Pregnancy is the most special and magical period of women`s lives, they said that “you never understand life until it grows inside of you” –Rebecca Malachi. During pregnancy women always wonder how the baby will look like, they always wish for a healthy baby, waiting patiently 9 months to meet their babies and holding them between their arms is one of the greatest feelings a woman can ever experience. Love, joy, anticipation, anxiety … all mixed feelings while waiting for the baby to be delivered to live. However, some women may develop health problems during their pregnancy such as diabetes. (Mayo Clinic Org., 2018)
The fifth week of my training with HMC was about health education for gestational diabetes patients, the clinic is located in the Women’s Wellness and Research Center. Specifically, on 20/2/2019, my rotation was for gestational diabetes clinic- health education, I learned how to make maternity the best period of women`s lives. Moreover, health professionals at the clinic are working hard to assess, plan, implement, and evaluate health programs GDM patients. This team consists of physicians, podiatrist, pharmacists, nurses, dietitians, and health administrators. (Hamad, n.d)
What is Diabetes education?
Providing diabetic patients with needed knowledge and information about their diabetes according to their case, demographics, lifestyle, history of diseases, daily behaviors, and medications history. In order to plan and implement suitable programs during their treatment journey. (Diabetes Education, n.d).
What is gestational diabetes education?
It is providing health care for the mother and her baby during pregnancy period. At HMC/ diabetes education clinic they work hard to provide maximum benefits for GDM patients and prevent any further complications as mother and her baby in an increased risk of developing type 2 diabetes or other chronic diseases. (Hamad, n.d)
Activities: Describe the nature of the work you have been doing/Describe the weekly experience
1. At the gestational diabetes clinic I was assigned in room No. 4 with Ms. Najla she is a diabetes educator, and with Ms. Anna, she is a nurse working in the same room. They are kind and professional, they welcomed me to their room and explained their work briefly. They said that GDM patients are going in a different rotation that DM patients; as they are first seen by the physician, then dietitian, after that they will visit a diabetes educator. The dietitian she assigns the patient to a diet plan and then she gives her a chance to control her sugar if it is not controlled she will give her an appointment with the diabetes educator. The first patient had an appointment with Ms. Najla was a female aged 25 years old, she was crying because she is suffering from husband violence although she is pregnant. The lady was expressing her sad feeling about the violence she is facing with her husband, as he is asking her to do many exhausting home works and he calls her with hurtful words. Ms. Najla followed the code of ethics by respects the patient`s feelings and she was talking with her as if she is her sister (one-to-one conversation) and she was giving her advice, encouragements, and empowerment in order to raise her self-confidence (WHO, 2012). Ms. Najla was calming the patient down by providing her more information about the good health of her blessed baby, talking about how great she is doing in regards of GDM self-management, her eating behavior is good, and her weight is normal. The conversation was full of a sense of humor and peace. Once the patient stops crying, Ms. Anna took her height and weight, after that, Ms. Njala reviewed the patient`s sonar to check for the baby`s sonar to check for the fluid surrounding the baby, it is important to check it for GDM patients because if there is up normal fluid it may cause cord wrap around the baby's neck and may cause death. Ms. Najla checked with the patient whether she is injecting her insulin pen correctly or not and she did an activity of practicing insulin pen injection with the patient on a plastic ball to make sure that she is aware of the correct way. In the end, I distributed a brochure which is about diabetes self- management.
Planning for Health Education:
After a needs assessment, Ms. Najla discovered that the patient needs and awareness and education for her husband, the best method is to plan on assigning the patient`s husband into a support group which is organized by HMC/ diabetes unit. Planning is the most important part of any program, as it indicates the implementation and evaluation strategies, moreover, planning for health-related programs needs a systematic decision about what activities will be rolled? How, when, and where it will be done? (Issel, 2013)
• Logic Model:
The logic model could be used in many health education program`s planning, as it involves many elements which assess any program, as there is assess and needs assessment, capacity assessment, inputs, activities planned for, outputs, outcome, and impact. (OHPE, n.d) therefore, this will be applied for the female patient and her husband (support group program):
- -Awareness of GDM for family members.
- -Education about helping the patient in daily life duties.
- -Lack of knowledge about pregnancy and its health complications.
- -Data collection and entry.
- -Injecting insulin pen correctly.
- -Equipment (laptop for data entry, printer for printing brochures)
- -Human resources( health educators, administrators, dietitian, nurses, and doctors)
- -Physical resource (room for the support group) Activities:
- -Educating family members about using insulin pen correctly.
- -Quizzes about GDM diseases and their complications.
- Education about the importance of helping pregnant women in daily life practices in regard to mental, physical, and psychological health.
- -100% of family members used the insulin pen correctly.
- -99% joined quizzes activity and answered correctly.
- -96% raised awareness about the importance of helping and involving. Outcome:
- -Increasing knowledge and awareness of family members regarding GDM.
- -Increasing the awareness about using insulin pen correctly.
