Diabetes and Education – Knowledge Level about Diabetes Management in Nurses Student

Introduction

Society being burdened by chronic non-communicable diseases is a major public health challenge worldwide, and is one of the main reasons for the use of health care. Although significantly preventable, this disease shows a paradox, although knowledge of these diseases is increasing rapidly and the methods and results of treatment are improving the incidence of these diseases is increasing [1].

Diabetes is one of the most common chronic non- communicable diseases. The World Health Organization and the International Diabetes Federation estimates that in 2014, 387 million people in the world suffer from diabetes, and that the number of diabetic patients by 2035 will increase to 592 million [2].

The number of newly diagnosed people with type 2 diabetes during 2014 in Serbia was 15.000. The incidence rates of type 2 diabetes per 100.000 inhabitants was 112.3 [3]. According to the estimate of the Institute of Public Health of Serbia, in the Republic of Serbia, diabetes affects approximately 710,000 people or 12.4% of the adult population, which corresponds to the comparative prevalence of 9.9% [4].

As a chronic illness effective self-management is critical to the success of the treatments. Diabetic care is primarily self-care, which requires the patient to actively participate in making decisions, setting goals and in the process of daily management. Multiple changes in behavior are needed for diabetic patients to manage their illness effectively and to achieve their desired level of glycemic control. Creating and maintaining behavioral changes is required for the management of diabetes and it requires cooperation between the patient and the provider of health care for the development of a plan. A multidisciplinary team consists of nurses, dietitians, pharmacists and doctors [5].

However, the nurses, as the largest number of medical personnel, and as who spends most of their time with patients, have a major role in educating patients with type 2 diabetes [6]. No matter in what sphere of health care the employed are, in all fields they can encounter the disease, and need to transfer the necessary knowledge to patients. The role of nurses in the education of diabetics is to help patients with self-care and in managing their illness through education and support. However, nurses need to have adequate knowledge and a wide range of professional skills, which include communication, counseling, leadership and a talent for teaching, in order to successfully carry out the training [7].

Therefore, nurses are key treatment providers. Experience and knowledge about diabetes and its management is essential for effective education of patients with diabetes. However, the information which will be transferred by the nurse to the patients depends on their knowledge of this subject, the possession of pedagogical competences, and whether they are capable of supporting patients to initiate and maintain behavior changes associated with the optimal control of diabetes [8].

The aim of this study is to investigate the level of knowledge of students of vocational nurses in relation to diabetes. The main hypothesis is that there is a significant difference among employed and unemployed students because of workplace experience, during which the nurses acquire a certain degree of knowledge and necessary skills.

Discussion

Respondents have low knowledge (58.75%) on diet in diabetics, medium expertise (60%) on the control of blood sugar, and high skills (75.7%) of insulin therapy and hypoglycemia and medium knowledge (63%) of chronic complications.

Considering employment and seniority, nurses with several years of experience are better informed on the control of blood sugar and insulin therapy (p≤0.05). Nurses in their daily work are regularly confronted with such patients, and with direct work they can acquire the necessary information, and transfer it to other newly discovered patients. Also, higher level of knowledge in the field of chronic complications (foot care, signs of ketoacidosis) achieved people with 6-10 years of experience. However younger, unemployed, students have greater knowledge about nutritional principles.

In the field of nutrition, the reverse correlation between employment and knowledge has been identified (p= -0.013), it is observed that a higher percentage of correct answers was among students with fewer years of experience, which can be explained by the relative fresh knowledge they got during secondary medical school. While employees with over 10 years of experience obviously have forgotten the principles of proper nutrition in diabetic patients, and are not able to consult in this area.

We can say that the students who are unemployed have better theoretical knowledge while better practical skills are present by employed students on the basis of which we accept this hypothesis. If we look at all these segments as a whole, the respondents completed the test of knowledge about diabetes with 64.4% accuracy, which according to the criteria described above corresponds to the middle level of knowledge about diabetes.

It warns us that we have to organize seminars and educational programs on the subject of diabetes management for refreshment and for the expansion of knowledge of nurses. Since half of the respondents is conducting regular training of diabetic patients, there is a possibility of transferring of inaccurate and incomplete information. Respondents have very low knowledge about nutrition and the composition of carbohydrate foods. However diabetes primarily (and very often exclusively) is treated with a diet, with patient education necessary for proper selection and food preparation.

