Role of the Diabetes Health Professional in diabetes care, education and management

1. Role of the Diabetes Health Professional in diabetes care, education and management

2. Objectives

3. Activity Note to the educator: Ask participants to reflect on a personal level on these questions. Ask the participants to discuss these questions either in small groups or as one large group. Make a list of the challenges. Challenges may be addressed later in the presentation. Make a list of opportunities they have to influence diabetes education and management. We will be using the term “diabetes healthcare professional” throughout this and other modules. This term refers to all the health professionals – nurses, dietitians, psychologists, social workers, pharmacists, physicians etc – who are involved in the education, care and management of people with diabetes. Ask the group to discuss the term “diabetes educator” or “diabetes health professional”. Ask participants which term they think best explains the role and why. Note to the educator: Ask participants to reflect on a personal level on these questions. Ask the participants to discuss these questions either in small groups or as one large group. Make a list of the challenges. Challenges may be addressed later in the presentation. Make a list of opportunities they have to influence diabetes education and management. We will be using the term “diabetes healthcare professional” throughout this and other modules. This term refers to all the health professionals – nurses, dietitians, psychologists, social workers, pharmacists, physicians etc – who are involved in the education, care and management of people with diabetes. Ask the group to discuss the term “diabetes educator” or “diabetes health professional”. Ask participants which term they think best explains the role and why.

4. Historical review The roles of health professionals evolve and change over time. These changes are influenced by social, technological and political factors and by research that influences the way healthcare is delivered, the complexity of the care provided and the role played by people with diabetes. Different countries are at different stages of implementing an interdisciplinary team approach to diabetes education and management. The specific tasks performed by each team member will differ between countries and the category of health professionals. It will also depend on available resources and equipment. The tasks are usually described in job descriptions but not the roles. There have been many advances since the late 1800’s but there is still a wide variance in the preparation of health care professionals in diabetes education and management. In many countries there is additional training for professionals caring for people with diabetes. These specialty training programmes are multidisciplinary and range from a couple of weeks to two year programmes at a Masters level.The roles of health professionals evolve and change over time. These changes are influenced by social, technological and political factors and by research that influences the way healthcare is delivered, the complexity of the care provided and the role played by people with diabetes. Different countries are at different stages of implementing an interdisciplinary team approach to diabetes education and management. The specific tasks performed by each team member will differ between countries and the category of health professionals. It will also depend on available resources and equipment. The tasks are usually described in job descriptions but not the roles. There have been many advances since the late 1800’s but there is still a wide variance in the preparation of health care professionals in diabetes education and management. In many countries there is additional training for professionals caring for people with diabetes. These specialty training programmes are multidisciplinary and range from a couple of weeks to two year programmes at a Masters level.

5. Reflection Note to the educator: Ask participants to reflect on these questions at a global level. Ask the participants to discuss these questions either in small groups or in one large group and to make a list of the benefits. If time allows, discuss ways to enhance and develop the role of health professionals in diabetes education. Reflect on both local and national changes that need to occur. Note to the educator: Ask participants to reflect on these questions at a global level. Ask the participants to discuss these questions either in small groups or in one large group and to make a list of the benefits. If time allows, discuss ways to enhance and develop the role of health professionals in diabetes education. Reflect on both local and national changes that need to occur.

