The Role of Diabetes Educators in the Society - Essay Example

? Final Project – The Story Final Project – The Story Introduction People living with diabetes suffer from a condition in which insulin is either produced insufficiently by the body, not produced at all or is not used effectively to convert blood sugar into energy. In the year 2011, more than 26 million American citizens were reported as living with diabetes, and 1.9 million out of the recorded number were new cases for that year alone. Such high and undesirable figures call for the creation and implementation of effective policies in the prevention of new cases as well as caring for those already with the condition. Such policies should also define stakeholders who will be held accountable on the progress, success or failure of the initiative. Inevitably, policy makers, physicians, nurses, nursing bodies, educators, patients, insurance firms and state authorities must collaborate to bring diabetes under control. The most effective control measure would be the prevention of the occurrence of new cases, while at the same time controlling and managing the condition among those already living with it (Davies, Dixon & Currie, 2001). The role of educators, therefore, becomes a key emphasis of the policy making procedure. This becomes a key issue because a 20 year old patient representing a diagnosis was interviewed for the project and confirmed not having been sufficiently informed on the necessity of a healthy lifestyle in the prevention and treatment of diabetes. This, in turn, means that the role of diabetes educators is not sufficiently felt in society, creating a knowledge gap. This issue is linked to nursing because nurses have the abstract information on patient care and can contribute significantly towards formulating policies that will effectively curb the growing numbers of diabetic cases. Being the ones closest to patients in terms of provision of care, they are in a better position to know what advice needs to be given in the prevention and control the problem. Therefore, their role is significant in promoting the initiative through providing evidence-based and up-to-date facts about education and care in diabetes (Davies, Dixon & Currie, 2001). This essay will discuss the problem, the policy and political procedures and provide a concluding solution. Policy Analysis The subject of diabetes has faced numerous policy challenges. The American Association of Diabetes Educators (AADE) pointed out that at some time, when citizens were diagnosed with diabetes, access to life insurance available in their states became unaffordable and even sometimes unavailable (Oliver & Mossialos, 2012). The reason was that federal law permitted life insurance firms to operate on policies that rated or charged a premium basing on the health status of applicants. Essentially, such plans allowed the insurance companies to deny an applicant the sought cover depending on their health status. Even so, patients requiring access to diabetes educators require a physician’s referral in order to receive the services (Peeples & Austin, 2007). This poses another policy challenge in the management of diabetes. Some physicians may not be giving the referrals as a measure to safeguard their revenue sources, and even if they did, the number of available educators is not sufficient to handle them. On the other hand, without a physician’s referral, the services of an educator are not among the covered benefits of insurance. According to the American Diabetes Association (ADA), diabetes at any stage needs round-the-clock management to alleviate long term complications associated with hyperglycemia and hypoglycemia. Within the learning environment, levels of blood sugar not within the target range will interfere with the learning ability of a student. Non-diabetic students must be taught healthy lifestyles to avoid it, while the diabetic ones should have the ability to check and respond to blood glucose levels accordingly. Although some may handle the routine independently, others, due to developmental level or young age, must use help, and that is where another policy problem arises (ADA, 2002). Cases are reported of diabetic students facing barriers to the care of diabetes in learning institutions. They include the students being barred from their district schools; not being allowed to take part in extracurricular activities or field trips; missing precious time from class by high school students in order to check levels of blood glucose; and even parents resigning from employment so as to avail themselves to give care to their children at school. In such schools, there are no equal basic medical opportunities as well as educational opportunities for diabetic students (Peeples & Austin, 2007). The patient representing a diagnosis was in a school that had no policy on diabetes and the management was not willing to facilitate accommodations. This is what informed the ADA to develop a state legislation model for care of diabetes at school. Political Analysis As the number of people living with diabetes and the associated costs of treating each person grow, payers of insurance premium also continue resisting paying for the management of the condition. They term it more of an issue in lifestyle management rather than an acute case of medical care. It is even ironical that states have passed laws improving ease of use of insurance for diabetics, but most are unable to afford the costs. The law has not yet provided a national health care plan geared towards providing full coverage at an affordable and sustainable cost for all diabetics country wide (Oliver & Mossialos, 2012). The most effective way to handle diabetes before the population living