Problem
Thirty percent of all hospitalized patients have diabetes. Research related to diabetes has concluded that tight glycemic control of hospitalized patients reduce morbidity and mortality. However, there are many barriers to achieving this tight control. Care of diabetes is often secondary to a primary diagnosis of infection, glucocorticord therapy, surgical trauma, and decreased physical activity. Additional barriers include timing of blood glucose monitoring, nutrition interruption, misuse of sliding scale protocols, and lack of knowledge amongs nursing staff about current management strategies.
Purpose
The purpose of this project was to give the bedside nurse the "tools," "rules," and "skills" to manage the diabetic patient more effectively.
Objectives
(1) Describe the barriers to achieving glycemic control in the hospitalized diabetic patient. (2) Identify 3 strategies the CNS can use to facilitate positive outcomes in the diabetic patient. Project
Description
A comprehensive approach was taken to educate nursing staff, develop protocols, and support nurses in the practice of diabetes management. The project was led by a CNS with collaboration from an outpatient NP and a hospital-based NP.
Methods
This multifaceted project involved establishing a multidisciplinary team to identify obstacles to effective management; develop and disseminate protocols; create unit-based diabetic resource nurse who interfaced with the medical staff and supported nursing staff in clinical decision making, revise documentation to facilitate communication amongst disciplines; promote the new ACE guidelines by a question/case of the week posted on nursing units, and develop weekly interactive educational sessions.
Outcomes
Forty diabetic resource nurses have been educated and work at the unit level to provide support to staff nurse colleagues. They are conversant with the current science driving tight glycemic control, and are consulted by their peers to resolve clinical issues. One hundred and fifty staff nurses within the Heart Center have attended monthly educational sessions presented by CNSs, NPs, dietitians, pharmacists, and physicians. The feedback from these sessions has been extremely positive. Protocols for SSI, hypoglycemic management, and nutrition interruption have been created and disseminated. The impact on glycemic control and error reduction has been positive, although data collection is in its early stages at this time.
Conclusions/Implications for Practice
The CNS is intensely aware of the interplay between "rules," "tools," and "skills" on patient outcomes. The CNS is well positioned to influence the standard of care and change the practice environment. As a result of this project, nursing staff has a clear vision of the goals for glycemic control and has been given a voice in helping achieve it.
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.