Doctor of Nursing Practice
Anna Goddard, Ph.D., APRN, CPNP-PC
Erica Muller, RN
Significance and Background:
Poor diabetes management is linked to serious long and short-term health complications. Despite this, medication adherence is a significant problem in adolescents with type 1 diabetes. Management is further complicated by low socioeconomic status, even when mitigated by free healthcare, highlighting health literacy as a culprit of disparities. Evidence shows that a common barrier for adolescents is proficiency in dose determination. Carbohydrate counting is an integral skill, necessary for attaining glycemic control. At a homecare agency serving adolescents with poorly controlled diabetes by providing oversight of medication administration and education, it was noted that patients continued to struggle with carbohydrate counting and appropriate coverage of food relative to other aspects of dose determination due to infrequently eating at nursing visits. However, patients who benefited from agency-provided food through initiatives addressing food insecurity experienced the opportunity for increased education relating to carbohydrate counting and anecdotally demonstrated improvements in proficiency and subsequent gains in diabetes control.
A quality improvement team within the homecare agency met with a goal of improving diabetes education using the Model for Healthcare Improvement framework. Relevant evidence was synthesized and showed that education which utilized multiple, short education sessions and problem-based learning improves diabetes education in this population.
It was determined that formalizing food-provision and problem-based learning as a diabetes educational approach, already informally occurring at this agency, into three of the patient’s normal nursing visits would allow for improved equity and quality of the education and allow for more formal assessment of the benefits of the change.
Patient satisfaction data was taken as a primary outcome measure and showed that all patients found this was a helpful educational approach and would recommend it to other patients with type one diabetes. Process measures of glycosylated hemoglobin and pre- and post- diabetes self-efficacy scales were also tracked showing changes in line with the literature.
The findings of this PDSA cycle demonstrate that this intervention is an evidence-based improvement on current diabetes education in homecare and can be used to help address health disparities in diabetes outcomes.
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McCaslin, A. (2022). Standardizing naturalistic teaching opportunities for problem-based learning in diabetes education: A quality improvement project [Unpublished DNP project]. Sacred Heart University.