Health Education Teaching Assignment
Health Education Teaching Assignment
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Diabetes:
Teaching Patients Self-Care
Author: Tracey Long, RN, PhD, APRN
Contact hours: 4
Expiration date: October 1, 2021
Course price: $29
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This course has been approved by The Commission for Case Manager Certification.
Course Summary
mailto:info@ATrainCeu.com
Healthcare professionals who are not diabetes educators are still often called upon to teach
diabetes patients techniques of self-care. This involves an understanding about how adults
learn and how to create an environment that supports their learning. It is essential to the
daily life and future of people with diabetes that they understand and practice self-care so
they can manage a disease that can be devastating if it is left unchecked.
COI Support
Accredited status does not imply endorsement by ATrain Education or any accrediting
agency of any products discussed or displayed in this course. The planners and authors of
this course have declared no conflict of interest and all information is provided fairly and
without bias.
Commercial Support
No commercial support was received for this activity.
Criteria for Successful Completions
80% or higher on the post test, a completed evaluation form, and payment where required.
No partial credit will be awarded.
Accreditations
California Board of Registered Nursing
ATrain Education, Inc. is approved as a provider by California Board of Registered
Nursing (#CEP15099).
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ATrain Education, Inc. is an AOTA Approved Provider for continuing education
(#6558). The American Occupational Therapy Association does not endorse specific
course content, products, or clinical procedures.
California Board of Physical Therapy
ATrain Education, Inc is recognized by the Physical Therapy Board of California as an
approved reviewer and provider of continuing competency and continuing education
courses for physical therapists and physical therapy assistants in the state of
California.
New York State Board for Physical Therapy
Approved by the NY State Board for Physical Therapy as an approved provider of
Physical Therapy and Physical Therapy Assistant continuing education.
Florida Board of Occupational Therapy
ATrain Education Inc. is approved as a provider of continuing education by the Florida
Board of Occupational Therapy.
Georgia State Board of Physical Therapy
This course is accepted by the Georgia State Board of Physical Therapy.
Certified Case Managers
This program has been pre-approved by The Commission for Case Manager
Certification (CCMC).
Course Objectives
When you finish this course you will be able to:
Explain the four classes of diabetes and how they differ from one another.
Discuss the ways you can motivate a diabetes patient using at least two of the
education models presented here.
Be prepared to create a lesson plan for a patient, with the goal of achieving a specific
new aspect of self-care.
Teaching Diabetes Self-Care
Have you ever tried to introduce diabetes to a newly diagnosed patient and found yourself
at a loss? Do you stumble trying to explain the difference between type 1 and type 2
diabetes? Are you frustrated by the disconnect between your own understanding of
diabetes and your ability to explain it? You are not alone! Diabetes educators specialize in
the management of diabetes and effectively teaching it to patients.
As a healthcare professional you have learned the basics of diabetes mellitus, but not how
to teach a patient who lives with it. Simplifying pathophysiology, medication usage, blood
glucose monitoring, meal planning, and overall management of the disease is daunting but
it is a skill you can acquire with practice. Teaching patients to take their prescribed
medications correctly may be as important as the medication itself because, without a
good understanding, patients may take it incorrectly, with poor outcomes.
Studies confirm positive behavioral and economic outcomes of outpatient diabetes
education programs on self-care (Brown, 1990). Patients with diabetes who have received
diabetes education have better A1C glycosylated hemoglobin levels, fewer emergency
department (ED) visits, and better overall health compared to those with diabetes who
never received education. Clearly diabetes education matters.
The Need for Diabetes Educators
With over 29.1 million Americans—9.3% of the United States population—diagnosed with
diabetes and another 86 million with prediabetes, there are a lot of people needing
diabetes education (ADA, 2014). Diabetes is steadily increasing in incidence and
prevalence in the United States and remains the seventh leading or contributing cause of
death; further, it represents almost 26% of adults age 65 and older, which is 1 out of every
4 elders.
Diabetes in youth age 20 and under has also continued to rise, to 208,000 Americans
compared to approximately 23,500 in 2008. Overweight and obesity trends and an aging
population have been identified as risk factors causing the growing “diabesity” epidemic in
our country. Almost 50% of all Americans are overweight or obese. Clearly a lot of people
need your professional knowledge for health education, prevention, treatment, and
management of diabetes. It’s a sad truth, but with the climbing rates of diabetes and
obesity and projected trends, those who teach patients with diabetes have job security!
Most people with diabetes hear about the disease initially from a healthcare professional,
and yet many people with diabetes leave more confused after being given the startling
diagnosis because of the heavy use of medical jargon and the complicated information.
Being able to simplify diabetes education and meet the learning needs of your patient can
make the difference between patients who leave feeling empowered to take control of their
diabetes or feeling overwhelmed, depressed, and inclined toward noncompliance.
Although there is plenty of information available via the Internet for anyone to learn about
diabetes, most people need the help of a healthcare professional to decipher the
information. Referring patients to www.diabetes.org is a great resource of the American
Diabetes Association, but it is not enough. You are still needed to help guide your patients
through the vast resources on diabetes.
Describing Diabetes Mellitus
A quick review of diabetes mellitus will give you confidence when you are needed to help a
newly diagnosed patient cope with this sometimes overwhelming diagnosis.
What Is This Disease?
Knowing more about diabetes, and how to teach your patients about it, will put you in a
position to answer the question “What is diabetes mellitus?” Diabetes mellitus has
formally been defined by the American Diabetes Association as “a group of metabolic
diseases characterized by hyperglycemia resulting from defects in the insulin secretion,
insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term
macro- and microvascular damage, dysfunction, and failure of various organs, especially
the eyes, kidneys, nerves, heart, and blood vessels” (ADA, 2011).
Although that is a correct medical definition, it can be frightening and unintelligible to a
patient who may still be in disbelief about having diabetes. Being able to simplify the
definition to “Diabetes means your body doesn’t use your food effectively” makes more
sense to most people.
Diabetes was recognized as a medical problem over 2000 years ago in Greek writings, so it
is not a new disease. It wasn’t until the early 1900s, however, that insulin was identified as
the hormone that controls blood sugar levels. Early scientists removed the pancreas from a
dog, thus creating a diabetic dog, which helped them confirm that the pancreas produces
insulin from beta cells within the islets of Langerhans. In 1921 insulin was finally purified
for human injection by Eli Lilly, an early pharmaceutical company, which began the
treatment to save lives for type 1 diabetics who produced no insulin.
What Is the Disease Process?
Without insulin, the food we eat, broken down into simple forms of glucose, can’t enter
the cells of the body and remains in the bloodstream. After a meal, glucose levels in the
body rise, which triggers insulin to be released from the beta cells of the pancreas. Glucose
levels in the blood fall as glucose moves into the cells, where it is used for energy
production to fuel the body. Extra glucose in the blood can be stored in fat and skeletal
muscle tissue. Glucose stored in the liver becomes glycogen.
An opposing hormone, glucagon, has the opposite effect of insulin, resulting in elevated
levels of glucose in the blood, where it can be sent for energy throughout the body. The
perfect balance of insulin and glucagon production keeps our blood sugar levels regulated
between 60 and 100 mg/dL in a fasting state and 100 to <140 mg/dl 2 hours after a meal.
When the body doesn’t produce any insulin (type 1 diabetes) or has a sluggish or resistant
response to insulin (type 2 diabetes), chronic hyperglycemia develops; this is known as
diabetes mellitus. The term diabetes means “to siphon through,” which refers to the loss of
urine as the body attempts to rid itself of the excess glucose and pulls water along with it.
The term mellitus was added years later; it means “sweet” or “honey,” referring to the
glucose in the urine.
Source: Mikael Häggström, 2014. Wikimedia Commons.
Types of Diabetes
The pathology that causes each type of diabetes is different, and it is important for a
patient to understand the medical management for their particular type of diabetes. In
type 1 diabetes (the term now used instead of the older term juvenile diabetes), the
body stops producing insulin completely. This has been linked to an autoimmune response
and occurs mostly in children, representing only 5% to 10% of all people with diabetes.
People with type 1 diabetes have to take insulin injections or they will die, as their brain
and body cells starve without the needed glucose. The body can use protein and fat for fuel
but the ketones from metabolizing these fuels can create acidosis and become toxic to the
body, leading to death. The discovery of insulin through injections has saved millions of
lives.
Type 2 diabetes, representing 90% to 95% of all people with diabetes, stems from
cellular insulin resistance, or sluggish insulin production, and is generally found in adults.
Insulin resistance has a genetic risk and is often found in people who are overweight or
obese. Type 2 diabetes can generally be treated with weight loss, meal planning, and
exercise because the onset is related to overweight and obesity in 75% of diabetic
patients. If lifestyle modifications don’t help, then medication management is added.
Source: WebMD, 2014.
Differences Between Type 1 and Type 2 Diabetes
Type 1 Diabetes Type 2 Diabetes
Symptoms usually start in childhood or young
adulthood. People often seek medical help,
because they are seriously ill from sudden
symptoms of high blood sugar.
The person may not have symptoms before
diagnosis. Usually the disease is discovered
in adulthood, but an increasing number of
children are being diagnosed with the
disease.
Episodes of low blood sugar level
(hypoglycemia) are common.
There are no episodes of low blood sugar
level, unless the person is taking insulin or
certain diabetes medicines.
Cannot be prevented. Can be prevented or delayed with a healthy
lifestyle, including maintaining a healthy
weight, eating sensibly, and exercising
regularly.
In the past decades the only medications available were insulin and a single class of
antihyperglycemics called sulfonylureas. Today more than eight classes have been
created, making medication management more complex. People often think incorrectly
that if you take insulin you have type 1 diabetes and if you could manage blood sugar
levels with a pill you have type 2 diabetes. Research has added significantly to our
understanding of the pathophysiology, and type 2 diabetes involves more organs than just
the pancreas. Some patients with type 2 may eventually require insulin injections due to
pancreatic fatigue and the duration of the disease.
