The physical environment
Many aspects of the physical environment can affect how safe and comfortable we feel in a face-to-face group situation.
The following activity asks you to think about your venue and identify what aspects of the physical environment can make people feel safe and comfortable. Consider what would make an ideal venue that did not present barriers to attending face-to-face DAFNE course.
Activity 1: Venue
What can you do to create a physical environment that feels safe and comfortable for participants on your own face-to-face DAFNE course? Begin by considering your venue.
Make some notes against each heading before looking at our suggestions.
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Listed below are some of the things you need to consider when choosing an appropriate venue in which to hold a face-to-face DAFNE course and when planning for course delivery. Discuss these factors with your team when you consider appropriate venues.
Venue location
- Will your venue be on a hospital or community site?
- Will there be a financial cost for using your venue, if so how much and how will you budget for this?
- Is the venue easy to get to for you and participants in your catchment area, how far will people need to travel?
- Are there public transport links to your venue, do they operate at appropriate times for people to arrive and leave on time, do they accommodate people with disabilities?
- Is parking available?
- Is parking free or is there a charge? Can you negotiate a reduced charge or free parking?
- Consider lone working requirements. Is the venue safe after dark?
- How and when will you transport equipment and resources to your venue?
The venue
- Is the venue appropriate for your DAFNE course?
- Is it available for the duration of your course, Monday to Friday or one day a week for 5 weeks?
- How will you access the venue, who will be responsible for accessing and closing the venue, is a member of staff available or will you be a key holder?
- Is it open long enough for you to be able to set up and pack away your resources?
- Are you allowed to attach posters to the walls, if so how (sticky tack / magnetic boards)?
- Are you allowed to store your resources and equipment at the venue overnight?
Venue facilities
What facilities does the venue offer? For example:
- Disabled access / lift / hearing loop
- Sufficient number of toilets / disabled access toilets / hand washing facilities
- Safe storage space for resources / sharps bins / hypo treatments
- Private spaces if required, for example for prayer
- Projector and screen / smart board
- Extension cables for laptop / visualiser / projector
- Whiteboard or flipchart and paper, pens
Catering
- What catering options are available?
- What will you eat and drink, and where?
- Does the venue offer lunch and refreshments for breaks, if so, what is the cost?
- Will participants bring their own lunches?
- Will you provide a kettle / cups / teas / coffee / milk / sweeteners / sugar / squashes?
- Will you be able to offer culturally appropriate refreshments?
Now you have considered your venue, let’s think about some other specific factors that relate to face-to-face DAFNE courses.
Activity 2: Classroom
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Play the video clip here for factors to consider about your classroom layout and use. Discuss these factors with your team.
There is accompanying audio so ensure you have your headphones or speakers on. Click on the square icon below the video to watch in full screen.
Click 'Start' to begin.
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Transcript
Slide 1 narration:
Ideally, your classroom should be a medium to large room with natural light, ventilation and heating or air conditioning, a central table and seating, and additional tables in the room for practical breakout activities required in some DAFNE sessions. You also need a screen or wall area for projection of shared DAFNE diaries or CGM downloads for group discussion using a laptop, visualiser and projector. You need a wall area to display the DAFNE flip chart and insulin action posters, or a smart board to show these electronically. Remember to check with your venue if you can use blu tak on the walls or if alternative arrangements are in place for affixing posters to the walls. You will also need a flip chart stand, flip chart paper and pens, and you may need two of these set up if you have limited wall space. The classroom should have enough space to accommodate eight participants, two educators and any support people who wish to accompany participants for appropriate sessions, for example, severe hypos and illness management. Also consider if colleagues may be observing part of a course. If so, you will need space to accommodate a maximum of two observers as well. Also consider the location of the room within the building – is it quiet and private, or will you be disturbed by other venue users?
Slide 2 narration:
There are a number of ways that you can use the DAFNE flip charts, depending on your local resources and your personal preferences. For example, in this setup, you need space at the front of the classroom to display the DAFNE flip charts used during your session. By doing so, you will be able to highlight significant learning points and remind the participants of key DAFNE principles throughout the session. When the session has finished, you can move the flip charts to another part of the room where they will still be easily visible. An advantage of using the hard copy resources in this way is that you can refer to these flip charts quickly at appropriate times throughout the course. Then, as the DAFNE course progresses, more flip charts will be put up around the room demonstrating how the participants’ learning is building session by session. The printed DAFNE flipcharts may be appropriate if you do not have access to digital technology.
Slide 3 narration:
It is not helpful for participants to display all the DAFNE flip chart pages and insulin action posters on the walls all the time, from the beginning of the course. Participants need to be able to focus on the appropriate information at the right time rather than being overloaded by information and unclear about where to find it from the start. However, by putting flip charts up on the walls, as and when they've been used during your sessions, the participants will see how their knowledge is building and will be familiar about where to find information during discussions.
