The current status and influencing factors of diabetes knowledge among non-endocrinology nurses of tertiary general hospitals: a cross-sectional survey study

The study used a cross-sectional design and convenience sampling approach.

This study utilizes an online cross-sectional questionnaire survey method, with the collection of questionnaire data following informed consent from the survey subjects. From February 2023 to March 2023, we conducted a cross-sectional survey involving 3,117 participants recruited from registered nurses in tertiary general hospitals in Guizhou Province, China. The inclusion criteria consisted of the following: (1) Obtained a nursing practice certificate and worked for ≥ 1 year; (2) Not an endocrinology nurse; (3) Non-endocrinology nurses who have provided informed consent and voluntarily agreed to participate in this study. Exclusion criteria included: (1) Interns, advanced study, and standardized training nurses; (2) Non-ward nurses in the operating room, sterilization supply department, preventive healthcare, outpatient, physical examination, etc.; (3) Nurses not on duty during the survey period. The research sample was drawn from nine tertiary hospitals located in nine prefectures and cities of Guizhou Province. Each selected hospital was ranked as the top comprehensive hospital in its respective city or prefecture.

This study used convenience sampling for sample recruitment. The formal questionnaire was edited into an electronic format, with a standardized instruction attached. The project leader first contacted the directors of the nursing departments at the surveyed hospitals to explain the target participants, purpose, and methods of the study. The nursing directors then distributed the questionnaires to the head nurses of departments meeting the inclusion criteria, providing the same explanations. Subsequently, the head nurses forwarded the questionnaires to eligible nurses within their departments, offering necessary clarifications to ensure the nurses fully understood the content and procedures of the questionnaire. This study adhered to the principle of voluntary participation, allowing participants to withdraw from the survey at any time. The questionnaire was completed independently by nurses after obtaining their informed consent. All questionnaires were completed through an online survey and an electronic data collection tool, Questionnaire Star (www.​wjx.​cn). We had performed a pilot study on twenty nurses before carrying on the survey process to assess the clarity, feasibility, and time needed to fill out the questionnaire. To avoid duplicate submissions and ensure the quality of the questionnaire, the Questionnaire Star backend is set so that the same IP, mobile phone, tablet, or computer can only submit once. Incomplete answers cannot submit the questionnaire, and all questionnaires are filled out anonymously. The survey link was available for one week (from February 5, 2023, to February 19, 2023). A total of 3,249 nurses completed the survey. Based on the total number of survey items, we estimated that completing all items will take approximately 8 min. To ensure data quality, we have decided to exclude questionnaires completed in a very short time (2 min) or a very long time (20 min). Two researchers reviewed the questionnaire results, and after eliminating invalid responses, a total of 3,117 valid questionnaires were collected, resulting in a valid response rate of 95.93%.

According to Medical Practical Multivariate Statistics, the sample size for multi-factor studies should be 10 to 20 times that of the study variables. With approxi-mately 10 influencing factors on the analysis variables in this study, and considering a 20% sample loss and invalid questionnaires, a final required sample size of 240 was calculated. In actuality, a total of 3117 valid questionnaires were collected for this study.

This study has passed the review of the Ethics Committee (approval number: KLLY-2023-104). The voluntary nature of participation and confidentiality of the responses were described in the online questionnaire. Informed consent was obtained from all participants and care managers. All participants were informed of their right to withdraw from the study at any time without facing any consequences.

A total of 2964 female and 153 male nurses from 9 hospitals participated in the study. In sum, 95.10% of respondents were female. Most nurses were aged between 20 and 39 years (86.05%). Regarding educational level, 85.15% of participants held a bachelor’s degree. The demographic characteristics of the participants are presented in Table 1.

The self-assessment total score of 3,117 non-endocrinology nurses is 18.68, with a standard score of 62.27. The objective assessment total score is 20.64, with a standard score of 57.33. The self-assessment score is moderate, while the objective knowledge score is poor. The scores of each dimension and each entry are shown in Tables 2 and 3.

