Determinants of nurse satisfaction using insulin pen devices with safety needles: an exploratory factor analysis

Background A paucity of data exists to examine nurses\u2019 satisfaction with the use of insulin pens with safety needles in hospitalized patients with diabetes. We investigated major determinants of nurses\u2019 preference of the method of insulin administration in the context of a General Hospital in Northern Italy. Methods Consecutive patients admitted to three hospital units of different care intensity requiring insulin received insulin therapy through either the vial/syringe method (October to December 2012) or pen/safety needles with dual-ended protection method (January to March 2013). Before the implementation of insulin pens, floor nurses received a specific training program for proper insulin pen injection technique including individual testing of the devices (pen/safety needles). At the end of the study, nurses completed the Nursing Satisfaction Survey Questionnaire. Cronbach\u2019s alpha was used to determine the internal consistency and reliability of the questionnaire. Major determinants of satisfaction were investigated through an exploratory factor analysis. The association between each retained factor and time spent to teach patients how to self-inject insulin with pen devices was also investigated. Results Fifty-three out of 60 nurses (mean age\u2009\ub1\u2009SD 36.2\u2009\ub1\u20098.5 years, 85 % women, 57 % with 10+ years of working experience) returned the questionnaire. Internal consistency of the questionnaire was satisfactory (Cronbach\u2019s alpha\u2009>\u20090.9). Three months after their introduction, about 92 % of nurses considered pen devices an \u201cimprovement\u201d over the vial/syringe method. Two factors explained 85 % of nurses\u2019 satisfaction, one related to convenience and ease of use, and the other to satisfaction/time spent for dose preparation and administration. The latter factor was inversely correlated with time spent on patients\u2019 training tasks. Conclusions Nurses\u2019 satisfaction with pen devices was higher than previously reported, possibly reinforced by safety needles with dual-ended protection. Perceived workload was a major determinant of nurse satisfaction using pen devices with safety needles. To facilitate the introduction of insulin pens in the hospital setting, it should be specifically addressed during training programs in the switch-over period