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80
VOLUME 8 NUMBER 2 • JUNE 2011
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes Personality
S Afr J Diabetes Vasc Dis 2011;
8
: 80.
DIABETES EDUCATION – WELL WORTH
DOING AND WORTH DOING WELL
‘The reward of a thing well done is to have actually done it.’ That’s the motto of
Durban-based diabetes specialist nurse, Fiona Prins.
She’s one busy woman. Not only does she still have a private practice,
which is run in her own time, but she is also currently working full time
for a pharmaceutical company. Her portfolio there is exclusively diabetes
education. ‘To this end, I assist patients one on one with the issues of daily
living associated with diabetes and the motivation-induced behavioural
changes the condition requires for optimal management.’
In addition, Fiona does a fair amount of training of medical personnel
at hospitals and allied healthcare professional training centres, for exam-
ple the Pharmacology Department at the University of KwaZulu-Natal and
various nursing schools. ‘I also undertake insulin pump training and pump
initiation for patients in KwaZulu-Natal when required’, she says.
‘I do many demonstrations and training on how to manage diabetes.
Among other things, I show patients the different insulin pens and test kits
available and, when a choice has been made, we formulate goals together
and write them down before the patient leaves’, she continues. ‘I use a
lot of pictures in the course of these demonstrations, as I’ve found many
patients like this method of doing things. I also make a point of only giving
them literature relevant to what we have discussed on any given day, as
too much paperwork can be very overwhelming.’
Fiona has always been passionate about diabetes, but a personal issue
made her even more so. ‘Diabetes became a priority for me when my
godchild was diagnosed at 13 months and I needed to know more! In any
event, I had always preferred the educational aspects of nursing, to the
clinical practice thereof. As an educator, I find I have more control over
what I’m able to do and I can make a more meaningful difference.’
All diabetes educators face similar challenges, for example, how to en-
sure patients understand the disease, accept the diagnosis and then com-
ply with different therapeutic regimens. Fiona’s approach is very positive.
‘I try to break any problems down into bite-size pieces. I use a technique
called motivational interviewing, which allows me to use the patient’s pri-
orities to progress, rather than my own agenda. There is a big difference
between simply dispensing information and real education’, she observes.
She wishes that the medical aid schemes could be made to see the
value of the educator in the team of healthcare professionals. ‘We seldom
get reimbursed directly by them and, as a result, very few of us can make
education a full-time career, even if we do it really well. We need an ad-
equate income, after all.’ She attributes this poor perception of diabetes
educators to the fact that the level of care is not governed adequately and
that not all educators approach their work with the requisite degree of
passion and professionalism. ‘As a result, we all get tarred with the same
brush’, she says.
Asked about which aspects of her job she finds rewarding, Fiona com-
ments, ‘I can honestly say I love every day of my work and know I make a
difference in my patients’ lives. Obviously we do get the odd patient who
is more difficult than others, but I see this as my problem, not theirs. I vary
my approach in each case, because every patient is different.’
‘I still believe we need to listen more than talk’, says Fiona. She refers to
a specific case in which an elderly gentleman came to her with this com-
plaint: ‘I just feel so bad all the time – maybe I am doing something wrong
with my diet or not taking my meds right but I need to feel human again.’
‘In this case, the actions of the various medications had never been ex-
plained to the patient. He had never been given targets to aim for, so all
his efforts were inappropriately actioned. The problem was that he had
been prematurely placed on insulin after one random high reading, with
the result that his levels were running way too low all the time. Once we
stopped the insulin, readjusted his oral medications and provided some
dietary counselling, he felt 100% better and all his symptoms (the inves-
tigation of which had cost him an entire year’s worth of medical savings!)
resolved. Obviously I did all of this in consultation with his medical team,
with dignity and as ethically as possible.’
Fiona feels strongly that many patients are not seeing the appropriate
specialists. ‘This makes our lives harder as the wrong messages still get
perpetuated, such as: ‘you have a touch of sugar’, ‘you just need to stop
eating sweet stuff’, ‘as long as the levels come down you are on the right
track.’ ‘This has to stop. I’m just not sure how to make it happen over-
night. I guess I need a few miracles’, she concludes with a smile.
