. --·-l
CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
I
I
A DIABETIC CURRICULUM FOR REGISTERED NURSES
at
UCLA MEDICAL CENTER
A graduate project submitted in partial satisfaction
of the requirements for the degree
of
Master of Public Health
by
Antonia Catherine Rothe
June, 1977
--~-----------------------------
The graduate project of Antonia Catherina Rothe
·is approved:
E~leen
Nebel Levine,
M.P.H~
J9.Jirt T. Fodor,;' Ed. D.
Waleed Alkhateeb, Dr. P.H., Chairperson
California State University, Northridge
ii
DEDICATION
This
graduate
project
is
dedicated with sincerity and
appreciation to UCLA Medical
Center:
diabetic patients,
nurses and doctors who provided kindness and motivation
to make this goal possible.
iii
ACKNOWLEDGEMENTS
To my
husband Carl who gave
his
continuous
offered
invaluable
support
and
Iguidance.
To
numerous . friends
who
suggestions
for the graduate project.
A special thanks to Eileen Nebel'Levine, M.P.H., who cheerfully gave of her time during many anxious moments throughout this study.
To
John
T.
Fodor,
Ed. D,
for
his
encouraging
assistance
in the structuring of the diabetic curriculum.
To Waleed Alkhateeb,
Dr.
P.H., who served so expertly as
chairperson of my graduate study.
iv
TABLE OF CONTENTS
Page
APPROVAL . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • .
ii
DEDICATION . . . . . . . . . . . . . . . . . . . . . . • . . • . . . . . . . . . • . . . . . •
iii
!IACKNOWLEDGEMENTS ................................... .
iv
ILIST
OF TABLES ..........................•............
vii
ABSTRACT . . . . . • • . . . • • • . . . . . • . . . . . • . • . . . . . • . • . . • . . . . • •
viii
I.
II.
III.
INTRODUCTION. . . . • . . • . . • . . • . . . • . . . . . . . • . . . . . . • .
1
Statement of the Problem....................
1
Purpose of the Study........................
4
Limitation of the Study.....................
4
REVIEW OF THE LITERATURE......................
5
Prevalence and Incidence of Diabetes........
5
Patient-Nurse Roles in SelfManagement of Diabetes......................
8
Patient's Level of Understanding
Related to Management of Diabetes...........
10
Role of Professional Staff
in Patient Compliance.......................
12
Patient Education as Part of
Total Process of Patient Care...............
14
Planned Organized Education
Program: Team Approach.....................
17
METHODS AND RESULTS...........................
20
Background of the Study.....................
20
Interviews with Health Educators
in Hospital Settings........................
20
Results of Diabetic Education Assessment Questionnaire for Registered Nurses....
22
----------~-~-------~---------------------~----~-----
v
....
~·
Results of Diabetic Assessment Questionnaire for Patients . . . . . . . . • . . . . . . . . . . . . .
IV.
28
CURRICULUM DEVELOPMENT • . . . . . . . . . . . . . . . . . . . . . . . •
33
Phase I - Suggested Implementation . . . . . . . . . . .
33
1.
General Implementation .....•.....•.•...
33
2.
Inservice Education . . • . . • . . . . . . . . . . . . . .
36
3 • ' Total Evaluation .....•..•........•..••.
39
Revision-Updating • . . . . . . . . . . . . . . . . . . . • .
42
Phase I I - Diabetic Curriculum ••..••.•.......
44
SUMMARY AND CONCLUSIONS ...•..••.....•..•.......
51
BIBLIOGRAPHY . . • • • . . • . . . . . . . . . . . . . . . . .-. . . . . • . . . • • . . • • .
54
4.
v.
APPENDICES
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
DIABETIC EDUCATION ASSESSMENT
QUESTIONNAIRE FOR REGISTERED NURSES ......
57
DIABETIC EDUCATION ASSESSMENT.
QUESTIONNAIRE FOR PATIENTS ..........•••..
62
ANSWERS TO DIABETIC EDUCATION ASSESSMENT QUESTIONNAIRE FOR PATIENTS ...•.....•
68
TIME SCHEDULE FOR SUGGESTED
IMPLEMENTATION OF DIABETIC
CURRICULUM PROGRAM. • . • . . • . . . . . . . . . . . . . . . .
69
PRE- AND POST-TEST FOR DIABETIC
CURRICULUM WORKSHOP . . . . . . . . . . . . . . . • . • . . . .
73
ANSWERS TO PRE- AND POST-TEST
FOR DIABETIC CURRICULUM WORKSHOP ..•......
81
DIABETIC WORKSHOP EVALUATION
QUESTIONNAIRE............................
82
POST DIABETIC WORKSHOP QUESTIONNAIRE
FOR REGISTERED NURSES •...•.•..••.........
84
PATIENT DIABETES EDUCATION ,
EVALUATION QUESTIONNAIRE . . . . . . . . . . . . . . . . .
86
DIABETIC CURRICULUM . . • . . . . . . . . . . . . . . . . . . .
90
vi
,
I
LIST OF TABLES
Page
Table
I.
II.
III.
Readmittance of Adult Diabetic Patients
at UCLA Medical Center, Years 1974-1976......
3
Summary of Diabetic Education Assessment
Questionnaire for Registered Nurses at
UCLA Medical Center..........................
26
Summary of Diabetic Education Assessment
Questionnaire for Patients at UCLA
Medical Center...............................
29
I
I
vii
ABSTRACT
A DIABETIC CURRICULUM FOR REGISTERED NURSES
at
UCLA MEDICAL CENTER
by
Antonia Catherine Rothe
Master of Public Health
The purpose of this study was to develop a diabetic
teaching program for registered nurses on the adult medical
and
surgical divisions at UCLA Medical Center.
A small
scale assessment of the current diabetic teaching program
was first conducted in terms of the nurses'
educational needs.
and patients'
This assessment consisted of two ques-
tionnaires, one aimed at the nurses and one at the adult
diabetic patients.
cated their
'
An analysis of the questionnaires indi-
pe~tinent
educational needs which were used in
the development of the diabetic teaching program.
The diabetic teaching p;rogram included a diabetic
curriculum with
concepts,
behavioral
objectives,
content
outline, learning opportunities, educational resources and
evaluative methodology.
This curriculum was suggested to
be implemented at a two-day diabetic workshop at UCLA Medical
yiii
Center. The development of the diabetic curriculum was divided
into
two
major
phases:
Suggested
and the Diabetic Curriculum.
Implementation
Phase
The Suggested Implementation
Phase was divided into four parts: General Implementation,
Inservice Education, Total Evaluation and Revision-Updating.
Four major concepts with subconcepts were identified
and were used to stress the course outline to be covered in
the curriculum.
The instruction focused on self-care manage-
c
ment of the diabetic patient.
The initial major concept per-
tained to the background information on diabetes.
The second
major concept consisted of basic information on diet, medication and urine monitoring.
The third major concept stressed
preventive measures which included complications of diabetes
and proper foot care.
The final major concept centered on
psycho-social factors of the diabetic patient.
I
II_
-- ..
ix
I.
INTRODUCTION
Statement of the Problem
Because diabetes is a condition which may be controll~d,
I nursing
but for which no known cure exists, the planning of
care involves a long-term perspective including iden-
1
tification, prevention, diagnosis, treatment and follow-up of
diabetes-prone and diabetic individuals.
The nurse's role
demands thought, personal and interpersonal involvement, and
understanding.
No longer can the nurse operate on the role
expectations of the past; e.g., by teaching only how to give
insulin, observing for reactions and planning for just the
immediate needs of the present.
As a professional offering a
social service, the nurse is expected to learn and use the
knowledge and competencies essential to nursing in maintaining or restoring health and supporting the patient and his
family in living with the inevitable.
(11:3)
According to Rosenberg, there is a "three failure concept":
the clinical failure,
educational failure.
the medical failure,
and the
The "clinical failure" is the patient
whose primary diagnosis is worsened because of an unavoidable exacerbation.
This is best exemplified by the diabetic
patient who is doing well, takes his drugs faithfully, maintains his diet, but has to be hospitalized because pneumonia
has wrecked havoc with his insulin needs. The "medical failure"
[is the patient
for~-~~~ ~~-~-~~-a-~-~-~-~ence
L
can provide no cure;
2
e.g., the kidney patient who cannot be transplanted, the museular dystrophy patient or the mul ti'ple sclerotic.
The "educa-
tional failure" is the diabetic patient who will not follow a
prescribed regimen.
Examples include the diabetic patient
who eats candy or the diabetic patient who won't take his
medication.
Little can be done for the first two failures,
but there is no acceptable excuse for the educational failure.
This occurs, not from lack of knowledge of what the patient
needs to know to maintain optimum health, but rather because
a planned approach is not provided to satisfy the patient's
educational and informational needs.
Although we would never
consider allowing a person to practice medicine without years
of training, we ask a patient to be responsible for, and continue his own care and treatment without telling him why or
how.
Then we become angry with him when he returns to the
hospital as an educational .failure.
(22:7)
With the large numbers of diabetic patients readmitted
at UCLA Medical Center
program is needed.
cant number
(10.37%)
an organized diabetic educational
Table I reveals that there is a signifiof diabetic patients who return after
being discharged following their initial series of treatment.
This indicated a need for more intensive patient education in
self-management of his diabetic condition.
I
-
__ j
I
3
TABLE I
READMITTANCE OF ADULT DIABETIC PATIENTS
AT UCLA MEDICAL CENTER
YEARS 1974-1976
Times
Readmitted
2
3
4
5
6
Number of
Patients
322
96
35
14
10
7
4
8
1
0
1
11
9
10
11
12
13
14
0
0
1
Percent of
Sample Population*
10.37
3.09
1.12
0.45
0.32
0.13
0.03
0.00
0.03
0.35
0.00
0.00
0.03
*Based on total sample population of 3,104 patients
discharged after receiving diabetic treatment.
At present, diabetic patient education at UCLA Medical
Center consists of the informal nurse-patient interaction
type,
such as providing
information,
or teaching on a one-to-one basis.
answering questions,
A diabetic patient in
need of guidance regarding his diet is usually referred to the
I dietitian. Once a year a diabetic two-day workshop is usually
held for RN's and LVN's selected by the head nurses.
This
workshop is coordinated by the Staff Development Department
at the UCLA Medical Center and consists of lectures conducted
4
lby an endocrinologist, dietitian, and RN's who have attended
previous diabetic workshops.
The nurses attending the work-
of the diabetic patient in a sequential manner and to aid in
the teaching-learning process.
Research by Feustel indicates:
Expectations for learning are ?hared in
common by the nurse and the patient.
The
topics and plans for dealing with specific
subjects must be organized in the way most
appropriate for the individual patient and
the patient has an understanding of the order
planned.
( 8 : 5)
Purpose of the Study
The purpose of the study was 1) to assess the current
diabetic teaching program at UCLA Medical Center
in terms
of nursing staff and adult diabetic patient needs, and 2) to
plan a diabetic teaching program for RN' s on the adult medical
and surgical divisions at UCLA Medical Center, which will
include a curriculum with concepts, behavioral objectives,
educational resources and evaluative methodology.
Limitation
of the Study
The study is limited to the registered nurses on the
II.
REVIEW OF THE LITERATURE
According to Simmonds:
When there is an increasingly aged population, the likelihood of chronic diseases
increases, and with the larger number of
individuals with chronic diseases,
far
more attention has to be given to helping
·the patient care for himself.
Aside from
a few acute problems requiring hospitalization, the patient must care for himself on
an ambulatory basis. Chronic diseases are
not curable, but hopefu~ly can be controlled with proper care over long periods of
time.
The emergence of chronic diseases
as a major health problem has provided a
considerable stimulus to the need for patient education services and programs over
the last few years.
(25:12)
Prevalence and Incidence of Diabetes
Estimates
from
the
American
Diabetic
Association
show that 4,500,000 people in the United States have diabetes mellitus.
1,600,000 are undiagnosed diabetics,
5,600,000 are potential diabetics.
and
Approximately 250,000
new cases of diabetes are diagnosed each year.
These fig-
ures are rapidly increasing as blood screening tests are
tripling the numbers diagnosed.
(28:9)
According to C.
Goetz, M.D., professor of medicine, University of Minnesota
Medical School, diagnosis at present is based on a laboratory determination, but because there is not complete agreement on what the cutoff point for the diagnosis of diabetes should be,
the frequency of diagnosis will change as
the cutoff point is raised or lowered.
5
Estimates of preva-
6
if more sensitive criteria for diagnosis were used.
Diabetes mellitus
is
ranked
(12:77)
statistically
as
the
lfifth most common cause of disease in the United States.
It is now believed that many of the deaths formerly attri/ buted to heart disease and arteriosclerosis should beattributed
I
to diabetes,
making
cause of death.
1
it
the
third
or
fourth
most
It is also the first cause of new cases
of blindness and a common factor in kidney failure,
disease,
strokes,
is predicted
that
only to heart disease.
by
1985
the
heart
gangrene and other disorders caused by
faulty blood circulation brought about by diabetes.
It
common
general
by 1980,
diabetes will
( 1: 1278)
rate second
Another prediction estimates that
population
will
have
increased
by
about twenty percent and the percentage increase of diabetics will be seventy-four percent.
(18:936)
Today, with the ever-increasing findings of medical
science. more questions have arisen about "who the diabetics
are."
factors
Research has offered
which
contribute
information on the following
to diabetes
in
some people and
may activate a latent diabetic condition.
Sex:
In the United States, women are more likely
than men to be diabetic from age twenty-five until around
sixty-five; thereafter, the incidence among women declines
7
Since reverse differ-
to match more closely that in men.
ences are found elsewhere in the world, some factor other
than sex hormones may be implicated.
After age sixty, the
incidence becomes much higher than for the younger generation.
(28:30)
Genetics:
The
hereditary
being researched further.
believed
some
to be
for
in
etiology
is
Although diabetes is generally
inherited as a Mendelian recessive trait,
investigators
increasing
factor
are
incidence
questioning
of
the
this
disease
in
beyond
view
of
the
expectations
transmitted recessive characteristics in the simplist
terms.
( 20: 1586)
Previous methods used to determine the
occurrence, among the Jewish people, are also being questioned in the light of findings that the incidence in Israel
is
comparable
to
the
incidence
in
the
United
States.
(14:86)
While the incidence is higher
Obese Individuals:
among obese individuals,
itself
does
beg inning
it is now known that obesity in
not cause diabetes.
to consider
whether
Some
investigators
the weight problem
is
are
not
a by-product of the "metabolic fault" leading to the diabetic state.
Because insulin is required in the conversion
of glucose to fat, obesity may bring to the surface a diabetic
condition
(11:10)
capable
of
control
by
weight
r~duction.
8
Parity:
betes
affects
rise after
with
Parity as
a
the
the
history
a
factor
incidence,
as
associated with dia-
shown
third pregnancy tending
of
abnormal
amounts
by
a
progressive
to occur
of
glucose
in women
in
their
urine. (2:8) The majority of women who have delivered babies
weighing over twelve pounds have developed diabetes at a
later
time in life, and so are considered diabetes-prone.
(4:100)
Physiologic and Psychologic Stressors:
Other fac-
tors that may activate a latent diabetic condition include:
physiologic
stressors
such
as
endocrine disorders involving
and
psychologic
stressors
worry, or frustration.
the
accidents,
infection,
and
increased adrenal activity,
such
as
(30:535)
mood
swings,
intense
Prolonged therapy with
thiazide diuretics may reduce
the diabetic's ability
to metabolize glucose and result in hyperglycemia.
(14:60)
Patient-Nurse Roles in Self-Management of Diabetes
At the present time, diabetes mellitus is a
chronic
condition which may be controlled but for which no known
cure exists.
Therefore, the planning of diabetic teaching
involves a long-term perspective including identification,
prevention, diagnosis, treatment and follow up of diabetic
prone and diabetic individuals.
wiler,
(8:5)
According to Etz-
the treatment of each chronic disease requires the
patient to assume an active, participatory role, while the
9
r
i physician
and
his
assistants
more supportive status.
relegate
their
skills
to
a
Few diseases demand as
(7:113)
much participation in therapy as diabetes does.
In fact,
nearly all diabetics must manage their disease by themselves
in everyday life. They may think it relieves the nurse of
the
responsibility
for
managing
therapy,
but
it
places
perhaps even more responsibility on her, making a patient
a
knowledgeable
and
willing
manager
of
his
own
care.
(6:17)
Persons
with
a
chronic
are entitled to as much
presented
in
a
manner
disease
information as
which
will
such
orders,
problems,
diabetes
they can handle,
enable
them
responsibility for a large part of their care.
Surgery,. cardio-renal
as
pregnancy,
to
assume
(23:1324)
vascular
dis-
and untoward developments of therapy such as fat
atrophy or hypertrophy and hypoglycemic attacks are considerations for the diabetic facing the long-term effects of the
disease. Rather than allowing the patient to be overwhelmed
by
the
reality
of
a
lifelong
condition,
the
nurse
can
help him to sort out the areas of concern so that they can
be worked out gradually.
(30:536)
Effort is directed toward corrective therapy, forestal1 ling
irreversible changes
and maintaining
conditions possible under the circumstances.
the
healthiest
i
10
Joslin stated:
There is no disease in which an understanding by the patient of the methods of treatment avails so much.
Brains count, but
knowledge alone will not save the diabetic. This is a disease which tests the character of the patient, and for success, in
withstanding it, in addition to wisdom, he
must possess common sense, honesty, selfcontrol and courage.
(14:12)
Just as the disease may test the character of the patient,
caring for the patient with diabetes mellitus may test the
character of the nurse.
challenges
assisting
of
the
Is the nurse willing: to face the
responsibility,
patient
more effectively with
to
knowledge,
understand
or
better
the condition;
function
and
to share,
to
in
cope
learn and
explore with the patient and his family the factors affecting the individual situation?
have pointed out,
(17:20)
As Gillum and Barsky
"the patient must become involved with
his disease and its treatment--he cannot be allowed to be
, a bystander ••.. And, finally, the patient must be reassuredhis anxieties and tensions about his diabetes be relieved.
Too often patient fantasies
are far
worse than reality."
(9:1564)
Patient's Level of Understanding Related to
Management of Diabetes.
As one mechanism among many, organized patient health
education may contribute to enhancing the individual's understanding
of
and
compliance
with
his
treatment
regimen.
ll
Patient education reinforces the patient's awareness of his
responsibility for his own health, and self-responsibility
is crucial for
the ultimate effectiveness of health care,
especially for the diabetic patient.
(13:76)
Studies have been done in various settings outside
the hospital situation to assess the level of understanding
and its relation to the management of diabetes.
Watkins and
others in the diabetes program of the North Carolina Regional
Medical Program canvassed patients at horne and found that
patients--even those with diabetes of long duration--made
numerous errors, but also confirmed that those who have more
knowledge about diabetes manage their condition better than
those
without
this
knowledge.
(29:455)
Etzwiler
and
others reporting studies done at camps for diabetic children
showed that patients and their families are often ignorant
of the most basic facts pertaining to diabetes and concluded
that a complete educational program for the patient is needed to achieve optimal management of the diabetes.
(7:1114).
A diabetic should have a working knowledge of his
condition, its problems and the means of control.
ing to Richards,
Accord-
experience has shown that when patients
receive an "educational experience" that helps them understand
the nature of
their
illness
and
the
specific
role
which they are expected to play in their own convalescence,
there is less need for readmission to health care institu-
1
12
r·.
I tions
j
and greater adherence to medication, rest, diet and
exercise regimens
that may have been ordered.
( 21: 23)
Little research has been conducted to determine the
amount
of
disease;
accuracy
of
a
diabetic's
knowledge
about
his
however, many investigators believe that persons
with diabetes have less than adequate knowledge about the
disease.
( 8: 4)
Investigators
affiliated with
the Uni-
versity of North Carolina Schools of Medicine and Public
Health made
a
study of
metabolic clinics.
sixty diabetic patients from
two
Even though the patients had diabetes
on an average of fourteen years, forty-eight had "unacceptable"
practice
in
made
errors
patients
administering
in
insulin
insulin.
Thirty-one
dosage,
twenty-seven
used urine tests in a way which would probably affect control adversely,
unacceptable
foot care.
forty-four' had meals and spacing of meals
for
(3:38)
diabetics,
thirty-one
carried
out
poor
This study and others suggest that the
education of a person with diabetes should continue throughout his lifetime.
manage better.
Those who know more about the disease
People also forget, or grow careless; they
must be taught and retaught.
Role. of Professional Staff in Patient Compliance
Patient's
lack
of
understanding
of
diabetes
may
stem from management by poorly informed professional personnel, nurses, dietitians and even physicians.
To evaluate
13
the potential for establishing comprehensive patient education
programs,
Etzwiler
surveyed
nurses'
understanding
Results showed misconceptions and errors in
of diabetes.
management by all three groups.
(7:114)
Research by Feustel
indicated that even though nurses acknowledge the responsibility of patient education, over sixty percent of fifteen
hundred nurses studied did not have adequate knowledge of
lteaching methods to carry out this function.
,l
Until
medical
science
prevent or cure diabetes,
with
I
no guarantees
~ell i tus
is a
of
advances
avoiding
more
complications.
"1 ifelong condition,
to
continuity
discharge
after
Diabetes
calling for
(11:10)
care
still
the diabetic must live with it,
nursing care and concern."
of
(8:6)
long
term
Staff concerned about
and
interested
in
patient teaching are needed if patient education programs
are to be a reality.