The third class of diabetes is gestational diabetes and it results when hyperglycemia is
first manifest during pregnancy. Many pregnant women with diabetes can control blood
sugars by careful food planning and avoidance of simple sugars during pregnancy, however
some may require insulin injections just for the duration of the pregnancy. Gestational
diabetes only occurs in about 2% to 5% of all pregnancies. Unfortunately, a women with
gestational diabetes may be at 4 to 6 times greater risk of developing type 2 diabetes later
in life.
The problem with hyperglycemia during pregnancy is potentially the large growth of the
baby, who has been used to high volumes of glucose during gestation, and delivery
complications for the mother. Generally, after the baby is born the mother’s blood glucose
stabilizes and she will no longer need insulin. The baby, who had been so used to
hyperglycemia in utero, does run the risk of dropping into hypoglycemia after birth and
must be monitored until stable.
A fourth class of diabetes is “other,” and it includes endocrinopathies, mature onset
diabetes of the young (MODY), and latent autoimmune diabetes of the adult (LADA, or
diabetes 1.5). The pathophysiology of each varies and is related to genetic problems,
hormone imbalance, and autoimmune destruction of beta cells. The “other” category also
includes prediabetes and impaired fasting glucose (IFG).
Both prediabetes and IFG are precursors to diabetes and deserve increased attention by
healthcare professionals to avoid chronic hyperglycemia and complications. Each class of
diabetes requires different medication management based on the unique needs of the
individual.
Knowing what kind of diabetes patients have been diagnosed with is important so you can
help them understand specifically what is happening within their own body. The more
informed you are about patients’ type of diabetes the better you can anticipate problems
they may experience and develop a plan for prevention. By teaching them about symptoms
of complications you can help identify problems earlier and get appropriate treatment
sooner.
Using common analogies to explain the pathophysiology also can be helpful. Many diabetes
educators use the comparison of insulin in the body like a lock (a body cell) and key (the
insulin). A patient with type 1 diabetes no longer has the key (insulin) to open the door
(the body cell) and food (glucose) cannot be used. The cell ends up starving and suffers
damage even if the person eats food.
Even children with type 1 diabetes can understand the analogy of a “diabetic car.” A type 1
diabetic car has no insulin (key) to open the gas tank so the tank stays empty, with no fuel
for energy. Without being able to open the lid, a meal is eaten but no gas enters the tank
and the car doesn’t function correctly. An outside key must be used (insulin injection) to
open the tank and fill it with gas (food). A type 2 car is able to receive some gas, however
a lot of it spills on the outside of the car leaving noticeably high gas levels (glucose levels)
outside the tank.
Using analogies, comparisons, and simple common terms and objects that people are
familiar with can help them understand the complicated diabetes pathophysiology.
Approaching patient education in simple terms can be less scary for both you and the
patient. Many pharmaceutical companies involved in diabetes products and education have
wonderful pictures, diagrams, and other resources to help teach the basic anatomy and
physiology of food metabolism and diabetes (see Resources at the end of the course).
Clinical Scenario
Mr. Johnson wonders why he now has to take four insulin injections each day for his
diabetes when he used to take a pill only twice daily.
Q: What questions would you ask Mr. Johnson to help him understand the medical
management for his diabetes?
A: Examples could include:
How long have you had diabetes?
Tell me what you understand causes diabetes?
Did you try weight loss, exercise, and meal management?
What do you understand about insulin?
Overcoming Barriers to Effective Teaching
Many barriers prevent healthcare professionals from teaching effectively, or even at all.
The first barrier is the fear of inadequate knowledge about the disease. Some don’t know
all the facts about diabetes and feel embarrassed to admit it in front of a patient, so they
just omit the teaching. You do not have to be a certified diabetes educator (CDE) to teach
patients about diabetes. Healthcare professionals who teach about diabetes include lay
health workers, health aids, medical assistants, nurses, pharmacists, physical therapists,
social workers, nurse practitioners, physician assistants, and certified diabetes educators.
Clearly knowledge is needed before you can teach, however research confirms the adage
that people care more about how much you care and not just how much you know
(Ciechanowski, 2001;Brown, 1990). Creating relationships of trust, non-judgment, and
emotional safety are foundational for effective teaching.
Barriers to teaching also include poor communication, lack of time, low priority in acute
settings, low or no reimbursement for teaching, low resources, and low interest from the
patient; yet making sure the information is correct and correctly understood are critical to
good patient outcomes. Overcoming these barriers has been the quest of the American
Association of Diabetes Educators (AADE), and the organization is a wonderful resource for
content, study guides, and even lesson plans for teaching (www.diabeteseducator.org).
Strategies to overcome barriers of poor communication begin with simplifying medical
jargon. Healthcare professionals speak in medical (often Latin) vocabulary that can be
confusing to patients. A persisting legend tells that a physician teaching a patient to inject
insulin used an orange for practice. After having the patient return-demonstrate how to
draw up and inject the insulin into the orange, the physician felt confident that the patient
understood. Weeks later ,when the patient returned for a followup appointment, the
patient’s blood glucose levels remained extremely high. Puzzled, the physician asked the
patient if he was still taking the insulin injections as instructed. “Of course,” declared the
patient. “But I don’t understand how injecting it into the orange is going to help my
diabetes.”
Clearly, we often make assumptions about what the patient understands and forget we
may speak a different language! Try to simplify the vocabulary you use as you discuss
pathophysiology and other diabetes topics. Instead of saying “insulin resistant,” you could
say “Your muscles don’t use the insulin you may be producing.” Instead of metabolic
acidosis, you could say “When the body has too much sugar and no insulin it creates a
state of too much acid, which makes the body sick.”
For communication barriers related to foreign language, it is important to have a
professional translator or use pamphlets and instructional material in the native tongue of
the patient. Many credible online sources, including the National Institutes of Health (NIH),
provide a large library of free patient education materials in Spanish, Tagalog, and many
other foreign languages.
Remember, second-language learners who are conversant in English may still be unfamiliar
with slang words common to native English speakers. Phrases such as “fast-food” and “eat
and run” may be confusing. Clarify terms and confirm understanding periodically during a
teaching session to avoid undesirable outcomes. Click this link for more information.
https://www.nlm.nih.gov/medlineplus/languages/diabetes.html
Another barrier to effective communication has been the approach, often perceived as
condescending, when the goal was getting a patient to “comply” with a medical plan of
care. Compliance and adherence have always been legitimate issues of concern for
healthcare professionals. In the past, educators were often sent to “set the patient
straight” or use scare tactics to get a patient to adhere to the prescribed management
regimen.
Traditional approaches to patient education have been disease-oriented and based on
compliance. If patients disagreed with a plan of care, couldn’t afford the medications, or
wanted to try alternative therapies, they were often seen as noncompliant. Good patient
outcomes suffered if patients felt judged or dismissed. A useful strategy to overcome this
barrier is for healthcare professionals to take on the role of health coaches instead of
health dictators. Creating a partnership with the patient improves health outcomes.
The barriers of lack of time, low priority in acute settings, low or no reimbursement for
teaching, low resources, and low interest from the patient can also be overcome. Time for
diabetic teaching can be found in regular interactions with patients. Every interaction with
a person who has diabetes can help educate the patient without making it a formal
session. Giving patients their regular insulin dose in a hospital provides a few minutes for
assessing their understanding of the purpose and action of the medication. Testing a
patient’s blood sugar also creates a space for purposeful conversation.
You may not have the luxury of a half-hour teaching appointment, but can provide a few
minutes of teaching during regular interactions of care throughout a shift or home visit. In
the acute care setting, diabetes education is often delayed; however, it should be offered
after the urgent medical problem has been addressed and the patient is stabilized.
Patients are often more interested in learning how to avoid a hypoglycemic episode or
diabetic ketoacidosis (DKA) once they have experienced the emergency. As the saying
goes, “When the student is ready, the teacher appears.” Lack of time is often cited as an
excuse. A strategy to overcome that barrier is leaving a simple pamphlet or note with
contact information for future diabetes education when the patient may be ready.
After years of lobbying by the American Association of Diabetes Educators (AADE), using
persuasive research to prove the benefits of diabetic education, reimbursement is now
available and diabetes education is paid for by most insurance companies. Free resources
for diabetes education are exploding in availability. A simple search on the Internet for the
word diabetes will quickly produce over 250 million links! Healthcare professionals can feel
relieved that, even if their patient education time is limited, learning can continue via
reputable online sites. Asking the patient if they are interested in free diabetes education
may pique their interest in personally searching the Internet if they have computer skills
(also see Resources at the end of this course).
Clinical Scenario
Mrs. Sanchez, a patient with type 2 diabetes who has limited English-speaking skill,
keeps missing her diabetes education appointment because she “doesn’t have
transportation” but she does have medical insurance.
Q: What strategies could you use to overcome barriers to her receiving diabetes
education?
A: Identify alternative transportation for her. Provide Spanish literature through the mail.
Find resources within her neighborhood for diabetes education. Inquire if she has access
to a computer and the Internet. Provide education on the phone with a translator. Find
her diabetes classes in Spanish.
Patient Centered Diabetes Education
Traditional patient education models focused on disease-oriented patient education (DOPE)
and were physician centered. Newer models are known as health-oriented patient
education (HOPE) and include empowerment strategies that place the patient rather than
the physician at the center; this strategy sees the patient as a partner in decision making.
Based on adult learning theory, psychodynamic motivational theories, and the Chronic Care
Model, diabetes educators now focus on strategies that help patients help themselves.
The goal of diabetes education is to help patients manage their own chronic disease with
the resources of a team of healthcare professionals supporting them. The role of the
diabetes educator has changed from “sage on stage” to “guide on the side.” Effective
diabetes education begins with a paradigm shift to a role as health coach and often
cheerleader instead of professional laying down orders for the patient to follow.
Each patient should have a partnership role in making medical decisions. That means
patient education must be customized to meet the individual’s needs and include the
patient’s goals and desires. Instead of a diabetes educator simply writing a patient’s diet
and exercise plan, an effective diabetes educator needs to assess the patient’s goals,
abilities, barriers, interests, and resources and develop a goal plan together. Adherence
improves because patients are working toward their own goals and not those dictated to
them.
