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I’m your host, Jamie Davis.
This month, Nursing Notes Live takes a look at nurses who work with and educate our patients with diabetes. With 26 million adults and children struggling with this disease and millions more at risk for developing diabetes, nurses who specialize in diabetes care and education will have their work cut out for them. This month’s featured “Get to Know Nurse” is Lynda Stallwood. Recently, I got the chance to chat with Lynda about her nursing career and her important work with patients living with diabetes.
Jamie Davis: Lynda, let’s start off with asking you how you decided to become a nurse. What encouraged you that nursing was a career you wanted to follow?
Lynda Stallwood: As a very young girl, my sister and I always knew in our hearts, as very young children, nursing was what we wanted to do. We grew up wearing nursing uniforms. I’m not exactly sure why I knew that. I’m not even sure I knew what a nurse was at the time. But it was in my heart to always provide care. We took care of sick animals, dead flies, all kinds of things. It was just that caring gene perhaps that my family has.
I am one of many nurses in my family. So it was just only something that was deep within my heart. I didn’t have the opportunity to go to nursing school until after my children were born. But once I did, I went into it full-fledged. I knew it was just what I needed to be. I think even as my children were born and growing,
I saw that there tended to be a gap sometimes between the medical profession and taking care of your child at home. And I felt like if I could help bridge that gap as a nurse with educating my patients, empowering them to answer my questions, of your healthcare provider, that that’ll be very gratifying. Perhaps as important in their care is providing the correct medication is also providing them the tools that they need to navigate the healthcare system.
Jamie: I agree completely. There’s so much about our current healthcare system that requires even more skills and navigating it. So it’s really important. I agree that nurses need to be the pilots for our patients to navigate that system.
Lynda: Yes, absolutely.
Jamie: So tell me a little bit about how you decided or what drove you into becoming a diabetes care specialist. There’s a lot of things that nurses go through and we come in contact with a lot of different specialties but something in diabetes care keep your interest.
Lynda: It is. It was a particular young woman, I was working at a general peds unit at the time. This was over 25 years ago. She came in – she was about 10 years of age – she and her parents came in with a diagnosis of “rule out diabetes.” And they were very calm. They were very attentive. They presented themselves as very confident. That no matter what they will be able to handle the diagnosis which is wonderful. As the care progress and lab tests revealed it was in fact this young woman had Type 1 diabetes.
So we started all the education. She was learning how to draw for insulin, test her blood sugar. She was going on a diet and exercise and lifestyle changes and all of those things that are part of diabetes care and management. Her parents were very active, very supportive. Everybody was just – “We can handle this, everything is fine.” And so I was taking [the cues 0:05:01.5] and trying to just continue to support them but listening very carefully to what they were saying and how they were saying it.
I was working the afternoon shift at the time and before I left for the evening, I wanted to check in on this young woman to make sure she was resting comfortably. I could hear her crying very softly but she was crying. So I just went in and asked her what I could do to help. And she started to open up about how frightened she was and how she didn’t like it and how this was going to affect her the rest of her life and she liked to go out and do things and this would perhaps change her lifestyle and she was worried about her parents.
So she asked if I could actually hold her in my lap, if would sit down on the chair next to her bed and hold her. So I did. I’m only 5”2”. She was very close to my height. She was a tall and lean young lady. I held her in my lap and then just listened to her. And she cried and she talked about things until she settled down and she said she felt better about it.
So I asked her that moment if I could call her parents up just to let them know how she was feeling and that she expressed some concerns. So she agreed to that. So I called her parents. And it was a very important and very precious phone call because her parents then began to see the same things that this young lady did.
They were trying to be strong for her but all the while they were scared to death. They were trying to put on this persona of confidence, that this is no big deal, things will be fine. In essence, they were concerned about her having to check her blood sugar. “What if she had a low – what if she wants to go out, we’re not around? What if she needs medication and it’s not quickly available.”
So it really was a bridge-building time. In this instance, it was more building a bridge between the family members, helping them to understand we’re really both on the same page and then it was very appropriate for them to express their innermost feelings. That they were really feeling the same thing. So when they came in the next day to visit her, it was perhaps the most joyful time. Even though the situation didn’t change, they were able to relax, saying, “You know what, we don’t like it but we’re going to do it.”
I just felt like that because that young lady was able to open up to me, she might have done it with someone else somewhere down the line but that particular night, when she needed a nurse, not to give her a shot, not to give her oxygen or anything else but to listen to her and allow her to express those innermost feeling that she needed to which then put her on the path towards the rest of her journey. I felt very privileged. It was a wonderful family to work with and it made me feel as though I did make a difference in their lives.
So that experience then carried on so that I had this burning desire to work with other families of children that were living with diabetes because it is a very pervasive condition. It affects the diet. It affects activity. It affects your freedom. It’s getting better and better as we increase the various types of insulin delivery but still it’s something that you always have to think about, you always have to plan for. So I had such respect for these families and such respect for the children that it just encouraged me to want to work with them and I have had the privilege of doing and talking with parents.
