Marilyn Gallichan, MSc, RN, Cert Ed.
Diabetes Specialist Nurse, East Cornwall Hospital, Bodmin, CornwallThis paper describes a district diabetes education programme for care home staff that was established through inter-agency and inter-professional collaboration, and has been running monthly since January 2000. Although there have been other initiatives in this field, we are, as far as we are aware, the only team to have developed a multidisciplinary, county-wide, rolling programme.
The prevalence of known diabetes within residential homes is approximately 12% (Sinclair et al, 2001), but it is recognised that large numbers currently remain undiagnosed, so that this is likely to be a gross underestimate of the true prevalence. A more realistic estimate is that one in four residents has diabetes (Sinclair et al, 2001). Compared with other older people with diabetes, residents in institutionalised settings suffer a higher prevalence of macrovascular complications, tremendous susceptibility to infections, increased hospitalisation rates, and high levels of physical and cognitive disability (Sinclair et al, 1997a).
We agreed that our aim should be to improve the health and well-being of residents with diabetes through an educational programme that would be:
Collaboration with the joint inspection unit The collaborative network for this project is shown in Figure 1. Our first step was to seek advice from the principal officer of the joint inspection unit whose remit is to promote and monitor standards in care homes and services. In one of its mailings to every residential home, the joint inspection unit included a letter outlining our plan to provide free diabetes education, and invited offers from managers of homes with accommodation suitable for training who would be willing to open their doors to staff from neighbouring homes.
Our learning objectives are that, following this training, staff should be able to:
Numbers In the first two years of our programme, staff from more than 40% of the county's residential homes have participated in this training. Two hundred-and-seven care staff from 71 residential homes attended during 2000 and 157 from 67 homes in 2001, including staff from 46 homes not represented in the first year (Table 1).
We had originally invited care staff to contact their chosen training venue to book their place, but this booking method proved impossible to implement, as the homes' telephones were frequently manned by staff with no knowledge of the planned training sessions. Central bookings made via the district diabetes centre have proved a much more reliable method. In 2000 we found that attendance was less good when bookings were made too far in advance. In 2001 we advertised the training more frequently and, as an experiment, introduced a £5 fee per participant to help with administration costs, and to serve as an incentive not to forget to attend. Interestingly, we have found that the £5 fee made no difference. Attendance was still poor unless the homes received a telephone reminder a few days before the session.
This initiative has been received with great enthusiasm both by diabetes care professionals and by the care home staff.
Diabetes UK (formerly British Diabetic Association), 10 Queen Anne Street, London W1M 0BD. Tel: 020-7323 1531. Email: firstname.lastname@example.org Website: www.diabetes.org.uk.
British Diabetic Association. (1999) Guidelines of Practice for Residents with Diabetes in Care Homes: A British Diabetic Association report. London: BDA (now Diabetes UK). Also available at: www. diabetes.org.uk
Diabetes UK. (2000) Diabetes Care Today: A guide for managers and staff working in residential and nursing homes. London: Diabetes UK. Also available at: www. diabetes.org.uk
Sinclair, A.J., Allard, I., Bayer, A.J. (1997a) Observations of diabetes care in long-term institutional settings with measures of cognitive function and dependency. Diabetes Care 20: 5, 778-784.
Sinclair, A.J., Turnbull, C.J., Croxson, S.C.M. (1997b) Document of diabetes care for residential and nursing homes. Postgraduate Medical Journal 73: 864, 611-612.
Sinclair, A.J., Croxson, S.C.M., Gadsby, R. et al (2001) Prevalence of diabetes in care home residents. Diabetes Care 24: 6, 1066-1068.