National Standards for DSME and DSMS – Part 4

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Part 4 of 6 Parts
The sixth standard states, “Awritten curriculum reflecting current evidence and practiceguidelines, with criteria for evaluating outcomes, will serve as theframework for the provision of DSME. The needs of the individualparticipant will determine which parts of the curriculum will beprovided to that individual.”
Here again, the door is wide open fordiscrimination. CDEs are nefarious for deciding that individualsdon't need some part of training when a mandate will work just fine. This means that the patient with diabetes is not taught something orpossibly a key that is necessary in the self-management of diabetes. If the patient cannot figure out from the mandate what needs to beaccomplished and why, they are left in the dark and wondering whatthey missed. I know this by the questions I receive in emails. People with type 2 diabetes are asking why is this so important or isthis really necessary. You can bet I ask if they have had any timewith a CDE. No all have, but those that have had time with a CDE,say they were told to do it with no explanation.
Another part of this that makes mewonder at the training of CDEs is the number of times people askquestions that should have been covered in an assessment. The time Ihad an individual say they had just seen a CDE and the question waswhat do I do now. He had asked the CDE what to do for depression ashe was feeling very low and in addition to just having a diagnosis ofdiabetes, the previous week he had buried his wife of 46 years. Hisquestion was not answered and the session was ended without anyindication that the CDE would talk to his doctor or anyone. As hesaid in his email – it was as if she could not get out the doorfast enough.
Even my suggestion to call his doctordid not get him any help and it took almost two weeks to find someonehe could talk with and actually give him the help he needed. He wasdoubly blessed that the person he got set up with also had type 2diabetes and knew what he was talking about.
Why the next section is talked aboutreally has me wondering, especially since most people with diabetesare not being serviced by CDEs and the people with prediabetes are notseen by CDEs. Yes, a very few have consulted with CDEs if they area relative or close friend of the family. I even had one of thesepeople email me telling me that they had been educated by a CDE, butthey refused to answer the question of how close they were related orif they were a friend of the family.
“Individuals with prediabetes anddiabetes and their families and caregivers have much to learn tobecome effective self-managers of their condition. DSME can providethis education via an up-to-date, evidence-based, and flexiblecurriculum.”
“Thefollowing core topics are commonly part of the curriculum taught incomprehensive programs that have demonstrated successful outcomes: 1. Describing the diabetes disease processand treatment options2. Incorporating nutritional management intolifestyle3. Incorporating physical activity intolifestyle4. Using medication(s) safely and formaximum therapeutic effectiveness5. Monitoring blood glucose and otherparameters and interpreting and using the results for self-managementdecision making6. Preventing, detecting, and treating acutecomplications7. Preventing, detecting, and treatingchronic complications8. Developing personal strategies to addresspsychosocial issues and concerns9. Developing personal strategies to promotehealth and behavior change”
The above areas are important andshould be part of the content in a carefully planned program, butunless an assessment is performed and the program adapted to theindividual, the curriculum may miss the target and not be absorbed bythe individual. When a proper assessment is done and the approachesto education are interactive and patient centered, then it should beeffective. Also necessary is the development of action-orientedbehavioral goals that are creative and experienced based in deliverymethods are effective. This should indicate that mandates are noteffective, but they are too often used.
The seventh standard states,“The diabetes self-management, education,and support needs of each participant will be assessed by one or moreinstructors. The participant and instructor(s) will then togetherdevelop an individualized education and support plan focused onbehavior change.”
The idea of individualized education isthe key to this standard. This could or should be what every CDEstrives for in the education. This seldom is the case because noassessment is done and the education is handed out almostwillie-nillie based on the CDEs attempt to hurry through theeducation. Because the assessment is also a key to giving educationon an individualized basis, I am quoting what is important in anassessment.
“Theassessment process is used to identify what those needs are and tofacilitate the selection of appropriate educational and behavioralinterventions and self-management support strategies, guided byevidence. The assessment must garner information about theindividual’s medical history, age, cultural influences, healthbeliefs and attitudes, diabetes knowledge, diabetes self-managementskills and behaviors, emotional response to diabetes, readiness tolearn, literacy level (including health literacy and numeracy),physical limitations, family support, and financial status. Theeducation and support plan that the participant and instructor(s)develop will be rooted in evidence-based approaches to effectivehealth communication and education while taking into considerationparticipant barriers, abilities, and expectations.”
The assessment and education plan,interventions, and outcomes must be documented in the patient’srecords. This will facilitate and provide assistance to others onthe patient's healthcare team and increase the likelihood that allthe members will work in collaboration. This will create anatmosphere of learning and success for the patient resulting inimproved quality of care.

This information is from the National Standards for DSME and DSMS.