Introduction
A Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager, collaborator, practitioner, advanced clinician, consultant. educator and researcher (Wilson-Barnett, 1994). The role of the CNS emanated from the premise of the need to provide social and psychological support and education on how to manage disease for patients and their families (Dunne, 1997).
Diabetes is a complex disorder of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin deficiency is the essential feature (Drury, 1986). Diabetes is recognised as a model of broader based communicable disease control programmes (WHO, 1991 – 1998).
The management of diabetes demands a broad range of professional skills which include communication, counselling, leadership, teaching and research to name but a few. The Diabetes Nurse Specialist has the expertise and specialist knowledge to incorporate these skills into practice and so develop standards of care that benefit the patient (Daly, 1997).
It has been suggested that patient-orientated outcomes are likely to be positively influenced by a CNS (Wilson-Barnett, 1994). A CNS is considered an important contribution to advancing clinical practice, nursing diagnosis and as an advisor in setting standards and policies of care (McCarthy, 1996).
The CNS is prepared beyond the level of a generalist (The Report of The Commission on Nursing 1998; Section 6.33). The CNS should have extensive experience and advanced expertise in the relevant specialist area of nursing or midwifery.
The Diabetes Nurse Specialist (DNS) plays a pivotal role within a multidisciplinary team. The recognition of the contribution of the Diabetes Nurse Specialist in helping patients achieve good diabetes control highlights his/her essential role in diabetes care (DCCT, 1993, UKPDS ,1998). Metcalfe (1998) states that a Diabetes Nurse Specialist who works in collaboration with a team to ensure continuity of care lends towards more successful management.
References
Daly F (1997) The Role of the Diabetes Nurse Specialist. Irish Medical Times 14 (17) 18
Diabetes Control and Complications Trial (DCCT) 1995 Annals of Internal Medicine 122: 561-568
Drury Ml (l986) Diabetes Mellitus 2nd Ed. Blackwell & Scientific Publications
Dunne L (1997) A literature review of advanced clinical nursing practice in the United States of America. Journal of Advanced Nursing. 25: 814-819
McCarthy O (1996) Advantages and Disadvantages of Specialism in Nursing. Paper presented to An Bord Altranais Conference, Continuing Education for Nurses.
Metcalf L (1998) Ensuring continuity of care for diabetic patients attending hospital. Journal of Diabetes Nursing 2(5) 135-138
Report of the Commission on Nursing (1998) Government Publications Section 6.33 page 105.
United Kingdom Prospective Diabetes Study (UKPDS) 1998 British Medical Journal 317(7160) 703-713
WiIson-Barnett J & Beech S. (1994) Evaluating the Clinical Nurse Specialist. A review. International Journal of Nursing Studies 13 (6) 561-571
World Health Organisaton Publications (1991-1998)