Diabetes Nursing
Introduction
Job
description
Outstanding Issues
References
The Diabetes nurse specialist association was formed in mid 1980s by a small group of dedicated diabetes nurse specialists. They identified the need to provide a forum for specialist nurses involved in the long term care of diabetes patients It has grown in numbers over the years with almost one hundred and seventy nurses on the current register
A
Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager,
collaborator, practitioner, advanced clinician, consultant. educator and researcher,
Wilson-Barnett (1994). The role of the CNS emanated from the premise of the need
to provide social and psychological support and education on how to manage disease
for patients and their families Dunne (1997).
Diabetes is a complex disorder
of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin
deficiency is the essential feature, Drury (1986). Diabetes is recognised as a
model of broader based communicable disease control programmes, WHO (1991 - 1998).
The management of diabetes demands a broad range of professional skills,
which include communication, counseling, leadership, teaching and research to
name but a few. The Diabetes Nurse Specialist has the expertise and specialist
knowledge to incorporate these skills into practice and so develop standards of
care that benefits the patient, Daly (1997). It has been suggested that
patient-orientated outcomes are likely to be positively influenced by a CNS, Wilson-Barnett
(1994). A CNS is considered an important contribution to advancing clinical practice.
nursing diagnosis and as an advisor in setting standards and policies of care,
McCarthy (1996). The CNS is prepared beyond the level of a generalist (The
Report of The Commission on Nursing 1998 Section 6.33). The CNS should have extensive
experience and advanced expertise in the relevant specialist area of nursing of
midwifery. The Diabetes Nurse Specialist (DNS) plays a pivotal role within
a multidisciplinary team. The recognition of the contribution of the Diabetes
Nurse Specialist in helping patients achieve good diabetes control highlights
his/her essential role in diabetes care, DCCT (1993) UKPDS (1998). Metcalfe (1998)
states that a Diabetes Nurse Specialist who works in collaboration with a team
to ensure continuity of care lends towards more successful management.
Definition
of diabetes nursing practice:
Diabetes Nursing is the provision of primary
secondary and tertiary care to people who are diagnosed with diabetes and where
nursing interventions contribute to a healthy lifestyle and prevention of complications
associated with diabetes.
The diabetes nurse:
- Prioritizes
care interprets. prescribes and initiates nursing interventions. monitors. evaluates.
refers to other healthcare professionals and /or discharges from their care.
- Makes
autonomous decisions with /or on behalf of the patient to augment and support
their health potential and to promote continuitv of care.
- Has the appropriate
education and his 'her competency is continuously assessed.
Components
of the role of the diabetes nurse specialist:
- Patient
assessment and diagnosis
- Prioritize care based on the assessment
- Nursing
interventions based on evidence based practice
- On going assessment, monitoring
and evaluation.
- Patient education, discharge planning and referral to
other sources of care within their scope of practice.
The following
are the factors that are taken into account in determining the Diabetes Nurse
Specialist role: - Professional accountability
- Education
- Clinical practice
- Management
- Professional responsibility
Professional
accountability - Actively participates in the management of the
Diabetes Service making decisions for which they are personally accountable.
- Professionally
accountable to the Director of Nursing.
- Professionally responsible in
conjunction with the Medical Director for provision of the diabetes service.
Educational
- The setting of realistic educational and treatment goals.
- The
assessment and evaluation of learning abilities of patients.
- To educate
people with diabetes so that they can manage their diabetes and enable them to
learn to live a full active and healthy life.
- Involve significant others
where appropriate in the teaching process.
- To educate people with diabetes
so that they become active partners in their care.
- To act as a resource
person for people with diabetes.
- Provide individual and group education
for people with diabetes and their families.
- Provide a service for special
needs groups with diabetes. such as adolescence's, expectant mothers. ethnic minorities
and those with learning difficulties.
Education of Staff - To
respond to the educational needs of staff and students.
- To liase with
the training and academic departments to deliver an ongoing programme of diabetes
education both in the hospital and in the community.
Clinical
- To organize the planning and implementation of care for people with
diabetes and their significant others.
- To encourage a healthy lifestyle
behaviour as part of the health promotion strategy.
- To work in collaboration
with other colleagues and as a member of the multidisciplinary team to provide
specialist advice for people with diabetes.
- To provide a telephone advice
service for ongoing assistance and help.
- To participate in the provision
of a specialist outpatient service for people with diabetes.
- To participate
in the provision of psychological care for people with diabetes and their significant
others.
- To alter treatment within the prescribed clinical options recognising
agreed protocols.
- To maintain accurate and complete nursing records.
- To establish clear referral patterns for communicating and co-operating
with medical staff. ward staff. and other relevant professionals. such as general
practitioners, public health nurses and practice nurses.
- To provide a
service that is evidence based. and aims to improve the quality of life.
- To
improve the standards of care by promoting nursing research. and developing nursing
expertise.
- To evaluate the effectiveness of education programs on an
on-going basis.
Management
- To promote a safe
environment in accordance with Health and safety regulations and Risk Management
guidelines.
- To set standards appropriate for a learning environment for
patients and staff.
- To be actively involved in data collection. for audit
purposes for the evaluation of the service provided.
- To Identify service
needs in relation to change and to best utilize available resources.
- To
be involved in the development of an annual service plan with the relevant personnel.
- To be actively involved in clinical decision making.
Professional
- To demonstrate responsibility for professional growth by ensuring
personal and professional development.
- To demonstrate a knowledge of
and work within the An Bord Altranais. Code of Professional Conduct.
- To
be accountable for nursing decisions and actions.
- To he a member of a
supportive multidisciplinary team and to be able to assist persons with diabetes
with their self management.
- To be actively involved in research that
is relevant to clinical practice.
