School Nurses' Self-Efficacy in Diabetes Education and Management and Their Diabetes Attitudes

Monday, 30 October 2017

Mee Kyung Lee, MSN, BSN
School of Nursing, University of Washington, Seattle, WA, USA

Purpose: The purpose of this study is to explore the relationships between self-efficacy levels in both diabetes management and education as well as school nurses’ attitudes towards diabetes to gain a better understanding of their current practices with students.

Providing care to students with type 1 diabetes can be highly demanding work for school nurses who are the designated healthcare professionals in school settings. Students with type 1 diabetes may benefit from school nurses’ positive attitudes about and high self-efficacy levels related to diabetes management and education that can improve students’ selfmanagement behaviors in schools. There is little information about relationships between school nurses’ attitudes about diabetes and self-efficacy levels in diabetes education and management.

Methods: A total of 115 school nurses who provided diabetes care in schools participated in a descriptive study that was designed to explore school nurses’ roles in diabetes education and management. Their attitudes, current practices, self-efficacy, and transitional care practices with students with type 1 diabetes were reported using online surveys via the REDCap system and semi-structured interviews. Demographics, the Diabetes Attitude Survey (3rd version, the Self-Efficacy on Diabetes Education, and the Self-Efficacy on Diabetes Management measured school nurses’ practice, attitudes, and self-efficacy in diabetes management and education. Descriptive statistics, Pearson correlations, and regression analyses were conducted.

Results: Participants were highly homogeneous: predominatly female (97%), non-Hispanic (95%), White (90%), registered nurses (94 %). The majority of participants (79%) were between ages 35 and 64 years. Seventy-two percent of school nurses had moderate or high confidence in diabetes education and 73 % also had moderate or high self-efficacy.

Nurses’ self-efficacy in diabetes education correlated with their self-efficacy levels in diabetes management (r(105) = .59, p<0.01). Most (from 49 % in the patient autonomy subscale to 96% in the need for special training scale) also had positive attitudes about diabetes. Also, the mean scores of the Diabetes Attitude Survey ranged from a low of 4.02 (patient autonomy) to a high of 4.56 (need for special training). School nurses’ attitudes towards their need for special training were associated with their attitudes about the psychological impacts of diabetes (r(112) = .25, p < .01), and the autonomy of students with type 1 diabetes (r(112) = .45, p < .01). There were significant correlations between school nurses’ attitudes towards the value of tight control, psychosocial impact of diabetes, and patient autonomy (r = .19 to .45, Ps < .05). While there was no association between diabetes attitudes and self-efficacy in diabetes education, nurses’ attitudes about psychosocial impacts and self-efficacy in diabetes management were significantly associated, r(106) = .24, p <.05.

Conclusion: Most school nurses had moderate or high levels of self-efficacy in diabetes education and management, and positive attitudes about diabetes. Although these attitudes were not related to nurses’ self-efficacy in diabetes education, specific attitudes about psychosocial impacts of the diseases positively impacted their confidence in diabetes management. These findings suggest that school nurses can be confident in their education and management of students with type 1 diabetes, regardless of their attitudes towards the disease.