Tuesday, 18 August 2015


Succulent plant in pot
Peckover House, August 2014
"Another blog post so soon after the last?" I hear you cry. Well, I've been working on this one and another as yet unpublished post for ages, and I'm a bit busy for the rest of the week and the weekend, so here goes.

I have had a look back at the blog, and I can hardly believe that I haven't really explained what DESMOND is. Given that it has formed a large part of what I've been doing over the past 9 months or so, I'm surprised I haven't described the programme.

DESMOND is a nationally delivered structured education programme, designed to meet the criteria within the NICE guidelines for Type 2 diabetes, which has quite a lot to say about patient education:
1.1 Patient education

1.1.1 Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review. Inform people and their carers that structured education is an integral part of diabetes care.

1.1.2 Select a patient-education programme that meets the criteria laid down by the Department of Health and Diabetes UK Patient Education Working Group.
  • Any programme should be evidence-based and suit the needs of the individual. The programme should have specific aims and learning objectives, and should support development of self-management attitudes, beliefs, knowledge and skills for the learner, their family and carers. 
  • The programme should have a structured curriculum that is theory driven and evidence-based, resource-effective, has supporting materials, and is written down. 
  • The programme should be delivered by trained educators who have an understanding of education theory appropriate to the age and needs of the programme learners, and are trained and competent in delivery of the principles and content of the programme they are offering. 
  • The programme itself should be quality assured, and be reviewed by trained, competent, independent assessors who assess it against key criteria to ensure sustained consistency. 
  • The outcomes from the programme should be regularly audited. 
1.1.3 Ensure the patient-education programme provides the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills.

1.1.4 Offer group education programmes as the preferred option. Provide an alternative of equal standard for a person unable or unwilling to participate in group education.

1.1.5 Ensure the patient-education programmes available meet the cultural, linguistic, cognitive and literacy needs in the locality.

1.1.6 Ensure all members of the diabetes healthcare team are familiar with the programmes of patient education available locally, that these programmes are integrated with the rest of the care pathway, and that people with diabetes and their carers have the opportunity to contribute to the design and provision of local programmes.
So we offer group education delivered by trained and quality assessed educators with a curriculum that is written down. The only part that deviates slightly from the guideline is that I don't believe we are meeting the cultural and linguistic needs in the locality, but we're working on it.

The name DESMOND stands for Diabetes Education for Self-Management of Ongoing and Newly-Diagnosed. The syllabus content is prescribed, as are the Educator Behaviours in delivering the content. Educators are assessed on the manner of their delivery as well as including the messages that need to be delivered, because there is also a philosophy behind the curriculum. I do agree with this approach but I sometimes find it difficult to educate in the approved manner without sounding patronising.

During our delivery we are supposed to give as few direct answers to participants' questions as possible, because the emphasis is on self-management - if they have questions after the course we want them to be able to work out how to find the answers when we're not around. Of course, if nobody knows what is represented by the two numbers in a blood pressure measurement or how sulphonylurea medications work then we're going to tell them. But if someone asks "Is [food x] good for you?" as they often do, we are supposed to first throw the question back to the group, and encourage them to use the principles they've learned in order to work it out for themselves.

The course is delivered by two DESMOND educators either in one full day or two half days a week apart. After introductions and housekeeping, sessions include information about what diabetes is, causes, medications, monitoring, carbohydrates, calories, long-term effects and how to avoid them, other aspects of health associated with diabetes (cholesterol, blood pressure, smoking, depression), the annual review, physical activity, fats and overall food choices. Participants are encouraged and supported in recording their own results in a 'Health Profile', and at the end they are expected to create an Action Plan containing one thing that they are going to try to change or achieve as a result of the course, and how they will go about doing it.

My journey as a DESMOND educator started in October last year, when I attended the two-day course in London. The next stage is for educators to go away and practise educating, and within six months they are supposed to arrange a session when they are observed for half a day by a mentor and given feedback, and then the final quality assessment of a whole day's course, of which you deliver about half, alongside your co-educator.

There are some interesting assessment tools, including a 'beep score'. The assessor listens to a track in one ear that beeps every ten seconds, and marks down who is talking at the point of the beep - is it the educator, the participants, or is something else happening (an activity, or silence, or laughter)? A percentage score is calculated to represent the proportion of time that the educator is speaking, which needs to be less than the particular percentage threshold set for that session. Other assessment is more conventional - is all the content delivered, are the educator behaviours as they should be, are the learning objectives met?

I had my mentor visit in February, and my final assessment in June. Thankfully I passed, so I am now DESMOND accredited, but it's lucky that the assessors have some leeway in their assessment. My Physical Activity session has never been great, but it was dismal on this occasion - I think it has since improved a little. We are expected to devise our own action plan along the same lines as the participants, and I really should have a look at mine soon. Accreditation is periodically re-assessed, and you have to deliver a certain number of courses a year in order to remain accredited.

I do enjoy delivering DESMOND, and of course every group is different. I haven't had anything very difficult to deal with - the most challenging was probably one participant with mental health issues who spent some of the time asleep, and walked in and out of the room at random. He wasn't very disruptive though, as we could ignore him or include him as appropriate. Every now and then a participant tells us that they don't know why they have been invited to the group because they don't actually have diabetes - of course we have checked beforehand and they do have diabetes, but the way the programme is delivered means that they usually work this out for themselves as we go along. The most negative comments we get are generally those that say they wish they had been given the information earlier.

We were given extra funding for a year because we got very behind with our courses and waiting times became unacceptable, so I have been employed one day a week to help catch up. We have caught up and that funding ends in September, and I will actually be glad to go back to four days employment a week. In order to keep up my DESMOND accreditation I do need to deliver a few courses, which will be on top of my four days a week.

So from October I hope to have an extra day in the week for all the jobs that are hanging over me - much work around the house and garden, buying a new car, a dress for Sister D (the fabric has now been bought!) Or, more likely, I'll doss about as usual and nothing will get done. Place your bets.

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