According to Hall and Ross-Kerr (2006) teaching is an interactive process that promotes learning. Generally, teaching and learning begin when a person identifies a need for knowing or acquiring an ability to do something. A nurse, who embodies the role of a teacher provides information that prompts the client to engage in activities that lead to desired change. Teaching is most effective when it responds to the learner’s needs (Potter, Perry, Ross-Kerry, & Wood, 2006, p. 318). In this paper I will include an assessment of the learner, teacher, and resources with a teaching plan. I will provide evidence of implementation along with discussion of teaching material used in the presentation, including the rationale for its use. The paper will be able to clarify the description of the evaluation strategies as well as process and outcome evaluation. For the health teaching project paper I will interview Mrs. Patel, who is an immigrant from India and lives in Toronto GTA area with her two sons and in-laws. Mrs. Patel, who lost her husband 20 months ago, is 68 years old female diagnosed with diabetes two years ago with a family history of both parents who died from diabetes related complications. Mrs. Patel weighs 190 pounds and five feet three inches tall. Her health history includes high cholesterol and high blood pressure. Mrs. Patel is a physically inactive retired high school teacher, who is fond of eating Indian sweets and smokes one pack of cigarettes a day; she has a pack life of 40. The intended focus of the teaching sessions will be to define specific behavioural objectives with the patient and family and to make the learning experience outcome oriented and measurable. In addition to improving self management, the outcomes includes improving knowledge related to disease signs and symptoms, prognosis, risk factors and to support the patient to make healthier choices while living with diabetes. It is the hope that the learner will be able to maintain and promote heath by adopting behavioural change, which is the main focus of patient education. (Rankin, Stallings, & London, 2004, p 190). Detailed assessments facilitate the vital information about the learner, the teacher and resources available. To understand the patient’s unique situation I will systematically collect, verify, and analyze data. The client is the primary source while family, medical records and health professionals are secondary sources. In the paper I conduct Mrs. Patel’s complete physical, intellectual, emotional, social and spiritual assessment. During the initial assessment interview with Mrs. Patel she stated “I was feeling very worried and anxious after his [Mr. Patel] death, I just kept thinking about what will happen now and how will I manage everything without him; I feel so alone” . She also said “the worry prevented me from sleeping the whole night, I stopped going out, even stopped going to temple every Sunday; the only social contact I had”. After the death of her husband in November 2010, she was feeling isolated and stressed out during that time she diagnosed with diabetes. Initially, she was prescribed oral medication and she was checking her blood sugar once a month. She informed me that “once I got good a blood glucose result constantly for 3 times I thought that checking my blood sugar was no longer necessary. I stopped taking my medication and returned to my regular diet”. In addition she stated “within four weeks I experienced frequent urination during the night, which lead me to see the doctor. When reviewing my blood work, my fasting blood sugar was high the doctor prescribed me insulin along with oral medication”. Mrs. Patel continued by sharing “My doctor was not happy with the results of my blood work and gave me tonne of instructions with pamphlets. This made me feel overwhelmed and confused. I even don’t have the confidence to check my blood sugar and give myself needles. A nurse in the clinic explained to me the instructions just once and sent me home. I really feel exhausted after trying a couple of times and going through some of the information printouts”.
As a general guideline, patients need time to adjust to and accept their new health conditions. When a client feels frustrated, overwhelmed and confused the teacher needs to allow the patients to talk about their feelings to ensure the learners emotions do not interfere with the learning. As basic learning principal I would involve the learner in the teaching process and will the learner opportunities to improve their knowledge and skill. The patient’s perception about diagnosis and prognosis is very important in the assessment process. (Dadich, 1997). In this case, the learner is a 68 year retired teacher, so the English language should not be a barrier in the teaching process. Mrs Patel’s hearing is adequate for normal tone and speech. She reads the local news paper daily with the help of her glasses. During my first interview with Mrs. Patel, I assessed that her emotional status was disturbed, I decided to just sit and listen to her as she discussed her frustration. I was able to gather data about patient’s culture, values, and beliefs about herself and the disease. Mrs. Patel believes in Hinduism and she is a vegetarian. She believes in God and thinks that God will do everything right for her. As a learner she is ready to learn about diabetes and how to live healthy with it. In addition, she also wants to do self management of her diabetes.
