All clinicians and educators need good clinical and educational backgrounds, and experiential expertise to fill certain requirements. Experience is needed in current clinical practice of diabetes care and management, and the principles of teaching-learning. These roles demand much flexibility, as the populations served and the settings (inpatient, outpatient, clinical, research) vary. Diabetes educators offer support and a valuable service to the team, often fulfilling a role that it is difficult for a single physician or clinical care professional to provide because of time and availability constraints. Mensing and Norris advise that educators be familiar with and utilize a number of educational skill sets as outlined in Table 2.
After initial instruction, educators provide continued personal and telephone or electronic contact for follow through and assessment of progress. Many people require repeated instruction and teaching. Educators have the expertise, experience and, often, more scheduled time to assess, instruct and assist patients with the learning process, and working through the personal barriers to learning, such as language, reading levels, disabilities, etc. Scheduling of education, length and timing are often left to the educator, although new legislation promotes use of more group experience. Instruction in the basics for survival and more advanced learning are common approaches. The standards currently identify 10 basic content areas to be delivered; educators are prepared to develop these as needed:
■ Diabetes disease process
■ Nutritional management
■ Physical activity
■ Risk reduction
■ Goal setting/problem solving
■ Psychosocial adjustment
■ Preconception care, pregnancy, gestational diabetes management
More recently, the AADE 7 Self-Care Behaviors (3) have been introduced and offer a similar content structure incorporating the 10 basic content areas described in the revised standards. The AADE 7 content areas are:
■ Healthy Eating
■ Taking medications
■ Problem Solving
■ Reducing Risks
■ Healthy Coping
All members of the team are key players. Newer members of the clinical team are the CDE, the clinical nurse specialist (CNS), advanced practice nurse (APN), and those with the advanced clinical role with the newest credentials: the Board Certified Advanced Diabetes Management (BC-ADM) certification. Each of these members has a strong basis in diabetes
TABLE 2 Educator Skill Set Preparation: topics, materials, audio-visuals
Delivery: demonstratons, visits, discussion, empowerment, Powerpoint, homework
Assessment: individualized, readiness, confidence, conviction
Documentation: handwritten, automated medical record, phone and e-mail forms disease-specific practice, together with an expanded role. These are performed and guided by written procedures and policies, clinical practice guidelines, and evidence-based research (24). In conclusion, the CDE role is an important part of the integration of clinical care into a more formal educational approach to diabetes. Patients must learn to be skilled and knowledgeable in diabetes self-care, able to access care, and facilitate ongoing decision-making related to their ongoing medical and self-care practices. They are at the center of their own team. As the clinical role solidifies, educational programming and service development needs arise. The educator then assumes the role of coordinating these services, utilizing both business skills and quality management.
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