Diabetes Knowledge Assessment among Nursing Staff in Saudi Arabia - Research Proposal Example

Research Proposal Diabetes Knowledge Assessment among Nursing Staff in Saudi Arabia Table of Contents 3 Introduction/ Background 4 Study significance 6 Critical Literature Review 7 Search strategies 7 Summary of Reviewed Literature 8 Research Questions 12 Research Design and Methods 12 Design for the Study 12 Conceptual Framework 13 Setting 14 Population and Sample 15 Procedures 15 Ethical Implications 17 Time frame 18 Budgeting 19 Limitations 20 Dissemination of Findings 20 Project Funding 20 Bibliography 21 22 Abstract Diabetes has certainly become one of the world’s most prevalent diseases. It affects people of all ages (young, middle aged and old) regardless of their race, culture, background and origin. Hence, health care is very critical when it comes to a patient that has diabetes in the event that health care progress outcomes are to be achieved by the patient. As such, diabetes patients need effective care which should aim at improving their present and future health outcomes. In most occurrences, diabetes patients do not receive optimal care as they should. This could be attributed to the actual diabetes knowledge that the registered nurse (RN) has and the perceived knowledge that the RN has acquired in their career as a care giver. Based on that, the statement of the problem in this research proposal relates to the diabetes knowledge that nursing staff have in the Kingdom of Saudi Arabia. The problem statement stated above is what shall propagate the aim of this research proposal which is to make an assessment on the basic diabetes knowledge (whether actual or perceived) that registered nurses (RNs) in the Kingdom of Saudi Arabia have. This is based on the fact that diabetes in the Kingdom of Saudi Arabia has been prevalent over the past years and the health care techniques that are available do not guarantee optimal health care outcomes to the patient that has diabetes. In addition, the significance of this research proposal is to reveal the current status of the basic diabetes knowledge (whether actual or perceived) that RNs in Saudi Arabia have. The method that shall be used in this research proposal is the quantitative descriptive research method. As such, a total of 1000 registered nurses (RNs) in Al Qassim area shall be selected for participation in this research proposal. To ensure that the data collected is minimal for analysis, a sample population of 320 RNs shall be used. In addition, a total number of 151 primary health care facilities in the Al Qassim area shall be included in the research proposal. Lastly, for the case of diabetes knowledge assessment, the instrument that shall be utilized is the Diabetes Basic Knowledge Test (DBKT). Introduction/ Background Among the global health issues that exist in the world, diabetes is known to be the most prevalent global health issue which affects approximately 382 million people (World Health Organisation, 2012; International Diabetes Foundation; 2014; Diabetes Australia, 2013) in the world. In addition to that, the World Health Organisation (2012) also mentioned that an estimated number of 3.4 million people in the world were fatalities to diabetes due to the reason that their blood sugar level (BGL) was higher than the normal of 70 to 100 milligrams per decilitre (mg/dL) (Al-Arouj et al., 2010) and/ or a molarity (millimoles per litre) of 3.88 to 5.55 (mmol/l) (Diabetes UK, N.d). In the Kingdom of Saudi Arabia, the situation is not different. In an epidemiological health survey that was conducted by Al-Nozha et al. (2004) from 1995 to 2000, it was revealed that Diabetes Mellitus (DM) was in a position to cause a crisis in the coming years due to its ever increasing prevalence rates in the population. Diabetes Mellitus (DM) was quite a huge risk factor to the individual as they were more likely to adopt coronary artery disease (CAD). Out of the 16, 917 subjects that participated in the survey, 4,004 were diagnosed with DM. Based on those findings of the population sample, it was established that 23.7 percent of the general population in the Kingdom of Saudi Arabia had DM. The results of this study were supported by the cross sectional study that was conducted by Alqurashi et al. (2010). The aim of the study (Alqurashi et al., 2010) was to make an assessment of the prevalence of diabetes mellitus in the Kingdom of Saudi Arabia. As such, the results collected would be used to make better assessment procedures and come up with solutions for patients who had the condition. As such, the participating patients were provided questionnaires which were collecting information related to the history of the patient’s disease. In addition, the patient’s therapies were also recorded and projected in the form of charts. A total of 6024 patients participated in the study; however, 1792 were confirmed to have Diabetes Mellitus (DM). The results also revealed that the disease was highly common in the older generations – this was based on the fact that the average age and standard