Diabetes knowledge for patient self-management support and education : a concurrent mixed methods study of diabetes knowledge of nurses working in a major tertiary hospital in Saudi Arabia

University of Technology Sydney. Faculty of Health.: Diabetes Mellitus poses a growing burden globally and Saudi Arabia is no exception. Optimal health outcomes require those affected to be well-informed about the disease and its treatment to enable them to make appropriate lifestyle choices, and to adopt effective self-management strategies. Registered Nurses are at the front line of patient education and have the opportunity to determine and deliver strategies for optimal diabetes care. : The aim of this study was to examine nurses’ knowledge of diabetes care and its management, and to identify barriers and facilitators influencing diabetes knowledge acquisition among nurses working in a tertiary hospital in Saudi Arabia. : A concurrent mixed method design was used in this study. The study was comprised of two phases. During Phase One, a cross-sectional survey was distributed to 700 nurses in a range of specialties in the Prince Sultan Medical Military City (PSMMC) in Riyadh, Saudi Arabia, with a response rate of 60.4%. Perceived and actual knowledge was assessed using the Diabetes Self-Report Tool and the Diabetes Basic Knowledge Tool. In Phase Two, semi-structured interviews were conducted with 16 nurses from various specialties in the PSMMC. After data from the two phases were analysed individually to answer research questions specific to each phase, the results were integrated and considered in relation to Kanter’s Theory of Structural Empowerment. : Survey results suggested that Registered Nurses in the Prince Sultan Medical Military City perceived themselves as possessing adequate knowledge to provide diabetes care and education but knowledge test scores revealed insufficiencies. In-depth semi-structured interviews with nurses shed light on the organisational and individual barriers perceived to hinder acquisition of diabetes knowledge by these nurses. These barriers included organisational characteristics of wards and multi-disciplinary team function that served to disempower nurses in their diabetes education role. Individual-level barriers included lack of access to diabetes education and clinical experience, lack of motivation or interest. Findings highlight how nurses’ individual characteristics interacted with those of their environment in influencing the knowledge and skills they could apply in delivery of their roles. : Registered Nurses have the potential to influence the lives of many patients with diabetes. With the alarming growth in numbers of people with diabetes, nurses need to be empowered to engage patients in effective self-management. Thesis findings support development of policies and interventions to advance the diabetes knowledge and practice of frontline nurses, and strategies to empower them to apply this knowledge to promote better outcomes for people living with diabetes