6. The role of the diabetes health professional Education underpins self-care, which is essential to improved diabetes outcomes. Education is needed for learning self-care behaviours (or behaviour changes) and continuing to participate/carry out this care effectively and confidently over the lifetime of living with diabetes. Health professionals are accountable to people with diabetes to provide the current and necessary knowledge and skills needed for them to manage their diabetes and achieve optimal outcomes. In order to effectively teach others, health professionals must have sound diabetes knowledge and skills; and establish positive relationships with people living with diabetes and their families. Within their role and scope of practice, all health professionals working in the speciality of diabetes are responsible for providing diabetes self management education. Information about diabetes changes quickly due to research, continuous learning is essential. Health professionals have a responsibility to update their knowledge and reflect on their practice in order to constantly improve the education and care they provide. Depending on the prevailing healthcare system, a diversity of health professionals provide diabetes education, care and management. It is important that they give consistent evidenced based messages. Education underpins self-care, which is essential to improved diabetes outcomes. Education is needed for learning self-care behaviours (or behaviour changes) and continuing to participate/carry out this care effectively and confidently over the lifetime of living with diabetes. Health professionals are accountable to people with diabetes to provide the current and necessary knowledge and skills needed for them to manage their diabetes and achieve optimal outcomes. In order to effectively teach others, health professionals must have sound diabetes knowledge and skills; and establish positive relationships with people living with diabetes and their families. Within their role and scope of practice, all health professionals working in the speciality of diabetes are responsible for providing diabetes self management education. Information about diabetes changes quickly due to research, continuous learning is essential. Health professionals have a responsibility to update their knowledge and reflect on their practice in order to constantly improve the education and care they provide. Depending on the prevailing healthcare system, a diversity of health professionals provide diabetes education, care and management. It is important that they give consistent evidenced based messages.

7. Core focus of diabetes health professionals A range of health professionals assume the role of diabetes health specialists. This consists of six main core, integrated areas: Clinical care – includes assessment, management/care pathways, therapeutic interventions and investigations Education – includes education of people with diabetes, primary and secondary diabetes prevention and professional development Counselling Research – encompasses knowledge of how to find research reports and critically appraise them; knowing how to use research evidence in practice (evidence-based care); and undertaking research and quality management programmes Administration/management – includes planning, documenting care, managing departments and budgets, and service planning Leadership and role model The proportion of time spent in each area varies depending on the job description and other factors operating at the time. Both the scope and tasks are based on competencies. Competencies refer to what people with diabetes, peers and employers can expect a diabetes health specialist to do. A range of health professionals assume the role of diabetes health specialists. This consists of six main core, integrated areas: Clinical care – includes assessment, management/care pathways, therapeutic interventions and investigations Education – includes education of people with diabetes, primary and secondary diabetes prevention and professional development Counselling Research – encompasses knowledge of how to find research reports and critically appraise them; knowing how to use research evidence in practice (evidence-based care); and undertaking research and quality management programmes Administration/management – includes planning, documenting care, managing departments and budgets, and service planning Leadership and role model The proportion of time spent in each area varies depending on the job description and other factors operating at the time. Both the scope and tasks are based on competencies. Competencies refer to what people with diabetes, peers and employers can expect a diabetes health specialist to do.

8. Scope of practice Assess diabetes clinical status and educational needs Plan - Develop an individualised plan that includes appropriate interventions and behavioural change processes Implement mutually agreed individual educational plans Evaluate outcomes of care and education Document the education process, including follow-up Influence system change - Contribute to and influence strategic planning and health policy relevant to diabetes prevention, care, education, management and research Health professionals in the diabetes field must take responsibilities other than those related to direct care of people with diabetes. Raising public awareness about the importance of prevention and the challenges of living with diabetes should form part of the core role of the diabetes health specialists. Diabetes health professionals need to advocate for people with diabetes to ensure they get appropriate care and can function in the community. Furthermore, they should highlight the importance of education in helping people to manage their condition. Diabetes health professionals can play an important role in influencing governments and other organisations that fund healthcare to develop policies that reflect the importance of ongoing education, clinical management and research in diabetes. Assess diabetes clinical status and educational needs Plan - Develop an individualised plan that includes appropriate interventions and behavioural change processes Implement mutually agreed individual educational plans Evaluate outcomes of care and education Document the education process, including follow-up Influence system change - Contribute to and influence strategic planning and health policy relevant to diabetes prevention, care, education, management and research Health professionals in the diabetes field must take responsibilities other than those related to direct care of people with diabetes. Raising public awareness about the importance of prevention and the challenges of living with diabetes should form part of the core role of the diabetes health specialists. Diabetes health professionals need to advocate for people with diabetes to ensure they get appropriate care and can function in the community. Furthermore, they should highlight the importance of education in helping people to manage their condition. Diabetes health professionals can play an important role in influencing governments and other organisations that fund healthcare to develop policies that reflect the importance of ongoing education, clinical management and research in diabetes.

