| Objective1.To understand the knowledge related to insulin injection,the current situation of insulin injection and the injection skill needs of elderly diabetic patients.2.To explore the effectiveness of the teach-back method combined with a new insulin injection simulation tool in elderly diabetic patients,and to provide clinical reference and reference in improving health education for elderly diabetic patients.MethodsThe study is divided into 3 parts:1.A qualitative study of insulin injection misconceptions and injection skill needs in elderly diabetic patients.In this phase,12 elderly diabetic patients who met the criteria for nadir were selected for the study using purposive sampling method and admitted to the endocrine metabolism department of a tertiary hospital in Zhengzhou from January 2021 to February 2021 for semi-structured interviews to analyze and summarize the misconceptions,true feelings and injection skill needs of elderly patients in insulin injection.2.Design and application of a novel insulin simulation toolThe new insulin injection simulation tool was tested in the Department of Endocrinology and Metabolism of a tertiary hospital in Zhengzhou City from February to March 2021:firstly,16 patients who met the criteria of nadir were selected as the study subjects of the control group and were numbered Al-A16 according to the order of admission;then 16 patients were selected as the study subjects of the intervention group and were numbered B1-B16 according to the order of admission.8 nurses took a lottery to draw 2 patients each from the intervention and control groups respectively.Each of the eight nurses drew two patients from the intervention group and two patients from the control group for health education.The nurses applied the conventional insulin injection simulation tool to the health education of patients in the control group and the new insulin injection simulation tool to the health education of patients in the intervention group,and evaluated the clinical application effect of the new and old insulin injection simulation tools.3.The construction phase and implementation phase of the Intervention program(1)Combining the results of the preliminary qualitative study and the design and application of the new insulin injection simulation tool,the preliminary intervention plan was formulated and refined through expert consultation and pre-testing to form the intervention plan of the teach-back method combined with the new insulin injection simulation tool:①Intervention method:group intervention combined with individual intervention;②Intervention implementers:the researcher herself,the postgraduate supervisor,the head nurse of the endocrine metabolism department,the responsible nurses,the professional physician;③Intervention content:the responsible nurse repeatedly used the teach-back method to deliver information,repeat information,clarify and correct,and continuously supervise the sessions on the new insulin injection simulation tool daily to provide insulin injection health education to elderly diabetic patients;④Evaluation time:before the intervention,one insulin injection before discharge,the day of discharge,and three months after discharge.(2)In this phase,a convenience sampling method was used to select 103 elderly patients with diabetes mellitus who met the inclusion criteria in the order of admission from April 2021 to November 2021.Among them,53 study subjects from April to July 2021 served as the control group and 50 patients from August to November 2021 served as the intervention group.The control group used the conventional health education method combined with the new insulin injection simulation tool for health education and management of elderly diabetic patients,while the intervention group used the teach-back method combined with the new insulin injection simulation tool for health education and management.Results1.Qualitative research stageA total of 12 elderly diabetic patients were interviewed in this phase,and the extracted topics were:①Forced to receive insulin treatment;②Insuficient awareness of the normative level of self-insulin injection;③Insulin injection techniques need to be improved(aseptic technique is not standardized,unclear about injectable sites,specific site rotation,incorrect insulin mixing method);④No response to injection pain;⑤Need for insulin injection skills training during hospitalization(In-patient instruction on misconceptions about injections and repeated instruction during hospitalization,multiple opportunities to practice mock injections during hospitalization,and mock injection tools for elderly patients during hospitalization).2.Design and application phase of a novel insulin simulation tool.(1)A new insulin injection simulation tool suitable for health education of insulin injection in elderly diabetic patients was designed after clinical practice,qualitative research and expert consultation.(2)A total of 8 nurses and 32 elderly patients were surveyed in this phase.①The length of time required to explain insulin injection training by nurses using the new insulin injection simulation tool(22.75±3.40)was less than that of nurses in the group using the conventional simulation tool(26.31±5.31),and the difference was statistically significant(t=2.26,P<0.05).②After health education with the new insulin injection simulation tool,the scores of elderly patients in the intervention group were higher than those in the education with the conventional insulin injection simulation tool in terms of insulin injection site selection(2.67±0.49),site rotation(2.67±0.48),fast and slow absorption at different sites(2.72±0.46),and total score of insulin injection knowledge(25.50±2.23).patients,and the difference was statistically significant(P<0.01),while there was no difference between the scores of the two groups of elderly patients in terms of skin inspection before injection and insulin pen injection angle,and the difference was not statistically significant(P>0.05).③The new insulin injection simulation tool scored higher than the conventional insulin simulation tool in terms of convenience(4.13±0.64),ease of understanding(5.00±0.00),time saving(4.13±1.00),and economy(3.88±0.64),and the difference was statistically significant(P<0.05),while in terms of operability,both tools scored the same and the difference was statistically significant(P>0.05).3.Construction and implementation phase of an intervention program combining a novel insulin injection simulation tool with a teach-back method.In this phase of the study,data collection was completed on 103 patients,53 in the control group and 50 in the intervention group.The results of the study showed that:(1)Before the intervention trial,there was no difference in the scores of total insulin-related knowledge,insulin storage knowledge,medication knowledge,and injection knowledge between the two groups of elderly patients(P>0.05).After the intervention trial,on the day of discharge and 3 months after discharge,the scores of elderly patients in the intervention group in total insulin-related knowledge(48.02±1.06),(47.86±0.17),insulin storage knowledge(7.98±0.77),(7.68±0.82),medication knowledge(11.92±0.27),(11.36±0.72),and injection knowledge scores(28.12±0.72),(27.74±0.75)were higher than those of the control group,and the differences were statistically significant(P<0.01).(2)Before the intervention trial,there was no significant difference between the scores of the two groups of elderly patients in the total insulin injection skill score and between the sub-steps(P>0.05),after the intervention trial and 3 months after the intervention,the scores of the elderly patients in the intervention group in the total insulin injection skill score(7.99 ± 1.03),(7.65±0.10),hand washing(0.3 7±0.22),(0.37±0.22),verification(0.72±0.45),(0.62±0.49)were higher than those of the control group between the sub-steps,and the difference was statistically significant(P<0.01),while there was no difference between the scores of the intervention group and the control group in the installation and venting of the insulin pen(P>0.05).(3)Before the intervention trial,there was no difference in pain scores in insulin injections between the two groups of elderly patients(P>0.05),and after the intervention trial,the pain scores in insulin injections in the intervention group were lower than those in the control group once before discharge and 3 months after discharge,and the differences were statistically significant(Z=-4.58,P<0.01,Z=-2.96,P<0.05).(4)The satisfaction scores of the elderly patients in the intervention group were higher than those in the control group for health education by nurses,and the comparison of the results between the two groups was statistically significant(t=-5.44,P<0.01).ConclusionApplying the teach-back method combined with the new insulin injection simulation tool to provide health education to elderly diabetic patients can effectively improve patients’ knowledge related to insulin injection,insulin injection skills,reduce patients’ pain during insulin injection,and improve patients’ satisfaction with health education. |
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