Diabetes Specialist Nurses Research Articles

Liaison psychiatrist in a specialist diabetes centre

Aims and MethodTo identify psychiatric conditions that may require psychiatric treatment in individuals referred from a diabetes centre to a liaison psychiatry diabetes clinic and to examine the referral pattern and reasons for referral. the study was a prospective case-note survey over a 12-month period.ResultsThe most common reason for referral was low mood (37.5%) and the most common psychiatric diagnosis was adjustment disorder (28.6%). Most individuals were referred by diabetes specialist nurses (53.1%). the majority (85.7%) were seen by a clinical psychologist after an initial assessment by a psychiatrist.Clinical ImplicationsCommon mental disorders occur frequently in individuals referred to a liaison diabetes clinic, hence the importance of early diagnosis. the involvement of psychiatrists in specialist diabetes clinics is very limited and better involvement is desirable.

Diabetes specialist nurse telephone helpline: A survey of incoming and out-going calls

Background: Numerous telephone calls for advice on diabetes-related issues are received by diabetes specialist nurses (DSNs), but resources required to deal with such calls are rarely formally identified.Aim: To identify the number, duration, nature of calls, type of callers and impact of calls on DSN workload, in order to help plan future requirements of diabetes services.Methods: In preparation for restructuring how diabetes services are provided locally, a record of all calls made in relation to the diabetes clinic’s helpline during June 2007 was collated. Date and time, type of caller, duration and nature of call were recorded.Results: In June 2007, there were 386 calls (mean [range] 18.4 [4–33] calls per day). Duration was recorded for 80 of the calls, which took up 335 minutes in total, giving an average of 4.2 minutes per call. This gives an estimated total call time of approximately 1621 minutes’ (27 h) during the month. Of the 386 calls, 6% were from general practitioners, 10% from practice nurses, 44% from patients, 4% from nursing homes, 4% from care providers/relatives and 32% from others (ward nurses, doctors, dietitians, district nurses, diabetes care technicians and other primary care trust staff).Conclusion: The helpline is heavily used and its impact on DSN workload is considerable. Appropriate resource allocation is necessary when planning for the future requirements of patients with diabetes.

An evaluation of a Diabetes Specialist Nurse prescriber on the system of delivering medicines to patients with diabetes

To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. The National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and complications. Nurse prescribing creates an opportunity for nurses to improve care for these patients. A quasi-experiment using six wards in a single hospital trust. Inpatient care of a convenience sample of patients with diabetes was evaluated before (n = 27) and after (n = 29) the intervention of a Diabetes Specialist Nurse prescriber. Prospective data were collected to measure insulin and oral hypoglycaemic medication errors and length of stay. There was a significant reduction in the total number of errors between the pre-intervention and intervention group (mean reduction 21 errors) (p = 0.016). The median length of stay was reduced by three days. The total number of errors and length of stay were affected by admission category (p = 0.0004). A medicines management intervention, provided by a Diabetes Specialist Nurse prescriber, had a positive effect on the system of delivering medicines to patients with diabetes and significantly reduced the number of errors. This reduction had some effect on length of stay. The cost saving was sufficient to finance a Diabetes Specialist Nurse prescriber post. (i) Errors frequently occur in the prescription and administration of medicines to patients with diabetes. (ii) The education of healthcare professionals is a factor contributing to these errors. (iii) Nurse prescribing provides a new system by which to educate patients and staff about their medicines. (iv) A Diabetes Specialist Nurse prescriber can reduce insulin and OHA MEs. This reduction had some effect on LOS.

Abstracts from the Association of British Clinical Diabetologists (ABCD) meetings

Abstracts from the Association of British Clinical Diabetologists (ABCD) meetings

Pandemic diabetes: can developed-world health professionals do more to support care in developing countries?

