There is an increasing emphasis on the importance of nurses as educators. Therefore, it is essential to understand how to implement a teaching plan in clinical practice. Patient and family education are professional responsibilities of nurses. Nurses should aim for patients to achieve independence in managing their own health. This assignment will propose a teaching plan for self-administration of subcutaneous insulin in diabetes. It will include a one-to-one teaching session with a diabetic patient.
The aim of the teaching plan is to provide insulin-dependent diabetics with the skills and knowledge to independently control their diabetes through self-administration of subcutaneous insulin. Diabetes Mellitus is a metabolic disorder characterized by disturbances in carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion or action or both (Alexander et al., 2006). There are two categories of diabetes: type 1 diabetes (insulin-dependent) or type 2 (non-insulin dependent).
Type 1 diabetes occurs when the pancreas can no longer secrete insulin. This condition usually affects children or young adults and represents 5-10% of all cases of diabetes (Gulanick et al., 2003). On the other hand, type 2 diabetes results from a failure of pancreatic beta cells to produce sufficient amounts of insulin. This type usually occurs in older adults (Gulanick et al., 2003). I chose this topic because it is highly relevant to practice, given that diabetes is one of the most common chronic illnesses worldwide and is predicted to increase even further in the coming years.
According to the Diabetes Federation of Ireland (2011), there are 191,000 people in Ireland who have diabetes, with 14,000 of them having type 1 diabetes. The rationale for choosing to teach self-administration of insulin was influenced by the magnitude of sufferers of diabetes. Brod et al. (2008) reported that over 50% of diabetics are treated with insulin, either orally or via subcutaneous injections. Therefore, I thought it was an essential skill to teach in order to empower individuals.
For the purpose of this assignment, I will discuss the development of a teaching plan using the nursing process for the following hypothetical case study. Denis is a 53-year-old man who has previously been diagnosed with type 2 diabetes. Measures such as diet, exercise, and oral medication have proved to be ineffective in lowering his blood sugar levels. It was decided that Denis would be commenced on subcutaneous insulin to treat the problem. Although Denis already has a good understanding of diabetes, he needs to be taught about insulin therapy.
Assessment:
The assessment process will look at aspects of the individual’s learning needs to determine an appropriate teaching plan specific to him.
Gulanick et al. (2003) state that the assessment process should determine an individual’s learning needs to dictate the type and amount of information needed. According to Neary (2000), there are three reasons for carrying out assessments, which are as follows: determining the level of theoretical knowledge, assessing practical skills, and gaining insight into attitudes. The nurse as an educator completes the assessment to gain insight into patients’ prior knowledge, skills, and attitudes towards their condition.
This enables the nurse to establish an appropriate teaching plan. According to Bastable (2008), assessment of the learner must include:
- Learning needs – what the learner needs and wants to know
- Readiness to learn – if the learner is receptive to learning
- Learning styles – how the learner best learns
Learning needs are defined as gaps in knowledge that exist between a desired level of performance and the actual level of performance (Healthcare Education Association, 1985). Essentially, this is the gap between what someone knows and what they need to know.
To obtain this information, assessment strategies such as informal assessments and patient-centered assessments are utilized. Informal assessments involve conversations between patients, their families, and the healthcare team. As an educator, the nurse must rely on active listening skills and pose open-minded questions that encourage learners to reveal their perceived learning needs (Bastable, 2008). Patient-centered assessment is the individual’s self-assessment of learning needs according to Quinn & Hughes (2007).
To enable patients to assess their own learning needs, Bastable (2008) suggests asking questions such as: What do you think is the problem? What does your illness mean to you? What results do you hope to achieve from treatment? What are your strengths and weaknesses? These meaningful questions allow individuals to discuss and reflect on their learning needs and provide a foundation for the nurse as an educator. Readiness to learn is defined as the time when the learner shows an interest in acquiring the knowledge needed for optimal health maintenance (Bastable, 2008).
