A total of 36 nursing students (7-11 per group) participated in the focus groups. Each group included nursing students from both the 5-year Co-op program and the accelerated degree (ACE) program.
Based on results from the questionnaire administered at the beginning of each focus group, nursing students perceived nurses to have an important role in promoting healthy eating and in giving nutrition advice to patients with diabetes. These comments were similar to comments made during each focus group indicating that nursing students‟
perspectives were not influenced by discussing the topic in front of their peers during the focus group sessions.
The focus group discussions yielded four main themes of information: 1) nutrition education 2) perceived role of nurses in nutritional management of diabetes 3) perceived knowledge and comfort level of nutrition for diabetes management and 4) inaccurate nutrition statements.
Nutrition Education
The nutrition education category included all comments related to nutrition education in nursing students‟ current nursing program as well as suggestions for improvement. Drexel nursing students in the Co-op program confirmed that they were required to complete 2 nutrition courses during their 1st and 2nd year of the undergraduate Co-op nursing program. Nursing students in the ACE program confirmed that they were required to take 1 nutrition course prior to beginning the ACE nursing program. Nursing students in both the Co-op and ACE programs reported that additional nutrition education was received in clinical classes and clinical rotations throughout their student career. Few nursing students felt that nutrition is adequately covered in their nursing program, with the majority of nursing students feeling that nutrition was only “touched upon” during clinical nursing classes while discussing various disease states. Nursing students also reported that hands-on nutrition learning during clinical rotations was helpful but varies among student experiences and could be improved by implementing nutrition related objectives to the clinical rotation requirements.
When nursing students were asked how nutrition education could be improved within the nursing program, their suggestions included lectures, role playing activities
and incorporating additional nutrition examples during clinical classes and rotations. Nursing students also expressed interest in attending classes and lectures taught by dietitians rather than learning nutrition from nurses alone. These results indicated that nursing students learn nutrition primarily during nutrition course requirements which consists of 1 (ACE) or 2 (Co-op) nutrition courses. Additional nutrition information may be learned in clinical classes and rotations but varies among individual experiences. Nutrition objectives may be helpful to enhance nutrition learning during clinical rotations and nursing students may benefit from classes or lectures taught by registered dietitians. The Role of Nurses in Promoting Nutritional Management for Diabetes
The majority of nursing students were aware that diabetes is prevalent and may be encountered in many healthcare settings. Nursing students stated that, “this [diabetes] is a disease we‟re going to see coming through the door every day”. Nursing students agreed that, “sometimes you don‟t have the luxury of having a dietitian”. Because dietitians and diabetes educators are not always available to give nutrition advice, nursing students felt that nurses have an important role in giving nutritional advice to patients with diabetes. The perceived role of nurses among nursing students was also to emphasize and reinforce nutrition information that may have already been taught by the physician, dietitian or diabetes educator. Nursing students agreed that in order to reinforce nutrition
information to patients, a minimum of basic knowledge is necessary. Nursing students also agreed that the role of nurses is to provide total patient care which includes assisting with meals and educating patients about all aspects of their disease including basic nutrition information.
When asked to list three words or phrases to describe the role of nurses in promoting nutritional management of diabetes, 86% of participants listed at least one of the following: 1) to educate patients, 2) to reinforce nutrition information and 3) that their role in giving nutrition advice to patients is important or necessary. These results
indicate that nursing students strongly believe that giving nutrition education to patients with diabetes is part of the nursing scope of practice.
Perceived Comfort and Knowledge Level
Nursing students described their current knowledge level as “minimal” and “not good” to “fair” or “good”. The majority of nursing students reported feeling comfortable giving basic nutrition advice to patients with diabetes but that they would refer to a dietitian to give specific, detailed nutrition information. Nursing students reported that they are trained primarily to treat “crisis” situations such as hypoglycemia and may not be as well trained to treat daily blood sugar management. These results indicate that nursing students feel most comfortable with basic nutrition knowledge and are likely to refer to dietitians or other resources for specific nutrition information related to diabetes. Inaccurate Nutrition Statements
Though many nursing students report feeling comfortable when giving nutrition advice to patients with diabetes, they are not able to correctly identify the carbohydrate content of several foods. In general, nursing students in this study have inaccurate knowledge of the carbohydrate content of milk. While some nursing students are unaware that milk contains carbohydrate, others stated that whole milk contains more carbohydrate than nonfat or low-fat milk. When presented with a breakfast meal
consisting of bran cereal with milk, berries and 4oz of orange juice, nursing students stated that the bran cereal and berries would have a minimal effect on blood sugar levels.
Many nursing students stated that if a patient receives insulin injections then the patient may eat unlimited amounts of carbohydrate because the nurse will just “fix” their blood sugar by giving insulin.
In terms of treating hypoglycemia, one student reported that if a patient‟s blood sugar was below 50, they would inform the patient to “add sugar to the cereal”. These results suggest that nursing students‟ perceived knowledge level may be greater than their actual knowledge level of basic nutrition for diabetes management.
Nutrition Terms
When the focus group questioning route was originally developed a goal was to determine currently used and preferred terminology used to describe a diet appropriate for a patient with diabetes. This information was to be incorporated on the survey tool to ensure that the terminology used on the survey would be appropriate for a nursing
population. The information was also to be used to determine if nursing students were familiar with the American Diabetes Association‟s terminology that uses terms and phrases such as “healthy eating” and “healthy food choices” (6).
Nursing students were presented with a list of diet terms in which they were to identify which term they were most likely to use when describing the appropriate diet to a patient with diabetes. The diet terms included 1) Diabetes Diet 2) ADA Diet 3) Low Carbohydrate Diet 4) Well-Balanced Diet 5) Healthy Eating for Diabetes and 6) Healthy Eating for Diabetes Management. Overall, nursing students preferred the term “healthy eating for diabetes management” because it was the most comprehensive term, described
the appropriate lifestyle in a positive manner and did not include the word “diet”. Nursing students were least likely to use the term “ADA diet” mostly because they felt patients would not be familiar with the meaning of the acronym. Several nursing students were not aware of the meaning of “ADA”. Those who knew “ADA” to be the acronym for the American Diabetes Association were more likely to use this term to describe a diet for a patient with diabetes because it references a nationally respected organization that provides credited information for diabetes management. This topic could have been translated into a question for use on the survey however it was determined that the purpose of the study was to identify knowledge of nutrition in regards to diabetes management. The researchers of this study felt that with the final survey consisting of close to 40 questions already that it was not imperative to include an additional question regarding diet terminology.
The results of the focus group discussion regarding nutritional terms showed that the majority of nursing students disliked the term “diabetes diet” and other terms that included the word “diet” which is consistent with the ADA who does not support the use of the term “diabetes diet”. Unfortunately, many students were not aware of the meaning of “ADA” acronym for the American Diabetes Association which is a concern because the ADA is a valuable resource for both healthcare professionals and people with diabetes.