with it overwhelms the available nurses and physicians is availing more educators who will educate citizens on self management and avoidance of the complications (Davies, Dixon & Currie, 2001). However, diabetes being the most expensive item on the health care budget, politicians may not be ready to pass laws allocating more money towards educating and certifying educators to serve the population. It is not enough for them to pass state laws to improve access to insurance, care and education without empowering the educators (and also increasing their numbers) who are supposed to provide education. Training, accrediting and reimbursement of the educators must be part and parcel of the new laws. The crisis of making insurance available to more citizens without considering the availability of care providers was witnessed in Massachusetts, which saw admissions to the emergency room dangerously increase. Many critics have attributed this to the fact that some influential politicians are interested parties in the insurance arena, and always oppose the empowering or reimbursement of educators (DoH, 2011). Their aim is to channel all the business of treating diabetes to their insurance firms. Regarding learning institutions, suitable laws should also be drafted compelling schools to accommodate diabetic students as well as educators in their policies. However, the role of a diabetic educator in school should not be viewed as a threat to the job of the school nurse, but rather as a strategic and necessary move to give equal opportunities to all students. How Policy Issues can be Resolved The health care reform that took place in early 2012 proposed that Accountable Care Organizations are created to improve the cost effectiveness and results of health care in the US, and nurses would play crucial roles in implementing the changes. With over 30 million newly insured citizens, nurse practitioners will be at the core of the Patient Protection and Affordable Care Act (PPACA). Through the bill, more money has been advanced for both general and advanced nurse education. The number of family physicians is steadily going down, while programs in nursing practice are getting stronger. Among the innovations in safety programs is the introduction of clinics managed by nurse practitioners. This will overhaul the fraternity and provide an opportunity for increasing the number of diabetes educators. The PPACA covered the expansion of primary care considerably, which provides for flexible approaches to how primary care is delivered, where and by whom. In its abstract sense, nursing assists patients to maintain their optimum wellness levels. Nurse practitioners know how to prevent people from getting into health complications. That is the exact role played by diabetes educators in relation to diabetes (ADA, 2002). They assess patients continually to know their progress and what action to adopt. In that sense, I think nurse practitioners are best suited to take up the role of diabetes educators. They have proven their ability to achieve results in chronic care management, home visiting, transitional care and school health. Nurse practitioners have been working in rural areas for long, where they have always been the sole providers of primary care for people who could not pay (Peeples & Austin, 2007). With the new reimbursement plan contained in the PPACA, they will now get the same pay as physicians who handle Medicare B patients. By taking up diabetes educator roles, they will have the advantage of being on the list of preferred providers. This step will solve two policy problems; first, the nurse practitioners will have avoided the strenuous yet ambiguous procedures of the single certification as diabetes educators and second, they will be accessible to diabetics and get their reimbursement. I believe more nurse practitioners will move into private practice in states that permit them prescriptive privileges. Here, they can be the ideal diabetes educators where they work in nurse-managed clinics that are entitled to funding by the reforms. As more accountable care organizations are created, more nursing care managers will be absorbed into them, who will in turn work with patients directly to give comprehensive care and education. I think that will provide another opportunity to create diabetes educators who, having overcome the longstanding stalemate will now be able to get reimbursement for their services. This approach is capable of resulting in fewer hospitalizations and positive health management without lengthy policy procedures. How Policy resolution Issues Contrast with those from other Stakeholders First, I do not think that physicians and insurance firms will be comfortable with the idea of elevating nurses to manage clinics or, as diabetes educators, be reimbursed equally with physicians. This is due to the human nature that whenever one comes against competition, whether real or perceived, there is bound to be a feeling of insecurity, leading to reaction. Here, physicians and insurance companies see that health care reforms will provide everyone with insurance, care and education that that has traditionally relied on the dedication and well-preparedness of nurses to offer both management and leadership of patient care. There is an enormous amount of responsibility that will accompany the new opportunities, which is welcome by nursing practitioners, especially with the added incentives of managerial positions and higher pay (DoH, 2011). However, hospitals will be paid basing on results of patient care and satisfaction. Eventually, the already overburdened nurses, occasioned by a shortage of a licensed nursing workforce will come under extra pressure to perform. As a solution, most health