Nurses must accept the role of pa-
tient educator as congruent with other therapeutic roles.
Administrators need to create visible rewards for patient
teaching
and
facilitate
education on the ward.
but
a
designated
opportunities
for
patient
Discharge should not be a "surprise"
point
in a
series
of steps
"self-care and return to independence."
leading
to
(5:23)
The challenge of teaching patients how to cope with
their disease can be a difficult one.
Simmonds stresses
that one of the problems in patient educati6n today is the
14
r
I
llack
I
of
trained
people
who
both
know
the
health
system
i
land understand the educational process.
Contemporary edu-
lcation philosophy must be recognized and used--it is not
.,enough to provide instruction.
lmust
be
influenced
to
the
The patient's way of life
extent
that
!willing to maintain optimum health.
Encouraging nurses
he
is
able
and
(24:101)
to teach diabetic patients and
showing them how is a major responsibility of three clinical specialists at St.
in Dallas.
Paul Hospital,
a
490-bed facility
The specialists are nurses with extensive educa-
tional training and experience as both staff and teaching
lnur ses.
Each specialist divides her time between working
jwith patients and working
that
it
with other
nurses.
They find
is a challenge to get staff nurses actively in-
valved in patient education.
it as part of their
Some nurses don't recognize
responsibility, whether
it is simply
a lack of commitment to patient education or merely a need
to adapt their thinking along those lines.
(15:68)
Patient Education as a Part of the Total Process
of Patient Care
Health education is an integral part of the overall
planning for a diabetic patient, and should be tied in with
discharge
planning
for
that patient.
It is designed so
that when a patient is discharged, he is able to deal with
his own health care within his own environment, thus mini-
15
--
I rnizing
····-------
----
--·
the heavy cost of hospitalization.
(26:37)
Such
I efforts have the potential not only to lessen the demand
J
for medical services,
but also to improve the quality of
I care of the sick, and to prepare the patient for earlier
discharge and long-term rehabilitation.
(19:31)
At Los
Angeles County, University of Southern California Medical
I Center,
diabetic
problems
through
and
a
patients
provided
telephone
diabetic comas
educated
ready
"hot-line"
from 300
to 1,250 in 1970
Also,
visits,
the
and
to
resulted
in
in 1968 to 100
health
consultation
reduction
of
in 1970, and re-
from
2,680
in 1968
(despite rise in the clinic population).
avoidance
total
of
few
approximately
savings
million dollars was noted.
While a
their
access
duction of emergency room admissions
1
about
health
for
two
2,300
years
of
medication
nearly
1.8
(16: 1389)
facilities do provide a care-
fully planned health education program,
in most instances
teaching experiences are the result of coodinated efforts
of individuals untrained in current educational principles,
methodology, or educational research.
Patient and family
education, if provided, is usually on an "incidental, accidental ad hoc basis."
(1:1276)
Recently, a study of twenty-
six hospitals in Minneapolis-St. Paul was conducted in conjunction with the Diabetes Education Center.
The results re-
vealed that while all the administrators of the twenty-six
16
institutions professed educational programs for their pa-,
tients,
only
twelve
could
identify
a
specific
person
in
charge of the programs, and only fifteen of the hospitals
had purchased educational materials in the past year.
Only
three
that
they
of
the
twenty-six
had
any
budgetary
institutions polled related
allotment
whatsoever
for
patient
(15:66)
education.
Particular
emphasis
education in hospitals.
tion of services,
needs
to be
placed
on
health
Medical specialization, fragmenta-
rising costs and shortages of manpower,
contribute to the fact that the educational needs of
the
patients
not
in
are
keeping
health
not
with
care
being
the
system
met
present
is
properly,
levels
being
of
certainly
knowledge.
challenged
efficiency and effectiveness.
(10:8)
to
improve
The
its
The patient who is
readmitted or whose recovery at horne is lengthened because
of a failure
to take medications correctly,
a
regimen,
prescribed
program must
be
or
considered
and inadequately treated.
According
to
follow
as
an
a
to adhere
prepared
"educational
to
exercise
failure,"
( 2: 21)
to Rosenberg,
the
"educational failure"
is
the patient who will not follow a
prescribed regimen.
An
example
who
is
the
diabetid
won't take his medication.
for
the educational failure,
patient
eats
candy
or
There is no acceptable excuse
because this occurs not from
17
lack
of
knowledge of what
maintain
optimum
approach
is
not
health,
the patient
but
provided
to
needs
rather
because
satisfy
cational and informational needs.
to
the
know
planned
a
patient's
(22: 12)
to
edu-
Data available
from several projects indicate that diabetic patients who
are
adequately
process
informed
relate
to
and
their
included
own
care
in
the
and
educational
treatment,
have
fewer hospital readmissions, adhere better to their diets,
take
their medications essentially without error,
general
follow
closely.
fifty
orders
(27:564)
Hospital,
of
the
New
In
Jersey,
diabetic
of
a
their
small
it
was
patients
who
physicians
study
found
and
at
St.
that
Peter's
the
(18:936)
Planned Organized Education Program:
Team Approach
ultimate
education
is
attitudes
and
to care for
tive
state
possible.
to
goal
help
of
individuals
behavior
that
of
The
health;
and
emphasis
and maintenance.
programs
They
of
planned
acquire
will
education
must--the
reality
to
on
prevent
the need
in
for
Can
however
knowledge,
their
would
ability
recurrences
has
preventive
become
be
when
grown
ideal and
hospitals
patient
maintain a posi-
instruction
(3:37)
new
promote
themselves more adequately;
nationwide recognition of
care
organized,
out
diabetic
regimen did not require readmission.
The
more
eighteen
maintained
in
with
health
idealistic
a
reality?
dependent
on.
18
numerous
accomplishments
by
health
educators
and
other
health professionals in the health field.
Through
the
years,
patient
education
has
been
considered the responsibility of the physician.
However,
with
the
les-
the
in-
the
increased use of
ratio
sening
creased
of
specialists
on
the
family
doctor
once must
a
physicians
use
reliance
between
of
allied medical help,
and
technician
prescribing
who
by
is
(13:75)
has
patients
practitioner,
patient
have been.
patients,
to
the
the
longer
depends
in
upon
may
include
phramacy,
nursing,
inhalation
dietetics,
therapy
close
as
and
it
become
diagnosis
the
others to carry out the specifics of his
which
relationship
The physician has
expertise
He
treatment.
no
than
rather
and
skills
of
treatment plan,
physical
therapy,
In
education.
gen-
eral, the physician cannot and should not attempt all these
functions.
They are not his areas of competency.
The
development
of
medical
teams,
(1:1277)
consisting
of
physicians, nurses, dietitians, physical therapists, social
workers,
and
'
.
other
allied
health
personnel,
to
provide
high-quality care is encouraging because the team approach
has
proved
to
be
the most
effective method of achieving
the best medical treatment and care of diabetic patients.
(26:44)
Since
that
be
may
diabetes
expected
to
mellitus
last
for
is
a
the
chronic
lifetime
disease
of
the
19
patient,
and
the
who
dietitians
the
patient,
patient
The
in
patient's
to
and
overcome
functions
the
a
of
and
gram of
to
family
who
his
of
for
the
the
nurse,
who
with
the
patient,
betic diet therapy.
is
diet,
must
is
same
patient.
must
education
willing
are
to
very
for
help
the
important.
and dietitian who is eng aged
diabetic
more
physici~ns,
nurses,
provide
that
has
to
anxieties
the
nutritious
education
personnel
wish
the nurse
education
adequate
exposure
being
patient
regarding
understand
carried
It
out
the
by
follows
and
closer
understand
the
basics
pro-
nursing
then
constant
an
that
contact
of
dia-
(12:78)
Patient education seems to be an important aspect
of patient management.
According to research by Feustel:
Patients -Want to know
-Need to know
-Want to be taught
-Need to be taught
-Can be taught
and if a planned, organized educational program is
carried out it may:
-Cut readmission days and lessen
hospital days
-Provide more intelligent, cooperative patients
-Remove some of the burden for
patient information from the already
overworked physicians
-Allow for a more professional
use of staff time.
(8:6)
III.
METHODS AND RESULTS
Background_of the Study
The author has had many years of professional nursing
experience
at
UCLA
Medical
Center.
Numerous
conversa-
tions with the health educator in the UCLA Student Health
Service and with an
instructor
in
the
Staff
Development
Department (involved in patient diabetic education) revealed
a
need
for
a
planned,
organized
system
for
patient
diabetic education.
A subsequent
the
feeling
that
a
field
training
assignment reinforced
curriculum with
concepts,
objectives
and evaluative methodology for nurses was needed to effectively
teach diabetic patients on
the
adult
medical
and
surgical divisions at UCLA Medical Center.
Interviews with Health Educators in Hospital Settings
Interviews with health educators
hospital
tive
and
settings
strength
inservice
and
were
conducted
weaknesses
training,
and
of
to
in various local
obtain
their
the
diabetic
rela-
programs
to obtain constructive
ideas
that could be utilized in the anticipated program.
At
patient
Saint
education
assessments
Joseph 1 s
and
Medical
commitment
to
Joseph 1 s
Medical
consultant
Center
discussed
in
patient
evaluative
questionnaires.
Center
medical
effective
and
education
20
staff
for
Burbank
diabetic
The
have
the
a
inpatients,
Saint
broad
out-
21
and
patients,
offices.
referred
patients
from
medical
staff
The patient education program is. developed and
coordinated through the office of Continuing Medical Education.
The program and evaluation is carried out with the
medical, nursing and hospital staff under the guidance of
the patient
education consultant.
The consultant stated
that she could prepare the diabetic
self-teaching guides
with no problems but it is the implementation of the guides
in a hospital setting that has been very difficult for her.
At the Diabetic Maternal Out-patient Clinic at UCLA
Medical Center, the maternal health clinical specialist explained the self-management methods that she presented to
diabetic
is
pregnant
responsible
with
clinic,
for
a
The
mothers.
diabetic
follow-up
clinical
teaching
teaching
in
the
program
mothers are finally admitted to the hospital.
specialist
outpatient
when
the
Family cen-
tered nursing is the theme for UCLA's obstetrical nursing
division.
teams
Nursing staff members are assigned to mother-baby
which
provide
optimum
opportunity
for
post-partum
teaching.
Inquiries were made at Northridge Hospital with the
Director of Education and one of her instructors concerning
their diabetic teaching program.
Numerous teaching programs
i
lare available at Northridge Hospital, including practical,
community-oriented
education programs.
The
meeting
was
22
very informative in revealing sources of diabetic journals,
books and resource persons to contact.
Results of Diabetic Education Assessment Questionnaire
for Registered Nurses
A diabetic education assessment questionnaire
Appendix A)
(see
was given to forty RN's on the adult medical
and surgical divisions at UCLA, who have attended previous
diabetic workshops given by the Staff Development Department.
The purpose of the questionnaire was
current
diabetic
education
offered,
in
to assess the
terms
of
meeting
their educational needs to effectively teach self-management
methods to diabetic patients and their comments and suggestions for subject content to be included in a diabetic
curriculum which will meet these educational needs.
This
personnel at
UCLA,
questionnaire
was
also
given
to
key
such as clinical specialists and head nurses on the adult
medical and surgical divisions and the outpatient diabetic
clinic,
for
their
comments
and
suggestions
regarding
a
diabetic curriculum for the nurses.
Table II shows the summary of the diabetic assessment
questionnaire
for
RN' s.
The
topic
question
(2),
"Instructional Skills for
the Nurse Teaching the Diabetic
Patient,"
interviewing,
consisted
of
assessment
of
a
newly diagnosed diabetic, assessment of a previously diagnosed
diabetic,
how
to meet mutual goals and
evaluative
23'
tools.
This
participants
topic
as
question
skills
was
rated
critically
by
needed
35.8%
to
of
effectively
teach self-management methods to diabetic patients.
topic
question
Patients,"
(10) ,
consisted
"Health Care
Pointers
of
the
some
of
the
for
The
Diabetic
following:
foot
J
I
and
skin
care,
infections
balancing a diabetic diet,
and
diabetes,
importance
of
problems of elderly diabetics,
problems of long-term diabetics, and emotional and psychosocial aspects of diabetes.
25.9%
of
the
participants
to effectively
patients.
some
teach
The
of
the
techniques of
question
following:
the
skills
(6),
purpose
insulin injections,
of
rated by
critically
to diabetic
"Insulin,"
insulin,
proper
needed
included
sites
and
amounts and the
and syringe care--including purchase
and care of supplies.
of
as
self-management methods
topic
duration of insulin,
87.5%
This question was
This topic question was
participants
as
general
!
rated by'
knowledge
needed
to effectively teach self-management techniques to diabetic
patients.
a
need
The majority of the nurse participants indicated
for
knowledge
but
the
did
topic
not
questions
feel
as
general
that, they
were
background
necessarily
critical.
Several of the topic questions in the questionnaire
allowed the nurse participants to make comments and suggestions of their own choice which significantly reflected
24
that diabetic patient education is needed and desired by
the
nurse
utilized
The
participants.
in
the
following
Many of
development
comments
of
express
tliese
the
suggestions were
diabetic
their
curriculum
educational
needs:
"Instructional skills are needed to help the nurse determine
how
to
organize
time
to
allow
adequate
teaching,"
"Would l{ke to set a protocol at UCLA for diabetic teaching
because consistency
do
not
deal
in teaching
directly
with
is needed,"
diabetic
"Many nurses
patients,
therefore
need additional diabetic educational data, so patient will
have confidence in the nurse doing
the
teaching,"
"Some-
thing which would help in evaluating and assessing patients
to develop teaching to meet their educational needs," "Role
playing would provide good practice for interviewing," "No
consistency of teaching--feel a definite system should be
set
up
and
followed
through
by
all
the
nursing
staff
on all shifts in some manner so as not to confuse the patients," "Feel uniform education for the nurses is greatly
needed.
How
confusing
for
the
patient
to
receive
different slants of the same information," and "The basic
need for the nurses is to determine when to begin teaching
the patient so it will be more effective and then once the
patient is ready, how to develop and carry out the teaching
plan for optimal effectiveness.
It seems in most cases that
the approaches are usually disorganized and haphazard and
25
the patient rarely absorbs the information adequately.
This!
I
is validated by the constant readmissions of the same pa-i
tient with the same problem."
Topic
questions
15
through
17
asked
for
personal
comments by the nurse participants.
Question 15, for exam-:
ple,
like
asked
Diabetic
"What
Guide,
topics
would
booklet
you
for
the
included
nurse?
in
the
(Name
at
\
least five according
Eight out of sixteen!
to priority) .
nurse participants felt that "Diabetes--Etiology, Treatment,"
should
Another
be
given
top
significant
participants
were
nursing units.
priority
factor
involved
was
in
that
the
guide
only
booklet.
sixteen
nurse
in diabetic teaching on their
Two nurse participants were
involved
in-
frequently in teaching the diabetic patients and two nurses
did
not
conduct
teaching
until
the
day
of
discharge.
Individual bedside teaching was the method of teaching the
diabetic patient.
I
I
26
TABLE II
SUMMARY OF DIABETIC EDUCATION ASSESSMENT QUESTIONNAIRE
FOR REGISTERED NURSES AT UCLA MEDICAL CENTER*
Topic Question
Topic Needed as
General Knowledge
Critical
Frequency
%
Frequency
%
1. Background material
on diabetes.
42
68.9
29
31.1
2. Instructional skills
for the nurse teaching
the diabetic patient.
63
64.2
35
35.8
3. Visual aids as learning tools for the
nurse.
60
81.1 .
14
18.9
4. Visual aids as learning tools for the
patient.
55
83.3
11
16.7
5. Diet and diabetes.
27
71.1
11
28.9
6. Insulin.
77
87.5
11
12.5
7. Oral medications.
42
73.7
15
26.3
8. Urine testing.
69
85.2
12
14.8
9. Metabolism.
28
66.7
14
33.3
126
74.0
44
25.9
11. Complications of
diabetes.
23
62.1
14
37.8
12. Would you like an
"Educational Prescription" or check-off list
to evaluate patient?
education?
17
100.0
10. Health care pointers
for diabetic patients.
0
0.0
27
Frequency
%
13. Would a Diabetic
Guide, booklet for
the nurse, covering
the basic topics to
teach the diabetic
patient be hel.pful
to you?
16
100.0
14. How would you like
diabetic teaching
presented to you?
29
67.4
Frequency
%
0
0.0
14
32.6
15. What topics would you
like included in the
Diabetic Guide for
the nurse?
(Name at
least 5 topics according to priority)
(See results of diabetic
education assessment questionnaire for RN's)
16. Are you involved in
diabetic teaching on
your unit?
(See results of diabetic
education assessment questionnaire for RN's)
17. How are you conducting diabetic teaching
on your unit?
(See results of diabetic
education assessment questionnaire for RN's)
*Based on Total Sample Population of 40 RN's on the Adult
Medical and Surgical Divisions.
28
Results of Diabetic Assessment Questionnaire for Patients
An oral questionnaire
1
(see Appendix B)
was devised
to determine the patient's knowledge of his diabetic condi tion,
including
monitoring,
self-management
nutritional
restrictions,
techniques, proper foot care,
taining
to
population
of
age
of
consisted
of
thirty
of
such
as
insulin
urine
injection
and preventive methods per-
complications
consisted
and
females.
the
factors
diabetes.
diabetic
seventeen
The
patients
males
and
sample
on
the
thirteen
The length of time that the questionnaire parti-
cipants had been diagnosed as a diabetic ranged from one
day to forty years in duration.
Twenty-one patients in the
test group were insulin dependent and nine patients were on
oral hypoglycemic medication for their diabetes.
Table III shows the summary of the diabetic patients'
educational
needs.
Results
of
the
diabetic
assessment
questionnaire showed that ten questions out of thirty-two
quest ions
( 31. 3%)
asked were answered incorrectly,
"I don't know" or wrong.
either
This percentage appears significant
to establish the validity of a diabetic patient educational
program.
I
29
TABLE III
SUMMARY OF DIABETIC EDUCATION ASSESSMENT QUESTIONNAIRE
FOR PATIENTS AT UCLA MEDICAL CENTER*
Number of Responses:
InDon't
Correct correct Know
Question
1. Diabetes is a disease in which
the body: Does not have
enough insulin produced by
the body.
20
7
3
2. The insulin which the body
produces is chiefly responsible
for:
Helping the body use its
glucose (sugar).
20
2
8
3. Blood relatives of most diabetics:
Inherit a tendency to
get diabetes.
18
6
5
4. The following problems may happen
if diabetes is not controlled:
Circulation changes, decreased
feeling in feet, eye changes,
and/or kidney disease.
26
0
4
5. Diabetes can: Be controlled
with proper diet, exercise and
medication.
25
2
3
6. The person most responsible for
daily control of your diabetes
is:
Yourself.
26
2
2
7. Insulin may be:
injection only.
25
1
4
5
9
16
Taken by
8. Lente and NPH insulin becomes
effective:
Quickly and over a
long period of time (8-12 hrs.)
.. I
30
InDon't
Correct Correct Know
9. Regular insulin becomes effective:
Quickly and over a short period
of time (2 hrs.)
I
14
3
13
7
8
16
3
15
12
12. For insulin injections, it is a
good idea to: Rotate the site
of injections.
24
1
5
13. If a diabetic becomes involved in
unexpected exercise such as a
tennis match he should:
Increase
his food intake by eating something extra before he plays.
16
5
9
14. Use of the proper amounts of
insulin can: Control blood sugar.
23
0
7
15. When testing urine for sugar
before breakfast, use:
The
second urine that you pass
upon rising.
17
5
3
16. The reading of one plus (1+) in
any urine sugar test usually
means that the urine contains:
Small amount of sugar.
23
3
4
17. The reading of three plus (3+)
in any urine sugar test of a
diabetic person is: A bad
sign.
26
1
3
i 10.
I
Some oral hypoglycemic medicine
prescribed for diabetes: Stimulates the pancreas to secrete
more insulin.
11. When the diabetic has too much
insulin, the complication that
results is:
Hypoglycemia.
31
InDon't
Correct Correct Know
18. It is important for a diabetic
person to record the results of
his urine tests!
To help keep
track of his diabetic control.
To help his doctor or clinic plan
the right amount of diet, exercise
and medicine.
(Both A. and B. are correct)
18
9
3
19. When a diabetic's urine test is
usually negative he should:
Keep
testing as often as ordered by
his doctor.
13
15
2
20. A diabetic diet is~ A wellbalanced diet the whole family
can use.
16
9
5
21. Carbohydrates are:
starches.
18
7
5
9
13
8
23. All foods labelled "Diabetic"
are all right for diabetics to
use: False.
14
7
9
24. Which of the following groups
of foods is considered free:
Group A vegetables.
17
5
8
25. Some foods do not have to be
measured because: They contain
very few calories.
17
0
3
26. Canned fruit labelled "Diabetic"
is fruit prepared: Without added
sugar, but perhaps with an artificial sweetner.
28
0
2
27. A diabetic may go into diabetic
acidosis (diabetic coma) when
he:
Does not take enough insulin
and has an infection or other
illness or stress.
10
9
11
22. Cottage cheese is a:
exchange.
Sugars and
Meat
32
InDon't
Correct Correct Know
i
28. A diabetic may get a low blood
sugar reaction (insulin reaction):
When he does no eat enough food;
or does not eat at the proper
time.