ASSURE Mnemonic for Teaching
A diabetes educator can ensure effective education by following the activities in the
acronym ASSURE.
ASSURE effective education
A Analyze the learner
S State the objectives
S Select appropriate teaching methods
U Use effective instructional materials
R Require learner performance
E Evaluate the learning
Analyze the Learner
“Analyze the learner” means looking at the patient’s language ability, age, ethnicity, food
preferences, gender, and learning style. People of different ages learn differently. We don’t
teach a child or adolescent the same way we teach adults. Children need concrete
examples to which they can relate, and do well with role play and games, for example.
Adults can generally learn by references and analogies. Geriatric patients may need a
different approach based on physical limitations such as hearing or vision.
It is essential to confirm English-speaking ability, literacy, and ability to understand written
information. According to the National Center for Education Statistics, a national literacy
survey found 23% of our adult population lack adequate literacy skills and may not read
above a fifth-grade level (National Institute of Literacy, 2013; NCES, 2002). When
presenting material to patients in written form, look for simply worded phrases and the
inclusion of illustrations that can be understood easily across language and literacy levels.
Asking about formal education completed can also help guide you in what level of literature
would be appropriate for the person.
When teaching about food choices and meal planning for diabetes management, avoid
assumptions about foods. Assuming everyone eats cereal for breakfast, or that breakfast is
even in the morning when some people work night shift, can impact medications taken
with food. Ethnicity may also impact how learners understands diet planning based on their
background, preferred first language, values, and even associations with ethnic foods.
Do not assume people who “look like you” are the same as you! With the growing diversity
in our country, people come from a large variety of backgrounds with cultural norms that
impact their health; these may include food preferences and even adoption of
complementary and alternative therapies. Simply asking people open-ended questions like
“What do you typically eat for daily meals?” will provide valuable information to help you
guide them toward healthier choices. Long gone are the days when we would give the
same standardized ADA 1800-calorie diet handout to everyone. The patient often threw
away the seemingly irrelevant pamphlet.
Effectively teaching someone with diabetes about meal planning and food choices must be
customized based on food and cooking preferences and resources. Suggesting all patients
buy organic produce may be scientifically sound, however not realistic for those on limited
budgets or because organic stores may not be near them. Getting a 24-hour or even 3- to
7-day diet history will give you a better idea of what the patient generally eats and prefers
in a typical week. Then dietary suggestions for improvement can be made based on tastes,
budget, and schedule.
Gender differences are important to consider when teaching a patient about healthcare
needs and management of a chronic disease. Women are generally motivated by social
relationships and may thrive in a group class. Men, however, are often motivated by task
completion and may prefer a one-to-one teaching session so they can be finished and
leave. Research shows that male brains are more developed in motor and spatial skills
whereas female brains are more developed in verbal and social thinking (Lewis, 2013).
Men may prefer to see graphs, charts, and statistics about the disease whereas women
may prefer to learn how it will impact their daily life. Of course there is plenty of variation
between the genders but the fact remains that education needs to be customized to meet
the patient’s preferences.
Basic Styles of Learning
Source: Feberal Reserve Bank of Atlanta, 2011.
Source: Teach.com, 2015.
Descriptions of the Basic Learning Styles
Visual
Visual learners prefer the use of images,
maps, and graphic organizers to access
and understand new information.
Auditory
Auditory learners best understand new
content through listening and speaking in
situations such as lectures and group
discussions. Aural learners use repetition
as a study technique and benefit from the
use of mnemonic devices.
Read and Write
Students with a strong reading/writing
preference learn best through words.
These students may present themselves
as copious note takers or avid readers and
are able to translate abstract concepts
into words and essays.
Kinesthetic
Students who are kinesthetic learners best
understand through tactile representations
of information. These students are hands-
on learners and learn best through
figuring things out by hand (i.e.
understanding how a clock works by
putting one together).
Learning styles also impact how a person learns. Generally people can learn through all the
methods shown above, and teachers should include a variety of teaching approaches;
however, often people have a preferred method. There are online tests to help you identify
your own learning style preference. It’s unrealistic to have every patient take a learning
styles preference test before you plan your approach to fit their needs; however, you can
assess their style through good questioning.
Audiovisual
Case Study
Computer resources
Conference
Demonstration
Group discussion
Gaming
Lecture
One-to-one
Reading
Role playing
Simulation
Technology
Telecommunications
Workshop
You can ask them how they prefer to learn new information: by reading, watching a video,
seeing a demonstration, or learning by a hands-on approach. Based on their preference
you can create a more effective presentation of the needed material. The saying “The more
neurons that fire together, wire together” helps us remember that our brains require
repetition of information to “hard wire” it, no matter the style.
State the Objectives
There are so many topics that need to be taught regarding diabetes management that it
can feel overwhelming to both the clinician and the patient. Before teaching a patient with
diabetes, clarify the goal of the learning session. Stating “We’re going to talk about
diabetes” isn’t as clear as “You are going to learn how to test your blood sugar daily with
this meter” or “You are going to learn how to use an insulin pen to give yourself the
medicine your provider ordered.” Notice both sentences focused on what the learner was
going to be able to do at the end of the training, rather than what the teacher was going to
do.
People need to be able to come away from a teaching or training session with the ability to
do something that will make a positive impact on their health, and not to just learn
academic concepts. Behavior change is the focus of learning sessions in healthcare. Many
times the objective of the learning session is given by the prescribing clinician, it may be
learning about insulin devices or counting carbs. If you are the one choosing the topic and
don’t know what to teach, ask the patient what they need or want to learn first. Adult
learners are generally task-oriented and already know what they want to learn.
Select Appropriate Teaching Methods
Selecting appropriate teaching methods depends on what you have already discovered
about your learner’s preferences. The methods of teaching include auditory, visual, one-on-
one, group classes, and so on. If a person with diabetes seems interested in a group class,
find out your local resources and where you can refer them. If a person says that they
prefer private teaching, then schedule that if possible. The following list shows many
different methods that could be used for teaching about diabetes:
E-learning Return demonstration
Anatomical models
Charts
Demonstration materials
Displays
Food models
Graphs
Handouts
Pamphlets
Posters
Puzzles
Videos
Use Effective Instructional Materials
In addition to selecting appropriate teaching methods, using effective instructional
materials is important to creating an effective teaching experience for the patient. If you
found, for example, that your learner prefers to learn by watching videos, then a pamphlet
may be useless unless it summarizes information from the video. If patients disclose they
can’t read well in English, then other teaching methods need to be chosen.
Written instructional methods can be extremely helpful but they must be written at a fifth-
grade reading level and without medical jargon. Using pictures can be helpful for those
with limited English proficiency. Pharmaceutical representatives often offer diabetes
education materials, generally free of cost. The following list identifies some of the many
instructional materials available for diabetes:
Require Learner Performance
Learning for knowledge’s sake alone may not effect the actual behaviors needed to
improve physical health. Notice that, within this course, each module identifies a learning
objective. Knowledge becomes powerful when it prepares you to improve action toward a
desired goal. The four domains of learning depicted earlier include affective (emotional),
behavioral (ability to adopt new behaviors), cognitive (knowledge), and psychomotor
(physical ability). As a diabetes educator you will choose some combination of these to
achieve the goal of improved patient outcomes.
Insurance companies who pay for diabetes education want to know that their teaching
impacts physical health for the better. Learning what insulin does isn’t as valuable as
developing the skill to inject the insulin correctly and thus improve blood glucose levels.
For the patient, learning about hypoglycemia is good but learning to check the blood
glucose level regularly and take action when it drops to 60 mg/dL is more relevant for
diabetes control.
Choosing an action item for each teaching session is likely to produce a concrete result
from the training. Asking the patient “What will you do with this information now?” is
meant to connect the learning to an action toward better health. The question is
appropriate for you too, what will you do with the knowledge you’re learning in this
diabetes course?
Evaluate the Learning
Evaluating the learning experience is important to ascertain whether your explanation was
effective. Simply asking “You understand, right?” won’t elicit honest feedback. Many people
will say yes just to save face for both their sake and yours. Cultural norms in many Asian
cultures demand that patients nod a polite yes even if they don’t understand.
In fact, many people don’t want to admit they didn’t understand. Asking them to state
back what you said, or requiring them to do a repeat demonstration after your instruction,
will give you a better assessment of their learning. You may see holes in their
understanding, which you can then fill. Asking patients to teach you is a good way to
assess their understanding. Generally if someone can teach correctly, then they know.
Asking open-ended questions after your instruction is also helpful: “Explain to me how
insulin works in your body,” or “Tell me how you may know if your blood sugar is getting
too low.”
Clinical Scenario
A diabetic patient looks disinterested when you introduce a pamphlet.
Q: What questions should you ask yourself about using this instructional material?
A: Can the person read? Is the timing right for this patient to learn about diabetes?
Does the patient wear glasses? Is there someone else in the family who needs to attend
the training session? Is there a language barrier? Is there some other material that this
patient will find interesting and informative?
Achieving Patient Behavioral Change
If patients with diabetes are not moved to take action after being taught how to care for
themselves they will not thrive. Educators have developed a number of theories about how
adults learn and we will look at these in this section.
Motivation to Change
Essential to effective teaching is an understanding of why and how people learn. The field
of psychology helps us understand what drives human behavior. Russian physiologist Ivan
Pavlov demonstrated that behavior may be based on a conditioned response of reward or
punishment. If a dog is always rewarded with a bone after a bell rings, the dog will begin
to salivate upon hearing the bell. For a person with diabetes, being rewarded with a good
blood glucose level after daily exercise can be encouraging and can help encourage
repetition of the desired behavior. Unfortunately, however, the reward of comfort food may
overpower the “punishment” of a rising blood glucose level.
If a patient is reprimanded by a healthcare professional for being overweight or having
chronic hyperglycemia, the patient may stop returning to the doctor’s office. Our behavior
is determined by the promise/threat of reward or punishment. A teenage girl with type 1
diabetes may fear weight gain caused by insulin more than developing diabetic
ketoacidosis and choose to go without her needed insulin after a meal. Identifying the
predominant drive can help us understand the choices people make.
