Health Transition Fund Project NA012: Diabetes Community/Home Support Services for First Nations and Inuit

Health Staff Education about Diabetes

One of the Project objectives was to identify the education and training needed by community-based health care staff to provide improved services for persons with diabetes and their families. The knowledge and skills of health care staff clearly increased during the Project and this had a positive impact on their personal and professional practices.

Needs Identified

A common need identified in all pilot communities was increased diabetes education for all levels of community based health staff. The needs assessment package included one selfassessment tool for use by Registered Nurses and another for use by all other health staff members. In their self-assessment, the health staff identified most of the potential learning areas as important for learning. They also identified the need for up-to-date and consistent information to be given to clients.

Activities

The pilot team members took advantage of opportunities to access educational programs and workshops on diabetes throughout the Project. Workshops were accessed through the universities, diabetes education centers and regional conferences.

"The diabetes assessment tool to help identify gaps and facilitate goal setting and clients are reporting back that they have reached their goal and want to set new goals for themselves."
Home Care Nurse - Red Earth First Nation

In addition to the workshops, community staff found that the working relationship with diabetes education teams developed during the pilot had a mentoring effect. It was a positive experience to work with diabetes education team members and to have them available to discuss client-related issues and concerns. The pilot staff were also able to access numerous written resources from these outside experts.

The specific activities to address the learning needs to health staff related to diabetes occurred in two ways: a 3.5 day workshop for Registered Nurses (two from each community) was provided through the Project to develop skills in the area of diabetes education, and at the local communities. As a result of
this workshop, participants were able to:

• gain an understanding of the current principles for the care and treatment of diabetes;
• use and apply to their practice recognized standards of care and treatment (Canadian Diabetes Association Clinical Practice Guidelines);

"To become very comfortable and competent in diabetes management, staff members will need to actively participate in continuous learning: methods include obtaining subscriptions and reading magazines related to diabetes management, continue to participate in home visits with diabetes experts, and attend any information workshops and sessions available."
Home Care Nurse - Sliammon First Nation

"At first I would just teach this and this. I just wanted to get it done and check things off. The (Diabetes) Workshop helped me realize that clients are only ready to learn depending on their own needs. The Stages of Change taught me that if people are not ready I can't just push material at them until they are ready. I have learned to respect people more. When I realize they are not ready to learn, I have learned to be more encouraging, be more supportive. It made me realize that you need to base everything on the clients needs." Rigolet Home Care Nurse

• gain an understanding of the principles of diabetes education and one strategy to facilitate behavior change (Transtheoretical Model of Change/Stages of Change);
• use and apply a tool for client assessment developed specifically for the Project;
• obtain and try out practical tools for client education; and

As part of the community diabetes plan, the Registered Nurses who attended the above course provided education sessions for other health staff. Some examples included:

• eleven diabetes classes, each three hours long, held in the community for seven staff and three community members;
• ten in-service sessions for the Home Support Service Workers on diabetes management;
• twenty participants in diabetes workshops presented by the multi-disciplinary team; and
• Home Health Aide who worked closely with project nurse and diabetes educators, attended a three day workshop in the community.

Impacts of Health Staff Education about Diabetes

Health staff interviewed during the evaluation reported that the Project had increased their ability to deliver diabetes services to the members of their communities. Another significant impact was a change in the attitude and beliefs of the health care professionals who are working with the people with diabetes.

"Access to expert advice and creating professional clinical partnerships is also essential in providing quality care... The Certified Diabetes Nurse Educator provides expertise beyond the Home Care Nurse Coordinator's ability, and in some ways could be considered a mentor in diabetes management."
Sliammon First Nation - Project Coordinator

The understanding of health care providers was impacted by the Project in a number of ways:

• learning about diabetes is now more likely to be seen as a continuous and long- term process;
• the use of the Clinical Practice Guidelines has provided a tool and common standard for care amongst all the professionals;
• clients are seen as able to direct their own care and set their own goals while the professional is seen as a supportive resource and facilitator;
• high quality tools and processes can positively impact the care and treatment received by the people with diabetes;awareness that persons with diabetes can take charge of their health care and impact the course of the condition; and
• the effectiveness of the case management approach with a systematic follow-up by nurses can make a difference both to the clients but also to the care provided by physicians.

" I learned that people have to look at diabetes on a day to day basis. They have power to improve their quality of life by looking at nutrition, physical activity... and they can control it and also by reducing the stress. My motivation is now to help people to face the power of their lives and have better quality of life on a day to day basis." Psycho-social worker - Wendake First Nation

"We are more confident in meeting with doctors because we now know what we are talking about. We use the guidelines as bottom line. When the doctors are not working with those guidelines, we ask them why. We are more confident with this type of follow up."
Project Coordinator - Wendake First Nation

In conclusion, the education and training of front-line staff was one of the first and most critical steps in the creation of community-based diabetes services. This education served as a means to develop the vision for improved services and to develop new skills and knowledge which was then shared with other staff and community members.

Implementing diabetes services within a Home and Community Care Program will require a commitment to ongoing health staff education in both the technical aspects of diabetes care and treatment, and also the caring aspects of education and support for clients and their families.

Diabetes education and care skills need to be provided in a variety of ways, including formal and informal educational sessions, mentoring with diabetes education teams and written materials.

"The discussion of expectations of other team members and the establishment of roles and responsibilities needs to be done in the planning phase." Project Coordinator - Red Earth First Nation