deviation was 55.3 years and 13.2 respectively. Moreover, males were more prone to have Diabetes Mellitus (DM) as compared to women. The results were 34.1 per cent and 27.6 per cent respectively. With regard to Diabetes Mellitus (DM) and body mass index, it was established that majority of the patients (85.7 per cent) had a body mass index of ≥ 25. In addition, females were revealed to have a higher body mass index as compared to males with results of 87.7 per cent and 83.1 per cent respectively. This study concluded that Diabetes Mellitus (DM) was highly prevalent among the Saudi Arabia population. The solution that the study projected was that there was need for a national health program that would be utilized so as to communicate to the population about the risk factors that were associated to the disease. As such, nurses would play a crucial role to address these risk factors. Based on those statistics, nursing knowledge is very essential while dealing with patients that have Diabetes Mellitus (DM). This is because nurses play a very crucial role while offering care to these patients. Some of the roles that nurses play in primary care include: they offer patients diabetes self-management education (DSME) (Funnell et al., 2012); they assist patients to perform self care while they are not in the care of their nurse; they offer diabetes patients with information on how they could better manage their condition and they enable the patient to understand the need for compliance to medication (Shrivastava et al., 2013). In a cross sectional study that was conducted by Yacoub et al. (2014), it was established that diabetes nursing knowledge (actual knowledge as well as perceived knowledge) was a necessity for registered nurses so as to improve patient health care outcomes. In a bid to ensure that the needed (actual and perceived diabetes) knowledge was achieved and/ or attained by the registered nurse, continuing education (Yacoub et al., 2014) as well as the engagement in Continuing Medical Education (CME) programs were highly supported by the Saudi Commission for Health Specialties (Saudi Gazette, 2011). The end results of these programs – continuing education and CME programs would not only ensure that the registered nurse was well equipped with diabetes management skills, but it would also ensure that patients with diabetes in the Kingdom of Saudi Arabia had long term support from their care givers (Saudi Gazette, 2011). This research proposal shall seek to make an assessment of the diabetes knowledge that nursing staff in primary care have in the Kingdom of Saudi Arabia. Study significance It is without doubt that Diabetes Mellitus (DM) is on the increase not only in the Kingdom of Saudi Arabia but all over the world. Individuals need to know more about the condition from effective and reliable sources such as their primary health care providers (nurses). In addition, for patients who already have DM, the primary health care providers need to be well equipped with the correct and up to date knowledge that they could offer to the patients so as to help the patient perform self care in the event that the nurse is not within their reach. The significance of this research proposal is to reveal the current status of the diabetes knowledge (whether actual or perceived) that registered nurses (RNs) in Saudi Arabia have. This shall be achieved by using the Diabetes Basic Knowledge Test (DBKT). This is an instrument that is commonly used to make an assessment of the diabetes knowledge that RNs have or have acquired. It is also worthy to note that this research proposal shall provide essential information based on diabetes management knowledge in RNs. Hence, the research proposal shall be a valuable resource at the King Fahd University library collections. Critical Literature Review Search strategies The search strategies that shall be implemented in this research proposal shall be based on peer reviewed publications. These publications shall be focussed on data and information that is related to the importance and/ or assessment of nursing knowledge among nursing staff in the Kingdom of Saudi Arabia. The databases that shall be used include: Journal of Nursing Education and Practice, Science Direct, Wiley and Google Scholar. The search terms that shall be utilized include the following keywords: ‘diabetes in Saudi Arabia’, ‘patient education’, ‘nursing actual knowledge and perceived knowledge’ and ‘care for individuals with diabetes mellitus in Saudi Arabia’. The search will be limited to publications that were available from 2004 to 2014. Moreover, the language of the publications will be focussed to English since there could be a possibility of other peer reviewed publications in languages other than English. Based on those specifications, a total of 20 peer reviewed publications shall be selected so as to fulfil this criterion. Some of them include: Ahmed et al. (2012); Abduelkarem and El-Shareif (2013); Chan and Zang (2007); Ellis et al. (2004); Oyetunde and Famakinwa (2014); Rubin and McDonnell (2010); Spollett (2006); Yacoub