care institutions intend to bring on board an unlicensed team of health care workers to fill in the void in bedside nursing. This is in contrast with the interest of most already licensed nurses and physicians who would not like the idea of untrained nurses working under their licenses (DoH, 2011). Financially, nursing and nursing bodies will benefit more from reimbursement than other interested parties. Real and Potential Policy Conflicts Real and potential policy conflicts are not desirable because they eventually put the interests of interested parties, stakeholders and individuals before the interests of the initiative to educate people on the treatment, control and management of diabetes (Peeples & Austin, 2007). Further, they really do not have much to do with what diabetes educators’ roles are but, rather, vested interests of the members of the policy making bodies and political alliances. To this end, members of the policy making bodies or their boards of directors are the actual representation of the real or potential conflicts. Every board member and staff of the policy makers has a loyalty duty to the board, state and diabetics. Therefore, dual interests that are not disclosed at the time of joining the body or in the course of being part of it are the true conflicts (Oliver & Mossialos, 2012). It follows, therefore, that such omissions in disclosure will facilitate the inclination towards self interests or working for the sake of lobbying groups, which gives the matter a political (or criminal) angle. For instance, an interested person, who could be a director, committee member or principal officer with powers delegated to them by the governing board, could have financial interests with the policy body. The financial interests, indirect or direct, may be in the form of investment or ownership in an organization the body has business arrangements with. It can also be a potential compensation, investment or ownership interest with other bodies or individuals with which the policy body is negotiating an arrangement or transaction (Oliver & Mossialos, 2012). Possible Strategies to Resolve Conflicts To begin with, disclosure of dual interests procedure must be formulated for policy making bodies, and should be compulsory at the time of election or appointment to a policy making body. For example, in case of employment, the candidate must disclose the name and nature of all employments they are under. Fiduciary relationships with serving board members, membership of advisory panels, stock ownership, consultative arrangements and compensation status in relation to the body must all be disclosed. Existing relevant dualities of immediate kin must also be disclosed. Thereafter, annual and binding disclosures should be completed (Peeples, & Austin, 2007). This is the only way policies that truly serve the interests of the diabetic population will be drafted, and all resources channeled towards the. Physicians, insurance firms and policy making bodies should also accept that no studies or research have established that education or care from nurse practitioners is inferior to that provided by physicians or diabetes educators certified by the available bodies (DoH, 2011). Therefore, the issue of safety should not keep coming up whenever there is mention of empowering nurses to higher positions. It should be understood that nurses spend more time with patients than any other professional in the health care fraternity and are hence the most appropriate to convert into diabetes educators. Schools, too, should simply be compelled to act as per law. In a free country of equal opportunity, the law should enable all diabetic students to gain enrollment in any school in their district, and diabetes educators must work alongside school nurses to propagate diabetes awareness among the students. Outcomes of Satisfactory Resolution When conflicts are resolved satisfactorily, policies will be passed on ethical grounds and in the interest of the target group. Having licensed nursing practitioners working as diabetes educators and reimbursing their services will be the greatest motivation they receive to serve to the best of their ability. People living with diabetes will access insurance cover and turn up for education and treatment. The ultimate beneficiary will be the entire nation, which will see the number of new cases drop and existing conditions managed satisfactorily. When diabetes educators are available in most parts of states, school, hospitals and work places, the awareness reaches more people starting from the young to adults. Motivated educators working with a healthy nation will produce the best results for the initiative. Diabetes education then becomes the best weapon against the condition. References American Diabetes Association (ADA). (2002). Care of children with diabetes in the school and daycare setting (Position Statement). Diabetes Care, 25(1), 122-125. Davies, M., Dixon, S., & Currie, C. (2001). Evaluation of a hospital-based diabetes specialist nursing service: A randomized controlled trial. Diabetic Medicine, 18(2), 301-307. Department of Health (DoH). (2003). National service framework for diabetes: Delivery strategy. London: Department of Health. Department of Health (DoH). (2011). Diabetes: The human, social and economic challenge. London: Department of Health. Oliver, A., & Mossialos, E. (2012). Equity of access to health care: Outlining the foundations for action. Journal of Epidemiology and Community Health, 58(8), 639-651. Peeples, M. & Austin, M. (2007). Toward describing practice: The AADE national diabetes education practice survey: Diabetes education in the United States – who, what, where and how. Diabetes Education, 33(4), 424-433. Read More