Diabetes in Pregnancy
Summary
My RNAO Advanced Clinical Practice Fellowship took place over 24 weeks at Quinte Health Care (QHC), a multi-site organization which supports an average of 1500 births per year.
Providing exceptional care to women and their families during pregnancy has been the foundation of my practice for the last 17 years. I have witnessed the gaps in care for the patient with diabetes in pregnancy firsthand. Building on a strong foundation, it was a natural choice to focus on strengthening and sustaining existing management of diabetes in pregnancy and postpartum as my primary focus of my fellowship.
Diabetes is one of the most common metabolic disorders in pregnancy. Diabetes in pregnancy comes with an array of complex risk factors and a varying degree of individual client needs that often go unrecognized. The need for processes’ that impact clarity, consistency of practice, optimal team function, and outcome that address the patient’s whole needs and priorities for care not just their disorder was evident.
Completing my learning objectives and activities within my 24 weeks proved to be challenging due the effects of COVID. My overall goal for learning was to enhance my knowledge and skills related to diabetes so I would be able to effectively lead positive practice changes required to implement best practice guidelines and evidence-based care in the clinical setting. Through reviewing best practice guidelines, literature reviews, gap analysis, shadowing and consultation of experts in the field, regular meetings and support from the mentor team, I was able to achieve all my learning objectives.
The BPSO workshop introduced me to the principles of person and family centered care. The workshop set the foundation to work on developing the necessary skills to advance my knowledge of diabetes in pregnancy and focus on fostering the principles of person and family centered care. I was able to gain skills in identifying and adapting the recommendations of care for the obstetrical patient with diabetes at QHC. When it comes to the management of Diabetes in Pregnancy my research and a gap analysis confirmed that there is incredible variation between organizations and practitioners both regionally and provincially. Finding a way to provide care that centers around the person to optimize health and wellness over their lifetime proved challenging. The fellowship granted the time and resources to lead in developing a departmental guideline from the recommendations. I worked on multiple initiatives: building education for nursing practice, building and implementing order sets that standardize care, assisted in closing the inter-professional communication gap, and developed education for patients and their families.
I gained invaluable skills in leadership and communication to lead positive change in the clinical setting. Facing a large amount of resistance from the inter-professional team regarding the practice changes recommendations, resulted in having to go back to the drawing board and find a way to advocate for the patient and their family to bridge the inter-professional gap. This led me to look outside my organization for support. I was able to connect with Dr Gaudet, a MFM lead in the care of the patient with diabetes at Kingston Health Science Centre. She acted as a mentor and provided positive encouragement and feedback. With support from Dr. Gaudet for the need of consistency of practice and optimal team function, I was able to develop effective care planning tools and integrate them on the clinical unit. As well, having the opportunity work with Dr. Gaudet has opened the door to working on more of a regional approach. This allowing for optimal team function and outcomes for patient that require transfer to tertiary care center and continuity of care.
Outcomes
Patient:
Frequently as health care professionals we identify the patient/client as the disease or disorder. I have often found myself saying “The diabetic in Room 210.” Changing the culture with a positive attitude by placing the emphasis on the person rather than on the disease or disorder, has allowed for effective practice changes within the clinical unit. The diagnosis of diabetes in pregnancy brings with it an abundance of self-doubt, the wonder of “what did I do”. The education and resources developed during this fellowship has provided the inter-professional team with an understanding that allows them to support and empower the patient with diabetes in pregnancy. The use of these evidenced based tools, education and free flowing information have allowed for opportunities for the patient to seek clarification and participation at all levels of care. This has allowed for building trust and credibility with the patient and family.
Closing the inter-professional gap that had previously existed between the unit and the Outpatient Diabetes Clinic, has been a simple and effective coordination that will have an invaluable impact on the patient and her family. This has improved care transitions throughout the antepartum, intrapartum and postpartum periods. Patients and families are now provided with consistent information from all members of the multidisciplinary team to make informed decisions. This consistency supports the patient and family to understand the importance of glycemic control and how it will optimize health for the patient and newborn.
Colleagues/Organization
Inter-professional teamwork and relations has both a direct and indirect impact on patient and organizational outcomes. The fellowship provided an opportunity for me to communicate, collaborate, and learn from multiple interdisciplinary team members throughout the hospital, such as Diabetes clinic, Staff OBGYN, pharmacy, and professional practice team. The inconsistency of education and communication between all care providers was evident. After determining the knowledge gaps of all members of the inter-professional team I built resources aimed at improving the understanding of diabetes in pregnancy and the impact it can have on the person and family. Supporting an organizational culture that advocates for the safety and wellbeing of the patient and family with standardized order sets and improved inter-professional collaboration was achieved. The education material and eLearning sessions has provided guiding principles for multidisciplinary maternal-newborn care teams to ensure that they respect the goals and values for women and their families.
I have laid the foundation in which we will continue to build on to continue to create and foster the principles of person and family centered care. As well, resources created by this fellowship are currently being reviewed by stakeholders at a regional level.
Overall experience
Although undeniably challenging, the RNAO ACPF has been a unique opportunity that has let me grow personally and professionally. It has provided the opportunities to advancing my knowledge, skill and ability that I was craving. I have been fortunate to find a specialty that I love; because of this my entire nursing career has been frontline patient care. This opportunity has allowed me to experience a different nursing perspective. I have gained a greater understanding for health care from an organizational standpoint and developed an appreciation for our professional practice staff, managers and directors. I was fortunate to have skilled and knowledgeable team of mentors that supported me, making this experience a positive one.
I have enjoyed the chance to interact with my peers within a different scope of practice. One of my favorite opportunities was being able to work regionally with Dr Gaudet. Having her insight and support gave me validation for my fellowship.
I am grateful to the RNAO for funding this opportunity and to my fellowship team for their guidance, support, and mentorship.