14
5
11
29. When a diabetic feels any of the
symptoms of low blood sugar
reaction (insulin reaction) the
first thing he should do is:
Take fruit juice or a concentrated sweet immediately.
21
3
6
30. A diabetic must give special
care to his feet because:
Diabetes may slow blood circulation in legs and feet and
may cause an infection.
22
3
5
31. In caring for his feet, an
adult diabetic should:
Inspect
his feet every day and report
any irritation or injury to his
doctor.
21
3
6
*Based on Total Sample Population of 30 patients on the
adult medical and surgical divisions.
IV.
CURRICULUM DEVELOPMENT
The results of the diabetic assessment questionnaire
for
the nurses and diabetic patients on the adult medical
and
surgical divisions
were
used
ing the diabetic curriculum.
betic
curriculum
Phase I
four
was
as
a
guide
in develop-
The development of the dia-
conducted
in
two
major
phases.
is the Suggested Implementation which consists of
parts:
General
Implementation,
Inservice
Total ·Evaluation, and Rev is ion-Updating.
Diabetic Curriculum.
Appendix D shows
Education
Phase I I
a
is the
projected
time
schedule for the Suggested Implementation Phase of the diabetic curriculum program.
The activities are shown with
starting and completion dates.
PHASE I--SUGGESTED IMPLEMENTATION
1.
General Implementation
The diabetic curriculum will be initiated in a two-
day workshop at UCLA Medical Center by the Sta~f Development
Department coordinator and the curriculum project coodinator.
The
workshop
vironment
to
the
workshop
will
for
end
of
will
provide
the
nurse
the
be
an
uninterrupted
participants
curriculum.
conducted
twice
April and October.
33
The
a
from
learning
the
diabetic
year,
en-
beginning
curriculum
preferably
in
34
--------------;::·~-:-;;:~ula~·::::- R-~~:~-~-~red Nurses f-~~~--t-;~--~~-:;~---~
medical
and
surgical
will attend
divisions
at
UCLA
Medical
Center
Twenty RN
the diabetic curriculum workshop.
participants will be selected per workshop to permit significant
individualized
teaching,
therefore
adapting
the
workshop to their needs.
Time Allotment of Curriculum:
day
diabetic
curriculum
workshop
will
A two consecutive
consist
of
seven
hours of daily class activity--a total o£ fourteen hours.
Teaching
Facilities:
Location-
7
East
Class-
room at UCLA Medical Center, which has a seating capacity
for thirty movable chairs, will be used.
board
wi 11
be
in
the
room.
A screen and chalk-
Equipment-
slide
and
film
projector facilities,including the use of the Xerox machine,
will
be
available from
Materials-
the Staff Development Department.
free brochures and leaflets pertaining to dia-
betic information will be obtained from the American Diabetic
Association and various drug companies by the project coordinator
one month prior
to
the workshop.
Free diabetic
instructors' guides will be obtained by mail from Tran-aide
two months prior to the workshop by the project coordinator.
Trainex filmstrips and films applicable to class activities
will be provided by the Staff Development Department.
charts,
dietary
food
models
and
supplied by the hospital dietitian.
diet
exchanges
Food
will
be
35
Administrative Support
and
Clearance:
A meeting
will be planned, four months prior to the curriculum development, with the director of nursing service at UCLA Medical
Center, by the staff development director and project coordinator.
Permission will be obtained from the director to
implement the diabetic curriculum workshop at the hospital
and to provide the necessary paid class days for the nurse
participants from the nursing service budget.
will
be
obtained
for
the
instructional
Also, money
staff
to
attend
seminars for inservice training as necessary.
A written memo will be immediately sent out by the
director
of
nursing
service to the medical
and
surgical
assistant directors and evening and night supervisors on
the adult medical and surgical divisions.
stat~
that questionnaire
This memo will
interviews will be conducted by
the curriculum project coordinator to obtain diabetic education needs assessments.
The project coordinator will inter-
view RN's, diabetic patients and their families as necessary on the adult medical and surgical divisions.
With
the
coordinator,
the
cooperation
of
the
staff
development
two nursing assistant directors and
ten
head nurses from the adult medical and surgical divisions
will be asked
to select two RN' s with potential teaching
abilities from each of these ten nursing divisions to at-
36
This will be con-
tend the diabetic curriculum workshop.
ducted informally or through a directive memo about three
months before the workshop.
Curriculum
Planning
The
Committee:
curriculum
planning committee will consist of five members: the chair,man of the Endocrinology Department at UCLA Medical Center,
staff development coordinator, curriculum project coordinator, a head nurse representative from the medical division
and a head nurse representative from the surgical division.
I This planning committee will meet three months before the
I
I curriculum
workshop to solicit suggestions and
ideas
the curriculum planning committee at this meeting.
for
Another
planning meeting will be scheduled one month prior to the
curriculum workshop
by
the
development coordinators.
curriculum project
and
staff
This will be a discussion meet-
ing to decide the teaching approach that will be used in
the
implementation
topics
of
the
curriculum,
list
of
diabetic
that will be covered and suggested learning oppor-
tunities.
This meeting will be scheduled at 1400 in the
staff development coodinator•s office.
All the nurses will
be required to attend except the hospital physician.
An
individual meeting will be conducted at his convenience, if
he is unable to
2.
~ttend
this planning meeting.
Inservice Education
The
diabetic
curriculum will
be
more
effectively
37
utilized if it is accompanied by proper inservice training
for
the instructional staff.
Although this curriculum is
an uncomplicated one, the instructional staff will benefit
from further explanation and instruction.
Inservice educa-
tion will set the stage for the extent and depth of teach-
I ing
the
in
I up-date
diabetic
the
curriculum workshop.
instructional
staff
in
It
the area
will
of
also
diabetic
I
health education where facts are constantly changing.
Instructional
is a
I of
Staff:
complex disease whose
skills,
Since
treatment
diabetes
requires many kinds
a multidisciplinary team concept
teaching will be used.
mellitus
approach
for
This approach to teaching involves
a medical team of varying professional backgrounds and hospital roles whose expertise and personal abilities will be
I
especially helpful in the teaching-learning process.
The
instructional
the
nursing,
staff
dietary,
will
include
pharmacy
and
representatives
the
medical
of
professions
from the existing professional staff at UCLA Medical Center
and an RN from the Visiting Nurse's Association.
structional
staff
will
consist
of
the
staff
The in-
development
coordinator, curriculum project coordinator, hospital dietitian,
hospital
pharmacist,
nurses
from
and surgical divisions with diabetic
the
chairman
of
the
Endocrinology
staff will teach on a voluntary basis.
the adult medical
teaching
skills
Department.
and
This
38
Tentative Instructional Staff and Suggested Topics:
The tentative instructional staff and suggested topics for
1the diabetic curriculum using
the multidisciplinary
team
lconcept
approach for teaching, are as follows:
I
IMD
I
(chairman of the Endocrinology Department) ......•••. Background Information
on Diabetes (metabolism,
etiology, etc.)
I
RN (staff development
coodinator) •.•••....•....••.•... IntroductionPre- and Post-Tests
Diabetic Teaching Skills
RN (curriculum project
coordinator) .•.....•.....•.••... Needs Assessment of the
Diabetic Patient
RN (from adult surgical floor) .•... Urine Testing
!Hospital Pharmacist ••...•........•. Insulin and Oral Agents
RN (from adult medical floor) ..•... Insulin Injection Techniques
RN (head nurse from surgical
floor) .•••.....•..•..•.....••... Health Care of the
I
Diabetic Patient
RN (from Visiting Nurse's
Association) •.........•..•...... Psycho-social Adjustment
of the Diabetic Patient
and Family
Suggested
Diabetic
Seminars:
The
RN' s
will
be
required to attend diabetic seminars to update and increase
one seminar annually.
A two-day Southwestern Professional
Diabetes Symposium sponsored annually by the American Dia-
39
r ..
betic
Association
is
highly
recommended.
This
seminar
bonsists of professional speakers from UCLA Medical Center
~nd various hospital settings in California and other
states.
fhe speakers are physicians, nurses and dietitians actively
!involved in the current trends in diabetes.
I
Provisions
I
for
the
Instructional
Staff:
The
~ibrary in the Staff Development Department will be avail-
'
~ble for the instructional staff.
Books,
periodicals and
reference lists on their specific topics will be provided
for them if necessary.
lat
r'
1
UCLA Biomedical Library is located
the hospital if additional diabetic information is needed.
list of
audio-visual
aids
is
available'
and
inservice
jtraining on the use of equipment will be provided by the
t:af: :::e:::::::i::ordinator if required.
0
Purpose of Evaluation:
The purpose of this evalua-
tion is to determine whether the diabetic curriculum program will be meaningful and realistic for the nurse participants
on
the
adult
medical
and
surgical
divisions
in
!Order to meet their educational needs to effectively teach
diabetic patients on their nursing departments.
When
!weaknesses
to
of
Evaluate:
the
To
diabetic
assess
the
curriculum
strengths
program
and
there
I
iwill
be
evaluative
methods
eanning commi :te:__bef:~
conducted
by
du-rin:_an~-:fter
the
curriculum
the workshops
40
surgical divisions.
(See Appendices A and B.)
This will
establish baseline data from the medical and surgical divilsions to see if there is a need for the diabetic curriculum
workshop at UCLA Medical Center.
a •
Pre- and Post-test Questionnaire:
A pre-test
questionnaire will be given before the diabetic curriculum
workshop to the nurse participants to test their previous
knowledge on diabetics.
(See Appendix E.)
The response
from this pre-test will be used to measure the extent edu,cational objectives have been attained by the nurse participants at the completion of the curriculum diabetic workshop.
content
shops.
Also,
this pre-test will assist in the planning of
material
for
future
diabetic
curriculum
work-
The same test will be given as a post-test question-
naire evaluation at the completion of the two-day curriculum workshop, to measure the attainment of cognitive objectives sought as stated previously.
This pre- and post-test
will be a true-false and a multiple choice type of test.
b.
of
During Curriculum Workshop:
the first day of
discussion will
At the completion
the diabetic curriculum workshop,
a
be conducted to evaluate the program and
41
learning opportunities at this stage of the workshop to see
how
it
is
progressing
and
if
improvements are needed
meet the educational needs of the nurse participants.
will
allow for
and
learning
changes
in the teaching-learning
opportunities
if
they
are
The following questions may be asked:
cuss ions
informative?
(If
not,
why
to
This
approach
ineffective.
Are the class disnot?),
and
Are
the
diabetic filmstrips followed by a group discussion meeting
your educational needs?
c.
of
the
given
After Curriculum Workshop:
two-day workshop,
a
questionnaire
to
the
At the completion
nurse participants
evaluate
the
overall
will
be
workshop.
This will include questions regarding instructional staff,
learning
opportunities
Comments and
and
content.
(See
suggestions will be encouraged
Appendix
for
G.)
revision
and improvement of the diabetic curriculum workshop.
Long Range Evaluation:
d •
of
the
effectiveness
will be done
the
feedback
updating
of
in a
the
diabetic
curriculum program
continuous manner.
system
the
of
Long range evaluation
implemented
diabetic
This also will be
for
cur r i.culum
the
revision
program.
and
Starting
three months after the curriculum workshop the nurse parti-
··-····
--------------~---------··
--~
---------
---~-
- ---
-
-
- -- ------ -----·
1
1
42
skills
to the diabetic patients on the adult medical and
Starting within three ·to six months
surgical divisions.
after the diabetic curriculum workshop and on a continuous
basis, diabetic patients from the adult medical and surgical
divisions will be given a questionnaire.
This
questionnaire
needs
are
being
will
met
determine
by
the
if
nurse
(See Appendix I.)
their
educational
This
participants.
questionnaire survey will be conducted
in
the outpatient
diabetic clinic by the curriculum project coordinator.
4.
Revision and Updating
Specific Procedures and Personnel Involved:
Within
two weeks after the diabetic curriculum workshop a personal
interview will be conducted with each instructional staff
member
of
the . workshop,
Specific
questions
point of
view 11
betic
will
by
be
regarding
curriculum
asked
in
content
the
project
from
the
coordinator.
11
instructor's
retrospect whether
placed
proper
the
emphasis
on
diathe
important aspects of teaching skills for the nurse participants.
Feedback
participants
will
and
also be
diabetic
obtained from
patients
and/or
the adult medical and surgical divisions.
feedback
will
be
procured
by
the
the nurse
families
on
This systematic
long
range
evaluative
and
Updating:
methods as mentioned previously.
Time
Chart
for
Revision
The
43
'diabetic curriculum workshop will be conducted twice a year
preferably
workshop
in April
all
data
and October.
from
the
One month before each
questionnaires
and
personal
interviews will be analyzed by the staff development and
curriculum
project
coodinators,
revisions as necessary.
development
improvements
befor~
Also one month
a
diabetic curriculum workshop
staff
for
coodinator,
adult medical and surgical divisions.
I
'quest a
list of
available
the pending
memo will be sent,
to the head
nurses
and
by the
nurses
on
the
The memo will re-
that are
interested
in
1
idoing diabetic teaching at the workshop.
ii
·One week
!ment
and
before each workshop,
curriculum project
the staff develop-
coordinators
will
confer
on
!the evaluative data obtained from the systematic feedback
system.
Iand
.
I
1as
Diabetic content material, learning opportunities,
educational
necessary
to
objectives
meet
the
will
be
reviewed
educational
and
needs
revised
of
!participants to effectively teach diabetic patients.
!
nurse
44
.
I
--···----~------~-.
\PHASE II--DIABETIC CURRICULUM
I
The diabetic curriculum developed was. based on
i
Ia rationale suggested by Fodor and Dalis. (~)
(See Appendix
I
I
iJ for the diabetic curriculum.)
I
IIf our
.
maJor
concepts
an d
The curriculum includes
su b concepts
t h at
as
focal
practice
skill
serve
J
i
lpoints
for
diabetic
instruction.
Overt
I
!objectives
Irecall,
and
cognitive
understanding,
skill
analysis,
objectives
ihave been formulated for each concept.
I
jtwo
components,
the
general
relative
content
Each objective has
to
be
learned
!specifications of behavior sought in the learner
tion
to
this content.
with each objective.
to
synthesis and evaluation
1
i
Evaluative criteria are
and
in relaincluded
For each objective a suggested con-
tent outline, learning opportunities and resource materials
have been developed throughout the curriculum.
Particular
emphasis is placed on guidelines for the self-care management of diabetic patients.
This is intended to help the
nurse participants gain confidence in teaching self-management techniques to the diabetic patients on the adult medical and surgical divisions.
The diabetic curriculum consists of the
following
major concepts, subconcepts, and behavioral objectives.
!
I
I
l
···-1
45
Major
~CCEPT
Concept
I:
THE
PERSON
WITH
DIABETES ... CAN·-1
A MAJOR ROLE IN THE MANAGEMENT OF THE DISEASE.
This
ajor concept focuses on background information necessary
l:
or
the
understanding
of
diabetes.
Two
!specifically state content to be covered
'placing
the
the
res pons ibi li ty
patient
and
providing
of
a
knowing
subconcepts
in instruction,
about
diabetes
self-management
plan
on
unique
to their needs so the patient can function effectively.
Subconcept 1:
!familiar with diabetes
The person with diabetes can become
and
how
if
affects
his/her
body.
khe following four behavioral objectives formulated in the
curriculum
state
the
background
knowledge
required
of
the learner:
1.
Explain "What is Diabetes," including
the classical symptoms of' diabetes.
2.
Discuss "Who gets Diabetes."
3.
Describe the altered physiology of the
diabetic patient.
4.
List and identify the three types of
diabetes.
Subconcept 2: The needs of diabetic patients are varied
and unique to each individual patient.
Th~
following two
behavioral objectives as stated in the curriculum require
the nurse participants to personalize patient education:
-
----...-~--------
-------
--:-
---------------
------~------~--
-·
---~--
46
l.
Identify individual patient's need and
life style.
2.
Develop a patient education and management
plan unique to each patient.
Ma j OL Concept
CURED,
ALTHOUGH
I I:
DIABETES
CANNOT
BE
IT CAN BE CONTROLLED WITH A COMBINATION OF PROPER
DIET, EXERCISE AND MEDICATION, MONITORED BY URINE TESTING.
This major concept is divjded into three subconcepts per-,
taining
to
urine monitoring,
requirements.
proper
diet
and
medication
Stress is placed on self-management techni-
ques in the control of diabetes.
Subconcept
betic
patient
to
1:
be
Urine
watchful
testing
of
the
enables
degree
of
a
dia-
diabetic
control that is necessary in the management of his disease.
The
in
following
the
aware
four
curriculum
of
the
behavioral
require
importance
the
nurse
that
urine
objectives
participants
testing
listed
to be
has
in
the control of diabetes:
l.
Explain and demonstrate the limited
methods to test urine.
2.
Explain the interpretation of urine
test results.
3.
List and differentiate the advantages
and disadvantages of the four methods
I
I
i
l
to test urine for sugar and acetone.
·····-·~~~--~
47
4.
List and discuss five principles of patient
education regarding urine testing for monitaring diabetic control.
I
I
Subconcept
Meeting
2:
the
basic
nutritional
!requirements of the diabetic patient enables him to lead a
/normal
and
comfortable
I control.
stated
The
in
portance
the
of
life
following
curriculum
the
by
keeping
five
diabetes
behavioral
continue
patient's
his
to
objectives
emphasize
involvement
in
in
his
the
im-
diabetic
condition:
1.
Interpret and demonstrate the use of the
substitution (exchange)
2.
Describe the importance of the substitution (exchange)
3.
system.
system.
Compare the requirements of the carbohydrate, protein, and fat allowances in
a diabetic diet plan in terms of the
amounts and nutritional needs of the body.
4.
Discuss reasons for adjusting the meal
plan for varied situations.
5.
Plan a modified prescribed diabetic diet
according to the patient's needs, by
applying the dietary prescribed regimen.
Subconcept
3:
Since
the
aim of
diabetic
treat-
ment is to permit the patient to live a "normal life style,"
48
r
I
I the
diabetic can effectively administer his own medication.
\The
following
four
behavioral
identified
objectives
Ii n_t_h_e__c_u_r_r_1_·c_u...____l_u_m_a_r_e_r_e_q_u_i_r_e_d--o-f--t-h~e.___n_u_r_s_e_ part ic i pants
I
ito
encourage the diabetic patient to live a normal life:
1.
Describe the action and limitations of
oral drugs.
2.
Discuss the role of insulin in diabetes.
3.
Explain and demonstrate insulin injection
techniques.
4.
I
I
Plan a method for rotating these potential
injection sites on a daily basis.
I
Major
Concept
III:
THE
TREATMENT
OF
DIABETES
'REQUIRES THE PATIENT TO ASSUME AN ACTIVE AND PARTICIPATORY
I
ROLE
IN
PREVENTIVE
MEASURES
REGARDING
HIS/HER
CARE.
The main focus of this major concept is the active involvement of the diabetic patient in preventive factors of diabetes.
Two important topics were chosen and identified in
the following
hypoglycemia
two subconcepts:
and
two major complications--
hyperglycemia--and
special
care
of
the
feet that is needed.
Subconcept 1:
It
is
through
two major complica-
tions--hypoglycemia (insulin shock) and hyperglycemia (dia-
I betic
coma)--that diabetes can do its most damage if not
I treated
quickly
I behavioral
l__ ----
and
adequately.
objectives covered
The
following
three
in the curriculum are aimed
49
1
~t
the~l
the special importance in comparing and contrasting
causes, treatment and principles in preventive measures, for
these two complications, which is required of the learner:
I
1.
I
II
Compare and contrast causes of hypoglycemia and hyperglycemia.
I
2.
Discuss the principles of patient education in preventive measures for hypoglycemia and hyperglycemia.
3.
Describe the treatment of hypoglycemia
and hyperglycemia.
Subconcept
I
2:
Special
care
of
the
feet
is
needed because the circulation and nerve problems associated
with
diabetes
make
the diabetic
infections, and poor healing.
objectives
listed
in
the
prone
to numbness,
foot
The following two behavioral
curriculum
require
the
nurse participants to continue to emphasize the self-care
management of diabetic patients and actively involve them
in preventive measures regarding the care of their feet:
1.
Explain and demonstrate proper foot care.
2.
Discuss the importance of preventive
measures in foot care.
Major
Concept
IV:
SOME
DIABETIC
PATIENTS
ARE
SPECIALLY PRONE TO FEAR THE FUTURE AND ANTICIPATE HARDSHIPS
AND OBSTACLES IN THE WAY OF NORMAL LIFE.
This final major
concept focuses on the psycho-social factors that the diabe-
I
50
One subconcept stresses the importance of self-acceptance
of the diabetic patient in relation to sound mental health.
Subconcept
1:
Self-acceptance
of
the
patient is fundamental to sound mental health.
/two
behavioral
objectives
as
stated
in
diabetic
The following
the
curriculum
lrequire the nurse participants to identify the role of emo-·
tional stress and the adjustment of living patterns of the
diabetic patient:
1.
Identify the role of emotional stress in
diabetes.
2.
Discuss the adjustment of living patterns
of the diabetic patient.
V.
