This week, I had the opportunity to interview Carole Farris, Diabetes Nurse Educator at Arrowhead Regional Medical Center.
Start by telling us about yourself and what your interests are related to diabetes, or if you, yourself are affected by diabetes personally or through a family member?
I’ve been a diabetes educator for 20 years. I got into this business when I was a night shift nurse on a cardiac floor and I began to notice that most of these patients had diabetes along with their heart disease. I wanted to get a day job so I volunteered to help out at the hospital’s diabetes treatment center, which eventually led to a full-time position there. I wanted to get on the prevention end of diabetes, not the complication-side. My husband has Type 1 DM.
What is your area of expertise in the medical field of Diabetes?
I work as a Nurse Educator. I primarily teach self-management classes in the outpatient setting, but I also give diabetes seminars to nurses at the hospital, as well as working in the outpatient clinics with the pediatric and adult specialists.
What made you decide to choose the career path of a CDE?
I became a CDE to give my words meaning and expertise, over and above that of an un-credentialed RN.
How do you feel about the artificial or bionic pancreas coming out in 2017? Do you think that you feel comfortable working with patients with an artificial pancreas? How do you think it might help the patient?
The life of a person with diabetes is so “programmed“. I am all for anything that will give them more freedom in their lives not so routine. I welcome the challenge of this new “breed” of patients. It has been a long time coming!
When you teach a diabetes self-management education class, what teaching techniques do you mix and match to make sure the patient gets the concept you are teaching? Describe your typical diabetes class.
I do not use PowerPoint! I talk, draw pictures, and use models for everything that I teach. I think the “old way” is best. I interact with the patients by learning their names and calling on them for their input and experiences and have them demonstrate concepts learned. I work at a county hospital, so most of my patients are low income and have less than I high school education. Many of them have no routine medical care and end up seeing me after they have been hospitalized for a complication of diabetes. Most of my classes are 3-7 patients. I have a onetime 4-hour class: basically a meal plan and other info in a condensed format.
If you have a patient with low literacy, describe how you tailor the class to meet their needs.
Most of my patients fit this description. No PowerPoint and like I said drawing pictures and “hands-on” modalities.
Describe how you evaluate the effectiveness of your teaching methods and the actual learning experience of the client. Do you have the quality assurance measures in place for your DSME program?
The medical staff want to measure improvement in A1c as proof that education works, but I don’t agree with that. I evaluate patients learning by using a short questionnaire and mostly by them telling me subsequently that they don’t get up so many times to go to the bathroom in the middle of the night; how their pain is reduced with better blood sugars; and that they have more energy to work and enjoy their families more.
You have a new patient with a CGM. Describe your experience in working with patients with a CGM, and how you were best able to instruct them on the use of the CGM.
I do not have any patients with CGM’s. This is a county hospital remember? I do have some patients who would benefit from them, but this isn’t currently possible.
You patient comes in and after a full assessment and medication review, you determine that the patient is likely on the wrong medications for their diabetes, and there would be other medications that would provide better control for their diabetes.
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How do you approach their physician to make the recommendations for this new patient? How do you approach the patient about the medicine changes in their diabetes regimen?
This is easy. I do this all the time. My hospital is a “teaching ” hospital. I write recommendations for medicine changes with all of my charting. Some make use of this and some don’t. I will intervene with a phone call if I see someone grossly out of control and recommend the services of the Diabetes Specialty Clinic (specialist) to get them in control. I mention to people in class what the target BG levels are and they realize that they are not on effective medications. I tell them names of other medications and how they could benefit them, then they go and ask their doctors at their next visit.