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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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