AbstractBackground: The world is witnessing a global diabetes pandemic, likely to have devastating consequences for people with diabetes unless there are adequate measures to improve capacity for diabetes care. In December 2006 the United Nations passed a resolution (UNR), recognising diabetes as a serious health threat of the 21st century. The Unite for Diabetes campaign has three phases, the final stage being the development of programmes to facilitate lasting benefits for people with diabetes, globally.Aim: The developing world is witnessing the worst of the diabetes pandemic; such health communities are often least well-equipped to cope. Thus, there is a pressing need to adopt the UNR as a vehicle to catalyse improved capacity through measures including competence and skill development in these regions. An educational course of this nature was developed and implemented in Sri Lanka, in 2004. Consequently, diabetes specialist nurses, previously almost unseen in this developing nation, now run clinics a...

Self-management of type 2 diabetes mellitus: a qualitative investigation from the perspective of participants in a nurse-led, shared-care programme in the Netherlands

BackgroundDiabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes.MethodsThis study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory.ResultsPeople with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring.ConclusionSelf-management consists of a complex and dynamic set of processes and it is deeply embedded in one's unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.

Diabetes specialist nurses could save the NHS £100m a year

Diabetes specialist nurses could save the NHS £100m a year

The diabetes image: personal, professional, political, societal

The diabetes image: personal, professional, political, societal

The work setting of diabetes nursing specialists in the Netherlands: A questionnaire survey

Aim The aim of this study is to explore whether the work organisation of diabetes specialist nurses (DSNs) differs significantly from nurses working in hospital and nursing home and if so, does this difference result in positive or negative consequences regarding work and health. Background In traditional health care settings, nurses exhibit a high level of environmental uncertainty and low decision-making authority, which has a negative effect on psychological reactions towards work. In professional nursing, specialisation, e.g. diabetic nursing, is a current trend in many countries. Therefore, insight into the determinants of the work situation of nursing specialists is becoming increasingly relevant. Methods Comparisons were made between 3 different samples: 1204 nurses employed by 15 hospitals, 1058 nurses employed by 14 nursing homes, and 350 diabetes nurses working in other health care settings throughout the Netherlands. Data concerning organisation, work aspects, and psychological reactions were measured via questionnaires. Variances between the groups were analysed with ANCOVA, besides hierarchical multiple regression analysis was applied. Findings Environmental uncertainty scored lower amongst diabetes nurses when compared to nurses working in the other two types of health care settings. Social support and role conflict scored low for diabetes nursing specialists who simultaneously perceived autonomy and role ambiguity highest. Diabetes nursing specialists also scored highest on intrinsic work motivation and job satisfaction and lowest for psychosomatic health. Conclusion Except for social support and role ambiguity, diabetic nurses rate their [work] organisation, [work] aspects and psychological [work] reactions more positively than nurses employed in other health care settings.

Diabetes care in hospital—the impact of a dedicated inpatient care team

At any given time, people with diabetes occupy approximately 5-10% of acute hospital beds. In addition, diabetes is associated with a greater length of stay (LOS). This is partially because of increased complexity of the cases but also because of unfamiliarity of dealing with the condition by other specialist teams. In 2002, with increasing pressure on acute hospital beds, a team was established to improve the care of inpatients with diabetes admitted to Derriford Hospital. The team consisted of five diabetes specialist nurses dedicated to inpatient care, supported by a consultant and specialist registrar diabetologist. A link nurse responsible for diabetes was appointed on every ward and each individual with a diagnosis of diabetes was identified on admission. We have compared LOS of all patients with diabetes admitted between January 2002 and December 2006. LOS fell from a mean +/- se of 8.3 +/- 0.18 days in 2002 to 7.7 +/- 0.10 days in 2006 (P = 0.002). Significant falls were seen for emergency admissions (9.7 +/- 0.23 vs. 9.2 +/- 0.20, P < 0.001) but not elective admissions. The data show significant reductions in LOS for medical admissions (9.2 +/- 0.24 vs. 8.4 +/- 0.20, P < 0.001) but not surgical admissions. Over the same period, LOS for the total hospital population fell by 0.3 days (P < 0.001). In conclusion, a team specifically employed to focus on inpatient diabetes care has a significant impact on LOS of this patient group.

