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Report by:

Rita Forde Advanced Nurse Practitioner and Chair of Diabetes Education and Empowerment Sub Group Mater Misericordiae University Hospital Dublin

Sean Dinneen Consultant Endocrinologist/Senior Lecturer in Medicine Galway University Hospitals/NUI Galway Galway

Margaret Humphreys Clinical Specialist Dietitian - Diabetes Cork University Hospital Cork

Maeve Carmody Senior Community Dietitian Health Promotion Department, HSE South Eye, Ear and Throat Hospital Cork

Anna Clarke Health Promotion and Research Manager Diabetes Federation of Ireland Dublin

Kieran O’Leary CEO Diabetes Federation of Ireland Dublin

James Conway Assistant National Director HSE Palliative Care and Chronic Illness Kildare Review of Diabetes Structured Education Republic of Ireland 2009 Page One ea and to eview best practice in this ar oup Gr ment/education involving all the stakeholders ment/education involving all y Advisor t recommendations are clear, practical and deserve implementation for clear, are recommendations Colm Costigan . would like to thank Rita and her sub-group and congratulate them on this and congratulate them would like to thank Rita and her sub-group the benefit of all people with diabetes in Ireland. I valuable report. Dr Chair Diabetes Exper make recommendations to improve both the availability and the standards both the to improve make recommendations of A national review Ireland. in of patient education programmes is the synthesis of this work. followed and this document programmes The on 22nd April, 2009. to r The aim of the workshop was The subcommittee consulted widely, held many meetings and in widely, The subcommittee consulted held their first Federation of Ireland, conjunction with the Diabetes workshop on patient empower People with diabetes living in Ireland should be able to access diabetes People with diabetes living education that is appropriate to care expertise and self-management that is convenient and acceptable to them. their needs and in a location The Diabetes Expert Advisory Group (EAG) recognised from the beginning from (EAG) recognised Advisory Group The Diabetes Expert of each self care the education in the improving the value of patient diabetes. individual with scene chapter sets the of Care the EAG Standards Number 3 in Standard for this review… Foreword 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 3 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 ventions. fective clinical inter de would like to thank all the members of this sub-group, the Diabetes of this sub-group, would like to thank all the members Rita For Advanced Nurse Practitioner Federation of Ireland and the wider DEAG members, who gave so much of and the wider DEAG Federation of Ireland clinical outcomes and empower diabetes their time in the drive to improve people with diabetes with cost-ef The Diabetes Expert Advisory Group (DEAG) was established in 2006 and (DEAG) was Advisory Group The Diabetes Expert diabetes community. among the was sought from voluntary membership Education and the EAG was to emerge from sub-groups One of the many and workshop on Subsequent to a national conference Empowerment. Education in Diabetes of Structured in 2009, a review Diabetes Education The hard in this document. was conducted resulting Ireland the Republic of has of all of the members of this sub-group work, dedication and expertise account of what Diabetes Structured paved the way for this detailed Republic of Ireland. available in the are Education programmes I Acknowledgements

