CONSULT THE EXPERTS Clinical problems in diabetes care

articulate or perhaps appreciate the cause. Two of our experts stress the need for the

professionals to try to determine the under- lying causes of Edgar’s change in habit which are likely to have caused his recurrent admission with DKA. Often you do not discover such changes by sitting in the Clinic but by visiting Edgar’s home and talking to his mother and his family. The two experts draw attention to Edgar’s mother’s age and the impending problem of long-term care when she is too frail to cope. Patients like Edgar do pick up discussions about this and

often become unsettled. It requires a great deal of skill to know when to bring this problem out into the open for general discussion. It is also fallacious to think that patients like Edgar do not appreciate when these discussions are taking place.

All the experts agree that Edgar’s ability togive his own insulin injection and even to monitorhis own bloodglucoselevels should be tested. Pen injection devices and new monitoring equipment have certainly made this easier. If he could master these tech- niques he would be more independent.

I agree with the two experts about the need for more education of carers in Day Hos- pitals, Training Centres and Schools about diabetes and its modem treatment. It would certainly help Edgar. I think the suggestion of an identity bracelet is an excellent idea.

I find it difficult to accept the opinion of the Consultant Physician that there is really no problem. He or she has clearly led a very sheltered life but at least he/she has the sense to ask the opinion of the Diabetes Specialist Nurse.

The Forum continues to represent diabetes nursing on a number of national groups and committees as well as within the RCN while also pursuing the 1998-99 action plan, which includes the following:

Disposal of Sharps Campaign The Forum wishes to address the uneven access that people with diabetes have, to recognised sharps disposal containers. We are proposing that sharps boxes are made available on prescription and returned when full to local health centres. This campaign is supported by a number of other RCN membership groups and relevant pharmaceutical companies. We are also currently approaching other diabetes and medical organi- sations for their support.

If you would like to support this campaign or have views about the issue of sharps disposal in the home, please let me know.

Patient Empowerment Workshops There is a group of diabetes specialist nurses, including two from the Forum Steering Group, working on developing the concept of empowerment in the UK. With the generous support of MediSense, this group has been able to run a number of pilot workshops for nurses in various parts of the country, building on a model from the USA and Sweden. The next workshop will be for the Forum Regional Representatives and Steering Group in September. The project is under evaluation, both quantitatively and qualitatively, and information about the results will be widely published over the next year.

Diabetes Nurse Education Oneof the Forum’s key objectivesforthis year is todeal with the fact that there is no recognised training for diabetes specialist nurses nor recommended further education in diabetes for general nurses beyond the ENB 928 course. This is an aim shared by a number of other groups, including the UK Association of DSNs. These two groups, along with repre- sentatives from the BDA Education and Care Section and the RCN Paediatric Diabetes Special Interest Group, recently met as a steering group to take action!

This meeting resulted in the formation of four working groups, addressing: the availability of courses; criteria for ‘accreditation’ of courses; nurse prescribing in diabetes; defi- nition of the role of the nurse in diabetes care. Other parties, including primary health care representatives and those who have already expressed an interest, eg at the Forum Con- ference in April, will be consulted by the various groups in the course of their work. It is planned that the groups will complete their work by December and present a coherent strategy for nurse training in diabetes as soon as possible afterwards.

As always, I welcome comments and discussion about any of the Forum’s activities and I can be contacted via Anne Synnott, 5th Floor at RCN headquarters.

Rosemary Walker RON FETC, Chair

The Royal College of Nursing: The Voice of Nursing 20 Cavendish Square, London W1 M OAB. Telephone: 01 71 409 333 Fax: 01 71 647 3545

Practical Diabetes International July/August 1998 Vol. 15 No. 5 145