Empowerment Practice in Diabetes Patient Education

1. Empowerment Practice in Diabetes Patient Education Kan Ching Yee, Eva DMNS, AHNH 25th March 2006

2. Overall Effects of Patient Education • Diabetes educational programs are effective for patients across a different outcomes1-5 • Effect sizes: (from largest to smallest) for the outcomes of knowledge (ES = 0.88) > skill performance (ES = 0.51) > metabolic control (ES = 0.46) > psychological outcomes (ES = 0.28) > weight loss (ES = 0.16) • Interventions with regular reinforcement are more effective than one-time or short-term education5 • Intervention approaches using informed choices, and acquiring skills of self-management, including group work, audiovisual aids, and behavioral and social learning approaches, were more effective than didactic approaches1-5. • Interventions that involve patient participation and collaboration seem to produce more favorable effects on glycemic control, weight reduction, and lipid profiles than didactic ones6. 1. Padgett, D., Mumford, E., Hynes, M., & Carter, R. (1988). "Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus." Journal Clinical Epidemiology14(10): 1007-1030. 2. Brown, S. A. (1990). "Studies of Educational Interventions and Outcomes in Diabetic Adults : A Meta-Analysis Revisited." Patient Education and Counseling16: 189-215. 3. Brown, S. A. (1990). "Quality of Reporting in Diabetes Patient Education Research : 1954-1986." Research in Nursing & Health13: 53-62. 4. Brown, S. A. (1992). "Meta-Analysis of Diabetes Patient Education Research : Variations in Intervention Effects across Studies." Research in Nursing & Health15: 409-419. 5. Ellis, S. E., Speroff, T., Dittus, R. S., Brown, A., Pichert, J. W., & Elasy, T. A. (2004). "Diabetes patient education: a meta-analysis and meta-regression." Patient Education and Counseling52: 97-105. 6. Norris, S. L., Engelgau, M. M. & Narayan, K. M. (2001). "Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials." Diabetes Care24(3): 561-87.

3. Empowerment Approach in Diabetes Patient Education A promising approach based on key principles related to the reality of diabetes, its management, and psychology of behavior change • The patient is the locus of control and decision maker in day-to-day mx of diabetes (patient is in control) • HCPs role is to provide ongoing diabetes expertise, education, and psychological support to enable patients’ informed decision making regarding day to day mx of diabetes (partnership relationship & informed choice) • Adults are much more likely to make and maintain behavior change if these changes are meaningful and freely chosen (emphasize behavior change and maintenance) University of Michigan Diabetes Research and Training Center (MDRTC)

4. Patient Empowerment Philosophy Advanced Diabetes Nursing Practice

5. Empowerment Education in Nurse Clinic Practice • A real partnership relationship • Knowledge to enable an informed choice

6. A Real Partnership Relationship See how the process takes place 

7. The Patient Needs Insulin Therapy Mr. William Wong was referred to the Nurse clinic • M/58, cleansing worker, NSND • DM for 15 years, deteriorated glycemic control (Hba1c ~ 10%  overall glucose level ~ 14 mmol/L) since 6 years ago • Renal impairment (plasma creatinine ~ 170 mmol/L) • C/O thirst, polyuria, malaise and weight loss • Current treatment: Daonil 10 mg BD, Metformin 1 gm BD (a maximum dose)

8. The Patient Needs Insulin Therapy Short-term Goals of DM management • Improved glycemic control Hba1c to 7% • Patient understood and accepted insulin replacement therapy (to replace the oral drug treatment) • Mastered insulin injection and self-monitoring, etc

9. The Patient Needs Insulin Therapy

10. The Patient Needs Insulin Therapy

11. The Patient Needs Insulin Therapy

12. The Patient Needs Insulin Therapy

13. The Patient Needs Insulin Therapy

14. Knowledge to Enable an Informed Choice • Knowledge (1) to enable patient to make cost-benefit judgments • Self awareness knowledge (2) to clarify emotional, social, intellectual and spiritual components of their lives; so that the patient can discover her own resources for change and control – internal discovery

15. Background • Mr. Bang • 27 years old • Estate agent • BW = 78 kg (BMI = 27.6 kg/m2 )

16. Type 1 Diabetes since 14 years old • Now : mixtard insulin 60 units om, 42 units pm

17. Diabetic Control Status • Poor control for past 6 years • Hba1c = 10 - 12% • Rare self-monitoring his glucose at home • Drowned in business entertainment and little dietary control

18. HELPLESS The Danger • Sudden deterioration in right eye vision • Pending laser therapy

19. The Danger

20. The Reflective Journey What Am I Doing ?

21. The Reflective Journey

22. Information on Diabetes and Treatment • What is the diabetes and treatment goal • Knowledge of diet & insulin use • Treatment options: • BD insulin • Multiple injections • Insulin pump therapy

23. Knowledge to Enable an Informed Choice

24. Thank You !