Improving Patient Glycemic Control Through a Diabetes Management Mentorship Program

Background: The classic healthcare system is based on the concept of “curing” what ails the patient. Diabetes is incurable; a chronic condition requiring care that addresses more than just the medical and pharmacological needs of a patient (Arts, Landewe-Cleuren, Schaper, & Vrijhoef, 2011). During hospitalization, nurses educate patients regarding diabetes and diabetes self-management. However, several studies have shown that nursing knowledge deficits exist in the areas of pharmacokinetics of insulin, target blood glucose ranges, and the appropriate treatment of hypoglycemia (Modic, et al., 2013). In addition, nurses have poor comprehension of fundamental diabetes care, including appropriate HgA1c levels and self-care management (Young, 2011).

Purpose:  Implementation of a Diabetes Management Mentorship (DMM) program will increase nursing knowledge of fundamental diabetes care and nurse confidence in the provision of self-care management education to hospitalized patients with diabetes. Hospitalized diabetic patients will have reduced hypo/hyperglycemic episodes, their glycemic control will improve and they will have decreased hospital readmissions.

Methods/Practice: This IRB approved study is currently collecting baseline data via a voluntary survey to measure hospital nursing staff knowledge and self-confidence in teaching diabetes to hospitalized patients. Retrospective patient data from 2013 is being collected to measure patient outcomes while receiving standard care. In November 2014, 20 hospital staff nurses will be recruited to function as DMMs. The application process includes a written application, recommendations from Unit Directors, and a formal interview with study staff. Applicants are required to have a minimum of one year nursing experience. Once selected, nurses will have eight hours of protected time for monthly mentorship activities. They will complete additional education regarding diabetes, disseminate this information to other staff nurses, conduct hypo/hyperglycemia audits on their home units and teach diabetes self-management skills to hospitalized patients.

Findings/Conclusions: This is a replication of a previous study in an Ohio Hospital where the facility observed a decrease in hypoglycemic events, fewer insulin errors, an increase in outpatient education referrals and a 50 percent increase in hospital-wide adherence to existing hypoglycemia protocols (Modic, Canfield, Kaser, Sauvey & Kukla, 2012). Baseline data is still being collected with regards to nursing knowledge, self-confidence and patient outcomes.

Implications for Practice: The innovative DMM program will provide an educational opportunity for both nursing staff and hospitalized diabetic patients who may not have access to diabetes education in the rural communities. The DMMs will serve as empowering agents for their peers and their patients and will demonstrate an increase in diabetes knowledge and self-confidence.

This pilot program is designed to evaluate the effectiveness of the creation of an elite nursing team with advanced diabetes knowledge. This program could provide a way to close the gap between theoretical nursing knowledge of diabetes and actual nursing knowledge of the disease process and its treatment. This program will operationalize nursing knowledge and result in improved, sustainable patient outcomes in actual healthcare practice. If proven effective the DMM model, specific to diabetes, can be generalized with all chronic illness educational needs in the hospital inpatient setting.