Cognitive learning theory states that people can learn logically and by social example;
however, in eating we humans tend to be more emotional than rational. For example, a
person may know (cognitive) that pasta elevates blood glucose more rapidly than a lean
protein meal but still consume large amounts of pasta because it tastes so good
(emotional). Abraham Maslow who developed humanistic learning theory, believes that
what drives people to action, including learning and behavior change, is based on trying to
fill the most urgent need at the time. His classic pyramid model demonstrates that the
most primary human needs are survival, and only after having food, shelter, air,
elimination of pain and waste, can we then focus on higher-level needs such as safety and
security, social belonging, love and affection, and ultimately self-actualization.
Maslow’s Hierarchy of Needs
Source: Maslow, 1943; image from Wikipedia Commons.
The person with diabetes who is suffering from painful neuropathy, erratic blood sugars,
and retinopathy may not be interested in sitting in a class. He may be more focused on
learning about behaviors that promise elimination of pain. Sometimes simply asking “What
is the most important thing to you about learning to control your diabetes right now?” can
help clarify the present drive to learn.
Adult learning theory identifies how adults learn and helps anyone who teaches adults to
understand what motivates them. The following list identifies basic preferences of adult
learners.
Information is related to an immediate need.
Learning is voluntary.
Adults are problem- centered.
Adults are self-controlled and self-directed.
Learning is active.
Threat to self is minimized.
Learning is in a group.
Adults prefer a variety of learning activities.
Prompt feedback is given.
Teaching people of different ages requires different approaches. Adults generally prefer
information that will help solve an immediate problem or need. Adults seek prompt
feedback when learning a new skill and prefer a relationship where they are not
threatened. Research shows that the patient-provider relationship is crucial to
adherence to a prescribed medical regimen (Ciechanowski et al., 2001).
Adults who feel safe, valued, and free of judgment may be more compliant to a prescribed
management plan than those adults who feel they are “just a number” or are being talked
down to. Creating a collaborative relationship that includes the patient in diagnostic results
and creating the health plan is beneficial in creating positive outcomes. The approach of
teaching patients self- management that empowers them to take control of their own life
produces powerful improvements in health outcomes (ADA, 2015.)
Diabetes self-management support (DSMS) is defined by the ADA as “support and
education for the person with diabetes that facilitates the knowledge, skill, and ability
necessary for diabetes self-care.” The goal of any patient education needs to be to improve
the health of the individual and reduce diabetes-associated complications. Historically,
diabetes education and support has occurred primarily in hospitals and physicians’ offices,
however alternative settings such as clinics, community centers, homes, pharmacies, and
home-based technology are now available and accessible.
Clinical Scenario
You are teaching a man who has type 2 diabetes about his blood glucose meter and his
wife continually interrupts to ask questions about food and meals.
Q: What is the best course of action for you as the diabetes educator?
A: According to adult learning theory, you need to address her pressing need for
information. Allow her to ask the questions and answer them. Continue with your
demonstration when she feels her questions have been answered. It is still polite to
remind her your time is limited and the goal of this session is to teach them how to use
the meter. Using the meter can help them both identify the effects of the meals on blood
sugar.
Helpful Educational Models
Sometimes we look at educational models and assume they are meant for academics but
are not relevant to our daily teaching. Consider the models that follow and what they may
contribute as you teach your patients about diabetes self-care.
Health Belief Model
In addition to the learning theories, the Health Belief Model is a psychological model that
can help you understand and predict health behaviors (J Pharm Prac, 2015). It can also
help you to understand resistance to changing positive self-care behaviors. The model
identifies factors that can either help or prevent someone from likely engaging in health-
promoting behavior. If patients don’t view their health condition as serious or see that they
are truly susceptible, they generally won’t take any action.
The way patients perceive self-care actions as benefits or barriers determines what they
do. Even if patients acknowledge the seriousness of their condition and the benefits to
behavior change, when there are barriers to the action or they don’t believe they are
capable of doing the behaviors, the actions won’t occur.
The Health Belief Model is based on the patient’s perception and not necessarily on reality.
Many patients continue in denial and thus don’t take action toward positive behaviors that
will support their health. By addressing patients’ perceptions of their diagnosis, potential or
real consequences from the medical condition, and barriers to performing self-care
behaviors, you will have greater success in teaching.
The Health Belief Model
Source: Ontario Health Promotion System, 2015.
The gap between theory and practice closes as you understand the theories that explain
human behavior and begin to adjust the way you teach your patients about diabetes.
Teaching someone about the dangers of chronic hyperglycemia without asking if they have
a glucose monitor and know how to adjust their own behaviors creates a barrier they won’t
be able to overcome—and will not produce favorable glycosylated hemoglobin test results.
Teaching someone about the action of metformin and the need to take it twice daily won’t
be successful if the person can’t afford the medication or doesn’t believe in the benefits of
Western medicine. The theories and models can help you as you try to identify why a
patient doesn’t follow prescribed medication use or behaviors. Rather than labeling a
patient as “noncompliant,” try to identify the barriers to that desired behavior with the
patient and create solutions together.
Clinical Scenario
Thalia Smith, a 21-year-old female with type 1 diabetes, continues to have repeated
admissions to the emergency department in DKA due to inconsistency with her insulin
injections.
Q: What are questions you could ask to identify the cause of her behavior?
A: What does she understand about diabetes and insulin? What are her barriers to
taking insulin? Is there a cost barrier? Is she afraid of weight gain? Does she have
insurance? Is she living on her own now that she is 21? Does she see a benefit to taking
insulin? What is her understanding of complications from chronic hyperglycemia? Does
she just have diabetes burnout?
Transtheoretical Model
Assuming the patient has been taught effectively, there are different levels of behavior
change that need to be understood and acknowledged. Change is difficult, and most people
are inherently resistant to change. According to the Transtheoretical Model of change,
concepts from the other theories are applied to help us understand the various stages of
modifying behavior (Prochaska & Prochaska, 2011). Studies show that when people try to
change their behavior they move through a series of stages. The time within the stages is
variable; however, progress to action and maintenance of a behavior change must follow
stage by stage in a systematic manner. The process is also cyclical, in that people can slip
back into earlier stages with relapse and hopeful renewal.
Think about your success regarding a New Year’s goal you set this year. Did you achieve it
and stay in the ideal state of change or did your progress vary, relapse, and continue at
various stages? Knowing about the various stages can help you assess and support the
stage of change your patient may be in.
In the precontemplation stage a person hasn’t begun to take any thought or action
toward a goal. Research states that it takes on average ten times for a healthcare
professional to discuss a new behavior, such as smoking cessation, before the person
begins to truly think about it. In precontemplation the action hasn’t even been seriously
considered.
Transtheoretical Model
The next stage of contemplation is when the person begins to think seriously about
changing a behavior. “Someday I’ll really stop smoking.” The third stage of preparation is
when the person begins to think about all that is needed to make the change—for
example, looking into available smoking cessation resources.
The next stage is action, when the person begins to make changes (throwing out
cigarettes, joining a smoking cessation class, making an appointment to see his provider
for a nicotine replacement product). According to research on behavior change, the action
stage needs to occur more than 21 consecutive days to become habit. Once the new
behavior has been continued for over a month, the new habit moves to the maintenance
stage, which can take months or years. Relapse has been built into this model, as it
recognizes human nature’s tendency to fall back into old habits. Acknowledging that
change is hard and requires support, you can shore up continued efforts. Sometimes, the
relapse may be so severe that the person has to begin the entire cycle anew, starting with
precontemplation to decide if the effort was worth it.
Ruler Method of Change
A tool to help guide your patient change is called the ruler method. After patients identify
a desired area of improvement, such as ideal weight, ask them:
On a scale of 1 to 10, where do you think you are in this?
How much do you want the new behavior or outcome?
Using the 1 to 10 scale, follow up with questions to help identify barriers and motivation:
How ready are you to make that change?
How confident are you to make that change?
What would it take for you to move up 2 points from where you are now?
The ruler method can help identify patients’ level of change, barriers, and motivation. As
the healthcare professional you don’t have to lecture or nag, but merely ask good
questions to guide their own self-reflection and discovery. The burden is no longer on the
diabetes educator but on the patient to explore their own readiness to change and improve
health behaviors. The educator is there to answer any questions the patient may have and
to guide the discussion.
The following table demonstrates what you can do to support your patients as they develop
new healthy behaviors.
Stage of change Strategy
Precontemplation
(resistance/reluctance)
Establish rapport, ask permission to help
Build trust, express concern
Contemplation (considering) Strengthen self-confidence
Preparation Clarify short-term goals, resolve concerns
Action Assist and support
Maintenance Affirm, support, explore long-range goals
Kübler-Ross Grieving Model
Another model pertinent to people with diabetes is the grieving model, as identified by
Dr. Elizabeth Kübler-Ross (Pera et al., 2008). Each person diagnosed with diabetes
experiences the loss of their former good health and goes through stages of grief similar to
those of death and dying. Essentially, their old healthy self is now seen as lost. The stages
vary in timing and duration and often follow the sequence of denial, anger, bargaining,
depression, and acceptance.
Patients who are in the denial phase don’t make progress toward controlled blood sugar
levels if they don’t believe they have diabetes and need the medication. Many people with
prediabetes or metabolic syndrome deny they are at risk for diabetes and don’t make
changes, which later may result in pancreatic fatigue, diabetes mellitus, and complications
of chronic hyperglycemia. Patients may be in the anger or depression stage and not come
to an acceptance of the reality of their disease, which delays improvement and glucose
control. Recognizing the stages of valid grief can help you become a more compassionate
diabetes educator. Remember, unless you have lived with diabetes yourself, you truly don’t
know what it’s like, and compassion and support are some of the best medicines needed by
your patients who have diabetes.
Clinical Scenario
Isaiah Brown, a 58-year-old African American man, is resistant to testing his blood sugar
daily.
Q: What questions could you ask him to help him move to the next stage of action?
A: Tell me your concerns about testing your blood sugar. What gets in the way when
you think of testing your blood sugar? What do you think may happen if you continue to
have high blood sugar every day? What are some benefits of testing your blood sugar
daily? How many times do you think you need to test your blood sugar? What would you
do if you tested and had a high or low blood sugar?
