Principles & PracticePreparing the Woman with Gestational Diabetes for Self-Care: Use of a Structured Teaching Plan by Nursing Staff
Section snippets
Literature Review
Fitzgerald applied Orem’s Self-Care Nursing Model when caring for patients with diabetes.4 Her application was used as a framework for the Structured Teaching Plan. Self-care “is the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.”5 Patients who have gestational diabetes require help “with decision-making, behavior control, and acquiring knowledge and skills.”5 Therefore, nurses must interact with gestational diabetic
The Structured Teaching Plan
Several health-care professionals developed the text of the Structured Teaching Plan during the course of a year. Individuals involved in the process included a dietitian, a nurse educator, an obstetric clinical nurse specialist and clinician, and a diabetes clinical nurse specialist.
The Structured Teaching Plan guides the staff nurses through the educational process with their patients and incorporates effective teaching skills (Table 1) similar to the strategies outlined by Pichert.14 The
Guidelines
The staff nurses receive specific directions on how to proceed with each session through a document titled “Clinical Guidelines: Structured Teaching Plan for Gestational Diabetes.” These clinical guidelines are documents used in the hospital to direct the care of gestational diabetic patients. The guidelines include procedures, tasks, and nursing-care directives and direct the staff nurses to:
- 1)
use various teaching materials to reinforce instruction,
- 2)
encourage each patient to participate in
Presentation of Content
The content of the Structured Teaching Plan is presented in a flip-chart format designed by staff nurse volunteers. During each session, the patient looks at relevant photos and diagrams that illustrate the content, while the staff nurse provides instruction by following a suggested narrative. The initial content of the third session is outlined in Table 3. Each session begins with the nurse highlighting the previous session’s content and asking the patient to indicate any questions that she
Tests
The patient’s level of understanding of the content introduced in each session is evaluated before the next session through the use of a four-item multiple- choice test. The staff nurse reviews the patient’s responses and corrects any wrong answers before beginning that day’s session. A comprehensive 20-item test is also administered within 24 hours after the patient completes the fourth session. After the test is completed, the staff nurse reviews the correct response to each question with the
Patients’ Responses
Thirty-four newly diagnosed patients were taught using the Structured Teaching Plan in the first 22 months after implementation. Most of the patients seemed eager to learn the material presented. The mean score on the 20-item test was 85% correct answers. The authors observed that the patients who were instructed using the teaching plan frequently were independent in their self-care skills and knowledgeable about their care several days before blood glucose control was achieved. Many of the
Nursing Implications
Staff nurses’ responsibilities have become more com: plicated because of an increase in the intensity of patient care provided and the nursing shortage. Nurses have limited time in which to meet the demands placed on them. One example of a complex demand is teaching patients about diabetes self-care. Studies indicate that many nurses do not feel comfortable teaching diabetic patients because they are not confident about (1) their knowledge of the content to be taught or (2) their own teaching
Summary
Staff nurses needed help to improve the instruction of patients with gestational diabetes. A Structured Teaching Plan was designed to encourage the presentation of necessary content using effective teaching skills. Suggested teaching methods and strategies were integrated into the teaching plan. Nursing staff were active participants in the planning process, creating a flip chart to be used during instruction and thereby developing a sense of investment in the project. The staff nurses use the
Acknowledgments
The authors would like to thank Earlie Rockette, RNC, MN, OGNP, and Bernice Walter, RD, for their contributions to the design and implementation of the Structured Teaching Plan. The authors also appreciate the assistance of Barbara Fleming, RN, MS, and nurse researcher Sarah Strauss, RN, PhD.
References (14)
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ACOG Technical Bulletin
(1986)- et al.
Gestational diabetes: Evolving concepts and misconceptions. Supplement no. 9
Utilizing Orem’s self-care nursing model in designing an educational program for the diabetic
Topics of Clinical Nursing.
(1980)Nursing: Concepts of Practice
(1985)- et al.
Dorothea E. Orem
Staff nurses as patient educators
The Diabetes Educator.
(1983)