Diabetes is a chronic illness that can have an extensive range of complications on human health and quality of life. As of the 2010, around 285 million individuals estimated to have Diabetes and the number is still on the rise all over the world, with figures expected to double by the year 2030 (Wild et al. 2004). Among the developing countries, the rising incident rates of Diabetes is accounted to certain lifestyle changes such as following a Westernized diet, urbanization and the growing fast food culture. Due to the sheer number of people afflicted by the disease, it is important that each individual understand what it is and its complications and this can be done through health education. As Nurses, teaching is one of the focal points in the role of a nurse as Nurses are expected to conduct health education to patients as well as teach colleagues and junior staff.
Need For Teaching
Good knowledge of the disease process and how to manage lifestyle would certainly prevent grave complications and subsequent hospital admission. Generally, re-admissions to hospitals are brought about by health care providers themselves. This includes the inability of health care providers to determine patients who are at high risk for re-admissions, the inability to provide proper health education and discharge planning as well as the inability to conduct the necessary follow-ups on the patient. Patients have also been known to cause their own re-admission and hospitalization. This can be brought about by their failure to understand and meet the prescribed treatment regimens provided by the physician such as inability to perform self-care, inability to monitor their own symptoms as well as inability to act immediately to prevent further worsening of their symptoms or illness. Programs that are directed towards proper management of the illness have been proven to be very effective in decreasing the number of re-admissions of patients suffering from Diabetes.
Theory applied in this teaching
The Cognitive theory of learning is applied throughout the teaching session. According to Bandura (2001), cognitive learning is a process whereby learning is aimed at the individual, perceiving pertinent information, interpretation of current knowledge and being able to organize this information into new ideas and insights. The information-processing model of memory, in particular, is applicable when conducting health teaching as it aids in determining how information is perceived, interpreted and recalled by the learner and allows the instructor to make modifications that would best suit the learner. The first stage involves environmental stimulus, wherein teaching must take place at a place conducive for learning and in such a time that the learner would be most receptive. The second stage involves taking into consideration the sensory processing ability of the client, determining any sensory deficits and applying these during the teaching process. The third stage involves transforming the information into either short or long term memory. Finally, the last stage involves how individuals respond or act upon the information learned.
In conducting my health education, I ensured that the place was quiet and conducive for learning and that the patient is ready to receive the teaching I am about to impart. From our discussions, I found out that the client has hearing problems and would require the use of a hearing aid. Considering this and the fact that the client admitted that he is forgetful at times, I made sure to augment the teaching session with the use of visual aids and providing the patient with useful pamphlets and information cards. Ensuring that he has the hearing aid with him during teaching session is also essential to promote optimal learning.
Furthermore, it is necessary to become aware of barriers to patient education. As most patients with Diabetes are elderly people, it is necessary to assess for feelings of anxiety or depression as this may affect the learning process. Delayed treatment is also another barrier to patient education. There are several reasons given by patients in delaying health care treatment with a majority of patients citing that inability to perceive that they have a serious condition or illness as their primary reason in delaying treatment. Meanwhile, financial capacity is another major reason given by many. In one study, it was found out that 20% of citizens who typically delay healthcare consultations are African-Americans, have no insurance coverage and are below the socio-economic pole. Delay in healthcare are oftentimes experienced by the minority populations and migrant groups as they experience communication barriers and have tendencies to consult lay healers instead of medical professionals
Immigrants tend to delay in seeking first aid or any treatment in a health care facility and will only seek medical help once the problem has been greatly aggravated already. Immigrants also tend to have problems in communication with health care providers, thus, seeking medical aid or treatment is a great ordeal for them, and one which they would rather avoid. There is a need, therefore, to instill cultural awareness among providers of health care so as to maintain the efficient provision and delivery of health care services. Health care providers need to have the competencies to address the needs of a culturally diverse nation so as to decrease the disparities in health care that are prevalent nowadays in the country.
Principles of Motivation and Readiness
In addition, this theory is founded on the cognitive process undertaken by individuals in considering the different elements of their motivation prior to making the final decision. In the case of my patient, a motivating factor is preventing further complications from the disease.
At the end of the teaching session, patient will:
- Demonstrate knowledge and understanding of disease process and possible complications
- Demonstrate management of current condition such as:
- Pain relief
- Regular physical therapy
- Support group or Counseling
- Drug therapy
- Recognize importance of regular health check-ups
Communication is a lifelong learning process for a nurse. Nurses communicate with people from all walks of life and are by the patient’s side from birth up to the moment of death. Nurses also function as client advocates and as members of inter-disciplinary teams who may have different ideas about priorities of care. It is essential to possess assertiveness to be able to communicate one’s own needs and ensure that your viewpoint is heard. Being assertive also ensures balance in a nurse’s life as without such balance, the high stress environment may lead to burnout and diminish the effectiveness of the nurse (Balzer Riley 2000).
Being adept in communication helps the nurse to maintain a trusting and effective relationship with colleagues and patients alike. In addition, good communication skills allow nurses to care for patients in compliance with the standards of the profession. Furthermore, as nurses refine their communication skills and increase their confidence, they can progress professionally to become experts (Balzer Riley 2000). It must be taken note of that communication is a two way process and listening is a huge part of communication. Communication goes beyond talking, it is being able to understand and comprehend the message of the sender ad act on the message appropriately. Meanwhile, ineffective communication can pose several difficulties as nurses’ credibility comes into question and may also increase liability.