Pragmatic Guidelines
Armed with an understanding of diabetes and what motivates people to change, it is
necessary to know how to teach effectively in order to help patients achieve favorable
outcomes. The determinants of learning can be addressed by answering the who, what,
when, where, and how of teaching people with diabetes (Redman, 2004).
Who, What, Where, When, and Why
The who includes who you are teaching and, hopefully, family members. Parents of
children with type 1 diabetes especially need education and support. Although there is no
actual type 3 classification of diabetes, family members who care for a patient with
diabetes have coined the term for themselves. Their lives are touched directly as they care
for a family member with diabetes even though they don’t have diabetes themselves. It is
important to involve the family members who may be buying and preparing food and/or
administering medication. There is a very real phenomenon of diabetes burnout, and
caregivers also experience this and need support.
Deciding what needs to be taught may be easy if it is prescribed—such education for
insulin injection or blood glucose monitoring—however, most topics are up to the diabetes
educator. You must decide between the nice-to-know and the need-to-know. Because
formal diabetes education may be limited by insurance companies to a maximum of ten
hours in the first year, teach first survival skills such as basic physiology and medication
administration. Long-term goals and special topics such as eating during the holidays,
travel, and cooking ideas should be chosen after essentials such as weight loss and blood
glucose monitoring. All topics must be in accordance with the ADA national standards for
DSME.
Topics such as the use of alternative therapies should be limited if there is no position
statement from the ADA. For example, patients will want to know if they should be taking
cinnamon pills or chromium or cactus pear because they read about it on the Internet or
heard it from a friend. Unless the ADA has endorsed such products, you need to tell the
patient that they are not approved. Patients will highly value your opinion as a healthcare
professional so you must be careful what you say about vitamins, complementary
therapies, and practices not validated by evidence-based medicine.
Stay with the seven approved topics and interventions for diabetes management:
Weight loss
Medications
Diet
Exercise
Monitoring
Mental health and stress management
Self- management strategies
Avoidance of complications
A simple way to remember this are the “seven daily MnMs,” which include:
M Mass reduction (weight loss)
M Movement (exercise)
M Meal Planning (diet)
M Monitoring (blood glucose, weight, lipids, blood pressure, etc)
M Medications
N No complications (avoiding hypoglycemia, DKA and HKS)
M Mental Health
Make sure your patient understands you are not advocating eating M&Ms to manage their
diabetes! Once you know this is understood, the seven daily MnMs is a “sweet” way to
remember the daily strategies recommended by the ADA to control daily blood glucose
levels and overall diabetes. The use of mnemonics and acrostics help some people
remember action items.
How to teach is grounded in understanding basic principles of teaching. As mentioned
earlier in this module, you can ASSURE effective teaching by analyzing the learner’s unique
needs, stating the objectives for a teaching session, selecting appropriate teaching
methods, using effective instructional materials, requiring learner performance, and then
evaluating the learning.
Where diabetes education takes place includes both healthcare settings and non-
healthcare settings such as the home. Because time and insurance coverage may limit the
formal teaching, referring patients to public libraries, community support groups, the
Internet, and diabetes organizations can expand their learning resources.
When diabetes education can begin depends on the physical and emotional readiness of
the learner. Acute settings such as an emergency department may not be ideal for diabetes
education, especially when the patient is in pain or discomfort; however, initial seeds may
be planted as patients become newly motivated to avoid acute diabetic emergencies.
Other
factors that may impact a patient’s readiness to learn include their state of fear, open vs.
closed dialog, sense of safety or perceived threat to self, and discussing realistic or
unrealistic goals. Telling an obese patient to lose 20 pounds may be unrealistic and
overwhelming to the patient and close the patient off to any future discussions. Discovering
what is of most interest to the patient is key. Discussing erectile dysfunction may actually
become the right motivator to get a man interested in testing his blood sugar.
Just as children want to know the “why” of parental rules, many people with diabetes want
to know why they are being given certain medications and prescriptions. Again, being able
to explain the pathophysiology to them in a manner they understand can help them make
connections with the prescribed regimen. The overall goal of diabetes self-management
education is to help patients live as full and healthy a life as possible within their
limitations.
One overarching strategy to achieve this is through controlling chronic hyperglycemia.
Once patients understand the overall goal, monitoring their blood sugar levels throughout
the day can give them feedback on the effects of exercise and food on their body. The goal
is self-management, and information is key to being able to make adjustments. Blood
glucose monitoring or insulin is no longer the enemy, but rather the tool to help them
achieve better health.
How to teach effectively has been the overall question this continuing education course
attempts to answer. Strategies discussed have included:
Understand learning styles
Understand learning principles for patients’ ages
Understand motivation and compliance factors
Adjust teaching for cultural preferences
Control flow of time and pacing
Identify purpose of teaching session
Require learner to take an action
Organize the material
Be prepared
Have a sense of humor
Be flexible and adjust the teaching as needed
General principles of effective teaching include being prepared with the material you may
need. Give positive feedback and reinforcement rather than chastisement. Always
demonstrate an attitude of respect and compassion. After teaching a concept, allow
patients to rephrase it in their own words to evaluate understanding. Be flexible when the
patient asks questions about a topic you may not have planned for. Sometimes a patient
may ask general questions until gaining confidence in you and then the deeper questions of
sexual dysfunction or eating disorders may surface.
Clinical Scenario
The diabetic patient refuses to test his blood sugar and states he can just guess his
blood sugar by how he feels.
Q: What questions could you ask the patient to better help him?
A: Tell me how you feel when your blood sugar is high? When it is low? How do you
know? What benefits are there in testing your blood sugar? What barriers do you have to
testing your blood sugar? Do you have a meter? Would you like me to show you how to
use it? Let me tell you about hypoglycemic unawareness.
Creating a Lesson Plan
Creating a plan for effective teaching begins with identifying the overall purpose of the
teaching session. Writing your plan down helps focus on the overall goal and the topic for
learning. What are the learning objectives you want your patient to achieve? Outline the
related content to identify the topics you will need to cover, including the realistic time it
will take to cover the material. Choose the materials and instructional resources you will
use and how you will evaluate the learning.
The following table shows how you may outline a simple lesson plan to teach about blood
glucose monitoring.
Topic Content Time Materials Evaluation
Blood
glucose
monitoring
a. What is it?
b. Why do it?
c. How to use the
monitor
d. How to record
results
e. How to interpret
results
a. 2 min
b. 2 min
c. 10 min
d. 5 min
e. 5 min
Get monitor
w/instruction
manual
Get log book
Demonstrate first
and have patient
give return
demonstration of
meter use and
record in log book
Even though your lesson plan was perfectly organized and delivered, the patient may have
a less than impressive retention or understanding of the information you presented. There
are many factors that influence learning. Environmental elements may affect the learning
experience (eg, temperature, noise). If the environment isn’t conducive to learning, you
may need to reschedule or return at a different time. Simply ask your patient “Is this a
good time for you to discuss this?”
Emotional elements impact learning (eg, depression, readiness for change, fear). A patient
who is anxious while waiting for a test result may not be ready for a lecture on weight loss.
Social issues such as family dynamics can impact learning. Support or lack of support from
family members or loved ones can change the learning experience. A man who doesn’t feel
supported by his wife may reject a learning session and stay in denial or anger. Physical
condition can impact patients’ learning if they are in pain or tired. It’s generally not a
positive experience to try to teach someone who is waiting for a pain medication or who
keeps falling asleep from anesthesia. Ideally the planets will align and make all the
elements perfect while you have the opportunity to teach about diabetes; however, reality
is that you probably will need to teach in small segments of time based on the patient’s
preference and not your own schedule.
Even cultural values impact the learning experience. While teaching a Spanish-speaking
woman about diabetes, a bilingual nurse was surprised when the patient stated “Si Dios
quiere” (If God wants it) when asked “Would you like to learn more about how to monitor
your blood sugar?” Even though there wasn’t a language barrier, the deeper barrier was
the belief system of the patient that God is in charge and she had no power to control her
blood sugar levels. When confronted with a wall of resistance, endeavor to identify the
barriers you are facing.
Other special considerations are patients with low literacy, attention deficit disorder, or
mental illness. For more effective teaching with these persons consider the following
strategies:
Personalize all messages.
Repetition is key.
Use concrete illustrations.
Allow hands-on learning.
Be sensitive to word usage.
Identify family members to assist.
Word check for readability.
Provide education in short time segments.
Identify 1 to 2 main messages.
Allow patients to teach back to clarify understanding.
Teaching all there is to know about diabetes is a daunting task—and unrealistic. Being able
to connect your patient with reputable resources supports the patient’s ability to become a
lifelong learner with diabetes. Self-management education means you do not have to be
the sole person to educate about diabetes, which is a relief. Look at the Resources at the
end of this course for many options for you and your patient.
Maria
You are an RN working in a women’s clinic when 24-year-old Maria arrives for her regularly
scheduled obstetric appointment. She is 5’3″ and weighs 153 pounds, with her pre-
pregnancy BMI 29. She is a 26-weeks’ gestation primigravida and speaks basic
conversational English. She is scheduled to complete her 50-g glucose challenge. Her
mother has diabetes.
Q: What is the purpose of the 50-g glucose challenge?
It is a screening test for diabetes and identifies how much sugar the body can metabolize
after two hours of a glucose load.
1. What is the process of the screening test?
The patient needs to fast for at least 8 hours. The patient drinks a bottle of 50 grams of
pure glucose. Blood glucose values are measured before the beverage is consumed, at the
half-hour, 1-hour, and 2-hour mark. If the blood glucose remains above 140 mg/dL, the
person has diabetes.
2. The results came back 201 mg/dl after 1 hour. What does this mean?
This patient has diabetes and her body cannot metabolize the sugar adequately.
Maria was then scheduled for a 100-g glucose load. The lab tests are shown in the
following table.
Time of test Patient value Normal value
Fasting 131 mg/dl <95 mg/dl
1 hour 193 mg/dl <180 mg/dl
2 hour 182 mg/dl < 155 mg/dl
3 hour 151 mg/dl < 140 mg/dl
4. List at least three risk factors that predispose Maria for gestational diabetes mellitus
(GDM).
