NCS1201 Foundations of Nursing, Edith Cowan University, Australia
Theories of Development Information
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For this assessment students are required to choose one (1) of the scenarios outlined below and present a client teaching activity (CTA).
Scenario - Jaxson is a 5 year old boy who lives with both parents and his older sister in the suburbs of a large city. Jaxson was diagnosed with Type I diabetes 2 years ago which has been well managed by his parents. He is developing normally and is about to start pre-school. As he will need to become more independent in the management of his diabetes he requires further education on how to test his blood glucose level (BGL). It is your role as the practice nurse of his local medical centre to teach him how to do this.
Answer: Client Teaching Activity
Teaching someone in the clinical environment can be a difficult task for professional nurses because their practice roles change at a very fast pace. For effectively teaching a concept or method to someone in the medical field there are some specific skills necessary for the tutors. Majorly one need to identify knowledge deficit as well as the other factors which affected the individual client. It is also necessary that when family-centred care is being provided, then the time plus activity should be individualized (Annette, Delaney, & Hardy, 2014) . Educational programs are also arranged for the children in which they can gain information regarding medical equipment and procedures. However, it is necessary that programs comprise of sensory- based information so along with a knowledge gap, anxiety will also reduce. In this paper, a client teaching activity has been included in which a patient will learn to manage his disease in an effective manner and be independent.
According to scenario 1, Jaxon is the patient who is a 5-years old male. He was diagnosed with Type 1 diabetes at the age of 3. He is about to start pre-school. At this time Jaxon requires further education regarding his disease and testing process of BGL (Blood Glucose Level), so he could be more independent and manage the disease. Adults can act as the source of scaffolding for the child. According to Jean Piaget’s cognitive theory of development, scaffolding is the procedure in which an adult control a certain part of a task which is difficult for the child to manage (Geoffrey & Desforges, 2013) .
Due to this controlling procedure, the child is able to focus on the areas which he can do in an effective manner. it is also believed that the previous knowledge and information of the child can play an important role in overall performance for the short-term and its effects are also visible on the long-term. Piaget’s theory is concerned more about structure than content. this is mainly because a child advances cognitive ability in the sequential order during 0-15 years of developmental age. Patterns of thoughts or actions can be used for accommodation or assimilation or novel experiences. this effort is utilized for maintaining equilibrium. Age-appropriate teaching is required for the patient as he is in the preoperational development stage. Jaxon can be assessed by expression of his feelings via pictures and actions. Although at this phase of age he can use language for asking questions, but there are chances that he use words without grasping their meaning (Susan, Zaitchik, & Bascandziev, 2015) .
Egocentric nature is a common phenomenon among preschoolers. Thus, Jaxon should be motivated for learning regarding how he can take care of himself. Different techniques can be used for teaching Jaxon such as books which include different pictures and physical demonstration of the use of blood glucose monitors can be very helpful.
A nursing diagnosis is the knowledge deficit in the procedure as well as management of the individuals BGL relevant to the young age of the child and they are unable to understand the complex concepts. It is necessary that the effective domain of the patient need to be targeted in developing the attitude of the child towards enhancing his independence as well as feeling about diabetes. On the other hand, the cognitive domain of teaching will be concerned about teaching Jaxon what diabetes is and how it can be recorded using BGLs. Meanwhile, the psychomotor domain will reflect the ability of the child to manipulate BG monitor for correctly taking BGLs, including from where he should draw blood.
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Motivating the child for self-testing can be quite a difficult task because most of the time children are either afraid of blood or other such medical tools (Michael, 2013) . Thus, the nurse needs to make different motivational strategies with the help of parents for promoting the self- testing behaviour in Jaxon. For diabetic patients, it is necessary that they use glucose meter for analyzing the blood test strips 4 times a day for preventing hypoglycemia. In the case of diabetic children constant monitoring is necessary for maintaining the blood glucose level between 80 to 150 ml/dl almost 75% area of the day.
Specific goals and objective should be made for enhancing the chance of positive patient- care outcomes. Outcomes can be related to the knowledge, behaviour and attitude change. outcomes are checked right after the completion of the program. short-goals can be arranged in a SMART manner, but the long-term goals are measured after a certain time period. Objective management results in the increased knowledge of the patient regarding the subject in hand and correct management of the disease.
The main goal of this teaching session is Jaxon will be able to correctly identify his BGL as well as he will learn that in which range, he is out of danger and he will be able to perform the blood sugar test individually without any kind of assistance before leaving the clinic. Jaxon will also be able to take care of himself during the school hours and can easily identify when his sugar level should be adjusted. During the training program, all these things will be taught patients and thus outcomes are expected to be like this.
The patient is able to read his own correct blood sugar level within 15 days of training
This goal is most suitable in this case because the children are sometimes complex to handle. Jaxon will be able to learn in the first 15 days that when his meter reads 3 digits, then his sugar level is acceptable.
