Christine Manga, a diabetes nurse educator (DNE), explains what her job entails and shares some of the challenges faced as well as the pluses.
I am a diabetes nurse educator. I use this title without much thought. My mistake, not everyone knows what DNE stands for, let alone what we do. So, let me explain what a diabetes nurse educator is, why we are necessary, and what an average day routine consists of.
Part of a team
DNE is an acronym for diabetes nurse educator. A DNE is a healthcare professional who possesses comprehensive knowledge, skills and experience in diabetes management. We work as part of a diabetes management team, along with doctors, podiatrists, dietitians and ophthalmologists. Patients tend to spend more time with their diabetes nurse educator than any other of the team members.
Our role, as DNEs, is to assist patients to effectively manage their own diabetes. We strive to do this through education, coaching and support. Being non-judgemental is of paramount importance.
Because diabetes is a chronic condition – patients have to live with it 24/7 365 – it’s not surprising that managing diabetes effectively requires a lot of time and effort. Patients are required to take various medications at multiple times in the day. These may be tablets or injectables. Regular structured glucose testing is recommended. Constantly being aware of what they’re eating is tiring. It is therefore imperative that DNEs equip these patients with the tools and coping mechanisms to master self-management. We know that each patient is unique, hence we tailor a management plan around this.
During the first consultation, a DNE does a thorough history taking. From this information, we can assess diabetes duration, comorbidities, medication, diet, lifestyle, and patient motivation level.
Working within the South African guidelines for diabetes management and taking into account the patient’s preferences and habits, together we can formulate a management plan.
General information is given to all patients. This includes explaining what diabetes is. Many patients are not aware of what diabetes is and the serious complications that can occur without good control. A lot of time is spent correcting misconceptions. We explain the various targets that they should be aiming for.
Basic dietary information including meal planning, portion sizes and timing of meals are explored. Small changes to these choices can result in improved glucose control. Educating patients on blood glucose testing technique, injection technique, needle and site rotation is key to good management.
Explaining how the medication works in the body, what side effects to expect, and what medication may need to be used in the future seems to have improved medication compliance in my patients. Highlighting the importance of exercise and quitting smoking is vital to incorporate.
This generic information is given to all patients. Without the basics, one cannot easily progress.
In future consultations, DNEs coach patients on how to set a Specific, Measurable, Attainable, Realistic and Time-based (SMART) goals. Once the patient has set goals, we sit together and discuss how he/she can attain these goals. These goals are much more than just achieving a good blood glucose reading.
It’s the patient who needs to formulate a plan; a DNE will assist or give potential options that he/she may not have been aware of. By coming up with the solutions themselves, it empowers them and builds self-confidence. It encourages self-management, which is what we are aiming for.
A routine day consists of consultations, checking and responding to patient emails and, in most cases, managing an emergency hotline. Remember, diabetes doesn’t go away after office hours.
Though, saying a day is routine is not very accurate. No two patients ever present in the same way. So, although saying a consultation is routine is true, the content will never be routine. The patient may be in a bad space – unrelated to diabetes – resulting in 90% of the consultation being spent on that issue.
A DNE needs to be flexible. A consultation should have structure, but the content should be led by the patient. Our agenda may not meet the patient’s needs. We need to be attentive to where the patient is leading us.
Pros and cons
As with every profession, there are both rewarding and challenging moments. The most challenging issues being language differences, financial constraints, and a general resistance (from patients) to change.
These changes include lifestyle modification, increasing, changing or adding medication. Resistance is also common when initiating insulin. Financial constraints affect the choice of medication, the amount of testing strips that a patient can use as well as food that can be purchased. All of these have an effect on the way the patient responds to the recommendations.
On the up side, I love being the first person to interact with a newly diagnosed patient. Being able to allay the fear these patients feel is extremely rewarding. Many people are scared when they have been diagnosed with diabetes. They also fear being judged.
As time goes on and my patients come for follow-up appointments, it is wonderful to see how many of them have embraced the diagnosis, worked through and with it. Their self-esteem appears to blossom.
Sadly, this is unfortunately not the case with all patients. At the end of the day, we are all human. Helping one person might not change the world, but it could change the world for one person.