Using technology to enhance pre-registration nurse education in diabetes

A key aspect of nurse education programmes is to ensure that the theory–practice gap, often identified anecdotally both by students and clinicians, is bridged effectively. Bridging this gap is a challenge for educators, who should ensure that educational materials are clinically relevant and demonstrate effective evidence-based practice (Hopton, 1996; Rolfe, 1996; Gallagher, 2004).

With these issues in mind, the authors considered the available technologies to enhance educational outcomes in a diabetes module in their pre-registration nursing education programme. As a result, videoconferencing that linked clinical practice and a classroom was established. The video link allowed the student nurses to observe a group education session on the initiation of insulin.

Videoconferencing provided students with practice experience, linked to specified educational objectives, that could not have been achieved in a standard lecture format or the observation of a small clinic group.

Methods
The videoconference, in association with a lecture and a case study workbook, was designed to achieve four key educational objectives. The objectives were for the student nurses to consider the:

• Role of the nurse in diabetes management.
• Relationship between the nurse, people with diabetes and their carers.
• Efficacy of group education as a process.
• Importance of user and carer involvement. 

Prior to the videoconference session, student nurses were encouraged to complete a case study workbook. This was a self-directed learning exercise that gave the student nurses an opportunity to look at diabetes holistically, and to consider the impact of management on the individual.

On the day of the videoconference, a 1-hour lecture was given to the 32 participating student nurses (Figures 1 and 2). The lecture was a revision of on the nature of diabetes. This comprised pathophysiology, epidemiology, management strategies, complications and user issues. The lecture also developed the work undertaken by the student nurses on the case study workbook.

Procedure for videoconference link to diabetes centre
The necessary permissions from the NHS Trust were gained. 

People with diabetes who were participating in the group education session observed by the student nurses were currently attending the diabetes centre and on oral therapy that was no longer achieving good glycaemic control. The need to initiate insulin therapy had been agreed, and the person with diabetes – or a carer – were invited to attend a group education session on the initiation of insulin.

Four people with diabetes and one person who was the carer of a person with diabetes were approached by the DSN leading the education session to discuss the possibility of participating in the videoconference. All five people verbally agreed to participate. 

A followed-up letter and information sheet were sent explaining the process and giving the project team members’ contact details. The letter explained that, if they did not wish to be involved, they could participate in another group education session. 

The four people with diabetes and the carer approached by the DSN agreed to be involved in the student nurse observed session and signed the consent forms. It was explained that they could withdraw from the session at any time and attend another session on the initiation of insulin. 

Use of the technology
During the videoconference session, the support provided by the information technology technician was invaluable. A 990MMX videoconferencing unit (Tandberg, Staines) was located in the classroom, and a remote camera in the clinic room in which the group education session was being conducted. IPContact software (Numerex Corp, Atlanta, GA) was used.

During the group education session, the camera and microphone were switched off in the classroom. This allowed the student nurses to observe the session but not be seen or heard by the DSN, people with diabetes and carer. The student nurses were supplied with the same insulin delivery devices as the people participating in the group education session, and were able to practise the techniques being taught by the DSN at the same time as the participants.

At the end of the group education session, the camera and the microphone were switched on in the clinic room, allowing interaction between the two sites.

The student nurses had been asked to identify questions during the group education session that they would like to ask the participants. At the end of the group education session, the student nurses used the videoconferencing unit to ask questions of the group education participants. Some of the questions asked by student nurses that provoked discussion are listed in Box 1. 

Evaluation
The use of videoconferencing enabled the educational objectives to be met. All student nurses completed evaluations of the session, reporting that the use of videoconferencing had helped them to link theory to practice, and better understand diabetes from the perspective of someone with the condition or their carer.

The people with diabetes and their carers stated that they were pleased to be involved in helping the students to learn. One individual stated “they’ve got to learn”, and what better way to learn than from people with diabetes? 

Interestingly, the group education session participant’s response to one student nurse’s question – “How did you feel about being watched by us?” (Box 1) – was:

“We had forgotten about the camera during the session and were focusing on what the nurse was discussing with us.” 

This surprised some of the student nurses, but emphasised the insight into patient behaviour possible when observing a live group education session in a clinical environment using videoconferencing.

Conclusion
This project exceeded the expectations for the session. The educational objectives – to observe and interact with a patient group while undergoing a therapy change, to consider patient–nurse and carer issues in diabetes management, to assess the efficacy of group education – were all met. Furthermore, the use of this technology allowed many student nurses to observe a group education session on the initiation of insulin. For a large group of student nurses to simultaneously observe such a session without the aid of videoconferencing would be impossible, due to the specialist nature of the work within the diabetes centre and the limited number of practice opportunities.

This method of teaching diabetes management within the pre-registration programme is now undertaken on a regular basis at the authors’ institution. Subsequent cohorts have all reported the utility of this teaching and learning strategy, feeling that it captures a true picture of care delivery within a clinical setting, without external influences on patient behaviour or response.