- Ensure professional practice is research
based and clinicallv effective.
THE DOMAIN OF DIABETES NURSING
PRACTICE:
The domain of diabetes nursing practice is underpinned by the
concepts that guide the way in which diabetes nurses deliver care.
The
person
- Individual needs. developmental stages: child. adolescent.
adult. older person with diabetes.
Health
Health chronic
illness continuum
Primary and secondary nursing care and tertiary prevention.
Nursing
Values. beliefs. attitudes. arts. science. ethics and
self. Environment
Socio-economic and political
The
scope of diabetes nursing practice is defined as the range of roles, functions,
responsibilities and activities which diabetes nurses are educated and authorized
to perform.
CLINICAL CAREER PATHWAYS FOR DIABETES NURSING
Ward
Nurse (Generalist)
- Develop an appreciation for the care and management
of the person with diabetes.
- Is able to assess, plan. intervene and evaluate
nursing interventions for the person with diabetes in collaboration with a diabetes
nurse specialist.
Diabetes Nurse - Organizes, interprets,
intervenes, and monitors care of the person with diabetes.
- Is able to
develop an education plan in conjunction with the multi-disciplinary team.
- Is
able to intervene based on current guidelines with supervision and support.
- Is
aware of the need for personal and professional development.
Clinical
Nurse Specialist in Diabetes Nursing - Organizes nursing care independently
within the context of diabetes care
- Takes responsibility for initiating
primary. secondary and tertiary care of people with diabetes.
- Prioritizes
care. prescribes. initiates, interprets, intervenes. monitors nursing interventions
without supervision and informed by evidence based practice.
- Develops
the evidence base of diabetes nursing practice.
- Recognizes the need for
professional develop of self and other staff.
- Acts as a role model and
uses non-cohesive influence to direct others.
Advanced Nurse Practitioner
in Diabetes - Demonstrates expert skills in direct nursing care
of the person with diabetes.
- Is involved in the development of a quality
service for people with diabetes.
- Initiates research activity on diabetes
at local level.
- Contributes to the education of others including curriculum
development of appropriate courses.
- Critically evaluates the effectiveness
of care through clinical audits, and carries out research to identify generic
problems and change problems accordingly.
- Develop policies. protocols.
guidelines and systems of care in collaboration with the multi-disciplinary team.
- Acts as a role models and provides leadership by being a catalyst for
change through enthusiasm and knowledge.
- Has the authority to manage
own caseload. admit discharge patients from care and refer to other health care
professionals.
A)
THE CURRENT SITUATION:
The specialist environment in Diabetes has recognised formal advanced training structures since 1996:
- Higher Diploma in Nursing Studies (Diabetes Nursing). which is affiliated to University College Dublin and facilitated in the Mater Misericordiae Hospital Dublin.
Post registration education programs provide nurses with an in depth knowledge or skills for particular practice fields.
Prior to this. expertise in diabetes nursing was achieved through working in collaboration with the Medical Consultant in the area. and through ongoing professional development of knowledge and skills pertaining to the specialitv.
The Report of The Commission on Nursing 1998. page 110.6.56. states.
'It is important that Irish nurses and rnidwives, who have pioneered and led the development of nursing and midwifery without the benefit of advanced education (as it was not available at the time), or appreciated"
B) EDUCATION:
There is general concern that the structures available to facilitate further education are not standardized. The location of the accredited course currently running in Dublin is not accessible for everyone nationally.
SUMMARY OF SUBMISSION:
The Irish Diabetes Nurse Specialist Association has introduced the role of the nurse in diabetes care in the context of the continuum from a generalist to an advanced nurse practitioner. Within this submission diabetes nursing practice has been outlined in terms of professional accountability, managerial clinical and educational responsibilities.
We have also identified Diabetes Nurses who have greater than 5 years experience in the speciality of diabetes care. Their clinical experience and their input to the development of the current service should be acknowledged, as accredited training was not available prior to 1996. Those who have greater than 5 years experience should be considered for upgrading to CNM posts with a location allowance provided.
The Irish Diabetes Nurse Specialist Association is supportive of the Report of the Commission on Nursing in relation to specialization. We would envisage that those who are appointed to a diabetes nursing posts will in the future will have accredited training, or give their commitment to undergo accredited specialist training.
However, as an association we are very concerned that some of our members are not acknowledged for their valuable contribution to the nursing care of persons with diabetes, prior to the recognition of specialization within the nursing profession. We would hope that they would be suitably rewarded in terms of upgrading of their position in recognition of their experience and be provided with a location allowance.
Daly
F (1997) The Role of the Diabetes Nurse specialist. Irish Medical times 14(17)
18 Diabetes Control and Complications Trial (DCCT) 1995 Annals of
Internal Medicine 122: 561-568Drury Ml (l986) diabetes Mellitus 2nd Ed. Blackwell
& Scientific Publications Dunne L(1997) A literature review of
advanced clinical nursing practice in the United States of America. Journal of
Advanced Nursing. 25: 814-819 McCarthy 0 (1996) Advantages and Disadvantages
of Specialism in nursing. Paper presented to An Bord altranais Conference, Continuing
Education for Nurses. Metcalf L (1998) Ensuring continuity of care
for diabetic patients attending hospital. Journal of Diabetes Nursing 2(5) 135-138
Report of the Commission on Nursing (1998) Government Publications
Section 6.33 page 105. United Kingdom Prospective Diabetes Study
(UKPDS) 1998 British Medical Journal 317(7160) 703-713 WiIson-Barnett
J & Beech S. (1994) Evaluating the Clinical Nurse Specialist. A review. International
Journal of Nursing Studies 13 (6) 561-571 World
Health Organisaton Publications (1991-1998)
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