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Revisiting the Role of a Diabetes Educator: An Opportunity Not to Be Missed
Can J Diabetes 36 (2012) 157e158
Contents lists available at SciVerse ScienceDirect
Canadian Journal of Diabetes journal homepage: www.canadianjournalofdiabetes.com
Commentary
Revisiting the Role of a Diabetes Educator: An Opportunity Not to Be Missed Diana Sherifali RN, PhD, CDE a, *, Anne Belton RN, MDE, CDE b, Lori Berard RN, CDE c, Catherine Freeze MEd, RD, CDE d, Helen Jones RN, MSN, CDE e, Robert Roscoe BSc Pharm, ACPR, CDE, CPT f a
School of Nursing, McMaster University, Hamilton, Ontario, Canada International Diabetes Federation, Calgary, Alberta, Canada Health Sciences Centre Diabetes Research Group, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada d Department of Community Services and Seniors, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada e Hamilton, Ontario, Canada f Kennebecasis Drugs Ltd, Rothesay, New Brunswick, Canada b c
If ever there was a period of rapid change for diabetes educators, it is now. As diabetes prevalence rates increase, diabetes services adopt chronic care models, and traditional diabetes healthcare teams expand, the diabetes educator role appears to be at the precipice of something bigda big opportunity. But an opportunity for what? In recognition of this opportunity, it bodes well for diabetes educators to reflect on the successes that have been achieved since the creation of the role. First, diabetes educators have been widely recognized as healthcare providers who have specialized skills, knowledge and abilities to meet the education and management needs of individuals living with diabetes. To that end, this has led to the successful implementation of the credentialing process, the Certified Diabetes Educator (CDE), through the Canadian Diabetes Educator Certification Board (CDECB). This widely respected benchmarking process ensures basic competencies and knowledge of diabetes educators. Second, the Diabetes Educator Section (DES) of the Canadian Diabetes Association (CDA) has furthered the role of the diabetes educator in diabetes care by working collaboratively with the Clinical & Scientific Section (C&SS) of the CDA on the annual general conferences, joint publications and clinical practice guidelines (CPGs). The increase in interprofessional collaboration has resulted in a broadening of one another’s contributions to diabetes care, resulting in a greater understanding of the role that diabetes educators have in clinical practice, policy development and research. Finally, there is little doubt that Canada has been seen as a leader in diabetes self-management education and training for educators nationally and internationally. This has led to several innovative endeavors, such as: 1) the CDA’s Building Competency in Diabetes Education: The Essentials and Advancing Practice, 2) the International Diabetes Federation (IDF) recognized Diabetes Educator Graduate Certificate Program at The Michener Institute, and 3) D-Net, a virtual global community of diabetes educators engaged in education discussions. Although D-Net is an initiative of the IDF, the concept was developed at an international
* Address for correspondence: Diana Sherifali, School of Nursing, McMaster University, HSC-3N25E, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. E-mail address: [email protected] (D. Sherifali). 1499-2671/$ e see front matter Ó 2012 Canadian Diabetes Association http://dx.doi.org/10.1016/j.jcjd.2012.07.010
meeting hosted by DES following the IDF Congress in Montreal, 2009. However, as with any change comes uncertainty and challenges. One must critically reflect on what this means for the quantity and quality of diabetes educators and our role in the broader healthcare system. There is a perception that with the increasing number of professionals engaging in diabetes education, many are entering practice that are unprepared, unsupported and lacking professional mentorship. Education institutions offering “certificate” education programs that differ in their curricula, create greater variability in diabetes educator competencies and skills. As there are no mandated criteria for entry to practice, many are concerned about the inconsistency in competencies and the perceived “outsourcing” of education to generalists engaging in diabetes education or chronic disease self-management. Processes of self-management have been explicated across other chronic diseases; however, the concern is that diabetes self-management education (DSME), although foundational for diabetes self-management, may be getting lost in the grand scheme of chronic disease selfmanagement and care. The lack of understanding of what constitutes DSME and who is best positioned to deliver it may position the diabetes educator role as superfluous to some government policy and decision makers. Finally, diabetes educators are used differently from program to program. Under institution approved medical directives, many diabetes educators are working beyond their regulatory scope of practice, thus facilitating management directly through medication/insulin initiation and adjustments. Perhaps this added scope in practice needs to be further recognized through an additional credentialing process similar to the Board Certified Advanced Diabetes Manager (BC-ADM) role, as seen in the United States. There is no question that healthcare professionals working in the area of diabetes recognize the “value-added” in a diabetes educator. However, this may not be recognized by funding agencies or government decision makers currently embracing other service delivery paradigms. Rather, funders and decision makers have typically required evidence of success from diabetes education programs, such as utilization rates and wait list management. This is concerning and we need to ask ourselves.are these outcomes reflective of a diabetes educator’s practice or quality
158
D. Sherifali et al. / Can J Diabetes 36 (2012) 157e158
self-management education? Although there is evidence for the effectiveness of DSME, we need to start to examine our own practices and reflect on what it is that we do. If we as educators are hard pressed to define and measure what it is that we do, others will decide for us, therefore leaving others to determine whether we are value-added or redundant. So what is the big opportunity you may ask? It is an opportunity to start a candid dialogue of what we see in our future as diabetes educators. Does this mean requiring all diabetes educators to become a CDE and/or join their professional bodydDES? Does this
mean that diabetes educators complete a standardized curriculum? Does this mean a 2-tier credentialing system that recognizes the advanced roles of diabetes educators, apart from generalists or chronic disease educators? These are all valid questions with no simple answers. To borrow words from Sir Winston Churchill, “the farther backward you can look, the farther forward you are likely to see.” Let us take a moment to reflect on where we have come from, and recognize the opportunities that lie ahead. Let us start the dialogue with each other, our diabetes healthcare team and policy decision makers.