One thing I would like to add when I was doing some dissertation work is that when things that were doing well as far as they were able to keep their child’s hemoglobin A1C levels in normal range or very close to the target, those parents actually felt as so they receive less support from their healthcare providers who were like, “Oh, you’re doing a great job. You don’t need me, ha-ha-ha,” out the door they went. When in essence, those individuals because they were really shooting for these marks, ended up having very high levels of stress and perhaps really would have benefited from additional resources from – we’re talking more with the healthcare provider rather than getting an “Attaboy” and a pat on the back to say, “You’re doing a great job but how is this affecting your life?”
So everybody, regardless of how well or how they might need to improve or be more supported in their efforts of maintaining good diabetes management, everybody deserves that support and that extra look rather than just a pat on the back and saying, “See you in three months.” So that’s about it.
Jamie: You know, it’s funny that’s been my experience, I have a daughter with chronic illness and I have – when things are going great, I still need that support system to help us navigate and steer through what we’re dealing with as a family. And it is a family dealing with the illness. It’s not just the child although they have to plan for a lifetime with diabetes. The family itself is really greatly affected and goes through this disease to some extent themselves.
Lynda: Absolutely. And there are some children – I know of a child who was 18 months when he was diagnosed with diabetes. These parents have a lot of child care issues. They have to have people who are qualified to watch their child while they were trying to work. There’s issues with skipped schools.
Even though we feel like we’re in this 21st century, we still have schools that are not prepared and, quite frankly, some don’t welcome students with type 1 diabetes or I would assume maybe other chronic conditions. But because it has something to do with blood. They won’t allow them to have their snack in the classroom because other children are having snacks. As strange as that might sound, that is the reality of what some of these families are dealing with.
So advocacy in every area of their lives but schools were a really big concern. When parents had a school that work with them, they felt like they were on cloud nine but other families that I talked to, they would move their child from one school to the next to the next in an effort to try to find somebody that would help them manage their child’s diabetes when they were in a school setting. So they really deserve a lot of respect and support. That for certain.
Jamie: And often they deal with a school nurse in these situations and we’ve interviewed them in the past here on the show talking to them about the various conditions they deal with diabetes being one of them. And just another point where nurses are really having an impact.
Lynda: Oh, absolutely. And most of the schools, the families were having concerns with, they had a school nurse but the school nurse would be in charge of 25 schools. So she wouldn’t be able to be there every day. And her workload was so heavy. If they had a school nurse, that would just really empower these families and the kids so that they don’t feel like they’re weird or different but they have a school nurse who’s supporting them, who’s there, who’s able to watch them, check their blood sugar, provide insulin if needed for the very young children that aren’t able to do that for themselves. So absolutely a school nurse.
I have high regard for school nurses and I believe that that is a pivotal place where we can make a difference for families and for kids that are wanting to stay healthy or that have a condition that requires a little assistance. So a big shout out to school nurses. Absolutely.
Jamie: Many of the diabetes educators are nurses, why is it that nurses are chosen for that task? Is there something about nursing that you think lends itself to educating about this type of illness?
Lynda: I think that nurses inherently have this ability to look at the big picture. With diabetes or any other condition where you’re doing the same thing over and over again, it can become task orientation. “Okay, well this is your blood sugar. This is what you need to do – blah, blah, blah.”
I believe that most nurses that I’ve worked with have the capacity to look at one of the psychosocial impacts that this has on this child and family. Whether the spiritual impacts this child and family might be experiencing as a result of their diagnosis and their chronic condition, what resources are available, what works, what doesn’t work. We recognized that families are also developing.
The concerns that parents might have as their family. The child diagnosed with diabetes might be a toddler or a very young preschooler, as that child grows, that family also grows and develops. We told them when the child was five it’s not going to be appropriate when the child is now 15 and say, “I want to do this on my own.” So knowing what we do about growth and development not only of human beings but of families that puts us in a position to say, “Okay, well, we need to rethink this. We need to relook at our plans.”
And even when the child is pulling back from parents, is that a bad thing? Developmentally, this is what we would anticipate. If we didn’t see that, we would be concerned. So it’s putting all of the pieces together rather than isolated events and being able to get a clear picture of what’s going on.
And I believe nurses are also excellent communicators. They listen well and they also can put things together so that they can communicate clearly. Getting clarification where they need to understand something better from a family member. They know the questions to ask to get the patients or the families to actually express what’s really going on. So I believe that that’s one of the strengths.
Nursing has a lot of strengths but I believe that that’s one of them. When I talk with my students, it is so much about communication. And 99% of an accurate diagnosis is from taking a great history and physical. So history is – we receive that when we’re communicating with our patients. So we want to really emphasize and applaud nurses that take the time to listen, to think and to get the big picture, and then communicate and facilitate parents and kids down the path that they have of managing their diabetes.
Jamie: I’m glad you mentioned your students because one of the things that I saw recently in the news mentioned the misunderstanding that much of the public has about that they might be experiencing condition of pre-diabetes, heading towards an adult diabetes, type 2 diabetes problem. And we see so many people developing diabetes that’s preventable. How does this change how we approach talking to our patients about their wellness in the future and we got new students coming out all the time? This is going to be one of the problems, the premiere issues they deal with in their nursing career moving forward.
