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Teaching Plan for Mrs. Rosenshine

Student Name

Practical Nurse Program, NorQuest College

NFDN 1002: Nursing Foundations II: Basic Nursing

Instructor’s name

Date
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Introduction

Meet Mrs. Rosenshine (she/her), a 64-year-old woman living independently and alone in a

condo who has been diagnosed with diabetes twenty years ago. Her diabetes has been managed with

diet and 500 mg of Metformin twice a day until last week when she had an HgbA1C result of 10% and

therefore was prescribed a long-acting basal insulin pen. She has had Chronic Obstructive Pulmonary

Disease (COPD) for the past ten years, smokes 3 cigarettes a day, is on oxygen, and uses a Ventolin

Inhaler when it is needed. Mrs. Rosenshine requires glasses to read however, due to her financial

situation has not been able to afford her new prescription for the last two years. With an achievable,

specific plan, focusing on medication education and health promoting information, and integrating this

information with her current knowledge regarding her diabetes, COPD, and vision impairment, Mrs.

Rosenshine will have the opportunity to improve her quality of health. I have learned how a patient can

overcome certain barriers with adequate and realistic resources to be successful in the implementation

of their own nurse care plan.

Assessment Data & Learning Needs

Learning Need 1: Mrs. Rosenshine has been prescribed a new insulin medication and needs to learn

about how the medication is administered, how it works, its importance of maintaining her blood sugar

levels, her responsibility in monitoring and recording her blood glucose levels as recommended by her

physician. To ensure her impaired vision does not become a barrier for her medication self-

management, Mrs. Rosenshine will learn about resources available to her. Learning about possible

adverse effects from the insulin medication and pen use are important for her to manage her diabetes

successfully.

Learning Need 2: Mrs. Rosenshine would be safer with learning strategies on how to reduce her use of

cigarettes and finding healthier alternatives. She would benefit to learn how the cessation of smoking
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could potentially help reduce the amount of medication and oxygen needed to maintain her health

status, possibly improve her overall health and wellness. Education about the hazards of smoking near

oxygen tanks could also prevent unnecessary risk.

Priority Learning Need and Diagnosis

Nursing Diagnosis: Deficient knowledge related to increased risk of complications secondary to her

diseases, as evidenced by fluctuating glucose levels leading to the prescription of a new insulin

medication to help control her diabetes.

Goal: Provide Mrs. Rosenshine thorough and clear explanations and demonstrations for her to integrate

this knowledge into her daily life while providing encouragement to her learning approach.

Expected Outcome: Mrs. Rosenshine will demonstrate how to use a Basal Insulin Pen, observe and

record her blood glucose reading, and verbalize why this is important after an hour and a half of

teaching and guided practice. After a month, her HgbA1C will decrease from 10% to 6.5%, and her

recorded blood sugar levels will show a decrease.

Domains of Learning: Using the Basal Insulin Pen will require psychomotor learning, which involves

“acquiring skills that require the integration of mental and muscular activity, such as the ability to walk

or to use an eating utensil” (Potter et al., 2019, p. 327) or in this case, an insulin pen. Through

psychomotor learning, Mrs. Rosenshine will be able to observe the nurse perform the use of the Basal

Insulin Pen and then model her behavior, allowing the nurse to provide feedback and answer questions.

For Mrs. Rosenshine to successfully explain why using her insulin pen properly is important she will need

to engage in cognitive learning, more specifically, “understanding: the ability to construct the meaning

of learned material” (Potter et al., 2019, p. 327). She will be presented with important information

regarding safe use of her pen and will be provided the opportunity to reflect and explain why it is

important to her using her own words.

Client Barriers: Mrs. Rosenshine’s visual impairment and lack of financial resources poses a challenge for

her to focus on her health education. She has indicated that for the past two years, she has been unable

to pay for prescription glasses. An assessment would need to be completed to properly identify if this

lack of financial resources is preventing her from purchasing food items to facilitate a healthy diet to

manage her diabetes which could have led to her recent HgbA1C result of 10%. She has been able to

manage her diabetes for the past twenty years with diet and oral medication, Metformin, for the past

twenty years, it would be ethical to properly assess what has changed whether it is her diet, financial

status, marital status, or other life event to accurately address her barriers. This same barrier is

preventing Mrs. Rosenshine from obtaining prescription glasses posing a challenge when ensuring that

she is administering the correct dose from her insulin pen, accurately reading her blood glucose

readings, and recording these readings in the correct place in her chart.

Teaching Plan

Educational Content: Mrs. Rosenshine will be provided with the concepts of why and how to use her

basal insulin pen, monitoring and recording her blood glucose, proper storage of her insulin pen, and

how this practice will effect her diabetes. She will review the importance “correct administration of

insulin is essential since employing an incorrect technique may lead to hyperglycemic crisis or severe

hypoglycemia, necessitating emergency department visits” (Truong, et al., 2017, p.221).

