line is a Diabetes Resource Expert (DRE), followed by a Self Management Trainer would leads group diabetes classes focused on self management, train coaches and …
NEWSLETTER ALLIANCE FOR DIABETES EDUCATION IN COMMUNITIES ADEC
eshahady@attnet
October 17, 2008
Issue 2
Diabetes is the most demanding chronic illness It challenges every fiber of a patients body and spirit and demands a system of care that ministers to the biological, social and psychological aspects of the illness It takes a village to accomplish this task
ADECs purpose- Provide a forum for individuals medical and non-medical in
clinicians practices, community health centers, county health departments, community and faith based organizations, and others to network and share information about best, promising and developing diabetes patient education practices activities
Second meeting of ADEC
The second meeting was held October 17th 2008 in Tallahassee There were several presentations that provided excellent insight into diabetes education in communities
List of presentations
1 The Diabetes Education Pyramid-expanding Diabetes Education Rob Lombardo, 2 Group Visits for Diabetic Patients-Are they effective in a physicians office? Scottie Whiddon and Sandy Baker 3 The Diabetes Pyramid in Action- diabetes education in the hospital setting Dawn Smith, 4 The Diabetes and You
Project, M Miaisha Mitchell, 5 How Nurses and Medical assistants use Diabetes Report Cards in Clinicians Offices- Ed Shahady, Joanne Lopinski and Ruth Cuzzort 6 Health Ministries and Community Health Workers outreach in Jefferson and Madison Counties - Kim Barnhill, 7 Faith Based Initiatives: Faith Community Health Ministry at TMH - Travis Greenman 8 Tips to Improve Health Literacy with Diabetic Patients - Joanne Lopinski, 9 Pyramid Power: North Florida Group Education Project - Rob Lombardo
The Diabetes Education Pyramid-expanding Diabetes Education Rob Lombardo
Rob reminded us that 76 of persons with type 2 diabetes reported never attended any kind of educational class about diabetes Unfortunately there are only 739 Certified Diabetes Educators CDE in Florida and over 1 million diabetics The ratio of CDEs to diabetic patients is approximately 1700 to 1 Because diabetes education is critical to successful diabetes management more individuals who can provide diabetes education are needed Rob proposes a system of training different levels of diabetes educators He
proposes a Diabetes Education Pyramid At the top of the pyramid is the CDE; next in line is a Diabetes Resource Expert
DRE, followed by a Self Management Trainer SMT and Self Management Coach Facilitator SMCF The DRE could be a Nurse, RD or other licensed health professional; that receives the identical 20-30 hrs of clinical training received by the CDE but chooses not to pursue certification, or is pursuing certification but has not accumulated the required 1,000 contact training hours There may be a large cadre of different levels of nursing, dietary and other allied health professionals, in both urban and rural areas who may wish to become DRE The SMT would leads group diabetes classes focused on self management, train coaches and creates Self Management teams They could be health educators, case managers, CNA or similarly trained professional or para-professional working in health care or allied field A curriculum for training of SMT would focus on adult education, literacy, empowerment and goal achievement The SMCF would be a lay person, neighbor, church member, co-worker, friend or family member who would assist and guide patients in self management techniques They would address barriers such as exercise, medications, emotional support, shopping for healthy foods, transportation and
loneliness They would need a basic understanding of diabetes and training in adult learning, self management goal setting, tracking of goals, and familiarity with community resources, literacy issues and motivational techniques
Group Visits for Diabetic Patients-Are they effective in a physicians office? Scottie Whiddon and Sandy Baker
Dr Scottie Whiddon and his assistant Sandy Baker discussed how they performed diabetic group visits in their office located in Quincy They have been doing them for the past 5 years They thought the group visits were of significant value to the patients and were a source of satisfaction for the physicians and staff They related stories of patients
who attended group visits and how the patients were able to better self manage their diabetes after attending the group visits
The Diabetes Pyramid in Action- diabetes education in the hospital setting Dawn Smith
Dawn Smith presented a discussion of how to implement the above pyramid in the inpatient setting She described a program initiated at TMH that has improved the spread of diabetes-related clinical knowledge and expertise to all nurses who care for inpatients A large number of people entering acute
