Document Type : Original Article

Authors

1 Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

2 Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran Nursing and Midwifery Sciences Development Research Center, Najafabad Branch Islamic Azad University, Najafabad, Iran

3 Medical Education Research Center, Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: Limited research has been conducted in the field of diabetes educator’s competency.
However, no comprehensive and integrated explanations of educator’s competence requirements
in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes
educator’s competence in diabetes self‑management education in Iran.
MATERIALS AND METHODS: This was a qualitative descriptive‑exploratory study. The data were
collected through semi‑structured and in‑depth interviews and using purposeful sampling method
in Isfahan University of medical science from April to October 2018. Sampling continued until data
saturation. Participants included 20 people who were selected by purposive and snowball sampling
method. The interviews were analyzed using content analysis method of Graneheim, Lundman.
RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and
family centered education, (2) process‑based education, and (3) continuous progress in profession
and also seven subcategories (patient and family activation, empower), facilitating educational
process, comprehensive education assessment, development, implementation and evaluation of
educational plans, developing educators’ educational knowledge and skills, development of creativity
and innovation, promote inter‑professional cooperation in education.
CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and
family along with creativity and interprofessional collaboration for comprehensive evaluation of patients
in designing, implementation of educational programs were mentioned as important competencies
of diabetes educators, which can have a significant impact on patients’ recovery, treatment, and the
promotion of society’s health.