There are several components that must be considered when assessing an individual’s readiness to learn, including physical readiness, emotional readiness, experiential readiness, and knowledge readiness. As an educator, the nurse should take into account the individual’s own values and beliefs about health and illness. According to Giger & Davidhizzar (2004), patients are unlikely to accept health education unless their values and beliefs are respected.
Other factors that should be considered when determining an individual’s readiness to learn include knowledge deficits or physical deficits such as hearing impairment.
Learning styles must be assessed to determine an individual’s characteristics and needs for effective learning (Hinchliff, 2004). According to Honey and Mumford (cited in Hinchliff, 2004, pp. 73), there are four categories of learners: activists, reflectors, theorists, and pragmatists. The teaching plan should consider the learner’s style preference to develop a compatible teaching plan. Planning the teaching plan allows for identifying and developing resources and strategies that the nurse as an educator will need to use.
Planning how you are going to teach is vital to avoid omitting vital elements of the teaching session and ensure all necessary information is included (Quinn, 2000). The establishment of the teaching plan should be a joint effort with the nurse, patient, and family. Teaching is most effective when the objectives of the patient and nurse are in agreement (Bastable, 2008). Involving patients and families in establishing goals and planning teaching strategies promotes their cooperation in implementing the teaching plan (Smeltzer et al., 2008).
When developing a teaching plan, it is essential to utilize various types of subject knowledge. Subject knowledge refers to the quantity and organization of information in the teacher’s mind, including key facts, concepts, principles, and explanatory frameworks (Shulman & Grossman, 1988). The teaching plan should incorporate key facts about the pathophysiology of diabetes and hyper/hypoglycemia. Additionally, it should encompass learning goals and intended outcomes as well as principles for effectively managing diabetes.
When developing a teaching plan, it is important to consider learning theories. For this particular plan, the Cognitive learning theory was chosen as the appropriate approach. This theory is based on an individual’s cognition which involves perception, thought, memory and ways of processing and structuring information (Bastable, 2007). It aims to change the individual’s thought process to allow for new understanding and insights. This learning theory is effective because it focuses on the learner’s thought process.
Gagne et al. (1992) identified the elements necessary for cognitive learning, including gaining the learner’s attention, informing them of objectives and expectations, stimulating recall of prior knowledge, presenting information, providing guidance to facilitate understanding, having the learner demonstrate knowledge or skill, giving feedback and assessing performance. These steps were used as guiding principles in developing a teaching plan (see appendix) to promote cognitive learning. Additionally, adult learning principles were considered in the development process. According to Quinn (2000), adult learning should involve individuals taking responsibility for their own efforts with a teacher-learner relationship based on equality and a patient-centered approach.
The nurse, as an educator, should encourage these principles to ensure that the individual is being proactive in their learning. The teaching plan incorporated these principles, allowing participants to actively participate in the learning process. The teaching method was particularly patient-centered as it was customized to meet the individual’s specific needs. When developing the teaching plan, a number of different learning theories were considered, including the behaviorist learning theory.
The theory presented by Hinchliff (2004) involves a passive learner in the learning process, where learning is dependent on input from others. On the other hand, the behaviourist theory proposes two forms of learning: classical conditioning and operant conditioning. This theory suggests that learning depends on interaction with contextual circumstances (Quinn, 2000). However, after further research, I disregarded this theory because Bastable (2008) raised concerns about its teacher-centered approach that easily manipulates learners and raises ethical questions about desirable behavior.
When developing a teaching plan, it is essential to be aware of potential barriers to teaching or learning to increase the chances of successful learning. Factors such as denial, depression, or anxiety can hinder individuals from participating in their own care (Valentine, 2000). If these issues are recognized, the nurse can overcome them and facilitate effective learning. The problem should be discussed with the individual and treated appropriately and sensitively. When planning a teaching session, it is crucial to be organized and use effective time management skills.
The nurse, as an educator, should establish a suitable time with the patient and other staff members. Quiet times during the middle of the day may be more appropriate for conducting teaching sessions to avoid disruptions or the nurse having to abandon the session. The nurse should organize a suitable environment for learning and ensure all related materials and resources are available.