Review of Diabetes Structured Education Republic of Ireland 2009 Page Two 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 4 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Three 20 10 14 eland Ir T Berger DAFNE 2 Diabetes Type CODE DESMOND X-PER Paediatric BRUCIE Type Mapping of Diabetes Structured EducationMapping of Diabetes Structured CostingsRecommendationsAppendix 1 22 24 23 25 Background Education Structured Definition of Diabetes Education Structured Benefits of Diabetes Key CriteriaStandards Education ProgrammesDiabetes Structured 5 6 9 4 7 8 Table of Contents Table 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 5 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 eland was invited as the keynote speaker for the eland was invited as the keynote speaker Ir n ther Ireland, BERGER, DAFNE, and BRUCIE. Ms Florence BERGER, Ireland, T Diabetes UK Nor , Advisor e CODE, DESMOND, X-PER e eland. The workshops were arranged to facilitate a cross section of the disciplines in each arranged to facilitate a cross eland. The workshops were ed in Ir the day, key criteria for structured diabetes education in Ireland were agreed by a multidisciplinary agreed were diabetes education in Ireland key criteria for structured the day, owne, National Car esented wer ith diabetes, professional caregivers and managers who provide the resources for that care. One of the for that care. the resources and managers who provide caregivers ith diabetes, professional iabetes affects 1 in 20 people in Ireland. Type 1 Diabetes is also increasing, though much more slowly. though much more Diabetes is also increasing, 1 Type in Ireland. 1 in 20 people iabetes affects day and participated in the afternoon workshops. The conference shared information on courses being shared day and participated in the afternoon workshops. The conference deliver in Ireland. education programmes a consensus on the criteria for structured to reach order in group On should be that programmes diabetes experts of agreed and HSE personnel. In addition, it was group and flexible enough to meet the needs of every be cost effective diabetes care, integrated into standard and content. while still maintaining structure group to by the DEAG Education and Empowerment sub-group the above, it was agreed Following on from is the outcome This report patient education in the Republic of Ireland. of structured carry out a review of that work. Br Diabetes Mellitus is one of the major chronic illnesses. The prevalence of continues to 2 diabetes of Type illnesses. The prevalence one of the major chronic Diabetes Mellitus is 2 Type the obesity levels of the Irish population. in driven by the epidemic increase rapidly, increase d 5% to from health expenditure: up a substantial portion of national make care The costs of diabetes the location. 15% depending on was established in 2006 and voluntary membership (DEAG) was Advisory Group The Diabetes Expert assembled in 2006 included people The DEAG that first community. among the diabetes sought from w and Empowerment. The First Report of the Diabetes the EAG was Education from to emerge sub-groups was launched in November 2008. Expert Advisory Group First Report in November 2008 and Expert Advisory Group’s Subsequent to the launch of the Diabetes Service Executive in conjunction with the Diabetes Federation the Health thereof, the recommendations and Empowerment. on Diabetes Education and Workshop held their first National Conference of Ireland and experts the available structured to health professionals The objective of the day was to present 2 diabetes. The programmes Type 1 and on both Type in the Republic of Ireland education programmes pr Background

Review of Diabetes Structured Education Republic of Ireland 2009 Page Four 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 6 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Five planned and graded process that facilitates the knowledge, skills and ability for diabetes that facilitates the knowledge, skills process planned and graded a “ their to maintain and improve and empowers individuals to live healthily, self-management team.” in their diabetes care an active role quality of life and assume Structured diabetes patient education as defined by the Education and Empowerment sub-group is: sub-group by the Education and Empowerment diabetes patient education as defined Structured Definition of Diabetes Structured Education Structured of Diabetes Definition 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 7 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 diabetes self-management. • living with diabetes. Psychological adjustment to • behaviours. undertaking of diabetes self-management Improved • clinical outcomes. Improved • of diabetes. by the individual of knowledge/understanding application Increased • participating in their own and confidently person effectively Self-empowerment with the ∑ ∑ ∑ The expected benefits of structured diabetes education from a patient standpoint are: diabetes education from of structured The expected benefits ∑ ∑ Benefits of Diabetes Structured Education Structured of Diabetes Benefits

Review of Diabetes Structured Education Republic of Ireland 2009 Page Six 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 8 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 9 R e v i

Key Criteria e w o f D i a b e t e s S t

The following are the key criteria pertaining to diabetes structured patient education agreed at the r u c

National Conference and Workshop: t u r e d E

∑ • Philosophy – each programme is underpinned by an explicit patient-centred philosophy d u c

which will guide the learning theories to be utilised and hence the delivery of programmes. a t i o n ∑ • Curriculum – the written document based on a needs assessment establishes the R e

components covered in each session so that all professionals know what is covered in the p u b l

programme. It makes explicit the aims and objectives of the programme through detailed i c o

lesson plans, including a description of learner and educator activities. f I r e l a

∑ • Trained educators – the educator needs to be an effective information-processor, be n d

familiar with learning theories and have facilitation skills to assist the participants to 2 0 0 problem solve and set personal goals. The educator will need to have diabetes expertise at 9 a defined level such as an academic diabetes qualification or equivalent.

∑ • Quality Assurance – review is necessary to ensure the programme is delivered as outlined in the curriculum and within the stated philosophy. Initially, this may be internal (self, peer reflection) however ultimately this should be by external reviewers and include participant feedback.