Keywords

  1. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM,
    Fischl AH, et al. Diabetes self‑management education and
    support in type 2 diabetes. Diabetes Care, 2015; 38:1372-1382 |
    doi: 10.2337/dc15‑0730.
    2. ADA.American Diabetes Association, 5. Lifestyle management:
    Standards of medical care in diabetes—2019. Diabetes Care,
    42(Supplement 1), S46‑S60. doi: 10.2337/dc19‑S005.
    3. Walsh N, George S, Priest L, Deakin T, Vanterpool G, Karet B,
    et al. The current status of diabetes professional educational
    standards and competencies in the UK—a Position Statement
    from the Diabetes UK Healthcare Professional Education
    Competency Framework Task and Finish Group. Diabetic
    Medicine. 2011;28(12):1501‑7.
    4. Alharbi T, McIntyre M, Thomacos N, McLelland G. Core
    competencies for diabetes educators: A scoping review protocol.
    JBI database of systematic reviews and implementation reports.
    2018;16(6):1381‑6.doi: 10.11124/JBISRIR‑2017‑003503.
    5. Australian Diabetes Educators Association( ADEA). National
    Core Competencies for Credentialled Diabetes Educators 2008a.
    [Last accessed on 2016 Aug 09].
    6. American Association of Diabetes Educators (AADE).
    Competencies for diabetes educators and diabetes
    paraprofessionals: A companion document to the practice Levels
    for Diabetes Educators & Diabetes Paraprofessionals. 2016.
    7. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK,
    Condon JE, et al. 2017 National standards for diabetes
    self‑management education and support. Diabetes Care
    2017;40:1409-1419 , doi.org/10.2337/dci17‑0025.
    8. Alotaibi A, Al‑Ganmi A, Gholizadeh L, Perry L. Diabetes
    knowledge of nurses in different countries: An integrative
    review. Nurse education today. 2016;39:32‑49. doi: 10.1016/j.nedt.
    2016.01.017.
    9. Simmons D, Deakin T, Walsh N, Turner B, Lawrence S, Priest L,
    et al. Competency frameworks in diabetes. Diabetic Medicine.
    2015;32(5):576‑84.doi: 10.1111/dme.12702.
    10. Abazari P, Vanaki Z, Mohammadi E, Amini M. Inadequate
    investment on management of diabetes education. Journal of
    research in medical sciences: The official journal of Isfahan
    University of Medical Sciences. 2012;17(8):792.
    11. Kashani F, Abazari P, Haghani F. Challenges and Strategies of
    Needs Assessment Implementing in Diabetes Self‑management
    Education in Iran: A Qualitative Study. Iranian Journal of Nursing
    and Midwifery Research. 2020;25:437‑43. doi: 10.4103/ijnmr.
    IJNMR_10_20.
    12. Soltani‑Molayaghobi N, Abazari P, Taleghani F, Iraj B,
    Etesampour A, Zarei A, et al. Overcoming challenges of
    implementing chronic care model in diabetes management: An
    action research approach. International journal of preventive
    medicine. 2019;10:13,1‑6, doi: 10.4103/ijpvm.IJPVM_485_18.
    13. Modic MB, Vanderbilt A, Siedlecki SL, Sauvey R, Kaser N,
    Yager C. Diabetes management unawareness: What do bedside
    nurses know? Applied Nursing Research. 2014;27(3):157‑61.
    doi: 10.1016/j.apnr.2013.12.003.
  2. 14. Burke SD, SherrD, LipmanRD. Partnering with diabetes educators
    to improve patient outcomes. Diabetes, metabolic syndrome and
    obesity: Targets and therapy. 2014;7:45‑53.doi: 10.2147/DMSO.
    S40036
    15. Sleezer CM, Russ‑Eft DF, Gupta K. A Practical Guide to Needs
    Assessment. 2014;3th ed. Edition (San Francisco: By John Wiley
    & Sons, Inc; 2014).
    16. Houghton C, Murphy K, Shaw D, Casey D. Qualitative case
    study data analysis: An example from practice. Nurse researcher.
    2015;22(5):8‑12.doi: 10.7748/nr.22.5.8.e1307.
    17. Graneheim UH, Lundman B. Qualitative content analysis in
    nursing research: Concepts, procedures and measures to achieve
    trustworthiness. Nurse education today. 2004;24(2):105‑12.
    doi: 10.1016/j.nedt.2003.10.001.
    18. Streubert HJ, Carpenter D. Qualitative research in nursing:
    Advancing the humanistic imperative (5th ed.) Philadelphia:
    Wolters Kluwer, Lippincott Williams and Wilkins.: Lippincott
    Williams & Wilkins; 2011.
    19. Pinchera B, DelloIacono D, Lawless CA. Best practices for
    patient self‑management: Implications for nurse educators,
    patient educators, and program developers. The Journal
    of Continuing Education in Nursing. 2018;49(9):432‑40.
    doi: 10.3928/00220124‑20180813‑09.
    20. Chen J, Mullins CD, Novak P, Thomas SB. Personalized strategies
    to activate and empower patients in health care and reduce health
    disparities. Health Education & Behavior. 2015;25:(1‑10). doi:
    10.1177/1090198115579415.
    21. Lange K, Swift P, Pańkowska E, Danne T., International Society
    for pediatric and Adolescent Diabetes. ISPAD Clinical Practice
    Consensus Guidelines 2014. Diabetes education in children
    and adolescents. Pediatr Diabetes 2014;15(Suppl 20):77‑85.
    doi: 10.1111/pedi.12187.
    22. Robinson D, Luthra M, Vallis M. Canadian diabetes association