According to a American Diabetes Education Association (ADEA) member’s survey from 2006, the educator should be active listener, able to adapt and be flexible, friendly, approachable, non-judgemental and professional (Hill & Clark, 2008). In this teaching project as a teacher I am RPN in Ontario and working fulltime in community, and practicing to my full scope, which makes me ideal for this purpose. As a community nurse, teaching is a major part of my job and consumes a great portion of my time. My work experience made me a more professional active listener with a non-judgemental approach. I am also flexible with my time, friendly and easily approachable for my patient as I live in the same condominium complex where Mrs. Patel lives. I speak the same Guajarati language, which she speaks; this makes the teaching process easier for Mrs. Patel.
Appropriate teaching resources and materials are crucial in effective teaching. Health care providers frequently use videos and printed materials for the purpose of health teaching. Most of the teaching materials prepared by commercial organizations to promote their product. (Woodring 2000). One study shows that information pamphlets found in pediatric offices were written at the tenth to twelfth grade reading level (Davis et al.,1994; Platt, 1996 as cited in Woodring, p.507), while most of the patents have less then a ninth grade education (U.S. Census Bureau, 1999 as cited in Woodring, p 507) and read at an average of a sixth grade level (U.S. Census Bureau, 1995 as cited in Woodring, p 507). In addition, printed material can misplaced and wear and tear easily. For those reasons, I decided to use online websites and added the websites used as favourites in client’s computer so the updated information would always be available. For a teaching resource, I used the Public Health Agency of Canada and St. Joseph’s Heath Care (SJHC) London’s websites, which are most reliable, trusted and easily navigated sites for the average person. As the first website is produced by the government it is assumed that the information is accurate, trustworthy, non-biased and current. The home page of the website is simple, friendly and clearly explains related content. The font size and language used in the website is easy to comprehend and uses short and simple sentences used in an active voice extensively within the website, and only few sentences contain embedded information. To serve the purpose the teaching website has used common words like unusual thirst, frequent urination, weight change, extreme fatigue, lack of energy. These words are common vocabulary and easy to understand. According to health on net foundation (HON), websites provided by the government are offered for public benefits only and usually contain lots of practical and reliable information and tips. After doing assignment on Critique of a Health Teaching Resource I decided that government of Canada websites for teaching purposes would be best. After searching through different resources I finally decided to use government of Canada website for my teaching project.
A plan of nursing care will change according to each individual’s need. Planning of the client’s goals and objectives are essential in the teaching process. Once the assessment of the client is complete I identified nursing diagnoses for the patient and established goals and expected outcomes to address and resolve their issues. The learners goals and objectives will provide a clear focus for the type of interventions necessary to provide best outcomes for the teaching plan. The main planning of the teaching session is to develop understanding about diabetes, self management of diabetes and to recognize treatment for diabetes for Mrs. Patel. The first objective for my teaching project for Mrs. Patel is that “Mrs. Patel will explain three signs of a hypo/hyperglycemic reaction by the end of teaching session. To achieve that goal I will use my first teaching session to focus on diabetes. The Health Canada website (CITE THIS) provides a clear definition of that Type-2 diabetes occurs; the body does not make enough insulin and /or does not respond well to the insulin it makes. The St. Joseph website clearly explains that type 2 diabetes is a progressive, life-long condition that can be managed with diet, exercise and medications (CITE THIS). This sentence was vital for Mrs. Patel as she realized that diabetes is a life-long condition and if she applies herself and is adherent to the treatment regimen, there should be minimal problems managing it. Mrs. Patel was very happy after passing through the frequently asked questions section. She told me that “this section has provided all the answers which were in my mind about diabetes” In the symptoms section, it clearly explains that early diagnosis of diabetes is extremely important. The earlier diabetes is diagnosed, the sooner a person can take steps to manage it well and prevent or delay any complications.
