Abstract
Caring for a person with diabetes remains a topic that can throw uncertainty into a nurse’s shift. Understanding how to safely care for the inpatient with diabetes is imperative to the nurse’s role; however, it’s just one part of the responsibility to the patient. The nurse must also be able to educate the patient on self-care behaviors in preparation for discharge.
The diagnosis of diabetes creates an overwhelming concern for both the patient and the nurse. Nurses struggle with what, when, and how to teach persons with diabetes when what they need is the knowledge, flexibility, and creativity to identify and utilize teachable moments. Diabetes care and education must begin on admission and continue throughout the course of the hospitalization and discharge.
This article details the creation, preparation, and implementation of a unique, interactive program using a themed approach to improve the knowledge and comfort level of nurses educating patients in diabetes self-management at the bedside.
Program Proposal
The AADE7 structure facilitates the nurse’s ability to create a nurturing environment that empowers patients to identify barriers, problem solve, and develop skills to live healthier, more productive lives with diabetes.
“Camp ‘Whatsasugar’“ is a creative educational program for bedside nurses that was developed and delivered at Missouri Baptist Medical Center in St. Louis. The program is based on the AADE7 Self-Care Behaviors® needed for successful diabetes self-management. The AADE7 structure facilitates the nurse’s ability to create a nurturing environment that empowers patients to identify barriers, problem solve, and develop skills to live healthier, more productive lives with diabetes.
The following individuals and groups reviewed and offered input and support on the program proposal: “Diabetes Champs” (staff nurses who act as glycemic liaisons sharing education with their peers), the hospital diabetes team, nursing management, manager of clinical nutrition, manager of pharmacy, program manager clinical service line rehabilitation administration, and vice president of development. Institutional Review Board approval was not necessary as there was no coding or identification of participants in any way throughout the program.
Gap Analysis
Through discussions at the Diabetes Champs’s meetings coupled with rounding on all nursing units, the current state of inpatient diabetes education in our hospital indicated that nurses were not using teachable moments to initiate education on admission for the person with diabetes. In addition, there was limited staff knowledge as to what to teach as well as a presumed lack of time to teach. The diabetes care and education specialist would receive a consult when a patient was ready for discharge, often with a noted lack of initiation or completion of diabetes education by the bedside nurse.
Program Goal
The immediate goal was to increase the confidence of staff nurses when teaching diabetes self-management to hospital patients. Achieving a continued increase in nurse confidence 30 days and 90 days postprogram would indicate success with retention.
Program Evaluation
Participants filled out an evaluation form preconference, postconference, at 30 days postconference, and at 90 days postconference. The evaluation measured knowledge and comfort level of the AADE7 and the retention level of comfort when teaching diabetes self-management skills.
Continuing Education Credit
Our hospital, an approved provider of continuing nursing education by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation, awarded 5.5 contact hours for attendance of at least 90% of the program.
Date and Location
The date and time chosen for the program coincided with available rooms in the Clinical Learning Institute and with the school of nursing on our campus being on break. The location provided the perfect choice for the anticipated audience due to its central location and easy access. Seating was available for up to 80 participants.
Program Development
The plan to create a fun, interactive, and informative workshop regarding diabetes self-management created an environment of increased interest of bedside nurses to learn about both the AADE7 and how to educate their patients during those just-in-time teachable moments.
Choosing speakers from our hospital increased interest and allowed staff to build on internal bonds that already existed. This allowed the participants to make a better connection with the speaker and the content presented.
Presenters included Diabetes Champs, outpatient dietitians, physical/occupational therapists, pharmacists, and interested nurses. Choosing speakers from our hospital increased interest and allowed staff to build on internal bonds that already existed. This allowed the participants to make a better connection with the speaker and the content presented.
The program environment reflected the camp theme throughout, including assigned “cabins,” nature sounds, food, favors, and “campfires” (Figure 1). Cabins were created by setting 3 tables together covered by a checkered tablecloth.
