Self-Help Group Observation
The purpose of the group (diabetic group) is basically to educate patients on how to sustain a healthy lifestyle in case they are diabetic. The main aim for patient education is for individuals suffering from diabetes to enhance their knowledge, confidence and skills, allowing them to have increased control of their condition and incorporate effectual self-management into their day-to-day lives. High quality structured education could have an intense impact on health outcomes and considerably enhance the quality of life (Tidy, 2014). Some of the potential benefits that patient education could have on individuals suffering from diabetes are:
Enhancing health, knowledge, beliefs, and lifestyle changes
Enhancing patient outcomes, for instance, smoking, weight, and psychosocial changes like depression levels and quality of life
Enhancing physical activity levels
Minimizing the need for, and potentially better targeting of drugs together with other items like blood testing strips.
Educational events, like community expos, offer individuals with diabetes or prediabetes information and experiential learning opportunities on matters, which emphasize the significance of self-management, and healthy lifestyle decisions. According to latest evidence, diabetes education has a general beneficial effect on both psychosocial and health outcomes. Particularly, enhanced patient behavior and knowledge has shown to improve glycemic control in different situations (Tidy, 2014)
Groups provide an opportunity for diabetic individuals to gather and learn together. Participants of the group as well as the educators have a chance to utilize creative approaches to learning. Presently, group education is receiving a lot of attention from policy-makers, educators, and payors. Various educators prefer groups where possible and actually suggest using them as a first-line approach to enhance diabetic outcomes. Group education is a cheap alternative to individual education. Reimbursement restraints and financial intermediaries are significant factors affecting the format of diabetes education in practice today (Mensing & Norris, 2003).
Diabetes self-management education (DSME) is known as a crucial element of diabetes care. The aim of DSME is to assist diabetic patients get the information, knowledge, self-care practices, coping skills, and mind-sets needed for the effectual self-management of their diabetes. In accordance to numerous meta-analyses and reviews, DSME interventions have a positive influence on diabetes-associated psychosocial and health outcomes, particularly increasing diabetes-associated knowledge and enhancing monitoring of blood glucose, exercise and dietary habits, taking of drugs, glycemic control, foot care, and coping. In relation to Mensing and Norris (2003), a group is defined as an assembly or gathering of individuals having a shared interest. In comparison with individual-based approaches, group-based approaches normally invite more interaction and interpersonal dynamics. In addition, group testing could promote various educational activities, like problem-based learning or social modeling better than the individual setting (Tang, Funnell & Anderson, 2006).
Most studies have reported that successful outcomes in group programs have not actually included a comprehensive account of the theoretical approach or the intervention itself, including the particular tactics used. The primary empowerment-based principles offered the conceptual basis for all the three programs described above. These particular guiding principles required the programs to be patient centered (majorly focused on issues and questions introduced by patients), problem based (utilized actual problems faced by participants to guide the learning or teaching process), culturally significant, evidence based, and includes the psychosocial and clinical aspects of living with diabetes. Apart from experiencing different challenges in the course of their lives, patients have varying needs, priorities, as well as diabetes self-management experience, and also come from varying cultural and social environments. Most DSME programs, however, are curriculum centered, and the lesson plans are founded on a predetermined set of topics and a particular learning/teaching sequence. On the other hand, the above prescribed interventions are founded on encounters, needs, conditions, and priorities of patients. This patient focused approach makes learning more meaningful, culturally and personally significant, and directly relevant to patients at that particular moment in their lives (Tang, Funnell & Anderson, 2006).
This particular approach to learning assists patients get the knowledge and skills needed to solve issues, which are important to them. The learning starts with patient-identified issues and concentrates on assisting patients gain the knowledge and skills required to deal with those issues. Applying a patient-centered, problem based approach is through definition culturally significant since the education concentrates on issues as prioritized and perceived by patients in the program. For instance, focus group research has illustrated that there is a strong cultural norm in the Latino and African-American communities putting family needs before self-care. This needs to be dealt with in education programs. Additional cultural tailoring takes place by providing the programs in community locations that participants are familiar with. Education researchers have ascertained that behaviorally oriented group patient education is effectual in the production of a series of positive changes in skills, knowledge, metabolic indexes, and self-management behaviors. Empowerment-based diabetes group education stresses strategies, which are patient focused, problem based, culturally significant, evidence based, and integrative. These strategies and programs could be carried out across various educational and clinical settings with the aim of responding to the unique diabetes-associated requirements of all patients (Tang, Funnell & Anderson, 2006).
