A focus on with DESMOND North cumbria
Example of a virtual session
June’s ‘A focus on…’ takes us to Cumbria, where we join DESMOND North Cumbria as they share with us an insight into prison life and their first face-to-face education session since the COVID-19 pandemic began.
The first DESMOND face-to-face education session to be held at HMP Haverigg was also the first socially distanced face-to-face group to be held in Cumbria since March 2020.
Initiated by the Nurse Practitioner and Quality and Safety Lead for HMP Haverigg, DESMOND North Cumbria were asked to provide a DESMOND face-to-face education session. The aim of the session is to improve the individuals’ wellbeing by promoting self-management of their condition, improving their type 2 diabetes control and aiming to reduce the risk of long-term complications associated with uncontrolled type 2 diabetes.
This group education was to be delivered to a hard-to-reach cohort of individuals with type 2 diabetes and to adhere to national guidance, as detailed by the National Institute for Health and Care Excellence (NICE).
Key objectives were set out by the team and included:
To promote wellbeing in a prison environment (understanding, creating confidence with the choices available and generally to encourage taking control of type 2 diabetes, whilst also being aware of when and who to ask for help).
To help prepare people who have been newly diagnosed with type 2 diabetes for their return to community living.
To fulfil National Diabetes Federation (NDF) diabetes requirements (The DESMOND course is a recognised educational course that fulfils the requirements of current diabetes guidelines, e.g. NICE, NDF).
To promote awareness of type 2 diabetes.
To discuss the attendees’ concerns.
The team were also keen to ensure that improvements could be implemented to the food choices and cooking methods provided by the prison kitchen.
The course was carried out in Haverigg prison, which is an open prison. The attendees’ choices are restricted, to an extent, due to this environment. It was proposed that the restrictions were considered throughout the course delivery and that relationships were established between the Educators, prison nurse and DESMOND co-ordinator.
The team involved consisted of the Deputy Service Manager and the Diabetes Manager, who co-ordinated the administration support.
The two Educators who delivered the group had a great deal of experience and qualifications. This allowed them to use the specific skills necessary to teach adults within a group environment.
One Educator is a registered dietitian, and the other is a Diabetes Specialist Nurse.
Both Educators have delivered the DESMOND and DESMOND Injectable Therapies interventions in various settings around Cumbria over the last decade.
The Nurse Practitioner and the Quality and Safety Lead for HMP Haverigg observed the session.
“The project went well, engagement from the men was fantastic and all feedback questionnaires were returned with extremely positive comments” said Educator, Diane Meth-Cohn, registered Dietitian.
“The course content needed to be adjusted to fit in with the prison routine, which resulted in reduced teaching time. However, given this was the first education session in a prison environment, when we arrange future courses, we will take this into account to ensure the inmates get the best results and meaningful, rich education” commented Educator, Nicky Higgins, Diabetes Specialist Nurse.
The team recognised that food choices and cooking methods are confined to what is available through the prison kitchen, and the usual advice may need to be adjusted to fit in with prison availability and routines, etc.
Language matters, and so the project also included educating inmates on the awareness of the type of language to use when discussing how people living with diabetes may make changes when discharged. In addition, the Educators needed to be careful to ensure that the appropriate language used whilst delivering, for example, when discussing erectile dysfunction.
With the current COVID-19 restrictions in place, the team ensured safety and social distancing measures were always adhered to. Residents remained seated during all education sessions and had their own chair, handbook, and pencil.
“The DESMOND North Cumbria team have delivered an exceptional face-to-face education experience for the inmates at HMP Haverigg. They had a very short space of time to co-ordinate and set up the education session, considering the Educators’ security checks for passes to be issued and provide two negative lateral flow tests to allow entrance. An amazing effort from everyone involved.”
Alison Northern, Implementation Manager.
As with all DESMOND groups, it was ensured that individual questions and concerns were addressed as fully as possible, and any gaps in knowledge were raised and discussed as a group. Confidential, socially distanced conversations were made available at breaktimes. It was noted that this particular group refrained from speaking over each other and did not go ‘off-track’, which meant that the group finished ahead of time.
Following the DESMOND education session, the Nurse Practitioner and Quality and Safety Lead for HMP Haverigg liaised with the prison kitchen on the availability of wholemeal/granary bread, larger portions of vegetables, smaller portions of carbohydrates, sauces on the ‘side’, as opposed to fish/meat served in sauce, and the consideration of alternative cooking methods.
The Lead Nurse will also ensure diabetes medication changes are carried out, when required by those who attended.
Feedback from the inmates was positive:
“Excellent range of information – well presented.”
“Thank you for providing the course, it was very well presented and done in a friendly atmosphere. The course has enabled me to learn a great deal about diabetes. Thank you so much.”
“Thank you so much for DESMOND.”
“Learned a lot from the course, helped me understand more about my diabetes and other things.”
Feedback from the staff at HMP Haverigg, following the delivery of the DESMOND education session, has resulted in the delivery of regular quarterly education sessions. HMP Haverigg have confirmed they would like to run future DESMOND sessions.
“It exceeded my expectations; Nicky and Di handled the questions really well.”