Teaching Methods: In a quiet, calm, and well-lit environment, Mrs. Rosenshine will participate in three

30-minute education sessions, scheduled before she is prescribed to check her blood glucose and

administer her insulin pen. This will allow enough time for the nurse to discuss the educational content

and provide a few minutes rest for Mrs. Rosenshine followed by an opportunity for her to provide

feedback on her learning experience. “In the process of patient feedback, if patient had

misunderstandings of education, more explanations can be provided by the nurse” (Rahmani et al.,
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2020, p.3). Following the feedback portion of this session, she will administer her insulin pen with the

supervision and guidance of the nurse.

Teaching Resources: Due to Mrs. Rosenshine’s visual impairment, she will be presented with large print

brochures, large print daily logbook to monitor her blood glucose, and a magnifying glass, in case Mrs.

Rosenshine has difficulty reading the dose on her insulin pen (Potter et al., 2019). If Mrs. Rosenshine

has a device that can access the internet such as a tablet, laptop, or PC, a short YouTube video link will

be saved under “favorites”, clearly labeled “Insulin Pen Instructions”, and with the font settings adjusted

so that she can easily find it on her device for her reference when a nurse is not present. The nurse will

also utilize Davis’s Canadian Drug Guide to ensure that the proper information is being provided to Mrs.

Rosenshine pertaining to her new insulin pen medication.

Evaluation of Learning

To evaluate Mrs. Rosenshine’s understanding and ability, she will first be asked to “describe the

signs and symptoms of hypoglycemia and the associated interventions and to describe the procedure

used at home for determining the correct dose of insulin needed and the injection site” (Potter et al.,

2019, p. 752). Next, she will be observed performing the administration of the insulin pen as she

described. Last, the information in her logbook will be reviewed for completeness and accuracy (Potter

et al., 2019, p. 752).

Analysis of the Teaching Process

Why Teaching is Important: Teaching is important because it gives nurses the opportunity to provide

resources to improve a patient’s quality regarding impaired functioning. For instance, Mrs. Rosenshine

has a visual impairment however is provided with the necessary resources and self-help devices to

overcome this barrier comfortably and independently to administer her own medication (Potter et al,

2019, p. 326). The teach-back method used for Mrs. Rosenshine can provide a sense of confidence in her
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ability to take responsibility for her physical health. “According to the experiences of frontline

pharmacists, more than 98% of the 66 patients in a study agreed that they felt confident about

performing subcutaneous injections according to guidelines after being instructed via the teach-back

method” (Truong et al., 2017, p. 224).

Strengths and Challenges: Providing Mrs. Rosenshine with resources to adapt according to her visual

impairment is a strength of this lesson plan as she can benefit in other areas of her life outside of

medication administration until she is able to be access other resources provided by social services or

government insurance subsidies to obtain new prescription reading glasses. Furthermore, “the teach-

back method as a patient-centered and a participatory educational approach fills the communication

gap between nurses and patients, resulting in improved patient self-care and self-management”

(Rahmani et al., 2020, p.11). Challenges of this teaching plan would be for Mrs. Rosenshine to be

motivated in the participation of her health education and utilize the resources provided to her when

nursing staff are not present. Another challenge would be how Mrs. Rosenshine prioritizes her health

obligations and responsibilities. For instance, she states that she does not have the finances to purchase

new prescription eyeglasses but is able to fund her smoking habit, a habit that compromises her health

and safety while she is on oxygen.

Benefits: Nursing plans provide clear and concise objectives for both the nurse and their patient to

achieve together. This helps develop a relationship as they work to achieve the patient’s identified

health goals while engaging the patient to participate in their own nursing plan as much as possible.

Furthermore, patients who are educated about their health conditions and provided with proper

guidance with engaging interaction are less likely to experience an emergency department visit post

nursing plan education (Rahmani et al., 2020).

Conclusion
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Mrs. Rosenshine has a greater chance of success in managing her health if she is able to

understand her diseases better, confident in attempting to manage her symptoms, develops an

appreciation for knowledge about her diseases, and applies her new skills consistently using the

resources provided to her to overcome her visual impairment.

References

Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A. M., Astle, B. J., & Duggleby, W. (Eds.). (2019). Canadian

fundamentals of nursing (9th ed.). Mosby/Elsevier Canada.

Rahmani, A., Vahedian-Azimi, A., Sirati-Nir, M., Norouzadeh, R., Rozdar, H., Sahebkar, A. (2020). The

effect of the teach-back method on knowledge, performance, readmission, and quality of life in

heart failure patients. Cardiology Research and Practice, 2020, 1-13.

Truong, T. H., Nguyen, T. T., Armor, B. L., Farley, J. R. (2017). Errors in the administration technique of

insulin pen devices: a result of insufficient education. Diabetes Therapy, 8, 221-226. Doi:

10.1007/s13300-017-0242-y
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Introduction

Assessment Data and Learning Needs

Learning Need 1

Learning Need 2

Priority Learning Need and Diagnosis

Nursing Diagnosis

Goal

Expected Outcome (SMART Criteria)

Domains of Learning

Client Barriers

Teaching Plan

Educational Content

Teaching Methods

Teaching Resources

Evaluation of learning

Analysis of the Teaching process

Why Teaching is Important

Strengths and Challenges

Benefits

Conclusion
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Reference