Reflecting on my recent experiences of teaching diabetes for Annie Barr Associates I have been really struck by the passion and commitment I have encountered within the nursing workforce in general practice. I have been so impressed with how Practice Nurses and Health Care Assistants have been enthusiastic about exploring knowledge and skills to help them support people with diabetes. The overwhelming necessity is to support people with type 2 diabetes and in our conversations it quickly becomes apparent that we are dealing with multiple morbidities and a great deal of complexity.
Helping people manage type 2 diabetes isn’t just about lifestyle advice, healthy eating and medication. It becomes clear from listening to staff working at the frontline that the management of care is multifaceted – it includes social issues, psychological and emotional factors as well as understanding food metabolism. The popular press is often full off advice about healthy eating and the recent focus on diabetes on the BBC has just added to the complexity of the picture rather than simplifying it.
As the picture becomes more complex how do we help people with type 2 diabetes manage their condition and succeed in reducing their HbA1c? The answer is that it has to be individualised and a trial and error approach might be needed to work out what dietary approach might work, what level of activity is needed and what pharmacological interventions might be needed. The complex picture needs active engagement from all parties in the care relationship. When watching a BBC programme about type 2 diabetes I found myself unable to watch after a while as I became so upset with the passivity and fatalistic attitudes from some of the people whose cases were being presented.
I was really concerned about how people become so powerless and without agency in their lives and in the management of their condition to such an extent that they show no emotional response to the necessity of a lower limb amputation? How does this happen and what is happening within the Health Care system to exacerbate the situation?
Listening to frontline staff it strikes me that all parties feel equally hopeless and powerless in keeping back the rising tide of type 2 diabetes so maybe we need to change the conversation? Health care professionals can’t fix people – however much we would like to and it occurs to me that a more open and honest dialogue around shared decision making and goal orientated care would make a difference for everyone.
The resources are all out there (see below) and the evidence supports a different way of working but the spread and impact is slow. However it is possible if we all make a little tweak to the way we work and encounter people with diabetes. Strive to be the one Health Care professional who turns a passive patient into an active and motivated leader – a peer supporter for others in the practice.
None of this can happen overnight but the models of care are available out there; it just needs more people to be willing to give it a try. It doesn’t take any more time it just needs a tweak in the way we transact the relationship. My vision is for all health care consultations in type 2 diabetes to be adult to adult conversations – no more threats, no more finger wagging – I may be a dreamer but someone has to re-imagine the current scene.
We always discuss these issues on the diabetes courses I deliver for Annie Barr Associates and I hope that all delegates leave with not just knowledge about type 1 and type 2 diabetes but also aware of new ways of working with their patients.
Link to resources
Written by Sue Spencer (PGIDIP LEADERSHIP COACHING, MA, PGCE, MSC, BA, NDNCERT, RN)