Diabetes: how nurses can empower patients to achieve realistic lifestyle change

Enabling the individual to take responsibility for managing their condition means you no longer take the role of ‘fixer’

Enabling the individual to take responsibility for managing their condition means you no longer take the role of ‘fixer’

Picture: Science Photo Library

Do you work with people who have diabetes or another long-term condition?

Do you advise them about changes they should make to improve their health?

Do they take your advice?

Does everyday life get in the way of their good intentions?

Who is responsible for the health outcomes of your patients?

We discuss these issues on a course designed to teach listening and empowerment skills to healthcare professionals working with people with diabetes. 

Diabetes Professional Care conference

The authors will run a session in the mental health hub at the conference, to be held at Olympia in London, 29-30 October.

Find out more about the conference

RCNi is the event's media partner

All healthcare professionals are trained in a model that casts them in the role of the expert, with the knowledge and skills required to give their patients the best possible advice about how to improve their condition.

Assuming the role of fixer

However, people with diabetes live with their condition 24 hours a day and are responsible for day-to-day management decisions. They have a life to lead as well as a condition to deal with and frequently the pressures of life make it difficult to follow professional advice.

In diabetes, the healthcare professional often sees their role as ‘fixing’ the blood glucose problem without taking time to find out what the person in front of them is thinking and feeling.

There may be problems or emotions that make the clinician's suggestion irrelevant; these will not emerge unless the professional takes time to find out.

By following the Knuston approach – the diabetes counselling and empowerment course that has been running annually at Knuston Hall in Northamptonshire since 1987 – the healthcare professional moves from ‘fixing’ the problem with advice, such as changing the insulin, to ‘facilitating’, a process in which the person identifies the changes they wish to make and feel are realistic.

Embracing empowerment

The empowerment process incorporates the following five steps:

  • 1. What is the problem?
  • 2. How do you feel about it?
  • 3. What would you like to change?
  • 4. How will you make this happen?
  • 5. How did it work out?

The underpinning philosophy is:

  • Choices made by the patient determine the outcomes
  • Control belongs to the patient once the consultation is over
  • Consequences of the choices made belong to the patient

The healthcare professional is not responsible for the consequences of the choices but is responsible for supporting the person to make the best possible decisions.  


Acknowledging emotional factors

The empowerment process requires listening skills, including the skill of acknowledging feelings, something many healthcare professionals are reluctant to do. They may fear that if people talk about their feelings they will get upset or raise an issue that the clinician is unable to solve. Healthcare professionals also worry that time is too short for emotions to be discussed.  

In reality, if an emotional issue is affecting someone’s ability to manage their diabetes, it will come as a relief to be able to talk about it and they will not expect a solution from the professional.

By helping to identify the real problem, the healthcare professional will be able to understand the barriers the patient faces. They can then work with the individual to explore how to move to a better place. If an underlying issue can be acknowledged and resolved, this may allow the patient to focus more on their diabetes.

Facilitating such a discussion requires the three core conditions of person-centred care, described by the psychologist, Carl Rogers. These are empathy, being genuine or authentic, and being non-judgemental. Person-centred care is central to the Knuston course and participants learn the skills they need to demonstrate the three core conditions.

Knuston Hall’s diabetes counselling and empowerment course for healthcare professionals
shifts the focus from ‘fixing’ the problem for patients to ‘facilitating’ change.

Multidisciplinary education

The empowerment course at Knuston Hall enables participants and facilitators to work together in a combination of large and small group sessions to practise skills and discuss the philosophy. 

RCNi Learning’s modules on diabetes care 

Although most participants are nurses, the course is multidisciplinary. Every member of the diabetes team is represented, with participants from primary and secondary care and paediatric and adult services. 

Whatever hierarchies may exist in the workplace, there is an overarching sense of equality among participants, as everyone is experiencing the process of learning a new way of working with patients. 

Inspired to make changes

People leave the course inspired to make changes in the way they work with their patients – to move from fixer to facilitator. One nurse told us she felt freed from the burden of needing to find the answer for the patient. She was looking forward to ‘just letting someone see and explore’ the things that matter to them.

Consultant physician Anne Kilvert and research consultant Charles Fox are based at Northampton General Hospital



Further information

Knuston Hall diabetes counselling and empowerment course

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