Teaching diabetes survival skills for a safe discharge

Intensity of lessons requires time, patient focus

Patients newly diagnosed with type 1 or type 2 diabetes, or those admitted to the hospital because of an inability to manage the disease, need to learn certain skills for a safe discharge.

The teaching requires a few hours at the patient's bedside or in a learning lab; therefore, some institutions have staff dedicated to diabetes teaching that can be called if needed.

At the University of Minnesota Medical Center, Fairview, in addition to diabetes clinical nurse specialists who teach at the bedside, there is a learning center where patients can be referred. Yet on any given day 47% of the inpatient population has hyperglycemia so it is impossible to see them all, says Carol Manchester, MSN, APRN, BC-ADM, CDE, a diabetes clinical nurse specialist at the facility.

A detailed learning assessment is always conducted so patients are taught what they must know for a safe discharge. This would include basic information on the principles of diabetes treatment and prevention of complications.

Also taught is how to recognize, treat, and prevent hypoglycemia and hyperglycemia, as well as self-monitoring of blood glucose and medication administration. Education includes how to adjust medication on sick days when a patient is experiencing nausea and vomiting.

A list of community resources is given to patients and family members so they have an opportunity to seek more in-depth teaching after discharge. They also learn about the proper disposal of sharps and specimens for safety at home.

"The difficulty with survival skill education is that you have to teach quite a few things in a very short period of time," says Manchester.

In addition, the patients are usually very sick, says Gwen Klinkner, RN, MS, APRN, BC-ADM, CDE, a diabetes clinical nurse specialist at the University of Wisconsin Hospital and Clinics in Madison.

"It is often trying to find a balance between what the patient really needs to be safe at home and what they can manage at the time because of how sick they are and how ready they are to learn," Klinkner says.

Depending on how quickly the patient will be discharged, the teaching is usually broken out into two to three sessions. "We have a tool we use that is part of the permanent record that allows us to track the teaching specific to diabetes. Because it is on one form, it is a good way to track a person's progress from session to session and it communicates with the staff nurses and physicians what level the patient is at on all the different survival skills," says Klinkner. It also serves as a communication tool between the various clinical nurse specialists who do the teaching.

Assess learning needs

Even if a patient has had diabetes for years, he or she may know little about the disease so an educational assessment is essential. "We really try to figure out where their deficits are and make sure they have those survival skills. There are times when we go beyond that; if they have issues with carb counting or a need for more education on an advanced skill we focus on that instead of the basics," says Klinkner.

Clinical nurse specialists do not see all the patients admitted to the University of Wisconsin Hospital with diabetes. Sometimes bedside nurses assess and meet the patient's educational needs sufficiently and review the survival skills with him or her for a safe discharge.

Even when a clinical nurse specialist does the teaching, bedside nurses are expected to reinforce what was taught over the course of the patient's stay.

At the University of Minnesota Medical Center, Fairview patients can be referred to the Patient Learning Center for two-hour hands-on teaching sessions. One session is on insulin administration and a second covers the use of a blood glucose meter.

A third educational session provides more general information on diet, exercise, and stress management. Information on carb counting is being added and patients will practice creating their own meals and figuring their insulin based on the selections. Patients referred for the one-on-one sessions are usually newly diagnosed with diabetes.

"Patients learn much more than nurses would ever be able to teach on the unit and they do return demonstrations and practice as long as they need to in order to gain confidence in a skill," says Marie Buthe, RN, a patient educator at the Patient Learning Center.

During the session on blood glucose monitoring patients are taught to keep a diary of their meter readings so they can show their physician at their next office visit and also take to outpatient self-management classes so they can continue to adjust their medications, says Buthe.

At the University of Wisconsin, diabetes clinical nurse specialists are now being asked to see patients with pre-diabetes who have stress-related hyperglycemia following surgery. "Now we are able to intervene earlier, educating on the front side before people develop diabetes and are admitted to the hospital with a heart attack or stroke because of it," says Klinkner.


For more information on meeting the educational needs of diabetes patients at the bedside, contact:

  • Marie Buthe, RN, patient educator, Patient Learning Center, University of Minnesota Medical Center, Fairview, 420 Delaware St., SE, Minneapolis, MN 55455. E-mail: MBUTHE1@Fairview.org.
  • Gwen Klinkner, RN, MS, APRN, BC-ADM, CDE, diabetes clinical nurse specialist, University of Wisconsin Hospital and Clinics, 3330 University Ave., Madison, WI 53705. Phone: (608) 263-8225. E-mail: ge.klinkner@hosp.wisc.edu.
  • Carol Manchester, MSN, APRN, BC-ADM, CDE, diabetes clinical nurse specialist, University of Minnesota Medical Center, Fairview, 420 Delaware St., SE, MMC 732, Minneapolis, MN 55455. Phone: (612) 273-8948. E-mail: CMANCHE1@Fairview.org.