et al. (2014). For further discussion purposes, the following peer reviewed articles shall be used: Al-Nozha et al. (2004); Al-Arouj et al. (2010); Alqurashi et al. (2010); Funnell et al. (2012); International Diabetes Foundation (2014); LoBiondo-Wood and Haber (2013); World Health Organisation (WHO) (2012). Summary of Reviewed Literature A number of studies have supported the fact that nursing knowledge in diabetes is very essential in dealing with patients who have diabetes as well as improving their health outcomes. In addition to that, a number of studies have also assessed the effects that are caused by the lack of nursing knowledge in diabetes. Yacoub et al. (2014) conducted a cross sectional descriptive design study in Jordan whose aim was to assess the importance of nurses having knowledge about diabetes first hand before handling a patient. The registered nurses (RNs) who were offering primary care to diabetes patients were required to complete a set of self administered questionnaires. The Diabetes Self-Report Tool and the Modified Diabetes Basic Knowledge Test were both used to make a critical assessment based on the RNs actual knowledge regarding diabetes. The cross - sectional study involved 450 eligible registered nurses. However, only 277 fully accepted to participate in the study by submitting their responses. From the responses that were tabulated, it was revealed that the nurses in the hospital lacked adequate clinical knowledge that related to diabetes. In addition to that, these nurses did not know what theories it is that they could implement while handling patients with diabetes. A good example that the study projected was the lack of knowledge in: handling insulin as well as its storage; planning as well as preparation of meals for the patient and how to treat hypoglycaemia. The limitations of this study were that the participants were selected out of a convenience sampling technique. As such, the time that the RNs took to complete the questionnaires provided was much more than the anticipated 50 minutes. In conclusion, it was established that the RNs in the study had a clinical as well as a theoretical knowledge deficit. Based on that, this was a challenge in the manner in which the nurses handled their patients – for example, they had challenges in describing to the patient what the best channels to store their insulin and so on. From these study results, it can be established that nurses need to enrol for continuing education so as to boost their knowledge with regard to diabetes. In addition to that, it was also established that there is need for nurses to disburse information that is evidence based to their patients while offering primary care. This enables not only the nurse to have a reliable knowledge base, but it also improves the patient health outcomes. The findings of this cross sectional study were supported by a questionnaire based statistical analysis (t-test) study that was conducted by Abduelkarem and El-Shareif (2013) at a Tripoli Medical Centre located in Libya. The aim of this study was to assess what areas of diabetes management do registered nurses (RNs) lack information in and/ or have a deficit in information. The RNs who were to be assessed were a total number of 116 nurses. The total number of questionnaire questions that were handed to them was 66. The responses to the questionnaire were as follows: the average total score was 48.5 ± 15.1. When interpreted, it was established that nurses who were in the field of paediatrics were more knowledgeable with regard to diabetic knowledge as compared to nurses who were in other fields in the hospital setting. The results were as follows based on the stated variables (paediatric nurses and other nurses): the average score for diabetic knowledge in paediatric nurses was 62.0 ± 5.5 and the later had an average of 53.0 ± 12.8. Based on those numbers, it was established that some RNs had a diabetes knowledge deficit. As such, the recommendation to these RNs was that they ought to engage in educational programmes that would help them to gain more knowledge with regard to diabetes as well as knowledge based on primary care for in-patients who had diabetes. Hence, this would improve the health outcomes of the patients. Furthermore, the aspect of a deficit in diabetes knowledge and the need for continuing diabetes knowledge was also propagated by Ahmed et al. (2012) and Oyetunde and Famakinwa (2014). Ahmed et al. (2012) conducted a 21 questionnaire based study on the awareness that resident trainees and registered nurses (RNs) in the fields of internal medicine (IMR), family medicine (FMR) and surgery (SR) had with regard to diabetes management in tertiary care hospitals that were located in Karachi, Pakistan. A total of 99 RNs, 27 FMRs, 169 IMRs and 86 SRs were involved in the study. The results of the study were as follows: the average correct responses from all the participants was 50% +/- 21; there was no statistical significant difference between the knowledge that IMRs and FMRs participants had – that is, 64% +/- 14 and 60% +/- 