Knowledge of diabetes mellitus amongst nursing students

Effect of an intervention
Sukhpal Kaur, Indarjit Walia

Abstract : Nurses are the key providers of diabetes care. However the information provided by
them will depend upon their knowledge regarding the subject. Becton Dickinson India Private Limited
in collaboration with student council organized three days workshop for [Link]. Nursing interns on
'Better Diabetes Care' in the month of January 2006 at National Institute of Nursing Education, Post
Graduate Institute of Medical Education and Research, Chandigarh. A total of 48 interns attended the
workshop. Using a multiple-choice questionnaire their knowledge was assessed three times i.e.
before starting the workshop, at the end of the workshop (post test I), and after three months of the
workshop (post test II). There was a statistically significant difference in the mean knowledge score
between the pre test and post test I, between pre test and post test II and also between post test I
and post test II (t= 25.07, p<0.001, t=15.94, p<0.001, t=10.30, p<0.001) respectively. More than
50% scored between 91 %-1 00% marks in post test I. About one third scored between 81 %-90% in
post test II. It was concluded that to provide quality diabetes care and education to the patients, the
nursing staff should receive continuing education.

Introduction
Key words :
Diabetes mellitus is a chronic disorder
Knowledge, diabetes mellitus, nursing characterized by abnormalities in the
students. metabolism of carbohydrate, protein and fat.
In the last two decades there has been a
marked increase in the prevalence of diabetes
among urban Indians. According to a recent
WHO report, India today leads the world with
Correspondence at : over 32 million diabetic patients and this
Sukhpal Kaur number is projected to be 79.4 million by the
Lecturer, National Institute of Nursing Education , year 2030. 1 Diabetic patients are 25 times
PGIMER, Chandigarh.

Nursing and Midwifery Research Journal, Vol-3, No. 1, January 2007 30

more likely to develop blindness, 17 times teaching etc. Nurses have been major
more likely to develop kidney diseases, contributor to the improvement in the quality
30-40 times more likely to undergo major of care provided to the people with diabetes.
amputation and twice more likely to develop The role of nurse in diabetes is to facilitate
coronary ar tery diseases and suffer from patient empowerment and self care in the
stroke than the individuals without diabetes2 management of their disease through
Being a chronic illness effective self education and support. However the nurses
management is crucial to the success of need to be knowledgeable enough, must
treatment. Most diabetes care is actually self- possess basic communication skills to be
care that requires patients to actively comfor table and to be effective in their
participate in decision making, goal setting and teachings. New findings related to diabetes
the process of daily management. Multiple are constantly emerging and the nurses need
behavioral changes are often required for to be aware and keep themselves up to date.6
patients to manage diabetes effectively and Experience and knowledge in diabetes and its
to achieve their desired level of glycemic management are crucial for teaching patients
control. Making and sustaining the behavioral with diabetes effectively. The best educator is
changes needed for diabetes self someone who has teaching skills and can
management requires collaboration between assist and support the patients with initiating
the patient and the care providers to develop and maintaining behavior associated with
a relevant and useful plan. As has been optimal diabetes control. Studies indicate that
mentioned in literature3 that a multidisciplinary instructors without specialized training in
team consisting of a nurse, dietitian, diabetes, behavioral interventions, teaching,
pharmacist, physician, and behaviorist is learning and counseling skills may not focus
required for effective diabetes management. on patient's behavior change and therefore
The National Standards for Diabetes Self clinical outcomes may not improve.7,8 Thus
Management Education 4 best practice to provide quality diabetes care and education
standards suggest that the team should professional staff should have an continuing
consists of at least a registered nurse and a education in diabetes educational strategies
dietitian who communicate with other and behavioral intervention beyond their basic
disciplines as needed. However nurses, in the preparation.9
role of case managers for patients with Becton Dickinson India Private Limited
type- 2 diabetes have demonstrated positive in collaboration with student council
results and generally are involved in the formal organized a three days workshop on Better
diabetes education programmes. 5 The Diabetes Care in the month of January 2006
management of diabetes demands a broad at National Institute of Nursing Education,
range of professional skills which includes PGIMER Chandigarh.
communication, counseling, leadership and

Nursing and Midwifery Research Journal, Vol-3, No. 1, January 2007 31

 National Institute of Nursing Education diagnosis of diabetes, management which
is one of the premier institutes offering three included detailed information regarding diet,
programmes - [Link]. Nursing (4 years), [Link]. drugs, exercise, monitoring and education
Nursing (Post Basic) and [Link]. Nursing. The and in the end complications and their
workshop was organized for [Link]. Nursing management. The participants were also given
interns who are posted in various units of demonstration on subcutaneous insulin
hospital round the clock and are expected to injection.
provide total patient care. The task of Results
organizing the workshop was undertaken by
Becton Dickinson India Private Limited with The mean age of the participants was
an objective to update the knowledge of 21.7 years ±0.92 with the range of 20-24
nursing interns regarding diabetes so that years. All were female with the basic
they can make use of that while working with qualification of 10+2 (with medical subjects).
the diabetic patients in clinical settings. Mean knowledge score of the participants
Materials and Methods The mean knowledge score of the
Total 48 [Link]. Nursing interns attended participants before starting the workshop was
the workshop. A detailed multiple-choice 21.9±3.37 with the range between 14-31 and
questionnaire of 40 marks was administered it improved to 35.5±3.78 with the range of
to assess their knowledge regarding the 21-40 marks at the end of the workshop. After
disease diabetes. Each correct answer was three months i.e. in post test II, the mean
graded as 1 and incorrect answer as o. The knowledge score was 31.2±3.47 with the
test was administered three times i.e. before range between 18-37. There was a statistically
star ting the workshop, at the end of the significant difference between the pre test and
workshop, and after three months of the post test I, between pre and post test II and
workshop. The various topics discussed also between post test I and post test II.
during the workshop were-histor y of (t= 25.07, p<0.001, t=15.94, p<0.001,
diabetes, understanding, classification and t=10.30, p<0.001 respectively). (Table 1)

