Diabetes Education is not always about educating; It's about listening.
Aug 23, 2011, 01:00 AM
It’s been a long day. In addition to seeing patients, I have filled out insulin pump request forms, called patients to discuss blood sugars and worked on developing a new intake form. The phone rings, and it is a distraught parent whose child’s blood glucose values are sky high and dad is so frustrated. The situation is not under his control; his child has been in the adolescent unit due to psychiatric issues, and her insulin pump has been removed. The nurse is following the insulin protocol, but dad is watching, and she does not seem to know how to use an insulin pen. The nurse gets angry when dad makes suggestions. Dad does have a history of anger and blame. There is also the question of a past history of dad sneaking food into the unit resulting in carbohydrates that are not included in insulin dosing.
I’m really ready to go home, but the voice inside me says, “you are his link, the one he trusts and you need to listen.” How many times during the day do you find yourself getting away from the diabetes instructor, and becoming the “one they can trust?” In some cases, you are the person they have seen multiple times over the course of their child’s life. The one who tries to understand the age of rebellion from testing, the frustration and unfairness of multiple chronic disease diagnoses and the tedious nature of type 1 diabetes. I love working with families with children with diabetes, and when I think about going home when they are in need, I think of the fact that they cannot go home. Their home is the constant day to day struggle with blood sugars along with all the other co-diagnoses.
So I listen. I make a few phone calls, talk with the endocrinologist I work with, and we think through the possibility that this could be a nurse new to diabetes care and unsure of how to use the insulin pen. On this nurse watch, BG values have risen precipitously. Dad may be right. And so he is. The technique for injecting was incorrect, and the insulin dose was not completely administered. But...this is not the story of a problem nurse. It’s difficult to reach all the new staff on everything they need to know about caring for a patient with diabetes. This is a story of listening. Had the nurse been willing to take some coaching from dad, she might have learned. If I had not listened, the blame may have continued to be on sneaking food and inappropriate behavior on dad or his child’s part. If the endocrinologist had not listened, the problem would not have been resolved.
Listening and caring: it is what diabetes educators do all day. The education piece is a fraction of our job. We listen, problem-solve and help patients to achieve their own best management goals within the context of their lives and abilities. What a challenging but worthwhile profession!