16 respectively with a p value of 0.47; RNs overall diabetes knowledge was determined to be an average of 40% +/- 20; the correctly answered responses from SRs and RNs was determined to be 40% +/- 16 and 31% +/- 15 respectively. From those statistics, it was established that RNs and SRs had massive deficit knowledge in diabetes management – that is, 31% +/- 15 and 40% +/- 16 respectively. Moreover, the questionnaire that was offered to the participants also revealed that the engagement in diabetes programs significantly improved between the first to the second year with a p value of 0.03 and after the second year, there were no further improvements. Lastly, the average score of RNs clearly indicated a deficit in diabetes management knowledge and the need to improve this aspect. The study that Oyetunde and Famakinwa (2014) conducted in the region of Ondo in Nigeria supported the conclusions by Ahmed et al. (2012). The survey (Oyetunde and Famakinwa, 2014) revealed the essence of diabetes education and knowledge on the part of the registered nurse. This was established to be essential to the achievement of better quality of care for patients with diabetes in government hospitals in the region of Ondo in Nigeria. From the study, a total of 401 randomly selected nurses were eligible for participation. The instrument that was used was a questionnaire which has 44 items that were mandatory to respond to. The questionnaire was focussed on knowledge that was related to skin care, glucose monitoring, foot care, exercise and physical activity and nutrition education. The results were as follows: 29.2 per cent of the participants showcased good nutrition knowledge; 24.9 percent showcased good knowledge related to exercise and physical activity; 34.4 percent hygiene/foot care knowledge; 24.9 percent glucose management knowledge. The results vividly revealed that there was need for RNs to engage in modules that boosted their diabetes knowledge. Moreover, there was emphasis on continuing education for nurses in a bid to achieve optimal diabetes management knowledge in RNs. Chan and Zhang (2007) conducted a similar but correlation survey of two (2) hospitals in Hong Kong, China. The aim of the study was to make an assessment of the nurse’s actual and perceived knowledge with regard to diabetes mellitus in the two (2) hospitals. The methodology that was used was a cluster analysis. There were 245 nurses who completed the questionnaire. They were divided into three (3) clusters. The first cluster of nurses showcased good competence level as well as diabetes knowledge from their responses. However, the other two (2) clusters of nurses were not adequately knowledgeable with regard to diabetes management knowledge. More evidently, cluster 2 nurses were better as compared to cluster 3 nurses. Based on the cluster 1 nurses, there was a statistical correlation between the nurse’s actual knowledge as well as their perceived knowledge about diabetes management. The conclusions from the study were that nurses need to be adequately informed about diabetes management information. The recommendations from the study were that the lack of knowledge on the side of the nurse had an impact on the general health outcomes of the patient. That is, the patients with diabetes received health care that was not up to standard. Moreover, the effectiveness of the care from the nurse to the patient was inadequate. As such, nurses were required to engage in relevant forms of training that would enable them to improve on their current knowledge about diabetes management as well as patient education (Spollett, 2006; Ahmed et al., 2012; Oyetunde and Famakinwa, 2014; Rubin and McDonnell, 2010). Based on the critical analysis of the literature reviewed, it can be stated that all the studies conducted confirmed a diabetes management knowledge gap among the registered nurses. Most of the conclusions advocated for in the studies reviewed emphasized on the need for nurses to engage in nursing programs and modules that would enable them to improve on their knowledge about diabetes management. Research Proposal Aim The main aim of this research proposal is to make an assessment on the basic diabetes knowledge among registered nurses (RNs) in the Kingdom of Saudi Arabia. The objective of the proposal includes conducting a questionnaire based study which shall collect information related to diabetes knowledge of RNs in Saudi Arabia. This is due to the reason that there is need to maximize on health care outcomes for patients with diabetes in Saudi Arabia. Research Questions 1. What is the general (basic) nursing knowledge about diabetes in primary health care in Saudi Arabia? 