She is Hispanic, overweight, and has a family history of diabetes.
5. You now give Maria nutrition guidelines for her GDM. She gives a diet history mainly of
rice and beans, fried meats, and tortillas. She tells you her grandmother in Mexico had
diabetes and cured it with nopales (prickly pear) and cinnamon. She says she gets
nauseated with dairy products. What are your dietary goals for Maria?
Support her nutritional needs during the pregnancy. This is not a time for weight loss.
Provide her a realistic diet plan based on her dietary and cultural preferences and provide
calcium in forms other than dairy.
6. What survival skills that you will teach Maria this first session?
She needs to learn how to measure her blood glucose and how to create a realistic diet
plan she can follow during the pregnancy.
7. Maria returns in 4 weeks and has gained 10 pounds. Her FBG today in the clinic is 238.
You now instruct her to measure her FBG and 2 hours after eating twice daily. What type of
monitor would you suggest for Maria? What is your approach for education at this visit?
What resources do you have for her?
She needs a simple monitor. She also needs education in Spanish. Refer to the ADA for
Spanish videos and pamphlets.
8. What are the potential complications for GDM to both Maria and her baby?
She could continue to gain excess weight and create complications for herself and the
baby. With excess blood glucose the baby may grow too much and make a vaginal birth
difficult (eg, a baby >9 lb). She is at greater risk of developing diabetes mellitus.
9. When she comes 1 week later you will teach her insulin injections TID. What are your
teaching approaches and considerations?
She needs to understand why she will be taking insulin and that it will help her baby grow
normally. She needs to know how/where she can get supplies and how she can afford
them.
10. During the next months, she will return to the clinic every 4 weeks. What are other
topics you will assess and teach her?
She needs to learn about fetal kick counts and plan for a safe delivery. She also needs to
begin to think about weight loss after the delivery to avoid fully getting diabetes type 2
after her gestational diabetes.
11. In preparation for her labor, she wants to know if she will be on insulin for the rest of
her life like her mother. What pre- and postpartum counsel do you have for her?
Explain to her how the pathophysiology of gestational diabetes compares to type 1 and
type 2. Assess what kind of diabetes her mother had. Explain that she will have her blood
sugar tested after delivery and may not need to be on insulin anymore.
Frank
Frank comes to the clinic where you are employed. He has been complaining of chronic
fatigue, increased thirst, constant hunger, and frequent urination. He denies any pain or
burning on urination. He admits to smoking since losing his job but has recently found a
new job at a loan company. He also complains of having difficulty reading numbers and
reports and making more mistakes in his paperwork.
He reports that his feet hurt as he stands at a bank teller station for many hours and so he
sits and watches TV when he gets off work at night, not having enough energy to do
anything else. His weight is 245, BP is 152/97, random BG is 291 mg/dl. His labs reveal
the following: FBG=184 mg/dl, HgbA1C=10.4, negative for ketones on urine, cholesterol
256 mg/dl, triglycerides 346 mg/dl, LDL 158 mg/dl, HDL 32 mg/dl.
1. What is the probable diagnosis?
Type 2 diabetes mellitus.
2. What are his risk factors for this diagnosis?
Obesity, sedentary lifestyle, high lipids, hyperglycemia, ethnicity, age.
3. What are four methods of diagnosing this type of DM?
Fasting blood glucose >100 mg/dL, random BG >200 plus symptoms, A1C >5.5, OGTT
>200 mg/dL.
4. Frank was started on lispro (Humalog) and glargine (Lantus) insulin with carb counting.
What is the most important point to make when teaching the patient about glargine?
Lispro is fast-acting and glargine is long-acting. They cannot be mixed together even
though they are both clear in the vials.
5. Frank wants to know why he can’t take NPH and regular insulin. He has a friend who
does.
Each body and type of diabetes requires different medication regimens and really can’t be
compared to another person’s diabetes.
6. Frank is confused with counting carbs and says he doesn’t want to have to calculate
foods. What are your options for teaching him meal planning?
He can use the plate method, portion control, food guide pyramid, or other food
management systems.
7. What other complications does Frank have with his diabetes? What questions would you
ask to assess other complications?
It appears he is already developing retinopathy, neuropathy, lipodystrophies, and possible
cardiovascular complications.
8. What are some changes Frank can make to reduce the risk or slow the progression of
both microvascular and macrovascular disease?
The seven self-management strategies endorsed by the ADA.
Interpret the following record of his visits and list your treatment suggestions.
Tests and other services Dates and results
Flu shot 9/28/00
Urine protein or microalbumin
(mg)
2/1/15
40
6/11/15
38
9/28/15
35
Creatinine 1.0 1.0 .8
Total Cholesterol (mg/dL) 256 225 199
HDL cholesterol (mg/dL) 32 35 40
LDL cholesterol (mg/dL) 146 140 135
Triglycerides (mg/dL) 250 240 228
Tobacco use 5 cigars a day 2 cigars 0
Eye exam (dilated) 10/1/00 10/4/2001 10/20/2002
Foot exam ulcer ulcer healing ulcer
1. Interpret the following blood glucose log book. What are your recommendations?
Insulin
Type
Breakfast Lunch Dinner
Dose
Blood
Sugar
Dose
Blood
Sugar
Dose
Blood
Sugar
Mon
Reg 8
141
3
287
4
158
NPH 20
Tue
Reg 8
112
2
204
4
215
NPH 20
Wed
Reg 8
159
3
178
4
261
NPH 20
Thur
Reg 8
191
2
114
4
110
NPH 20
Fri
Reg 8
132
2
152
3
68
NPH 20
Sat
Reg 8
124
3
161
4
118
NPH 20
Sun Reg 9 175 2 99 4 110
The fasting blood sugars are still higher than the recommended 110 mg/dL and the patient
may need to take p.m. insulin or decrease carbohydrate consumption at dinnertime.
Mr. Brown
Mr. Brown is a 59-year-old African American male. He and his wife have grown children and
he works as a manager of a mechanic shop, which he states is very stressful. He has had
type 2 diabetes for fourteen years, which has been “controlled by a pill” (metformin). He
was put on insulin three years ago: Humalog 75/25 pen at breakfast and Lantus at
bedtime. He is afraid of hypoglycemia because at work he had one episode when he felt
sweaty and shaky and had to lie down. His last eye examination revealed a few
microaneuysms and he was diagnosed with mild nonproliferative retinopathy in both eyes.
He checks his fasting blood glucose most days and occasionally before bedtime. He
complains that the test strips are expensive so he will just let the doctor do the lab tests
once a year. He doesn’t keep a log book because he states his meter has a memory. He is
in the office today because he’s inquiring about Viagra.
1. From this brief history, what are your priorities of teaching with Mr. Brown?
Blood glucose testing with a monitor and teaching him how to avoid and identify
hypoglycemic episodes.
2. Interpret his 24-hour food recall and explain your suggestions for improvement.
Breakfast 7 a.m. 2 cups Starbucks coffee
2 donuts
Mid morning 10 a.m. Chips
Orange juice
Lunch 1 p.m. Double cheeseburger
Large fries
Diet Coke
Mid afternoon 3 p.m. Apple, soda
Dinner 6:30 p.m. Green salad with ranch dressing
2 rolls w/butter
1 pork chop w/gravy
collard greens
1 slice chocolate cake
1 beer
Bedtime snack 10 p.m. cookies
He needs to cut out excess sugar consumption, such as the soda and cookies and desserts,
until he gets his blood glucose levels stabilized. He needs to include lean protein in his diet
and more vegetables.
3. After committing him to monitor his blood glucose for 1 week he shows you the
following log book. Interpret the findings and make your recommendations.
Date Breakfast Lunch Dinner Bedtime Other Comments
Time
Blood
Glucose
Time
Blood
Glucose
Time
Blood
Glucose
Time
Blood
Glucose
Time
Blood
Glucose
1/30 7:00 205 12:00 158 5:00 198 10:30 215 3:30p 250 Felt tired & some
blurred vision,
mid afternoon
1/31 7:30 220 11:30 178 5:30 190 11:30 175 Tried to eat
smaller portions
at dinner
2/01 7:00 172 11:30 142 5:30 185 11:00 170 Felt better today!
His morning fasting blood glucose values are still too high and needs p.m. medication or
a.m. coverage. He does well for lunch testing so his breakfast meal is OK.
4. Discuss the following info for Mr. Brown and list your recommendations.
Initial visit 3 month F/U 6 month F/U 9 month F/U Norm
Weight 226 220 224 221 180
BP 132/84 128/82 144/88 134/80 120/70
A1C 11.3 10.9 11.1 9.6 4–6
Monofilament
foot check
Decreased
sensation
bilaterally
Decreased
sensation in
toe
Decreased
sensation in
toe
Decreased
sensation in
toe
Improving
sensation
bilaterally in feet
FBG 216 182 190 178 <110
Cholesterol
HDL
LDL
Triglycerides
216
35
116
300
201
40
110
293
200
39
112
306
195
38
102
288
<200mg/dl
>40 mg/dl
<100 mg/dl
<150 mg/dl
Creatinine
Microalbumin
.9
34
.8
30
.9
35
.7
32
0.5-1.4 mg/dl
<30 mg/g
5. Where is Mr. Brown making progress? What areas can he improve on?
He is losing weight. His blood pressure is improving, his FBG is better and he must surely
be feeling better. He deserves congratulations. He can continue to watch his feet for
wounds and healing. Be sure to engage with him on his initial question about using Viagra.
