Hi everyone,
I am just about to embark on a 3 year journey as American Association of Diabetes Educators (AADE) President elect, President and Past President so I thought it would be a great time to revive this blog to remember all of my experiences and travel as well as the new people I meet! If you see that I am attending a diabetes meeting that you will also be attending, please email me and let me know.  My goal is to connect with as many individuals as I can. I am really hoping to meet many diabetes e-patients around the US and world wide. I am hoping this blog will help me keep a record of all of my experiences and to capture some key moments in my life.

Although not officially representing AADE, I will be attending and speaking at the International Diabetes Federation World Congress in Melbourne, Australia December 2-6, 2013. This will kick off my adventures!  Please let me know if you will be attending the conference so we can say hello! I will be presenting on Wednesday, December 4 regarding diabetes self-management support using Telehealth communications. I will also be presenting a poster related to my dissertation research, specifically data from a systematic review of Telehealth clinical trials and the incorporation of key elements of structured self-monitoring of blood glucose.

I have been busy this fall, I presented a Webinar on the e-Patient in diabetes education in October and was interviewed live streaming on Tu Diabetes.  In November I sat on a panel during an advocacy meeting in Palm Springs, CA where we focused on the ADA Safe at School program. While in Palm Springs I participated in the ADA 5K walk through the beautiful La Quinta golf course. I was so impressed that the resort closed their golf course on a beautiful Saturday morning in November!


Here we go!

Deb

Exploration of the e-patient phenomenon in nursing informatics

Those of you who know me, know that I am very interested in the topic of the e-Patient.  When we published this paper last year, we realized that only academics with access to journals through a university library or those with journal subscriptions would be able to read this paper and learn along with us.  We asked if there could be open access to this paper so that patients would be able to read our paper and know that there were clinicians in practice that welcomed and encouraged engaged patients, but unfortunately it did not happen.  Today while searching for something unrelated, I came across our paper online in a PDF format so thought I would share.

http://www.nursingconsult.com/nursing/journals/0029-6554/full-text/PDF/s0029655411003587.pdf?issn=0029-6554&full_text=pdf&pdfName=s0029655411003587.pdf&spid=25426495&article_id=1090306

If you are going to the American Association of Diabetes Educators meeting in Philadelphia next month, Perry Gee and I will be presenting on this topic as it specifically relates to diabetes.  We are looking forward to taking the conversation to more clinicians and e-Patients in the future.

Back to school writing now.....

Strip Safely

I have not posted in quite a while, just a few things going on in my life that have gotten in the way! But this recent campaign encouraged me to send letters to my congressman and the FDA.
Please check out this link and if so inclined please write a letter yourself.  Strip Safely 

 

The is the intro to my letter, a true story that happened just a couple of days ago. 

Jeffrey Shuren, MD JD

jeff.shuren@fda.hhs.gov

Director, Center for Devices and Radiological Health

Food and Drug Administration

10903 New Hampshire Avenue, WO66-5442,

Silver Spring, MD 20993

July 7, 2013

Dear Dr. Shuren.

I am a certified diabetes educator and also a friend of many people with diabetes, both type 1 and type 2. I am also a researcher conducting a study in individuals with type 2 diabetes focusing on blood glucose monitoring.  I cannot tell you how many messages I receive from patients confused and upset that their blood glucose values vary dramatically between tests and between meters. These people are working so hard to improve their glucose control and are diligently testing and confirming their values, just to learn that the range can be so incredibly different.  This past week a patient had a blood glucose value of 548, she called frantic trying to decide what she should do.  She then tested on a second meter she had at home and the value was 323. When I told her that I was not at all surprised by the drastically different value she was in shock.  A variance of 20% could indicate that the real value may be between 440-656, or 259-387.  How do you make an informed, educated decision knowing the real value is somewhere between 259 and 656?  No one should live with a chronic disease and have to face daily challenging decisions that may impact life or death based on their actions.  We can fix this problem and we need your help!  It is not asking too much to be able to reassure a worried person that at least their glucose value is accurate while they face the other multitude of issues required to live and be healthy with diabetes. I urge you to please address this issue soon.

Deborah Greenwood, PhDc, RN, MEd, CNS, BC-ADM, CDE, FAADE

 

 

Diabetes Education finds a Second Life!

Second life is an interesting tool that health care is exploring for patient education, raising awareness, health promotion and prevention activities as well as providing emotional support. More research is needed to identify if participation in virtual reality education and support will transfer to real world behavior changes, improved quality of life and clinical outcomes.

As a diabetes educator, I can see potential benefits and opportunities to enhance the patient-provider relationship as well as the nurse educator patient relationship.  Second Life may provide an opportunity to increase access to diabetes education services and overcome some of the barriers to diabetes education. Most comprehensive diabetes education programs exist in metropolitan areas and are attached to large medical centers.  It can be extremely difficult in rural areas for people to participate in education without traveling a long distance from home. In addition, many educational programs occur during the work day which limits younger, working individuals from participating.  Second Life can eliminate these barriers since the patient can participate from their home, at a time that may be more convenient.

In addition, most diabetes education programs are conducted in a group format due to both staffing limitations as well as insurance requirements. Typically more women participate in diabetes education groups.  However research on Second life users indicate a younger population with slightly more men that participate.  This fact may encourage more men to engage in health education, health promotion and prevention programs through a virtual medium.  

