1. School of Nursing 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

2. School of Nursing 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)

3. School of Nursing 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)

4. School of Nursing 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)

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

6. School of Nursing 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

7. School of Nursing 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

8. School of Nursing 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

9. School of Nursing 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)

10. School of Nursing

11. Methods Once 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

12. School of Nursing 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

13. School of Nursing 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.

14. School of Nursing 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.

15. School of Nursing Acknowledgments Supported by UPMC diabetes appropriates for DoD USAARMAA. Patricia Schmitt Monica Dinardo Feng Guo

16. School of Nursing Questions?