Resources and
References
Resources
Professional Groups
American Association of Diabetes Educators (AADE)
www.diabeteseducator.org
800 338 3633
American Diabetes Association
www.diabetes.org
800 diabetes (800 342 2383)
American Dietetic Association
Eatright.org
800 877 1600
American Association of Clinical endocrinologists
www.aace.com
Juvenal Diabetes Research Foundation International
www.jdrf.org
800 533-CURE (800 533 2873)
Centers for Disease Control and Prevention
cdc.gov/diabetes
800 CDC-INFO (800 232 4636)
Diabetes Care
www.diabetescare.org
National Diabetes Education Program
www.ndep.nih.gov; www.yourdiabetesifo.org
888 693-ndep (6337)
National Diabetes Information Clearinghouse
diabetes.niddk.nih.gov
800 860 8747
National Diabetes Education Initiative
www.ndei.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://diabetes.niddk.nih.gov/dm/pubs/dictionary/index.htm
Books
Funnell M, Arnold M, Kasichak A. (2003). Type 2 Diabetes: A Curriculum for patients and Health
Professionals. Alexandria, VA: American Diabetes Association.
The Art and Science of Diabetes Self-Management Education: A Desk Reference for Healthcare
Professionals, 1st ed. (2006). Chicago: American Association of Diabetes Educators.
References
American Diabetes Association (ADA), American Association of Diabetes Educators (AADE), Academy
of Nutrition and Dietetics. (2015, July 1). Joint Position Statement. Diabetes Care 38:1372–82.
Retrieved November 20, 2015 from
http://care.diabetesjournals.org/content/38/7/1372.full +html.
American Diabetes Association (ADA). (2014). National Statistics Report. Statistics About Diabetes.
Retrieved November 1, 2015 from http://diabetes.org.
American Diabetes Association (ADA). (2011, January). Diagnosis and classification of diabetes
mellitus. Diabetes Care 27:s62. Retrieved November 1, 2015 from
http://care.diabetesjournals.org/content/27/suppl_1/s5.full.
Brown S. (1990, December). Studies of educational interventions and outcomes in diabetic adults: A
meta-analysis revisited. Patient Education and Counseling 16(3):189–215.
Ciechanowski P, Katon W, Russo J, Walker, E. (2001). The patient-provider relationship: Attachment
theory and adherence to treatment in diabetes. American Journal of Psychiatry 158(1):29–35.
Retrieved November 18, 2015 from http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.1.29.
Health Beliefs Describing Patients Enrolling in Community Pharmacy Disease Management Programs.
(2015, January 20). Journal of Pharmacy Practice.
Lewis T. (2013). How Men’s Brains Are Wired Differently Than Women’s. Live Science. Retrieved
November 6, 2015 from http://www.livescience.com/41619-male-female-brains-wired-
differently.html.
National Center for Education Statistics. (2002). Adult Literacy in America. Retrieved November 5,
2015 from https://nces.ed.gov/pubs93/93275 .
National Institute of Literacy, U.S. Department of Education. (2013, September). Retrieved
November 5, 2015 from http://www.statisticbrain.com/number-of-american-adults-who-cant-read/.
Prochaska JO, Prochaska JM. (2011). High-impact paradigms for changing behavior to enhance
health, productivity, and well-being. In J. Brown and D.B. Nash (Eds.), Disease Management and
Wellness in the Post-Reform Era. Washington, DC: Atlantic Information Services, Inc. Retrieved
November 20, 2015 from.
Pera I, Vasallo M, Andreau O, Rabasa T. (2008). Alignment of the Kübler-Ross grief cycle phases with
the process of adaptation to type 1 diabetes mellitus. Endocrinology Nutrition 55(2):78–83. Retrieved
November 21, 2015 from http://www.ncbi.nlm.nih.gov/pubmed/22964100.
Redman BK. (2004). Advances in patient education. New York: Springer.
Post Test
Use the answer sheet following the test to record your answers.
1. Glycogen:
a. Is glucose when it is stored in the liver.
b. Is another spelling for glucagon.
c. Is the same as glucagon.
d. Is interchangeable with insulin.
2. The four classes of diabetes are:
a. Type A, type B, type C, and gestational.
b. Type 1, type 2, gestational, and “other.”
c. Gestational, childhood, adolescent, and adult.
d. Class 1a, class 1b, class 2a, and “other.”
3. Which class of diabetes has absolute insulin deficiency?:
a. Prediabetes.
b. Gestational diabetes.
c. Class 1a diabetes.
d. Type 1 diabetes.
4. One strategy for overcoming barriers to poor communication is:
a. Look directly into the patient’s eyes.
b. Speak as loudly and clearly as possible.
c. Simplify medical jargon.
d. Repeat yourself until you are certain the patient is following you.
5. “When the student is ready, the teacher appears” may apply to reluctant diabetes
patients. What strategy can you use with such patients?:
a. Remind them that their PCP has mandated their training.
b. Give them a note or pamphlet and your phone number.
c. Pull together all your printed materials to send home with them.
d. Point out how much other diabetes patients have benefited from the training.
6. The purpose of the ASSURE mnemonic is:
a. To remind you to appear assured as a teacher.
b. As a memory tool for your diabetes patient.
c. To make sure you remember all of your teaching aids.
d. As a reminder of steps to effective learner education.
7. Motivation to change may be based on a conditioned response to reward or punishment.
Which one of the following is likely to result in compliance with a diabetes regimen?:
a. A reduced blood glucose level following daily exercise.
b. Running out of money for insulin at the end of the month.
c. Being scolded by the diabetes educator.
d. Gaining weight despite following the regimen pretty well.
8. The most successful way to gain patient compliance with a diabetes regimen is:
a. Behave formally and be the expert in the room.
b. Be informal and try to get the patient to like you.
c. Develop a collaborative relationship with the patient.
d. Insist on strict compliance from the outset or you will lose the patient’s respect.
9. The Health Belief Model is useful in identifying barriers to compliance.:
a. True
b. False
10. The stages identified by the Transtheoretical Model are:
a. Novice, moderate, and expert.
b. Action, relapse, and reaction.
c. Inattention, interest, and concentration.
d. Precontemplation, contemplation, and action.
11. The Ruler Method of change uses a scale from:
a. A to Z.
b. One to ten.
c. Minus 1 to +5.
d. One to 100.
12. Elizabeth Kübler-Ross’s On Death and Dying applies to diabetes patients in what way?:
a. They get stuck in denial and fail to progress.
b. They are in total disbelief about having diabetes and don’t take their insulin.
c. The newly diagnosed patient experiences a loss of health in a way similar to the five
stages of dying.
d. Most patients haven’t read the book so it really doesn’t apply.
13. The mnemonic MnMs applies to what?:
a. Seven daily interventions for diabetes management.
b. A reminder not to eat candy.
c. Medication but no motivation.
d. Make me no mnemonics.
14. Which of the following demonstrates progress toward a behavior goal?:
a. MJ has read pamphlets about Diabetes.
b. Sue monitors her blood glucose 3x per day.
c. Mark can identify 4 foods that contain 15 gm carbs.
d. Walter can describe hypoglycemic symptoms.
15. Changes in physical activity and problem-solving abilities are good indicators of:
a. Long-term outcomes.
b. Continuous quality improvement.
c. Behavior change.
d. Clinical improvement.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Name (Please print your name):
Date:
Answer Sheet
Diabetes: Teaching Patients Self-Care
Passing score is 80%
5 4 3 2 1
5 4 3 2 1
5 4 3 2 1
*
5 4 3 2 1
*
5 4 3 2 1
*
Yes No
*
Yes No
*
Course Evaluation
Please use this scale for your course evaluation. Items with asterisks * are required.
5 = Strongly agree
4 = Agree
3 = Neutral
2 = Disagree
1 = Strongly disagree
Upon completion of the course, I was able to:
a. Explain the four classes of diabetes and how they differ from one another.
b. Discuss the ways you can motivate a diabetes patient using at least two of the
education models presented here.
c. Be prepared to create a lesson plan for a patient, with the goal of achieving a specific
new aspect of self-care.
The author(s) are knowledgeable about the subject matter.
The author(s) cited evidence that supported the material presented.
This course contained no discriminatory or prejudicial language.
The course was free of commercial bias and product promotion.
*
Yes No
*
*
5 4 3 2 1
*
*
*
As a result of what you have learned, do you intend to make any changes in your
practice?
If you answered Yes above, what changes do you intend to make? If you answered No,
please explain why.
Do you intend to return to ATrain for your ongoing CE needs?
Yes, within the next 30 days.
Yes, during my next renewal cycle.
Maybe, not sure.
No, I only needed this one course.
Would you recommend ATrain Education to a friend, co-worker, or colleague?
Yes, definitely.
Possibly.
No, not at this time.
What is your overall satsfaction with this learning activity?
Navigating the ATrain Education website was:
Easy.
Somewhat easy.
Not at all easy.
How long did it take you to complete this course, posttest, and course evaluation?
60 minutes (or more) per contact hour
50-59 minutes per contact hour
40-49 minutes per contact hour
30-39 minutes per contact hour
Less than 30 minutes per contact hour
I heard about ATrain Education from:
Government or Department of Health website.
State board or professional association.
Searching the Internet.
A friend.
An advertisement.
I am a returning customer.
My employer.
Other
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46+
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Please enter your comments or suggestions here:
A paper copy of the course.
Yes No
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Health Education Pre-Brief Activity_STUDENT VERSION
·
Review Course Lecture PPTS and readings for Chapter 5: Frameworks for Health Promotion, Disease Prevention and Risk Reduction.
· Read the “Diabetes: Teaching Patients Self-Care” Module by Tracey Long RN, PhD, APRN (see attachment in Bright Space).
· NOTE: This module is to help you understand the process of
health education,
not to educate you about any specifics related to diabetes. Please keep this in mind. The principles of education that are covered in this module are essential for ALL educational topics (not just the one focused on here). You are encouraged to create an educational plan based on your “client’s” needs. (examples: weight loss, hypertension management, stress relief etc). Do NOT do a plan on diabetes management, because this is covered in full in this module.
· Using this module, answer the following questions:
1) Pages 4-9 provide a brief summary of this client’s conditions (in this example, Diabetes Mellitus). This demonstrates why it is important to have a good understanding of the client’s condition/disease before beginning a health education activity.
· For your client:
· Identify the disease/condition that you plan to address in this teaching plan
· What resource/s will you use to review this disease/condition, in preparation for teaching? (Remember, all resources should be current and evidence-based).
2) Pages 9-12 discusses barriers to effective teaching.