The anonymity may be an important feature for some users that are not comfortable discussing their medical conditions in a group setting.  Questions patients may not be at ease inquiring about may be discussed somewhat anonymously while retaining a comfort level that many desire.  This is especially important for issues that are difficult to discuss such erectile dysfunction (ED) a common complication associated with diabetes

A few studies have shown that behaviors learned in the virtual world can translate to the real world.  I think more studies need to be implemented to validate this information. Recent NIH funding was awarded to a researcher from Boston University to study diabetes education in Second Life for black women.  This study is a feasibility study to examine Second Life as a method for health education.  Clinical outcomes will be monitored and compared to a control group that will participate in standard face-to-face diabetes education. I will be very interested to learn about the process and outcomes.

Although I believe there is potential, I think the applicable patient population is still small at present. I consider myself an “early adopter” internet user, and I participate in internet based educational courses, yet I am not sure I am ready for a Second Life educational course.  I find the learning curve steep on how to navigate in-world. However, there is certainly a demographic that is not being reached in the educational environment that exists today. Maybe we should focus on this younger, internet savvy patient population now while the novel tool is evolving. We can evaluate, improve and enhance this educational method so that when mainstream population engages, we will have a robust, user friendly diabetes education platform in place.

I am excited for what is on the horizon and I look forward to exploring more opportunities “in-world” in the future.  My avatar’s name is Ning Zise, say hello if you find me in Second Life!

KVIE Public Television - ViewFinder - Digital Doctors: The Future of Healthcare RSVP

KVIE Public Television - ViewFinder - Digital Doctors: The Future of Healthcare RSVP

KVIE Public Television invites you to a preview screening of
ViewFinder - Digital Doctors: The Future of Healthcare

Thursday, December 2, 2010
5:30pm Hors d’oeuvres Reception
6:15pm - 7:15pm Preview, Program and Q&A

KVIE, 2030 W. El Camino Avenue
Sacramento, CA 95833
[Get Directions]

Guest Speakers
Kelly Peterson, Producer - KVIE
Thomas Nesbitt, MD, MPH - UC Davis Health System
Panel of Experts

Digital Doctors: The Future of Health Care explores how technology and medical experts are teaming up and saving lives outside the traditional hospital or doctor’s office. Join us as we experience the inspiring story of a UC Davis pediatrician who worked with a team of physicians utilizing telemedicine to help save a toddler’s life. The newest documentary in our ViewFinder series uncovers how digital technology is connecting doctors to patients in need, even though they may be physically separated by thousands of miles.

RSVP by November 29
by filling out the form below or
by calling (916) 641-3555.

The IOM Report on the future of nursing

Last week a landmark report was released by the Institute of Medicine entitled, “The Future of Nursing: Leading Change, Advancing Health.” The report  identified four key messages:

• 1.       Nurses should practice to their full potential
• 2.       Nurses should achieve higher levels of education.
• 3.       Nurses should be full partners with physicians and other health care professionals in redesigning health care in the US.
• 4.       Workforce planning and policy making require better data collection and improved information infrastructure

Some important recommendations highlighted in the report include eliminating scope of practice barriers for nurses; implementing nurse residency programs; increasing the number of nurses with baccalaureate degrees and doctoral degrees; and to collect data on the interprofessional health care work force. The report concluded that nurses are essential in the transformation of health care. 

Although lauded by most nursing groups, the physician community did not have the identical reaction. The AMA responded quickly with a response stating that, “Physician-led team approach to care helps ensure high quality patient care and value for health care spending.” The AMA does not agree that nurse practitioners have the capacity to function independently due to not having the same years of training as a physician.  In addition the AAFP replied that the report did not take patient safety into account when addressing the education and certification requirements of a nurse practitioner. There are additional blog posts by physicians also unhappy with the report commenting that nurse practitioners are not as educated as physicians and do not merit the same responsibilities or reimbursement. 

As a certified diabetes educator and clinical nurse specialist (CNS), board certified in advanced diabetes management, I believe advanced practice nurses are proficient and deserve reimbursement for their expertise. Currently, most patients with Type 2 diabetes are managed in primary care; so I argue there is a clear advantage for a patient to be managed by advanced practice nurses (APN’s) who are specialists in diabetes care.  A family physician needs to digest an incredible volume of information, generated on a daily basis, where a CNS can focus on a single specialty area.  I have often found myself educating providers on how to initiate contemporary insulin therapy, yet I am then required to get the provider’s approval to order or adjust the recommended medication. Countless reports identify that diabetes is not being managed well, with a significant proportion of patients not achieving the goals for blood glucose, blood pressure and cholesterol.  APN’s are needed to shift this trend.

I agree there are environments that warrant physician oversight and a physician-led team, but not always.  There is an evident need for a new paradigm in the management of diabetes, and APN’s as the team leader might just be the suitable choice! I implore practitioners and policy makers to keep an open mind while health care is restructuring and to look beyond the title of “nurse” as being one dimensional.  

Dance Out Diabetes

On November 14th, World Diabetes Day, a new non profit organization will launch in San Francisco called Dance Out Diabetes!
The event will create a safe place for people at risk for and with diabetes, along with their family and friends, to engage in physical activity that is fun, while also managing or preventing diabetes.
Along with dancing, there will be education by diabetes specialists including dietitians, certified diabetes educators, exercise specialists and physicians.  Congratulations to Theresa Garnero, founder and my colleague and friend! 
For more information about the event, visit their Facebook page!