9. Interdisciplinary role Diabetes education, care and management, policy development, implementation and monitoring are all the responsibilities of a team. Many health professionals and sometimes people with diabetes undertake all or specific parts of the role, depending on their knowledge and competence – which depends largely on their education. Each team member brings a particular focus and set of skills to the team. Each health professional category, for example foot care or nursing, must operate within the legal and professional requirements of their profession. It is important that diabetes health professionals are aware of the limits of their knowledge and competence and seek advice or refer the person with diabetes to another team member when appropriate. There is an increasing need for team members to be multi-skilled because of the increasing numbers of people with diabetes. Therefore, respect, tolerance, role definitions and effective communication within the team are important to provide evidenced based education and management to people with diabetes. Diabetes education, care and management, policy development, implementation and monitoring are all the responsibilities of a team. Many health professionals and sometimes people with diabetes undertake all or specific parts of the role, depending on their knowledge and competence – which depends largely on their education. Each team member brings a particular focus and set of skills to the team. Each health professional category, for example foot care or nursing, must operate within the legal and professional requirements of their profession. It is important that diabetes health professionals are aware of the limits of their knowledge and competence and seek advice or refer the person with diabetes to another team member when appropriate. There is an increasing need for team members to be multi-skilled because of the increasing numbers of people with diabetes. Therefore, respect, tolerance, role definitions and effective communication within the team are important to provide evidenced based education and management to people with diabetes.

10. Teamwork is evident through IDF. (2009). International Standards for Diabetes Education, 3rd Ed. Brussels: International Diabetes Federation. Teams that really work together operate more efficiently. This does not mean that one professional does the work of another professional, but that the boundaries of the roles are flexible and there is overlap. For instance, the dietitian understands blood glucose results and can help people interpret these. The nurse can assist people in deciding what to eat; the doctor reinforces and supports the teaching of both the nurse and the dietitian. Key to working together is good communication amongst all team members. IDF. (2009). International Standards for Diabetes Education, 3rd Ed. Brussels: International Diabetes Federation. Teams that really work together operate more efficiently. This does not mean that one professional does the work of another professional, but that the boundaries of the roles are flexible and there is overlap. For instance, the dietitian understands blood glucose results and can help people interpret these. The nurse can assist people in deciding what to eat; the doctor reinforces and supports the teaching of both the nurse and the dietitian. Key to working together is good communication amongst all team members.

11. Teamwork Providing a team approach to care is a collaborative effort that keeps the person with diabetes at the centre of their care and education. All team members including the person with diabetes need to work together to define treatment, education and self-care goals and support and monitor the realization of those goals. Providing a team approach to care is a collaborative effort that keeps the person with diabetes at the centre of their care and education. All team members including the person with diabetes need to work together to define treatment, education and self-care goals and support and monitor the realization of those goals.

12. Preparing to become a diabetes health professional/content Preparation to specialise in diabetes education and management varies from country to country. However, there are core competencies required. The International Curriculum for Diabetes Health Professional Education is an excellent resource to guide the development of these core competencies. Psychological, spiritual, and socio-economic aspects have a strong impact on diabetes outcomes and may be more important than the level of diabetes knowledge of the person with the condition. Therefore, diabetes health professionals must be proficient in assessing these issues. Continuity of care within the diabetes health team is important and is facilitated if members of the team have a common, core knowledge base. Preparation to specialise in diabetes education and management varies from country to country. However, there are core competencies required. The International Curriculum for Diabetes Health Professional Education is an excellent resource to guide the development of these core competencies. Psychological, spiritual, and socio-economic aspects have a strong impact on diabetes outcomes and may be more important than the level of diabetes knowledge of the person with the condition. Therefore, diabetes health professionals must be proficient in assessing these issues. Continuity of care within the diabetes health team is important and is facilitated if members of the team have a common, core knowledge base.

