Teaching and Learning in Nursing Practice (Health Education Plan)

Introduction

The concept of nurse practitioners or independent nurses is relatively new in Bhutan. As a result, currently, majority of the nurses simply wait for the doctors´ orders. Since nurses are in maximum contact with the patients they can play crucial role in the health education of the patients and public.

The International Council of Nurses’ code of ethics for nurses (cited in Nancy, 1984) states that the basic duties of the nurses are to: promote health, prevent illness, restore health and, alleviate suffering.  Accordingly, it is important to educate patients, such as, on how to live normally with the disease and to disseminate information to the communities on healthy habits. This makes it is very essential for the nurses to learn to design a formal health education plans and execute them professionally. A well-designed health education plan aids in disseminating accurate information to the learners; it prevents deviation from the main theme of the teaching.  In the absence of a written plan, a teacher risk missing out important information which might cost or save lives.

This Paper seeks to analyze health education plans (Plan) and design and execute one on dietary regimen for a patient who is recently diagnosed as a case of diabetes mellitus. The author used the format for the patient’s teaching plan which was developed by the Ramathibodi School of Nursing, Mahidol Unversity, Bangkok, Thailand (please see annexure I). The diabetic diet plan was designed at Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan. It is designed to suit Bhutanese patients considering their dietary habits and availability of food items (please see annexure II). This Plan takes into consideration the use of all three domains of learning: cognitive, affective and psychomotor (Ray, 2004). The session includes the patients and his wife since she has to assist the patient to cope with the changes in his diet.   

Knowledge Needs and Characteristics of Learners

There is little or no official data on the diabetic morbidity among the Bhutanese population. There fore, the Plan draws mainly drawn from author’s personal and hands-on experience during service in hospitals around the country. The path to ensuring the prescribed food to the patients according to their ailments is strewn with hurdles; different eating habits, socioeconomic status, lack of choice of foods and literacy of the patients are some of the challenges.  Critical analysis reveals that term ‘balanced diet’ lacks equivalent term in Bhutanese vocabulary, especially that of the general public. As a result, foods are mainly consumed for the purpose of satiating hunger more than to obtain vitamins and minerals for smooth function of the bodies. In other words, Bhutanese cuisines lack variety.

Initially, it was erroneously inferred that the reason why the diabetic patients’ were repeatedly hospitalized was solely due to their non-compliance with the medical regimen. However, a closer look at the problem revealed that there were misconceptions and myths about the dietary requirements of diabetic patients: some patients completely stopped consuming foods that grew under the soil; some patients ate only boiled rice; some ate only maize and locally produced corn flakes – thereby depriving their bodies of the essential minerals and vitamins. There fore, it was found that patients and their parties need to be educated on dietary aspect of the disease as much as on the medical aspect. In one incident, a known patient of diabetes was brought to hospital. She complained of giddiness, sweating and slurring of speech following an insulin injection. When she was given sugar she refused to eat it saying that she should not anything that tastes sweet. This could be interpreted to reflect poorly on the effectiveness of the health educations on a condition called hypoglycemia where the sugar in the blood falls below the normal level which is equally dangerous for the patient.

The need exhibited by the patient and his wife for this session is a normative need which is identified by nurses for the benefit of patient (Bradshaw 1972, cited in Wass, 2000). The needs are listed in the lesson plan according to their priorities.  This is expected to be covered in 30 minutes. (Please see annexure I)

Strategies

Grand plans would serve little purpose if they are not supported by appropriate strategies to execute them. However, Forbes and Prosser (cited in Forbes, 2004) are of the view that besides the strategies, the teachers’ perceptions and approaches are equally important. The success of the health education also depends on factors such as location, illness or fatigue, literacy, self efficacy, maturation and habituation of the learners (Forbes, 2004).  Accordingly, one-to-one instruction of experiential learning strategy is used to give the health education on diabetic diet (Fitzegerald, 2003). This is the most appropriate strategy for this session since the patient and his wife are in the state of pre-contemplation (Fitzegerald, 2003); they are aware that they need to learn about and live with the changes in the diet of the patient.

One-to-one instruction has many advantages over other teaching strategies; it gives sufficient time to understand the topic as well as build rapport between the teacher and the learner and, adjust the strategy in accordance with the learner’s pace of learning. This strategy also enables the educator to assess barriers for learning, for instance the level of motivation of the learners.

Conclusion

As the doctors’ are required to learn and teach besides diagnosing diseases, learning and teaching is also inherent in nursing profession. Teaching involves planning and knowing ways in which people could be taught effectively for successful learning outcomes. Plan involves formulating aims and objectives, and devising strategies to ensure proper learning environment while keeping the learners’ needs and evaluation in sharp focus throughout the entire phase of the implementation of the Plan.  This Plan dispelled many myths woven around the diabetes and dietary requirement of its patients; it aided the author in driving home of the message that ‘sugar disease’ (as the diabetes is known among the Bhutanese people) requires maintaining optimum level of sugar, not avoiding it altogether.