The second and third objectives of my teaching project are “Mrs. Patel will be able to describe the diabetic medication that she is on and how to properly take the medication by the end of teaching session” and “Mrs. Patel will be able to demonstrate the technique of blood sugar monitoring by using a blood glucose meter and recording of blood sugar measurement results by the end of teaching sessions” (RK, Personal Communication, DATE). I used SJHC website’s treatment for diabetes for the teaching of these two objectives. This section of thed website explains all common medication available for diabetes. I sat with Mrs. Patel while we reviewed her prescriptions and she tried to give rationales for each of the prescribed medication, their time and specific action. I am working as a community nurse and have more than 4 years of experience. Many of my clients require health teaching for diabetes; I was able to use previous knowledge and experience to demonstrate and teach the technique of blood sugar monitoring and using a blood glucose meter.
For rest of the objectives which are related to regular exercise, walking, and decreasing or quitting smoking and improving daily diet, I used SJHC’s website manage your heath session (CITATION). Through this section of the website I was able to thoroughly discuss the importance of how management activity, exercise, diet, nutrition, weight management, emotional wellness work in tandem to optimize the care of diabetes. In the Heath Canada website living with diabetes section I discussed about the programs and services, which are available for people with diabetes and how an individual can receive reimbursement for their diabetes medication and supplies. The entire teaching session was completed in two sessions, each of 45 minutes length. For these sessions I sat with the client in her home, during the afternoon when there was minimum disturbance. After teaching session evaluation is final step in the learning process.
Evaluation is an ongoing process, which requires the use of critical thinking skills (Potter at al., 2006) Evaluation is most important phase of the learning process because it determines the effectiveness and usefulness of entire teaching session (Lin, 1996). Evaluation which is done as part of teaching and is referred to as formative (Woodring, 2000). To do a formative evaluation, I asked a few questions to Mrs. Patel during the teaching sessions. For example, after providing general information about diabetes I asked “Can you please tell me what type 2 diabetes is in your own words?” and she was able to explain the related answer very clearly. Furthermore, I then asked her “tell me three signs of hypoglycemia and what you should do when you experience it?” Mrs. Patel was able to explain; she told me that she would like to a glass of orange juice or take a sugar candy to elevate her blood sugar quickly. I observed verbal and non-verbal cues during the teaching session. I noted that the patient asked me to repeat information when she was not clear, she asked questions, and sometimes shook her head when she did not agree or was confused. I also observed Mrs. Patel directly when she was demonstrating her skill of checking blood sugar and administering herself insulin. Above explained short-term evaluation techniques help to understand a patient’s perception of disease and skill mastery.
For long-term evaluation I did follow up with Mrs. Patel and talk with the members of her family. After two weeks, when I met her again, I inquired about how she was feeling. I spoke with Mrs. Patel’s son to gain collateral information about whether she was exercising on a regular basis and assessing her blood sugar on a regular basis. I received a satisfactory reply, that she was indeed completing these tasks to optimize wellness. Mrs. Patel was taking her medication regularly and had also joined community laughing club for seniors. She informed me that her blood sugar results each morning were gradually coming toward a therapeutic range. Her son told me that Mrs. Patel is getting up early in the morning and doing yoga and daily eats raw vegetables. Furthermore, he informed me that Mrs. Patel has not stopped smoking,but she has just decreased a bit. I explained him that initial goal is to decrease it and finally reach to the goal of smoking cessation.
Teaching is not just imparting information; the evaluation of a teacher is also important in the teaching process. The teacher is the person who arranges, plans and manages the external condition to encourage and facilitate learning. (O’Brien 2006)medsurge book pp 43-44 ). Knowledge, communication and skill play a very important role in the teaching process. As diabetes teacher, one must have complete knowledge about the disease, signs and symptoms, complications, management and improvement of the condition as well as living with diabetes: This is the real strength of teaching. Another important factor is the communication skill. A teacher should be able to communicate in the patient’s language, which provides an environment of comfort and relaxation. When the teaching session has ended, summative evaluation data can be used to improve the overall teaching effort. Feedback from learner about what they liked or disliked about the whole learning/teaching experience, including teaching method, teaching material, pace of learning activities, and teacher-learner interactions is integral. For that purpose I did gave one questionnaire to Mrs. Patel, which is joined as a separate attachment with this assignment. As a community nurse I have provided diabetes teaching for many of my patients. In order to receive feedback on my performance I spoke directly with Mrs. Patel and her family. Mrs. Patel was satisfied with the teaching sessions as well as the resources used. She told me “this website is really handy for me and I can go though it anytime for any questions”. In addition she also told “I am happy with the way you presented the whole concept of diabetes and how you taught me about the disease, I now realize that diabetes is not going away and I can surely live a healthy life, which includes exercise, diet and medication”.