care hospitals will experience either a stressrelated elevation in blood glucoses, or will have undiagnosed diabetes This is especially true with patients who have acute coronary syndrome and are in the CCU or ICU The goal is to have one trained nurse on each hospital unit The qualifications for the nurses were as follows: RN with a minimum of one year experience at current assignment Strong clinical skills Credibility with the nursing staff Good communication skills Works primarily day or evening hours or is willing to attend monthly lunch meetings full time is best Willing to make a one year commitment Desire to become more expert in diabetes care and education and is willing to pass that information on to the staff There are currently 20 nurses in the program called DEEP DEEP is now considered a workgroup of the Practice Council and part of the Shared Governance for Nursing at TMH Other outcomes include, new pre/post-op order sets, CABG post-op orders for glycemic control, and insulin drip protocols for ICU
The Diabetes and You Project-Miaisha Mitchell
Ms Mitchell presented and discussed a video that addressed diabetes in the African American community The presentation stressed
the need for a change in nutritional habits and exercise Comments in the video stressed the increased incidence of diabetes in the African American community and how diabetes prevention was being stressed in the Diabetes and You Project The faith based community has embraced the project and several have shown the video to their congregations
How Nurses and Medical assistants use Diabetes Report Cards in Clinicians Offices- Ed Shahady, Joanne Lopinski and Ruth Cuzzort
Dr Shahady first presented some of the data and reports from the Diabetes Master Clinician Program He stressed the importance of empowering the patient to better self management by providing them a report card that list their diabetes evidenced based goals in patient friendly language, the reasons for these goals and how well they are doing in reaching the goals Here is an example of the report card in a fictitious patient
The office nurses and medical assistants have also played a significant role in increasing the number of patients who reaching diabetes goals The following is an example of how one practice changed its numbers over an 8 month period of time
1-07
9-07
These changes are attributed to the MA or
Nurse providing patients their report cards at the time of the visit, ordered tests, exams and immunizations per protocol and performing the monofilament exams Joanna Lopinski and Ruth Cuzzort then shared their experience with teaching practices how to use the report card and the positive reception the report cards received from staff and patients
Health Ministries and Community Health Workers outreach in Jefferson and Madison Counties - Kim Barnhill
Ms Barnhill presented a community wide project that encourages exercise in their communities Several community 
partners were solicited and the results were encouraging More sites to exercise were available and as a result more members of the community were exercising
Faith Based Initiatives: Faith Community Health Ministry at TMH Travis Greenman
Ms Greenman from the Tallahassee Memorial Hospital Pastoral Care Department presented the Faith Community Health Ministry The primary focus of the program was cancer The initial activity was a day of dialogue on minority health to decide the role of the church in community health They discussed the State of Minority Health for Gadsden, Leon, and Jefferson Counties and health disparities for
infant mortality, heart disease, cancer and diabetes They obtained a grant from the American Cancer Society for health ministry training for 5 African American Churches in Gadsden County, Wakulla County, and Jefferson County The goal of the grant was to increase breast cancer screening in women by 2 and to put together a transportation coalition for cancer screenings Training included a video from Dr Green of Bethel AME welcoming to the training, healthy food catered by Simply Soulful, Rev Dr John Galloway spoke on the Church and Healing and what Health Ministry is and scripture was read to begin each section Other items included were Power to End Stroke, Stress Reduction and Mental Health Issues, Infant Mortality, Exercise, First Aid and CPR, 3 hours of Breast Cancer Training, together with the 2 hours of Triple Touch II training, a total of 5 hours dedicated to Breast Cancer Many of the churches have had Health Events for Breast Cancer Training and other Health Training Our team has been invited to some; others have been presented by the church Goal to empower the Health Ministers to lead the trainings and promotion Most promoted the Prostate Screening in September and starting
to record members BP and weight Jefferson County Health Ministers have organized and meet every other month Transportation Coalition 1 church in Gadsden will volunteer their church van 2nd Saturday of each month; 1 church in Wakulla says they can drive a mini van once a month
Evaluation and future plans include: Continue to gather documentation from May Training to ascertain if Health Promotion by Health Ministers resulted in desired 2 increase in women who screen for Breast Cancer Clergy Luncheon of clergy with Health Ministry needed clergy support Continue to create transportation team Finding ways to continue working with these Faith Communities and offer continued training to more targeted Faith Community Health Ministry Teams in the Big Bend Area Decisions about training such as location, content, length Will create other faith traditions rationale as well