Critical thinking can help the nurse overcome perceptual biases which are human tendencies that interfere with accurately perceiving and interpreting messages from other people. There may be a tendency to ignore or distort information that goes against expectations, preconceptions or stereotypes (Beebe, Beebe and Redmond 1999). The nature of communication process also requires that nurses constantly make decisions about what, when, where, why and how to convey messages to other people. The nurse’s decision making is contextual wherein the unique feature of any situation influence the nature of the decisions made.
The nurse must become an active part of the community by knowing the members, their needs and the available resources and then working to establish effective health promotion and disease prevention programs. The nurse should have a strong knowledge regarding family theory, principles of communication, group dynamics and cultural diversity as vulnerable clients frequently come from varied cultures, have different beliefs and values, few sources of social support and may face language barriers (Chalmers et al 1998). The client/family unit is in equal partnership with health care professionals (Bond Phillips and Rollins 1994). The nurse aims to educate the client about the necessary care techniques, how to integrate care within family activities, and allows the family to assume a greater percentage of care in graduated increments (Lund 1994). This is critical in order to attain a leadership role in health care regardless of the practice setting (Stanhope and Lancaster 2000).
In a publication on the subject of cultural competence, the American Medical Association said that cultural awareness is a basic component in the efficient provision and delivery of health care services such that it must be integrated in the education, training and regulation of health care workers. Take the case of cultural and linguistic barriers brought by racial and ethnic diversity which often impede the ability of health care professionals to diagnose and treat diseases and injuries. In dealing with a multicultural population, free expression of thoughts, views and opinions should be encouraged especially in the workplace setting. By observing this, a sense of respect for the other person is conveyed, thus fostering trust and a harmonious working relationship.
Communication is undoubtedly an essential skill amongst health care workers. In the nursing profession, effective communication is critical both in dealing with patient and with colleagues as well in order to facilitate a good working relationship and avoid misunderstandings (Chapman 2009). In communicating with patients, it is important to initially identify barriers that would impede communication. This could include language barriers (if the patient speaks in a foreign language and has limited grasp of the English language), medical conditions such as Alzheimer’s or Dementia, cognitive function, and such. Health care professionals and providers thus need to focus first on the patient and evaluate their needs, competencies and level of understanding. Providers should refrain from pressing their own views on the client as this will only serve to instill negative feelings. Instead, providers of care should try to place themselves in their clients’ positions so as to better understand their views and their way of thinking.
In educating the patient, it is of primary importance to follow five steps that is comprised of assessment, diagnosis, planning, implementation and evaluation, which is very much like a nursing care plan. In the assessment phase, the nurse must gauge the current knowledge of the patient regarding his condition, the patient’s attitudes and motivators, learning style, cognitive ability as well as any misconceptions about the disease. The assessment phase can be accomplished through patient interviews, reviewing the patient’s history and medical records as well as conducting tests to measure cognitive capacity and personality. Primary assessment is equally important so that the needs of the client are addressed and so that the plan of care that will be carried out are in accord to their own health beliefs and points of view. After the assessment phase, the nurse can now diagnose the learning needs of the patient as well as possible barriers that could hinder patient education. The third phase involves planning wherein objectives are laid out and goals for the patient are set. Also included in this phase is deciding the mode of delivery of patient education, teaching materials to be used, the frequency of teaching sessions as well as the timing of teaching sessions. The fourth step, implementation, consists of putting the plan into action. Lastly, there is a need to continuously evaluate the needs of the patient and whether the goals and objectives were met. This last criterion determines the need for further teaching or areas where emphasis must be placed.
Patients are most receptive to learning when their condition has stabilized as they may still be undergoing a crisis at the time when they were diagnosed with the disease. In addition, patient education must be continuous and needs to be repeated due to the large volume of information that the patient needs to know regarding their condition and because their condition and treatment options may change as the disease progresses. Appropriate teaching materials include books, newsletters and media such as videos and internet resources. Patients could also be encouraged by the nurse to subscribe to newsletters that contain relevant information on Diabetes
- Patient demonstrated interest in learning
- Patient demonstrated understanding of disease process
- Patient demonstrated understanding of indication for medications
- Patient was able to demonstrate understanding of the importance of regular physical therapy and health checks
- Patient demonstrated proper wound management
Health care providers must also learn to provide basic information regarding health promotion and disease prevention at a language that is easily understandable by the client. Family members must be encouraged to work towards a certain goal in achieving optimal health and should be allowed to make their own informed decisions regarding the management of their condition. With all these steps taken into consideration, the disparities that exist today in healthcare may be decreased.
Balzer Riley J (2000).’Communication in Nursing.’ 4th edition, St. Louis, Mosby
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1–26.
Beebe S, &, Redmond M (1999). Interpersonal communication: relating to others. 2nd edition, Boston, Allyn and Bacon
Bond N, Phillips P and Rollins JA (1994). Family centered care at home for families with children who are technologically dependent. Pediatric Nursing 20:123
Chalmers K.L et al (1998). The changing environment of community health practice and education:perception of staff nurses, administrators and educators. Journal of Nursing Education 37:109
Lund SM (1994). Family centered nurse coordinator-early childhood intervention: development and implementation of the CNS role. Clinical Nurse Specialist 8:109
Oliver, R. (1974). Expectancy Theory Predictions of Salesmen’s Performance. Journal of Marketing Research 11, 243-253.
Stanhope M and Lancaster J (2000). Community and public health nursing. 5th edition Mosby, St. Louis
Wild, S; Roglic, G; Green, A; Sicree, R; King, H (2004). “Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030”. Diabetes care 27 (5): 1047–53.