Patient education: A model for autonomous decision-making and deliberate action in diabetes self-management

A conceptual model of health/wellness stressing deliberate action as a function of development of capabilities and of individual choice is presented. An approach to diabetes education within a framework of personal values and social norms is suggested. The purpose of the model is not to define teaching content, but rather to provide a focus for educational intervention. A model of health based on individual choice challenges health care professionals to extend options to diabetic patients. While in the hospital, application of knowledge, decision making, and taking deliberate action can be more effectively taught if the diabetic patient is allowed to make menu choices, to decide upon an exercise program commensurate with physical abilities, to test blood glucose levels or at least be made aware of what measurements made by others are, and to determine insulin dosage and administer the insulin according to physician-directed protocol. While under the supervision of health care personnel, the individual receives immediate feedback on his actions and support when needed. In addition, the diabetic patient must be allowed to reject recommendations made by health care professionals if his decision is based on adequate knowledge and an exploration of the benefits and risks. An alternative to flat refusal is to encourage the patient to try the suggested course of action for a given period of time, with the option to discontinue the action after the specified period if he so chooses. If discontinuation is the choice, a nonjudgmental stance should be taken, allowing for continued open communication between the patient and health care professionals and for the possibility of change in the future. Determining an individual's level of health and wellness is truly a personal responsibility. By encouraging deliberate action based on informed decisions and reinforced through appropriate feedback mechanisms, the view of health in terms of individual surveillance and autonomy is supported. The challenge to diabetes educators is to facilitate in their patients competent and autonomous behavior empowered by purpose and commitment.