Compared with non-Hispanic white adults, Native American adults are 2.2 times as likely to have diabetes, and non-Hispanic blacks are 1.8 times as likely. The prevalence among Hispanics also is high, with Mexican American adults 1.7 times as likely as non-Hispanic whites to have diabetes. Data are not sufficient to estimate the prevalence among other Hispanic groups.1
Two nurses who care for Hispanic patients described their programs in this round table discussion. The experiences of three other nurses are described below, offering insight into providing diabetes care and education to high-risk ethnic groups. Robin Thompson, MS, APRN, BC-ADM, CDE, works with the Indian Health Service; Carol Laws-Krause, RN, CDE, works with black patients; and Michelle Sheldon-Rubio, BSN, RN, CDE, works with diverse populations, including many blacks.
Diversity Within Groups
A shared heritage between providers and patients can provide a certain level of comfort, but establishing a trusting relationship independent of ethnicity is what really matters, according to the nurse educators.
Somebody who belongs to a particular ethnic group, for example, may not share all traits associated with that group. In her work with the Indian Health Service, Thompson sees some patients who follow traditional customs but far more who are well assimilated into mainstream American life. Her patients are diverse in other ways too: some are well-educated professionals, whereas others don't have a high school diploma.
Although she is Native American, Thompson is not Cherokee, the dominant population in the Oklahoma area where she works. Laws-Krause is black, as are members of the diabetes support group she has been running in Trenton, New Jersey, since 1989, but she is Roman Catholic and the support group is based at a Baptist church. These cultural differences haven't impeded the formation of successful patient–provider relationships.
Connecting on a Personal Level
Rubio facilitates a support group where she works, at the Joslin Diabetes Center in downtown Baltimore. Her group is open to anyone, whether or not they receive diabetes care at the center. Many attendees of the support group, which is called the Joslin Circle, are black, and many have been attending since the group's inception nine years ago. Spirituality is an important factor in the lives of these attendees. Meetings always begin and end with an affirmation: "We are not here to make a chronic situation even darker. We are here to enlighten a situation that you can manage."
In talking about the Joslin Circle, Rubio stresses the importance of hospitality. The free dinner and door prizes may be as much of a draw as the theme of the evening (such as foot or eye care, physical activity, or medication). The circle meets after working hours in the center's waiting room, where the attendees sit in a circle and introduce themselves by first name only. The group creates a safe and nurturing environment in which attendees can share their feelings and describe their difficulties in dealing with diabetes, as well as learn more about the disease and self-management.
In addition to the diabetes support group that meets at the church, Laws-Krause also runs one that convenes at nearby senior housing. Attendees learn the same type of information they would from diabetes educators in a clinical setting—information about blood glucose monitoring and insulin, for example—but the residential setting allows them to connect with the educator on a personal rather than professional level.
For the patients participating in each of these programs, limited income rather than any specific ethnic trait may be the most critical factor in successful diabetes self-management. Each of the nurses attempts to address the highly personal issue of financial resources without the patient mentioning it. For Thompson, this means helping patients with meal plans that feature foods available through government assistance programs, which often are short on lean protein sources and vegetables. Because insurers rarely cover education for patients with prediabetes, Rubio has addressed their educational needs by opening the free support group to everyone and including information useful in daily diabetes management.