∑ • Audit – evaluation of the programme is based on the stated outcomes of the programme and should include data on biomedical parameters, quality of life people with diabetes experience and the degree of self-management achieved as a result of attendance at the programme. P a g e S e v e n . 1 viewing, ovement based ra 2007. tunities for impr ventions. eviewed to identify oppor egularly r eland should be able to access high quality diabetes education eland should be able to access high 1 d receive care that is person-centred and encourages self-management. They should be and encourages self-management. is person-centred that care receive oven advances in educational strategies and psychological inter STANDARD 2 STANDARD living in Ireland should… People with diabetes … and service to the planning planning in clinical decision making, care enabled to participate and comfortable with doing this. confident extent that they are 3 STANDARD should… People with diabetes living in Ireland appropriate expertise and self-management education that is …be able to access diabetes care convenient and acceptable to them. to their needs and in a location that is Eigenmann C, Colagiuri R. Outcomes and Indicators for Diabetes Education – A National consensus Position, Diabetes Australia, Canber on pr 1 ...that is of the highest quality and r 5 Standard the knowledge, that reflect ...that is evaluated within defined timelines incorporating selected indicators behaviours. psychosocial determinants of diabetes self-management and diabetes self-management of assessing the impact of education on clinical outcomes and cost effectiveness, Due to the difficulty on nationally (National Diabetes Services Scheme 2007) linked and reported these should be cross Standard 3 Standard by a trained educator with training in learning to the target …that is delivered theories appropriate motivational inter population of people with diabetes population, facilitating skills which include 4 Standard Standard 2 Standard team. The diabetes ...that is documented and communicated to all members of the diabetes care and educational intervention is based on needs assessment of the total client population education. individualised to deliver patient-centred level of diabetes self-management knowledge. solving, goal setting and an approved problem Standar which will guide the learning…that is underpinned by a philosophy theories to be utilised and the underpins the education goals and objectives which delivery of diabetes education. The philosophy and forms the basis for the quality the delivery process in the outcome, determines reflected are assurance process. People with diabetes living in Ir that is convenient and acceptable to them... appropriate to their needs in a location The Standards for Structured Patient Education are based on Standard 3 above, and emerged from based on Standard Education are Patient for Structured The Standards by the Sub Group: subsequently agreed and were and Workshop the National Conference First Report of the Diabetes Expert Advisory Group includes two Standards (Standards 2 and 3) (Standards includes two Standards Diabetes Expert AdvisoryFirst Report of the Group and/or empowerment: patient education to structured relating Standards

Review of Diabetes Structured Education Republic of Ireland 2009 Page Eight 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 10 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Nine nd how it is delivered. The programmes are: programmes The nd how it is delivered. The following section outlines the programmes presented at the national conference and workshop in and workshop at the national conference presented outlines the programmes The following section on the course content is given including information of each programme April 2009. A description a Diabetes Structured Education Programmes Education Structured Diabetes in Ireland available 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 11 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 e ticipant ovision in specialist pr e ogramme and the materials ovided free of charge to the of charge ovided free pr e is completed by each par e elation to the pr 086 0482605 Mobile: of Berger each Diabetes Nurse and Dietitian must attend a Berger each Diabetes Nurse and Dietitian must attend of Berger y mation and the educators packs ar ning. riculum. A knowledge questionnair ogramme ofessionals (nurses and dietitians) actively involved in car pr e ticipation and lear elevant patient infor vices are eligible to become Berger educators. eligible to become Berger vices are incorporated in the cur ticipating centre. Food models and flip charts are used in conjunction with patient workbooks Food models and flip charts are ticipating centre. [email protected] ocesses involved in behaviour modification. All aspects of diabetes self-management and car ocesses involved in behaviour modification. All aspects of diabetes self-management e The programme curriculum is delivered utilising adult learning the curriculum is delivered techniques and recognising The programme pr par integral to enhancing solving are Review of case studies and problem and supporting literature. patient par ar at the outset and again at completion of each course. which promotes meal breaks, with organised days over three is delivered The programme participant cohesion and enhances the learning environment. All of the r become involved with the deliver eople attending this course learneople attending this choice. dose depending on their food how to adjust their he Berger Programme is a comprehensive diabetes self care skills course, named after Professor skills course, named diabetes self care is a comprehensive Programme he Berger o diabetes ser How to deliver a pr • training programme. In addition each educator must attend a Berger Structured Education Programme Education Structured In addition each educator must attend a Berger training programme. all materials with will review The Diabetes Development Manager for Berger by a centre. being delivered the educators, facilitate an education session specifically in r How to become an educator How to become an educator T Berger Training is organised by Mary Frances Williams, Diabetes Development Manager is organised Training Berger Email: The course also focuses on enhancing diabetes self management skills. on enhancing diabetes self management The course also focuses STARTED HOW TO GET Contact details used. Only healthcar Berger T value of teaching people how to adjust the eminent Endocrinologist who recognised the Michael Berger, 1 diabetes. for people with Type is designed daily food intake. This programme insulin to match their P Type 1 Diabetes Structured Education Programmes Education Structured 1 Diabetes Type • •