In spite of the setting, conveying the data as well as the supporting skills, which are needed to promote effective self-management and coping needed for daily living with diabetes call for a thorough and personalized approach. Effectual delivery entails professionals in clinical, educational, behavioral, and psychosocial diabetes care. Effective and clear collaboration amidst the health care team that entails an educator, provider, and an individual suffering from diabetes are vital in making sure that goals are clear, that progress towards the goals is being realized, and that suitable interventions are being utilized. A patient-centered approach to DSME/S at diagnosis offers the basis for current and prospective future requirements. Ongoing DSME/S could assist the individual overcome obstacles and cope with the constant demands so as to facilitate changes in the course of treatment as well as life changes (Powers et al., 2015).
The diabetes education algorithm offers an evidence-based visual depiction of when to identify and refer diabetic patients to DSME. The algorithm describes four important time points for delivery and vital information on the self-management skills, which are needed at all these vital moments. The diabetes education algorithm can be utilized by health care systems, personnel, or teams, and also diabetic individuals, to direct when and how to refer to and receive or deliver diabetes education. The algorithm depends on five guiding principles and represents the manner through which DSME need to be offered via patient engagement, behavioral and psychosocial support, sharing of information, coordinated care, and incorporation with other principles. Related with every principle are main elements, which provide particular suggestions about interactions with the diabetic individual and topics to address at diabetes-associated educational and clinical experiences (Powers et al., 2015).
Assisting individuals to learn and implement skills, knowledge, and behavioral problem-solving and coping strategies needs a delicate balance of several factors. There exists interplay between the patient and the milieu in which he/she lives, for instance, clinical status, values, culture, family, and social and community environment. The behaviors entailed in DSME/S are multidimensional and dynamic. In patient-focused approach, effectual communication as well as collaboration is regarded as route to patient engagement. This particular approach entails drawing out emotions, knowledge, and perceptions via active and reflective listening; exploring the need to change or learn; encouraging self-efficacy; and asking open-ended questions. Via this approach, patients are better capable of exploring options, choosing their own course of action, and feeling empowered to make informed self-management choices (Powers et al., 2015).
The team approach to diabetes care effectually assisted individuals cope with the enormous range of complications, which could arise from diabetes. Individuals with diabetes could lower their risk for microvascular complications, like kidney and eye disease; macrovascular disease, like stroke and heart disease; as well as other diabetes complications, like nerve damage, through:
Sticking to an individualized meal plan
Evading the use of tobacco
Managing their ABCs (AIC, blood pressure, cholesterol, and smoking cessation)
Effectively coping with the demands of a complex chronic disease
Taking part in regular physical activity
Taking prescribed drugs
Patients that increase their use of effective behavioral interventions to minimize the risk of diabetes could delay or stop development to kidney failure, nerve damage, loss of vision, cardiovascular disease, and lower extremity amputation. This could in turn result to patient satisfaction with care, enhanced health outcomes, reduced health care expenses, and improved quality of life (Team Care Approach for Diabetes Management, n.d).
Criteria for Membership
The members have to be diagnosed with diabetes. The meeting recognizes four critical instances for offering education and support. There existed four vital instances for evaluating, offering, and adjusting the meeting goals: 1) people with a new diabetes diagnosis, 2) yearly for health maintenance and avoidance of complications, 3) when new complicating aspects impact self-management, and 4) when changes in care happen. Even though four separate time-associated opportunities are important, the meeting considerably acknowledged that diabetes is a chronic condition and situations could emerge at any time, which needs additional attention to self-management needs. While the needs of patients are constant, the four vital times call for evaluation and, if needed, intensified re-education and self-management support and planning. Self-care behaviors present a framework for establishing topics to include at every time: being active, healthy eating, taking drugs, minimizing risks, healthy coping, and problem solving. The educational contents are not intended to be all-inclusive, given that specifics rely on the patient. Nonetheless, these topics could direct the educational evaluation and plan. Frequently, a series of constant education and support visits are needed to offer the time for an individual to exercise new behaviors and skills and to develop habits, which support self-management objectives (Powers et al., 2015).
