Improving nursing management of patients with diabetes using an action research approach
Denise Craig
Clinical Nurse Consultant, Diabetes Education Centre, Endocrinology, St George Hospital, NSW
Judith Donoghue
Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney NSW
Marilynn Seller
Diabetes Educator, Diabetes Education Centre, Endocrinology, St George Hospital, Kogarah NSW
Suzanne Mitten-Lewis
Research Officer, Acute Care Nursing Professorial Unit, St George Hospital, Kogarah NSW
PP: 071 - 079
Abstract
Nurses in an acute hospital implemented an action research process supporting changes to the assessment and management of acutely ill patients admitted with diabetes and other co-morbidities.
An audit of practice identified inaccurate documentation and uncoordinated care that included inflexible protocols for blood glucose level (BGL) assessment and administration of insulin, unrelated to patients' meals and snacks, that in some instances resulted in hypoglycaemic episodes. Specialist nurses and ward staff collaborated to improve practice by increasing nurses' knowledge of insulin and by designing and trialling a blood glucose monitoring form that enabled a more individualised approach to patient care.
A subsequent audit showed improved coordination of BGL measurement and insulin administration in relation to meals, sustained over eighteen months, and increased accuracy in documentation.
Keywords
nursing practice development; diabetes management; acute care context; patient record documentation
References
American Diabetes Association (2000): Tests of glycaemia in diabetes. Diabetes Care, 23 (suppl 1): S80-S81.
American Diabetes Association (2001): Standards of medical care for patients with diabetes mellitus (Position statement). Diabetes Care, 24(suppl. 1): S33-S34.
Balfour M & Clarke C (2001): Searching for sustainable change. Journal of Clinical Nursing, 10(1): 44-50.
Beebe C (1987): Self blood glucose monitoring: an adjunct to dietary and insulin management of the patient with diabetes. Journal of the American Dietetic Association, 87(1): 61-65.
Dimitriadis GD & Gerich JE (1983): Importance of timing of pre-meal subcutaneous insulin administration in the management of diabetes mellitus. Diabetes Care, 6: 374-377.
Gallichan M (1997): Self-monitoring of glucose by people with diabetes: evidence based practice. British Medical Journal, 314: 964-967.
Gebhart S (2000): Inpatient Management of Diabetes. In: Leahy J, Clark N & Cefalu W (ed.s) Medical Management of Diabetes Mellitus, Marcel Dekker, New York.
Gibb H (1998): What is action research? An introduction to the concepts. Nursing Matters, 16: 20-21.
Hillson R (1996): Practical Diabetes Care, Oxford Medical Publications, Oxford.
Hirsch B (1999): Type I diabetes mellitus and the use of flexible insulin regimens. American Family Physician, 60(8): 2343-2352.
Holloway I & Wheeler S (1996): Qualitative Research for Nurses. Blackwell Scientific Publications, Oxford.
Karim K (2001): Assessing the strengths and weaknesses of action research. Nursing Standard, 15(26): 33-35.
Meyer J, Spilsbury K & Priety J (1999): Comparison of findings from a single case in relation to those from a systematic review of action research. Nurse Researcher, 7(2): 37-50.
Schade D, Burge M & Boyle P (1993): It's all in the timing. Diabetes Forecast, July: 33-38.
Scheen AJ (1999): Minimal influence of the time interval between injection of regular insulin and food intake on blood glucose control of Type 1 diabetic patients on a basal bolus insulin scheme. Diabetes and Metabolism, 25(2): 157-62.
The Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Clinical Practice Manuals Literature Review Archive (Feb 2002): Insulin.
Wilmshurst E & Harris G (1993): Self monitoring of blood glucose: its role in the management of diabetes mellitus. Modern Medicine, July: 114-122.
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