Barrett consulted with PHMI to develop the Diabetes Center of Excellence at Asan Medical Center, pictured above.
Making a difference one patient at a time: The role of a diabetic nurse educator
Monday, February 9, 2009
Written for PHMI WORLD by Eddah Wakapa
Due to the rising prevalence of diabetes in communities and the shortage of medically qualified staff, a new professional component of the diabetes care team has emerged: the diabetes educator. The role of diabetes educators is dynamic and shaped by the environment in which they practice. It extends beyond the delivery of discrete clinical services and often involves advocacy for patients and consultation with other health care providers and all agencies involved in the care of people with diabetes.
The challenges faced by diabetes educators differ between and within communities, depending on health care policies and resources. The prevalence of diabetes calls for an urgent need for educational programs and the mentoring of health care providers to deliver effective care. Yet many people—whether at risk of the disease or not—do not understand the seriousness of the diabetes disease process and its multisystem effects. Quality diabetes education and care is important in preventing complications associated with diabetes. It also makes the patient active, informed, and a participant in the interaction between the patient and provider. A patient-centered approach to care is central to diabetes management; this focuses on helping people learn to meet the challenges of living with diabetes and become self-caring problem solvers.
Jo-Ann Barrett, RN, BSN, CDE has been a registered nurse for 32 years, and for 19 of those years has been involved in diabetes education in one form or another. She first worked as a diabetes educator at the Veterans Administration (VA) hospital in Boston. This experience, says Barrett, presented her with the opportunity to truly make a difference in the lives of people who live with diabetes, and strengthened her belief that “patients wake up each morning wanting to take good care of themselves and that providers wake up each morning and want to give good care, and with that assumption, they both need tools to do that.”
In her role at Partners HealthCare, she has been engaged in developing those tools and seeing them put to use. Her official title is Diabetes Clinical Improvement and Education Program Manager, High Performance Medicine Team 3. This role evolved as a result of the diverse and rich culture that is the Partners HealthCare system. Upon joining Partners, her role was to develop an American Diabetes Association-recognized diabetes program across the organization. However, it soon became appparent that because of the varied cultures and styles of the different Partners institutions, no single education program was going to serve the entire organization. Therefore Barrett works to develop ADA programs within Partners that are tailored to individual settings: clinics, hospitals, and physician practices. She summarizes this role broadly as helping to ensure that patients within Partners — about 100,000 per year with diabetes — have access to quality diabetes education and care.
Barrett also describes her role as one of a mentor to other diabetes educators. Her goal is to provide educators the tools needed to successfully manage their roles and patients. The dynamic nature of the role requires educators to constantly tailor their education curriculum and teaching methods around the patient, not the provider. “It is key for the educators not only to understand the role, but also see the shift from being provider-centered where educators tell patients what to do, to patient-centered where patients guide the tools they need to be successful in their disease management. Patients are the driving force in their own education,” she says. “I feel that if I can help diabetes educators understand that their job is to help the patient find out what they need to do and how to do it, then that educator can make a difference to patients.”
Another aspect of Barrett’s role at Partners is working with physician groups on process redesign so that they can optimize patient care and experience in primary care settings. This involves working with both patients and physicians and making sure that both parties are fully prepared during the visit. This minimizes medication errors and facilitates patients asking questions to their providers. This role also involves developing a plan of care for the patient, creating a diabetes program within the continuum of care, and promoting health literacy and cultural awareness.
A successful diabetes educator, says Barrett, not only needs skill and knowledge, but also should bring to the role empathy and the ability to listen. Most diabetes educators are self-taught and have no formal teaching background. Because diabetes education takes a multidisciplinary approach, the certification process can be pursued by nurses, physicians, dieticians, exercise physiologists, and social workers, among others. Certification involves passing a national exam after a minimum of two years of professional practice experience and a minimum 1,000 hours of diabetes self-management education experience and employment in a diabetes educator role.
Eddah Wakapa, RN is a Northeastern University nursing graduate student undertaking her Masters in nursing degree specializing in nursing administration. She is currently interning at PHMI under the preceptorship of Elizabeth Brown, RN, MSN, MBA, Director of Clinical Services.
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