Introduction
Ms. Sally is an 83-year-old patient with a 15-year history of type 2 diabetes. She also has spinal stenosis and cannot reach her feet to examine them, interfering with the recommended daily regimen to prevent ulcers. The client lives with her sister, who also reports that Ms. Sally may forget her daily medication, Humulin N 20 u SC, which the patient must take before breakfast.
Recently, the patient developed an ulcer due to wearing unfit shoes and did not notice it until it began to drain; now, Ms. Sally fears a recurrence of the situation. Given her physical limitations, the current teaching plan concentrates on orienting Miss Sally about caring for her feet. This experience helps nurses learn the patient-centered approach, the choice of patient interaction methods, and planning patient education.
Assessment Data
Learning Need 1
The patient needs to learn to use additional tools for maintaining regularity in taking medication. This need is dictated by the fact that Ms. Sally may miss the intake time. Given the importance of drugs in retaining the necessary sugar levels, slowing the progress of neuropathy, and supporting the patient’s stable condition, their omission is unacceptable.
Simultaneously, Ms. Sally has a long history of diabetes and is already informed about the importance of medication. Therefore, the disruption of regularity and forgetfulness is most likely a consequence of older age. Adaptation is required to meet the patient’s new needs, which involves searching for and training reminder tools.
Learning Need 2
Due to the impossibility of reaching her feet for examination and the case of inappropriate shoes, the patient also needs training in additional foot inspection and care methods. Due to the difficulties Ms. Sally encounters, she may miss signs of severe complications of neuropathy, such as ulcers or infections. In the most severe cases, the complication carries the risk of amputation.
Priority Learning Need and Diagnosis
Nursing Diagnosis
Knowledge deficits related to difficulties in adherence to treatment regimes and personal limitations, as evidenced by the patient’s report and the case of ulcer development, increase the risk of infection and injury.
Goal
Inform the patient of alternative methods for checking and caring for the condition, confirm Ms. Sally’s understanding of the importance of foot care in preventing complications, and encourage regular foot care.
Expected Outcome (SMART Criteria)
Within a week, Ms. Sally will become accustomed to the daily application of alternative foot examination and care methods taught by a nurse, which can be adapted to her limitations.
Learning Domains
Ms. Sally’s training should cover psychomotor and cognitive domains, which will be the most valuable for her. The psychomotor domain focuses on motor skills, the practice and proper performance of specific actions (Astle et al., 2019). Following this goal, Ms. Sally needs to learn foot self-examination and care methods to achieve the outcome of their regular application and prevent the repetition of new complications. Demonstration and practice will be most effective, which is the rationale for domain selection.
Psychomotor skills strengthen the knowledge transferred to patients, so prior involvement in the cognitive domain is necessary. They provide the patient with an understanding of their disease, its impact, and the required actions, thereby offering a rationale for domain use (Astle et al., 2019). To achieve the set teaching goal, Ms. Sally needs knowledge about foot care, including choosing the right shoes. These measures will provide the necessary care and create the basis for practicing psychomotor skills.
Client Barriers
Due to the patient’s barriers, the teaching and learning process may not be effective enough. Specifically, Batista et al. (2020) emphasize that age is a significant obstacle to patient education; older adults face challenges in trying to understand and remember new information. Since Ms. Sally is 83, this obstacle is relevant to her case. The patient may not remember how to use specific methods and what aspects require particular attention during the foot examination.
The second obstacle is Ms. Sally’s forgetfulness, and her sister drew attention to its frequent cases. Forgetfulness also affects the perception and memorization of educational information. It can disrupt the regularity of care, which has already happened with medication, and lead to deterioration. Therefore, after educating Ms. Sally, it is crucial to ensure that tools are found to remind her of the necessary actions.
Teaching Plan
Educational Content
The history of the ulcer indicates an increased risk of repetition of such a situation, and education should cover methods and ways to prevent the problem. Given the difficulties of conducting a self-examination, the nurse should show Ms. Sally how to use a mirror for the examination and advise her to resort to her sister’s help. Topics should also include symptoms and signs of complications to consider. It is necessary to train Ms. Sally to avoid actions that increase the risk of ulcers, be cautious when trimming nails, wash her feet in the water at a specific temperature, and choose appropriate socks and shoes (Pourkazemi et al., 2020). These topics can be presented in cognitive and psychomotor domains and will be helpful for the patient.