Table 1. Mean knowledge score of the participants Maximum Score = 40

't' valve
Mean ± S.D Range Pre test Vs Pre test Vs Post test I Vs
post test I post test II post test II
Pre test 21.9±3.37 14-31
Post test I 35.5±3.78 21-40 25.07, 15.94, 10.30
Post test II 31.2±3.47 18-37 p<0.001 p<0.001 P<0.001

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Percentage marks during pre test and post However after attending the workshop more
tests than 50% of the participants scored between
About one third of the participants had 91-100% in post test I. In post test II, 45.8%
their score less than 50% and approximately participants could score between 71-80%.
half scored between 51-70% and just 4.2% (Table 2)
could score between 71-80% in the pre test.

Table 2. Percentage marks during pre test and post tests

Marks (%) Pre test Post test I Pre test II
n (%) n (%) n (%)
<50 18 (37.5) 00 00
51-60 19 (39.6) 01 (2.1) 03 (6.3)
61-70 09(18.7) 01 (2.1 ) 04 (8.3)
71-80 02 (4.2) 08 (16.7) 22 (45.8)
81-90 00 13 (27.1) 18 (37.5)
91-100 00 25 (52.0) 01 (2.1 )

Discussion Therefore nurses need to identify the needs

Diabetes mellitus is a disease which can of the diabetics, as health education is an
be very well controlled but at times can be life integral part of nursing care. The value of
threatening if it is not properly taken care of. diabetes education is evident from a study
Although there is no cure of this disease, but where it is reported that the patients who
a great progress has been made in controlling never received diabetes education showed
and managing diabetes. The nurse encounters four fold increased risk for major
patients of all ages with diabetes in all clinical complications.10
settings including the outpatient and home In the current study it was observed
settings. Thus she is expected to plan, organize that the mean knowledge score of the
and coordinate care among the various health par ticipants before star ting the workshop
care providers and also is expected to provide was 21.9, and about one third of the
care and education and thus to promote the participants scored even less than 50% which
health and well being of all the diabetic is quite less to manage patient independently.
patients. Education is not only a par t of As has been reported in a study in which a
treatment but it is the treatment in diabetes. level of 80% in diet nutrition was considered

Nursing and Midwifery Research Journal, Vol-3, No. 1, January 2007 33

necessary for proper management of diet for post II. These results show the importance
diabetic patients and this level was reached of continuing education. As has been
by only 26% of nursing personnel. 11 Another emphasized by Dunn 14 that to provide quality
study indicated deficit in senior nursing diabetes care and education the nurses should
students knowledge about diabetes mellitus obtain continuing professional education. In
in which they considered a student to be one of the studies 15 an education program
eligible to teach diabetic patients if she could on diabetes was implemented for the nurses
answer all the questions correctly and there and the results indicated that the nurses were
was no one who could answer all the more confident in providing health education
questions correctly. 12 In another cross- to the diabetic patients after attending the
sectional study 13 the attitude of first, second program. In another study16 it is reported that
and third year undergraduate nursing students continuing education and years of experience
regarding care of diabetic patients was had positive impact on exercise teaching
studied. They found that the attitude of program and methods used. Similar findings
graduating students to the care for people have also been revealed by Anderson9 in which
with diabetes was significantly more there was increase in knowledge and skill
appropriate than those of beginning students amongst nurses who attended symposium
as the senior students had experience to on diabetes and also considered it the
diabetes related education. Since nurses play preferred method for obtaining continuing
a significant role in empowering the patients education. Anderson17 in another study has
to understand their disease, there is need to also repor ted that the par ticipants who
sensitize and train them to provide quality care. underwent 3 days diabetes care regimen
The mean knowledge score of all the followed by a 3-day intensive skills based
par ticipants improved significantly after workshop showed significant gains in their
attending the workshop irrespective of age. counseling skills and demonstrated a positive
Although there was decrease in mean change in their attitude.
knowledge score in post test II i.e. after three Conclusion
months of workshop, even then it was
significantly more than the pre test score. In Education for self-management is an
post test I, more than 50% participants scored integral part of diabetes care and is an evolving
between 91-100% and about half of the process especially in India. It is the
participants scored between 71-90%. In post cornerstone of care for all individuals with
test II, only one par ticipant could score diabetes who want to achieve successful
between 91-100% and about one third scored health related outcomes. Therefore all the
between 81-90%. Approximately half were in individuals suffering from diabetes mellitus
between 71-80% of score. No one had the must learn self-management skills. Patients
score less than 50% both in the post I and can manage their disease well if they have

Nursing and Midwifery Research Journal, Vol-3, No. 1, January 2007 34

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is very important for all the nursing personnel Johnson PD. The continuing education needs of
to keep updating their knowledge. diabetes nurse educators. J Continuing Educ Nurs
1991; 22:163-66.
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