Tips to Improve Health Literacy with Diabetic Patients - Joanne Lopinski,
Joanne Lopinski RN from the Big Bend Rural Health Network provided an overview of the importance of literacy in Diabetes Care Knowing how and when to seek medical care, and taking advantage of preventive measure require that people understand
and use health information Health literacy is defined as a persons ability to obtain, process, and understand health information needed to make informed health decisions Populations at risk for low literacy include older adults, racial and ethnic minorities, and individuals with a chronic illness such as diabetes, those with low socioeconomic attainment and people with less than a high school degree Low health literacy is associated with poorer health outcomes, less likely to seek preventive services, enter the health care system sicker, make greater use of emergency services, and require more hospitalizations hospital and longer length of stay Low health literacy is associated with increased medication errors and unintentional overdosing of both prescribed and OTC medications and increased risk of a chronic health condition Joanne stated that low literacy can be overcome in a variety of ways Involve patients and families by encouraging a family member or friend to accompany patient to appointments Create a shame free environment by promoting a culture of helpfulness, caring and respect by everyone on the team and provide easy to follow instructions for appointments, check in,
referrals and tests Use patient friendly written materials because most patients regardless of their reading or language skills prefer medical information that is simple and easy to understand Improve interpersonal communication with patients by using the words what or how instead of those that can be answered with a yes or no response For example say tell me about your problem What do you think may have caused it? Try asking what questions do you have? instead of do you have any questions? Dont ask patients if they understand They will always shake their head yes even if they dont Check for understanding by asking the patient to state in their own words what has been discussed Limit the number of written and verbal messages The Chunk and check technique involves breaking down complex information into small amounts Reinforce verbal messages with written materials Say something like: I want to
make sure I did a good job explaining this to you, please share what you heard me say Low literacy presents many daily challenges for people and even more so when dealing with a health condition as complex as diabetes An environment in which the patient understands the health events, makes
informed health decisions and knows what they need to do to ensuresbetter outcomes For your Local literacy program, go to http://wwwliteracydirectoryorg/ Joanne Lopinski can be reached at bbjoanne@rosenet for questions and comment
Pyramid Power: North Florida Group Education Project - Rob Lombardo
Rob presented a potential project that would use the principles of the Diabetes Education Pyramid to train a cadre of rural diabetes resource experts DRE They would receive ongoing in-service training and diabetes seminars targeting He proposes collaboration with Tallahassee Memorial Diabetes Center ADA Recognized Center, Big Bend and Panhandle Rural Hospitals Physician Practices including 13 Diabetes Master Clinician Sites, Community Health Centers Bond and Neighborhood Health, Nursing Homes, Home Health, Hospice, Nursing schools at FSU, TCC and NFCC, North Florida Area Health Education Center and Community and Faith Based Organizations The proposed action plan Form Project Team: TMH, BBRHN, AHEC, others Form Curriculum Team: TMH CDEs lead Develops training curriculum and training materials for participants; develops CEU plan for training Form Recruitment Team: Recruits health
professionals to attend training - Contacts health providers in the region; sends information for distribution to health professionals; informs colleges of program to recruit students; Form Logistics and Support Team: Helps locate venues for training contacts providers; sends out flyers and other information to ADEC list serv or other email lists; connects with organizations planning health fairs; arranges meeting refreshments Project overview Purpose: Increase number of health professionals with up to date diabetes knowledge Goal: Have more rural health professionals with current diabetes training available to support a wide array of diabetes education programs, from patient education within physician offices to community education workshops and church based health ministry studies Expected Outcomes: Within 2 years train an additional 100 rural health professionals, with at least 10 trained professionals in each Big Bend county and Connect newly trained health professionals with community based diabetes education programs
Source:biopharmconsortium.com