Review of Diabetes Structured Education Republic of Ireland 2009 Page Ten 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 12 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Eleven ticipants and facilitated by the Diabetes Nurse and Dietitian. he administration time involves inviting participants, inputting data, arranging the follow-up session and arranging the follow-up inputting data, inviting participants, time involves he administration Three months following each course all participants are invited back for a review in their original group. invited back for a review months following each course all participants are Three This is generally led by the par Educator support This is invited to attend an annual meeting. are in the delivery of this programme All educators involved feedback and updates on the to the educators and provide support and guidance to provide course. involved in the delivery of the Berger specifically for those These meetings are programme. OTHER CONSIDERATIONS OTHER time Administration T 2 hours. Approximately assurance process. engaging with the quality 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 13 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 ). is a curriculum for the DEP along with e ned to DAFNE Central with the etur [email protected] Email: ogramme [email protected] ve a DAFNE course (5-days) http://www.dafne.uk.com/downloads/CentreApplicationForm.pdf Email: ed by experienced DAFNE educators. Ther Follow-up Workshop and DAFNE Collaborative (1-day) Follow-up Workshop Orientation (1 hour) Deliver a week’s peer supported DAFNE course (5-days) Deliver a week’s Attend a preparatory workshop (2-days) Attend a preparatory Background reading (3-5 hours) reading Background Obser – – – – – – 5040 211 Step 3 Step 4 Step 5 Step 6 Step 1 Step 2 0044 (0) 191 293 4115 01 information on DAFNE in the Republic of Ireland contact: of Ireland information on DAFNE in the Republic · · · · · · for the DAFNE educators and doctor. An application form must be completed (containing details An application form must be completed (containing for the DAFNE educators and doctor. and r for Diabetes Nurse, Dietitian and the Physician) fee ( appropriate ovided and expectations for participants. The DEP is a six step course as below: AFNE is a structured education course delivered in a five day intensive skills based education skills based in a five day intensive delivered education course structured AFNE is a AFNE aims to encourage and equip people who have Type 1 diabetes to manage their insulin regimens 1 diabetes to manage their insulin and equip people who have Type AFNE aims to encourage The DAFNE Educator Programme (DEP) The DAFNE Educator Programme The DEP is deliver How to deliver a pr 09:00–16:30 by A Diabetes Nurse and/or approximately to Friday from Monday is delivered The programme within the hospital. in a suitable meeting room and is delivered is comprehensive Dietitian. The programme specific training resources. All DEP trainees receive a comprehensive training information file prior to training information file a comprehensive All DEP trainees receive specific training resources. teaching resources commencing training. This file clearly sets out what the learning objectives are, pr First steps in becoming a DAFNE centre First steps in becoming a DAFNE 1. as DAFNE educators. Identify at least one Diabetes Nurse and one Dietitian to train 2. Identify one Physician to train as a DAFNE doctor. 3. and to cover the costs of training funding to set up and operate as a DAFNE centre the Secure DAFNE training is organised centrally in the UK, contact: centrally DAFNE training is organised Director Gillian Thompson, National Central DAFNE Administration Tel: For HOW TO GET STARTED HOW TO GET Contact details Mary O’Scannail, Diabetes Nurse Specialist Tel: DAFNE - Dose Adjustment For Normal Eating For Normal - Dose Adjustment DAFNE D course, people learn 1 Diabetes. In this adjust their insulin how to with Type to people programme their insulin doses. around to work their life rather than having choice of food, suit their free dosage to D actively and independently. All six parts of the DEP must be successfully completed in sequence, in order for DAFNE educator All six parts of the DEP must be successfully completed in sequence, in order DAFNE educator status, educators must deliver at least 1 to retain to be obtained. In order registration DAFNE course every 6 months.

