Paediatric Diabetes Specialist Nurse Research Articles

Oxfordshire Childrens Diabetes - The Primary Schools Intervention Programme.

Poorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily ‘Individualised Care Plan (ICP)’.After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children.The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive ‘ICP’ and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA p<0.001). This requires 500-1000 hours of DSN time to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed.We advocate that our programme supports each child’s ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.

Glucagon injection for type 1 diabetes in children

Glucagon has been prescribed routinely on diagnosis of paediatric type 1 diabetes. A forum of paediatric diabetes specialist nurses sought to examine whether this practice is evidence based. Forum members audited their own caseloads, including the families and carers, their professional practices and those of other teams nationally. It was found that the prescription of glucagon varies and its use is often limited by lack of confidence. They found little evidence to support routine prescription on diagnosis and recommend that individual case assessment of risk and of the needs and preferences of families and carers would be more cost effective. Families and carers who do acquire a glucagon injection kit should receive regular training in its use.

Meeting the psychosocial needs of children with diabetes within routine clinical practice

There is little guidance for paediatric diabetes teams on how best to meet their patients' psychosocial needs. The aims of conducting this survey of practitioners were to examine the challenges they face in delivering routine care, elicit their approaches to encouraging behaviour change and to inform the development of a training package to be evaluated in the Development and Evaluation of a Psychosocial Intervention with Children and Teenagers Experiencing Diabetes (DEPICTED) Study. A semi-structured telephone interview was completed with 44 doctors and seven paediatric diabetes specialist nurses and emergent themes identified. The key challenges for practitioners were categorized as engagement and communication, meeting the needs of different ages and helping patients and their families integrate diabetes into their everyday life. Approaches to behaviour change were described in terms of education, advice and listening. The survey demonstrates the complexities of communication with such a heterogeneous patient group and the range of approaches taken by practitioners in addressing behaviour change within routine care.

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.

Extension of a paediatric diabetes home care service

AbstractAt the end of 1994 a paediatric diabetes specialist nurse (PDSN) was appointed to extend the paediatric diabetes home care service between the Birmingham Children's Hospital and a district general hospital (City Hospital) in Birmingham. As a result 24‐hour home care can now be offered to newly diagnosed and existing paediatric patients with diabetes at City Hospital. The initial mean HbA1c for the clinic was 9.8%, which since then has fallen to a mean of 8.95% (range 7.9–9.4%); a mean reduction of 0.85%. As a result of home care there has been a sustained reduction in bed‐days for newly diagnosed patients (median five patients per year) and for re‐admissions of existing patients. In addition to any long‐term benefits arising from improvement in diabetic control, the cost savings of reduction in bed‐days alone at £235 per day (Total £15110 per year) outweigh the cost of the PDSN post (£14800 per year). Copyright © 2003 John Wiley &amp; Sons, Ltd.

The paediatric diabetes specialist nurse and diabetes education in childhood

The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process. A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%). The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education. The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.

Evaluation of a paediatric diabetes specialist nurse post.

The specialist nurse caring for children with diabetes is widely recognized as a valued member of the paediatric diabetes team. However, there has been minimal exploration or examination of the clinical role of the paediatric diabetes specialist nurse (PDSN). This in-depth evaluation critically examines the impact of a PDSN post, comparing data from the first 2 years of the post against corresponding data from the previous 2 years. Results are encouraging, showing that much has been achieved. Home management was successfully introduced, length of stay was halved for newly diagnosed children initially hospitalized, suggested guidelines for length of stay for readmissions were met, age-banded education sessions were implemented and clinic non-attendance was substantially reduced. The readmission rate for children with established diabetes was increased, and reasons for this are discussed outlining intervention being introduced to proactively address this problem. The findings from this evaluation support the belief that PDSNs, as members of a multidisciplinary team, make a substantial and valuable contribution to paediatric diabetes care.