Development of an educational model with a management approach to improve the competency of diabetes educator nurses; utilizing King's conceptual framework and goal attainment theory

Introduction

Diabetes educator nurses have an essential role in diabetes management education. Nurses have a precise position to educate diabetes patients because they accompany them more often than other professionals (Schwarzkopf et al., 2024). Education is a fundamental responsibility for nurses (Khazhymurat et al., 2023) so that diabetes patients have the knowledge and skills to live life (Clemens et al., 2021), fast well (Carroll, 2023), prevent acute and chronic complications (Yeşil & Çövener Özçelik, 2024).

Diabetes nurse educators should have good competence in managing diabetes patient education (Khazhymurat et al., 2023) because it must provide information that is relevant to the patient’s condition (Anderson et al., 2021), evidence-based (Hecht et al., 2021), teaches survival skills (Ergun-Longmire et al., 2021), to take appropriate action (Pueyo-Garrigues et al., 2022). Diabetes nurse educators must have good communication (Khazhymurat et al., 2023), always motivate diabetes patients (Al Nadhiri et al., 2023), and be respectful and culturally sensitive (Korsah et al., 2022). In addition, they can work together with patients and families to increase patient compliance with the instructions taught (Taibanguay et al., 2019).

The limited number of diabetes educator nurses in hospitals is inconsistent with the much larger number of diabetes patients (Dickinson et al., 2021). The high work demands of diabetes educator nurses mean that education for diabetes patients is not managed well. The education for diabetes patients is not managed well due to the low competency of diabetes nurse educators to manage diabetes patient education (Hecht et al., 2021), so an educational model with a management approach is required. Suppose you integrate the management function into the education management of diabetes patients. In that case, the diabetes nurse educator works in a structured, systematic manner because the management function guides the diabetes educator nurse to carry out education at each stage, measure efficiency, and evaluate results (Piplica et al., 2024). Management of diabetes patient education requires in-depth understanding and an appropriate educational model for diabetes nurse educators. Therefore, research is needed to explore educational models with approaches so that management nurses have diabetes educator competence. Based on this phenomenon, researchers are interested in developing an educational model with a management approach that impacts the competency of diabetes nurse educators.

Methods

Results

Twenty nurse managers from three hospitals participated in focus group discussions (FGD). All participants were married. 13-28 years of work experience. Education levels are bachelor’s degree and master’s degree. Forty staff nurses from three hospitals participated in this study. All participants were married. 5-21 years of work experience. Education level is D3 and bachelor’s degree. All staff nurses in the treatment room care for diabetes patients. Level clinical nurse levels II and III. There were no participants who refused to take part in this research.

Nine staff nurses from three hospitals participated in in-depth interviews. All participants were married. 9-13 years of work experience. All education levels are bachelor’s degrees. All staff nurses in the room care for diabetes patients, level clinical nurse levels II and III. There were no participants who refused to take part in this research.

Thematic analysis of the data collected revealed five themes: 1) Educational planning, 2) Organization of nursing resources, 3) Nurse staffing, 4) Nurse direction, and 5) Educational control. These five themes form the basis components of developing an educational model (Table 1).

The five themes are components of developing an educational model with a management approach integrated with King’s conceptual framework, Theory of Attainment Goals (King, 2016), and management theory. The development of this educational model begins with creating a draft educational model that uses an input, process, output, and outcome approach. The input uses King’s conceptual framework approach, the method uses the Theory of Attainment Goals and Management Functions, the output is the competency of nurses to educate diabetes patients, and the outcome is the health literacy of diabetes patients. Draft an educational model with a management approach (Figure 1).

Figure 1. Draft an educational model with a management approach.

The input stage integrates three things, namely patients, nurses, and the hospital environment, using King’s conceptual framework approach, namely the Nurse’s personal system, the interpersonal system between nurses and diabetes patients, and the social system, namely the hospital environment, hospital management policies, culture and the role of the patient’s family. This approach emphasizes that education does not only consider the patient’s condition but also involves the crucial role of nurses as diabetes educators, as well as aspects of the hospital environment and hospital management, as well as local culture/wisdom.

The process stage of integrating education with a management approach and Goal Attainment Theory includes perception, reaction, interaction, and transaction. This stage illustrates that implementing education with a management approach requires a perception. Diabetic patients provide perceptions to diabetes nurse educators, and communication transactions will occur between nurses and diabetes patients if both are actively involved in achieving goals. The output is on the competency of nurses to educate diabetes patients, and the outcome is an increase in the health literacy of diabetes patients.

The educational model with a management approach has a core circle as the central position, surrounded by five circles, and each circle’s colour has a meaning. The educational model with a management approach has a core circle as the central position, surrounded by five circles, and each circle’s colour has a meaning. In the circle, the Nurse’s competence in educating diabetes patients is placed in a central position. The circle’s core is white, which indicates the sincerity of the diabetes nurse educator in carrying out education. The first circle contains five competencies that diabetes nurse educators must have following the management function.

Outside the circle, three systems influence the competence of diabetes nurse educators. 1) Personal nurse system: nurses’ commitment as diabetes educators, skills of nurses as educators, motivation of nurses, workload of nurses, work management of nurses, perceptions, reactions, interaction, and communication of nurses. 2) Interpersonal system: the relationship between diabetes nurse educators and patient, patient culture. 3) Social System: hospital environmental conditions, hospital management policies regarding nurse training as diabetes educators. Figure of an educational model with a management approach (Figure 2).

Figure 2. Educational model with a management approach.

Discussion

An educational model with a management approach is used to improve the competency of diabetes nurse educators. There are five competency stages arranged systematically and structured, namely 1) Educational planning includes identification of educational targets, strategy formulation, and situation analysis. 2) Organizing nursing resources includes strengthening the role of nurses as diabetes educators. 3) Nurse staffing includes intraprofessional and nurse collaboration with patient families. 4) Direction includes nurse motivation for diabetes patients and respecting patient culture and values. 5) Controlling includes evaluating nurse education for diabetes patients.

Planning education by identifying educational targets, diabetes nurse educators are guided to 1) identify the demographics of diabetes patients (Ojurongbe et al., 2024) such as educational background, religion, ethnicity (Anwar et al., 2020), type of health insurance the patient has, employment, social status (Vamos & McDermott, 2021), address (village or city) (Aljassim & Ostini, 2020), age, especially the elderly, (Vafopoulou et al., 2024), patient room (Class III/ward, Class II, Class I, VIP). 2) Identifying patient health literacy using a questionnaire (Voigt-Barbarowicz & Brütt, 2020). 3) Identifying the patient’s ability to read and speak Indonesian (Muscat et al., 2021). Educational planning by identifying educational targets. Because each patient has different educational needs, diabetes nurse educators must identify educational targets so that educational planning is appropriate to the patient’s needs. In addition, the approach used is relevant and in accordance with the patient’s learning preferences.

Planning education by formulating strategies, diabetes nurse educators are guided to 1) determine the educational goals to be achieved (Ravik et al., 2023), 2) determine educational methods that are appropriate to the patient’s condition (Meyer et al., 2024), 3) determine the suitable educational media (Farooq et al., 2024), 4) determine the right educational time (Liao et al., 2023), 5) determine educational material (LaVela et al., 2022). Educational planning utilizes strategy formulation because it directs diabetes nurse educators to use appropriate strategies to increase learning effectiveness. Patients easily understand and apply the information taught.

In educational planning using situation analysis, the diabetes nurse educator is guided to 1) Analyze the situation from the diabetes patient’s perspective, such as pain problems (Zammit et al., 2023), anxiety (Shang et al., 2024), the patient’s experience of suffering from diabetes mellitus, the patient’s enthusiasm for receiving education (Linnavuori et al., 2024). 2) Analyzing the situation from the Nurse’s side includes the Nurse’s commitment as a diabetes educator to mastery of educational material (De Bellis et al., 2020). 3) Analyze the situation from the hospital environment, such as a quiet educational room, an educational room free from interference from other people, and facilities that support the implementation of education (Linnavuori et al., 2024). Educational planning is done by analyzing the situation of diabetes patients, diabetes educator nurses, and the hospital environment. The diabetes patients, diabetes educator nurses, and the hospital environment, are like a circle. The patient is the centre of education, and the diabetes educator nurse is the facilitator, whose quality and commitment influence the education process and results. A conducive hospital environment facilitates an effective education process.