Photo of a campfire created for each cabin of tables, Camp “Whatsasugar”
Generous donations from the Hospital Foundation paid for the costs of supplies, “camping gear,” and beverages. Vendors, including 4 hospital departments and 13 outside companies, set up tables and interacted with participants during program breaks.
Logistics and Schedule
Each participant signed in, filled out a preconference evaluation form, and received a binder of the program slides and extra handouts. A certificate of attendance was awarded at the end of the program when the participant turned in a completed postconference evaluation form.
The program schedule included presentations on all 7 AADE self-care behaviors as well as an opportunity for teach back and evaluation. Each topic was presented in 40 minutes and included providing the content, educating participants how to teach the information to patients, and an associated participant activity.
At the end of the conference, each cabin presented a randomly chosen topic presented during the workshop. This provided the audience with repetitive education.
Breakfast, lunch, and snacks were provided.
Educational Planning Forms
Each of the AADE7 topics as well as the introduction and teach back at the end of the program had an Educational Planning Form. Each form outlined the content presented, a return skill related to the topic, a question/answer period, and evidence-based references submitted by each speaker.
Speakers were responsible for conducting a literature search for current best practice to use in their presentations. Each speaker had 40 minutes to present their topic and were asked to keep with the camping theme. As an example, “camp coaches” presented the importance of exercise and led “campers” in a variety of activities.
Speakers also completed a Conflict of Interest Form with their credentials and position. This activity had no sponsorship or commercial support, and content experts, speakers, and planners noted no conflicts.
Marketing
A flyer created and posted in all nursing areas of the hospital noted the incidence of diabetes and prediabetes and acknowledged that the diagnosis of diabetes can strike fear in the minds of patients, their families, and those who care for them in the hospital. The flyer described Camp Whatsasugar as a creative and interactive program teaching the AADE7 Self-Care Behaviors that patients need for successful diabetes self-management. The flyer also informed the participants that they would engage in activities related to AADE7, learning how and what to teach patients during those just-in-time teachable moments at the bedside.
The hospital newspaper included information about the program, and nursing managers and Diabetes Champs encouraged participation. Signup in the hospital’s learning management system provided a reminder to registered participants prior to the conference.
Program Topics
General education in the AADE7 requires more than telling the patient what to do; it enhances the collaborative process by supporting and empowering patients with tools, resources, encouragement, and motivation. It includes educating the patient on how to take an active role in behavior change that leads to glucose control and improved quality of life. Each of the AADE7 topics were presented during the conference (Figure 2).
Individual topics presented at Camp “Whatsasugar.” Adapted from Camp “Whatsasugar” conference, August 23, 2017.
Healthy Eating
The group discussed identifying the relationship between carbohydrates and blood glucose as well as determining the grams of carbohydrates in foods using nutritional food labels and other carbohydrate-counting tools. Sharing this information with the patient allows the patient to make more informed and hopefully better choices with his or her diet. Program participants practiced counting carbohydrates using food samples.
Participants also received gloves and hand sanitizer as they were educated on completing foot assessments by checking their own feet.
Being Active
Participants learned the positive relationship that exercise has to hypoglycemia and hyperglycemia. Exercise or physical conditioning assists in the normalization of glucose levels. Reaching the appropriate body weight helps the body use insulin more efficiently and improves the cardiovascular system, possibly delaying complications related to high blood glucose. Participants received guidelines for educating the patient, including the importance of leg and foot care. Participants also received gloves and hand sanitizer as they were educated on completing foot assessments by checking their own feet.
Taking Medication
Attendees in this presentation reviewed oral hypoglycemic medications, injectable medications, and insulin with a focus on action, side effects, special considerations, counseling, and costs. The group received a hands-on demonstration in the use of an insulin pen and engaged in a return demonstration using a “stop stick” ball. Although our entity does not use insulin pens, the importance of the bedside nurse having the knowledge and comfort level to educate the patient on this topic is essential for discharge preparation.