Table 4 presented objective assessment of diabetes knowledge for different general characteristics. The diabetes knowledge scores of female nurses are significantly higher than those of male nurses (P<0.005). Nurses in different departments have varying scores in diabetes knowledge, with ICU nurses scoring significantly lower than those in other departments (P<0.005). Nurses with clinical teaching experience scored higher in diabetes knowledge than those without relevant experience (P<0.005). Nurses who have received diabetes knowledge training scored higher in diabetes knowledge than those who have not received such training (P<0.005). The closer the time to caring for diabetic patients, the higher the nurses’ diabetes knowledge scores (P<0.005).

Using statistically significant items from the one-way analysis as independent variables and the total score of the objective assessment of diabetes knowledge as the dependent variable, a multiple linear regression analysis was conducted. The results showed that the department of employment, whether the nurse had received diabetes knowledge training, and the time since the last care of a diabetes patient are influencing factors for the diabetes knowledge level of non-endocrine nurses (P < 0.05), as shown in Table 5.

In this study, the objective assessment score of diabetes knowledge among non-endocrinology nurses was (57.33 ± 25.78), indicating a relatively low level of knowledge about diabetes. This finding aligns with the conclusions of Chinese scholars Wang and Qiu but reflects a lower score compared to their research [22, 23]. The discrepancy may be attributed to the use of a self-developed questionnaire in this study, which incorporated content aligned with the latest guidelines and included advancements in diabetes-related technologies. These factors may have increased the difficulty for nurses who have not undergone continuous diabetes education.

Among the six dimensions of this survey, nurses performed the worst in knowledge of diabetes complications, scoring only (51.00 ± 33.17) points. This may be related to the detailed specialization in tertiary general hospitals, where nurses and relevant managers focus more on learning and training for diseases within their own departments, thereby neglecting in-depth study and knowledge accumulation of other diseases. The investigation found that in China, over 75% of diabetes patients have at least one complication [24]. Diabetes-related complications not only severely affect the patients’ quality of life and prognosis but are also a major cause of their death [25]. Early identification and management can reduce the incidence of complications and delay the progression of the disease. Therefore, strengthening diabetes knowledge training for nurses in non-endocrinology departments and enhancing their ability to identify and care for complications is of significant value. Healthcare managers should prioritize tailored nurse training based on the disease distribution in different departments.

This study found that the level of diabetes knowledge among non-endocrinology nurses is related to the department, diabetes training experience, and the time since their last care of a diabetes patient. ICU nurses scored the lowest in diabetes knowledge. This may be related to the complexity of ICU patients’ conditions and the nature of the nurses’ work. Due to the broad scope of the discipline, nurses focus more on managing life-threatening issues such as circulation and respiration, while neglecting the long-term care needs of chronic patients. However, research has found that diabetic patients are more prone to complications during acute conditions [26]. Therefore, relevant managers should prioritize diabetes knowledge training for ICU nurses, especially blood glucose management [27].

Nurses who have received diabetes-related training demonstrate significantly higher knowledge levels compared to those without such training. This aligns with findings from Yang L and others [28], who reported that participation in diabetes-related training enhances nurses’ knowledge and health education skills. However, in this survey, only 30.7% of nurses had participated in relevant training, highlighting insufficient training efforts. To address this, managers should intensify training initiatives, broaden participation, and design systematic, targeted programs based on a comprehensive assessment of nurses’ knowledge levels and training needs. Additionally, the recency of caring for diabetes patients was identified as a factor influencing knowledge levels—nurses who had more recent experience in diabetes care exhibited better understanding, consistent with Kaya’s research [29]. Clinical practice plays a crucial role in helping nurses internalize and apply theoretical knowledge. To improve future training programs, it is essential to integrate theory with practice. Incorporating case discussions, demonstrations, reverse demonstrations, and scenario simulations into the curriculum can enhance nurses’ engagement, health education capabilities, and communication skills. Such approaches will improve training quality and foster the standardized development of diabetes care.