Review of Diabetes Structured Education Republic of Ireland 2009 Page Twelve 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 14 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Thirteen eviewed r e e. DAFNE ar t). e ough local Educator Networks. A lead ogramme in their own centr ce materials and literatur ucial administrative suppor (including cr y . vice deliver ning contract. to communicate closely with DAFNE Central and other DAFNE nal quality assurance of the pr e lear on a case study a ough DAFNE Central and also thr t text on educational methods. ee TIONS outine ser om Step 1 to Step 3 with some minor amendments: om Step 1 to Step 3 with some minor ead epor ee year cycle. is available thr oximately 2-3 hours per course (8 patients). t no need to agr no need to r no need to r – – – es and the ongoing inter ganises an annual Collaborative meeting to bring together all educators, doctors and ganises an annual Collaborative meeting to bring together all educators, doctors Step 1 Step 2 Step 3 rain in DAFNE principles. Conduct a Quality Assurance programme. Collaborative. Decide how best to contribute to the DAFNE Completion of the DEP fr · · · T Incorporate DAFNE into r Attend a 1-day workshop. • The DDP has the following components: • • Administration time Estimated at appr Educator support Educator suppor OTHER CONSIDERA educator is identified in each centr centres at all times throughout the year. Educators are encouraged to get involved in peer-reviewing Educators are the year. at all times throughout centres other centr The DAFNE Doctor Programme (DDP) The DAFNE Doctor Programme management and the aim is that the doctor is able to provide The DDP is a four part course. The general service to: clinical support that enables a diabetes • • Central or and feedback Ongoing quality assurance provides in the wider DAFNE group. involved researchers continued quality development and training to educators. Resour and updated on the thr • 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 15 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 ticipants must agree to deliver 3 ticipants must agree years. 2 y or to request the programme for your patients contact: for your the programme or to request ogramme content. Par props plus a full outline for each session. The CODE props y eal element of long-term involvement and commitment to www.diabetes.ie annual development day ever [email protected] y Email: 01 8363022 trained educator while the third programme will form part of the peer review process. Each educator process. will form part of the peer review programme trained educator while the third stated curriculum, are quality assured and evaluated at local and national level. CODE is a programme quality assured stated curriculum, are ODE is delivered to people with Type 2 diabetes attending primary care centres by the Federation’s centres diabetes attending primary care 2 with Type to people ODE is delivered uality of life through informed decision making. The sessions are based on an empowering philosophy, have based on an empowering philosophy, decision making. The sessions are informed uality of life through el: CODE programmes to their patients within 2 years of training. The first programme will be supported by to their patients within 2 years of training. The first programme CODE programmes a must attend a mandator over an initial 3 weeks and a 6 month of 4 sessions, each 2 hours in duration, is delivered programme is a telephone support call at 10 weeks. Each programme follow up session. Participants also receive open to 16 individuals. This brings a r participants that behaviour change is a long-term process. Participants automatically receive free Participants automatically receive participants that behaviour change is a long-term process. ensuring they get a personal invitation to attend membership of the Diabetes Federation of Ireland in a quarterly copy of “Diabetes Ireland” ongoing public education meetings in their locality and receive to maintain ongoing support and access to new and updated information. order How to deliver a programme The CODE manual contains the necessar How to become an educator solving and behaviour facilitation, motivation, problem occurs in 2 stages. Stage 1 covers Training change training. Stage 2 covers the CODE pr For further information log onto HOW TO GET STARTED Contact details a integrated with a view to it being part of the proposed designed for and validated on an Irish population population. diabetes to changing needs in Ireland’s model. It is in a position to respond diabetes care of Ireland Diabetes Federation Manager, and Research Dr Anna Clarke, Health Promotion T CODE - Community Orientated Diabetes Education Orientated Diabetes CODE - Community C qualification who have been diabetes or practice nurses with a recognised staff professional healthcare and the HSE. Diabetes Federation of Ireland CODE is fully supported by the trained as CODE Educators. learning. group It or living with diabetes through with diabetes either newly diagnosed CODE supports people management and aims to improve self care to become confident in their diabetes encourages participants q Type 2 Diabetes Structured Education Programmes Education Structured 2 Diabetes Type

