Robins and I thank Diabetes Australia-Victoria and the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) for permission to reproduce the Feltman teaching tool shown in Figure 10.1.

My thanks also go to the people who reviewed the book proposal and found it worthy of publication. I do not know who you are, but thank you.

Thanks are also due to Michelle Robins, Adjunct Professor Margaret McGill, Dr Sheridan Waldron, Dr Bodil Rasmussen, Dr Martha Funnell, Dr Seyda Ozcan, Eva Kan, Anne Belton, Anne Marie Felton, Dr Linda Siminerio and Dr Ming Yeong Tan for providing a wealth of information on the questionnaire about leadership that is discussed in Chapter 13 and to the peer educators who shared their stories in Chapter 9—Rhonda Lee, Helen Thomasic, Norma Ryan and Millie Glinsky.

The book would not exist without the fabulous work and enthusiasm of the authors.

I am deeply grateful to Sir Michael Hirst, President Elect of the International Diabetes Federation, for agreeing to write the foreword and for writing such a great foreword despite being so busy.

Finally, my thanks go to my husband, John, my Westies, MacBeth and Bonnie, for their love, support and understanding when meals and walks were delayed so I could write just a few more lines, and my alpacas and chooks whose social interactions are a constant source of learning.

Trisha Dunning AM

List of Tables, Figures and Boxes

Tables

Chapter 3

Table 3.1

Principles of learning.

Table 3.2

Laws of learning.

Table 3.3

There are specific sites in the brain where particular learning activities occur.

Table 3.4

Overview of some of the psychological (behaviour) theories that influenced diabetes education; the theories are not presented in any order.

Table 3.5

Teaching strategies should suit the individual or group and consider the principles and laws of learning.

Chapter 7

Table 7.1

Some benefits of using the creative arts in diabetes education and care and the processes by which the benefits occur.

Chapter 8

Table 8.1

Broad stages of growth and development organised according to the primary development tasks in each stage; however, the ‘boundaries’ of each stage are not fixed: individual differences need to be considered.