2016 Research and EBP projects
Chemotherapy Induced Peripheral Neuropathy (CIPN): Assessment of Oncology Nurses’ Knowledge and Practice
Counting Sheep, A Good Night’s Sleep: Mindfulness in Noise Reduction Strategies to Improve the Quietness of the Care Environment
Nursing knowledge and perceived comfort of inpatient diabetes management
Jennifer Meaney, MS, BSN, RNBC
Study Aim: Will focused diabetes education offered to nurses on a medical surgical unit improve their knowledge and perceived comfort for inpatient diabetes management?
Project Goal: To deliver an eight hour educational program to inform the educational needs of an enterprise wide change in insulin therapy and to assess the nursing knowledge and perceived comfort for diabetes management patient care. This project qualified for an expedited review by the IRB and approval was granted on November 2, 2016
The American Diabetes Association (ADA) recommends a target glucose range of 140 -180 mg/dL for both critically and non-critically ill hospitalized patients. Both hypoglycemic and hyperglycemic episodes in hospitalized patients can lead to adverse outcomes. Patients with hyperglycemia in the hospital have longer lengths of stay, higher readmission rates, and lower patient satisfaction scores.
An analysis of point of care testing (POCT) on a medical unit from January through June 2016 revealed 33% of time points were above the ADA target range (>180 mg/dL).
Previous studies reveal bedside nurses lack the current knowledge and confidence needed to adequately treat and educate patients with diabetes. Newer tools to assess these areas are available. Assessment is necessary prior to the implementation of a basal-bolus protocol.
Methodology: An eight hour course (7 Continuing Education Units) advertised to all nurses across the enterprise Topics reviewed included:
- Carbohydrate counting
- Types of insulins and action profiles, oral and injectable insulins, insulin pumps
- Basal-bolus method of insulin therapy
Measurement Tools: A baseline survey was administered at the beginning of the class. Basic demographic data, primary unit, work status (FTE), years of nursing experience, time of most recent diabetes education, number of patients treated each week, and personal experience with diabetes was obtained. The Diabetes Management Knowledge Assessment Tool (DMKAT) and the Confidence in Teaching Diabetes Education (CTDE) were administered. Participation was voluntary and anonymous using a student-derived code.
The survey was administered again at one month (mail) and three months (email). Responses remained anonymous and this analysis was based on aggregate data.
Results: Participants attending classes work mostly on medical/telemetry units (37.5%) and were female (92%). The majority has personal experience with diabetes (55%), hold a BSN (67%), and work 8-hr day shift (55%).
The response rate at 1 month was 14% and 27% at 3 months after class attendance.
There was a statistical increase in all metrics between baseline and month 1. At month 3, the increase remained, however this was no longer statistically significant.
Conclusion: Nurses are more familiar, comfortable, knowledgeable and confident in their diabetes management shortly after the course. However, this improvement was not sustained three months after the course.
A larger enterprise-wide education program to introduce basal/bolus insulin therapy will need continued emphasis to improve and sustain knowledge of diabetes management and in patient education.
Ongoing education opportunities will be necessary in order to sustain gains in knowledge and confidence levels. This may be in the form of a diabetes resource group comprised of class attendees or interested nurses from across the enterprise.