Instruments that measure nurses' knowledge about diabetes: an integrative review

Background and Purpose: Diabetes mellitus is an increasingly prevalent disease among hospitalized patients. Educators are challenged to build evidence-based programs for nurses based on sound nursing needs assessments using valid and reliable measures. The purpose of this integrative review is to examine instruments that measure nurses' knowledge about diabetes. Methods: The Databases PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Database of Systematic Reviews were searched for articles published between 1983 and 2012 using the keywords: diabetes knowledge; diabetes mellitus; diabetes self-management, nurse, and nursing knowledge. Fifteen articles reflecting the psychometric properties of 7 published instruments were reviewed. Results: The most commonly used instruments are the Diabetes Basic Knowledge Test (DBKT) and Diabetes Self-Report Test (DSRT). Several replication studies using the DBKT and DSRT did not consistently report reliability and validity measures. Five additional investigator-developed tools also lack strong validity and reliability measures. Conclusions: The findings suggest the need for continued development and psychometric testing of instruments to measure nurses' knowledge about diabetes.Keywords: diabetes knowledge; diabetes mellitus; nurse; nursing knowledgeDiabetes mellitus (DM) has become an increasingly prevalent disease for many Americans. It is estimated that 25.8 million Americans have diabetes-8.3% of the U.S. population (National Diabetes Fact Sheet, 2011). In 2009, the average length of stay for hospitalized patients with diabetes was 5 days (National Hospital Discharge Survey, 2009). Registered nurses (RNs), as part of the health care team, must be knowledgeable and competent to provide care and educate patients about diabetes. Much of the literature on inpatient diabetes education confirms that staffnurses often lack knowledge to teach patients about diabetes.Nurses must receive continuing nursing education to remain competent to provide their patients comprehensive, effective diabetes management and education. To design continuing nursing education programs on diabetes, as a first step, it is important to measure the nurses' knowledge level using reliable and valid instruments.PURPOSEThe purpose of this integrative review is to evaluate the instruments in place to measure nurses' knowledge about diabetes. Integrative reviews summarize past research by drawing overall conclusions from many separate studies that are believed to address related or identical hypotheses.BACKGROUNDThe incidence of diabetes has increased proportionally as the incidence of obesity has increased. From 1980 to 2004, the number of Americans with diabetes more than doubled (from 5.8 to 14.7 million). In 2010, the total number of people in the United States with diabetes, both diagnosed and undiagnosed, was 25.8 million. The incidence of diabetes in Americans older than the age of 65 years has risen to 26.9% (National Diabetes Fact Sheet, 2011). Type 2 diabetes accounts for about 90%-95% of all diagnosed cases of diabetes, and there is an increasing incidence of Type 2 diabetes occurring in adolescents and teens. Complications from diabetes are the seventh leading cause of death in the United States (National Diabetes Fact Sheet, 2011).The general management of diabetes involves multiple aspects of care including medical nutrition therapy (MNT), exercise, and medications (American Diabetes Association [ADA], 2011). The MNT includes an assessment of the patient's metabolic status with laboratory studies, food preferences and patterns of food intake, the patient's lifestyle and readiness to make changes, goal setting, dietary instruction, and evaluation. To facilitate adherence, the plan should be individualized and address the patient's lifestyle and specific cultural and financial resources. In general, registered dieticians and certified diabetes educators (CDEs) facilitate MNT through individualized counseling sessions, monitoring glucose, glycosylated hemoglobin (HbA1C), and cholesterol and lipid levels. …