I have had the privilege of practising in the specialty of diabetes and working with people with diabetes for over two decades. Over this time I have come to understand that the ongoing management of diabetes amidst the complexity of life is personal and challenging. This eventually became the focus for my doctoral thesis, which was completed in 2011.
The following are some of the key insights I learned from the people with diabetes who participated in my research about living with diabetes, and how interactions with health professionals impact on their self-care:
- Active self-care changes with the duration of the disease, in response to life events, development of complications, others around them, life pressures, self-care fatigue, and interactions with health professionals.
- Effective interpersonal relationships with health professionals are critical to the development of self-care skills and the confidence to carry them out.
- Positive interpersonal relationships between health professionals and patients were very important in diabetes care.
- A health professional who made the effort to know and understand their health beliefs and them as a person, and who understood the nuances of diabetes was highly valued.
- Having the personal expertise of the person with diabetes acknowledged and utilised in the decision-making process with different options discussed and considered was very important.
- The value of having time where treatment plans were discussed, and improved understanding was achieved, was frequently mentioned.
- Nurses were perceived to take more time and to make an extra effort to help with diabetes self-care requirements. This is important, as time spent has been found to be the only significant predictor of reduction in HbA1c (Norris et al., 2002).
- Diabetes specialist nurses were perceived to be more knowledgeable than other nurses about diabetes and more skilful with the nuances of diabetes care, were able to problem solve more effectively, and had a greater appreciation for the difficulties experienced from living with and self-caring for diabetes.
- Diabetes specialist nurses responded to questions, freely gave pertinent information and advice that was practical and relevant to their life, and were more likely than other health professional groups to recognise personal expertise and be willing to work together.
- Nurses, especially diabetes specialist nurses, were perceived to be more effective in general at supporting decision-making and in communicating in a way that the person felt acknowledged as a person, information was shared freely, and time was spent discussing pertinent diabetes or life issues.
- Continuity of care from the same provider, or team of providers who were knowledgeable about diabetes, appeared to support the development of positive relationships and more active self-care.
To summarise, this research provided insightful examples of the importance of positive therapeutic relationships where both people with diabetes and health care professionals are encouraged to participate openly and fully. To enable this to happen, changes in care delivery models are required, particularly in primary health care/general practice where a large proportion of diabetes care occurs. It is important that health professionals are well skilled in diabetes in order to provide high quality diabetes care and people with diabetes should demand this.
Dr Helen Snell