Determining the Needs for Pediatric Diabetes Education among Nurses

Abstract

INTRODUCTION: Inpatient management of children and adolescents with diabetes requires a cohesive multidisciplinary team confident in the needs of patients requiring insulin. Previous studies have reported diabetes-related knowledge deficiency in adult-medicine nurses, however there is limited literature in pediatric nurses. Other researchers have trialed various diabetes education (DiabEd) programs in small cohorts and encountered barriers with study retention. At our hospital, pediatric patients with diabetes are often, but not always, admitted to a specific unit (8 East, 8E), which may lead to unequal experience in nurses caring for these children on other units. OBJECTIVE: Our objective was to measure the previous experience, training, comfort, and knowledge of pediatric nurses related to insulin and diabetes care. We also sought to understand the distribution of patients with insulin needs across units of the hospital. METHODS: A needs assessment was conducted with surveys to nursing representatives, review of diabetes resources available on each unit, and data surrounding insulin usage and incident reports pertaining to diabetes or insulin. Surveys consisted of six questions regarding current DiabEd provided for nurses and interest in further DiabEd. A pretest consisted of 2 validated tools: a modified Diabetes Self-Report Tool (mDSRT) and modified Diabetes Knowledge Test 2 (mDKT2). The mDSRT used a 4-point Likert scale for 10 items covering confidence in aspects of inpatient diabetes care, with higher scores reflecting higher confidence. The mDKT2 consisted of 15 multiple choice questions. RESULTS: Of 8 non-acute care units (nonACUs) evaluated, 25% had standard diabetes-specific training for new nurses and none had ongoing education after orientation. Seven units expressed the desire for additional DiabEd. Unit resources were out-of-date and 63% of nonACUs lacked any physical resources. Although nonACUs outside of 8E were responsible for only 16% of insulin usage in the hospital over the prior 24 months, they were referenced in 29% of incident reports. Of 47 nurses who completed the pretest, 13 (28%) missed >1 hypoglycemia-related question and 31 (66%) missed >1 ketone-related question. Of all survey responders, 22 (45%) reported receiving no DiabEd in the prior 2 years, 86% of whom had taken care of patients with diabetes in that timeframe. There were no differences in mDKT2 scores between nurses who had received DiabEd within the last 2 years (12.9+/-1.4) and those who had not (12.8+/-1.8, p=0.812). Nurses on 8E scored higher on the mDSRT (3.6+/-0.5, n=5) compared to nurses on other nonACUs (2.9+/-0.5, n=44; p=0.004). There was a positive correlation between mDSRT and mDKT2 scores (p<0.001, r=0.512), representing higher confidence with higher diabetes knowledge scores. CONCLUSION: The needs assessment and pretest data are consistent with previous studies in adult-medicine nurses and support the need for ongoing DiabEd for pediatric nurses. To our knowledge, this is the first study to evaluate educational needs of nurses related to diabetes care in children and adolescents and to create a curriculum to meet those needs. From these findings, a new DiabEd curriculum was developed and is currently implemented, with posttest data planned.