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Diabetes education nurses handle complexity with care

Donohue-Porter, Patricia RN, PhD

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doi: 10.1097/01.NURSE.0000343089.60042.8f
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BOTH NEW AND EXPERIENCED nurses should consider exploring the wide array of opportunities and challenges in the field of diabetes nursing and patient education, or diabetes education. It can be an exciting, demanding, and rewarding career path.

By focusing on type 1, type 2, and gestational diabetes, you'll deal with patients at every stage of human development. You'll help them cope with the many disease processes that complicate the illness as well as complex family issues and their psychological responses to this chronic illness.

In this article, I'll focus on six challenging areas in diabetes education where you can use your complex critical-thinking skills and caring actions to help patients.

  1. Interdisciplinary team involvement. Diabetes is a chronic illness that makes huge demands of patients. For self-management, they need information from a team of expert healthcare providers, including professionals from pharmacy, medicine, nutrition, psychology, exercise physiology, podiatry, and nursing. You'll learn from other perspectives that transcend traditional nursing knowledge.
  2. You'll also share your nursing perspective with other team members. For example, as a clinical specialist in diabetes, I've made rounds with an interdisciplinary team. I've been able to educate medical residents about nursing roles in diabetes management. For instance, I've taught residents that when nurses teach the patient, we can prevent the patient from developing diabetic ketoacidosis during an illness and keep him from returning to the hospital. Such collaboration always benefits the patient.
  3. Diabetes' impact on development. Many nurses choose to care for special groups of patients such as children, women in labor and delivery, or people with psychiatric diseases. When you enter the world of diabetes nursing, your focus will widen dramatically to include patients from all stages of life. For instance, you'll help a pregnant woman needing expert care for a healthy delivery, a small child afraid of her first injection, an adolescent who is dealing with peer pressure as she makes choices about diet, and an older adult with visual loss. All patients, no matter how young or old, will have different responses to the crisis of being diagnosed with diabetes and the complications of this disease. Crises can be viewed as opportunities when patients may be more receptive to therapeutic influence.1 You'll have the opportunity to dramatically influence the patients under your care.
  4. Nursing interventions' complexity. Nursing practice has always mirrored the science and technology of its era.2 As such, you'll interpret the latest technological advances in healthcare for your patients. Today, patients with diabetes must cope with insulin pumps, continuous blood glucose monitoring, prosthetic devices for amputations, and at-home dialysis. They must master an array of technological interventions.
  5. Who do patients turn to for expert guidance? I believe that whether we nurses work in the home, hospital, clinic, or office, we have the full responsibility of embracing technology and using it to care effectively for patients, and most importantly, start them on the transition to diabetes self-management. Technology and caring are intimately interwoven and we can demonstrate the highest level of caring by applying technological advances to benefit our patients.3
  6. The challenges of the comorbidities of diabetes. If you choose to care for patients with diabetes, you'll become an expert in many areas. You'll quickly become aware of how diabetes affects all body systems and intertwines with numerous other conditions. This correlation will require you to sharpen your assessment skills and boost your knowledge level in a variety of specialties.
  7. You'll need to be committed to life-long learning in this endeavor. Nurses will always need to take the extra problem-solving steps to critically analyze what's affecting their patients. Dermatology, cardiology, neurology, nephrology, gastroenterology, ophthalmology, and psychiatry will become subspecialized areas of concern for you as you learn more about how to assist and educate your patients. As your level of knowledge increases, you'll feel a sense of pride in how much information you're able to share with your patients.
  8. Patient-education goals. Every nurse is an educator, but when you enter the world of diabetes nursing, you'll receive great support to help you increase your teaching skills. For instance, the American Association of Diabetes Educators and the American Diabetes Association offer publications, teaching sessions, online programs, and other supports along each step of the way as you develop a new and complex skill set. You'll find out about national standards for diabetes self-management and efforts to promote behavior change for patients.4 Tap into the exciting national and international research that's already in place to make the teaching arena come alive for you, your patients, and their families. The family is essential to the teaching and learning process, and you'll benefit from keeping the family members central to that process.
  9. Increased psychological support. Psychological support is essential in every field of nursing but particularly when patients are experiencing chronic illness and its complications. Patients with diabetes sometimes receive difficult news and are asked to make tough decisions. They may be diagnosed with kidney failure and be required to choose between dialysis and transplantation, or they may have to decide on medical or surgical treatment of cardiovascular disease or whether to undergo an amputation.

They need hope, courage, and patience. They also need a nurse who is present, empathetic, and caring. If that nurse is you, and if you take the time to develop the skills you need, you'll contribute much as a diabetes nurse and diabetes education nurse.

Making a difference

Finally, don't be afraid of the challenges of diabetes nursing. With your enthusiasm and caring, you can make a difference in confronting this illness.

Organizational power

Consider joining a professional group, the American Association of Diabetes Educators. When I presented research at its annual conference, I found this group of over 3,000 diabetes educators to be enthusiastic, dynamic, and dedicated to excellence in practice and education. The association provides cutting-edge research, advanced teaching techniques, and interdisciplinary collaboration. For more information, see


1. Aguilera DC. Crisis intervention: Theory and Methodology, 8th edition. St. Louis, Mo.: Mosby; 1998.
2. Nelson S, Gordon S. The rhetoric of rupture: Nursing as a practice with a history? Nurs Outlook. 2004;52(5):255–261.
3. Locsin RC. Technological Competency as Caring in Nursing: A Model for Practice. Indianapolis, Ind.: Sigma Theta Tau; 2005.
4. Miller DK, Fain JA. Diabetes self-management education. Nurs Clin North Am. 2006;41(4):655–667.
© 2009 Lippincott Williams & Wilkins, Inc.