Organizing nursing resources by strengthening the role of nurses as diabetes educators. Diabetes educator nurses are guided to 1) Manage their work so that every diabetes patient receives sufficient education (Linnavuori et al., 2024). 2) Sorting educational materials with other health professions (Teuwen et al., 2024). Organizing nursing resources by strengthening the role of nurses as diabetes educators so that diabetes educator nurses organize their work according to a priority scale. The priority scale can use patient flow management, namely information gathering, continuous triage, resource management, throughput management, and care oversight (Benjamin, 2024).

Staffing, diabetes educator nurses are guided to 1) Collaborate intraprofessionally, and work solidly with other nurses (Weber et al., 2022). 2) Collaborate with the patient’s family (Vinarski-Peretz et al., 2023). Intraprofessional collaboration is needed to coordinate, share information regarding patient progress, adopt an integrated approach, and motivate each other. Nurses collaborate with patient families to support patients in making the right decisions.

Directing, the diabetes nurse educator is guided to 1) Motivate diabetes patients. Build positive relationships with patients in education (Zhao et al., 2023). 2) Respect patient culture and values (Maboko et al., 2024). 3) Educate patients using simple, easy-to-understand language and avoiding medical terms (Kovach & Pollonini, 2022). Diabetes nurse educators build positive and supportive relationships with patients. Nurses provide emotional support and appreciation if patients make progress. Nurses must be empathetic, active listeners and understand the concerns felt by patients. In addition, nurses must understand the patient’s culture and adapt educational methods and nursing interventions that align with the patient’s values and culture as long as they do not conflict with nursing theory. Nurses must maintain patient comfort in the education process.

Controlling, diabetes nurse educators are guided to 1) evaluate using the teach-back method (Hong et al., 2020); 2) repeat educational material if the patient shows signs of not understanding (Berghout, 2021); 3) complete documentation (Everett-Thomas et al., 2021). The teach-back method is used to ensure diabetes patients understand the information that has been taught. The patient is asked to repeat the information that has been trained using the patient’s own words. If the patient does not understand, the Nurse repeats the material that the patient does not understand. After completing the education, the Nurse documents the education process and the results of the educational Attainment s using a documentation sheet.

King’s conceptual system influences all stages of diabetes nurse educator competency. A system is a series of components connected through communication links that exhibit purposeful and directed behaviour (King, 2016). The three interacting systems (Nurse, patient, and environment) determine the physical and social environment in which humans operate (King, 2016). Educational planning is influenced by the Nurse Personal System, namely the commitment of nurses as educators, and influenced by the Nursing Social System, namely the atmosphere of the hospital/room environment and hospital management policy. The main focus of the Personal System is the individual as a unique and complex entity, considering personal characteristics, health needs, and environmental adaptation (King, 2016).

The organization of nursing resources is influenced by the Nurse Personal System, namely Nurse workload and Nurse job management. A high workload can cause burnout (Nining et al., 2024), and the quality of education decreases. Hospital management considers the number of diabetes educator nurses according to the number of diabetes patients and provides professional development training opportunities. Work management requires solid communication among team members.

The nursing staff is influenced by the Nurse Interpersonal System, namely the relationship between diabetes educator nurses and diabetes patients and cultural influences. The relationship between the diabetes nurse educator and the patient requires a balance between the diabetes educator nurse and the patient. Both must support each other, have the same enthusiasm, and utilize the culture of Sipakatau, Sipakalebbi, and Sipakainge. Sipakatau is mutual respect and respect for each other’s roles. Sipakalebbi is mutual glorification. Nurses glorify patients as individuals who need information, and patients glorify nurses as providers of nursing services. Sipakainge is a mutual reminder. The Nurse reminds the patient about diabetes management, and the patient conveys the desired educational needs.

Directing is influenced by the Nurse’s personal system, namely nurse communication. Nurses communicate with patients, from perception, reactions, interactions, and transactions to goal attainment (King, 2016). The Nurse’s perception of the patient’s situation, condition, and needs, getting a reaction to the information obtained. Information exchange occurs between diabetes nurse educators and diabetes patients (interaction) so that communication happens. Nurses communicate with empathy and a patient-centric approach. They are building a relationship of mutual trust and openness. Educational control is influenced by the Nurse’s Personal System, namely the integrity of nurses. The integrity of the diabetes nurse educator shows that all educational processes are documented accurately and completely. Nurses have strong work morals, tenacity, and consistency.