Teaching Methods
Patient training should occur in a spacious and well-lit room, where external influences, like noise and interruptions, will not interfere with teaching. The nurse should appoint a time convenient for the patient. In the cognitive domain, one-on-one discussions and question-and-answer sessions will be appropriate methods. They will provide the necessary information to the patient, and Ms. Sally can ask questions about unclear aspects.
The benefits of these methods are active patient engagement, addressing patients’ concerns, and knowledge testing (Astle et al., 2019). In the psychomotor domain, demonstration methods from the nurse and return demonstration from the patient are necessary. They present required procedures and patient repetition with nurse observation (Astle et al., 2019). The method can be applied when using a mirror to examine the legs or demonstrate procedures to care for them.
Teaching Resources
Ms. Sally’s training requires specific resources and materials, and it may be necessary to involve her sister if the patient is ready to resort to her help. A nurse can use video and mirrors as resources to demonstrate foot-checking techniques. Moreover, using specially printed materials for the patient is also valuable. They must be carefully prepared to be understandable and helpful to patients, as poor-quality materials can be a barrier to treatment (Betschart et al., 2019).
Applicable to Ms. Sally’s situation, materials must contain information about foot care – necessary examination schemes, shoe data, pictures with signs of complications risk, and routine maintenance. The nurse should review the materials with the patient to answer possible questions and provide clarifications.
Evaluation of Learning
After teaching Ms. Sally, the nurse will test her knowledge and learning outcomes. The patient will have to show the necessary skills to examine the feet and care for them using the return demonstration method. To test the knowledge provided to the patient, the nurse can apply the teach-back method. Following this approach, the patient retells her understanding of the information received during training (Yen & Lease, 2019). If necessary, the nurse can correct inaccuracies in the data. A phone call a week after teaching will allow the nurse to remind and check the regularity of foot care.
Analysis of the Teaching Process
Importance of Teaching
Education helps maintain the necessary quality of life even in the presence of chronic diseases—good health ensures dignity and control over life for the patient. Moreover, preventing complications and controlling diabetes reduces the burden of ulcers and the cost of treating them imposed on healthcare (Van Netten et al., 2020). For these reasons, Ms. Sally’s training is of critical importance.
Strengths & Challenges of Teaching
The current plan’s strength is teaching and evaluation methods, which suggest significant patient engagement through questions and discussion. Another strength is the possibility of attracting the patient’s family members for improved results. Potential weaknesses are the dependence on the patient in the regularity of the routine of care, her forgetfulness, and her age, which are obstacles to treatment.
Benefits of Teaching
The plan development helps organize the necessary information, highlight priorities in the patient’s needs and training, and provide the required knowledge following preferences (Astle et al., 2019). In practice, plans help implement a patient’s education more easily, making it less formal and pressing. Nurses learn to highlight priorities when developing plans and choose actions following the patient-centered approach.
Conclusion
Thus, the current teaching plan highlights Ms. Sally’s learning needs in foot care. The goal of the education is the client’s regular foot examination and routine care to prevent ulcers and other complications. Teaching covers psychomotor and cognitive domains, with the choice of respective methods. The plan considers the necessary teaching content, resources, and possible obstacles in the implementation. The successful completion of the plan will increase the patient’s attention to the importance of caring for the feet and preventing complications.
References
Astle, B. J., Duggleby, W., Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (Eds.). (2019). Canadian fundamentals of nursing (6th ed.). Elsevier.
Batista, I. B., Pascoal, L. M., Gontijo, P. V. C., Brito, P. D. S., Sousa, M. A. D., Santos, M., & Sousa, M. S. (2020). Association between knowledge and adherence to foot self-care practices performed by diabetics. Revista Brasileira de Enfermagem, 73(5), 1-7.
Betschart, P., Staubli, S. E., Zumstein, V., Babst, C., Sauter, R., Schmid, H. P., & Abt, D. (2019). Improving patient education materials: A practical algorithm from development to validation. Current Urology, 13(2), 64–69.
Pourkazemi, A., Ghanbari, A., Khojamli, M., Balo, H., Hemmati, H., Jafaryparvar, Z., & Motamed, B. (2020). Diabetic foot care: Knowledge and practice. BMC Endocrine Disorders, 20(1), 1-8.
Van Netten, J. J., Woodburn, J., & Bus, S. A. (2020). The future for diabetic foot ulcer prevention: A paradigm shift from stratified healthcare towards personalized medicine. Diabetes/Metabolism Research and Reviews, 36, 1-7.
Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal Practitioner, 36(6), 284-289.