13. Preparing to become a diabetes health professional/content Teaching and learning are part of a continuous, inter-related process. Along with effective communication they are essential aspects of the diabetes health professional’s role. Diabetes health professionals need to recognize the interaction between teaching, behaviour change and self management. Given that they work in a climate of evidence-based care, research is an essential aspect of the diabetes health professional’s role. This means diabetes health professionals should be able to: Recognise a care issue or problem Describe the issues precisely Access and review relevant literature, including guidelines and protocols, to find out what has already been said about an issue Determine whether the findings or recommendations relate to their area of practice and can thus be implemented Teaching and learning are part of a continuous, inter-related process. Along with effective communication they are essential aspects of the diabetes health professional’s role. Diabetes health professionals need to recognize the interaction between teaching, behaviour change and self management. Given that they work in a climate of evidence-based care, research is an essential aspect of the diabetes health professional’s role. This means diabetes health professionals should be able to: Recognise a care issue or problem Describe the issues precisely Access and review relevant literature, including guidelines and protocols, to find out what has already been said about an issue Determine whether the findings or recommendations relate to their area of practice and can thus be implemented

14. Preparing to become a diabetes health professional/methods There are few formal, accredited education programmes to prepare health professionals in the field of diabetes. Most undergraduate programmes – those in nursing and dietetics, for example – spend limited time on diabetes and do not prepare health professionals for the role in diabetes education and management. Most diabetes health professionals learn on the job. This experiential learning is important but it is recommended that it be part of a formal programme that is evidenced based and supported by a mentor and evaluation process. Self-assessment and reflecting on individual learning needs and professional goals are an essential part of becoming an effective diabetes health professional. Resources are available through diabetes organizations such as IDF (www.idf.org) , national member associations and professional associations. There are few formal, accredited education programmes to prepare health professionals in the field of diabetes. Most undergraduate programmes – those in nursing and dietetics, for example – spend limited time on diabetes and do not prepare health professionals for the role in diabetes education and management. Most diabetes health professionals learn on the job. This experiential learning is important but it is recommended that it be part of a formal programme that is evidenced based and supported by a mentor and evaluation process. Self-assessment and reflecting on individual learning needs and professional goals are an essential part of becoming an effective diabetes health professional. Resources are available through diabetes organizations such as IDF (www.idf.org) , national member associations and professional associations.

15. What is a mentor relationship? Mentoring is a one-to-one relationship where an expert, through regular contact, guides and educates a less experienced colleague. All health professionals have a duty of care to the people they educate and their professional colleagues. The mentor must encourage reflection by the learner, and provide the opportunity for discussion. This might be done by taping a session and reviewing it together. Mentoring can be a key factor in developing and maintaining professional competence. Sometimes mentoring occurs but is not formalised. Anybody can be a mentor. In most cases the mentor also benefits from the relationship. Mentoring is a one-to-one relationship where an expert, through regular contact, guides and educates a less experienced colleague. All health professionals have a duty of care to the people they educate and their professional colleagues. The mentor must encourage reflection by the learner, and provide the opportunity for discussion. This might be done by taping a session and reviewing it together. Mentoring can be a key factor in developing and maintaining professional competence. Sometimes mentoring occurs but is not formalised. Anybody can be a mentor. In most cases the mentor also benefits from the relationship.