Review of Diabetes Structured Education Republic of Ireland 2009 Page Fourteen 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 16 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Fifteen ofessional ts the person delivering the ogramme and then ongoing pr eam suppor ofessional Development T t continues post the programme delivery through ongoing receipt of personal receipt ongoing delivery through programme continues post the ough co-facilitation of first post training pr ost course screening and review of achievements and goal setting. Diabetes of achievements and and review ost course screening t P Regional Pr t. s ollow-up phone call to review personal goals. to review ollow-up phone call before week 26. before re-programme screening; diabetes explained; risk factors; signs and symptoms; and diabetes explained; risk factors; signs screening; re-programme F Importance of regular follow up; complications; self-management and optimal diabetes control. self-management and optimal diabetes follow up; complications; Importance of regular y P goal setting. activity; lifestyle changes and personal Healthy eating; physical ogramme initially thr eek 26 follow up: eek 10: eek 1: ODE contains the diabetes education topics as defined in international topics as defined the diabetes education ODE contains but its flexible best practice diabetes suppor pr education and suppor updates. education and diabetes information invitations to local diabetes Educator suppor The Federation’ Administration time call is people to attend on 4 specific dates. A reminder CODE, the practice invites sixteen organise To necessar OTHER CONSIDERATIONS W Week 2: Week 3: Week W What is covered What is C of each group. to meet the needs permits tailored the sessions to be approach W cardiovascular link to diabetes. cardiovascular 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 17 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 www.desmond-project.org.uk www.desmond-project.org.uk [email protected] [email protected] Email: Email: 258 6165 ogramme 0116 ed in groups of up to 10 people with diabetes and guests. Two trained educators of up to 10 people with diabetes and guests. Two ed in groups Fax: 00353 91 548335 educators explore the theoretical and philosophical basis of DESMOND as well as having the opportunity the theoretical educators explore 0116 258 7757 ogramme is deliver DESMOND Newly Diagnosed. DESMOND Foundation (for those with established diabetes). DESMOND ‘walking away’ (for those with IGT & IFG). course. DESMOND Ongoing – A refresher e pr nd how it is optimally managed, the potential risks of diabetes, self-monitoring, diet, exercise, stress self-monitoring, diet, exercise, managed, the potential risks of diabetes, nd how it is optimally heir own specific behavioural goals. DESMOND supports behaviour changes through changes in behaviour changes through goals. DESMOND supports heir own specific behavioural Information is available on the DESMOND website at: Information is available on the DESMOND contact: the Republic of Ireland For further information on DESMOND in Ciara Heverin; Tel: deliver it in two three hour sessions or one six hour session. Programmes available include: hour sessions or one six hour session. Programmes deliver it in two three • • being piloted: are two further programmes At the time of going to press • • How to deliver a pr A How to become an educator of up to 15. course in groups in a 2 day residential professionals health care to registered is provided Training Her involves and accreditation to practice the skills involved in delivery and facilitation. Ongoing quality assurance external and quality development. per annum, reflection, review delivering at least 5 programmes HOW TO GET STARTED HOW TO GET Contact details by: organised are DESMOND training programmes UK Leicester, Desmond Central Office, Tel: people’s health beliefs. DESMOND is delivered as 6 hours of education by 2 trained Educators. People as 6 hours of education beliefs. DESMOND is delivered health people’s family with them. to bring a member of their encouraged are who attend the course DESMOND - Diabetes Education and Self Management for Ongoing and for Ongoing Self Management Education and - Diabetes DESMOND Newly Diagnosed on patient philosophy based basis and clearly stated has a theoretical programme The DESMOND story”, informationpatients to “tell their includes time for The curriculum empowerment. about diabetes a to develop a personal action encouraged At the end of the course people are and emotional issues. to them by setting health risks and responding people in identifying their own plan. DESMOND supports t

