Introduction of a Diabetes Educational Program to Improve Knowledge and Self-Efficacy among Ambulatory Care Registered Nurses

Purpose: The aim of this quality improvement project was to increase the knowledge base and self-efficacy of ambulatory care registered nurses (RN) around diabetes education.

Background/significance: Diabetes mellitus (DM) is a preventable disease that increases the risk for serious complications, increases the risk of death by 50%, and requires chronic management. Many studies have shown that nurses do not possess adequate knowledge about diabetes to lead patient education effectively. Knowledge deficits are greatest in the areas of medications, insulin treatment, blood glucose monitoring, dietary recommendations, symptoms, and complications. Inadequate patient self-management could be improved if nurses received more in-depth training to increase their basic foundational knowledge.

Methods: Participants were recruited through convenience and snowball sampling from several ambulatory care clinics of a large academic medical center. The intervention consisted of four modules focused on DM self-management education which included pathophysiology, symptom management, and blood glucose monitoring; medications and treatment; complications, diet and health care; and patient teaching and motivational interviewing. A validated tool, adapted from 4 validated instruments from previous studies (diabetes self-report tool, diabetes knowledge tool, diabetes survival knowledge test, and diabetes knowledge questionnaire), was used to assess actual and perceived knowledge of diabetes management before and after each module.

Assessments were completed in REDCap, and IBM SPSS version 24 was used for statistical analysis. Paired t-tests were performed to analyze scores before and after the intervention. Partial eta squared values were calculated to determine effect size and statistical significance was set at p = 0.05. Descriptive statistics were used for the demographic survey and program evaluation.

Results: There were about 16 participants in the program, and more than half have been nurses for ten years or less. Post-education scores for module 1 and 2 were statistically significant (p ˂ 0.001), and the effect sizes were large at 65% and 45%, respectively. Modules 3 and 4 were not statistically significant. Aggregate data for modules 1-3, n=45, resulted in statistical significance (p ˂ 0.001). Aggregate effect size was large at 31%. Close to 60% of participants found this educational intervention very helpful, with 55% stating that they are very comfortable leading diabetes care and education as a result of program participation.

Conclusions and implications: A significant finding is that despite a fully virtual platform, this educational intervention was effective in increasing nurse knowledge related to diabetes. Continuing to promote the virtual platform for education as well as incorporating role playing and recording options into future programs will be important in engaging nurses in a way that is helpful to their practice and provides the flexibility necessary within the unpredictable ambulatory care environment. More than a third of our population has pre-diabetes, and our findings suggest that educational interventions are necessary, welcomed, and effective in providing outpatient nurses with the knowledge necessary to lead diabetes and prediabetes care and education. Nurses are well-positioned to support the shift in care to population health management, help prevent or delay type 2 diabetes, and promote overall wellness with a focus on quality outcomes.