--1
SUMMARY AND CONCLUSIONS
I
Research
studies
from
the
review
of
the
litera-
l
! ture have pointed out that there
planned programs
diabetes
·with
about
it.
with
its
i vague
for
their
teaching
a
faceted
definite
hospitalized
diabetic condition
A patient's
many
is
initial
leaves
impressions· about his disease.
of
patients with
and
how
introduction
problems
need
to
live
to diabetes
him
with
many
As the introduction
may occur in the hospital, the hospital plays a very important role in diabetic education.
Since diabetes mellitus is a complex disease whose
treatment requires many kinds of skills, a multidisciplinary
team approach for the diabetic curriculum project was used.
This approach to teaching involves a medical team with varying professional backgrounds and hospital roles whose expertise and personal abilities will be especially helpful
in
the
teaching-learning
process.
Because
UCLA . Medical
Center has outstanding professionals with these qualifications, it was suggested that the instructional staff include
representatives of the nursing, dietary,
pharmacy and the
medical professions.
Since a diabetic education assessment questionnaire
had been devised for the nurses, it was at first felt that
it
would
not
be
necessary
·-~------------·-···---------------- -----~-----~---
to
.
-~--
51
conduct
an
educational
.
.j
- - - - - - - - - - - - - - - ···-·-------·--·----------·----·---··--·
52
assessment questionnaire for the patients on the adult medical and surgical divisions.
The information obtained from
the questionnaires given to the nurses appeared to be sufficient
to
diabetic
effectively
patients.
teach
self-care
However,
the
management
patients
must not be overlooked as candidates for
with
to
the
diabetes
teaching.
They
too have many unique educational needs regarding their diabetic condition, as was shown by the oral diabetic education assessment questionnaire given to the diabetic patients.
Because
the questionnaire was oral,
illiterate and blind
patients could also be questioned about their basic knowledge of diabetes.
or
secondary
All patients questioned had a primary
diagnosis
of
diabetes;
some
patients
were
mentally alert and knew they had diabetes and some did not.
This oral patient questionnaire was a valuable source of
information
about
how
well
hospitalized
patients
with
diabetes had been informed about living with their diabetic
condition.
It also enabled the author to gain deeper in-
sights into the patient's unique educational needs, which
included
sonal
psycho-social
educational
needs
factors.
were
Many
taken
of
into
these
per-
consideration
as the curriculum was being developed.
The UCLA Medical Center hires a considerable number
of entry level nursing school graduates each year.
betic education curriculum will provide for
The dia-
these nurses,
53
structure and consistency as to what is being taught to the
patient and provide the means for achieving the educational
objectives
of
the
diabetic
program.
The
curriculum
also will identify the essentials for self-care management
of the diabetic patients in a sequential manner to aid in
the teaching-learning process.
BIBLIOGRAPHY
1.
Anonymous, Editorial, "The Need for Patient Education,"
American Journal of Public Health, LXI (July,
1971), 1277-1279.
2.
Anonymous, Readings in Health Education, American
Hospital Association-,-Chicago, Illinois, 1970.
3.
Alston, Kenneth N., "Hospital and Community Join in
Diabetic Education Program," Hospital Topics,
(September, 1970) , 38-40.
4.
Bloom, Arnold, Diabetes Explained, St. Leonardgate,
England: Medical and Technical Publishing Co. LTD.,
1975.
5.
Crabtree, Katherine, "Discharge Planning for the Adult
Diabetic," The Diabetes Educator, I (March, 1975),
20-23.
6.
Engle, Veronica, "Diabetic Teaching: How to Win Your
Patient's Cooperation in His Care," Nursing J..!i..,
(December, 1975) , 17-24.
7.
Etzwiler, Donnell, "Who's Teaching the Diabetic?",
Diabetes, II (1967), 1111-1117.
8.
Feustel, Delycia, "Nursing Students' Knowledge About
Diabetes Mellitus," Nursing Research, XXV (JanuaryFebruary, 1976) , 4-8.
9.
Fodor, John T., and Dalis, GusT., Health Instruction,
Philadelphia: Lea and Febiger, 1971.
10.
Gillum, F. G., and Barsky, A. J., "Diagnosis and
Management of Patient Noncompliance," Journal of
American Medical Association, CX (1974), 1563-1567.
11.
Grissom, Deward K., "Expanding Concepts in Education,"
Proceedingsr Southern Illinois University at Carbondale, (June 25-26, 1974), 7-10.
12.
Hornback, May, "Diabetes Mellitus-The Nurse's Role,"
Nursing Clinics of North America, X (March, 1970)
1-11.
13.
Jernigan, Katherine A., "Diabetic Patients Require
Education and Understanding," Hospitals, XLIV
(November 1, 1972), 77-81.
54
55
i
il4
0
I
/15
0
:i
116
0
I
i
Jl7
0
Lesparre, Michael, "The Patient as Health Student,"
Hospitals, XLIV (March 16 1 1970), 75-80.
Marble, Alexander et al., Eds., Joslin's Diabetes
Mellitus, Philadelphia: Lea and Febiger, 1971.
McCool, Barbara P., "The Hospital: An Educational
System," Hospital Progress, LVI (July, 1975), 67-71.
Miller, Leona, and Goldstein, Jack, "More Efficient
Care of Diabetic Patients in a County Hospital Setting,
New England Journal of Medicine, (June 29, 1972),
1388-1391.
Morrei:w, Lanny E., "Motivating Pa,tients Toward SelfManagement," Education and Management of the Patient
With Diabetes Mellitus, Elkhart, Indiana: Ames;
Company, 1973, 18-26.
Nickerson, Donna, "Teaching the Hospitalized Diabetic,"
American Journal of Nursing, LXXII (May, 1972),
935-938.
Pearson, Clarence E., "Rx: Education for the Patient,"
Proceedings, Southern Illinois University at Carbondale, (June 25-26, 1974), 27-42.
21.
Perks, Jenefer, "Please Nurse, What is Diabetes,"
Times, (November 22, 1913), 1585-1586.
Nursin~
22.
Richards, Ruth F., and Kalmar, Howard, "Patient Education," Health Education Monograph Q, (Spring 1974).
23.
Rosenberg, Stanley S., "A Case for Patient Education,"
Hospital Formulary Management, VI (June, 1971), 8-14.
24.
Salzer, Joan, "Classes to Improve Diabetic Self-Care,"
American Journal of Nursing, VXXV (August, 1975),
1324-1326.
25.
Shaw, JaneS., "New Hospital Commitment:
Teaching
Patients How to Live With Illness and Injury," Modern
Hospital, CXXI (October, 1973), 99-102.
26.
Simonds, Scott K., "Focusing on the Issues," Paper
presented at the Second Institutional Conference on
Health Education in the Hospital, sponsored by the
American Hospital Association, Chicago, (October,
1969)' 2-12.
56
27.
Skiff, Anna W., "Patient Education: A Reality,"
Proceedings, Southern Illinois University at Carbondale, (June 25-26, 1974), 43-47.
i
28.
I
I
Slowie, Linda A., "Patient Learning-Segments from Case
Histories," Journal of the American Diabetic Association, LXI (December 1972), 563-569.
I
29.
Tokuhata, George, Diabetes is People, Pennsylvania:
Pennsylvania Department of Health, Division of
Research and Biostatistics, 1972.
BO.
Watkins, Julia D., et al., "A Study of Diabetic
Patients at Horne," American Journal of Public Health,
XLVII (March, 1967), 452-459.
!
Bl.
I
Wells, H. R., "Care of the Diabetic Patient who Undergoes Emergency Abdominal Surgery," Nursing Clinics of
North America, VI (September, 1968), 533-537.
APPENDIX A
DIABETIC EDUCATION ASSESSMENT QUESTIONNAIRE
FOR REGISTERED NURSES
Instructions:
Place a + for the items that you feel are needed as general
knowledge to effectively teach self-management techniques to 1
diabetic patients.
Place a * for the items that you feel are critically needed,
to effectively teach self-management techniques to diabetic!
patients.
1.
BACKGROUND MATERIAL ON DIABETES:
Definition of diabetes.
Whb gets diabetesr
The development of diabetes.
The search for a cure.
Other topic of your choice _____________________________
Comments-
2.
INSTRUCTIONAL SKILLS FOR THE NURSE TEACHING THE
DIABETIC PATIENT:
Interviewing techniques.
Assessment of a newly diagnosed diabetic.
Assessment of a previously diagnosed diabetic.
How to meet mutual goals.
Evaluative tools.
Teaching techniques.
Other topic of your choice
Comments-----------------------------
3~
VISUAL AIDS AS LEARNING TOOLS FOR THE NURSE:
Trainex filmstrips.
Films.
Dietary food models and charts.
Booklets and handouts from drug companies and/or
American Diabetic Association.
Slides from Diabetic Education Center.
Other topic of your choice ____________________________
Comments-
57
58
4.
VISUAL AIDS AS LEARNING TOOLS FOR THE PATIENT:
Trainex filmstrips.
Dietary food models and charts.
Special dietary information from American Diabetic
Association.
Handouts and booklets from drug companies and/or
American Diabetic Association.
Other topic of your choice _____________________________
Comments-
5.
DIET AND DIABETES:
In-depth discussions on food exchanges.
Nutritionist to cover .this topic.
Basic information.
Other topic of your choice
----------------------------Comments-
6.
INSULIN:
Purpose of insulin.
Sites and techniques of insulin injections.
Proper amounts, including the duration of insulin.
Complications of insulin.
Syringe care, including purchase and care of supplies.
Other topic of your choice
Comments----------------------------
7.
ORAL MEDICATIONS:
Types of oral drugs.
Mode of action.
Treating the diabetic with oral drugs.
Advantages of oral therapy.
Other topic of your choice
----------------------------Comments-
59
8.
URINE TESTING:
Methods of testing.
Reasons for testing.
Times to test.
Interpretation of urine testing.
Purchase and care of supplies.
Other topic of your choice~--------------------------­
Comments-
9.
METABOLISM:
General information on metabolism in the normal and
diabetic patient.
In-depth material on metabolism.
Other topic of your choice _____________________________
Comments-
10. HEALTH CARE POINTERS FOR DIABETIC PATIENTS:
Foot and skin care.
Infections and diabetes.
Importance of balancing diet, exercise and insulin.
Problems of elderly diabetics.
Problems of long-term diabetics.
Management of diabetes in the surgical patient.
Diabetic retinopathy.
Disorders of the nervous system in diabetes.
Emotional and psychosocial aspects of diabetes.
Other topic of your choice
----~----------------------Comments-
11. COMPLICATIONS OF DIABETES:
Hypoglycemia (insulin shock): causes, symptoms and
treatment.
Hyperglycemia (diabetic coma): causes, symptoms and
treatment.
Other topic of your choice
-----------------------------Comments-
60
-!
12. WOULD YOU LIKE AN 11 EDUCATIONAL PRESCRIPTION 11 OR
CHECK-OFF LIST TO EVALUATE PATIENT EDUCATION?
Yes.
No.
Comments-
13. WOULD A 11 DIABETIC GUIDE" FOR THE NURSE, COVERING
THE BASIC TOPICS TO TEACH THE DIABETIC PATIENT BE
HELPFUL TO YOU?
Yes.
No.
Comments-
14. HOW WOULD YOU LIKE DIABETIC TEACHING PRESENTED TO YOU?
Lectures by various speakers.
Lectures with practical application.
Role playing.
Using a 11 Diabetic Guide," booklet for the nurse,
with the basic content material.
Other topic of your choice _________________________
Comments-
15. WHAT TOPICS WOULD YOU LIKE INCLUDED IN THE 11 DIABETIC
GUIDE," BOOKLET FOR THE NURSE"?
(NAME AT LEAST
FIVE ACCORDING TO PRIORITY)
i
61
16. ARE YOU INVOLVED IN DIABETIC TEACHING ON YOUR UNIT?
Yes.
No.
Comments-
17. HOW ARE YOU CONDUCTING DIABETIC TEACHING ON
18. ANY ADDITIONAL COMMENTS:
YOU~
UNIT?
APPENDIX B
DIABETIC EDUCATION ASSESSMENT QUESTIONNAIRE FOR PATIENTS
How long has it been since you were diagnosed as a diabetic?
Years
Months
____ Days
Are you insulin dependent?
Yes
No
_ _Age
Sex
Instructions:
Read each question carefully and all the answers before
you decide.
Circle the most correct answer for each
question.
1.
Diabetes is a disease in which the body:
A.
B.
c.
D.
2.
The insulin which the body produces is chiefly
responsible for:
A.
B.
c.
D.
3.
~
Slowing up the appetite for glucose (sugar).
Helping the body use its glucose (sugar).
Making the digestive juices effective.
I don't know.
Blood relatives of most diabetics:
A.
B.
C.
D.
4.
Does not have enough glucose (sugar) in the blood.
Has too much glucose (sugar) in the blood.
Does not have enough insulin produced by the body.
I don't know.
Inherit diabetes.
Inherit a tendency to get diabetes.
Always get diabetes.
I don't know.
The following problems may happen if diabetes is not
controlled:
A.
B.
C.
D.
Circulation changes, decreased feeling in feet, eye
changes, and/or kidney disease.
.
Emphysema, tuberculosis, and/or arthritis.
Stomach ulcers, rheumatic fever, and/or cancer.
I don't know.
62
63
5.
Diabetes can:
A.
B.
C.
D.
6.
~
The person most responsible for daily control of your
diabetes is:
A.
B.
c.
D.
7.
I
~
A.
B.
c.
Taken as a pill.
Taken by injection only.
Taken by mixing powder in a drink.
I don't know.
Lente and NPH insulin become effective:
A.
B.
C.
D.
9.
Your doctor.
Yourself.
Your family.
I don't know.
Insulin may be:
D.
8.
Be controlled with proper diet, exercise and
medication.
Be completely cured with proper diet, exercise
and medication.
Neither be cured nor controlled.
I don't know.
Quickly and over a long period of time (8-12 hours)
At different rates.
Both A. and B. are correct.
I don't know.
Regular insulin becomes effective:
A. At the same rate as NPH insulin.
B. Quickly and over a short period of time (2 hours).
C. Both A. and B. are correct.
D.
I don't know.
10. Some oral hypoglycemic medicine (medicine taken by
mouth to reduce blood sugar) prescriped for diabetes:
A.
B.
c.
D.
Is taken as oral insulin.
Stimulates the pancreas to secrete more insulin.
Cures diabetes.
I don't know.
64
11. When the diabetic has too much insulin, the complication that results is:
G
A.
B.
c.
D.
Diabetic coma.
Hyperglycemia.
Hypoglycemia.
I don't know.
I
!12. For insulin injections, it is a good idea to:
\7
A.
B.
C.
D.
Use the same place on the body for the injection~.
Rotate the site of the injections.
Place each injection right next to the previous
injection.
I don't know.
13. If a diabetic becomes involved in unexpected exercise
such as a tennis match, he/she should:
A.
B.
c.
D.
Increase his/her food intake by eating something
extra before he/she plays.
Take an extra dose of insulin before he/she plays.
Not do anything out of his/her ordinary routine.
I don't know.
14. Use of the proper amounts of insulin can:
~
A.
B.
c.
D.
Allow a diabetic to eat anything he/she likes.
Cure diabetes.
Control blood sugar.
I don't know.
15. When testing urine for sugar before breakfast, use:
\l
A.
B.
c.
D.
The first urine that you pass upon rising.
The second urine that you pass upon rising.
The urine passed on the previous evening.
I don't know.
16. The reading of one plus (l+) in any urine sugar test
usually means that the urine contains:
\~
A.
B.
c.
D.
Large amounts of sugar.
Small amounts of sugar.
No sugar.
I don't know.
65
r
117.
I
The reading of three plus (3+)
test of a diabetic person is:
in any urine sugar
i
L
I
i 18.
10
A.
B.
C.
D.
good sign.
usual sign that he is in control.
bad sign.
don't know.
It is important for a diabetic person to record the
results of his/her urine tests:
A.
B.
C.
D.
I
A
A
A
I
To help keep track of his/her diabetic control.
To help his/her doctor or clinic plan the right
amount of diet, exercise, and medicine.
Both A. and B. are correct.
I don't know.
19. When a diabetic's urine test is usually negative,
he/she should:
p
A.
B.
c.
D.
20.
Still test before every meal and at bedtime.
Keep testing as often as ordered by his/her doctor.
Test only when he/she suspects some sugar in the
urine.
I don't know.
A diabetic diet is:
A.
B.
C.
A well-balanced diet the whole family can us~.
A planned system of special foods that are not
included in regular diets.
I don't know.
21. Carbohydrates are:
A.
B.
c.
D.
Fats and oils.
Sugars and starches.
Vitamins and minerals.
I don't know.
22. Cottage cheese is a:
A.
B.
C.
D.
Meat exchange.
Fat exchange.
Milk exchange.
I don't know.
66
f
1
23. All foods labelled "Diabetic" are all right for
diabetics to use:
~
A.
B.
c.
True.
False.
I don't know.
24. Which of the following groups of food is considered
free:
A.
B.
C.
D.
Group A vegetables.
Fresh fruits.
Dietetic candies.
I don't know.
25. Some foods do not have to be measured because:
'0
A.
B.
c.
D.
They contain no carbohydrate, but many calories.
They contain very few calories.
They are all fat and have no effect on diabetes.
I don't know.
26. Canned fruit labelled "Diabetic" is fruit prepared:
f
A.
B.
c.
D.
With extra sugar.
Without added sugar, but perhaps with an artificial
sweetner.
In the same way as other canned fruit.
I don't know.
27. A diabetic may go into diabetic acidosis (diabetic
coma) when he/she:
A.
B.
c.
D.
Takes too much insulin and has an infection or
other illness or stress.
Does not take enough insulin and has an infection
or other illness or stress.
Eats too little and has an infection or other
illness or stress.
I don't know.
28. A diabetic may get a low blood sugar reaction (insulin
reaction):
I
~
A.
B.
C.
D.
When he/she eats too much food.
When he/she does not eat enough food, or does not
eat at the proper·time.
·
When he/she does not take insulin on time.
I don't know.
67
29. Some typical symptoms of low blood sugar reaction
(insulin reaction) are:
A.
B.
c.
D.
Lack of appetite, diarrhea, and fever.
Nausea, headache, fever, and drowsiness.
Trembling, irritability, sweating, and hunger.
I don't know.
30. When a diabetic feels any of the symptoms of low blood
sugar reaction (insulin reaction), the first thing
he/she should do is:
/J-
A.
B.
c.
D.
Take fruit juice or a concentrated sweet immediately.
Ask a relative to call for an ambulance.
Drink some black coffee.
I don't know.
31. A diabetic must give special care to his/her feet
because:
(_
A.
B.
c.
D.
A diabetic must walk a great deal.
Tight garters and shoes increase blood circulation
to the feet.
Diabetes may slow blood circulation in the legs
and feet and cause an infection.
I don't know.
32. In caring for his/her feet, an adult diabetic should:
L
A.
B.
c.
D.
Use sharp scissors and razor blade to cut toenails,
corns, and calluses regularly.
Bathe his feet daily in hot water with a strong
i
soap.
Inspect his feet every day and report any irritatio~
or injury to his doctor.
I don't know.
APPENDIX C
ANSWERS TO DIABETIC EDUCATION ASSESSMENT
QUESTIONNAIRE FOR PATIENTS
1.
c.
17.
c.
2.
B.
18.
c.
3.
B.
19.
B.
4.
A.
20.
A.
5.
A.
21.
B'.
6.
B.
22.
A.
7.
B.
23.
B,.
8.
A.
24.
~-
9.
B.
25.
B.
10.
B.
26.
B.
11.
c~
27.
B.
12.
B.
28.
B.
13.
A.
29.
c.
14.
c.
30.
A.
15.
B.
31.
c.
16.
B.
32.
c.
68
I
APPENDIX D
TIME SCHEDULE FOR SUGGESTED IMPLEMENTATION OF DIABETIC CURRICULUM PROGRAM
1.
General Implementation
Activity
()\
\.0
(1) Diabetic Curriculum Workshop
Begin April 4, 1977
Completed April 6, 1977
Begin Oct. 3, 1977
Completed Oct. 5, 1977
(2) Room reservation for workshop
(3) Obtain diabetic literature
from Amer. Diabetic Assoc.
(4) Apply for instructor's guides
from Tran Aide
(5) Meeting with director of
nursing service to implement
curriculum project at UCLA
(6) Memo sent our by director of
nursing service to staff
(7) Nursing assistant directors
and head nurses on adult
medical and surgical floors
.select nurse participants
(8) Development of curriculum
planning committee meeting
-1977Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
(1)
(1)
(2)
(2)
(3)
(3)
( 4)
(4)
(5)
(6)
(6)
(7)
(7)
(8)
(8)
2.
Inservice Education
Activity
(1)
( 2)
(3)
(4)
(5)
Instructional staff to
attend diabetic seminarspreworkshop
Planning meeting for
curriculum development
Individual meeting with
staff M.D.
Guided tour for the nurse
from the Visiting Nurse~
Association
Orientation to Staff
Development Department
-1977Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
( 1)
( 1)
( 2)
(2)
(3)
(3)
. ( 4)
( 4)
( 5)
(5)
-....]
0
3.
