475-P: School Nurses Report Low Confidence in Many Skills with Diabetes Devices

Abstract

New diabetes devices are increasingly standard of care for pediatric type 1 diabetes management. Youth often need caregiver assistance to use these devices, including at school. The aim of this study was to assess school nurse confidence with devices, which, to our knowledge, no study has previously evaluated. School nurses in Pennsylvania were recruited to complete a questionnaire, designed by our group and demonstrating content validity, evaluating confidence in specific skills. Each item was scored on a 5-point scale with low confidence considered a response of 1-2, moderate confidence 3, and high confidence 4-5. Respondents (n=269) were 99% female, 96% white, and mean age was 52 years. The majority had experience with insulin pumps (95%) and continuous glucose monitors (CGM, 92%), but not sensor-augmented pumps (34%). Primary forms of device training were informal learning from parents (68%), other nurses (49%), or web searches (49%); fewer (37%) received formal training from a medical center. Median response for insulin pump-related items was 3.1/5 and for CGM items 3.5/5, suggesting moderate confidence overall. We found a moderate positive correlation between confidence with pumps (0.47, p<0.001) or CGM (0.48, p<0.001) with confidence in general nursing skills; we did not find a significant association (p>0.05) between device confidence and years of experience as a school nurse, grades covered, or geographic region. A high proportion of nurses reported low confidence with certain skills, including operating a sensor-augmented pump (63%), setting a temporary basal rate (58%), changing the pump site (54%), knowing when CGM calibration is appropriate (48%), overriding pump calculations (42%), monitoring a CGM tracing (42%), or suspending insulin delivery (40%). Our findings suggest that school nurse confidence with diabetes devices varies by type of skill. Further validation of this questionnaire may help identify gaps in skills and tailor education as newer technology continues to emerge. Disclosure C. March: None. A. L. Hill: None. T. M. Kazmerski: None. G. E. Switzer: None. E. Wallace: None. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Advisory Panel; Self; Novo Nordisk. Funding Cochrane Weber Endowment Award