Polymorbidity in diabetes in older people: consequences for care and vocational training

Objective:To investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of disease and use of medical...

Attitudes to prescription of antiplatelet drugs by diabetes health workers

AbstractThe aim of this survey was to explore the attitudes to antiplatelet drug use amongst a group of UK diabetes specialist medical and nursing personnel.A postal questionnaire survey was circulated to all consultant diabetologists, specialist registrars in diabetes and diabetes specialist nurses working in the Mersey Deanery area.Seventy‐eight questionnaires were sent out, 63 (81%) returned. The perceived use of antiplatelet therapy was significantly higher for type 2 diabetes compared with type 1 diabetes, especially in the absence of complications or cardiovascular risk factors (52% vs 21%, p = 0.0004). Responses were more variable for type 1 diabetes: more nurses than doctors advised antiplatelet drugs in the absence of risk factors (46% vs 5%, p = 0.0002) and in the presence of smoking (79% vs 51%, p = 0.034). Aspirin was first‐line choice of antiplatelet drug; clopidogrel was generally used for gastric intolerance and aspirin allergy.We conclude that the combination of limited evidence base and imprecise guidelines is not favouring proper usage of antiplatelet drugs and that more evidence‐based didactic guidelines are required. Copyright © 2007 John Wiley &amp; Sons.

The little diabetes book you need to read. By Michael A Weiss and Martha Funnell. © 2007 Michael A Weiss and Martha Funnell. Published by Running Press Book Publishers. ISBN: 0 7624 3116 4.www.runningpress.com (This book is also available at amazon.com)

The little diabetes book you need to read by Michael A Weiss Published by Running Press Book Publishers ISBN 0 7624 3116 4 www.runningpress.com June James Senior Diabetes Specialist Nurse*, * Peterborough Primary Care Trust, UK After a short introduction this book is divided into three main parts: these lead the reader through a process of learning and doing, and then invite discussion around future challenges, options, care support and new developments in diabetes management. The empowerment approach to care is the foundation stone of this narrative; it imbues every area and topic raised and enables the reader to take charge of their own condition and make realistic decisions relating to their care. In each section of the book Michael (Weiss) offers insight into his personnel journey of living with diabetes, whilst Martha (Funnell), acting as an advocate for the many individuals she has met during her career as a diabetes educator, describes her journey from treatment focused diabetes care to the empowerment approach developed with her colleague Bob Anderson. In addition, carers and family members are not forgotten: each section ends with a special note of support and encouragement in recognition of the important role they play in the care of the person in their family with diabetes. This book offers a simple commonsense approach to living with diabetes. It incorporates all the best elements of a good self-help book in a form that is easily understood and leaves the reader with a strong sense that they and only they have the right and power to effectively manage their diabetes.

Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist

Background: In the region of Maastricht, The Netherlands, a disease management programme (DMP) for patients with diabetes mellitus was implemented. The programme aims to improve quality of care within existing budgets. To achieve this, diabetes nurse specialists (DNSs) were given a central role within a multidisciplinary team of care providers. This study describes the cost-effectiveness of this approach. - Aim: To measure the incremental cost-effectiveness of a diabetes DMP, with a central role for the diabetes nurse specialist, in comparison to usual diabetes care. - Methods: Within the DMP, patients with low, medium and high complexities of care are cared for by general practitioners, DNSs and endocrinologists, respectively. The DNSs independently treat patients assigned to them and pay special attention to extensive self-management education. A quasi-experimental trial with two-year follow-up (n = 473) was undertaken to measure the cost-effectiveness of the DMP compared with usual care. - Results: A total of 23% of patients were assigned to the GP, 66% to the DNS and 10% to the endocrinologist. Statistical significant improvements in glycaemic control, health-related quality of life, compliance and most aspects of self-care behaviour were found. No statistically significant changes were found concerning total costs of care. All improvements were greatest in patients assigned to DNS. - Conclusion: A DMP in which DNSs play a central role is associated with improved quality of care within existing budgets. Patients assigned to DNS benefit most, indicating that the central role of DNS in the diabetes DMP is one of its critical success factors.

