Anne T. Nettles, MSN, CS, RN

In Brief Recent concern about the optimum management of hyperglycemia for hospital patients has heightened awareness of necessary standards of care. Publications have confirmed that diabetes is not diagnosed or treated when detected in acute care settings, and opportunities for education are missed. Hospitalization presents an opportunity to address patients' unique urgent learning needs. In centers where quality diabetes management is a priority, education is readily available, roles are clear, and quality is monitored, evidence supports the notion that inpatient education is related to earlier discharge and improved outcomes following discharge.

From the 1950s (and even earlier) to the 1970s, patients with newly diagnosed type 2 diabetes and certainly those with type 1 diabetes were admitted to the hospital for initiation of medication and nutrition therapy, as well as comprehensive patient education. Given a long stay, nurses and sometimes nurse specialists, along with inpatient dietitians, provided one-to-one instruction with multiple opportunities for patient practice. Group classes were rare in this setting, and outpatient programs were not usually available. Patients were expected to be able to provide "return demonstrations of concepts and psychomotor skills before discharge. Pre- and post-instruction knowledge tests were the norm. The curriculum was long and detailed, and information was provided through discussions, videotapes, or booklets written for patients.1 Yet incidences of last-minute medication instruction occurred then just as they do today.2Much of the literature on inpatient diabetes education then focused on the knowledge deficiencies of hospital staff and what to teach newly diagnosed patients.37 Continuing education for nurses in the hospital was important. Nurses agreed, and some believed patients were more knowledgeable than they were themselves.

December 05, 2011