Majority of the members cannot control their diabetes, and are scared of losing their limbs and dying. The group was quite diverse. The emotional reaction to the diagnosis in some of the group members was a considerable obstacle for self-management and education. To commence the process of coping with the diagnosis and implementing self-management into day-to-day life, a diabetes educator or an individual on the team ought to closely work with the diabetic patient and his/her family members to provide answers to immediate questions, to deal with immediate issues, and to offer referrals and support to the required resources. The health care team together with others could assist in promoting the adoption as well as maintenance of new diabetes management tasks. Maintenance of these behaviors is, however, often challenging. Identification of diabetes complications or any other patient aspects, which might affect self-management in the meeting was regarded as a vital diabetes indicator, which calls for ample resources and instant action (Powers et al., 2015).
Diabetes education can help address the incorporation of several conditions into the overall care. The education will help deal with proper ways of adjusting medication, advice on physical activity levels and eating plans so as to improve health outcomes. Several other issues that can be addressed in DSME include: teaching effective coping, introduction of self-care skills, self-management, positive relationships with others and improving quality of life. More emotional support may, however, be needed for depression, diabetes-related stress, general stress and anxiety. Diabetes linked medical conditions may lead to restriction of physical activities, dexterity issues and/or dexterity issues. Self-help groups can also help provide information about available resources and help the group members in creating self-management plans that reflect on these challenges (Powers et al., 2015).
Throughout the lifespan of a patient, health insurance coverage, living situation, health status and changes in age may require reassessment of diabetes self-management and care goals. Important transition periods include transition into adolescence, hospitalization, moving into a rehabilitation centre, a correctional facility, an assisted living facility or a skilled nursing facility. DSME provides critical benefits to patients during such transitions. Offering advice on the drafting of realistic self-management plans and goals can be an important asset to help individuals to transit into new environments or situations. Working together with caregivers, family members, the patient and diabetes educators to identify strengths, resources, concerns and deficits can help facilitate a successful transition. Personalized diabetes treatment targets psychosocial, educational and medical history to provide the best support to the patient. Nutritional needs, risk factors, support resources and emotional considerations are also taken into account to enable better health and quality outcomes. Diabetes is a complicated and burdensome condition that requires the affected individual to make daily decisions on medications, physical activity, and nutrition. It also requires the individual to be proficient in different types of self-management skills (Powers et al., 2015).
Group Structure, Primary Theme, Group Leader and Communication Pattern Observed
The meeting group was a diabetic group with a purpose of educating patients on how to maintain a healthy lifestyle as a diabetic. The members of the group were individuals diagnosed with diabetes. Most of the members were unable to control their diabetes, overweight, and afraid of dying and losing their limbs, which shows that the group was very diverse. The set ground rules for the group were respect, no cell phone, confidentiality and no outburst, the main topic in the group meeting was how to cope with diabetes and controlling the insulin, causes of diabetes and improving health by eating healthy. The group had a leader who embraced democratic leadership. Since the group leader was very easy going, people were more willing to be open and forthcoming about the challenges that they faced with diabetes. The members were very descriptive in describing their pain with diabetes. Some members lost their husband because of diabetes. Diabetes had changed some of the members’ lifestyles because they can’t eat certain things and drink alcohol. Some members see this as a burden and punishment.
Mensing, C. R., & Norris, S. L. (2003). Group education in diabetes: effectiveness and implementation. Diabetes Spectrum, 16(2), 96-103.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2015). Diabetes Self-Management Education and Support in Type 2 Diabetes A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 41(4), 417-430.
Tang, T. S., Funnell, M. M., & Anderson, R. M. (2006). Group education strategies for diabetes self-management. Diabetes Spectrum, 19(2), 99-105.
Team Care Approach for Diabetes Management (n.d.). Retrieved 25 February 2016 from http://www.cdc.gov/diabetes/ndep/pdfs/ppod-guide-team-care-approach.pdf
Tidy, C. (2014). Diabetes Education and Self-management Programmes. Patient — Patient. Retrieved February 25, 2016, from http://patient.info/doctor/diabetes-education-and-self-management-programmes
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