The level of knowledge about chronic complications is very concerning, primarily at questions in diabetic foot care and in recognizing signs of ketoacidosis. Chronic complications of diabetes create the greatest burden for the health sector, their occurrence can be prevented and slowed down by adequate health educational work and successful self-care. We are obligated to teach patients how to take care of their feet, so that they recognize the signs of high and low blood sugar and what to do in these cases. We have to motivate them for continuous medical monitoring to detect possible complications.

Education for self-management of diabetes is an important component in improving the state of the patients and in preventing the complications associated with diabetes. Every person who has diabetes is responsible for controlling this condition and therefore must understand the basic principles of pathophysiology and of the disease’s treatment so that it would be more efficient. Clearly, the importance of preventive measures is high. Investing in relatively simple and inexpensive procedures leads to a significant positive effect on human health and therefore reduces the cost of their treatment [12].

Knowledge deficits of diabetes care represent a major risk for delivery of unsafe practice. Significant knowledge deficiencies are demonstrated in core aspects of diabetes care amongst nurses, and barriers to nurses' diabetes knowledge acquisition are also identified. Research on the registered and practice nurse in Canada shows the highest level of knowledge in the field of nutrition and the management of hypo and hyperglycemia, and the lowest level of knowledge about self-management of diabetes, oral medicines and insulin. However, most clinical nurses consider that there is a need for additional education [13]. Also, in West Pennsylvania as the main cause of low level of knowledge and a moderate level of self-efficacy of nurses, they emphasize that nurses are not trained for counseling and education, and that they are not familiar with techniques of increasing self-confidence [14].

In West Africa, similar problems have been discovered, the knowledge of nursing medics about nutritional management of diabetes is low, which calls into question the effectiveness of the nurse counseling. Almost 90% of nurses do not know the recommended daily intake of carbohydrates for diabetic patients, and over 70% of nurses consider that diabetic patients can exclude any of the major nutrients from their meals. A higher level of knowledge was discovered among the meds who attended a course on nutrition and counseling for diabetes patients during and after school [15].

In Saudi Arabia the nurses generally had a positive view of their diabetes knowledge, with a mean score of 46.9 (of maximum 60) for the Diabetes Self-Report Tool, but their actual knowledge scores ranged with a mean score of 25.4 (of maximum of 49). So, findings indicated a significant gap between participants' perceived and actual knowledge [16]. All in all, findings indicate widespread serious and persistent deficiencies in the knowledge of nurses in many aspects of diabetes care and about diabetes, and urgent strategies are needed to overcome identified obstacles to acquire knowledge [17].

Study on the education of clinical nurses on diabetes conducted in South Korea and India. After conducting several workshops on diabetes, it showed not only a higher level of knowledge about diabetes, but also the practical application of knowledge. In the post test more than 50% of the subjects achieved results between 91- 100%, and about half between 71-90%, therefore, the nurses had greater confidence in providing health education after attending the program [18].

These findings call for the need to introduce educational programs. Therefore, to enable our health care system to implement educational programs and to boast with such results, it is necessary first of all to invest in the training of senior nurses for the implementation of such programs.

Conclusion

Highly educated nurses are responsible for patient education to successfully manage diabetes. In this study the average student nurses' knowledge about diabetes was 64.4%, which corresponds to the middle level of knowledge about diabetes. The lowest level of knowledge demonstrated was about nutrition. In order to ensure the transmission of quality information for diabetics, it is necessary to update the knowledge of health workers, including the latest information on diabetes, in the form of annual seminars. It is not enough to just listen to new information, but they must be implemented in everyday practices.

Highlights

• The basic form of diabetes treatment is a change in the life style, especially in the field of nutrition.
• Nurses are responsible for training and education of patients with diabetes.
• Diabetes self-management depends primarily on the knowledge and ability of the nurse to transfer information. However, in the education of nurses, we face low knowledge of adequate nutrition in diabetes.
• For successful education in diabetes, we need to find an adequate solution for nursing training.

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