Slide 4 narration:
You may prefer to display the electronic DAFNE flip chart pages using a smart board or projector. Think about your access to IT in your venue and your own IT skills. Can you display more than one flip chart page at a time and find the appropriate page to display quickly? The resources section of the curriculum for each session outlines which DAFNE flip chart pages or insulin action posters you need to refer to. The electronic DAFNE flip chart pages and insulin action posters may be appropriate if you have limited wall space or are not able to use the walls for display purposes.
Slide 5 narration:
Participant interaction is an integral part of the DAFNE course and your classroom should enable small group and pair work so a lecture hall layout with seating in rows is inappropriate for this reason. Participants spend a whole day in the classroom. They need to complete activities in the activities book and refer to other resources throughout the course, so seating without appropriate table space is also not appropriate.
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A downloadable version is also available in a PowerPoint format.
Activity 3: Resources
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Play the video clip below to find out more about the resources you will need to deliver a face-to-face DAFNE course format and how to order DAFNE specific resources.
There is accompanying audio so ensure you have your headphones or speakers on. Click on the square icon below the video to watch in full screen.
Click 'Start' to begin.
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Transcript
Slide 1 narration:
The slides that follow outline the resources required for DAFNE course delivery. As part of planning your DAFNE courses, you may also need to consider if any of the course participants require large print versions of resources. Do any course participants require an interpreter? Make sure all your resources have been ordered and delivered before your course dates.
Slide 2 narration:
There are DAFNE specific resources that are essential to deliver face-to-face DAFNE course formats.
Make sure that you have ordered and received your DAFNE resources and that you are familiar with them before planning for course delivery. In addition to DAFNE resources, you will also need some resources that are provided locally. The course resources checklist, shown here, details all the resources required for course delivery and can be found in the central resources area of the OpenLearn Create platform, shown here. Please remember the central resources area is updated from time to time, so the location of documents may change.
Slide 3 narration:
The DAFNE flip chart set is an essential resource for DAFNE course delivery and contains key information and images illustrating the DAFNE principles for insulin dose adjustment and carbohydrate counting. The resources section for each DAFNE session in the curriculum outlines which flip charts are used in each of those sessions.
Slide 4 narration:
These four flip charts are used to explore and describe how insulin works in the body and what happens in type 1 diabetes when insulin production stops. They’re used primarily in the session ‘what is diabetes?’ but may also be referred to in the sessions ‘insulin injection technique’, ‘insulin regimen’, ‘Glucose checking and targets’ and ‘illness management and sick day rules’. The lesson plans for each session contain references to appropriate DAFNE flip charts that may be used to support the participants’ learning.
Slide 5 narration:
These two flip charts are used primarily in the sessions on mild and severe hypoglycaemia. The flip chart ‘managing hypos and hypo alerts’ is referred to throughout the course to remind participants of the hypo treatment guidance in DAFNE, as this may be different from their usual hypo treatment. Hypo treatment guidance is first referred to in the 'introduction to DAFNE' session and reiterated in the session 'introduction to carbohydrate counting'. It’s also helpful to display the flip chart during the group discussions of DAFNE diaries or CGM downloads, to inform discussion of appropriate actions to take to manage a hypo or hypo alert. The flip chart ‘causes of hypoglycaemia’ may also be referred to in the sessions on managing alcohol and physical activity and exercise, because it’s not uncommon for these lifestyle factors to be associated with hypoglycaemia if insulin adjustments are not made.
Slide 6 narration:
Counting carbohydrate in 10 gram portions is a key DAFNE principle and this flip chart is first referred to in the 'introduction to carbohydrate counting' and 'counting CPs' sessions. It’s also a useful reference during group discussions of CP counting at lunchtime, as well as during the 'insulin dose adjustment' and 'action planning' sessions when it acts as a reminder of the importance of accurate CP counting.
Slide 7 narration:
These flip charts are used in the session ‘Glucose checking and target ranges’ to illustrate accurate blood and sensor glucose checks, DAFNE Glucose targets and how achieving Glucose targets can contribute to optimal Glucose management in the longer term. The ‘DAFNE Glucose target ranges’ flip chart is also referred to in the sessions on the ‘stepwise approach’, ‘insulin dose adjustment’, ‘corrections’ and ‘increasing or decreasing an insulin dose’. Appropriate dose adjustment is based on accurate Glucose checks and CP counting. Without accurate Glucose checks, participants will be unable to take the appropriate amount of insulin. Participants need to be clear about their glucose targets so they can take steps to return out-of-target Glucose back to target when necessary. Participants are encouraged to aim for DAFNE targets pre-meal and pre-bed, or if these targets are not appropriate for them, to set personal glucose targets initially, then work towards DAFNE Glucose targets over time. Achieving DAFNE targets as often as possible can help participants achieve their longer term HbA1c or time-in-range targets, which may relate to their daily action plans as they work through the course and ultimately to their long-term diabetes goal. The DAFNE Glucose targets are often referred to in the lunchtime CP counting discussions and the group discussions of DAFNE diaries or CGM downloads.
Slide 8 narration:
These flip charts are used in the DAFNE sessions on the DAFNE insulin regimen, correcting out-of-target glucose, increasing or decreasing an insulin dose and the stepwise approach. Participants need to consider the onset, peak and duration of the insulin they are using in order to identify which insulin is acting and to inform appropriate insulin dose adjustments. These flip charts are used in conjunction with the DAFNE insulin action posters to demonstrate the action profiles of different insulins.
Slide 9 narration:
The stepwise approach is the cornerstone of insulin dose adjustment in DAFNE and it outlines the steps to follow to implement safe and appropriate insulin dose adjustment. The stepwise approach flip chart is used in the sessions on increasing and decreasing an insulin dose, alongside activities in the activities book and it’s key to the DAFNE diary and CGM download discussions at the beginning and end of each day.
Slide 10 narration:
Managing physical activity and exercise can be one of the most challenging parts of daily Glucose management. It’s important that participants are aware of the effects of different types of exercise on their Glucose in order to determine the most appropriate way of managing that effect. The physical activity and exercise flip chart is used primarily in the session ‘managing activity and exercise’ but it's also a useful reference when considering other causes of out-of-target Glucose during group discussions of DAFNE diaries or CGM downloads at the beginning and end of each day.
Slide 11 narration:
These flip chart pages are used in the long-term health and diabetes session. They provide a framework for group discussion about the long-term complications of diabetes, the importance of accessing healthcare checks, as well as the value of working with their diabetes team to promote and maintain their health in the long term. The annual review game is also used in this session and reflects the flip chart content. The group discussion about long-term health and diabetes often generates questions for the doctor, so you may find it helpful to ‘bank’ or ‘park’ questions in the usual way during this session. Participants may find it helpful to have the results of their last annual review checks to hand during this session.
Slide 12 narration:
The DAFNE insulin posters illustrate the following. Number 1 shows insulin production in a person without diabetes. Number 2 shows once-daily BI analogue and QA analogue with meals. Please note that this poster and the examples in the course book are not based on an ultra-long acting once daily BI. Number 3 illustrates the DAFNE insulin regimen based on twice-daily BI and QA analogue with meals. The posters are used to illustrate the insulin coverage given by the DAFNE regimen and how this mirrors insulin production in a person without type 1 diabetes. As you know from your clinical experience and experience with Remote DAFNE, those using once-daily BI may notice their Glucose rises at times when once-daily BI may wane; this is illustrated in the dose adjustment activities and may promote discussion on self-management strategies or changes to an individual's insulin regimen.
Slide 13 narration:
The DAFNE food plates are used in the session ‘Counting CPs’ to compare visual estimation with actual CP counts. They can also be a useful resource in the session ‘eating out’ when participants are discussing how to manage their Glucose when eating away from home; the food plates may be used to create fictional restaurant meals of one, two or three courses, which participants can choose and discuss.
Slide 14 narration:
The replica food models are used in the introduction to carbohydrate counting session as part of an activity to identify which foods contain carbohydrate, which do not and foods the group is unsure about. They’re also used in an activity to divide carbohydrate containing foods into those that require QA, those for hypo treatments and those that may digest too slowly to need to be matched with QA. They are also used in the session ‘counting CPs’ to compare visual estimation with actual CP values from the Carb portion list. They can also be a useful resource in the eating out session; they may be used to create fictional plated restaurant meals which participants can choose and discuss.
Slide 15 narration:
Each course participant requires a participant pack to include the items shown here. The course book which contains all the content referred to during the course. The activities book which includes examples and activities to complete as part of DAFNE sessions. The DAFNE diary which is a paper diary that some participants may wish to use during their course, or they may prefer to use their CGM downloads if you have the IT equipment at your venue to share this information. Remember, downloads should include CPs, QA and BI doses, and comments about lifestyle factors as well as Glucose checks. The Carb portion list is also included in the participant pack, and this is used as the main carb counting reference during the course. Order the course book, activities book, DAFNE diary and Carb portion list from central DAFNE. The blank A4 diary sheet can be used to transfer information from the DAFNE diary to share using the visualiser. This can give a clearer image than sharing the diary directly and allows participants to transfer only relevant information. The GP letter allows participants to note any prescription changes they would like at the end of the course, for example, the inclusion of a Glucagen kit and ketone check strips. Both the blank diary sheet and the GP letter can be downloaded and printed from the central resources area. The blank diary sheet is under the tab ‘resources for face-to-face delivery’. The GP letter is under the tab 'Recruiting & planning and delivering a DAFNE course'. You will need to provide each participant with a name badge, pen or pencil and labels for their personal equipment to avoid mix ups and possible needle stick incidents from people using someone else’s lancing device or pen.
Slide 16 narration:
There is a tab in the central resources area that provides information on how and when to order your resources. If you work in a new centre or a centre that has not yet delivered any face-to-face courses, give yourselves plenty of time to order your resources. Remember to order your replica food models three months before your first course! As DAFNE resources are updated, the order form will also be updated, so always download a new form from the central resources area when you place an order!
Slide 17 narration:
In order to deliver your DAFNE course, you will also need the locally provided resources in the checklist. Have you made sure that DAFNE resources are available for your course dates (i.e. the DAFNE flip chart, insulin action posters, food models, food plates / pictures)? Have you got enough participant resources (course books, activities books, Carb portion lists, DAFNE diaries and evaluation sheets)? Have you planned for safe sharps disposal with a sharps bin and some cotton wool? Have you got spare meters, pens and needles available at your venue, in case a participant forgets their own, and for demonstrations in the insulin session? Have you arranged for fresh, cooked and dried real foods and examples of food labels to be available for the session ‘counting CPs in everyday foods and from food labels’?
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A downloadable version is also available in a PowerPoint format.
Activity 4: Time
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Comment
Play the video link here for information on the timings of sessions, breaks and lunchtime on a face-to-face DAFNE course.
There is accompanying audio so ensure you have your headphones or speakers on. Click on the square icon below the video to watch in full screen.
Click 'Start' to begin.
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Transcript
Slide 1 narration:
The DAFNE course timetable for participants outlines the following things. The start and finish time each day, the content covered each day, and break times and lunch times, including the option to delay lunch on one day in order to carry out a daytime BI check. You’ll see that timings for each session are not included in the participant timetable. This is because timings may need to be flexible to suit the needs of the group. However, it is important that the course finishes on time.
Slide 2 narration:
The 5x1 DAFNE course timetable, shown here, follows a similar format to Remote DAFNE, in that each week follows a theme such as ‘getting the basics right’, ‘insulin and insulin dose adjustment', 'below target Glucose', 'Above target Glucose' and 'Long term health and diabetes'. It also includes the option to delay lunch on one day, in order to carry out a daytime BI check. It can be helpful to provide a course timetable as part of the pre-course appointment, to clarify the time commitment for the course and highlight sessions when it can be helpful for a participant to have a support person attend with them, for example, the severe hypos, when you need help session, and sick day rules session. A support person is welcome to attend other sessions but the content of these particular sessions include when a participant may need help from someone else.
Slide 3 narration:
The DAFNE and 5x1 DAFNE timetables for the educator are in Sections 2.1 and 2.2 of the DAFNE curriculum. The timetable is provided for each day and includes the start and finish times, as per the participant timetable, session titles, as in the participant timetable, as well as the lesson plan required for each session, including the section number in the curriculum. The timetable also includes the timing of the session. The timing of the session is also outlined in the lesson plan. Part of the educator role is to keep control of the pace of learning. Allow plenty of time for discussion and appropriate activities, and don’t forget to provide resources to meet the participants’ learning needs. Use the group agreement appropriately to keep on track, including the importance of punctuality for both you and the course participants.
Before you deliver a course, make sure you have a thorough knowledge of the timetable and the content of the lesson plans for your sessions; this will help you manage the group and keep to time.
Slide 4 narration:
Time for morning and afternoon breaks is included in the timetables. Break times are important to allow the group the opportunity to reflect, interact, share experiences and have a break from learning. So, don’t cut into the break times.
Slide 5 narration:
Having lunch as a group on each day of the course is an essential learning opportunity. CP counting and insulin dose adjustment at lunch time allows participants the opportunity to practise their CP counting with guidance from both the educators and to learn from the CP counting of other group members. Lunch time CP counting is also an opportunity to weigh carb-based food and count CPs accurately so that both educators and participants are confident in lunch time CP counting. This helps in diary or CGM reviews when considering if an insulin dose needs to be adjusted. Participants will learn about a broader range of foods containing carbohydrates by sharing this CP counting experience with the rest of the group, than if they only count their own CPs each day. Participants also need time alone as a group without educators present to share their thoughts about the course and gel as a group. The pre-course appointment is an opportunity to highlight that lunch time CP counting is part of the course but they will have a 30-minute lunch break after the CP counting session. On the DAFNE course, Wednesday includes the option to delay lunch to check their daytime BI whereas on 5x1 DAFNE, this opportunity occurs in Week 3.
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The learning environment