Total Evaluation
.Activity
( 1)
(2)
(3)
( 4)
(5)
( 6)
( 7)
( 8)
Diabetic survey questionnaire conducted to establish
baseline data for the curriculum project
Pre-test questionnaire of
curriculum project
Given on April 4, 1977
Given on Oct. 3, 1977
Discussion during curriculum project
Given on April 5, 1977
Given on Oct. 4, 1977
Post-test questionnaire
of curriculum project
Given on April 6, 1977
Given on Oct. 5, 1977
Questionnaire regarding
curriculum project
Given on April 6, 1977
Given on Oct. 5, 1977
Meeting of curriculum
evaluation committee
Evaluative questionnaire
interview of diabetic
patients and their
families
Evaluation questionnaire
sent to nurse participants
-1977Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
(1)
(2)
(2)
(3)
(3)
(4)
(4)
(5)
(5)
(6)
(7)
(7)
(8)
(8)
-...]
t-'
4.
Revision and Updating
Activity
(1) Personal interview with
each instructional staff
member
(2) Evaluative data will be
analyzed by coordinators
(3) Memo sent to head nurses for
list of new nurse participants for the curriculum
workshop and a list of nurses
interested in diabetic teaching
-1977Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
(1)
(1)
(2)
(2)
(3)
(3)
-....1
['...)
APPENDIX E
PRE AND POST TEST FOR DIABETIC CURRICULUM WORKSHOP
Purpose:
To function as a learning tool and to
assist in planning future workshops.
Instructions:
Circle the most correct answer before
and at the end of the workshop.
Before
Workshop
1.
Questions
1.
A.
Diabetes is a disease in which
the body:
A.
B.
B.
c.
c.
D.
D.
2.
2.
A.
B.
B.
c.
c.
D.
D.
3.
A.
B.
c.
c.
4.
4.
A.
B.
c.
c.
B.
c.
D.
2.
A.
B.
c.
D.
3.
True.
False.
I don't know.
Insulin resistance has been
established as the major cause
of diabetes mellitus:
A.
B.
A.
Glucosuria results if too much
glucose builds up in the blood.
Glucosuria may cause polydipsia
and polyuria.
A and B above.
I don't know.
The offspring of two diabetic
parents has a 100% probability
of developing diabetes:
A.
B.
1.
Has insufficient amount of
glucose in the blood.
Has too much insulin.
Has a relative insufficiency
or lack of insulin.
I don't know.
Choose the most correct statement:
A.
3.
After
Workshop
True.
False.
I don't know.
73
A.
B.
c.
4.
A.
B.
c.
74
I
Before
~Workshop
I
'5.
I
I
Questions
5.
A.
B.
B.
c.
c.
D.
D.
6.
I
I
I
I
A.
B.
I
A person with diabetes should:
A.
16.
A.
B.
c.
c.
D.
E.
7.
A.
B.
B.
c.
c.
D.
D.
8.
8.
A.
B.
B.
c.
c.
D.
D.
B.
c.
D.
6.
A.
B.
c.
D.
E.
7.
To help keep track of his/her
diabetic control.
To help his/her physician or
clinic plan the correct amount
of diet, exercise and medicine.
A and B above.
I don't know.
Polyuria is a symptom of diabetes.
This is the result of the body's
attempt:
A.
A.
First voiding.
Penicillin.
Keflex.
Second voided specimen
I don't know.
It is important for a diabetic
person to record the results of
his/her urine tests:
A.
5.
Exercise as much as he/she
desires.
Exercise only if he/she is not
taking diabetic medication.
Follow his/her physician's
advice about how much exercise
he/she should do.
I don't know.
Name two factors that will give
false positive or negative urine
tests:
D.
E.
17.
After
Workshop
To get the glucose to the
body areas that need it.
To replace fluids lost through
the kidneys.
To get rid of the excess
glucose in the body.
I don't know.
A.
B.
c.
D.
8.
A.
B.
c.
D.
75
Before
Workshop
9.
After
Workshop
9.
A.
Some foods don't have to be
measured because:
A.
B.
B.
c.
c.
D.
D.
10.
They contain no carbohydrates,
but many calories.
They contain very few calories.
They are all fat and have no
effect on diabetes.
I don't know.
10. Which of the following groups
of food is considered free:
A.
B.
A.
B.
D.
D.
c.
11.
c.
11.
A.
B.
c.
12.
c.
12.
A.
B.
c.
c.
D.
D.
E.
E'.
13.
A.
B.
D.
D.
c.
c.
D.
10.
A.
B.
c.
D.
11.
A.
B.
c.
12.
Popcorn.
Sherbet.
Peanut butter.
Popsicles.
I don't know.
13. Cottage cheese is a:
A.
B.
B.
c.
True.
False.
I don't know.
Which of the following is not
included in the bread exchange:
A.
B.
A.
Group A vegetables.
Fresh fruits.
Dietetic candies.
I don't know.
All foods labelled "Diabetic" are
all right for diabetics to use:
A.
B.
9•
Meat exchange.
Fat exchange.
Milk exchange.
I don't know.
A.
B.
c.
D.
E.
13.
A.
B.
c.
D.
76
/ Before
Workshop
After
Workshop
14. Persons taking oral hypoglycemic
agents for diabetes:
14.
A.
A.
c.
B.
B.
C.
D.
D.
15.
15.
A.
B.
c.
D.
16.
16.
c.
D.
17.
17.
c.
D.
18.
A.
B.
c.
D.
The insulin dependent diabetic may
respond to excessive exercise
without additional food by:
B.
c.
D.
15.
A.
B.
c.
D.
16.
A.
B.
c.
D.
17.
4 to 6 hours.
18 to 26 hours.
28 to 36 hours.
I don't know.
One unit of U-100 insulin has
the same action in the body as:
A.
B.
C.
D.
A.
Having an insulin reaction.
Developing Keto-acidosis.
Developing a diabetic coma.
I don't know.
The action of NPH or Lente
insulin lasts:
A.
B.
C.
D.
A.
B.
May need to take insulin
later on in life.
Take them all of their lives.
Use them to replace their
natural insulin.
I don't know.
Oral hypoglycemic agents can be
used:
A. By anyone who has diabetes.
B. Only by a diabetic whose
pancreas makes insulin.
C. Only by juvenile diabetics.
D.
I don't know.
A.
B.
C.
D.
A.
B.
14.
10 units of U-40.
1 unit of U-40.
5 units of U-80.
I don't know.
A.
B.
c.
D.
18.
A.
B.
c.
D.
77
I
After
Workshop
Before
Workshop
19.
119.
A.
B.
A.
B.
D.
D.
c.
20.
c.
20.
I
I
When the diabetic has too much
insulin, the complication that
results is:
A.
B.
B.
c.
c.
D.
D.
21.
21.
c.
c.
22.
22.
A.
B.
c.
c.
c.
D.
20.
A.
B.
c.
D.
21.
True.
False.
I don't know.
Hyper.kalemia may occur after
approximately four to six hours
of therapy for diabetic acidosis
and may be a fatal complication.
A.
B.
A.
B.
Call his physician or clinic,
drink liquids without sugar, go
to bed, keep warm, and continue
taking his diabetic medication.
Call his physician or clinic,
drink some orange juice and
keep walking.
Call his physician or clinic,
drink some orange juice and
take some extra diabetic
medication.
I don't know.
Minimal doses of insulin such as
15 units infused intravenously on
an hourly basis may be effective
in the treatment of diabetic
acidosis:
A.
B.
A.
B.
Diabetic coma.
Hyperglycemia.
Hypoglycemia.
I don't know.
When a diabetic is fairly sure
that he has hyperglycemia or
acidosis, he should:
A.
19.
True.
False.
I don't know.
A.
B.
c.
22.
A.
B.
c.
78
I
Before
I
!Workshop
I
123.
After
Workshop
23.
When a diabetic begins to have an
insulin reaction, he should:
A.
B.
A.
B.
c.
C.
D.
D.
24.
24.
A.
B.
c.
C.
D.
D.
25.
25.
A.
B.
B.
c.
C.
D.
E.
D.
E.
26.
A.
A.
B.
B.
C.
D •.
D.
E.
c.
E.
Check their feet every day with
a mirror.
Always wear shoes and socks.
Break in new shoes by wearing
them one to two hours a day.
A., B., and C. above.
I don't know.
C.
D.
A.
B.
c.
D.
25.
Diabetics have bad circulation
which prevents white blood cells
from reaching the germs.
Diabetics have sensory loss which
allows injuries to go unnoticed.
Bacteria grow better in the
tissues of the diabetics because
of the extra sugar.
A. and B. above.
I don't know.
Diabetic patients with neuropathy
should:
A.
B.
24.
When he/she eats too much food.
When he/she does not eat enough
food, or does not eat at the
proper time.
When he/she does not take insulin
on time.
I don't know.
Foot infections occur frequently
in patients with diabetes because:
A.
26.
Immediately take some insulin.
Immediately eat some sugar or
some food with a large amount of
sugar in it.
Immediately drink some salty soup.
I don~t know.
A diabetic may get an insulin
reaction:
A.
B.
23.
A.
B.
c.
D.
E.
26.
A.
B.
c.
D.
E.
79
After
Workshop
Before
Workshop
27.
27.
From the list below, choose the
correct statements about foot and
skin care. There are several
correct answers. Mark all the
choices you think are correct.
A.
A.
B.
B.
c.
C.
D.
D.
E.
E.
F.
G.
F.
G.
H.
H.
I •
I.
J.
J.
K.
L.
K.
L.
M.
M.
i
28.
28.
A.
B.
c.
D.
E.
27.
Bathe daily in lukewarm water
using a mild soap.
Cut off corns or calluses with
a pair of scissors.
Use baby powder on sweaty feet
and skin and moisture lotion
on dry skin.
Use a pumice stone on corns or
calluses.
Wash all cuts and scrapes with
warm water and soap and keep clean.
Take a hot bath every day.
Crossing the legs slows blood
circulation, and elevating the
legs helps increase blood
circulation.
Use a hot water bag or a heating
pad for cold feet.
Soak hard toenails in warm water
before cutting. Then cut straight
across and file the corners smooth
with a nail file.
Use soaks for warming cold feet,
or soak them in warm water.
Cut toenails back at the corners.
Use corn pads, corn removal
liquids, and strong iodine if
needed.
I don't know.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
Each teaching session for a patient 28.
should have:
A.
B.
C.
D.
E.
A behavioral objective.
A different teaching technique.
Unusual visual aids.
A different environment.
I don't know.
A.
B.
c.
D.
E.
80
After
Workshop
Before
Workshop
29.
29.
In working with an individual with
a dependent personality, one
should not:
A.
A.
c.
B.
B.
C.
D.
D.
E.
E.
F.
F.
30.
30.
c.
D.
E.
31.
31.
A.
B.
c.
D.
E.
F.
G.
H.
Attempt to change long-established
patterns of response.
Pay attention to small details.
Be available to the patient by
phone.
Confront the patient with all the
facts of his illness.
Reward the patient for assuming
responsibility.
I don't know.
All of these are common reasons
for failure to comply with the
diabetic regimen except:
A.
B.
C.
D.
E.
A.
B.
Diet.
Frequent eye examination.
Taking medication regularly.
Avoiding extended travel abroad.
Accurate urine testing.
Seeing his podiatrist regularly.
Daily physical activity.
I don't know.
A.
B.
C.
D.
E.
F.
30.
Severe depression.
Dependency conflicts.
Role confusion.
Denial.
I don't know.
The four most important topics
necessary for the newly diagnosed
diabetic are:
A.
B.
C.
D.
E.
F.
G.
H.
29.
A.
B.
c.
D.
E.
31.
A.
B.
c.
D.
E.
F.
G.
H.
APPENDIX F
ANSWERS TO PRE- AND POST-TEST FOR DIABETIC
CURRICULUM WORKSHOP
1.
c.
17.
B.
2.
A.
18.
B.
3.
B.
19.
c.
4.
B.
20.
A.
5.
c.
21.
A.
6.
A. and
22.
A.
7.
c.
23.
B.
8.
c.
24.
B.
9.
B.
25.
D.
10.
A.
26.
D.
11.
B.
27.
A,
12.
c.
13.
A.
28.
A.
14.
A.
29.
A.
15.
B.
30.
c.
16.
A.
31.
A, C, E and G.
c.
I
'·
c,
D, E,
G, I and J.
81
APPENDIX G
DIABETIC WORKSHOP EVALUATION QUESTIONNAIRE
Instructions:
Please complete this form so we may have a better understanding of your needs and know how we can improve the
effectiveness of future workshops.
1.
What was your overall opinion of the workshop?
Good
Fair
Poor
2.
Which topics helped you the most?
3.
Which topics helped you the least?
4.
State specific reasons why some speakers were more
effective than others.
5.
State specific reasons why some speakers were more
ineffective than others?
82
83
6.
Was the length of the workshop adequate?
45 min. lectures
7 hours/day
2 day workshop
too short
too 'long
too short--- too long
too short
too long
Yes
No
adequate ___
adequate
adequate=
7.
Was the room location of the workshop:
Good
Fair
Poor
8.
Were the audio-visual aids pertinent to the general
theme of the workshop? Yes
No
Comments:
9.
Before you attended the workshop, which topics were
least understandable to you?
10. What are your specific suggestions for improvement of
this workshop?
(Including additional topics, timing,
etc.)
APPENDIX H
POST DIABETIC WORKSHOP QUESTIONNAIRE FOR REGISTERED NURSES
Instructions:
Please comment on the following questions as to whether
or not you are teaching or communicating to patients.
(If
yes, briefly state; e.g., through pamplets, etc.
If not,
why not; e.g., lack of time. etc.)
I
1.
Do you thoroughly understand the nature of
diabete~?
Are you identifying diabetic patient needs and using
this information to develop a unique self-management
plan?
3•
Are you demonstrating and teaching the principles
of urine testing as part of your routine care of diabetic patients?
4.
Have you been informing the diabetic patien~ as to the
need of adjusting his meal plan for varied situations?
5.
Do you include a method for rotating potential sites
when you explain and demonstrate the insulin injection
technique?
84
85
Are you informing the diabetic patient of the principles
in preventive measures for hypoglycemia and hyperglycemia?
!
I
I
!
Have you been including proper foot care methods in the
diabetic patient's daily schedule?
I
I
II
I
I
Are you able to reduce emotional stress in the diabetic
patient while attending to his physical needs.
I
I
II
I
APPENDIX I
PATIENT DIABETES EDUCATION EVALUATION QUESTIONNAIRE
How long has it been since you were diagnosed as a
Years
Months
Days ___
I diabetic?
!Are you insulin dependent
Yes
No
I
.I Age___
1
Sex
Last date admitted to UCLA Hospital __________
I Instructions:
1.
Circle as many as apply in your case.
While you were a patient at UCLA Medical Center did
you receive the following areas of instruction?
A.
B.
C.
D.
E.
F.
G.
General information regarding the nature or
physiology of diabetes.
How and when to give yourself medications.
How to test urine for sugar levels.
Planning a diabetic diet.
Caring for your skin and feet.
Complications and problems of diabetes if it is
not controlled.
None of these areas were covered.
Other
------------------------------------------------------
Comments:
2.
If you received diabetic teaching, how was it
presented?
A.
B.
C.
I was given
I was given
teaching by
Nurse spoke
Other
diabetic booklets to read by a nurse.
diabetic booklets with additional
a nurse.
to me at the bedside.
----------------------------------------------------~
Comments:
86
87
3.
Were you given a demonstration and allowed to repeat
the demonstration in the following areas?
A.
B.
C.
D.
Urine testing for sugar levels.
Proper insulin injection technique~
Planning a diabetic diet with the use of exchange
lists.
Proper foot care.
Other
--------------------------------------------------------
Comments:
4.
Did a member of your immediate family or someone
caring for you receive diabetic teaching?
A.
B.
C.
Yes.
No.
I don't know.
Comments:
5.
Did that member of your family or other individual
caring for you find it helpful to learn more about
diabetes?
A.
B.
C.
Yes.
No.
I don't know.
Comments:
6.
How soon after being admitted to the hospital were
you given instructions in diabetic management?
A.
B.
C.
D.
E.
Same day as admitted.
Second day.
Third or fourth day.
Within the first 7 to 10 days after being admitted
No instructions given.
Comments:
88
7.
Do you feel you were started on diabetic selfmanagement:
A.
B.
C.
Too soon after being admitted.
At just about the right time.
Too close to my discharge date.
Comments:
8.
If you received diabetic booklets, did you feel the
material was:
A.
B.
C.
Too technical to understand.
Organized and understandable.
Too simple.
Comments:
9.
Did you receive reading materials such as exchange
lists from a dietitian?
A.
B.
Yes.
No.
Comments:
10.
Did you receive bedside teaching regarding meal
planning from a dietitian?
A.
B.
Yes.
No.
Comments:
11.
If you received bedside teaching, who do you recall
worked with you?
A.
B.
C.
D.
Physician.
Nurse.
Dietitian.
None of the above.
Comments:
89
I
112.
Were all or most of your questions answered to your
satisfaction by:
II
A.
B.
C.
D.
!
Physician.
Nurse.
Dietitian.
None of the above.
Comments:
13.
What is it that you are now doing (or doing differently as a result of the teaching you received?
14.
Do you feel that the teaching you received was related
to your needs?
A.
B.
Yes.
No.
Comments:
APPENDIX J
DIABETIC CURRICULUM
TARGET
POPULATION:
Registered Nurses on the
Adult Medical and Surgical
Divisions at UCLA Medical
Center for the Health
Sciences .
90
91
TABLE OF CONTENTS
CURRICULUM CONCEPTS AND OBJECTIVES
Page
I.
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR
ROLE IN THE MANAGEMENT OF THE DISEASE
Concept 1.
Explain "What is Diahetes," including
the classical symptoms of diabetes
96
2.
Discuss "Who gets Diabetes". .
98
3.
Describe the altered physiology of
the diabetic patient . . . . . . .
100
List and identify the three types of
diabetes . . . . . . .
. . . .
102
l.
4.
Concept 2.
1.
2.
II.
The person with diabetes can
become familiar with diabetes
and how it affects his/her body.
.
.
.
The needs of diabetic patients
are varied and unique to each
individual patient.
Identify individual patient's needs
and life style . . . . . . . . . . .
.
Develop a patient education and
management plan unique to each
patient
. . . . . . . . .
ALTHOUGH DIABETES CANNOT BE CURED, IT CAN BE
CONTROLLED WITH A COMBINATION OF PROPER DIET,
EXERCISE AND MEDICATION, MONITORED BY URINE
TESTING.
Concept 1.
Urine testing enables a diabetic
patient to be aware of the degree
of diabetic control in the management of his disease.
106
109
92
Page
l.
2.
Explain and demonstrate the limited
methods to test .
. 113
Explain the interpretation of urine
test results
. 116
3.
List and differentiate the advantages
and the disadvantages of the four
methods to test urine for sugar and
acetone .
. 118
4.
List and discuss five principles of
patient education regarding urine
testing for monitoring diabetic
control .
..
Concept 2.
. 122
Meeting the basic nutritional
requirements of the diabetic
patient enables him to lead a
normal and comfortable life by
keeping his diabetes in control.
l.
Interpret and demonstrate the use of
the substitution (exchange) system • . 125
2.
Describe the importance of the
substitution (exchange) system
. 128
3.
Compare the requirements of the
carbohydrate, protein, and fat allowances in a diabetic diet plan in terms
of the amounts and nutritional needs
of the body .
. 131
4.
Discuss reasons for adjusting the meal
plan for varied situations
. 134
5.
Plan a modified prescribed diabetic
diet according to the patient's needs,
by applying the dietary prescribed
. 137
regimen • .
Concept 3.
Since the aim of diabetic treatment
is to permit the patient to live a
"normal life style," the diabetic
patient can effectively administer
his own medications.
93
Page
1.
Describe the action and limitations of
oral drugs .
. 141
2.
Discuss the role of insulin in
diabetes • . . . . . . . . • • . . . . . 144
3.
Explain and demonstrate insulin
injection technique . . . .
4.
Plan a method for rotating these
potential injection sites on a daily
basis
III.
. . . . 146
. . . . . . . . . . . . . . . . . 148
THE TREATMENT OF DIABETES REQUIRES THE PATIENT
TO ASSUME AN ACTIVE AND PARTICIPATORY ROLE
IN PREVENTIVE MFASURES REGARDING HIS/HER
CARE.
Concept 1.
1.
2.
3.
Compare and contrast causes of
hypoglycemia and hyperglycemia
. . . 152
Discuss the principles of patient
education in preventive measures for
hypoglycemia and hyperglycemia . .
. 155
Describe the treatment of hypoglycemia
and hyperglycemia
. . .
. . . . 159
Concept 2.
1.
It is through two major
complications - hypoglycemia
(insulin shock) and hyperglycemia (diabetic coma) that
diabetes can do its most damage
if not treated quickly and
adequately.
Special care of the feet is needed
because the circulation and nerve
problems associated with diabetes
make the diabetic prone to numbness, foot infections, and poor
healing.
Explain and demonstrate proper foot
care for diabetic patients . . . . . • . 163
94
Page
2.
IV.
Discuss the importance of preventive
measures in foot care . . . . . . .
166
SOME DIABETIC PATIENTS ARE SPECIALLY PRONE TO
FEAR THE FUTURE AND A."t\JTICIPATE HARDSHIPS AND
OBSTACLES IN THE WAY OF NORMAL LIFE.
Concept 1.
1.
2.
Self acceptance of the diabetic
patient is fundamental to sound
mental health.
Identify the role of emotional stress
in diabetes . • . . . . . . . . . .