· List 3 barriers that healthcare professionals experience:
·
·
·
· List 3 strategies to overcome the barriers you identified:
·
·
·
3) Pages 12-13 discusses Patient Centered Diabetes Education.
· What is the difference between DOPE and HOPE?
·
· How has the role of (diabetes) health educator changed in recent times?
·
· How do we keep our education “patient-centered”?
·
· What is the benefit of patient-centered education?
·
4) Pages 13-18 discuss the ASSURE mnemonic for teaching.
A: Analyze
· Which elements are important to “Analyze” in our learners?
·
· What are the 4 basic learning styles discussed in this module?
·
· How can you assess learning styles in your client?
·
S: State the Objectives
· Remember, all objectives should be SMART. What does this mean?
·
· When creating objectives for the learning session, how do you best decide what to teach?
·
S: Select appropriate teaching method
· List 3 examples of teaching methods that can be implemented during health education sessions:
·
·
·
U: Use effective instructional materials
· List 3 examples of instructional materials that can be used for health education:
·
·
·
R: Require learner performance
· What are the 4 domains of learning?
·
·
·
R: Evaluate the learning
· What are the best methods to utilize to evaluate effectiveness of teaching?
·
5) Pages 18-26 discuss various theories and models for change. Use this information to guide your selection of a theory/model for your educational session.
6) Pages 30-32 discuss Creating a Lesson Plan. Use this information to guide you as you create a lesson plan for your client.
HealthEducation Teaching Activity
Purpose:
The purpose of this activity is to help you understand the process of health teaching of patients/clients by engaging in effective assessment; identification of learning needs/issues associated with the learning experience; planning and implementing interventions and evaluating the effectiveness of interventions with a target client (using a family member or friend).
Note that this clinical activity is meant to facilitate the application of course content about health education/teaching—a common and significant Public Health intervention. Most clinical experiences in the Community/Population Health course typically involve some type of client contact which includes formal or informal teaching of minor to complex content.
Using course content sources at minimum, you will be able to:
1. Construct a health teaching/lesson plan for a single client, based on the following:
· a thorough assessment of a client’s learning needs and barriers/facilitators of their learning,
· appropriate selection of relevant and effective teaching/learning strategies, and
· application of concepts using a common health promotion model and/or learning theory.
2. Demonstrate implementation of the plan in video format.
3. Evaluate the success of implementing the plan.
4. Document this activity in a formal written paper.
Course Outcomes:
This activity aligns with several of the course outcomes as stated below:
1. Demonstrate critical thinking through analysis and interpretation of assessment data and the development of individualized health education solutions.
2. Demonstrate the use of culturally appropriate and effective communication techniques.
Directions for parts 1-4 of this assignment:
Part 1: Preparation:
· Review Course Lecture PPTS and readings for Chapter 5: Frameworks for Health Promotion, Disease Prevention and Risk Reduction.
· Review the “Diabetes: Teaching Patients Self-Care” Module by Tracey Long RN, PhD, APRN (see attachment in Bright Space).
· Complete the Pre-Brief activity questions
Part 2: Design a teaching module to help educate a client about a health-related topic.
A. Complete this grid for your education session:
Client: Describe client (no names please): Age, gender, health risk-factors
Topic:
Learning Style:
Learning Theory:
Learning Objectives *
Content Outline
Strategies ** & Materials***
Evaluation
Was the learning objective met? If not, why? Suggestions for future?
*
At least 2 objectives are required. What do you want your client to know by the end of your teaching? (Objectives can be cognitive, affective and/or psychomotor in type – usually a combination is best). Note that achievement of the objective is part of the Evaluation column.
** What strategies did you plan to use to facilitate your client’s learning? Visuals? Demo?
*** Materials like visuals used, handouts, etc. can be appended to this paper
[Feel free to adjust column widths as needed]
B: Summarize your teaching plan in an APA formatted word document, 3-4-pages (not including the reference page and appendices)
Sections of the Paper (copy bolded titles here as subheadings in your paper to enhance organization and clarity).
· The Client: Describe the client (initials only), including:
· at least 3 demographics that are related to learning (e.g. age, language etc);
· any “red flags” for low health literacy (for this exercise, it will be useful to assume low health literacy for your client)
· any contributory/relevant health history (e.g. physical or cognitive limitations)
· Analysis of Learning Needs: Including:
· clearly identify the topic of focus for the plan
· barriers to learning that need to be considered (e.g. developmental stage, special learning needs)
· individual learning style(s)
· facilitators of learning (e.g. willingness to learn; education level etc)
· Teaching/Lesson Plan: This section will be written in narrative format as a summary of the teaching plan in table format (see above).
· Application of a Behavior Model/Theory. Select ONE “Behavior Model/Theory” cited in your textbook or the pre-briefing material. (An example would be the Health Belief Model or one of the Learning Theories). Consider how this model/theory may apply/did apply to this teaching activity? Comment in at least 2 paragraphs.
· Reference list. Format in APA. Include any class content you used.
· Appendices. Append any visuals you used during your teaching session (links are ok).
Part 3: Implementation of the Teaching Plan (Videotape)
Create a short (7 to 10 minute) video of your Plan-based teaching session with your client. It should have adequate light and sound quality to allow for evaluation by your instructor. Your session may be shared among your clinical group as well.
Avoid conducting a monologue. There must be some evidence of your interaction with the client using various methods and materials other than simply talking.
Please post the tape to the appropriate folder under ASSIGNMENTS in the course shell. Clearly label it with your name and that it’s a health education session. If it’s a large file, it needs to be compressed, so consult w/ IT if you don’t know how to do this or if you are having any other issues.
Parts 1-3 to be completed first.
Part 4: Evaluation of the Teaching Plan
· Evaluation: How do I know your client learned anything?
· Were stated objectives met? Provide some detail as to how you know the objective was met (for example, did the client repeat back the information to you (teach-back method?) or do a return demonstration? If the objective was NOT met, reflect on why it was not and propose a different approach.
· Summary Reflect on this activity. Include at least 1 paragraphs of comments that include a balanced assessment of how things went!
Part 4 to be completed at the end of the term.
Hints for Success!
Teaching well takes time! Do NOT leave this assignment to the last minute!!
Choose a topic with your client that’s fairly simple, but not too simple-like hand hygiene! This activity is mostly about seeing how you engage in teaching based on thoughtful consideration, including application of class content pertaining to effective health education. Recall that health education is one of many significant primary or tertiary prevention strategies in Public Health. So, this is NOT about detailed content about a complex medical problem as much!
See grading rubric below:
Grading Rubric_Health Education Activity
Criteria graded on a 4-point scale reflect the following distribution: 0=no response provided; 1=poor response; 2 =adequate response; 3=good response; 4=excellent response..
Criteria
Potential Points*
Part 1: Preparation
Pre-Briefing Activity completion
· On time completion/submission (2)
· All questions addressed thoroughly (8)
10
Part 2: A. Teaching Plan (Table Format)
Plan in Table Format
· At least two objectives were noted. (2)
· Objectives were specific and relevant to the topic chosen (2)
· Content matched the objectives (2)
· Content included some details to be covered during the videotaped session (2)
· Active teaching-learning strategies were named and some detail about how they would be used during the teaching session was included (2)
· An evaluation of whether each objective was met was noted (yes/no). Note that how each was met (or not) will be described in more detail in the narrative section of this paper. described. (2)
12
Part 2: B. Narrative Format
The CLIENT was described according to:
· demographics that are related to learning (2)
· any “red flags” for low health literacy (4)
· any contributory/relevant health history (4)
10
The client’s LEARNING NEEDS were identified and analyzed in a comprehensive way, including assessment of his/her:
· Developmental state/stage (2)
· Special learning needs and/or other barriers to learning (4)
· Dominant or preferred learning style (1)
· Facilitators of learning (2)
ONE health-care topic was clearly selected as the focus for the teaching plan and taping. (1)
10
The TEACHING/LESSON PLAN SUMMARY
· All components of the tabular plan were well summarized (NOTE: This narrative should follow the tabular plan closely)
· Objectives (2)
· Content (4)
· Teaching Materials/Methods (4)
· Evaluation (4)
14
A BEHAVIOR MODEL/THEORY was Applied to the Teaching Activity.
· In at least two paragraphs (2), a single model/theory was considered in terms of how it applied to this activity (2).
4
Part 3: B. Implementation of Teaching Plan (Videotape)
The VIDEOTAPE (with adequate sight and sound for evaluation purposes) included:
· An introduction of self and client (first name only) and the reason for the session was spoken clearly and succinctly (1)
· The actual teaching session:
· Reflected the Teaching/Lesson Plan (content and materials/methods) well. (2)
· Included content that was accurate and organized well. (2)
· Showed that the student spoke clearly and was respectful. (1)
· Showed that the student addressed the client’s questions and other behaviors appropriately. (2)
· Showed that the student used visuals and/or other relevant materials during the session to enhance his/her verbal commentary. (2)
· Provided evidence that the client understood the teaching was emphasized. (2)
· Wrap-up with the client. (1)
The videotape was about 10 (+/_ 3) minutes in length. (2)
15
The REFERENCE LIST:
· included at least two references other than the course textbook or Unit 2 ppt content (2)
· Note that references must be written in proper APA format (2) and match in-text citations (1)
5
Your WRITING demonstrated:
· organization according to the directions (2)
· overall clarity of thought (2)
· fewer than 2 unique errors of basic writing mechanics (including spelling, grammar, punctuation, sentence and paragraph structure) (one point deducted from six total for more than 2 unique writing errors) (6)
10
Parts 1-3 due by Sunday 8/2/2020
Part 4: Evaluation of the Teaching Plan
EVALUATION
· In at least one paragraph (1) state whether objectives were met or unmet (2)
· If unmet, suggest improvements (2)
5
SUMMARY
· Reflect on this activity, including the videotaped session. Include at least 1 paragraphs of comments that include a balanced assessment of how things went!
5
Part 4 due by Sunday 8/23/2020
Total
100
*Note that instructors have the option of embedding points/comments in the word doc instead.
Points may be given in fractions such as 0.5.
[This clinical activity is worth 20 clinical hours]
7/8/2020YC