When the teaching plan is developed, it is now time to implement it. The nurse as an educator must deliver information in an appropriate manner.
According to Smeltzer et al. (2008), effective learning requires the teacher to use language that is appropriate and understandable for the individual. It is important to avoid using medical terms and instead explain the condition using language that can be comprehended easily. To keep learners engaged during the session, nurses as educators should utilize visual aids and encourage active participation. It may also be helpful to use appropriate teaching resources, such as internet resources, while encouraging individuals to participate actively in their own learning (Smeltzer et al., 2008).
Using a variety of teaching aids promotes the retention of information. Visual aids and practicing psychomotor skills achieve better retention of learning than continuous teacher transmission (Quinn, 2000). During the implementation of the teaching plan, diagrams were used along with individual practice for subcutaneous injections. When implementing a teaching plan, it is vital to keep the learner motivated to facilitate effective learning. Motivation is described as the willingness of the learner to embrace learning, with readiness as evidence of motivation (Redman, 2007).
To aid in motivating individuals throughout the session, the following factors were considered to facilitate or block learning (Bastable, 2008):
- Personal Attributes – physical, developmental, and psychological components
- Environmental Influences – physical and attitudinal climate
- Learner Relationship System – significant others, family, and teacher-learner interaction.
Maslow’s Hierarchy of Needs was also considered in promoting motivation for learning. This involved creating a suitable, safe, and welcoming environment where the student is valued and respected while their individual needs are met.
I chose a one-to-one method of teaching as it was the most suitable for this teaching plan. This method involves delivering information that is specifically designed to meet the needs of an individual learner (Bastable, 2008). Experiential learning was the most suitable approach in delivering much of the information, although a degree of lecturing was also used. Experiential learning is about doing rather than just listening to information. According to Quinn (2000), key characteristics of this form of learning include active learner involvement, a degree of interaction, measures of autonomy and flexibility along with a high degree of relevance.
This approach was suitable for implementing the teaching plan as it involved the learner in completing physical skills related to their care.
Assessment and evaluation are often used interchangeably (Hinchliff, 2004), but there are significant differences. Assessment measures student learning achieved through a learning situation, while evaluation is a series of activities designed to measure the effectiveness of the teaching system as a whole (Ellington et al., 1993).
The assessment is the collection of data on which to base the evaluation and is both descriptive and objective (Hinchliff, 2004). I have chosen three assessment strategies: questions and answers, interviews, and observations (see appendix). These strategies allow for the collection of data to determine if learning was successful. Assessments are learning experiences that can enhance content understanding and promote individual skills. The evaluation of the teaching process determines if goals have been achieved.
According to Hinchliff (2004), evaluation is the process of making judgments and decisions about achievements, expectations, and the effectiveness of a plan. To establish an evaluation tool, I used the following steps outlined by Smeltzer et al. (2008):
- Collect objective data
- Determine if goals were achieved
- Include patients, family members, and significant others in the evaluation
- Identify alterations that need to be made to the teaching plan
- Make referrals to appropriate sources after discharge
- Continue all steps of the teaching process.
The main goal of the evaluation is to determine elements that can be changed to improve the teaching plan. To achieve this, I used a questionnaire as an evaluation tool. The questionnaire was designed to determine if individuals achieved the learning outcomes and if they were satisfied with the material that was covered (see appendix). It is important to note that evaluation is not the final step in the teaching process but rather, it marks a new beginning for assessment. The information gathered during the evaluation process should be utilized in modifying a new teaching plan aimed at improving learning outcomes (Smeltzer et al., 2008).
The nurse as an educator should constantly strive to improve teaching and learning within the clinical environment. In conclusion, this teaching plan discussed important aspects to consider when generating a teaching plan. The concepts of this teaching plan can be used to develop teaching plans for any clinical topic in education. This assignment was helpful in furthering my knowledge of the importance of the nurse as an educator, and I will implement such teaching plans in practice.