169
Discuss the adjustment of living
patterns of the diabetic patient
172
MAJOR CONCEPT 1:
CONCEPT 1:
OBJECTIVES
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
MANAGEMENT OF THE DISEASE
The person with diabetes can become familiar·with diabetes
and how it affects his/her body.
1.
Explain "What is Diabetes," including the classical symptoms
of diabetes.
2~
Discuss "Who Gets Diabetes."
3.
Describe the altered physiology of the diabetic patient.
4.
List and identify the three types of diabetes.
\.0
U1
-------------
---- ---------
HAJOR CONCEPT I:
CONCEPT 1:
OBJECTIVE 1:
Evaluative
Criteria:
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
HANAGEMENT OF THE DISEASE.
The person with diabetes can become familiar with diabetes and
how it affects his/her body.
Following instruction: The student will be able to explain
"What is Diabetes," including the classical symptoms.
(Understanding)
The student will explain the meaning of diabetes including
factors on insulin insufficiency with 100% accuracy and include
the five classical symptoms with 100% accuracy.
SUGGESTED CONTENT OUTLINE
A.
Definition of Diabetes:
- is a chronic hereditary disease
characterized by hyperglycemia (abnormally high level of blood sugar)
due to relative insufficiency or
lack of insulin which leads to abnormalities of the metabolism of
carbohydrates, proteins and fat.
B.
Classical Symptoms of Diabetes:
1.
2.
3.
4.
5.
excessive thirst
increased urination
fatigue
increased hunger
loss of weight
SUGGESTED LEARNING OPPORTUNITIES
Teacher shows film, Diabetes, What You
Don't Know Can Hurt You.
This film is
followed by a question and answer period on the highlights of the film that
pertains to the class discussion to
follow the film.
The teacher will conduct class
discussion on the meaning of diabetes,
stressing factors on insulin insufficiency and the classical symptoms.
Volunteer students will write on the
blackboard either the definition of
diabetes or the classical symptoms.
1..0
0'\
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
The class will participate in correcting the statements on the blackboard
so that all students will be able to
explain the meaning of diabetes including the 5 classical symptoms.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Diabetes, What You Don't Know Can Hurt You.
Company, Elkhard, Indiana.
(loaned free)
2.
Joslin, Elliott P., Diabetic Manual, Philadelphia:
3.
Perks, Jenifer, 11 Please Nurse, What is Diabetes? .. , Nursing Times (November
22, 1973), 1585. Leaflet.
11-minute color film, Ames
Lea and Febiger, 1959.
PATIENT
1.
Sindoni, Anthony M., The Diabetic's Handbook, New York:
1969.
2.
''Understanding Diabetes, .. New York:
pamphlet.
Ronald Press Co.,
Pfizer Laboratories Division, 1972 -
1..0
-..J
------------- ---------- --- ---------
HAJOR CONCEPT I:
CONCEPT 1:
OBJECTIVE 2:
Evaluative
Criteria:
THE PERSON WITH DIABETES CAN ACCEPT A HAJO.R ROLE IN THE
HANAGEHENT OF THE DISEASE.
The person with diabetes can become familiar with diabetes and
how it affects his/her body.
Following instruction:
The student will be able to discuss "Who
Gets Diabetes."
(Understanding)
The student will include at least
two factors in diabetes
susceptibility, such as the type of persons who get diabetes
and the predisposing factors, in her discussion.
SUGGESTED CONTENT OUTLINE
A.
Factors in Diabetes Susceptibility
1.
Females are more susceptible
than men.
2.
Overweight persons.
3.
Heredity is a predisposing
factor.
4.
Certain disturbances of the
endocrine glands.
5.
Victims of disease and various
infections which produce great
stress and shock.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will use the blackboard in
this class discussion. A content outline with significant points will be
put on the blackboard.
The content
outline will be as follows:
1.
Females
2.
Oven1eight persons
3.
Heredity
4.
Disturbances of endocrine
glands
5.
Victims of disease and infections that produce great stress
1.0
00
SUGGESTED CONTENT OUTLINE
6.
SUGGESTED LEARNING OPPORTUNITIES
Pregnancy for some
individuals.
6.
Pregnancy
The teacher will then obtain volunteer
responses from the class to elaborate
on these factors as each point of the
outline is covered.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Danowski, T. S., Diabetes as a Way of Life, New York:
1970.
Coward-McCann, Inc.,
2.
Dolger, H. and B. Seeman, How to Live With Diabetes, New York:
1975.
Pyramid,
PATIENT
1.
"Diabetes," New York:
Health Series, 1973.
Prudential Insurance Company of America, Prudential
2.
Sindone, Anthony M., The Diabetic's Handbook, New York:
1959.
Ronald Press Co.,
1..0
1..0
----
-·-
··------- ---·--··---------- ------------------ ·----------- --------
MAJOR CONCEPT I:
CONCEPT 1:
OBJECTIVE 3:
Evaluative
Criteria:
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
MANAGEMENT OF THE DISEASE.
The person with diabetes can become familiar with diabetes and
how it affects his/her body.
Following instruction: The student will be able to describe the
altered physiology of the diabetic patient.
(Understanding)
The student will include at least three points on the disorders
of carbohydrate metabolism, such as insulin release, ketone bodies
in the circulation and the absence of sufficient insulin.
SUGGESTED CONTENT OUTLINE
A.
Altered Physiology - Disorders of
Carbohydrate Metabolism.
1.
In diabetes, insulin release
is not proportional to portal
vein blood sugar levels for
the following reasons:
a.
Insufficient numbers of
islet cells (juvenile
diabetes.
b.
Delayed release (adultonset diabetes).
c.
Excessive inactivation by
chemical inhibitors.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will show
hydrate metabolism of
tients. These slides
selected from medical
slides will accompany
slides on carbodiabetic pawere specifically
journals.
The
the lecture.
There will be a question and answer
period following the slides and lecture,
to clarify the complex sections of the
presentation.
A handout, "Disorders of Carbohydrate
Metabolism in Diabetes Mellitus," will
be given to each student at the completion of the class.
I-'
0
0
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
2.
Excess ketone bodies appears in the
circulation, causing acidosis.
3.
In the absence of sufficient or
effective insulin, partial compensation is achieved by increasing
the blood sugar.
4.
Attempts by the body to compensate
for the acidosis results in hyperventilation and the loss of sodium,
potassium, chloride and water.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Bondy, Phillip K., Disorders of Carbohydrate Metabolism in Diabetes
Mellitus, Philadephia, W. B. Saunders, Co., 1969. -class handout.
2.
Joslin, Elliott P., Diabetic Manual, Philadelphia:
Lea and Fabiger, 1959.
PATIENT
1.
Cholesterol and Other Blood Fats in Diabetes, New York:
Assoc., Inc., 1972 - pamphlet.
2.
The Beta Cell, New York:
--·----
American Diabetes
American Diabetes Assoc., Inc., 1972, -pamphlet.
-------- ·-· -··------··
1-'
0
1-'
MAJOR CONCEPT I:
CONCEPT 1:
OBJECTIVE 4:
Evaluative
Criteria:
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
MANAGEMENT OF THE DISEASE.
The person with diabetes can become familiar with diabetes and
how it affects his/her body.
Following instruction: The student \<Till be able to list and
identify the three types of diabetes.
(Recall)
The student will list three types of diabetes with 100% accuracy
and will identify the three types of diabetes including at least
two factors such as the onset of occurrence and physiological
aspect for each type of diabetes.
SUGGESTED CONTENT OUTLINE
A.
Types of Diabetes
1.
2.
Growth-onset (Juvenile type)
a.
usually begins in childhood
but may occur at any age
b.
Onset abrupt
c.
more prone to ketoacidosis
and is dependent upon insulin
Maturity-onset (Adult diabetes)
a.
usually occurs after 40
_____________________ _ __
SUGGESTED LEARNING OPPORTUNITIES
The teacher will use the overhead
projector with her transparencies to
accompany the class discussion.
The
transparencies will outline and familiarize the students with the three
types of diabetes: growth onset,
maturity onset, and non-hereditary.
The students will then be asked by the
teacher if they can identify these
types of diabetes with the diabetic
patients that they have cared for in
the hospital.
They will also be
required to list some factors as
stated in the class discussion to
substantiate their selecting that
. ____ t::Y:P.e_ ~~ __di_9-_e_et_e~------- ----------------·· _______..
f-J
0
N
SUGGESTED CONTENT OUTLINE
3.
SUGGESTED LEARNING OPPORTUNITIES
b.
usually retains a capacity £or
endogenous insulin production
c.
not usually
d.
control can be achieved if
treatment is well planned and
patient cooperative
ketosis~prone
Nonhereditary
a.
damage to or removal of
pancreatic islet tissue - tumors
of pancreas, pancreatitis
b.
disorders of endocrine glands
other than pancreas - pituitary,
adrenal & thyroid disorders
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Brunner, L. S. and B. Suddarth, The Lippincott Manual of Nursing Practice,
Philadelphia: Lippincott Co., 1974.
2.
Meadows, Dorothy, "Patients Learn About Diabetes," Readings in Health
Education, Chicago, American Hospital Association, 1969.
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----------------- ------------------·-·--
SUGGESTED RESOURCES
PATIENT
1.
"The Diagnosis of Diabetes," Michigan:
Upjohn Co., 1969.- booklet.
2.
Dolger, H. and Seeman, B., How to Live With Diabetes, New York,
Pyramid Communications, Inc., 1975.
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I
~~
MAJOR CONCEPT I:
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
OF THE DISEASE.
~ffiNAGEMENT
CONCEPT 2:
OBJECTIVES:
The needs of diabetic patients are varied and unique to each
individual patient.
l.
Identify individual patient's needs and life style.
2.
Develop a patient education and management plan unique
to each patient.
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MAJOR CONCEPT I:
THE PERSON WITH DIABETES CAN ACCE.PT A MAJOR ROLE IN THE
MANAGEMENT OF THE DISEASE.
CONCEPT 2:
The needs of diabetic patierits are varied and unique to each
individual patient.
OBJECTIVE 1:
Following instruction: The student will be able to identify
individual patient's needs and life style.
(Analysis)
Evaluative
Criteria:
The nurse will include at least three factors, such as assessing
the patient's knowledge of the disease, priority of disease in
life situation and their psychological ability to cope with the
disease, in order to identify the diabetic patient's needs and
life style.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED CONTENT OUTLINE
A.
The teacher will conduct a brief
lecture on the handout, "Nursing
Assessment in Planning Care for a
Diabetic Patient."
Needs assessment factors
l.
2.
Assess patient's knowledge of
disease:
a.
family experience with diabetes
b.
current level of knowledge of
disease
c.
knowledge of diet
Assess patient's concerns about
diabetes:
Then the students will participate in
role playing to show the interaction
between the diabetic patient and the
nurse in the hospital setting on the
day of admission. The nurse will
portray interviewing techniques to
obtain a patient needs assessment to
determine the patient's current knowledge about diabetes and his concerns.
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SUGGESTED CONTENT OUTLINE
3.
4.
a.
raction to initial diagnosis,
i.e., rejection, fright,
passivity
b.
priority of disease in life
situation
Assess current living factors:
a.
responsibility for care, self
and others
b.
financial state
The diabetic patient portrays verbally
and non-verbally his anxiety during
the interview, questioning the nurse
as the need arises.
This will be followed by a class
discussion on the learning principles
of a needs assessment accomplished by
this role playing.
Assess psychological ability to
deal with disease - evaluate and
identify:
a.
5.
SUGGESTED LEARNING OPPORTUNITIES
psychosocial factors
Assess patient to determine
appropriate educational program:
a.
educationa level
b.
vision
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SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Etzwiler, D. D., Education and Management of the Patient with Diabetes
Mellitus, Indiana: Ames Company, 1973.
2.
Huang, Sheila, "Nursing Assessment in Planning Care for a Diabetic Patient,"
Nursing Clinics of North America (March 1971) 135-139. - class handout
3.
Schumann, D., "Assessing the Diabetic," Nursing 7fi (March, 1976), 62-67.
4.
Tokuhata, P. H., Diabetes is People, Pennsylvania:
October 15, 1972.
PATIENT
1.
"Guide for the Diabetic," Indiana:
2.
"You and Diabetes," Michigan:
Eli Lily
&
Co., 1971. - pamphlet
Upjohn, 1971 - booklet
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I>:IAJOR CONCEPT I:
CONCEPT 2:
OBJECTIVE 2:
Evaluative
Criteria:
- - ----------
THE PERSON WITH DIABETES CAN ACCEPT A MAJOR ROLE IN THE
MANAGEMENT OF THE DISEASE.
The needs of diabetic patients are varied and unique to each
individual patient.
Following instruction:
The student will be able to develop a
patient education/management plan unique to each patient.
(Synthesis)
The nurse will include at least three points such as the patient
must have an understanding of the disease, the necessity of control of the disease and general concepts of self-management, when
developing a patient education/management plan unique to the
patient's needs.
SUGGESTED CONTENT OUTLINE
A.
-· - ·------·- -
Factors to be considered in education/
management plan
1.
Necessity of control in order to
lead an active and relatively
normal life.
2.
Introduce to patient what he will
need to know about diabetes include that his understanding of
condition will help him care for
self.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will give each student the
following handouts:
a case history of
a diabetic patient and a diabetic
assessment check-list care plan that is
currently being used on the adult medical and surgical divisions.
This will
be accompanied by a brief class dis~us­
sion.
Then the students will be placed in 4
small groups consisting of five persons
in each group.
Each group selects
their own chairman.
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SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED CONTENT OUTLINE
3.
Select education aids suited to
individual needs reading level,
etc.
4.
Explain diabetes.
5.
General concepts of management
regarding urine, diet, drugs
and exercise.
6.
Include publications of interest.
7.
Include where to seek assistance
in solving problems.
With this case history and "check list"
as a guide each group will be responsible for developing an education and
management plan unique to this patient.
The teacher will circulate between the
groups as a consultant.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Engle, V., "Diabetic Teaching," Nursing 75 (Decemher 1975), 17-24.
2.
Ralli, Elaine, Management of the Diabetic Patient, New York:
Sons, 1971.
3.
Reader, George, "Developing Patient's Knowledge of Health," Hospitals (March
1973) 1 111-115.
4.
Watkins, Julia D., "Confusion in The Management of Diabetes," American
Journal of Nursing (March 1970), 521-525.
G. P. Putnam's
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SUGGESTED RESOURCES
PATIENT
l.
Bierman, J., and B. Toohey, The Diabetic Question and Answer Book, Los
Angeles: Sherbourne Press, Inc., 1974.
2.
"Guide to Self Care in Diabetes," Nebraska:
Program, 1971. - pamphlet
Nebraska Regional Hedical
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MAJOR CONCEPT II:
CONCEPT l:
OBJECTIVES':
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Urine testing enables a diabetic patient to be aware of the degree
of diabetic control in the management of his disease.
l.
Explain and demonstrate the Clinitest method to test urine
for sugar and acetone.
2.
Explain the interpretation of urine test results.
3.
List and differentiate the advantages with the disadvantages
between four methods to test urine for sugar and acetone.
4.
List and discuss four principles of patient education
regarding urine testing for monitoring diabetic control.
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MAJOR CONCEPT II:
CONCEPT 1:
OBJECTIVE 1:
Evaluative
Criteria:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Urine testing enables a diabetic patient to be aware of the degree
of diabetic control in the management of his disease.
Following instruction: The student will be able to explain and
demonstrate the Clinitest method to test urine for sugar and
acetone.
(Understanding and Practice Objective)
The student will explain the steps of the Clinitest method and
demonstrate while she is explaining with 100% accuracy.
SUGGESTED CONTENT OUTLINE
A.
Steps to be followed in Clinitest
Method of Testing Urine:
NOTE: It is done with reagent tablets
in a miniature test tube provided in the Clinitest Sugar
~~alysis Set.
1.
Collect urine in clean receptacle.
With dropper in upright position,
place 5 drops of urine in test
tube.
Rinse dropper and add 10
drops water.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will show the filmstrip
Urine Testing, using the record which
explains the urine procedure. This
filmstrip will be followed by a brief
question and answer class discussion.
One student will be selected to
demonstrate this procedure to the
class. The student will explain while
performing the complete procedure.
The class will gather in a circle
around her in order to see the tablets,
test tube, etc.
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SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
2.
Drop 1 tablet into test tube.
Watch while reaction takes place.
Do not shake test tube during
reaction nor for 15 seconds after
the boiling inside test tube has
stopped.
3.
After 15 seconds waiting period,
shake test tube and compare with
Clinitest color chart.
Each student will be required to repeat
this demonstration and explanation.
Interpretation of Color Chart
Negative
no sugar - color is
blue.
Positive - sugar present - color
changes to green, tan,
orange.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Urine Testing, filmstrip with record, Trainex Corp., Garden Grove,
California.
2.
Rosenthal, H., Diabetic Care in Pictures, Philadelphia:
Co., 1968.
J. B. Lippincott
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SUGGESTED RESOURCES
PATIENT
1.
"Guide to Urine Testing at Home," Michigan:
2.
"Pitfalls of Urine Testing," New York, American Diabetic Assoc., ADA
Forecast, 1970. - leaflet.
3.
"Urine Test Record," New York:
leaflet.
Upjohn Co., 1971.- booklet.
Pfizer, Inc., 1972 - urine test record
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- · - · - - - - - - - - - - - - - · - · - - · · - - - - · · - - - - - - - · ---·---
Vl
~~JOR
CONCEPT II:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
CONCEPT 1:
Urine testing enables a diabetic patient to be aware of the
degree of diabetic control in the managerr~nt of his disease.
OBJECTIVE 2:
Evaluative
Criteria:
Following instruction:
The student will be able to explain the
interpretation of urine test results.
(Understanding)
The nurses will include at least two factors such as the
importance of using the urine results to readjust the diabetic's
diet, and readjustment of drugs the patient is taking.
SUGGESTED CONTENT OUTLINE
A.
SUGGESTED LEARNING OPPORTUNITIES
Urine Test Results as Guide for
Treatment
1.
Results will indicate the need
for redistribution of food in
the diet.
2.
Results will provide for the
readjustment of the dosage of
insulin or oral drugs as necessary.
3.
Result during course of certain
complications, especially acute
infections and gastro-intestinal
upsets (vomiting and diarrhea)
are extremely important because
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~----·--
--·~--
- --·-·
The teacher will give each student a
"Urine Test Record Guide."
Then a lecture discussion will begin
on the use of this urine record guide,
such as:
using this guide to readjust
the insulin dosage or oral drugs as
indicated; using this guide in the
course of illness; during travel, etc.
This will be followed by a brief
question and answer period.
The student will then be required to
give examples of urine results in the
urine test record, so they will be
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SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
the control of diabetes is often
disrupted during these times.
4.
able to explain the use of the guide
for treatment of the diabetic patient.
Results during varying circumstances such as travel require
special monitoring because the
body requires more or less insulin
depending on the circumstances.
SUGGESTED RESOURCES
TEACHER-STUDENT
L
Eastman, David G., "Managing the Adult Diabetic," The Journal of Practical
Medicine: Patient Care (June 1, 1975), 16-49.
2.
Etzwiler, Donnell D., Education and Management of the Patient with Diabetes
Mellitus, Indiana: Ames Company, 1973.
3.
"Urine Test Record," New York:
Pfizer, Inc. , 19 72. - leaflet, class handout.
PATIENT
1.
''Care of Diabetes During the Stress of Injury, Surgery or Illness,"
pamphlet, reprinted from ADA Forecast, New York: American Diabetic Assoc.
2.
"Toward Good Control," Indiana:
diabetic.
Ames Co., 1973. - a guidebook for the
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-....]
MAJOR CONCEPT II:
CONCEPT 1:
OBJECTIVE 3:
Evaluative
Criteria:
~~THOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Urine testing enables a diabetic patient to be aware of the
degree of diabetic control in the management of his disease.
Following instruction: The student will list and differentiate
the advantages with the disadvantages between four methods to
test urine for sugar and acetone.
(Recall and Analysis)
The student will list at least three methods to test urine and
include one advantage and two disadvantages for each of the three
methods in her comparison.
SUGGESTED CONTENT OUTLINE
A.
Urine Testing Methods
1.
Advantages - accurate quantitative
measure of urine sugar.
2.
Disadvantages a.
Measures all kinds of sugars
excreted - not just glucose.
b.
Process somewhat involved
drops of urine, water, use
of tubes, etc.
c.
Tablets can degenerate.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will write on the blackboard four methods to test urine.
During class discussion advantages and
disadvantages will be highlighted.
The teacher will then ask for 4 students to role play being a diabetic
patient.
Each student will select a
method and state their reasons for
choosing it, comparing the advantages
with the disadvantages.
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SUGGESTED CONTENT OUTLINE
d.
B.
C.
Action of tablets interfered
with by large amounts of
Vitamin C, aspirin, some
antibiotics.
SUGGESTED LEABNING OPPORTUNITIES
The teacher will ask one volunteer
student to list these methods on the
blackboard including the advantages
and disadvantages as the students
give their reasons.
Clinstix, Testape Method
1.
Advantages - easy to use away
from home.
2.
Disadvantages a.
Clinistix: less specific
measure of urine glucose
(3 values).
b.
Testape: color gradations
may be hard to evaluate;
substances on fingers can
give false readings.
Ketodiastix Method
(Similar to Clinitest, but also
tests for acetone)
l.
Advantages - Easy method of
testing both sugar and acetone
in 30 seconds.
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SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED CONTENT OUTLINE
2.