2. What is the impact of demographic factors that influence of nurse knowledge? Research Design and Methods Design for the Study The design that the final research study shall undertake is a quantitative descriptive study. This is a type of design study in which the variables under consideration are related to one another (LoBiondo-Wood and Haber, 2013). As such, these types of studies need to have a sample of the population (participants) that shall be in a position to respond and/ or provide information that will be used to make an assessment for the research study. Moreover, questionnaires are the major tool for the collection of data and/or information from the participants in a systematic manner. With regard to quantitative descriptive studies, it is important to note that research questions are the main mode for the collection of information from the participants. In addition to that, it is worthy to note that relationships and/ or the causative and effective relationships between the variables are not established (LoBiondo-Wood and Haber, 2013; Babbie, 2010; University of Southern California, 2014). Conceptual Framework As noted by Spollett (2006), Ahmed et al. (2012), Oyetunde and Famakinwa (2014) and Rubin and McDonnell (2010), nurses need to have the basic diabetes knowledge while handling their patients. The benefit of this is that it helps to improve on the patient health care outcomes. The following variables shall be conceptualized: basic diabetes management and registered nurses. Moreover, the action of engaging in training as well as educative modules so as to gain more knowledge with regard to basic diabetes knowledge shall also be taken into consideration in the conceptual framework. Table 1 summarizes the conceptual framework Table 1: The table above indicates what nurses ought to have – for example, they ought to engage in training, practice the skills that they have acquired in training and finally, gain more experience as they practice the skills that they have acquired in training. This helps to improve their basic diabetes management knowledge in the hospital setting. Setting The final research study will be conducted in the Al Qassim area which has 151 primary health care hospital settings (Ministry of Health Portal, 2014) that were set up by His Excellency Abdullah bin Abdulaziz Al-Rabeeah. There are approximately 1000 eligible registered nurses in the area. As such, these are the main and/ or primary care givers for patients with diabetes in the area. Population and Sample The research study population shall include a population of 1000 registered nurses who are from the primary health care setting in the Al Qassim area. It is worthy to note that total sampling technique shall be implemented in a bid to establish a reliable and efficient sample size for the research study. Based on that, an approximate number of 320 registered nurses shall be the population sample for this quantitative descriptive research study. Procedures Instruments The instrument that shall be used is the Diabetes Basic Knowledge Test (DBKT) that was developed by Drass, Muir-Nash, Boykin, Turek, and Baker in 1989 as an improvement to the Diabetes Knowledge Tool (DKT) that was developed by Scheiderich, Freibaum, and Peterson in 1983 (Francisco, 2013). The main reason for this choice is because the DKT tool was based on diabetes patient education literature while the DBKT retrieved the following information from the registered nurse: the nurse’s knowledge with regard to insulin administration; nurse’s knowledge on physical activity; knowledge on stress and how to avoid and/ or prevent it; knowledge on how to monitor blood glucose levels; knowledge on the various forms of complications with diabetes, nutrition and diet; foot care; how to handle hypoglycemia and hyperglycemia (Francisco, 2013). Hence, the DBKT instrument was more reliable and resourceful given that its authorization was also granted. Data Collection Before the data collection process shall be started, approval has to be sought from the Ministry of Health in the Kingdom of Saudi Arabia. This is in a bid to enable data to be collected from some of the 151 primary health care facilities in the Al Qassim area. It is important to note that, this shall be conducted three weeks before the questionnaire is disbursed to the participants. Therefore, the researcher shall have to meet with some of the Head Nurses and/ or Nurses in Charge so that they can be elaborated to the research proposal objective, significance, procedures and the DBKT questionnaire test. In addition, they shall also be informed on the mode of questionnaire submission that shall be used – that is, once the participants have filled in the questionnaire, they shall have to take a marked envelope from a centralized location in the hospital setting and place the responses to the questionnaires in it. After that, they shall have to drop the marked envelope in an adjacent collection box that is also in a centralized location in the hospital setting. In a bid to ensure that all the responses are collected, posters shall be placed in the hospital setting after 10 days which shall seek to remind the registered nurses (RNs) to drop their responses in the centralized collection box in their respective hospital setting. After the collection process has been completed, the responses shall be stored securely for the next process of data analysis. It is also worthy to note that the research study data and/ or information