Principles & Practice
Preparing the Woman with Gestational Diabetes for Self-Care: Use of a Structured Teaching Plan by Nursing Staff

https://doi.org/10.1111/j.1552-6909.1991.tb02530.xGet rights and content

Staff nurses are expected to teach patients with diabetes effectively, but studies indicate that nurses are often uncertain about determining the proper content to teach and the teaching methods to use. Evidence suggests that patients with gestational diabetes are crisis oriented and may have barriers to learning the necessary skills for self-care. To combat this problem, the authors developed the Structured Teaching Plan to guide staff nurses in teaching patients with gestational diabetes. This tool provides reinforcement of content and objective evaluation, thereby assisting the patient in overcoming learning barriers. This article reviews and outlines the components of the Structured Teaching Plan and its implementation and evaluation.

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)

  • American Diabetes Association

    Position statement on gestational diabetes mellitus

    Diabetes Care.

    (1986)
  • Management of diabetes mellitus in pregnancy

    ACOG Technical Bulletin

    (1986)
  • K.J. Leveno et al.

    Gestational diabetes: Evolving concepts and misconceptions. Supplement no. 9

  • S. Fitzgerald

    Utilizing Orem’s self-care nursing model in designing an educational program for the diabetic

    Topics of Clinical Nursing.

    (1980)
  • D.E. Orem

    Nursing: Concepts of Practice

    (1985)
  • P.C. Foster et al.

    Dorothea E. Orem

  • S. Weinzierl

    Staff nurses as patient educators

    The Diabetes Educator.

    (1983)
There are more references available in the full text version of this article.

Cited by (0)

View full text