I am an insulin dependent Type 2 diabetic. It has been some years since I did any diabetic teaching and am now preplexed at some of the information that I have received, both as an inpatient and as an outpatient. I am wondering just what inpatient, as well as out patient, nurses think is their responsibility in educating a new diabetic or adding to the education of a diabetic who has been one of a number of years. Do you feel that a hospitalized patient should be taught to know when and how to take his medications? To have consistent eating patterns? To have knowledge of symptoms and foods for hypoglycemia? To understand who and when to call for help? Do you believe that hospitalized patients are too ill to learn or retain information or skills? Do you believe that there are abundant resources for outpatient education? Are there diabetic educators available at your facility? Do you believe, as a staff nurse, that you have adequate knowledge to educate patients? Does your facility provide education sources for you the staff nurse, to update your knowledge? Do you believe that education is a lenghty, complex, and elective process? Do you bvelieve that the education, in the hospital, is essential? Do you believe that outpatient programs are not equiped to address such complex issues? Do you feel management supports your efforts and gives you the time? Are you aware that Medicare pays little for 're-education'? Are you aware of the programs available, in your community, at little or no cost? Does your facility offer such programs and do they charge for them?
Thank you for any who decide to answer my questions.
Thanks for the link. I hate pulling rank and informing the staff that I am a nurse and have been a diabetic for more then ten years. But I do what I have to do. My PCP joined a group practice and it is my misfortune to get a physician from the group, who doesn't know me.
I'm an endocrinology CNS and work on a mixed specialty (including endocrinology) ward, and so am very familiar with how difficult teaching can be, both with newly-diagnosed and established diabetes.
We are fortunate enough to have two diabetes education nurses, who service the hospital - they get blanket referrals with all newly-diagnosed cases, and can be referred by any member of the team for patients previously diagnosed with diabetes who present with another problem but where there is concern about diabetes management.
The educators set up a program of slowly escalating patient responsibility, with blood glucose monitoring, recording, and administration of meds and/or insulin. The nursing staff caring for the patient document this in the patient's record - if the patient needed prompting, or initiated monitoring; how well they managed; if they drew up the appropriate dose etc.
Patients who are admitted with a diabetes-related problem (eg DKA, worsening renal function) or who have unstable/high/low BSLs while admitted have an HbA1C performed, referral to diabetes education, and to the endocrinology team if the unit are having trouble with management. They also have an endocrine outpatients appointment made as part of discharge follow-up.
We have pamphlets in a number of languages about what to do in the case of illness, and recommended websites (like Diabetes Australia). We also have a tick list of what to do for optimal management - monthly podiatry appointments, quarterly check ups by the LMO, six-monthly endocrinology reviews, and yearly ophthalmology assessment, plus nephrology review if there are early indications of renal failure.
Unfortunately not every one is able or prepared to follow these guidelines. My favourite is when a patient with two half legs, chronic renal failure, ishemic heart disease and retinopathy tells me that they know their sugars and it's fine if they're that high. And even the most compliant patient can run into trouble, especially if their LMO thinks s/he can manage diabetes on their own. Don't get me wrong, many times they're fine, but the number of patients I've had come in with near-end-stage renal failure, who'd never been seen by an endocrinologist or nephrologist...!
I know what you mean by patients experiencing the side effects of the disease and their insistence. Believe it or not, when I was first diagnosed, I thought I could handle my problem as well. Talk about ego, mine was up in ouer space. Fortunately, I have not suffered any problems due to my arrogance. I worry about my fellow diabetics, who either over manage their disease or do not manage it enough. It is like being caught between a rock and a hard place.
I recently did a nsg school clinical with a nurse working in an endocrinology office. I am in colorado - the issues facing diabetic patients in this area is disturbing.
A couple things that I learned from this clinical rotation that you may find interesting. You may disagree - this is just what the RN told me.
1. There is a shortage of endocrinologists in the U.S. It is near the bottom of specialties that med students will go into since there just isn't enough money in it.
This particular MD that i observed was near retirement age and was pretty "old school." The info he gave patients - it kindve bothered me b/c I didnt feel he got to their level of understanding. He would start explaining what diabetes does to the body, ect and I can't say I understood what he was saying so I really doubt the patient did either.
Also, family practitioners don't really know enough about diabetes, and probably don't care. They don't like to put patients on insulin, b/c it increases their liablility, and also takes time, obviously.
2. Office visits are only supposed to be 20 min - how can you give all the needed education in 20 min? You cant.
3. Language barriers - Many diabetic patients are of hispanic origin, only speaking limited english. Therefore, teaching is harder and more time consuming. Also, diabetes is such a complex condition that i think it is hard for the average person to really understand it, anyway.
4. Diabetes education doesn't make money for the hospitals. Reimbursement from medicare,ect isn't enough. Also, these diabetic educators cant quantify the results - meaning it is hard for them to prove they are doing their jobs and being effective. It is near impossible for them to make sure that patients are being compliant.
5. in a neighboring town to where I am, recently the hospital cut their diabetic education program since it wasn't making money, although the attendance was good.
I recently did a nsg school clinical with a nurse working in an endocrinology office. I am in colorado - the issues facing diabetic patients in this area is disturbing.
A couple things that I learned from this clinical rotation that you may find interesting. You may disagree - this is just what the RN told me.
1. There is a shortage of endocrinologists in the U.S. It is near the bottom of specialties that med students will go into since there just isn't enough money in it.
This particular MD that i observed was near retirement age and was pretty "old school." The info he gave patients - it kindve bothered me b/c I didnt feel he got to their level of understanding. He would start explaining what diabetes does to the body, ect and I can't say I understood what he was saying so I really doubt the patient did either.
Also, family practitioners don't really know enough about diabetes, and probably don't care. They don't like to put patients on insulin, b/c it increases their liablility, and also takes time, obviously.
2. Office visits are only supposed to be 20 min - how can you give all the needed education in 20 min? You cant.
3. Language barriers - Many diabetic patients are of hispanic origin, only speaking limited english. Therefore, teaching is harder and more time consuming. Also, diabetes is such a complex condition that i think it is hard for the average person to really understand it, anyway.
4. Diabetes education doesn't make money for the hospitals. Reimbursement from medicare,ect isn't enough. Also, these diabetic educators cant quantify the results - meaning it is hard for them to prove they are doing their jobs and being effective. It is near impossible for them to make sure that patients are being compliant.
5. in a neighboring town to where I am, recently the hospital cut their diabetic education program since it wasn't making money, although the attendance was good.
Scary
take care!
Yes, endocrinologists are in short supply. And likely you are correct in your judgement of the physician. And a good family practice physician will refer for evaluation, as to the need for insulin. However, not every one is a good one, or is willing to admit his/her limitations.
As for the rest of your comments. That is the reason for diabetic nurse educators, they have the time. And Hispanics do have a high incidence of diabetes and poor control due to the language barriers.
grannynurse FNP
82 Posts
Thanks for the link. I hate pulling rank and informing the staff that I am a nurse and have been a diabetic for more then ten years. But I do what I have to do. My PCP joined a group practice and it is my misfortune to get a physician from the group, who doesn't know me.
Denise :balloons: