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Unified approach

Award-winning nursing researcher asks: 'Where does diabetes exist'?

Research

By Marcia Porter

Dr. Renee Crossman is ahead of her time.

The Memorial Faculty of Nursing member was honoured with a special award during her graduation ceremony for her doctoral degree at the University of Alberta.

The Genevieve Grey Medal in Nursing recognizes a distinguished graduate for the most clinically relevant research that has potential to make a difference going forward.

“What you are proposing and what you are thinking is a few years ahead of where we are now,” said Dr. Crossman’s external reviewer during her virtual defence, jokingly asking her to “Please slow down.”

The title of her PhD dissertation is Living with a Machine: A Critical Focused Ethnography of Diabetes Practices in the Context of Insulin Pumps.

Patient-inclusive

What Dr. Crossman proposed was that care for people with diabetes and other chronic diseases should be more appropriately called patient-inclusive rather than the often over-used term, patient-centred.

That might not sound like a radical change.

But over the past few decades, health-care systems around the world have adopted a philosophy and approach that emphasizes patient-centred care.

While well-intentioned, it doesn’t take into account that a patient-centred approach can sometimes lead to patient-centred blame and shame.

“There are so many actors that come together . . . with each one having agency at different points in time.” — Dr. Renee Crossman

She points out that people living with diabetes or other chronic conditions are often their own worse critics when something goes wrong.

Instead of focusing on the 5Ws — or the who, what, when where and why — of diabetes practices among insulin pump users, she instead explored how factors come together in the management of the disease.

Dr. Crossman calls these factors actors because they each have a role to play in how a person manages their condition.

Agency of each actor

Actors can be human or non-human, with each having agency at different points in time.

“The person with diabetes is just one actor,” she said. “For example, consider checking blood glucose with a meter. There are so many actors that come together: the glucose monitor, the test strips, fingers, eyes, manual dexterity, blood, to name a few, with each one having agency at different points in time.”

Closeup photo of someone's hands holding a pink insulin pump
Even with an insulin pump, Dr. Renee Crossman says it’s not always easy to manage diabetes.
Photo: Submitted

Using actor-network theory, a novel approach to considering diabetes management, Dr. Crossman suggests that diabetes exists in a colossal network of interrelated practices with numerous actors.

In her dissertation, she began and ended with a story that illustrates how complicated it is to manage diabetes.

She asked: “What is your schedule like on a given day? Are you rushing to a meeting? Do you have kids to get to school? Can you afford your supplies? Can you afford to eat healthy foods? Do you have easy access to a pharmacy or grocery store?”

‘Diabetes never takes a day off’

It was partly Dr. Crossman’s own personal history that got her thinking about these issues.

When she was diagnosed with type 1 diabetes 16 years ago, it was a life-changing event.

“We need to revisit how we have come to think about, and use the term, patient-centred care.” — Dr. Renee Crossman

There was so much to learn about living with a chronic condition.

“As a nurse, I had cared for hundreds of patients living with diabetes, but it was a whole new world caring for myself,” she said. “It was not just about taking injections, counting carbohydrates and checking blood glucose. It was about fitting these things into a life that already had so much in it. It was about always having to be ‘on game.’ Diabetes never takes a day off and therefore neither could I.”

Over the years, she began to wonder if there was a good understanding of how people managed their diabetes on a day-to-day, moment-by-moment basis.

She says that taking the focus off the person as the sole driver of diabetes management opens up the conversation.

Dr. Renee Crossman sits at a counter in a hospital setting with two small electronic devices in front of her.
Dr. Renee Crossman’s most recent research project is focused on learning about the diabetes management practices of people who use insulin injections.
Photo: Submitted

“Every actor, whether human or non-human, must all come together and work in a unified way,” she said. “If we step back and consider the person with diabetes as just one actor, then we need to revisit how we have come to think about, and use the term, patient-centred care.

“We should always start with this question, where does diabetes exist?” she continued. “It exists in everyday practices, not just in numbers, foods, pumps, injections or in a pancreas, but in the messy, entangled relations among them.”

Dr. Crossman’s most recent research project is focused on learning about the diabetes management practices of people who use insulin injections. You can reach her via email or at (709) 864-4459.


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