Abstract
BackgroundThe number of patients with a diabetes mellitus (DM)-related diagnosis is increasing, yet the number of hospital-based diabetes educators is being reduced. Interest in determining effective ways for staff nurses to deliver diabetes education (DE) is mounting. The purpose of this multi-phase feasibility study was to develop and evaluate the Nurse Education and Transition (NEAT) inpatient DM education model.MethodsExploratory focus groups were conducted with staff nurses from inpatient units at academic tertiary and community hospitals to gain insight into barriers, content, delivery and support mechanisms related to providing DE to hospitalized patients. Findings informed the development of the NEAT model, which included a delivery protocol and toolkit with brief educational videos on key diabetes topics uploaded onto iPads, patient assessments and “teach back” tools, a discharge survival skills summary sheet, and guidelines for electronic medical record documentation and scheduling outpatient DE visits. Trained staff nurses used NEAT to deliver DE to hospitalized patients with DM and then participated in follow-up focus groups to assess their experiences, with particular attention to the usefulness of NEAT in meeting the needs of nurses related to the delivery of diabetes survival skill education. Information generated was analyzed to identify emerging key themes.ResultsExploratory focus groups revealed that staff nurses view teaching patients with DM as part of their job, but report barriers. Nurses agreed that inpatient DE should be designed to assure safety after discharge and advised that it be patient-centered, targeted, assessment-based and user friendly. Nurses who participated in the delivery of NEAT found that the process and tools met the majority of the basic DE needs of their patients while relieving their workload. In particular, they reported that video and iPad technology provided a convenient and standardized method for facilitating teaching at the bedside, but requested that an interactive feedback mechanism be added to encourage patient self-knowledge assessment.ConclusionsThis study presents challenges staff nurses face in providing DE to hospitalized patients and identifies opportunities and strategies for improving content and delivery to ensure safe transition of patients with DM from hospital to outpatient setting.
Highlights
The number of patients with a diabetes mellitus (DM)-related diagnosis is increasing, yet the number of hospital-based diabetes educators is being reduced
Nurses agreed that education was important and should be designed to assure safety after discharge, focusing on “survival skills” related to hypoglycemia, medication, nutrition, and blood glucose monitoring, and directing patients to outpatient Diabetes self-management education (DSME)
We demonstrate that Nurse Education and Transition (NEAT) – developed based on information gathered from nurses who are expected to deliver inpatient DM education - is a useful program for bedside nurses in providing survival skill education for the hospitalized patient with DM
Summary
The number of patients with a diabetes mellitus (DM)-related diagnosis is increasing, yet the number of hospital-based diabetes educators is being reduced. It is no surprise that interest is growing in determining ways to improve hospital management with evidence-based protocols [6,7,8] and a Transition of Care Coalition [9], established to develop approaches to assure a safe transition following discharge. Some patients may receive a new diagnosis of DM while those diagnosed are likely to have their treatment plans adapted Those formerly taking oral antihyperglycemic medications may start insulin injections, or have their monitoring, activity or nutrition plans changed, all of which require extensive education so that a patient can self-manage their condition upon discharge [10]
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