16. Reflective practice Reflective practice includes assessment, goal setting , development of a plan, implementation and evaluation. After every intervention, diabetes health professionals should reflect on what happened and ask themselves how they could improve and what knowledge or skills they need to develop professionally. Reflective practice results in learning and growing as a diabetes health professional. Reflective practice includes assessment, goal setting , development of a plan, implementation and evaluation. After every intervention, diabetes health professionals should reflect on what happened and ask themselves how they could improve and what knowledge or skills they need to develop professionally. Reflective practice results in learning and growing as a diabetes health professional.

17. Activity Note to the educator: If you are teaching a small group you could ask the group as a whole to respond to these questions. If your group is large you might break them into groups and have each group answer only one question then report back to the group as a whole. Note to the educator: If you are teaching a small group you could ask the group as a whole to respond to these questions. If your group is large you might break them into groups and have each group answer only one question then report back to the group as a whole.

18. Activity Note to the educator: If you are teaching a small group you could ask the group as a whole to respond to these questions. If your group is large you might break them into groups and have each group answer only one question then report back to the group as a whole. Note to the educator: If you are teaching a small group you could ask the group as a whole to respond to these questions. If your group is large you might break them into groups and have each group answer only one question then report back to the group as a whole.

19. Advanced practice In many countries, advanced roles – especially those of nurses, dietitians and pharmacists – are developing, often to reflect increasing specialization within an area of practice. In order to perform an advanced role, professionals are expected to engage in further training. The International Curriculum for Diabetes Health Professional Education (2008) does not prepare diabetes health professionals to practise at an advanced level. Advanced practice often involves autonomous practice. It is important to note that this does not mean “independent practice”. In autonomous practice, the health professional is capable of working without supervision or direction but continues to work collaboratively as part of a team. Independent practice in the field of diabetes is not regarded as optimal; people with diabetes need to have access to the interdisciplinary team in order to maximise outcomes. In many countries, advanced roles – especially those of nurses, dietitians and pharmacists – are developing, often to reflect increasing specialization within an area of practice. In order to perform an advanced role, professionals are expected to engage in further training. The International Curriculum for Diabetes Health Professional Education (2008) does not prepare diabetes health professionals to practise at an advanced level. Advanced practice often involves autonomous practice. It is important to note that this does not mean “independent practice”. In autonomous practice, the health professional is capable of working without supervision or direction but continues to work collaboratively as part of a team. Independent practice in the field of diabetes is not regarded as optimal; people with diabetes need to have access to the interdisciplinary team in order to maximise outcomes.

20. Quality management Terminology can be confusing. Generally, accreditation applies to education programmes. An external body such as a professional association or regulatory authority is responsible for ensuring a curriculum meets certain standards and prepares the students for an appropriate level of practice. In most countries, this is the responsibility of an institution or academic authority rather than a professional association. Accreditation is granted if the programme meets the necessary standards after being reviewed by experts. To ensure that the content and delivery methods are reviewed regularly, this is usually granted for a defined period of time. The terms “credentialling”, “recognition’” and “certification” are used interchangeably to refer to a person who meets the specific criteria that are set out by a regulatory body or professional organisation. Recognition/certification is usually a voluntary process by a professional body – not a statutory body – where peers review performance against a set of guidelines. Terminology can be confusing. Generally, accreditation applies to education programmes. An external body such as a professional association or regulatory authority is responsible for ensuring a curriculum meets certain standards and prepares the students for an appropriate level of practice. In most countries, this is the responsibility of an institution or academic authority rather than a professional association. Accreditation is granted if the programme meets the necessary standards after being reviewed by experts. To ensure that the content and delivery methods are reviewed regularly, this is usually granted for a defined period of time. The terms “credentialling”, “recognition’” and “certification” are used interchangeably to refer to a person who meets the specific criteria that are set out by a regulatory body or professional organisation. Recognition/certification is usually a voluntary process by a professional body – not a statutory body – where peers review performance against a set of guidelines.

21. Activity

22. Summary (1 of 2)

23. Summary (2 of 2)

24. References