Many patients that are diagnosed with chronic conditions have a hard time understanding how to take care of themselves at home, especially if there is a language barrier.  Community Health Workers (CHW’s) work in the community and empower people to take care of their chronic conditions.  One of the chronic conditions that drives the bills up for Medicaid is Diabetes.  Many  of the people who were being seen in the clinic were Hispanic and had trouble understanding how to take care of their Diabetes.


Some of these clinics started to take charge and work with Medicaid to decrease the cost of hospital admissions and frequent clinic visits.  What ended up happening was that once per week, a Diabetic Educator would teach classes in Spanish about managing their Diabetes.  The educator went over checking their blood sugar with the blood glucose monitor, exercise, insulin administration, diet, skin and foot care as well as regular follow up with their primary care physician.  This population was very non-compliant and would prefer to use the emergency room instead of the doctor to manage their chronic condition.


The CHW’s made visits to the patient’s homes and reinforced the teaching that the Diabetic Educator taught the week prior at the center.  Some patients would not be able to get out to the community center, so the teaching would be brought to them by the CHW.  When I read about comparing old thinking and new thinking, one of the things that is mentioned is the difference between a background question and a foreground question.  The foreground questions are more specific and probably a better fit for the studies that need to be done on the Hispanic population suffering from Diabetes.  With the foreground question one can ask which works best for reducing hospitalizations for Diabetic patients instead of how can we manage someone’s Diabetes which is a background question (Rubenfeld & Scheffer, 2005).



Rubenfeld, M. G., & Scheffer, B. K. (2005). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from

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