Telecare motivational interviewing for diabetes patient education and support: a randomised controlled trial based in primary care comparing nurse and peer supporter delivery.

BackgroundThere is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services.Methods/DesignIn a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial.Discussion and implications of the researchWith its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications.Trial RegistrationCurrent Controlled Trials, ISRCTN63151946

An evaluation of an insulin transfer programme delivered in a group setting

This study assesses the efficacy of a group education programme through the improvement of the patients' HbA1c status and their overall understanding of diabetes. The transfer from tablets to insulin is a crucial time for patients with diabetes. The provision of diabetes education is essential, enabling patients to develop a knowledge base from which to manage their diabetes and consequently take control of their life. The growing numbers of referrals for insulin transfer meant that the traditional one-to-one education approach is unrealistic and a local diabetes team developed a group programme to meet the demand. The study has a pre-post test design. Biomedical outcomes are: HbA1c and weight. Self-report outcomes are: diabetes knowledge, diabetes treatment satisfaction (DTSQ) and quality of life (EQ-5D). All outcomes were measured prior to the group education programme and then after the programme had been completed. HbA1c was also measured again at three months after the education programme had finished. A repeated measures anova was used to analyse the main data. Seventy-two patients were recruited into the study and at follow-up 77% (n = 65) remained in the study. The mean age of the participants was 64.5 (SD 12.01) years and the median time since being diagnosed with diabetes was 7.3 years (range two months to 20 years). There was an overall significant reduction in the HbA1c scores across the three time points (F(1.5) = 57.87, p < 0.0001). Post hoc tests indicate there are significant reductions (p < 0.0001) from the pregroup mean at both the postgroup (9.84% vs. 8.54%) and three-month follow up means (9.84% vs. 8.10%). The difference from times 2 and 3 (8.54% vs. 8.10%) was also significant (p < 0.0001). There were no significant changes in weight. After the programme, satisfaction with diabetes treatment was high and knowledge about diabetes had improved (t(54) = 7.46, p < 0.0001). There were significant improvements reported on the five health dimensions of the EQ-5D. These results indicate that a group education programme can be an effective method of helping patients transfer from tablets to insulin. These group sessions have reduced waiting times for patients transferring from tablets to insulin and have proved an effective use of time management by Diabetes Specialist Nurses.

Agenda for Change and NHS reconfiguration

AbstractThe impact of Agenda for Change, NHS reconfiguration and financial restraints on diabetes health care professionals and specialist services is unknown. There has been considerable concern, however, that these initiatives have resulted in significant reductions in specialist diabetes services. The aim of this study was to investigate the effect of the recent NHS changes.Paper questionnaires were sent to 484 diabetes specialist nurses (DSNs) who were asked to complete the survey on behalf of their local multidisciplinary team and to 500 people with diabetes (user representatives [URs]).In all, 162 (33%) of the DSN questionnaires and 77 (15%) of the UR questionnaires were returned. Forty‐three percent of DSN respondents indicated that posts had been frozen, while 26% reported unfilled posts following maternity leave or retirement. Nine percent and 32% described redundancies and downgraded posts respectively. DSNs and paediatric DSNs were the staff groups most affected by budget cuts. Forty‐five percent identified reduced access to professional development and 40% reported denied requests for study leave. The impact on people with diabetes was significant, with 55% of DSN responders highlighting reductions in patient contact time and increased delays in patients' access to DSNs and consultants. Thirty‐four percent reported that specific diabetes services had been cut. Fifty percent of DSNs reported reductions in home‐based care and 49% reported decreases in patient education provision. These results were mirrored by the user representative survey.These findings indicate a major adverse effect of Agenda for Change and NHS reforms on the provision of diabetes specialist services and access to continuing professional development. Copyright © 2007 John Wiley &amp; Sons.