The results of this study indicate that non-endocrinology nurses have a moderate level of self-assessed diabetes knowledge. Among the various dimensions evaluated, medication knowledge scored the lowest (59.40 ± 18.00). This may be attributed to the continuous advancements in diabetes prevention and treatment technologies, the rapid updates and iterations of medications, the complexity of drug mechanisms, and the variability in treatment plans [30]. Studies have shown that over 50% of patients are on multiple medications [31]. As key providers of health education, nurses’ proficiency in medication knowledge and their ability to educate patients directly impact patients’ understanding and adherence. Therefore, it is crucial to enhance nurses’ training in drug knowledge to improve their nursing skills and health education capabilities.

Another important finding of this study is the noticeable gap between non-endocrinology nurses’ self-assessed knowledge of diabetes and their actual knowledge levels. In the self-assessment, the top three dimensions identified by these nurses were monitoring knowledge, dietary knowledge, and complication knowledge. However, these same dimensions scored the lowest in the actual diabetes knowledge assessment, highlighting a significant discrepancy. This gap may be attributed to the continuous advancements in diabetes-related technology, while many non-endocrinology nurses may rely primarily on outdated knowledge from their training, highlighting the need for ongoing education. To address this issue, it is recommended that healthcare managers strengthen diabetes-related training programs, regularly organize knowledge assessments and practical evaluations, and help nurses gain a clearer understanding of their actual knowledge and nursing competencies. This approach would enable the development of personalized training plans to bridge the knowledge gap effectively.

IDF places significant emphasis on the training of diabetes care professionals and advocates for enhancing the critical role of nurses in diabetes prevention and management. The campaign, Nurses Make the Difference, which is led by the IDF highlights the vital contributions of nurses in caring for diabetes patients and preventing the disease in high-risk populations. It calls on governments to strengthen diabetes education within nursing curricula and provide ongoing education and professional development opportunities throughout nurses’ careers [32].

This study also found a positive correlation between continuing diabetes education and nurses’ knowledge levels. Therefore, it is recommended that local governments formulate policies to support nurses’ participation in diabetes continuing education, incorporate diabetes-related knowledge into core nursing education curricula, and establish standardized guidelines for continuing nursing education. Healthcare institutions should regularly organize diabetes knowledge update courses and promote interdisciplinary collaboration to facilitate knowledge sharing and enhance comprehensive skills. Additionally, nursing managers are advised to design targeted training programs based on nurses’ knowledge levels and job requirements to bridge the gap between actual knowledge and self-perception.

To enhance the reach and effectiveness of diabetes continuing education, it is recommended to fully leverage the potential of e-learning platforms. By developing online educational courses and resources, geographical barriers can be overcome, delivering the latest diabetes care knowledge and skills to more regions, particularly underserved remote areas or resource-limited communities. E-learning platforms offer flexible learning options, enabling nurses to study at their own pace and convenience. They can also enhance learning outcomes through interactive courses, virtual case simulations, and real-time Q&A sessions. Furthermore, it is suggested that governments and healthcare institutions work together to promote the adoption of e-learning platforms. Providing free or low-cost access to these platforms will ensure that more nursing professionals can participate in diabetes continuing education, ultimately improving overall care quality.

This study provides valuable insights into the current state of diabetes knowledge among non-endocrinology nurses and the factors influencing it. When interpreting the results, several limitations of this study should be considered. The use of convenience sampling may introduce selection bias, as the findings might disproportionately represent hospitals and nurses who are more interested or more readily available to participate. This limits the generalizability of the results beyond the study population. Additionally, the reliance on self-reported assessments may lead to social desirability bias and self-perception bias, where participants could overreport favorable knowledge levels, potentially resulting in an overestimation of their actual knowledge. Lastly, the limitations of the questionnaire content and the selection of study participants may restrict the applicability of these findings to other hospitals, regions, or countries with different healthcare systems and cultural contexts.

Future studies are recommended to conduct larger-scale research, expanding the target population to include nurses from primary and community hospitals. Additionally, exploring the role of organizational factors, such as leadership support or resource availability, in enhancing diabetes knowledge among non-endocrinology nurses could provide valuable insights. Furthermore, implementing targeted training for non-endocrinology nurses and evaluating the long-term impact of such interventions on patient outcomes represents a promising avenue for research. Such efforts could not only improve nurses’ diabetes knowledge but also enhance the quality of life and prognosis for patients with diabetes.