The qualifications required by diabetes specialist nurses (DSNs) are currently being discussed and debated (see The Link page 80). In particular, there seems to be a feeling that DSNs need to have a degree specifically in diabetes. There are several strands to this debate, some of which are addressed below.
It is apparent that ‘diabetes’ degrees are somewhat thin on the ground, as noted by Crowley (2000), making accessibility difficult for most nurses. There are likely to be several reasons for this. Perhaps the content of the degree can help explain the paucity of courses. Assuming that prospective course participants have already acquired sufficient academic credits to have a diploma in higher education, they will only need to study for one further academic year (approximately equivalent to 1200 hours work) to achieve a degree. Some would argue that the knowledge of ‘pure’ diabetes needed to enable practitioners to become experts in diabetes nursing would not require this amount of time.
Types of knowledge
Of course, this leads to the issue of what makes up ‘pure’ diabetes knowledge. It would probably include the physiology of diabetes and its complications; available treatments; psychosocial aspects unique to diabetes; and diabetes-related equipment. However, many other healthcare professionals need exactly the same knowledge to perform their role effectively. We are then left with the question of what constitutes diabetes nursing knowledge, and therefore what additional elements are required for a diabetes nursing degree.
In general, nursing knowledge is notoriously difficult to define because it is not discrete; it is eclectic by its very nature. We use information from the biomedical sciences, psychology, sociology and many other fields. Our artistry lies in the fact that we integrate elements of these knowledge bases into our work. In order to be effective practitioners, we need not only to have information, or knowledge, at our fingertips but also be able to understand and apply it to the specific work context. This, of course, necessitates practice, which makes clinical experience and practice an essential component of effective learning.
Acquiring intellectual skills
As individuals become more experienced, the use of higher order intellectual skills of analysis, synthesis and evaluation, often in the context of reflective practice, enables them to develop their repertoire of solutions to problems and to view situations more broadly. Undertaking degree-level academic work can help in acquiring these higher order skills more quickly and effectively; for instance, they are the very skills which are required to produce good academic essays.
Once these intellectual skills have been developed they can then be applied to any context, i.e. they are transferable. This consequently suggests that the degree subject is not as important as the intellectual development that it induces. Some would even argue that the subject is irrelevant. Outside the health arena, possession of a degree can place job candidates at an advantage, even if the subject is totally unrelated; employers consider the degree as evidence that the individual has critical thinking abilities and can learn independently.
Are diabetes degrees necessary?
It may be that we have to shift our attitude towards diabetes degrees. The purpose of degree level studies should be to improve our practice by developing critical thinking skills and broadening our perspectives; it is not just about learning more, but about learning better. This may be achieved by undertaking any health-related degree-level course, such as health promotion, psychology or health care studies, for example, and applying the content to diabetes nursing practice. There are clearly many more of these courses available and accessible, obviating the need to wait for a diabetes degree to be developed locally. Another potential advantage of taking a more general degree is that the individual is likely to be exposed to good ideas from other healthcare contexts which could be adapted to diabetes care.
Additionally, it must be remembered that factual knowledge of diabetes is not only acquired in classrooms; it can be learnt in many other ways, e.g. by reading, and questioning colleagues. I would suggest that knowing how this information is best used to provide effective nursing care to people with diabetes is what constitutes diabetes nursing knowledge, and this can only be gained through practice.
If the purpose of nurses doing a degree is to improve their nursing care, rather than merely acquiring a qualification, then they need to think carefully about the content of the degree under consideration, regardless of whether or not it is a ‘diabetes’ one. Will it make you a better nurse?