Teachers can improve their performance by following the joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recommendation like promoting interactive communication between teachers and learners, involvement of the patient in decision making and self-management of disease (Rankin, Stallings, & London, 2004, p 104). AU book p 104) Information given at right time and right place is most critical. Lack of time, knowledge, disagreement with patient, powerlessness and frustration can be a weakness or source of stress for the teacher. To overcome these stressors, teachers need to set realistic goals and use all possible opportunities for teaching. Improving knowledge by studying, reading and screening teaching material before presenting it to the patient in combination with the approach that learning is lifelong process is most helpful. A health teacher can join seminars, teaching sessions and continue upgrade of ones’ self and will certainly help to broaden their knowledge base. Small achievements need to used as encouragement to perpetuate behaviour change. (O’Brien 2006).MEDsurge page 46) Positive and constructive feedback to patients promote goal achievements. A health teacher needs to be a good listener along and solicit feedback rather than impose. Instead of arguing or pushing, one needs to present alternatives and needs to make sure that patient is interpreting information correctly by checking back with the patient on a regular basis during the teaching session. Instead of giving advice, the teacher need to share information while working towards minimizing information overload for patients. (Rankin, Stallings, & London, 2004, p 302). (AU book 302). These are some suggestions for teachers to improve their performance and outcomes of teaching sessions.
Teaching material is also plays a cardinal role in teaching the process. For this teaching project I used government Canada health website and St Joseph Health Care London website (CITE THEM). In both websites, I easily found my objectives to the related topic, which I wanted to teach. Each topic was discussed in fair detail and provided the latest updates. Mrs. Patel was impressed by the quality and efficiency of each website. Along with excellence, she found that this information was available for her at all times. A quiet and uninterrupted place is an ideal learning environment. For that purpose I decided to conduct my teaching session in the early afternoon at the patient’s home, which was also a good place for safety and security reasons.
Patient and family teaching is a critical part of nursing care. Presenting the education information in conjunction with proper realistic objectives, knowledge and resources will lead to the desired behavioural change in client. Nurses need to understand each individuals learning style and conduct a proper assessment and planning of the learner goals and objectives as these are the cardinal aspects of teaching sessions. A teacher needs to know the readiness of the learner along with their emotional and physical status for a successful teaching-learning outcome. Self-management education along with patient and family participation in decision making will incorporate cognitive behavioural interventions such as goal setting and problem solving. The individual nurse has an enormous impact on learning outcome of the patient. If nurses use critical thinking skills along with the nursing process (Assessment, diagnosis, planning, implementation, evaluation) during teaching sessions; positive behaviour learning outcomes will be inevitable (Rankin, Stallings, & London, 2004, p 158).

References;
Dadich, K. A. (1997). Practical tips for patient teaching. Nursing 27(8), 17-18. http://www.hon.ch/visitor_safeUse.html http://www.sjhc.london.on.ca/diabetes-education-centre/type-2-diabetes
Hill, P., & Clark, R., (2008). The Australian diabetes educators’ skills and readiness for the tsunami of diabetes in the 21st century. Australian Journal of Advanced Nursing, 26(2), 55-65
Lin, C.-C. (1996). Patient satisfaction with nursing care as an outcome variable: Dilemmas for nursing evaluation researchers. Journal of Professional Nursing, 12(4), 207-216.
O’Brien. P,. (2006). Client and Family Teaching in Medical-Surgical Nursing in Canada pp 43-57 (1st Canadian ed). Toronto: Ontario.
Potter. P. A., Wood. M. J., Ross-Kerr J. C., Gilbert. J. A., Stephen. T., & Day. R. A., (2006). The Nursing Process in Canadian Fundamentals of nursing pp. 182-232(3rd ed). Toronto: Ontario.
Rankin, S. H., Stallings, K. D., &London, F., (2004) Patient education in heath and illness (5th ed) Philadelphia: Lippincott.
Woodring, B. C., (2000). If you have taught-have the child and family learned? Pediatric Nursing 26(5), 505-509.