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|01 Born Burton on Trent, 1968. Mum, Barbados nurse. Dad, Jamaica power station worker. 1988, came to train, Queen Elizabeth Hospital, Birmingham. Not vocation.|
|02 Pilot study training - 1st year, wards. 2nd year, specialities mine in community. 3rd year, responsibility. Assignments & exam. Before degree necessary Project 2000.|
|03 During training 1988-91, saw Type 2. Difficulties getting blood, measuring insulin, timing meals, avoiding cutting toe-nails - fitted in with non-diabetics.|
|04 Practical training suited me. Long allocations increased understanding. Not bad for patients supervised numbers improved care.|
|05 After qualified `91, staff nurse on female medical ward mixed conditions. People with diabetes came with other conditions - affected diabetes visited diabetes ward for education or stayed there if newly-diagnosed.|
|06 If hypo, gave chocolate or sugary milk. If reagent stick showed sugars low, gave sugar. If high, called doctor for insulin. Mainly urine-testing. Checked food in lockers. Diabetic meal`.|
|07 Checked insulin with 2nd person; set times; cloudy & soluble; no self-injection?; mostly breakfast & evening. |
Diet exchanges, diabetic menu, food looked different. Snacks.
|08 After being staff nurse at Birmingham General, redeployed to Selly Oak female medical ward. Then on mixed medical ward acute episodes of chronic illness. Had daughter `95. Returned to ward on night shifts.|
|09 Wanted to escape night shifts. 1996, became Diabetes Nurse Educator in diabetes centre. Different from acute medical ward time for relationships. Most began with GP, progressed to us.|
|10 Had seen diabetes on acute wards & attended day courses. Now attended more courses re diabetes & teaching skills. Recently, non-medical prescribing course. After 2 years, called DSN. After maternity leave, 2005, called Clinical Nurse Specialist in Diabetes.|
|11 Few DSNs from Caribbean background. Lack of culturally-specific care for patients nothing since Afro-Caribbean help group organised awareness day, 2003.|
|12 High prevalence in Afro-Caribbean groups. This oral history makes me think about doing more. More culturally-specific work exists for South Asians. Awareness day, 2003, showed many wrongly think of Type 2 as mild. |
|13 Need for smaller portions of starchy Caribbean foods, different cooking methods, exercise. Must take diabetes seriously, even without obvious symptoms. |
|14 Since 1996, more self-management - shorter courses, plus phone contact or nurse review. NSF establishing standards e.g. DAFNE done before, but delivery different.|
|15 BERTIE & DESMOND courses for Type 2. NICE-approved. I`m DAFNE-trained for Type 1.|
|16 DAFNE HbA1c results disappointing, but patients love course. Early days. Some say we`re re-inventing wheel`.|
|17 DAFNE patients talk of old syringes. Now variety of pens & insulins. I was involved with inhaled insulin withdrawn - now insulin pumps. Research centre investigates new therapies. |
|18 Many Type 2s seen by GPs. We see Type 2s starting insulin similar to Type 1s. With dietitian, run groups for 2/3 hours, then see them again. Phone advice line. Patients in control. Type 2s access DESMOND or Expert Patient courses in primary care. We lecture on them primary/hospital partnership.|
|19 Used to invite patients to meet each other may revive it. Patient initiated chat room. |
Assessing Byetta & Sitigliptin.
Some patients prefer coming to hospital less, with phone support. Self-management from outset.
|20 Multidisciplinary team. In outpatients I see complex problems. Some Type 2s annual review only. Intermediary clinics GP plus consultant. Partnerships for maternity clinics etc. Some GPs involved in annual reviews. Annual reviews in community in future? Primary care may buy our services. |
|21 I work 3 days weekly recruiting for research; nurse-led clinics; patients phone & email; departmental clinics; education for professionals; pump clinic; DAFNE; case discussions; assessing new treatments; phone GPs, practice nurses; conferences.|
|22 More time with patients than doctors have - ½ hour, hour with new patients. Phone consultations. Equivalent of 9 DSNs see 100+ patients monthly. |
|23 Since 1996 - new technologies on prescription, more group education, more specialisation. Still see some patients individually.|
|24 Father a hospital porter. |
March 2000 pen needles free. Diabetes UK lobbied for free disposable syringes. Blood-testing replaced urine. My job easier.
|25 I had O Levels, experience, diabetes-specific training. Now need for university degrees. |
Older Caribbean nurses didn`t specialise more do now necessary.
Now consultant nurses. I`d like to do degree, but value of experience shouldn`t be ignored.