Review of Diabetes Structured Education Republic of Ireland 2009 Page Sixteen 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 18 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Seventeen eview their beliefs about their work with to enable educators to r t the change and the use of the word ‘development’ instead of ‘assurance’ the change and the use of the word t t for organising local venues is encouraged which can be organised centrally to be organised local venues is encouraged which can for organising t etting the Big Picture; introductions and housekeeping; patient story (understanding and (understanding patient story and housekeeping; introductions Big Picture; etting the G 2 – Food Control story physical activity; Taking (risk factors and complications); Professional of newly diagnosed courses and Foundation courses to meet all needs. courses and Foundation courses to meet of newly diagnosed e hoices – Focus on Fats and Cardiovascular disease; diabetes self management plan; patients concerns; disease; diabetes self management and Cardiovascular hoices – Focus on Fats ession 1: an really help the person with diabetes maximise their self management skills. Most centres offer a offer skills. Most centres diabetes maximise their self management help the person with an really ecognises the need for ongoing suppor what happens next. C expectations); professional story (diabetes and glucose); monitoring diabetes (how and when); Taking (how and when); monitoring diabetes and glucose); story (diabetes professional expectations); questions. and reflection and ; – glycaemia 1 – Food Choices Control r Administration suppor Educator suppor the educator behaviours and processes terms of its philosophy, DESMOND has sought to be explicit in (QD) Framework has The Quality Development the programme. of its educators to deliver that it requires been designed to suppor By offering the DESMOND Foundation course to people who have had diabetes for a number of years it course to people who have the DESMOND Foundation By offering c mixtur Administration time on their actual performance. Educators and reflect review people with diabetes and be able to personally days and the Desmond network. study supported by Central office, are OTHER CONSIDERATIONS HSE area. cover an entire What is covered What is S Session 2: 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 19 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 ovide ongoing support, a crucial aspect eceives a copy of this manual upon der to pr in or , In addition, your local community nutrition and dietetic In addition, your local community nutrition . eafter oup session ther onic conditions. It is recommended that 15-18 people with Type 2 Diabetes be that 15-18 people with Type onic conditions. It is recommended ovides a full outline for each session. Each educator r oup size of between 20-24 people. Health Service Executive (HSE) programme for all adults with Type 2 Diabetes either newly diagnosed 2 Diabetes for all adults with Type (HSE) programme Health Service Executive -PERT has been shown to improve people’s diabetes control and knowledge, increase the skills needed and knowledge, increase control diabetes people’s has been shown to improve -PERT he X-PERT Ireland (Patient Education versus Routine Treatment) programme, is a specially designed is a specially programme, Routine Treatment) Education versus (Patient Ireland he X-PERT of the management of chr and to deliver the programme manual contains all the necessary information required Ireland The X-PERT it pr to in order required are visual props educator training. Furthermore, Ireland completion of the X-PERT also available upon completion of the educator training. these are run the programme, How to deliver a programme 6 X 2.5 hour invited to attend friend) are or carer 2 Diabetes (and a family member, Participants with Type and at months session at three refresher also includes a group programme Ireland sessions. The X-PERT six months and an annual gr in a course, which, including family and friends who chose to attend, will result onto each registered gr How to become an educator educators and Ireland known as X-PERT to people with diabetes are Ireland All those delivering X-PERT All educators must delivering the programme. the Educator’ course before must attend a 3 day ‘Train to best adhere training and all educators must sign and before meet identified minimum competencies Ireland. of X-PERT practice guidelines for the implementation Contact details and training is available on programme Information on the X-PERT www.xperthealth.org.uk/localcenter_living.php HOW TO GET STARTED X-PERT Ireland X-PERT T this document. It criteria as listed in which meets the patient education programme dietetic structured It is manage their diabetes. necessary to self knowledge and skills the confidence, people with provides a diabetes. or with established X 6 x 2.5 hour invited to attend 2 Diabetes are health. People with Type and improve to look after diabetes of 1.5 hours approximately receives the average person with diabetes education sessions. Usually group 16 approximately person with diabetes receives the Ireland year whilst with X-PERT dietetic support per over the course of the programme. hours of dietetic support service may be contacted for further information on X-PERT in the Republic of Ireland. in the on X-PERT service may be contacted for further information

Review of Diabetes Structured Education Republic of Ireland 2009 Page Eighteen 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 20 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Nineteen from your local Community from or med decisions regarding their own health their own med decisions regarding people in making infor medication. Demonstration of what health results mean such as results medication. Demonstration of what health t y www.xperthealth.org.uk/home.html www.xperthealth.org.uk/home.html vice. questions and evaluation. , essure, blood cholesterol levels, BMI and waist circumference. levels, BMI cholesterol blood essure, market Tour/Reading food labels. market Tour/Reading view Super Possible Complications of Diabetes. Over Carbohydrate Awareness and Meal Planning. and Meal Carbohydrate Awareness What is Diabetes? Identification of symptoms of diabetes and how these may be alleviated by What is Diabetes? Identification of symptoms Management – Healthy Eating and Physical Activity. Weight ovide skills training to suppor Organisation of a suitable local venue, ideally a HSE facility, otherwise costs may be incurred. costs may be incurred. otherwise of a suitable local venue, ideally a HSE facility, Organisation waiting list, liaison with of current Recruitment of participants may take various forms e.g. review and local advertising. or Network Team members of Primary Care from GPs, referrals for the programme. of resources Organisation eek 6: eek 4: eek 1: ifestyle changes and if necessar Nutrition and Dietetic Ser Further support is available on • • Educator support These Dietitians are Trainers. Ireland known as X-PERT are the Educator Training Those who run the Train and for supporting ongoing development, supporting the educators and for the preparation responsible is whose role trainers in each HSE area Ireland 2-3 X-PERT are the Educator courses. There running of Train courses. the Educator and run Train to: support ongoing development; support the educators; and to prepare Administration time • OTHER CONSIDERATIONS W Week 2: Week 3: Week W 5: Week What is covered W l HbA1c, blood pr The final 20-30 minutes of each session is allocated to goal setting. The ‘lifestyle experiment’ is intended The final 20-30 minutes of each session to pr results and diabetes self care. diabetes self care. and results which they use to and a copy of their ‘diabetes health profile’ Each participant gets their own handbook learn about and monitor their own progress. 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 21 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 [email protected] Email: known eating disorders. 091 548463 091 524411 Adolescents must be over 12yrs. People with diabetes must be on Multiple Injection Therapy. HbA1c <12%. No RUCIE is an education programme aimed at providing adolescents over 12 years with diabetes the adolescents over 12 years with diabetes aimed at providing programme RUCIE is an education ractitioner in diabetes. ffect of diet on their blood glucose levels. Education sessions on carbohydrate counting are also counting are levels. Education sessions on carbohydrate of diet on their blood glucose ffect el: • • • How to deliver a programme invited to attend BRUCIE, based on the following inclusion criteria: 6-8 people are • How to become an educator available in Ireland. professionals for healthcare training programme is no current There or in Diabetes, University Hospital Galway Helen Burke, Advanced Nurse Practitioner T Contact details information please contact: in more interested If you are Seamus Quirke Road, Galway City Centre, West Ciara Heverin, Community Diabetes Dietitian, Tel: skills to understand the relationship between food, blood results and insulin dose adjustments. The and insulin dose adjustments. between food, blood results the relationship skills to understand understanding of the gaining a greater on developing practical skills and involves workshop is based e is parents A joint session with adolescents and of adolescents who attend BRUCIE. for parents provided Nurse the diabetes Dietitian and the Advanced by at the yearly follow up. BRUCIE is delivered provided P HOW TO GET STARTED BRUCIE - Better Regulation Using Carbohydrate and Insulin Education Regulation Using Carbohydrate BRUCIE - Better B Paediatric Patient Education Programme Education Patient Paediatric

