The Diabetes Educator: Myth and Reality

Abstract

This study investigated the current role of the diabetes educator and the historical and professional circumstances in which that role was defined to meet the challenges of a rapidly increasing health problem. Diabetes has been recognised as a chronic disease that requires a lifetime of good management practices. Long-term self management has been linked logically to being well educated and informed about diabetes and its long-term management. Wikblad (1991) considered that information about the disease was not sufficient; people also had to understand how to use that information. The diabetes educator became designated as the appropriate health professional to provide the information in a manner that promoted and encouraged patient participation in the self-management of their illness.

The approach to this study was to consider the role of the diabetes educator in terms of interaction with patients and associated health professionals. It was accomplished by framing four research questions that address the topics of legislation governing scope of practice, training, interaction with other health professionals, and the patient’s perception of how the educator assists them in promoting self management of their diabetes. The methodology used to assess the four questions consisted of semi-structured individual interviews with educators and patients in tandem with an observation, re-observation process of assessing the educator-patient interaction. This methodology was used in both Brisbane and Singapore health facilities.

The findings showed little knowledge of legislation, and training equated to each educator having a general nursing qualification. The observation, re-observation process indicated that the educator interacted with their patients by using a routine that seldom varied. Optimal scaling of the research results showed that participants from the Brisbane sites were more likely to be drinkers and older than the Singapore participants. A fifth research question about culture extracted from interview data showed that the Singapore educators were much more aware of cultural differences in their relationship with patients and knew how to deal with them when required to do so.

The outcome of the study demonstrates a clear need to bridge the gap between actual practice and published standards and requirements of practice determined by diabetes educators’ professional associations. The educators in this study were employed and practised on the basis of their nursing qualifications. As the Australian and Singapore diabetes educators associations invite other health professionals to consider employment as diabetes educators, the concept of training and qualification appropriate for the role has to be determined.

The implication from this study is that education of the diabetes educator must be taken to a level beyond that of the current nursing qualification. In order to move practice towards the recommended standards of educating patients for self-management, two concepts need to be considered. First, the education process must produce the best health management outcomes for the patient. Second, diabetes educators must be provided with the skills and level of training beyond that required for general nursing practice. An educational program specific to diabetes educators’ education, and the resultant qualification, should become a prerequisite for employment in the hospital and in community diabetes clinics. Although the diabetes educators’ professional associations in both Brisbane and Singapore have promoted the need for educators to become involved in research that will benefit patient self-management issues, it has not yet translated into practice.