• Diabetes & Endocrinology Clinical Trials
• Hyperglycemia/Hypoglycemia Diabetes & Metabolic Syndrome
• Nursing

• Diabetes & Endocrinology Clinical Trials
• Hyperglycemia/Hypoglycemia
• Endocrinology
• Diabetes & Metabolic Syndrome
• Nursing

Oncology patients treated with corticosteroids are at an increased risk for hyperglycemia; however, they may not be aware of this risk. Lisa Gurman, RN, MScCH, and Bo Fusek, RN, MEd, both of Hamilton Health Sciences, Hamilton, Ontario, Canada, described a patient-centered study within their tertiary care hospital to improve the discharge process by enhancing staff autonomy and knowledge in diabetes discharge planning.

Challenges in improving diabetes education in an oncology unit included knowledge gaps of health care professionals, some of whom did not realize the importance of testing blood glucose in patients without a history of diabetes, as well as feelings of being overwhelmed among the staff with last-minute duties at discharge time. In addition, only 1 diabetes clinical nurse specialist (CNS) worked in the hospital.

To address these challenges, a collaborative approach was encouraged. Open-dialogue education sessions allowed the staff to first identify the challenges to teaching home glucose monitoring to patients at discharge. The staff then discussed the implications of learning the new skill and practiced teaching it.

The study investigators helped to develop a nursing process flowchart where the diabetes CNS provided staff education, the inpatient oncology staff identified patients and educated them, and the outpatient pharmacist taught the patient how to use the home glucose monitor. Training on the home glucose monitor began within 24 hours of discharge to avoid the pressures at discharge time. Nurses obtained the glucose monitor prescription, sent it to the pharmacy, and arranged for the patient's education time.

Patients' education sessions included family members and occurred in a quiet room (established during the program) to avoid the distractions of multipatient hospital rooms. The pharmacy provided all medications at discharge and offered to transfer all prescriptions to the patient's home pharmacy, if desired.

Data collected during the study included pre- and postvoluntary responses to 6 knowledge measures on a 5-point Likert scale: the rationale for training, the 4 steps of home glucose monitoring, what to advise the patient (eg, where to get meters and supplies), glucose goal ranges, when to test, and a weekend contingency plan (eg, where to find glucometers on the unit) when the outpatient pharmacist was not available. The data also measured pre- and postlevels of confidence and conviction.

Postknowledge scores increased for all 6 measures. The greatest impact was related to goal ranges. Knowledge increased among 92% of respondents, and 90% found the hands-on portion of training helpful. Conviction levels increased by 26%, and confidence levels around discharge teaching increased 40%.

These results show that in this hospital setting, open-dialogue education sessions and a hands-on collaborative approach can be effective in enhancing nursing staff knowledge, increasing conviction that home glucose monitoring is important, and improving staff confidence levels.

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