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
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