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Integrating Preconception Counseling into Clinical Practice with an On-line Education Program for Health Professionals

Jessica Devido, MSN, RN, CPNP, Lisa Bernardo, PhD, MPH, RN, HFI, Andrea Rodgers Fischl, PhD, MPH, CRNP, Mary Schubert, MPM, RN, Lynn Cooper, Denise Charron-Prochownik, PhD, RN, CPNP, FAAN

University of Pittsburgh School of Nursing

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Background

• American Diabetes Association recommends, starting at puberty, all women with diabetes receive preconception counseling (PC) at each clinic visit.

• Nurses lack knowledge of and experience in delivering PC to their female patients with diabetes.

(ADA, 2004) (Michel & Charron-Prochownik, 2006)

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Background• RN CDE On-line Survey

– n = 202 AADE members

– 97% women

– 43% age range 40-49

• 45% told their patients about the importance of planning a pregnancy with diabetes

• 55% initiated PC

• 72% had never received formal training to provide PC for their female clients with diabetes

• 87% felt they would benefit from further PC training

(Michel & Charron-Prochownik, 2006)

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Background• Pilot on-site continuing education (CE) prototype for CDEs

– n = 27 healthcare professionals

– 100% women

– 78% nurses

– 22% other health care professional CDEs (e.g., dietitians)

• 100% felt they would benefit from further PC training

• Knowledge significantly increased post-program from 79% to 87% (p<.01)

• Self-efficacy significantly increased post-program from scores of 91 to 140 (p<.01)

(Cothran & Charron-Prochownik, 2009)

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Purpose

• To develop, implement, and evaluate the feasibility of an on-line PC continuing education (CE) program for registered nurses (RNs)

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Design/Sample

• One-group post-evaluation pilot study

• Convenience Sample– RNs self-selected from a large university

medical center with a diabetes institute

• n = 9

• 100% female

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PC CEU Program• Self-instructional program is based on the American

Diabetes Association’s recommendations on PC for women with diabetes

• Selected readings and segments from two interactive DVDs – “Reproductive–health Education and Awareness of Diabetes

in Youth for Girls” (READY-Girls) for teenage girls

– “Pregnancy Planning for Women With Diabetes” for women planning a pregnancy

• Both programs developed by Dr. Denise Charron-Prochownik’s research team

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Program modules

• All phase of PC were included in the program modules– Introduction to Preconception Counseling

– Not Ready for Pregnancy- Raising Awareness to Prevent Unplanned Pregnancy

– Getting Ready- Overview for Adult Women Considering Pregnancy

– Being Ready

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Phases of Comprehensive Preconception Counseling

• Phase 1: “Awareness Counseling” PC

• Phase 2: “Overview” PC (>6 mo)

• Phase 3: “In-depth” PC and Care (<6 mo)

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MethodsOnce nurses agreed to participate:

• A Blackboard system account and username created and assigned

• Directions emailed

• Completed the assigned readings and videos

• Completed Measures

– Knowledge measure regarding PC and pregnancies of women with diabetes was integrated throughout the modules

• Evaluated the objectives

• Emailed log hours to sponsor

• Received Continuing Nursing Education (CNE) certificate

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Results

• Mean completion time= 3.8 hours (range 2-6 hours)

• Mean knowledge score= 92% following the program

• 100% strongly agreed/agreed that the program met the content objectives

• 100% strongly agreed/agreed that strategies presented were conducive to learning

• 100% strongly agreed/agreed that they would be able to apply the ADA’s PC guidelines to potential patients

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Conclusions• This program was feasible and easily

disseminated. On-line makes it easier to access and could minimize cost.

• Knowledge of PC was high following the program.

• Participants were satisfied.

• Upon completion of the program, participants received 4.0 (CNE) contact hours.

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Implications

• This low cost, easily accessible CE program can potentially be cost-effective.

• Dissemination of this program can benefit RN’s and other health care professionals by preparing them to provide PC to their female patients with diabetes to improve pregnancy outcomes.

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Acknowledgments

• Supported by UPMC diabetes appropriates for DoD USAARMAA.

• Patricia Schmitt

• Monica Dinardo

• Feng Guo

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Questions?