shall be reported as grouped data and not as individual responses data. Data Analysis Before the process of data analysis is initiated, all the data collected from the responses shall be labelled so as to prevent a mix up of the different responses from the different hospital units. Moreover, labelling shall also be conducted so as to ensure that every response collected is accurate as well as fully completed – this will help to prevent inaccurate analysis of the data collected. The data shall then be stored in the computer’s hard disk drive. A backup of the data shall be stored in a USB drive so as to retrieve the data easily in the event that the actual data is lost and/ or gets corrupted. In a bid to ensure that the data collected is accurate and reliable, the Statistical Package for Social Sciences (SPSS) version 19.0 shall be implemented for statistical manipulation of the data and analysis. The software has the benefit of providing accurate statistical analysis information that is used for documentation. Based on that, the variables collected by the questionnaire such as: diabetes diet, insulin management, blood sugar control shall be recorded and finally interpreted accordingly; hence, the diabetes knowledge deficit shall be established. Moreover, recommendations shall be provided to the nurse – that is, what education do patients need so as to improve their health outcomes. Ethical Implications Due to the fact that this research proposal shall involve participants, ethical considerations need to be practiced and adhered to. According to the Royal College of Nursing (RCN) (2011) and Fouka and Mantzorou (2011), the following ethical considerations need to be adhered to. These include: informed consent – where the participant (s) to be involved in the study are well informed of the proposal and its objectives – as such, the participant (s) can give their consent to the study or not; offering beneficence – this involves assuring the participant (s) that the study is being conducted for the solemn purpose of promoting better service to medical care – in this case, the solemn purpose is to ensure optimal nursing knowledge in diabetes management by the registered nurse; promoting privacy and confidentiality of the data that the participant (s) share (s). As such, a written approval shall be received from the school as well as the Ministry of Health Department in the Kingdom of Saudi Arabia. Moreover, these approval documents shall be discussed to the Head Nurse and/ or Nurse in Charge together with the nursing staff in the various selected hospital settings so as to ensure that while the final study is being conducted, there are no hitches that shall occur which may hinder the progress of the quantitative descriptive research study. Moreover, the participants shall also be informed of their right to make their own personal decisions with regard to the questions asked. Moreover, the participants shall also be informed that they have the same opportunity to respond to the DBKT questionnaire. In the event that the participants have any inquiries, these shall be addressed accordingly. Due to the fact that the final study shall be conducted in a region whose native language is not English, language translators shall be present so as to help translate in any communication purposes or clarifications that shall be needed. It is important to note that this individual’s details shall be passed on to the Ministry of Health in the Kingdom of Saudi Arabia so that they can have a record of the additional participating personnel who is neither a researcher nor a nursing staff. Lastly, it is without doubt that the procedure shall have an effect on the normal working operations of the specific hospitals. Therefore, the participants shall be awarded in the form of a souvenir so as to appreciate their efforts in the research study undertaking. Time frame Table 3: Research study timeframe Project Activity July 2014 to June 2015   Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Research proposal finalization                         Submission of the ethical application                         Approval of the research                         Questionnaire translation                         Pilot testing of the instrument                         Data collection                         Data analysis                         Report writing                         Submission of the report                         Publication of the report                         Budgeting Table 4: Research study budget Budgeting variables Unit Unit price Total in Australian Dollars Project Personnel Compensation budget       Authorised translator in the study 1 120 120 Authorised statistician for the study 1 130 130 Data collectors in the study 10 20 200         Travelling Expenses Compensation Budget       Local travel expenses for 10 personnel 10 30 300 Air Travel to Al Qassim area from Saudi Arabia 1 600 600         Miscellaneous Costs To Budget For       Printing and copying expenditure 1 5 5 Posters to put in the hospitals 100 0.5 50 Envelopes to put