Setting & Timing
The client’s teaching activity will take place in the local medical centre. However, the private room will be selected for teaching the child in which friendly environment will be maintained so the child feels relaxed and could easily ask the questions. due to privacy, he will not have a fear of being judged. The room will be colourful, but there will be no major distraction so the child could focus on the work. Educational posters will be posted on the walls with reference to diabetes. Due to the presence of simple words and pictures the child will be able to process the pre-operational stage.
The teaching session will start daily at 10am. During the session, it will be ensured that parents are not in a rush. Every possible effort will be made for keeping the child focused. The session will be ended before nap time. the instructor will keep the session 2 hours long in which small breaks will be given to the child so he could relax, process the information and then start again with the new focus (Elizabeth, et al., 2013) .
An individualized plan is the main requirement for this session. The nurse can develop a diabetes plan for the child by taking input from the family members and teachers. Moreover, the main materials which are necessary for the management of diabetes include insulin administration, insulin and blood glucose monitoring (Karam, Bele, Bodhare, & Valsangkar, 2012) . Vitals should also be provided to the child but in simple information form in which instructions related to the diabetes-related tasks are present in the form of images which a small 5 years old child can cognitively process and understand. Brochures are the best for this purpose the nurse can provide Jaxon with these brochures from the pediatric ward.
Choice of Teaching Methods
There are a variety of methods for teaching the clients about a particular condition, but these depend on the mental state plus age of the client. In this specific case, the use of pictures and brochures is most suitable for providing the information to the patient. Moreover, with the passage of time, the situation can be analyzed and then regarding that teaching method can be changed. Generally, it is assumed that school-age children are capable of administrating their own insulin. For effectively teaching Jaxon regarding appropriate sites for injection, paper doll chart can be used. the chart can be prepared for a 1-month long time period. Jaxon can fill up the
spaces at which he has injected himself.
On the chart instructions will be in simple and easy language while the pictures will be arranged in the numerical order for instance:
Select an injection site- this can be anywhere in the skin which is easy to be pinched like abdomen, arms, hips and thighs.
Inject the needle by keeping the angle of 90 degrees (specific picture of the needle at 90 o )
Push down the needle and release insulin inside the body and then after emptying remove the needle.
Record the date
Mark the doll paper at the site where the injection has been used.
A famous psychologist named Erik Erikson has claimed in his psychosocial theory for preschoolers that this specific age of the humans depicts initiative versus guilt stage. At this age, children play and live to achieve as well as get satisfaction in the activities. they have high energy to do the things. However, at this time if the children are overstepped from their abilities, then the feelings of fear plus guilt start growing because they are not able to behave correctly. Thus, it is necessary that encouragement should be used to motivate the child and promote the independence of tasks (Linda, et al., 2012) . For example, the nurse can use happy and high tone for promoting positive energy. She can also appreciate the child on either correctly reading the level or remembering a specific instruction.
Developmental & Social Factors
It is also crucial that parents and the school personnel are able to identify the situation of the child and then provide the relevant treatment on time for saving him from hypoglycemia. This is mainly because preschool children are not able to correctly understand the danger of their situation and then they cannot take specific measures to overcome it. although, a 5-year-old child is able to recognize the injection site, identify which finger needs to be a prick and are also very cooperative. Social factors like mothers, family connections and other life complications and stresses can determine how parent act towards the diseased child (David & Weis, 2017) . For instance, disharmony among the parents and family can badly affect the child’s development and wellbeing.
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Nurses have the strict responsibility to not only prepare the patient for self-care but also educate his family members so they can effectively take care of the child. This practice will have a positive impact on the compliance, adaptation and anxiety of the patient who is dealing with chronic illness. There are following some of the methods that can be used for this purpose:
1. Telling- nurse should effectively highlight the task of blood glucose testing to Jaxon with precise and clear instruction so he could accomplish it. the information should be provided in a manner that the child of the preoperational stage remains engaged.
2. Selling- nurse gives the proper information about how to insert the needle subcutaneously. It should also be told how to do the whole process safely.
3. Participating- nurse should involve the patient in the goal-setting process, so he feels involved. For instance, the nurse can make plans set goals and set the method while the child can highlight his concerns so they can be addressed.
In the clinical practices, evaluation is made on the basis of care of patients plus client and then observing the performance. The evaluation includes the subjective judgement of the nurse. In this case, immediate evaluation should be made for assessing either the child has learnt the things or not. For instance, the nurse can ask Jaxon to explain the instruction and methods. He can also provide a physical demonstration of how to inject the needle. From the expression, fluency of the content and gestures of the child the nurse can identify his learning level.
It can be concluded that the major purpose of client teaching is to demonstrate the methods of learning, teaching and analysis of patients in the clinical environment. This practice is for improving the behavioural changes. Knowledge should be improved regarding the management of disease and self-care for enhancing the overall health. Teaching preschoolers can be quite difficult because they are not cognitively advanced due to which it is necessary that a variety of methods should be used for teaching them in an effective manner.
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