    clinical practice guidelines expert committee. Canadian diabetes
    association 2013 clinical practice guidelines for the prevention
    and management of diabetes in Canada. Can J Diabetes.
    2013;37 Suppl 1:S1‑212.
    23. ParchmanML, ZeberJE, PalmerRF. Participatory decision making,
    patient activation, medication adherence, and intermediate
    clinical outcomes in type 2 diabetes: A STARNet study. The
    Annals of Family Medicine. 2010;8(5):410‑7 doi: 10.1370/afm.1161.
    24. Abazari P, VanakiZ, Mohammadi E, Amini M. Barriers to effective
    diabetes self‑management education. Iranian Journal of Medical
    Education ,2013;13:221‑32.
    25. Martin D, Lange K, Sima A, Kownatka D, Skovlund S, Danne T,
    et al. Recommendations for age-appropriate education of children
    and adolescents with diabetes and their parents in the European
    Union. Pediatr Diabetes 2012;13:20‑8.
    26. Lange K, Klotmann S, Saßmann H, Aschemeier B, Wintergerst E,
    Gerhardsson P, et al. A pediatric diabetes toolbox for creating
    centres of reference. Pediatric diabetes, 2012;13 Suppl (16):49‑61.
    doi: 10.1111/j. 1399‑5448.2012.00913.x.
    27. Kalantari S, Najafi MK, Abbaszadeh A, Sanagoo A, Borhani F.
    Nurses’ Perception of Performance of Patient Education.
    Quarterly Journal Scientific research jentashapir. 2012;2(4):167‑74.
    28. Ramezanli S, Badiyepeymaie‑JahromiZ. Iranian Nurses’ Views on
    Barriers and Facilitators in Patient Education: A Cross‑Sectional
    Study. Global Journal of Health Science. 2015;7(5):288‑93.
    doi: 10.5539/gjhs.v7n5p288.
    29. Peltola M, Isotalus P, Åstedt‑Kurki P. Patients’ interpersonal
    communication experiences in the context of type 2 diabetes care.
    Qual Health Res 2018, 00(0): 1‑16.doi: 10.1177/1049732318759934 .
    30. Kashani F, Moghimian M, salarvand S, kashani P. Nurses’
    knowledge, Attitude, Practice about Effective Communication
    Skills in Patient Education. Journal of Research Development in
    Nursing & Midwifery. 2015;12(2):59‑67[Article in Persian].
    31. IrajpourA, FarziS, SaghaeiM, RavaghiH. Effect of interprofessional
    education of medication safety program on the medication error
    of physicians and nurses in the intensive care units. Journal
    of Education and Health Promotion. 2019;8(196):1‑12.doi:
    10.4103%2Fjehp.jehp_200_19.
    32. Coulter A, Entwistle V, Eccles A, Ryan S, Shepperd S, Perera R.
    Effects of personalised care planning for people with long‑term
    conditions. Cochrane Database of Systematic Reviews.
    2015;3.;3:1‑96, doi: 10.1002/14651858.CD010523.pub2.
    33. Yousefi H, Ziaee ES, Golshiri P. Nurses’ consultative role to
    health promotion in patients with chronic diseases. Journal of
    Education and Health Promotion. 2019;8(178):1‑19 , doi: 10.4103/
    jehp.jehp_146_19.
    34. Farzi S, Shahriari M, Farzi S. Exploring the challenges of
    clinical education in nursing and strategies to improve it:
    A qualitative study. Journal of education and health promotion.
    2018;7(115):1‑19, doi: 10.4103%2Fjehp.jehp_169_17.
    35. Krall JS, Donihi AC, Hatam M, Koshinsky J, Siminerio L. The
    nurse education and transition (NEAT) model: Educating the
    hospitalized patient with diabetes. Clin Diabetes Endocrinol,
    2016;2(1);1‑6, doi: 10.1186/s40842‑016‑0020‑1.
    36. De Sousa F, Jackson J, Knight R, Cloutier E, Basa R, Fourney A,
    et al. A social media intervention to improve hypoglycemia
    management at a multicenter hospital: A quality improvement
    pilot for clinical nurses. Contemp Nurse 2018;54(1):44‑51. doi:
    10.1080/10376178.2018.1440180.
    37. Sarda A. Creativity and diabetes Education: Essentiality, impact
    and way forward. Indian J Endocrinol Metab 2015;19: Suppl 1:26‑8.
    doi: 10.4103/2230‑8210.155363.
    38. Gucciardi E, Espin S, Morganti A, Dorado L. Exploring
    interprofessional collaboration during the integration of
    diabetes teams into primary care. BMC Fam Pract 2016;17(1):12.
    doi::10.1186/s12875‑016‑0407‑139.
    39. Farzi S, Saghaei M, Irajpour A, Ravaghi H. The most frequent and
    important events that threaten patient safety in intensive care
    units from the perspective of health‑care professionals’. Journal
    of Research in Medical Sciences: 2018;23:104:1‑11, doi: 10.4103/
    jrms.JRMS_140_18.
    40. Farzi S, Irajpour A, Saghaei M, Ravaghi H. Weak Professional
    Interactions as main Cause of Medication Errors in Intensive Care
    Units in Iran. Iranian Red Crescent Medical Journal. 2017;19:1‑7.
    41. Kishimoto M, Noda M. The difficulties of interprofessional
    teamwork in diabetes care: A questionnaire survey. Journal
    of multidisciplinary healthcare. 2014;7:333‑9:1‑13, doi: 0.2147/
    JMDH.S66712.
    42. Pekonen A, Eloranta S, Stolt M, Virolainen P, Leino‑Kilpi H.
    Measuring patient empowerment–A systematic review. Patient
    Educ Couns 2020;103(4):777‑87. doi: 10.1016/j.pec.2019.10.019.