D.
Disadvantages - High amounts of
acetone, if present, interfere
with correct reading on sugar
part of stick.
·
Ketostix (Acetest tablets) Method
1.
2.
Advantages a.
Easy to use.
b.
High amounts of acetone don't
interfere with sugar reading.
Disadvantages
a.
Tablets can degenerate.
b.
Requires dropper, dry place,
etc.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Dube, A. H., ''Diabetes Teaching Manual for Patient's and Hospital
Personnel,'' New York State Journal Medicine (March 1969), 1169-83.
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SUGGESTED RESOURCES
2.
Bloom, Arnold, Diabetes Explained, New York:
Publishing Compnay, 1975.
Medical and Technical
PATIENT
1.
Wilder, Russell, A Primer for Diabetic Patients, Philadelphia:
Saunders, 1970.
W. B.
2.
''In Diabetes Good Timing- Goes Hand in Hand with Good Control," Elkhart,
Indiana: 1970 - pamphlet.
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MAJOR CONCEPT II:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDIATION, MONITORED
BY URINE TESTING.
CONCEPT 1:
Urine testing enables a diabetic patient to be aware of the
degree of diabetic control in the management of his disease.
OBJECTIVE 4:
Following instruction:
The student will be able to list and
discuss five principles of patient education regarding urine
testing for monitoring diabetic control.
(Recall and Understanding)
Evaluative
Criteria:
The student will list five principles stated in class with 100%
accuracy and include at least 3 factors pertaining to these five
principles in her discussion on patient education in urine testing.
SUGGESTED CONTENT OUTLINE
A.
Principles to be Stressed 1n
Urine Testing
1.
Test urine for both sugar and
acetone at each testing.
2.
Test urine upon arising, before
lunch, in late afternoon and at
bedtime while control is being
attained or during periods of
illness.
3.
Test urine at least. once daily
during periods of good control.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will have a class
discussion on the principles to be
stressed in urine testing, such as:
test urine once a day during periods
of good control and test only freshly
voided specimen.
The class will form in 4 small groups
consisting of 5 students in each group.
Each group will list and discuss the
principles in urine testing.
By having
small groups, each student will be able
to participate in the discussion,
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SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
4.
Test only freshly voided urine.
5.
Keep a daily record of urine
sugar tests (date, hour, color
reaction) .
6.
Know that acetone in the urine ~
indicates need for more(urine •• ~(
7.
Take record of urine tests to
physician at appointed times.
offering their suggestions when
necessary.
After the small group discussions,
each group will share their findings
with the class.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Danowski, T. s., "Strict Control for the Diabetic, or, Let Him Spill a
Little Sugar," Journal of Practical Family Medicine (March 15, 1970), 80-89.
2.
Horwitz, Nathan, "Sugar Control-Important to Survival of Diabetic Patients,"
Medical Tribune and Medical News (November 12, 1975), 4-8.
PATIENT
1.
"Toward Good Control," Indiana:
Diabetic.
Ames Co., 1973 -A Guidebook for the
2.
"Urine Testing- Its Methods and Its Importance," New York:
Assoc., American Diabetic Reprint, 1970. -leaflet.
American Diabetic
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MAJOR CONCEPT II:
CONCEPT 2:
OBJECTIVES:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
1.
Interpret and demonstrate the use of the substitution
(exchange) system.
2.
Describe the importance of the substitution (exchange) system.
3.
Compare the requirements of the carbohydrate, protein and fat
allowances in a diab.etic diet plan in terms of the amounts
and nutritional needs of the body.
4.
Discuss the reasons for adjusting the meal plan for varied
situations.
5.
Plan a modified prescribed diabetic diet according to the
patient's needs, by applying the dietary prescribed regimen.
--·--------~---
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MAJOR CONCEPT II:
CONCEPT 2:
OBJECTIVE 1:
Evaluative
Criteria:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DJET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
Following instruction: The student will be able to interpret and
demonstrate the use of the Substitution (exchange)
The student will demonstrate the use of the Substitution System
and interpret at least three substitution lists, iuch as meat,
milk and vegetable substitution lists.
SUGGESTED CONTENT OUTLINE
A.
Interpretation of Substitution System
1.
2.
Example: Doctor prescribes a
180 0 calorie diet, which ·calls for
a total daily food allowance of
Milk Substitutions (4 subs), Vegetable Substitutions (any amount),
Fruit Substitutions (3 subs), Bread
Substitutions (6 subs), Meat Substitutions (5 subs), Fat Substitutions
( 3 subs) .
Example: If breakfast calls for
one Fruit Substitution - have
choice of 32 items.
SUGGESTED LEARNING OPPORTUNITIES
The teacher will show the filmstrip,
Diabetic Meal Planning with the record
which explains the 6 substitution
lists and how they are applied in meal
planning.
This will be followed by a
brief question and answer class
discussion.
The teacher will then give each
student a booklet entitled, "Meal
Planning With Exchange Lists," published by the American Diabetic Association.
The teacher will demonstrate
how to use the exchange lists from
the booklet and apply it to meal
planning.
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SUGGESTED CONTENT OUTLINE
3.
4.
SUGGESTED LEARNING OPPORTUNITIES
Example: Diet calls for
Meat
Substitutions - this gives a choice
of a 3 oz. portion roast chicken
or beef, 3 oz. portion broiled fish
or liver, 2 small lamb chops, a
larger 3-egg omelet or many equivalent possibilities of equivalent
nutrition.
Example: Lunch may be allowed 2
Bread Substitutions on this diet could skip uninteresting 2 slices
of bread and select instead 2 in.
diameter muffins or 2 1-1/4 in.
cornbread cubes, or baked potato,
an ear of corn or a cup of cooked
rice.
The students, by having participated
in the question and answer discussion,
will be able to interpret the use of
the exchange lists to prepare foods
for diabetic patients.
The students will then do a return
demonstration by using the food exchange lists from the booklet to
select foods in proper serving sizes.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Diabetic Meal Planning, 10-min. filmstrip with record.
Garden Grove, CA.
2.
"Diabetics Need to Know More About Diet," Hospitals (November 16, 1968),
91-96.
Trainex Corporation,
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SUGGESTED RESOURCES
3.
"Meal Planning With Exchange Lists," New York:
February, 1975 - class handout.
American Diabetic Assoc.,
PATIENT
1.
"Exchange List- Calorie Control," New York: American Diabetic Assoc.,
Southern California Affiliate, Inc., 1975. -booklet.
2.
"The Foods You Eat," New York:
Pfizer, Inc., January 1972- pamphlet.
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'MAJOR CONCEPT II:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
CONCEPT 2:
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
OBJECTIVE 2:
Following instruction: The student will be able to describe the
importance of the Substitution (Exchange) System.
(Understanding)
Evaluative
Criteria:
The student will include at least two reasons as to the importance
of the substitution system which involves the six basic food
groups.described in class.
SUGGESTED CONTENT OUTLINE
i
A.
SUGGESTED LEARNING OPPORTUNITIES
Substitution System
l.
2.
Any of the meal plans doctor
prescribes may be coordinated with
this system. In this system of 6
basic food substitution lists, an
infinite variety of foods is available to make the menu interesting
and adequate for the patient needs.
Reason these 6 categories are
called substitution lists - any
food on each list can be substituted
for· any other food on the same list.
----
---
.
~
~-·---
The teacher will lecture about the 6
basic food substitution lists.
The
teacher will then give each student
exchange lists for the class to review
if they are adequate for the patient's
dietary needs. The following exchange
lists will be given to the students:
l.
"Exchange List for McDonald's,"
published by the American Diabetic
Association.
2.
"Food Values for Passover Dishes,"
published by the American Diabetic
Association.
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SUGGESTED CONTENT OUTLINE
3.
4.
SUGGESTED LEARNING OPPORTUNITIES
System based on the following
basic principle - each list provides
approximately the equivalent food
value (carbohydrate, protein or fat)
as any other food on the same list.
Cannot go from one list to another
in making substitutions.
3.
"Meal Planning with Exchange Lists,"
published by the American Dietetic
Association.
Then the class will be divided into 4
small group buzz sessions, consisting
of 5 members in each group, to discuss
these exchange lists.
Six Basic Food Substitution Lists
a.
b.
c.
d.
e.
f.
Milk Substitutions
Vegetable Substitutions A&B
Fruit Substitutions
Bread Substitutions
Meat Substitutions
Fat Substitutions
SUGGESTED RESOURCES
, TEACHER-STUDENT
l.
"Exchange List for McDonald's," ADA Southern California Affiliate, Inc.,
19 75.
(exchange list) - class handout.
2.
"Expanded Food Exchange List," New York:
February, 1975.
American Diabetic Association,
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SUGGESTED RESOURCES
3.
"Food Values for Passover Dishes," ADA, Southern California Affiliate, Inc.,
1970. - class handout.
4.
"Meal Planning With Exchange Lists," Chicago:
1970 (exchange list) - class handout.
American Dietetic Association,
PATIENT
---.---·
1.
Kaufman, W. J., Sugar-Free Cookbook, New York:
2.
Donahue, Virginia, "Diabetic Cooking Made Easy," Minneapolis:
For Health, Inc., (paperback at $1.00).
- - - -·-- ---
------
-------------~
-------
---------.- ---- . ------
-----
-----
Doubleday & Co., 1966.
Education
----------------------------
- - - ----- ---··-· ------
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MAJOR CONCEPT II:
CONCEPT 2:
OBJECTIVE 2:
Evaluative
Criteria:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
Following instruction:
Compare the requirements of the
carbohydrate, protein and fat allowances in a diabetic diet plan
in terms of the amounts and nutritional needs of the body.
(Evaluation)
The student will include at least two factors pertaining to the
require~ent of carbohydrates, proteins and fats in a diabetic diet
plan by establishing criteria for them in terms of the required
amounts and nutritional needs of the body in her comparison.
SELECTED CONTENT OUTLINE
A.
Carbohydrates:
Requirements
Amount & Need
Carbohydrate is the food that is most
important to regulate in diabetes.
Now generally agreed that the diabetic
taking insulin must have a minimum of
180 grams a day and as much as 300
grams may be necessary for a young
man doing very heavy work.
SELECTED LEARNING OPPORTUNITIES
The teacher will display a postercollage showing the three food groups,
carbohydrates, proteins, and fats,
with criteria stated ·as to the amounts
and the nutritional need requirements
of the body.
The teacher will use this postercollage in her class discussion to
point out the amounts and needs of
the body.
-"----~~--------------
.
- - - ·--
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SELECTED CONTENT OUTLINE
B.
Fat:
Amount & Need Requirements
The fat prescription in the diabetic
diet is usually with normal limits.
Daily allowance of fat depends upon
both the activity and the weight of
the patient.
Fat contributes over
twice as many calories per gram as
carbohydrate and protein, the Rx
must not exceed the amount prescribed. Amount for men - (moderate
exercise) 105-140 grams.
Amount for women - 58-87 grams.
C.
Protein:
SELF.CTED LEARNING OPPORTUNITIES
Students will be divided into four
groups consisting of 5 persons in
each group to establish the amounts
and nutritional needs of the patient
in a diet plan.
Amount & Need Requirements
Protein is a valuable but expensive
form of food and there is no reason for
the diabetic diet to contain more or
less than that normally eaten.
In
adults, a recommended minimum of 1 gram
of protein daily for each kilogram of
ideal body weight is regarded as satisfactory.
In practice, this means about
75-85 grams of protein a day.
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SELECTED RESOURCES
TEACHER-STUDENT
1.
Bloom, Arnold, Diabetes Explained, New York:
Publishing Co., 1975.
Mitchell & Technical
2.
Mitchell, H. s., et al., Cooper's Nutrition in Health & Disease, Philadelphia:
J. B. Lippincott Co.-,-1968.
PATIENT
1.
"Composition of Food," Superintendent of Documents, U. S. Printing Office,
Washington, D. C.
20402 (paperback at $1.50).
2.
"Protein: Its Nature and Its Importance," New York:
Association, ADA Forecast, 1966 - leaflet.
------··-·-·-·- ---··-·----·---·------·-------
.American Diabetic
--------------··---- ·---
---- --------.-
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MAJOR CONCEPT II:
CONCEPT 2:
OBJECTIVE 4:
Evaluative
Criteria:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND ~lliDICATION, MONITORED
BY URINE TESTING.
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
Following instruction: The student will be able to discuss the
reasons for adjusting the meal plan for varied situations.
(Understanding)
Discussion will include four factors pertaining to altered
activities requiring food adjustment to meet these situations.
SUGGESTED CONTENT OUTLINE
A.
Varied situations when food adjustment
is needed.
1.
2.
3.
4.
5.
Travel
Restaurant
School
Office
When activity increases or
decreases, i.e.,
- on weekends and summer
(activity increases because
usually more active and
outdoors)
SUGGESTED LEARNING OPPORTUNITIES
The teacher with the use of the
overhead projector will use transparencies with the topic headings of
the content material written on them,
such as:
Varied Situations When Food Adjustment
Is Needed
l.
2.
3.
4.
etc.
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SUGGESTED CONTENT OUTLINE
6.
7.
B.
SUGGESTED
LEAP~ING
OPPORTUNITIES
-during work or school
· (activity decreases because
outdoors)
The teacher will then fill in the
spaces as the class discussion
proceeds.
When alochol is used
During the stress of injury,
surgery, and illness
Holidays (particularly an
energetic one)
The teacher will call on volunteer
students to participate in filling in
the spaces with the responses they
give in the class discussion, such as:
travel; restaurant; school; etc.
The teacher an0 class will discuss
each factor.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Bloom, Arnold, Diabetes Explained, Medical & Technical Publishing Co., 1975.
2.
Weller, c., and B. Boylan, The New Way to Live With Diabetes, Great Britain:
Wm. Heinemann Medical Books Ltd., 1967.
PATIENT
1.
"Diabetes Can Travel With You," Indianapolis:
Eli Lilly Co., 1971 -pamphlet.
2.
''Exercise, Calories, and Diabetes," New York:
ADA Forecast, 1970 - leaflet.
American Diabetic Association,
-----
--------------------------------
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SUGGESTED RESOURCES
3.
"Vacationing with Diabetes - not from Diabetes,'' New York:
pamphlet.
Squibb, 1973 -
4.
Dolger, H. and Seeman, B., How to Live With Diabetes, New York, Pyramid
Communications, Inc., 1975.
----------------·----------·----. ---- -·---- -------
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·------------------- -·----- -· -·- --·-
MAJOR CONCEPT II:
CONCEPT 2:
OBJECTIVE 5:
Evaluative
Criteria:
A.
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Meeting the basic nutritional requirements of the diabetic patient
enables him to lead a normal and comfortable life by keeping his
diabetes in control.
Following instruction: The student will be able to plan a
modified prescribed diet according to the patient's needs by
applying the dietary prescribed regimen.
(Synthesis)
The student will include at least five principles from the
prescribed dietary regimen for the selection of foods in her
plan to provide a varied, and nutritious diet within the patient's
caloric allowance.
SELECTED CONTENT OUTLINE
SELECTED LEARNING OPPORTUNITIES
Prescribed Dietary Regimen
Before the film, Patient Teaching Your Diabetic Diet, the teacher will
with the use of the instructor's
guide, conduct a class discussion on
the principles of a prescribed dietary
regimen pertaining to caloric values,
household measures, become familiar
with food exchange lists, three meals
a day, etc.
1.
Consume a constant daily diet
three times a day.
2.
Become thoroughly familiar with
the food exchange lists.
3.
Learn how to follow a calculated
diet.
4.
Know the caloric value of foods
frequently eaten.
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-·-··-··-·
SELECTED CONTENT OUTLINE
-·-·
---
·-----~---·-
-------
SELECTED LEARNING OPPORTUNITIES
5.
Use household measures or a gram
scale until serving sizes can be
judged accurately
6.
Avoid concentrated carbohydrates.
7.
If taking insulin, eat extra
calories when unusual physical
activity is anticipated.
8.
Eat a bedtime snack when taking
insulin (if permissible)
9.
Avoid foods high in cholesterol.
10.
Keep weight at optimal weight;
normalize body weight.
11.
Mealtimes should be regular and
the food regularly spaced throughout the day.
SUGGESTED
The students will be divided into four
small groups consisting of five members
in each group, after the question and
answer period following the film.
Each group will be responsible for
developing a modified prescribed diet
using the principles in the classroom
discussion.
P~SOURCES
TEACHER-STUDENT
1.
Patient Teaching - Your Diabetic Diet, 11-minute color film, Train-aide,
Glendale, CA (with instructor's guide).
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SUGGESTED RESOURCES
2.
"Diet and. the Diabetic," Kalamazoo, Michigan:
teaching guide.
Upj ohn Co. , 19 70 - programmed
3.
Williams, T. F., et al., "Dietary Errors Made at Horne by Patients with
Diabetes," JournalofArnerican Dietetic Association (July, 1967), 19-25.
PATIENT
1.
Behrarn, M., Cookbook for Diabetics, Recipes from the ADA Forecast, New York:
American Dietetic Association, 1968.
2.
"Nutrition: The Key to a Health Future,'' New York:
1970 - pamphlet.
E. R. Squibb and Sons,
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MAJOR CONCEPT II:
CONCEPT 3:
OBJECTIVES:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A CO}ffiiNATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Since the aim of diabetic treatment is to permit the patient to
live a "normal life style," the diabetic patient can effectively
administer his own medications.
1.
Describe the action and limitations of oral drugs.
2.
Discuss the role of insulin in diabetes.
3.
Explain and demonstrate insulin injection technique.
4.
Plan a method for rotating these potential injection sites
on a daily basis.
------ - - - - · .
._
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---·~---------·------·----··
-------- ----------·---- ----·--------- ·-----------·------
CONCEPT II:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
CONCEPT 3:
Since the aim of diabetic treatment is to permit the patient to
live a "normal life style,'' the diabetic patient can effectively
administer his own medications.
OBJECTIVE l:
Following instruction: The student will be able to describe the
action and limitations of oral drugs.
(Understanding)
~~JOR
Evaluative
Criteria:
The student will include at least two actions of oral medications
and two limitations of oral medications.
SUGGESTED CONTENT OUTLINE
A.
---
Action of oral agents (hypoglycemic
agents)
l.
Tablets do not contain insulin and
are no substitute for insulin.
2.
Bring down level of sugar in blood
to normal in mild diabetic.
3.
Exact mechanism not fully
understood but believed they
stimulate secretion of insulin
by beta cells in pancreas.
---···---·-
SUGGESTED LEARNING OPPOERTUNITIES
The teacher will bring oral drugs that
are commonly used by the physicians
and display them on the desk. A poster board will be provided with information regarding action and limitations of these drugs.
The teacher will have the class gather
in a circle so everyone can see the
poster boards and oral medications
during the class discussion.
Volunteer students will select the
medication as it is being discussed.
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SUGGESTED CONTENT OUTLINE
B.
SUGGESTED LEARNING OPPORTUNITIES
Limitations of oral drugs
1.
Advocated for maturity-onset
nonketotic diabetic who cannot be
controlled by diet and unable to
take insulin.
2.
Insulin is preferable to oral
agents if dietary treatment fails
to control diabetes.
3.
Insulin is required when
infection, trauma, major surgery
or gangrene is present.
4.
Not indicated for treatment of
children and most young adults.
5.
Not indicated for treatment of
severe diabetes when large amounts
of insulin are required for control.
After the class the students can
examine the medications and read the
inserts that come with each medication
describing the actions and limitations.
SUGGESTED RESOURCES
TEACHER-STUDEN'l'
1.
Beidleman, Barkley, "Oral Hypoglycemics-Use Orals with Caution and Consent,"
Journal of Practical Family Medicine (July, 1974), 56-73.
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-·- -------------
------------·---
SUGGESTED RESOURCES
2.
Colwell, John, "Therapy With Hypoglycemic Agents," Diabetes MellitusDiagnosis and Treatment, ed. Stefan D. Fajens, Vol. III, Ch. XXVI, . New York:
American Diabetes Association, 1971.
PATIENT
1.
"Hypoglycemic Reactions From Insulin or Oral Compounds," Kalamazoo, Michigan:
Upjohn, 1971 - pamphlet.
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-----·- -- -·--·
MAJOR CONCEPT II:
CONCEPT 3:
-·-- · - - - - - - - ·
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Since the aim of diabeti8 treatment is to permit the patient to
live a "normal life style," the diabetic patient can effectively
administer his own medications.
OBJECTIVE 2:
Following instruction: The student will be able to discuss the
role of insulin in diabetes.
(Understanding)
Evaluative
Criteria:
The student will include at least two points, such as when peak
action of insulin occurs and when to expect a. reaction from
insulin in her discussion.
SUGGESTED CONTENT OUTLINE
A.
Role of Insulin in diabetes
1.
Individuals who require regular
injections of insulin:
a.
b.
c.
d.
2.
growth onset of juvenile
diabetes
diabetic individuals who
lost excessive amount of
weight
diabetic individuals with
acute complications
severe diabetes
SUGGESTED LEARNING OPPORTUNITIES
The teacher will show the filmstrip,
Insulin Timing and Action using the
record provided. This will be followed by a class discussion.
The teacher will use a bulletin board
in her discussion.
The bulletin board
will have labels from the various insulin bottles that doctors prescribed
for their patients.
Also key factors will be listed in
insulin function.