- - Changing bad treating behavior into the helpful, acceptable, and peaceful home atmosphere.
- -Decrease the rate of morbidity and mortality from GDM disease and complications.
- -Increasing the quality of life for mothers and babies.
2. The second patient was a female aged 36 years, she was newly diagnosed with GDM, after welcoming her and checking her weight and height, Ms. Najla discovered that the patient came in with no home glucose records, she was not taking her medications on time. The patient was suffering from hyperglycemia which is critical for her health status and the baby, the patient had no knowledge or awareness before about the importance to take medications on time and controlling diet. Ms. Najla planned to assign her to a support group which is designed especially for newly diagnosed patients and for those who don’t take their medications on time, the purpose of this support group is to:
Save patients time, as they are pregnant can’t wait a lot in the hospital.
Save educator`s time, as they are doing group session about using insulin pens and medications correctly.
Q&A from patients to the educators and dietitians in the program.
Private consultation at the end.
• Process theory:
It is a theory used for program`s planning, it sets into place all strategies for a specific program, it involves needs assessment/ capacity assessment, planning, and setting an organizational plan and service utilization plan which will be implemented in the program. (Issel, 2013)
Applying the theory for the patient below:
3. The third patient was a female aged 28 years old, she was newly diagnosed with GDM (hypoglycemia), Ms. Najla reviewed her file before coming and she knew that the patient was diagnosed by A1C test, it is a blood test that provides average levels of blood glucose over the past 3 months, The blood glucose is considered normal if it is below 5.7, and the patient at risk of diabetes (Prediabetes) if she is 5.7 to 6.4 blood glucose, however, she is considered diabetic because she had a blood glucose 6.5 or above. Once she entered the room Ms. Njala welcomed her and Ms. Anna measured her weight and height. Ms. Najla followed a protocol of filling need assessment form, and she started to ask her: who is your Dr.? Do you smoke? Are you a second-hand smoker? Are you following your diet plan? Do you take your medications on time? Do you work? Do you sleep well? Do you have any family history of chronic diseases?. Ms. Najla planned to practice with the patient the correct places to inject the insulin pen which was the abdomen, thigh, and fatty area on the arm. Ms. Najla planned to do some activities for the patient in her appointment, she taught her how to inject the insulin pen correctly and she applied afterward. Also, because the patient is working, Ms. Najla planned to give her a membership voucher with Water Company to deliver water to her office every day, in order to avoid hyperglycemia by keeping her body hydrated and to encourage her to drink water for her body health and the baby`s health. I planned to give the patient brochures about managing GDM and injecting insulin pen correctly for her records.
1. Ms. Najla was following the code of ethics mentioned in the WHO document, where she was respecting patient`s autonomy, files confidentiality, providing maximum benefits of services, avoiding harms for mother and baby, respecting patient`s dignity, she respects people of different nationalities, respecting other professionals of different disciplines. (WHO, 2012)
2. Ms. Najla involved me in her work as I was distributing educational materials which were designed especially for GDM patients (brochures, flyers, and fact sheets).
3. All health care providers at the GDM unit was working collaboratively, in teams, and aware of health education code of ethics. they were consulting each other to understand the case scenario of the patient`s health status, they were respecting each other, respecting their different disciplines, and they focus on their target which is the “ patient” to provide her with maximum benefits for her and the baby. Furthermore, that is exactly what we are learning in CHS-QU in our IPE activities with other students of different health disciplines, we are always encouraged to work collaboratively with respect and manners.
Planning For Next Week:
1. Rotation to dietitian clinic, where dietitian is assigning patients into diet plans suits their case, doesn't interfere with their medications, managing diabetes with a healthy diet, and avoid food allergy. (Hamad, n.d)
2. I will be exposed to a new experience by meeting new health care providers who are experts in their field, learn from them, and add to my academic knowledge.
Challenges /concerns you may have:
1- The number of patients is huge compared to the clinic size and professionals working there.
2- There is no follow-up with GDM patients after delivery.
3- There is no evening clinic for GDM it is only in the morning, working women won’t be able to visit the clinic frequently.
Recommendations and suggestions:
1- I suggest establishing an evening clinic for working women.
2- I recommend hiring more health care providers at HMC- diabetes clinic, to avoid the rush, decrease waiting hours, and avoid far dates of appointments for the clinic.
At the end, we as a public health educators/ promotors, needs assessment/ capacity assessment is very important and crucial for understanding people`s behaviors, perceptions, and their knowledge level, it helps us in planning for health programs that suit people`s needs and raises their awareness, this will have a huge effect on the program`s outcome and impact. This week was about planning, health educators at the clinic were setting proper strategies and plans for GDM patients for better health short-term and long- term outcomes. Moreover, they were using multiple theories in their work, theories are used widely in the field as they build evidence-based/ scientific based programs. At the clinic, they used logic model and process theory which help us to change people`s behaviors, raise awareness, and set goals and objectives which will lead to successful health outcomes. (WHO, 2012)