Effect of an Evidence-Based Educational Intervention on Licensed Nursing Staff's Knowledge of Type 2 Diabetes in a Long-Term Care Setting

Abstract

Despite being the age group with the greatest prevalence of Type 2 Diabetes (T2DM), older adults have often been excluded from diabetes research. The paucity of studies about T2DM in long-term care (LTC) makes it difficult to apply conclusions from studies of younger diabetics to elderly diabetics who have shorter life expectancies and impaired functional/cognitive abilities. This DNP project was conducted at two LTC hospitals to implement T2DM clinical guidelines for elderly diabetics aged > 65 years and to educate the nurses about providing care to their diabetic patients. The Iowa Model was the conceptual framework for this project, conducted in four phases: 1) baseline chart review to examine pharmacologic treatment, most recent glycosylate hemoglobin (A1c) level; A1c lab standing order, sliding scale insulin (SSI) orders, and hyper/hypoglycemic events; 2) evidence-based (EB) educational interventions for LTC T2DM management; 3) nurses’ pre-test/post-test survey; and 4) chart review post intervention. The literature review revealed that A1c and glycemic control are individualized, less stringent, and balanced with clinical and functional status; SSI is contraindicated in LTC; and ongoing EBP continuing education, nursing staff interventions, EB clinical guidelines and policies are needed in LTC. The project’s expected outcomes were: A1c improvement; no orders for SSI; appropriate hyper/hypoglycemia management; accurate, concise reporting of patients’ status to providers; and increase in the nurses’ confidence in managing T2DM patient care. Descriptive statistics revealed improvement in nurses’ knowledge of T2DM, increased competence providing patient care, and reporting patients’ health status to medical providers. There was confusion regarding appropriate A1c levels for elderly diabetics, and LTC requirements for providers to see patients. It is too early to determine if A1c values have improved. SSI continues to be ordered – indicating a gap in providers’ knowledge. Implications: Ongoing EBP educational interventions are warranted for nurses and providers. A clinical leader/mentor is needed to support the staff as EBP is established. Limitations: The chart reviews were paper charts, thus often illegible; fluid environment, where diabetics were discharged or died; small sample sizes, 62 nurses and 80 diabetic patients; project timeline was one-year – inadequate to completely engage nurses to adopt practice changes.