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1988 - at Queen Elizabeth Hospital

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1988 -  at Queen Elizabeth Hospital Barbara, 2008
 
 
Interview 95 Barbara

Clinical Nurse Specialist in Diabetes
Born in Burton-on-Trent in 1968.


Overview: Barbara was one of the last generations to qualify as a nurse without a university degree. After training at the Queen Elizabeth Hospital, Birmingham, from 1988-91, she was a staff nurse on general medical wards until 1996, when she began to specialise in diabetes at the University Hospital in Selly Oak, Birmingham. Since then, she has been called variously a Diabetes Nurse Educator, a Diabetes Specialist Nurse and a Clinical Nurse Specialist. Although she feels well-qualified by experience, she would like to take a degree. Another ambition is to provide more culturally-specific care for patients who share her Caribbean background.

Please note that Overview relates to date of recording 25 March 2008

 Short samples

1 As a student she encountered people diabetes on a general medical ward and remembers that it was difficult to fit in all their requirements with the needs of other patients on a thirty bed ward. [ 63 secs ]

2 Barbara finds that some people from a Caribbean background still regard Type 2 as ‘mild diabetes’. She hopes to persuade them to take it more seriously, to reduce the risk of complications, and to eat a healthier version of their traditional diet. [ 61 secs ]

 
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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.
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02 Pilot study training - 1st year, wards. 2nd year, specialities – mine in community. 3rd year, responsibility. Assignments & exam. Before degree necessary – Project 2000.
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03 During training 1988-91, saw Type 2. Difficulties – getting blood, measuring insulin, timing meals, avoiding cutting toe-nails - fitted in with non-diabetics.
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04 Practical training suited me. Long allocations increased understanding. Not bad for patients – supervised – numbers improved care.
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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.
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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`.
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07 Checked insulin with 2nd person; set times; cloudy & soluble; no self-injection?; mostly breakfast & evening.
Diet – exchanges, diabetic menu, food looked different. Snacks.
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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.
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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.
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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.
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11 Few DSNs from Caribbean background. Lack of culturally-specific care for patients – nothing since Afro-Caribbean help group organised awareness day, 2003.
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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.
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13 Need for smaller portions of starchy Caribbean foods, different cooking methods, exercise. Must take diabetes seriously, even without obvious symptoms.
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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.
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15 BERTIE & DESMOND courses for Type 2. NICE-approved. I`m DAFNE-trained for Type 1.
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16 DAFNE HbA1c results disappointing, but patients love course. Early days. Some say we`re ‘re-inventing wheel`.
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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.
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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.
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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.
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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.
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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.
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22 More time with patients than doctors have - ½ hour, hour with new patients. Phone consultations. Equivalent of 9 DSNs see 100+ patients monthly.
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23 Since 1996 - new technologies on prescription, more group education, more specialisation. Still see some patients individually.
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24 Father a hospital porter.
March 2000 – pen needles free. Diabetes UK lobbied for free disposable syringes. Blood-testing replaced urine. My job easier.
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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.
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