Experiencia Educativa Inglesa
-
Upload
uba -
Category
Health & Medicine
-
view
323 -
download
0
description
Transcript of Experiencia Educativa Inglesa
The KICk-OFF study The KICk-OFF study (Kids In Control Of Food) (Kids In Control Of Food)
Progress towards a structured Progress towards a structured education programme education programme
Julie Knowles/Dr Kath PriceJulie Knowles/Dr Kath Price
Sheffield Children’s NHS TrustSheffield Children’s NHS Trust
The KICk-OFF study The KICk-OFF study (Kids In Control Of Food) (Kids In Control Of Food)
Progress towards a structured Progress towards a structured education programme education programme
Julie Knowles/Dr Kath PriceJulie Knowles/Dr Kath Price
Sheffield Children’s NHS TrustSheffield Children’s NHS Trust
Diabetes UK and Department of Health 2005
• Evidence based• Clear aims and
objectives• To meet personal
learning needs • Trained educators • Structured• Quality assured and
audited
Recommendations/guidelines
Diabetes NSF 2001
NICE 2004 and 2004
DAFNE – Dose Adjustment for Normal Eating for
Adults 5 day structured
training programme 4-5 injections a day 4-5 blood tests a day Free diet Insulin dose to match
carbohydrate intake Reduce HbA1c Improved QOL
Paediatric KICk-OFF courseresearch project
Phase 1 – 2002 -Development of a curriculumFunded by Sheffield Children’s Appeal
Phase 2 – 2004 - Pilot courses, refinement of curriculum Grant from DUK
Phase 3 - Multicentre Randomised Control TrialTo be funded by DUK awaiting confirmation of start date
Development of the KICk-OFF curriculum
• PDNS survey (Autumn 2002)
• Focus groups (Jan. 2003 Comparing current
education programmes with DAFNE )
• Lubeck, Germany (Jan. 2004)
• School teachers
Working with school teachers
• DAFNE to KICk-OFF• National schools curriculum
“Intellectual development” - growth in pupils knowledge understanding and skill “ Social development” - growth in self esteem, self confidence, greater maturity
• Office For Standards in Education (OFSTED) Is it clear what the purpose of the lesson is?Has the lesson taken into account the learnersneeds?
Working with school teachers
• Style of teaching (observation)
• Lesson planning
• Specific teaching skills
• Presentation
• Setting boundaries/learning environment
• Reading age
Monday Tuesday Wednesday Thursday Friday
Introduction to the course
What is diabetes?
Group discussesblood sugar levels
Hypoglycaemia
Discuss overnightblood sugar levels.
How to adjust insulin
Discuss blood sugarlevels Healthy eating/weightcontrolSweets, treats andsnacks
[Friends invited]Discuss overnight blood sugarlevels. Friends recap what is diabetesEveryone discusses using Kick-Off in school
Break Break Break Break Break
Signs and symptoms,InsulinTypes of food and
CP’sCP booklet and diary Insulin/CHO
relationship
Hypoglycaemia andKick-off treatment
CP/insulin ratio
Work out CP’s forpacked lunch
How to manageillness usingKICkOFF guidelines
Alcohol and socialissuesPoster displayExercise [theory]
Managing hypos in and out ofschool Puberty awareness and controlWhat happens next?Follow-up after the courseDiscuss school packs Recap weeks learning objectives Evaluation
Lunch Packed lunch Lunch Lunch Lunch - buffet
Insulin/CHOcontinuedCorrection dose Monitoring
Practicing countinggrams of CHO +practical
Diabetes and longterm healthdiscussionHealthy lifestyle vsunhealthy
ExercisePractical session.
Parents will discuss follow-upcare, discussion about the weekand continued supportChildren do fun activity
Break Break Break Break
Millionaire game Recapping the daysobjectives
Plan evening insulin dose.
Personal interviews
Practical session continued
Quiz Prepare food forparents Recap objectives ofthe dayPlan evening insulin
dose
Quiz Students to planevening insulin dose
Quiz Free session for guestspeaker or otheractivity
Continued Presentation of quiz winners Finish
Day 2, session 2. Counting grams of carbohydrate
TUESDAY
Session 2:-
Counting grams of carbohydrate
Practical session
Learning Objectives
Continue with carbohydrate and insulin ratios
Continuing with learning the skills for counting grams of carbohydrate
Materials
Scales Food ingredientsRecipesFlip chartPens Diaries Work sheets Calculators PlatesKitchen equipmentDigital scalesPots and pansBaking tinsWashing up materials(tea towels, cloths, washing up liquid)
Educator Dietitian and nurse
Preparation Transport children to school cookery room. Set up the work stations with foods needed for recipes.
TIME
EDUCATORACTIVITY
STUDENTACTIVITY
MATERIALS
11am Explain:-This session is a practical session to learn how to work out how much CHO is in the food you prepare.
Group to split into pairs and they are each given a recipe
Response:Split into pairs but not the same pairs as the morning
Follow recipes
Tidy up after the food is prepared
Complete work sheet
4 recipes for fruit muffinsfruit scones jam and butterscalesPaper platesingredientsutensilsCalculatorsPensFlip chartsWorksheet for estimating CP’s in rice, pasta, potato, cereals.
Pilot Study 2004
• 8 per course, 11-13 and 14-16 yr
• 2 research educators and 1 local educator
• 3 Paediatric centres Sheffield, Manchester and Derby
• Training the trainers course Sheffield Hallam University 3 days (2 theory, 1 practical)
• independent peer review• interview• daily feedback questionnaire
EVALUATION
Effectiveness:
Teaching, curriculum, course format :
• HbA1c pre course , 3 and 6 months• hypoglycaemia rates• BMI
Psychological outcome at 0, 2 weeks, 3 and 6 months• QoL• Satisfaction with treatment• family conflict• self management responsibility• self efficacy
Table 1. Mean HbA1c Values Over Time
Baseline 3-months 6-months
Mean (sd) 8.58 (1.80) 8.72 (1.98) 8.69 (1.98)
More mild hypo’s
No more moderate or severe hypo episodes
No significant change BMI
QOL: Generic
70
75
80
85
90
pre Post 3m 6m
children
parents
ChildrenF(3,81)=8.00,p=.0001***ParentsF(3,81)=6.14, p=.001**
60
65
70
75
80
85
90
pre Post 3m 6m
children
parents
QOL: Diabetes
ChildrenF(3,81)=9.25,
p=.0001***ParentsF(3,81)=4.56,
p=.005**
Psychosocial Outcomes for child and parent
Satisfaction with Treatment: Greater satisfaction with diabetes treatment after the course.
Self-Efficacy: Children more confident managing their diabetes after the course.
Family Conflict: no significant change (minimal before and after course).
Parent-child Responsibility: more responsibility for managing diabetes after the course.
Coping with Diabetes: more able to cope after the course.
Changes to the course:
• Venue• Timings of difficult sessions- in the first 2
sessions• More practical sessions• Specific parent teaching – 1 day teaching
course• Improved school support• Follow-up• Interactive booklet• More CHO/Ratio practice • 5 day skills training programme for educators
Multi-centre cluster randomised controlled trial comparingintensive education with standard education in 11-16 year olds on
intensive insulin therapy. Sponsored by DUK
36 UK paediatric diabetes clinics (576 total participants)
18 intervention/18 control – both using MDI
2 year follow-up
Control group receives skills training course and KICk-OFF curriculum
Outcomes measured at 0, 6, 12, 24 months:-
HbA1c
Psychological outcomes
Hypoglycaemia episodes
DKA
BMI
Diet related behaviours