Association of Diabetes Nurse Educators of the Philippines

It was the first time that ADNEP had a booth during the Philippine Nurses Association’s 86th Founding Anniversary, 51st Nurses Week Celebration and National Annual Convention at The Tent of the Manila Hotel last October 21-23, 2008. The event was attended by more than 2,000 nurses coming from all over the Philippines. It was a great opportunity to promulgate the mission of ADNEP and at the same time advertise our projects. One of our advisers, Dean Carmelita C Divinagracia, is the current recipient of AGT (Anastacia Giron Tupaz) award given by PNA. It is the highest award given to a Filipino nurse in our country.

Several activities were done at our booth. Delegates were asked to fill-up a Risk Assessment Form. Our Presentor and featured product partner, Roche Accu Chek, had free blood sugar checking for the visitors. Free health education and counseling were done to at-risk delegates. ADNEP ballpens and Roche kits were given as a prize to many delegates.

“I have no time to educate my patients…” Do these words sound familiar? Does guilt hit you bad? Worry no more, you are not alone.

The prevalence of Type 2 diabetes has increased exponentially over the past 20 years. It is a chronic condition that affects all areas of a person’s life and that demands high quality care. Since the publication of the Diabetes Control and Complications Trial in 1993, there has been growing consensus that diabetes education is a core component of quality health care for all people with diabetes.1 Numerous studies have been conducted to provide evidence of the positive effects of Diabetes Self Management Education (DSME) on the glycemic control of our patients.

Kanzer-Lewis2 addressed four critical issues why we must do patient education.

• It is the legal thing to do – We would often hear stories of patients doing insulin injection on the same site every time that results to lipodystrophies and uncontrolled blood sugar levels. There are also patients who met an accident from hypoglycemia because they don’t know what hypoglycemia is and what to do with it. These and many other incidents can be prevented with proper diabetes education.

• It is the moral thing to do – One of the most important roles of nurses is that of patient advocate, reflecting their ability to protect the interests of patients who cannot represent themselves because of illness or inadequate health knowledge. Our patients entrust themselves to us whom they didn’t know and it is our big responsibility not to betray that trust.

• It is the ethical thing to do – Ethics are the guiding principles of human behavior. How do we behave with people? Do we see them important human beings who have needs and specific concerns? We cannot send our patients out of our care unprepared for diabetes self management.

• It is the professional thing to do – The Article VI of our Philippine Nursing Act states that the registered nurse will provide health education to individuals, families and communities.2 Several studies have been published on how nurses on the diabetes team significantly improved some medical outcomes in patients with complicated diabetes.

Patient education need not to be cumbersome. Let us go back to our first statement “I have no time to educate my patients…” When time is limited, ask the patient his major complaints and needs. Develop a plan in conjunction with the patient and if possible, the significant other. Categorize these needs as needs to know, wants to know and nice to know.

The “needs to know” are the basic things a patient needs to know to go home safely. These include the four M’s: medication, meal planning, monitoring and motivation. The “wants to know” are the things that patients ask about. This is what they call the teachable moment. It is when the patient has an “Aha!” and “Ohh” as the result of an experience. When these occur, you have the best opportunity to get through them. They want to know something, so they have opened their minds to information and concepts. Lastly, there are the “nice to know“. These are things that may be interesting and fun but no one needs them to survive. These may be useless for our patients.3

Patient education can be a beautiful experience yet it can also take lots of energy and enthusiasm. It will be what you make it.

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1 New England Journal of Medicine 329:977-986, 1993
2 Philippine Nursing Law: Philippine Nursing Association website
3 Kanzer-Lewis, Ginger: Patient Education: You can do it! 2003

Early this evening, we had the chance to attend an international live web cast from the International Diabetes Center (IDC), Minneapolis, MN, USA hosted by Lilly Philippines at their office in Wynsum Corporate Plaza, Ortigas.

It was our first and we believe to most attendees as well. Three speakers with different specialties in Diabetes shared their expertise. The first speaker, Ms Ellie Strock, ANP-BC, CDE, talked briefly about the growing worldwide prevalence of Type 2 DM. She also mentioned the core defects in Type 2 DM and the plus the correlation of fasting and postprandial blood glucose to HbA1C.

Dr Robert M Cuddihy tackled the different kinds of insulin. He taught the audience on how to compute for the starting dose of insulin based on the glycemic factors and patient factors. Ms Strock took over the discussion and went on with insulin adjustment.

Ms Janet Lima, MPH, RN, CDE discussed the educational strategies for successful insulin initiation. She enumerated the barriers in insulin therapy in two views: the patient’s and the doctor’s.  Later on she  discussed the strategies to overcome these barriers.

The web cast was ended with a Q & A portion. Attendees from different  countries such as Malaysia, Thailand, India, Pakistan and the Philippines each submitted questions for the resource speakers. While not all questions can be answered, Dr Araceli A Panelo, MD, FPCP, MS, was present as a resource person. She reiterated the importance to start insulin because of the natural progression of Diabetes Mellitus.

As diabetes educators, it is our utmost role to explain the importance of good glycemic control. We help them prevent or further delay the onset of complications of diabetes.

JPEPA stands for Japan-Philippines Economic Partnership Agreement. It was signed by President Gloria Macapagal-Arroyo and former Prime Minister Junichiro Koizumi on September 9, 2006.

JPEPA is a bilateral “mega” trade treaty between the two countries that seeks to promote investments and the trade of goods and services; goods like bananas and services of our Filipino nurses and caregivers.

It was said that 400 Filipino nurses and 600 caregivers would be allowed to undergo training in Japan for the next years under the JPEPA scheme; 3 years for nurses while 4 years for the caregivers. These health workers will train under the supervision of a Japanese nurse and will have to take their Licensure Examination in Nihonggo. If they don’t pass the exam, they are immediately deported back to the Philippines.

During the years of training, our nurses only receive training allowances. They also risk of not being hired since they are neither employees nor workers. Our nurses are better off employed in other countries than in Japanese soil.

Filipino nurses are the best in the world. Let us safeguard our integrity and dignity. Junk JPEPA!

source: www.pna-ph.org