Krall Jodi Stotts, Donihi Amy Calabrese, Hatam Mary, Koshinsky Janice, Siminerio Linda
University of Pittsburgh Diabetes Institute, 4401 Penn Avenue, LMB Room 2112, Pittsburgh, PA 15224 USA.
School of Pharmacy, University of Pittsburgh, Pittsburgh, PA USA.
Clin Diabetes Endocrinol. 2016 Jan 14;2:1. doi: 10.1186/s40842-016-0020-1. eCollection 2016.
The 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.
Exploratory 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.
Exploratory 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.
This 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.
糖尿病（DM）相关诊断患者数量不断增加，但医院糖尿病教育工作者数量却在减少。确定护士有效开展糖尿病教育（DE）方法的兴趣日益浓厚。这项多阶段可行性研究的目的是开发并评估护士教育与过渡（NEAT）住院糖尿病教育模式。
对学术三级医院和社区医院住院科室的护士进行探索性焦点小组访谈，以深入了解为住院患者提供糖尿病教育相关的障碍、内容、方式及支持机制。研究结果为NEAT模式的开发提供了依据，该模式包括一个实施规程和工具包，其中有关于关键糖尿病主题的简短教育视频上传到iPad上、患者评估和“反馈教学”工具、出院生存技能总结表以及电子病历记录和安排门诊糖尿病教育就诊的指南。经过培训的护士使用NEAT为住院糖尿病患者提供教育，然后参加后续焦点小组访谈以评估他们的经验，特别关注NEAT在满足护士开展糖尿病生存技能教育需求方面的实用性。对生成的信息进行分析以确定新出现的关键主题。
探索性焦点小组表明，护士认为对糖尿病患者进行教育是其工作的一部分，但也报告了一些障碍。护士们一致认为，住院糖尿病教育应旨在确保出院后的安全，并建议以患者为中心、有针对性、基于评估且用户友好。参与实施NEAT的护士发现，该流程和工具满足了患者大部分基本糖尿病教育需求，同时减轻了他们的工作量。特别是，他们报告说视频和iPad技术为床边教学提供了便捷且标准化的方法，但要求增加互动反馈机制以鼓励患者自我知识评估。
本研究揭示了护士在为住院患者提供糖尿病教育时面临的挑战，并确定了改进内容和方式的机会与策略，以确保糖尿病患者从医院安全过渡到门诊环境。
