015–Adrenal Insufficiency in Children: Teaching Nurses to Teach Caregivers

Abstract

Background: Adrenal insufficiency (AI) is the impaired synthesis and release of adrenocortical hormones due to various mechanisms (e.g., autoimmunity, genetic, ACTH deficiency, and corticosteroid-induced). AI affects quality of life and is associated with increased morbidity and mortality, especially in younger patients. Children are at highest risk during times of physical stress. Many children do not receive stress doses of medication when needed. Relatively novice endocrine nurses do not feel adequately prepared to educate children, adolescents, and families about AI and its treatment. Purpose: The purpose is to increase nursing knowledge, skills, and competency in teaching caregivers about disease process and management of adrenal insufficiency day to day and during times of physical stress. Description of Topic: The poster will describe the action steps used to prepare endocrine nurses to teach caregivers about adrenal insufficiency and its management. The PRECEDE-PROCEED model will provide a framework for education. The project leader will secure organizational support, work with endocrinology providers to standardize stress steroid dosing, identify or modify evidence-based teaching resources, and develop charting templates and smart phrases for documentation. Components of the education plan include an overview of AI, pathophysiology (including congenital adrenal hypoplasia, Addison’s disease, hypopituitarism, and corticosteroid-induced adrenal insufficiency), daily medications, and prevention of adrenal crises (use of medical alerts; emergency hydrocortisone; and when to call clinic, go to ED, or call 911). Nurses will be mentored by an experienced pediatric endocrinology nurse. Clinical Implications: A major role of pediatric nurses is teaching children, adolescents, and families. Ineffective education of caregivers about AI places children at risk for adrenal crises. Nurses need to be able to teach caregivers of newly diagnosed children with AI and properly triage phone calls from caregivers during illness or injury or prior to procedures. They also need to be knowledgeable about school emergency plans. Investing in the training of novice endocrine nurses about AI can empower caregivers to better manage this disease. During times of physical stress, adherence to stress dosing can reduce the need for emergency department visits and hospital admissions.