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Table 2 Representative descriptions of CDEs by profession for responses to question 2 and proposals for improvement

From: The factors that limit activities of certified diabetes educators in Japan: a questionnaire survey

Profession

Explanations

Nurses

Reasons for “Yes”

➢ I am educating diabetic patients with other CDEs

➢ Physicians are cooperative with us.

➢ Interdisciplinary teamwork works well

➢ I feel that I can manage daily consultation for patients.

Reasons for “No”

➢ Too busy to spare my time for CDE’s service. We are required to prioritize our own section’s work and cannot have enough time to talk with diabetic patients.

➢ The physician who I am working with hates to listen to my comments.

➢ Interprofessional communication is insufficient and I cannot expect cooperation from other professions.

➢ I was allocated to the section I can hardly see diabetic patients.

➢ I do not think that CDEs are well recognized.

Reasons for “Not sure”

➢ Each CDE works individually and I think interprofessional teamwork is insufficient.

➢ I am the only CDE in my hospital and what I can do for patients is limited.

➢ I’m instructing insulin therapy for outpatients, but I’m not sure whether physicians and patients assess my work.

Proposal for improvement

➢ We need more staff so that CDEs can have more time to provide their special service to patients.

➢ Establish interprofessional teamwork among CDEs so that CDEs can appeal their activities more efficiently and can increase the recognition for their existence.

➢ Not just complaining that we are not recognized, we ourselves should take an action to advertise CDE’s ability and should let others know more about CDE’s service that can get health insurance reimbursement.

➢ We ourselves should improve our knowledge and abilities.

➢ Not just waiting other people ask us to do something; CDEs themselves should plan a project and submit it to the facility.

Pharmacist

Reasons for “Yes”

➢ Lectures to the local residents and educational classes for patients are being held and CDEs are involved.

Reasons for “No”

➢ Too busy doing other duties that I cannot provide a CDE’s service.

➢ There is no diabetologist in my hospital. Without physicians’ cooperation, we cannot manage diabetes efficiently.

➢ I was allocated to an irrelevant section so that I cannot contribute as a CDE.

➢ I’m the only CDE in my hospital. Now I’m recommending a nurse become a CDE so that we can work together.

Reasons for “Not sure”

➢ I’m attending interprofessional meetings and educational classes for patients, but I don’t think that is sufficient.

➢ Not only in my field, I think I’m able to educate patients using my knowledge about diet and exercise therapy. However, other pharmacists are not interested and I’m afraid I cannot continue my service as a CDE.

➢ CDEs are not sufficiently recognized. Even though educational classes for patients are operated, the hospital does not evaluate them.

➢ There are few diabetic patients in my hospital.

Proposals for improvement

➢ Each CDE is working individually; however, for efficient diabetes management, interprofessional teamwork will be necessary.

➢ Satisfy enough number of medical staff so that CDEs can have more time to spare their special activities.

➢ CDEs should develop their skill and knowledge and advertise their ability to other medical staff.

Registered dietician

Reasons for “Yes”

➢ After I became a CDE, I think I can answer questions from patients smoothly with self-confidence.

➢ I think I have been working effectively as a member of an interprofessional team.

➢ I have been contributing to educating patients through daily counseling and educational classes.

Reasons for “No”

➢ Owing to the lack of labor, I cannot work sufficiently as a CDE.

➢ It is impossible to work only for diabetic patients in my situation. I feel that I just have CDE qualification but cannot use it effectively.

➢ I am a leader of a nutrition support team at the university attached hospital, and don’t have time for additional CDE service.

➢ Hard to cooperate and share patient’s information with other professionals who are not CDE.

➢ I feel that what I do as a dietician now is not different from what other non-CDE dieticians do.

➢ Other medical staff do not think CDE is necessary

Reasons for “Not sure”

➢ There are only two CDEs in my hospital, a nurse and myself, and I cannot say that interprofessional teamwork works well. However, I feel that I have been contributing to improve diabetes management of my hospital.

➢ Although, we are organizing an association for patients with type 2 diabetes and also for children with type 1 diabetes, I still think that there is something more that I can do as a CDE.

Proposals for improvement

➢ Each staff should develop his or her own knowledge and experiences to maintain their ability as CDEs and to win recognition.

➢ Positive action will be necessary to establish interprofessional networks both inside and outside of hospital. That will make a favorable outcome in diabetes care and make others recognize the importance of CDEs.

Clinical laboratory technician

Reasons for “Yes”

➢ There are CDEs in the four professions in my hospital and regular interprofessional meetings are conducted. Each staff fills in their comments about patient’s education in one record so that we can share the information.

➢ I’m working at a small clinic and have time to talk with patients while I’m collecting their blood samples. I try to use my knowledge and experience as a CDE and do my best to answer patient’s questions.

Reasons for “No”

➢ Due to the nature of my profession, compared to other staff, I think I have less opportunity to talk with patients.

➢ I can’t spare time for CDE service because that will increase burden on other staff in my section.

➢ I have been educating patients my own way. I should have learned more.

Reasons for “Not sure”

➢ Interprofessional meeting and educational classes for patients have been held but I don’t think it is enough. However, we are too busy and cannot do more.

➢ I have time to talk with patients but not enough to do profound education.

Proposal for improvement

➢ Tighten and increase the amount of interprofessional communication among CDEs.

Physiotherapist

Reasons for “Yes”

➢ CDEs play a central role and made a diabetes care team. Educational classes for patients are held once a week and a walk rally is organized once a year.

➢ In addition to activities inside the hospital, CDEs give lectures to the residents in our areas.

Reasons for “No”

➢ Interest and motivation for diabetes care is low in my hospital.

➢ Interprofessional teamwork for diabetes care is insufficient.

Proposal for improvement

➢ We should show certain data demonstrating the importance and necessity of CDEs.