Contents lists available at SciVerse ScienceDirect
Canadian Journal of Diabetes journal homepage: www.canadianjournalofdiabetes.com
Commentary
Revisiting the Role of a Diabetes Educator: An Opportunity Not to Be Missed Diana Sherifali RN, PhD, CDE a, *, Anne Belton RN, MDE, CDE b, Lori Berard RN, CDE c, Catherine Freeze MEd, RD, CDE d, Helen Jones RN, MSN, CDE e, Robert Roscoe BSc Pharm, ACPR, CDE, CPT f a
School of Nursing, McMaster University, Hamilton, Ontario, Canada International Diabetes Federation, Calgary, Alberta, Canada Health Sciences Centre Diabetes Research Group, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada d Department of Community Services and Seniors, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada e Hamilton, Ontario, Canada f Kennebecasis Drugs Ltd, Rothesay, New Brunswick, Canada b c
If ever there was a period of rapid change for diabetes educators, it is now. As diabetes prevalence rates increase, diabetes services adopt chronic care models, and traditional diabetes healthcare teams expand, the diabetes educator role appears to be at the precipice of something bigda big opportunity. But an opportunity for what? In recognition of this opportunity, it bodes well for diabetes educators to reflect on the successes that have been achieved since the creation of the role. First, diabetes educators have been widely recognized as healthcare providers who have specialized skills, knowledge and abilities to meet the education and management needs of individuals living with diabetes. To that end, this has led to the successful implementation of the credentialing process, the Certified Diabetes Educator (CDE), through the Canadian Diabetes Educator Certification Board (CDECB). This widely respected benchmarking process ensures basic competencies and knowledge of diabetes educators. Second, the Diabetes Educator Section (DES) of the Canadian Diabetes Association (CDA) has furthered the role of the diabetes educator in diabetes care by working collaboratively with the Clinical & Scientific Section (C&SS) of the CDA on the annual general conferences, joint publications and clinical practice guidelines (CPGs). The increase in interprofessional collaboration has resulted in a broadening of one another’s contributions to diabetes care, resulting in a greater understanding of the role that diabetes educators have in clinical practice, policy development and research. Finally, there is little doubt that Canada has been seen as a leader in diabetes self-management education and training for educators nationally and internationally. This has led to several innovative endeavors, such as: 1) the CDA’s Building Competency in Diabetes Education: The Essentials and Advancing Practice, 2) the International Diabetes Federation (IDF) recognized Diabetes Educator Graduate Certificate Program at The Michener Institute, and 3) D-Net, a virtual global community of diabetes educators engaged in education discussions. Although D-Net is an initiative of the IDF, the concept was developed at an international
* Address for correspondence: Diana Sherifali, School of Nursing, McMaster University, HSC-3N25E, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. E-mail address: [email protected] (D. Sherifali). 1499-2671/$ e see front matter Ó 2012 Canadian Diabetes Association http://dx.doi.org/10.1016/j.jcjd.2012.07.010
meeting hosted by DES following the IDF Congress in Montreal, 2009. However, as with any change comes uncertainty and challenges. One must critically reflect on what this means for the quantity and quality of diabetes educators and our role in the broader healthcare system. There is a perception that with the increasing number of professionals engaging in diabetes education, many are entering practice that are unprepared, unsupported and lacking professional mentorship. Education institutions offering “certificate” education programs that differ in their curricula, create greater variability in diabetes educator competencies and skills. As there are no mandated criteria for entry to practice, many are concerned about the inconsistency in competencies and the perceived “outsourcing” of education to generalists engaging in diabetes education or chronic disease self-management. Processes of self-management have been explicated across other chronic diseases; however, the concern is that diabetes self-management education (DSME), although foundational for diabetes self-management, may be getting lost in the grand scheme of chronic disease selfmanagement and care. The lack of understanding of what constitutes DSME and who is best positioned to deliver it may position the diabetes educator role as superfluous to some government policy and decision makers. Finally, diabetes educators are used differently from program to program. Under institution approved medical directives, many diabetes educators are working beyond their regulatory scope of practice, thus facilitating management directly through medication/insulin initiation and adjustments. Perhaps this added scope in practice needs to be further recognized through an additional credentialing process similar to the Board Certified Advanced Diabetes Manager (BC-ADM) role, as seen in the United States. There is no question that healthcare professionals working in the area of diabetes recognize the “value-added” in a diabetes educator. However, this may not be recognized by funding agencies or government decision makers currently embracing other service delivery paradigms. Rather, funders and decision makers have typically required evidence of success from diabetes education programs, such as utilization rates and wait list management. This is concerning and we need to ask ourselves.are these outcomes reflective of a diabetes educator’s practice or quality
158
D. Sherifali et al. / Can J Diabetes 36 (2012) 157e158
self-management education? Although there is evidence for the effectiveness of DSME, we need to start to examine our own practices and reflect on what it is that we do. If we as educators are hard pressed to define and measure what it is that we do, others will decide for us, therefore leaving others to determine whether we are value-added or redundant. So what is the big opportunity you may ask? It is an opportunity to start a candid dialogue of what we see in our future as diabetes educators. Does this mean requiring all diabetes educators to become a CDE and/or join their professional bodydDES? Does this
mean that diabetes educators complete a standardized curriculum? Does this mean a 2-tier credentialing system that recognizes the advanced roles of diabetes educators, apart from generalists or chronic disease educators? These are all valid questions with no simple answers. To borrow words from Sir Winston Churchill, “the farther backward you can look, the farther forward you are likely to see.” Let us take a moment to reflect on where we have come from, and recognize the opportunities that lie ahead. Let us start the dialogue with each other, our diabetes healthcare team and policy decision makers.