Control, trust common themes for patients and nurses with inpatient insulin pump use

Control, knowledge, communication and trust are four themes patients and nurses focused on when discussing a patient’s insulin pump self-management during hospitalization, according to study data.
Ann R. Kaisen, MSN, MPA, APRN, ANP-BC, CDCES, an inpatient diabetes clinical nurse specialist at Yale-New Haven Hospital, and colleagues wrote that the findings provide a unique insight into challenges hospitalized patients with diabetes and nurses face with insulin pump management.
“Although insulin pump use is increasing, it remains a relatively low-volume, high-risk method of glycemic management. Given inpatient nurses’ limited exposure to insulin pump use, patients often have more knowledge, experience, and confidence with insulin pumps,” the researchers wrote in a study published in The Diabetes Educator. “This fact may negatively influence the experience of both patients and their nurses, creating undiscovered challenges.”

Researchers conducted a qualitative study at a 1,541-bed academic medical center. Patients were recruited from any of the center’s 35 non-ICUs across two campuses. All participants were aged at least 18 years, read and spoke English, and were admitted to the hospital for at least 20 hours while using their insulin pump. Registered nurse participants had experience caring for at least one patient who had self-managing insulin pump therapy.

Patients filled out questionnaires on demographics and insulin pump history, whereas nurses completed demographic and clinical work experience questionnaires. Semi-structured interviews were then conducted with participants answering general, open-ended questions, followed by specific questions based on practice knowledge of diabetes clinical nurse specialists and current evidence.

The study included 18 patient participants (mean age, 49.7 years; mean insulin pump experience, 10.7 years) and 16 nurse participants (mean age, 36.6 years). Both cohorts said there was a struggle about finding balance in managing diabetes when patients wore their insulin pumps, and their responses revolved around control, knowledge, communication, and trust.

Struggles with control

The nurse cohort said control was related to their perception of the patient’s knowledgeability to manage diabetes with the pump and reported that there was the advantage of readily available insulin for patients using their pump. Some nurses struggled to relinquish control, however, when they were concerned about a patient’s ability to use a pump, such as when a patient was acutely ill. Most of the patients said they wished to remain on the insulin pump during their stay and were confident in their ability to self-manage. For those who had less control, the patients described their hospital as frustrating. Many of the patients expressed a need to advocate for themselves.

In discussing knowledge, participants in both groups were forthcoming about a nurse’s lack of insulin pump experience. Some nurses mentioned that their understanding of insulin pumps was limited and said they needed more structured education on the subject. Patients generally had a high level of confidence and said they felt that they were able to make judgments about the nurses’ lack of knowledge.

Communication and trust

Both groups said communication was critical during hospitalization. The nurses discussed the importance of initiating conversation with patients and said the conversations gave them a better understanding of their patient’s knowledge. The patients agreed that communication was important for building a relationship with their nurses. In discussing trust, most nurses said the trust in their patients was based on their view of the patient’s confidence and knowledge with self-managing their diabetes. Some patients said they believe that the staff trusted them because of their experience living with diabetes, but there were some patients concerned with their perception of the staff’s lack of competency with glucose management.

Insulin pump guidance for nurses

The researchers used the study’s findings to create the PUMPS guide, a resource meant to better inform nurses taking care of individuals with an insulin pump during hospitalization. The guide includes information on patient assessment parameters, using and managing an insulin pump, and fostering a strong relationship with the patient.

“Creating an insulin pump toolkit with essential pump information for use by nurses will facilitate just-in-time training to ensure safe care,” the researchers wrote. “This resource will enhance nurses’ knowledge and competency necessary to build patient trust and enrich patient-nurse communication, thus enhancing collaborative decision-making about diabetes pump management.”

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