Review of Diabetes Structured Education Republic of Ireland 2009 Page Twenty 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 22 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Twenty One network has yet to be established. t unning BRUCIE and such a suppor only 2 people r e ar ed e ules; cise; joint session with adolescents and parents is provided at the yearly follow up. is provided joint session with adolescents and parents Insulin ratios and insulin dose adjustment; Insulin ratios and insulin dose adjustment; Hypoglycaemia; Sick day r Alcohol; Exer setting. Management of diabetes in the school · · · · · · Dietary Workshop is based on developing practical skills and involves gaining a greater Dietary Workshop involves of diet on their blood glucose levels. The dietary education understanding of the effect scenarios, eating out and snack choices. food games using food models, food labelling, discussion on: Education by the Diabetes Nurse involves Follow up sessions are provided at 3 and 6 months and yearly in the same group. at provided Follow up sessions are of adolescents who for parents counting is also provided An education session on carbohydrate attend BRUCIE. A Educator support At this time as ther OTHER CONSIDERATIONS Administration time of of dates and a suitable venue; organisation of participants; organisation This includes the recruitment follow up sessions. • • What is cover • • • 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 23 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 owne. ence Br ried out in N.I. by Flor g.uk ed Diabetes Education was car .diabetes.or uctur www mation go to Regional Audit of Str For infor See Appendix 1 for Dublin and Cork City extracts A • • Mapping of Diabetes Structured Education Structured of Diabetes Mapping

Review of Diabetes Structured Education Republic of Ireland 2009 Page Twenty Two 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 24 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 Review of Diabetes Structured Education Republic of Ireland 2009 Page Twenty Three approximate e Costs ar Nil = Costs incorporated in the training programme Costings 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 25 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 ed patient education. uctur ovision of str is dedicated funding for pr e ecommended that ther they can access the most appropriate programme for them. programme they can access the most appropriate hat Annual national audit should be conducted with a view to ascertaining the number of people with Annual national audit should be conducted patient education. diabetes who have availed of structured is value for patient education of structured being met; funding costs identified; that provision are money and quality assured. It is r for diabetes structured patient education programmes. patient for diabetes structured for all people with diabetes. intervals thereafter. and at regular t . pathway care component of the diabetes should be a core Patient Education Structured Diabetes 6. criteria as outlined in the Standards Key audit data should be utilised to establish that the core 7. 5. 1. and strategic direction national leadership provide National Clinical Lead for Diabetes should The 2 3. with diabetes at diagnosis should be available to all people patient education structured Diabetes 4. so available in their area programmes of the different People with diabetes should be made aware Recommendations

Review of Diabetes Structured Education Republic of Ireland 2009 Page Twenty Four 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 26 Page PM 2:11 6/28/10 ART DIABETES HSE 6593 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 27

Appendix 1 6593 HSE DIABETES ART 6/28/10 2:11 PM Page 28

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