the questionnaire responses in 500 0.5 250 Pen and marking pens 10 1 10 Writing pads 3 0.8 2.4 Souvenirs for the volunteer participants 320 5 1600 Setting up meetings with staff 20 1.5 30 Calls 1 20 20     Total 3317.4 Limitations The limitations of the study that shall be anticipated include biasness and the lack of accuracy in the responses by the participants. Secondly, time could also be a challenge in the event that the participants fail to drop their responses in a timely manner. Otherwise, the quantitative descriptive research study is prone to collect accurate and reliable data and/ or information subject for analysis and documentation. Dissemination of Findings The results of the quantitative descriptive study shall be presented in the form of a report to the participating hospitals in the Al Qassim area in the Kingdom of Saudi Arabia. In addition to that, the researcher shall also present the findings in the schools website so that medical students can have access to the information presented in a bid to help them advance their skills in diabetes management. Project Funding The researcher shall seek to apply for project funding from the school. This is based on the reason that the school advocates for research studies by the students. Moreover, an application for a grant shall also be filled out and presented to the Nursing Association in the Kingdom of Saudi Arabia. This is due to the reason that the information that the study shall uncover is prone to be used in the improvement of health care outcomes of patients with diabetes through minimizing diabetes knowledge gaps and/ or deficits by the nurses. Bibliography Al-Nozha, M. M., et al. (2004). Diabetes mellitus in Saudi Arabia. Saudi Medical Journal, 25(11), 1603–1610. Al-Arouj, M., et al. (2010). Recommendations for management of diabetes during Ramadan. Diabetes Care, 33(8), 1895-902. Alqurashi, K. A., et al. (2010). Prevalence of diabetes mellitus in a Saudi community. Annals of Saudi Medicine, 31(1), 19–23. Ahmed, A., et al. (2012). Diabetes related knowledge among residents and nurses: a multicenter study in Karachi, Pakistan. BMC endocrine disorders, 12(1), 18. Abduelkarem, A. R., and El-Shareif, H. J. (2013). Assessment of diabetes-related knowledge among nursing staff in a hospital setting. Journal of Diabetes Nursing, 17(6). Babbie, E. R. (2010). The Practice of Social Research. 12th ed. Belmont, CA: Wadsworth Cengage. Chan, M. F., & Zang, Y. L. (2007). Nurses’ perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis. Journal of clinical nursing, 16(7b), 234-242. Diabetes Australia. (December 2013).Diabetes Globally. Web. Retrieved from: http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-Globally/ Diabetes UK. (N.d). Blood Sugar Converter. Web. Retrieved from: http://www.diabetes.co.uk/blood-sugar-converter.html Fouka, G., & Mantzorou, M. (2011). What are the Major Ethical Issues in Conducting Research? Is there a Conflict between the Research Ethics and the Nature of Nursing?. Health Science Journal, 5(1). Francisco, M. A. (2013). Instruments That Measure Nurses Knowledge About Diabetes: An Integrative Review. Journal of nursing measurement, 21(1), 137-152. Funnell, M., et al. (2012). National standards for diabetes self-management education. Diabetes Care, 35 (8) 101-115. International Diabetes Foundation. (2014). Introduction – Key messages. Web. Retrieved from: http://www.idf.org/diabetesatlas/introduction LoBiondo-Wood, G., & Haber, J. (Eds.). (2013). Nursing research: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences. Ministry of Health Portal. (January 2014). Ministry News: MOH: this Years Budget Comprised 179 New Health Projects. Web. Retrieved from: http://www.moh.gov.sa/en/ministry/mediacenter/news/pages/news-2014-01-14-001.aspx Oyetunde, M. O., and Famakinwa, T. T. (2014). Nurses’ knowledge of contents of diabetes patient education in Ondo–state, Nigeria. Journal of Nursing Education and Practice, 4(4), 91. Royal College of Nursing. (January 2011). Research Ethics. Web. Retrieved from: http://www.rcn.org.uk/__data/assets/pdf_file/0007/388591/003138.pdf Rubin, D. J., and McDonnell, M. E. (2010). Effect of a diabetes curriculum on internal medicine resident knowledge. Endocrine Practice, 16(3), 408-418. Spollett, G. (2006). Promoting continuing education in diabetes management. Endocrine Practice, 12, 68-71. Shrivastava, S. R., et al. (2013). Role of self-care in management of diabetes mellitus. J Diabetes MetabDisord, 12(1), 14. Saudi Gazette. (2011). Saudi nurses participate in CME program on diabetes. Web. Retrieved from: http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20110520101111 Yacoub, M. I., et al. (2014). An assessment of diabetes‐related knowledge among registered nurses working in hospitals in Jordan. International nursing review. University of Southern California. (2014). Quantitative Methods. Web. Retrieved from: http://libguides.usc.edu/content.php?pid=83009&sid=615867 World Health Organisation (WHO). (2012). Diabetes. Web. Retrieved from: http://www.who.int/mediacentre/factsheets/fs312/en/ Read More