Patient and professional accuracy of recalled treatment decisions in out‐patient consultations

To test the assumption that professional recall of consultation decisions is valid and more accurate than patient recall of consultation decisions. One hundred and thirty-four consultations between diabetes specialist nurses and diabetes specialist dietitians in an adult out-patient diabetes service were audiotaped. Patients and professionals were asked to recall the treatment decisions made immediately after the consultation. Patient participants were also asked to complete the Health Care Climate Questionnaire (HCC). Recalled decisions, by patient and professional participants, were then compared with those extracted from the audio tapes, and with each other. The mean duration of consultations was 27 min. Patients recalled a mean of 2.5 (SD 1.4) decisions per consultation, and professionals a mean of 3.2 (SD 1.6) decisions per consultation. A mean of 2.2 (SD 1.1, range 0-4) decisions per consultation were identified on the audiotapes. Patients recalled a mean of 2.3 (SD 1.4, range 0-6) decisions per consultations that could not be found on the tapes, with professionals recalling a mean of 1.7 (SD 1.2, range 0-6) decisions per consultation that could not be found on the tape. More autonomy, as measured by the HCCQ, was correlated with better professional recall (r = 0.17; P < 0.05). Both patients and professionals have poor recall of decisions made in diabetes out-patient consultations. Although the mean professional recall is marginally better than that of the patients, they recall a vast number of unmade decisions and the implications of these being recorded in patients' notes is substantial.

Impact of nurse prescribing on the care of in‐patients with diabetes

Nurse prescribing, although primarily carried out in the community setting, is growing in secondary and specialist care— for example, in in-patient services. The advent of the Nurse Prescribing Course has provided an opportunity for nurses working within the specialty of diabetes not only to prescribe medicines such as insulin and oral hypoglycaemic agents, but also to adjust therapy legally. Recent research has shown benefits of nurse prescribing for both patients and doctors.1 However, little or no research has actually examined nurse prescribing in diabetes, especially in the hospital setting. The study by Courtenay et al. in this issue of Practical Diabetes International describes an evaluation of the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay and patients' ability to self-manage their diabetes as in-patients. The main findings of this study are interesting but not totally surprising: a number of the medication errors highlighted are not new and some have existed for many years. The authors comment on the fact that previous research has reported similar errors and also a reduction in length of stay when care is provided by a DSN.2 The main findings of this study suggest that a DSN prescriber can reduce prescribing errors, which in turn reduces length of stay, resulting in a cost saving— large enough to fund a DSN prescriber post. However, in view of the fact that actual nurse prescribing was initiated in such a small number of cases, was the real impact in this study that a DSN was available to give advice and education to other professionals involved in the care? Overall, although the numbers were small, this study has highlighted important aspects of care for people with diabetes admitted to hospital. The authors have also emphasised the problem of medication errors, especially in insulin therapy, which continue to occur for a significant number of in-patients.

An evaluation of a specialist nurse prescriber on diabetes in‐patient service delivery

AbstractThe aim of this study was to evaluate the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay, and patients' ability to self‐manage their diabetes whilst in hospital.The setting was six wards in a single United Kingdom district general hospital trust. The standard in‐patient care of a convenience sample of diabetic patients treated with insulin and/or oral hypoglycaemic agents was evaluated before (n = 187) and after (n = 265) the intervention of a DSN prescriber. Prospective data were collected in order to measure insulin and oral hypoglycaemic medication errors, and length of stay (i.e. primary outcome measures). A secondary outcome, the extent to which patients felt able to manage their care, was measured using a self‐report questionnaire.The results showed that the median number of insulin and oral hypoglycaemic agent medication errors was lower in the intervention group (four vs six, p&lt;0.01). The median length of stay was less for patients in the intervention group (seven vs nine days, p&lt;0.05). In all, 61% (59/96) of patients in the pre‐intervention group, compared with 71% (90/126) of patients in the intervention group (p = 0.118), reported that they were able to manage their diabetes during their hospital stay.It was concluded that a DSN prescriber reduced prescribing errors. This reduction had some effect on length of stay. The cost saving was at least sufficient to self‐finance the cost of a DSN prescriber post. Copyright © 2007 John Wiley &amp; Sons.