Management of Paediatric Diabetic Ketoacidosis and Occupational Stress in the Emergency Department: A Cross-Sectional Study

Introduction: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of Type 1 Diabetes Mellitus (T1DM) characterized by hyperglycaemia, ketosis, and metabolic acidosis. Management of DKA in the Emergency Department (ED) requires high knowledge and competencies, and it is challenging due to the unique needs of children. 

Purpose: This study aimed to investigate emergency paediatric nurses’ (EPNs) knowledge of DKA management in paediatric patients and to evaluate the correlation between this knowledge and occupational stress (OS). 

Methods: The study recruited EPNs from Children Hospitals, using an adapted questionnaire to assess knowledge of DKA management, and the Expanded Nursing Stress Scale (ENSS) to evaluate OS. Data were analysed with SPSS v23.0, with significance set at α=0.05. 

Results: Eighty-three EPNS participated, revealing a low level of knowledge in DKA management, particularly regarding insulin administration, fluid management, and bicarbonate use. EPNs reported mild OS, with higher stress levels related to patient care and life-threatening situations, and lower stress levels associated with discrimination and colleague issues. An unrevised DKA management protocol was linked to higher stress in situations involving death (p=.049), therapeutic uncertainty (p=.020), and disputes with doctors (p=.012). 

Conclusion: Overall, EPNs in Greece exhibit low knowledge in managing DKA and experience mild OS. These findings highlight the need for supportive training programs to enhance EPNs’ knowledge and reduce OS, optimizing nursing care in first line clinical settings.