Building Competency in Diabetes Education THE ESSENTIALS

SELF-MANAGEMENT EDUCATION & SUPPORT: PROGRAM DEVELOPMENT| 11-109

arousal and menopausal issues, sexual identity. • Pregnancy plans. • Sexual activity: Use of birth control, prevention of sexually transmitted diseases.

• Appropriate referrals to sex therapy, urology, gynecology. • Family planning for the family with diabetes: Should begin with pre-pregnancy counselling with a diabetes treatment team.

Coping and stress tolerance This part of the assessment is concerned with the person’s/family’s perceptions of stress and coping strategies.

Data collection should include: • Assessment of emotional reactions. • Completion of appropriate developmental tasks. • Coping style and skills.

Rationale for including this assessment area & application to SME:

• Potential responses, such as anger and depression toward diabetes. Expect recurrence of emotional challenges over the course of illness. The grief process may be reinitiated when a new treatment is started and is perceived as a new loss (e.g. starting on insulin). As educators, we may feel uncomfortable dealing with pain and loss. We need to become comfortable with people experiencing those losses and help them work through their painful emotions. Failure to do so may render all other education efforts useless. • Educational efforts: Should include support groups, patient visits/contacts with diabetes educators, literature and/or referral to mental health professionals (preferably with experience in treating people with diabetes), and involving the family/significant others. • Signs of burnout: Cessation of testing; “forgetting” medications and appointments. Screening for clinical depression should be regularly done. Relapse strategies for the person having this experience need to be part of the education program. These include “vacation from diabetes” planning, update sessions and reinforcement strategies. • Practice how to broach the subject of referral to a mental health professional, as stigma is still attached to the use of such help by many people (e.g. “I would like to recommend that we organize a visit with our team psychologist/psychiatrist. Most of our patients find it very helpful to discuss the difficulties [describe their feelings/actions they have shared with you] with him/her.”).