Blood Glucose Monitoring
This topic reviewed the importance of checking blood glucose as the results reflect the effects of activity, foods, medications, and current treatment plan. Discussion included blood glucose target levels and step-by-step instructions on using a meter, strips, lancing devices, and lancets. Proper disposal of strips and lancets was also covered. The participants received information on the importance of logging results. Each cabin received 2 to 3 meters, and participants practiced operating a meter.
As an advocate, the nurse must empower the patient by providing resources and support. The group discussed assisting the patient in setting realistic goals, tracking progress, and asking for help when needed.
Problem Solving
The group received scenarios requiring critical thinking for both the hypoglycemic and hyperglycemic individual while at a summer camp. Diabetes, a progressive disease, requires problem-solving skills to manage daily barriers and make appropriate adjustments to self-care management. This process incorporates the knowledge, needs, goals, and life experiences of the person with diabetes. Individualization of education creates a positive impact on the patient.
This discussion also reviewed the association between high blood glucose levels and the development of periodontal disease, and the participants also received information on how to avoid oral health problems. Participants received toothbrushes and information on proper brushing and flossing.
Coping
This presentation discussed the journey toward healthy coping, including the stages of grief and coping styles as they relate to diabetes. As an advocate, the nurse must empower the patient by providing resources and support. The group discussed assisting the patient in setting realistic goals, tracking progress, and asking for help when needed. The presentation also discussed the need for the nurse to acknowledge a patient’s needs, motivate the patient, and support patients while in the hospital when preparing for discharge.
Reducing Risks
The presentation involved the audience in identification of controllable versus uncontrollable risk factors. Participants held up a sign of Smokey the Bear for risk factors identified as controllable or a forest fire for those risk factors deemed uncontrollable. Lights in the room dimmed as scary and often unbelievable clinical stories were told around the table-top “campfires,” and attendees identified risk factors and potential solutions. For example, groups discussed a patient who was using his best friend’s insulin or a patient who stopped insulin because when he thought it was giving him diabetes.
Teach Back
This portion of the workshop reviewed the AADE7 through engaging the learners in dialog, small group discussion, critical thinking, role-playing, and repetition teaching. Each cabin randomly chose a topic, prepared a 2- to 3-minute presentation, and shared their creativity in presenting the information to the rest of the workshop attendees.
Program Results
Camp Whatsasugar had 61 attendees who filled out both the pre- and postconference questionnaires. A Likert scale was used, with 4 representing the individual who was completely comfortable with the topic, 3 representing an individual who was comfortable, 2 representing an individual who was not comfortable, and 1 representing the individual who was very uncomfortable with the topic (Table 1).
Central Tendency Measures for Camp “Whatsasugar.”
Average scores were as follows:
■ Preconference: 2.93
■ Postconference: 3.77
■ 30 days postconference: 3.61
■ 90 days postconference: 3.75.
The comparison of preconference to postconference data indicated a 21% increase in knowledge and comfort. The 30-day results indicated a 17% increase, and the 90-day results indicated a 20.50% increase in knowledge and comfort (Table 2).
Camp “Whatsasugar” Evaluation Results.
Conclusion
Collaborating with a multidisciplinary staff provided unique insight into our nursing staff’s educational needs and created a special buy-in from the bedside staff to support their peers by attending Camp Whatsasugar. A recommendation for future programs would be earlier marketing of the event to allow hospital management better opportunity to preschedule staff to attend.
Program data clearly indicated increased diabetes self-management knowledge, comfort level, and retention by bedside nurses, with 90-day evaluation results above 30-day results. This may also reflect increased confidence related to more familiarity and practice using the knowledge received at Camp Whatsasugar. Camp Whatsasugar demonstrated positive results by enhancing the ability of bedside nurses to provide inpatient diabetes management and diabetes education on discharge. ■
Footnotes
Janice Marienau, BSN, RN, CDE, is with Missouri Baptist Medical Center in St. Louis, MO.