The Experiences of Remote and Rural Aboriginal Health Workers and Registered Nurses Who Undertook a Postgraduate Diabetes Course to Improve the Health of Indigenous Australians
King, Meri, King, Lindy, Willis, Eileen, Munt, Rebecca, Semmens, Frith, Contemporary Nurse : a Journal for the Australian Nursing Profession
This paper reports on an evaluation of an educational initiative that seeks to improve the diabetes health outcomes of a vulnerable group, Indigenous Australians residing in remote and rural New South Wales. In this context seven Aboriginal Health Workers (AHWs) and ten registered nurses (RNs) undertook an accredited Australian Diabetes Educators Association (ADEA) course. The aims of this study were to identify the beliefs, attitudes and experiences of this group concerning specialist diabetes training, strategies already used by managers and those that could be used to help consolidate the diabetes expertise of AHWs and RNs. The findings indicate specialist diabetes training and constructive support is required if AHWs and RNs are to develop from a novice to an expert. We concluded that the ADEA diabetes course is highly relevant to the needs of Indigenous Australians and that constructive support from managers and the university is most important in the development of diabetes expertise.
KEYWORDS: Indigenous Australians; type 2 diabetes mellitus; diabetes education for Aboriginal Health Workers; perceptions of specialist diabetes courses
Type 2 diabetes mellitus (T2DM) is a significant health problem for Indigenous Australians. Not only does this condition emerge at an earlier age of onset (O'Dea, Rowley, & Brown, 2007), the prevalence is three to four times higher than in the non-Indigenous population (Australian Institute of Health and Welfare [AIHW], 2011; McDermott, Li, & Campbell, 2010). T2DM is also a major cause of morbidity and mortality and Indigenous Australians with this condition are hospitalised 12 times more frequently and die 17-19 years earlier than their non-Indigenous counterparts. Furthermore, Indigenous Australians experience the worst diabetes health status in Australia and globally have the fourth highest prevalence of T2DM in the world (AIHW, 2011; Thomson, Burns, Hardy, Krom, & Stumpers, 2007). Innovative strategies are required by health professionals to improve this situation for such vulnerable populations especially in rural and remote Australia.
In 1998 Flinders University opened their accredited Australian Diabetes Educators Association (ADEA) course to Aboriginal Health Workers (AHWs). This was the first time in Australia that AHWs were admitted to a nationally accredited diabetes course developed primarily for registered nurses (RNs) and allied health professionals. The outcomes from this initiative have been investigated in South Australia previously (King, 2006; King, Munt, & Eastwood, 2007).
The decision to accept AHWs entry into the course was seen to be important for several reasons. Graduates from accredited ADEA courses were equipped with the contemporary knowledge and skills to care for people with diabetes (Australian Diabetes Educators Association [ADEA], 2007a, 2007b). It was hoped that this initiative would enable AHWs to expand their roles as diabetes educators and help improve the diabetes status of Indigenous Australians. It was also anticipated that exposing non-Indigenous health professionals to the cultural needs of Indigenous Australians with diabetes and then working together, specialist diabetes AHWs and RNs would have the potential to improve diabetes outcomes for Indigenous people through best practice (Abbott, Gordon, & Davison, 2007; Sequist et al., 2010).
Previous literature had indicated that formal education alone, such as undertaking an ADEA course, was of limited value to quality care without constructive active support from management. In fact, the greater the support provided, the greater the motivation of the health professional to provide quality care to the people with the condition. Support can be seen by the formal acknowledgement of the particular role, the opportunity of the health professional to use their expertise in the clinical setting, access to people with the condition, access to an expert diabetes practitioner with whom the novice might discuss complex client problems with and the opportunity to develop from a novice practitioner to an expert practitioner (Anderson & Clement, 1987; Benner, Tanner, & Chesla, 1996; Cartwright, 1980; Henderson, 2010; Henderson, Briggs, Schoonbeek, & Paterson, 2011; Sequist et al. …