At the end of a previous project, - The Carlisle and District Diabetes Training in Nursing Homes, March 2001 - March 2002, an audit was completed which identified a need for diabetes training in residential care homes. The audit highlighted that:
72% of residential care homes had residents with diabetes
7% residents had diabetes
All the homes had concerns about:
Dietary needs including the needs of residents with diabetes and who also had poor appetites or dementia.
Residents with poor glycaemic control
Recurring episodes of hypoglycaemia
Blood glucose monitoring issues
Support for effective and high quality care throughout peoples' life time and the need for staff in institutions to have appropriate training to care for people with diabetes in these settings, is present in existing frameworks and guidelines.
To establish an infrastructure for the effective provision of diabetes awareness training with its subsequent benefits to care delivery on the understanding that this project would not continue after the twelve month period.
To raise awareness of optimal diabetes care for residential care home staff.
To provide a training programme for all staff of elderly care and psychiatric residential homes.
To introduce a protocol of care in each home.
To provide information files for both care staff and catering staff in each home as a practical back up to their training.
Develop evaluation criteria to demonstrate ongoing improvements and updating diabetes care.
To provide an information leaflet for relatives and visitors to give them a better understanding of diabetes and help address the issues of inappropriate food gifts that affect glycaemic control.
75 residential care homes were identified in the former East Cumbria providing care for elderly people, people with mental health problems or learning difficulties.
From this list it was decided which homes could realistically be offered training and because of the time scale it was decided to target the larger homes of 20 beds or more.
The smaller homes were invited to attend the training sessions if they wished to.
A time plan was drawn up for the 12 months
A map was used to establish where the homes were situated.
A decision was made to concentrate on elderly care homes and homes for people with mental health problems
Meetings were organised with training managers of the umbrella organisations managing the homes or groups of homes. Training needs were identified.
Meetings with home managers proved to be a positive step and they were very keen to be involved in the coordination of the training sessions.
Training schedules were established taking into account suitable venues, dates and times.
The 28 larger homes were identified as suitable venues for training.
Smaller homes were invited to attend of which 5 took up the offer.
All staff including managers, care staff and catering staff were invited to attend the sessions
The training package was devised to take account that many staff were unqualified
A programme of 2 sessions was delivered at each venue with no more than one week between each session. The sessions were:
Diet and diabetes
Additional Training Sessions
Because attendance at the sessions did not always include the managers or the cooks, additional sessions were organised for them after the initial training had been completed.
These additional sessions, identified as a need during the initial training, were well attended and very worthwhile:
3 managers meetings.
These meetings arranged one in each locality, addressed issues including the future care of residents with diabetes that only the managers could deal with.
3 cooks workshops.
These sessions looked at practical catering issues that arose during the main training and for which there was no time for discussion.
Practical aspects of menu planning
Increasing the variety of foods within meals and snacks
An exchange of ideas for recipes and dishes for main meals, light meals, soups and vegetables.
11 blood glucose monitoring workshops.
These were practical sessions that included the participation of the carers in order to instruct them on the correct use of equipment and procedures on performing blood glucose monitoring.
A named carer volunteered to be responsible for the quality control checks for ensuring the accuracy of the meter.
Roche Diagnostics issued certificates of attendance to each carer who attended.
2 files of information were given to every home that attended the training sessions.
· Diabetes information file
· Diet and diabetes information file
The coloured plastic folders held basic practical information, based on the training given, in removable plastic sleeves that the carers could use as a reference and guide in the care of their residents.
72 files in total were compiled and distributed.They were particularly designed to accommodate the needs of the residential care homes.
Blood glucose meters were given to a number of homes that received blood glucose monitoring training and were supplied by Roche diagnostics.
Certificates of attendance were issued to each member of staff attending both training sessions - 253 were issued during the project
An information leaflet for visitors of residents with diabetes was designed and printed copies given to each home. This was an attractive guide giving advice as to the most suitable gifts that visitors could give to their relatives or friends who were residents.
The leaflet had been requested during the course of the diabetes training delivered to the nursing homes in the previous project, in order to assist in improving glycaemic control.
A questionnaire was sent to the managers of the homes to distribute to the staff to identify the effectiveness and usefulness of the training sessions
34% were returned and indicated that the training topics were well received and helpful
Evaluation criteria for each home that can be assessed using observation include:
Each home having a Protocol of care with basic guidelines for care provision
Each home will have a blood glucose meter
Each home will have a named carer responsible for the quality assurance issues of the meter
Each participating home will have 2 files of information on diabetes and diet and diabetes
These criteria were designed with the assistance of inspectors working with the National Minimum Care Standards for Care Homes for Older People as set out by the Care Standards Act 2000. Care Homes Inspectors can monitor the presence of the above during their inspections.
Outcomes of the questionnaire:
Diet and Food:
Greater awareness of diet, food choice and the significance of snacks in relation to medication was evident. 70 per cent and above of respondents indicated sessions related to this were very helpful. The cooks workshops were well attended and for some were the first training they had had in diabetes.
Blood Glucose Monitoring and Hypoglycaemia:
Enthusiasm for ongoing training on the subject was evident. 62 per cent of respondents found the session on understanding blood results very helpful. 68 per cent of respondents found the session on recognising a hypo very helpful and 69 per cent found the session on treating a hypo very helpful. There was raised awareness in dealing with these situations and the significance of medication.
The project report has further details of the qualitative aspects of evaluation of the training received from the staff that attended.
Funding was received from the Cumbria and Lancashire Workforce Development Confederation for a twelve month period from January 2003 to January 2004. The funding was not ongoing.
The funding paid for
A nurse educator 15 hours per week
A senior dietitian 8 hours per week
Secretarial support 4 hours per week
Resources including stationary and postage
Tolerance and patience with the flexibility and ability to change according to need were resources that helped in the success of this project.
Bristol-Myers Squibb Pharmaceuticals Ltd donated the folders for the information files
Roche Diagnostics donated the blood glucose meters.
Barriers to Training
Residential care homes are busy environments that necessitated a flexible and pragmatic approach on behalf of the trainers.
Some of the issues involved included;
The need for clear and regular communication about who the training was for and how the training was organised.
Commitment from the managers to attend the training was poor although more effort was made for the managers session
Carers attending in their own time showing their commitment