Lynda: Well, that’s a great question. I just included that in a discussion that I have with some students the other day when we are talking about modifiable and non-modifiable factors in all of our lives. Things that we can’t change are our gender, our age, our genes that we’re born with. But the modifiable things that can be changed: our diet, habits, exercise, other lifestyle choices that we make whether it be smoking or drinking alcohol or taking other kinds of substances into our body or even where we live, our natural environment affects our health.
So with students, I try to encourage them to think about those things that the patient cannot change and those things that the patients can change and helping their patients to understand that they do have the ability to change. Find out what their thoughts are about why they’re continuing a certain lifestyle. If they actually are happy with their lifestyle and they have no desire to change, then supporting them, telling that there are things that they can do to improve their health but you will certainly not going to force anybody. That doesn’t work. But finding out what his thoughts are about it. What are their thoughts and feelings?
If someone will say, “Well, she’ll never change.” They’ll claim that over somebody and after a while you start to believe it. “I’ll never be healthy. I’ll never be the appropriate weight for my frame. My mother told me that for a number of years.” So we have to figure out what is it that people have heard. What is it they believe and if those things are not true, then we can say, “Well, wait a minute, I know that you’ve heard that all your life, but let’s stop and think about it. Have you tried this? What are your thoughts about this?” and providing them with examples or getting them in touch with peers that were in the same boat or something very similar to what they’re in and say, “Look, I was able to better understand. I’ll be able to break out of that mold.” Many times we believe what people have told us about ourselves.
I think one of the most important things that we can do is say, “Yes, but that’s what someone’s told you. What do you believe? What do you really think about? What is it that you really want? What did you imagine yourself being? Five years is going to go by, do you want to be different in five years? Maybe even one year. But start talking about five years. Start talking about ten years down the road. What are your goals and aspirations? If you don’t have a goal, you’ll never achieve it. So if we’re setting a goal, helping them to set up reasonable steps towards that goal, encouraging them that if you fall, you fall forward and you keep getting up, that everybody does. You keep getting up and you keep moving on.
But it’s important that there’s a lot of people in this world that are hopeless. They figured they’re situation will never change. They believe that. They’ve been told that. So I’m thinking if you been hoping to people, we’re not pushing ideals upon them but we’re giving them hope. That there are ways if they can change their lifestyle. That they can have improved health. That they can have better longevity. That they can have joy along the journey. That is powerful. That’s not a pie-in-the-sky.
There are things that we can do to help patients and families to receive hope. Looking at statistics or getting on the internet so, “Oh, boy, I’m in that category and I’ll never change.” That can be problematic. Information, if it’s not balanced with hope and with the human experience can be more damaging I believe than helpful. As much as we enjoy technology, we can use it and it’s great and wonderful. There’s nothing really in my estimation that can substitute for that human context, that human connection where we’re listening and communicating with other individuals and being patient with them and empowering them to be the very best that they can be.
Jamie: Well, Lynda, I want to thank you for taking some time and sharing with us. Before we wrap up and close out this interview, would you like to share a final thought about diabetes care for the nurses and students that are listening to this program perhaps? Because we’re all going to experience or come in contact with patients who are dealing with diabetes. The numbers point to the fact that we’re going to be hard-pressed to avoid handling a patient with the problem with diabetes. Is there some wisdom or some encouragement you’d like to offer to the nurses listening?
Lynda: First of all, for those that are already providing diabetes care, I applaud you. I thank you for the work that you’re doing. It’s worthy work. For those nurses or students that have yet to make a decision, I would encourage you to investigate, become connected with someone that has something to do with diabetes care because it is a very fulfilling position. You have the opportunity with [them] – as difficult as it is to do to have a chronic condition.
When you’re caring for someone with a chronic condition you have an opportunity to accompany them on a journey that they’re on. You see them grow and develop. It is a very gratifying experience and it makes a difference. It impacts these families. It encourages them. It helps them to be their own advocates which is what we want. And then we can encourage them to be advocates for other families.
I know of families that start their own peer support groups because they know that they needed it so badly, they needed to be connected with someone and they have helped other families. This child has been diagnosed for five years, they’re connected with someone who is newly diagnosed when their child was about the same age. That connection, it’s what we’re made to do as human beings. It’s to reach out and to assist one another in a powerful and meaningful way. So I just applaud all nurses and all healthcare providers that have anything to do with assisting children and families and adults with type 1 diabetes.
Jamie: Lynda, thank you very much for coming on Nursing Notes Live and sharing a little bit of your nursing story with us. It’s encouraging to hear how passionate you are about the care you provide for your patients.
Lynda: Well, thank you.
Don’t forget to check out the March 2013 issue of Nursing Notes, highlighting the work of nurses in caring for and educating people with diabetes. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month featuring a panel of nurse leaders involved with diabetes care sharing their insights into the challenges facing us from this worldwide epidemic. You’ll find this and other podcast episodes at the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.
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