Factors to be considered in
insulin function
..,...,.I-'
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SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
a. relationship to diet and
exercise
b. when peak action occurs
c. when to expect a reaction
from each type of insulin
(regular, intermediate)
d.
dose adjustment in relation
to urine tests, illness,
changes in diet and
activity.
This will be followed by a question
and answer period so students can
participate in the discussion.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Insulin Timing and Action, filmstrip with record, Trainex Corporation,
Garden Grove, CA.
2.
Hansten, Philip D., Drug Interactions, Philadelphia:
3.
Schumann, Delores, Coping With the Complex, Dangerous, Elusive Problem of
Those Insulin Induced Hypoglycemic Reactions, Nursing 74 (April 1974), 56-60.
Lea and Febiger, 1971.
PATIENT
1.
"Types of Insulin," New York:
1965 - leaflet.
American Diabetic Association, ADA Forecast,
2.
"U-100 Iletin (Insulin, Lilly," Indianapolis, Indiana: 1973 -pamphlet.
--------------------------
--------------
-----------
---
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-·--·--·-
--·-·~·"
IvlAJOR CONCEPT II:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
CONCEPT 3:
Since the aim of diabetic treatment is to permit the patient to
live a "normal life style," the diabetic patient can effectively
administer his own medications.
OBJECTIVE 3:
Following instruction: The student will be able to explain and
demonstrate the insulin injection technique.
(Understanding and
Practice Objective)
Evaluative The student will include at least six principles on injection
Criteria: technique in her explanation and demonstrate the insulin injection
technique with 100% accuracy.
SUGGESTED CONTENT OUTLINE
A.
Principles to be considered in
insulin injection technique
l.
How insulin is measured
2.
How to read the syringe
3.
Sterile practices
4.
How to measure, inject air
and withdraw
5.
Injection methods
SUGGESTED
LEAffi~ING
OPPORTUNITIES
The teacher will show film,
Subcutaneous Injection.
Then there will
be a brief class discussion.
~he teacher will have an insulin
administration tray with various types
of syringes (non~disposable and disposable) and different types of insulin (long acting and short acting).
Before the class discussion the
students will be required to examine
the tray with insulin supplies.
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-····----
·- -·-- ----· ---·-·-·
--·
SUGGESTED CONTENT OUTLINE
·--
··-------
SUGGESTED LEARNING OPPORTUNITIES
6.
Location and rotation of
injection sites
7.
Disposal of syringes
8.
How to store insulin
9.
Mixing_two kinds of insulin
in one syringe (if appropriate)
The teacher will explain and
demonstrate skin preparation with the
insulin injection technique. A student
volunteer will be the diabetic patient.
The students will then select partners
to do a return demonstration.
(The
nurse may inject herself/himself or
the partner).
SUGGESTED RESOURCES
TEACHER-STUDENT
P~erican
1.
Subcutaneous Injection, 11 minute film,
Southern California Affiliate, Inc.
Diabetic Association,
2.
Krueger, Elizabeth, The Hypodermic Injection - a Programmed Unit,
Philadelphia: J. B. Lippincott Co., 1968.
3.
"The C-Better Syringe Magnifier," Stuart, Florida:
Rehabilitation Center, 1975.
Tri-County
PATIENT
1.
"Two Accepted Techniques for Self-Injection, Rutherford, New Jersey:
Becton-Dickinson Company, 1969.
2.
"Care and Handling of Insulin Syringes," New York:
Association, ADA Forecast, 1963 - leaflet.
American Diabetic
-------- · - - - - ------------------------------------
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MAJOR CONCEPT II:
CONCEPT 3:
OBJECTIVE 4:
Evaluative
Criteria:
ALTHOUGH DIABETES CANNOT YET BE CURED, IT CAN BE CONTROLLED WITH
A COMBINATION OF PROPER DIET, EXERCISE AND MEDICATION, MONITORED
BY URINE TESTING.
Since the aim of diabetic treatment is to permit the patient to
live a "normal life style," the diabetic patient can effectively
administer his own medications.
Following instruction: The student will be able to plan a method
for rotating these potential injection sites on a daily basis.
(Synthesis)
The nurse will include at least three principles on the rotation
cycle when developing a rotating injection cycle plan for location of potential injection sites.
SUGGESTED CONTENT OUTLINE
A.
Principles on Rotation Cycle
1.
The place of injection is
changed with each injection
of insulin.
2.
First one arm is used and then
the .other.
3.
The abdomen may be used also.
4.
A place where an injection has
been made should not used again
for months.
-·-
-----·-··
··------------·--· -------------- ---·
SUGGESTED LEARNING OPPORTUNITIES
The teacher will give each student a
class handout entitled 11 Site Selector
for Insulin Injections, 11 published by
Becton-Dickinson Corp. for teachers
and patients.
The teacher will have a class
discussion on the use of the selector
sites for rotating injection sites.
A mannequin will be used to display
the diagram of potential injection
sites.
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- -- --·--
SUGGESTED CONTENT OUTLINE
B.
·-·
---------------------
SUGGESTED LEARNING OPPORTUNITIES
Setting up a Rotating Cycle Rationale
1.
The right arm is marked A
The right side of abdomen is B
The right thigh is C
2.
The left arm is marked F
The left side of abdomen is E
The left thigh is D
3.
Each of these places can be
marked as a rectangle and divided
into 8 squares more than l" on
each side.
4.
These squares are numbered
starting from upper outside
corner which is numbered 1, to
lowest corner which is 8.
The class will be divided into three
small buzz groups to develop a method
that they feel will be practical for
the patient to use to rotate insulin
injections on a daily basis.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Bird, Ida, RN, Clinical Specialist at UCLA - resource person.
2.
Etzwiler, Donnell, Education and Management of the Patient with Diabetes
Mellitus, Elkhart: Ames Co., 1973.
--~-------
----------------------
----·
-------·-·-· ··-·----
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SUGGESTED RESOURCES
·3.
"Site Selector for Insulin Injections," Rutherford, N.J.:
class handout.
Becton-Dickinson-'
PATIENT
1.
Patient's Diagram for Rotation of Sites for Insulin Injections (Furnished by
UCLA Medical Center).
2.
Travis, Luther B., An Instructional Aid on Juvenile Diabetes Mellitus, New
York, E. R. Squibb & Sons, Inc~, 1969.
:
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MAJOR CONCEPT III:
CONCEPT 1:
OBJECTIVES:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PREVENTIVE MEASURES REGARDING
HIS/HER HEALTH CARE.
It is through two major complications - hypoglycemia (insulin
shock) and hyperglycemia (diabetic coma) that diabetes can do
its most serious damage if not treated quickly and adequately.
1.
Compare and contrast causes of hypoglycemia and hyperglycemia.
2.
Discuss the principles of patient education in preventive
measures for hypoglycemia and hyperglycemia.
3.
Describe the treatment of hypoglycemia and hyperglycemia.
··---------- - - - - -
--------------------
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MAJOR CONCEPT III:
CONCEPT 1:
OBJECTIVE 1:
Evaluative
Criteria:
--- ··--·
----
----~----
It is through two major complications - hypoglycemia (insulin
shock) and hyperglycemia (diabetic coma) that diabetes can do
its most serious damage if not treated q~ickly and adequately.
Following instruction: The student will be able to compare and
contrast caus~s of hypoglycemia and hyperglycemia.
(Analysis)
The student will differentiate between the causes of hypoglycemia
and hyperglycemia by including at least two causative factors
such as insulin requirements and dietary situations for each
complication.
Causes of Hypoglycemia (Insulin
Shock) - rapid onset.
1.
Too much insulin
a.
b.
2.
----
THE TREA~MENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PREVENTIVE MEASURES REGARDING
HIS/HER HEALTH CARE.
SUGGESTED CONTENT OUTLINE
A.
-·
mistakes in insulin dosage
syringe may be a source of
error
SUGGESTED LEARNING OPPORTUNITIES
The teacher will conduct a class
discussion to differentiate between
these two major complications insulin shock and diabetic coma.
The teacher will use the blackboard in
her discussion by writing the two
major complications on the blackboard
to show their differences.
Change in requirements
a.
increase during illness,
infection, after an accident
Causes will be written on the
blackboard during the discussion.
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SUGGESTED CONTENT OUTLINE
b.
B.
SUGGESTED LEARNING OPPORTUNITIES
insulin should be decreased
when situation reverted to
normal
3.
Meal habits (not eating enough
food) - delayed meal
4.
Taking unusual amount of
exercise
The teacher then will divide the class
into two groups, consisting of ten
students in each group.
One group will
represent insulin shock and the other
group diabetic coma. Each group will
discuss the causes of the complication
given to them.
Each group will then report their
findings to the entire class.
Causes of Hyperglycemia (diabetic
acidosis) gradual onset.
1.
Too little insulin - considerable
excess of sugar in blood (failure
to increase insulin when urine
sugar is increasing)
2.
Failure to follow diet - dietary
excesses
3.
Infection, fever, emotional stress,
tonsillitis, pneumonia, enteritis
or infection of urinary tract are
common infections.
-
------~---·-
-~---
·-----------
--------- ---
-·
--
------------
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SUGGESTED RESOURCES
TEACHER-STUDENT
Medical & Technical Publishing
1.
Bloom, Arnold, Diabetes Explained, London:
Co., 1975.
2.
Sussan, K. E., "Failure of Warning in Insulin-Induced Hypoglycemia,"
Diabetes, Mar~h, 1966 (1-4).
PATIENT
1.
"Toward Better Control - Guidebook for the Diabetic," Elkhart, Indiana:
Co. , 19 7 5.
2.
"In Diabetes Good Timing Goes Hand in Hand with Good Control," New York:
Squibb & Sons, 1970.
Junes
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MAJOR CONCEPT III:
CONCEPT~=
OBJECTIVE 2:
Evaluative
Criteria:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PREVENTIVE Iv".£ASURES REGARDING
HIS/HER HEALTH CARE
It is through two major complications - hypoglycemia (insulin
shock) and hyperglycemia (diabetic coma) that diabetes can do
its most serious damage if not treated quickly and adequately.
Following instruction: The student will be able to discuss the
principles of patient education in preventive measures for
hypoglycemia and hyperglycemia.
(Understanding)
In her discussion the student will include at least two
principles pertaining to conditions that produce complications
and how to prevent these complications (hypoglycemia and hyperglycemia) .
SUGGESTED CONTENT OUTLINE
A.
SUGGESTED LEARNING OPPORTUNITIES
Preventive measures for hypoglycemic
reactions.
1.
Know conditions that produce
reactions
a.
b.
c.
2.
omission of meal
unaccustomed or strenuous
exercise
too much insulin
Know symptoms of an insulin
reaction
The teacher will conduct a class
discussion on the preventive measures
for these two major complications.
A poster board will be used with her
discussion to stress the following
points:
1.
that the student has a full
understanding why reactions occur.
2.
the student knows that reactions
are not anyone's fault but that
th~y occur for a number of reasons
----------------------·--------- - - - - -
------------------------------~-
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SUGGESTED CONTENT OUTLINE
a.
b.
3.
Know how to combat impending
insulin reaction
a.
b.
c.
d.
e.
f.
B.
any unfamiliar or peculiar
sensation
hunger, perspiration, palpitation, tachycardia, weakness,
tremor, pallor.
SUGGESTED LEARNING OPPORTUNITIES
and they are not a sign that he or his
physician have failed treating his
diabetes.
Then the students will discuss how
they can apply these preventive measures to the diabetic patients on their
nursing divisions.
eat carbohydrates (orange
juice, sugar, candy) when
symptoms first occur
test urine
carry extra carbohydrate at all
times (sugar lumps, candy)
eat extra carbohydrates before
strenuous exercise
eat a snack at bedtime
carry diabetic identification
card or wear identification
bracelet
Preventive Measures for Hyperglycemic
Reactions
1.
Know conditions that produce
reaction
a.
nausea and vomiting
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--------------··-. --------·-- --------· ___ --·- ---
SUGGESTED CONTENT OUTLINE
b.
c.
d.
2.
SUGGESTED LEARNING OPPORTUNITIES
failure to increase insulin when
urine sugar is increasing
failure to take insulin
dietary excesses
Know symptoms of a diabetic coma
a.
·:.J
3.
,.
increase thirst and urination,
large amounts of sugar and ketones
in urine, weakness, abdominal pains,
generalized aches; loss of appetite,
nausea and vomiting.
Know how to combat impending diabetic
acidosis
a.
b.
c.
d.
e.
f.
examine urine for sugar and acetone
and report results to physician
use Dextrosix to determine blood
sugar abnormalities
take additional insulin as
advised by physician
go to bed and keep warm
alert someone to be in attendance
drink a glass of liquid hourly
if possible
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SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Etzwiler, Donnell, Education and Management of the Patient With Diabetes
Mellitus, Elkhart, Indiana: Ames Co., 1973.
2.
"Patient Teaching- Your Diabetic Medication- Instructor's Guide,"
Glendale, CA, 1975. Catalog No. Tl503.
PATIENT
1.
Semlo, Leon, "The Recognition and Care of Hypoglycemic Reactions," New York:
American Diabetic Association, 1973.
2.
"Patient's Guide -Your Diabetic Medications,'' Glendale, CA, 1975, Catalog
No. Tl503.
......
co
Ul
MAJOR CONCEPT III:
CONCEPT 1:
OBJECTIVE 3:
Evaluative
Criteria:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PREVENTIVE MEASURES REGARDING
HIS/HER HEALTH CARE.
It is through two major complications - hypoglycemia (insulin
shock) and hyperglycemia (diabetic coma) that diabetes can do
its most serious damage if not treated quickly and adequately.
Following instruction: The student will be able to describe
the treatment of hypoglycemia and hyperglycemia.
(Understanding)
In describing the treatment of these complications, the student
will include at least two points for each complication pertaining
to insulin or carbohydrate needs of the body.
SUGGESTED CONTENT OUTLINE
A.
Treatment of Hypoglycemia
SUGGESTED LEARNING OPPORTUNITIES
The teacher will show slides to
describe the treatment of insulin
shock and diabetic coma during her
lecture.
l.
Give some form of glucose orally
if patient is conscious; orange
juice, candy, sugar.
2.
Give glucagon (subcutaneously)
or I.M.), (1.0 mg in adults) causes glycogenolysis in liver
which raises blood glucose level
The students will participate in .a
brief question and answer period after
each series of slides for each
complication.
3.
Give orange juice or gingerale
as soon as he regains consciousness - glucose level may fall
The teacher also will show charts
pertaining to the treatment for each
complication.
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SUGGESTED CONTENT OUTLINE
faster than the transient rise
produced by glucagon
4.
B.
SUGGESTED LEARNING OPPORTUNITIES
This will be followed by a class
discussion to summarize the highlights
of the lecture.
If patient is unconscious follow directions of physician.
Treatment of Hyperglycemia
1.
Best carried out in hospital
2.
Secure blood and urine samples
immediately
3.
Insert indwelling catheter as
directed - obtain urine specimens
at prescribed times
4.
Look for evidence of infection
5.
Administer rapid-acting insulin
as ordered
6.
Replace fluids and electrolytes
-------·----
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SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Gastineau, Clifford, "Hypoglycemia Secondary to Therapy,'' Diabetes Mellitus:
Diagnosis and Treatment, ed., Stephan Fajens, Vol. III, Chapter XLIII,
New York: American Diabetic Association, 1971.
2.
Brunner, L., and B. Suddaith, The Lippincott Manual of Nursing Practice,
Philadelphia: Lippincott Company, 1974.
PATIENT
1.
"Hypoglycemic Reactions from Insulin or Oral Agents," New York:
Diabetic Association, ADA Forecast, 1973.
2.
Muller, Sigrid, "Glucagon: Prompt Relief from Insulin Ractions," New York:
American Diabetic Association, ADA Forecast, 1961.
American
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------------------------------- -·-·-------
~ffiJOR
--
------~---
------------------ -----
CONCEPT III:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PEEVENTIVE MEASURES REGARDING
HIS/HER HEALTH CARE.
CONCEPT 2:
Special care of the feet is needed because the circulatory and
nerve problems associated with diabetes make the diabetic prone
to nu~bness, foot infections, and poor healing.
OBJECTIVES:
1.
Explain and demonstrate proper foot care for diabetic
patients.
2.
Discuss the importance of preventive measures in foot care.
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IV
---------------------------
-·-
MAJOR CONCEPT III:
CONCEPT 2:
OBJECTIVE 1:
Evaluative
Criteria:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN
ACTIVE AND PARTICIPATORY ROLE IN PREVENTIVE HEASURES REGARDING
HIS/HER HEALTH CARE.
Special care of the feet is needed because the circulatory and
nerve problems associated with diabetes make the diabetic prone
to numbness, foot infections, and poor healing.
Following instruction: The student will be able to explain and
demonstrate proper foot care for diabetic patients.
(Understanding and Practice Objective)
The student will include the four steps of routine foot hygiene
in her explanation and demonstrate each step with 100% accuracy.
SUGGESTED CONTENT OUTLINE
A.
Procedure for Regular Routine of
Foot Care (every day at same time)
1.
- - - ·---·---···-·-
SUGGESTED LEJI.RNING OPPORTUNITIES
The teacher will show the filmstrip,
Feet First, which will be followed by
a question and answer period.
Hygiene of feet
a.
b.
c.
d.
washed gently - care taken
to prevent the breaking of
skin between toes
feet dried with smooth, soft
towel
when feet dry and scaly should wipe lightly with
lanolin once a day
when feet perspire freely
and moist, rub lightly with
The teacher will display a postercollage when demonstrating the steps
to follow for proper foot care of the
diabetic patient.
Each student will then be given a
handout, "Care of the Feet in Diabetics," published by the U. s. Department of Health, Education and Welfare,
which also has the steps listed in
this booklet.
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-- ··- ------
SUGGESTED CONTENT OUTLINE
alcohol once or twice a day as
necessary.
2.
Care of toenails
a.
3.
SUGGESTED LEARNING OPPORTUNITIES
The students will be required to
select a partner for a return demonstration by going through the steps
of proper foot care.
always in good light, toenails
should be cut straight across
and never cut shorter than tips
of toes
Check for corns and calluses
a.
b.
c.
4.
--------··------------
should be treated by
chiropodist
may be rubbed down with fine
emery board after well soaked
corn remedies and corn cures
should not be used
Check for abrasions of feet
a.
b.
avoid strong irritating
antiseptics
consult doctor for redness,
swelling or inflammation
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SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Feet First, 10 minute filmstrip with record, Trainex, Garden Grove, California
2.
"Care of the Feet in Diabetics,'' U. s. Department of Health, Education and
Welfare, Public Health Service - leaflet.
3.
Rosenthal, Helen, Diabetic Care in Pictures, Philadelphia:
Company, 1968.
J. B. Lippincott
PATIENT
1..
Joyce, John, "The Diabetic Looks at His Feet," New York:
Association, ADA Forecast, 1969 - pamphlet.
American Diabetic
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· - - - - - - --------------------------------,.----------- ----
---------- ·-----··-.
MAJOR CONCEPT III:
CONCEPT 2:
OBJECTIVE 2:
Evaluative
Criteria:
THE TREATMENT OF DIABETES REQUIRES THE PATIENT TO ASSUME AN ACTIVE
AND PARTICIPATORY ROLE IN PREVENTIVE MEASURES REGARDING HIS/HER
HEALTH CARE.
Special care of the feet is needed because the circulatory and
nerve problems associated with diabetes roake the diabetic prone
to numbness, foot infections, and poor healing.
Following instruction: The nurse will be able to discuss the
importance of preventive measures in foot care.
(Understanding)
Discussion will include at least six preventive measure for
circulatory problems of the diabetic's feet.
SUGGESTED LEARNING OPPORTUNITIES
SUGGESTED CONTENT OUTLINE
A.
Prevention of Circulatory Problems
1.
Teach foot exercises that improve
circulation - BUERGER'S PASSIVE
EXERCISES
2.
Instruct patient never to wear
circular garters or tight leg
binding girdle
3.
Use heating pads with great
caution
4.
If foot soaks used for any
reason - water should be tested
The teacher will show slides of foot
complications due to lack of proper
foot care.
The class discussion on
preventive measures in foot care will
follow the slide presentation.
The teacher will then give each student
a class handout, "Buerger's Passive
Exercises" from Dr. Joslin's Diabetic
Manual.
These foot exercises are for
diabetic patients to do daily, to
improve circulation in their feet.
·-------------····-- - - - · - - · - - - - - - - · - - · - -
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·-------------------------·-------·-·-
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
5.
Avoid sitting directly in front
of direct source of heat for long
periods of time.
6.
Wear noncompressive shoes and
socks and stockings
7.
Don't sit with legs crossed
8.
Don't use skin vibrators, scalp
vibrators, or spot reducing
vibrators
SUGGESTED RESOURCES
TEACHER-STUDENT
l.
Joslin, Elliott, Diabetic Manual, Philadelphia:
Lea & Febiger, 1969.
2.
"Foot Care for the Diabetic Patient," Atlanta:
Center for Disease Control, 1968 - booklet.
Public Health Service,
PATIENT
l.
"Don't Let Your Feet Get Out of Hand," Yuckahoe:
Corp., 1972- leaflet.
U. S. Pharmaceutical
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- - · - - - - · - - - - - - - ·----·---------------
---
- - - - · - - - - - - - - - · · - - - · - - - - - - - - - - - - · - - - - · ---- ·--· ........ · - · - -
MAJOR CONCEPT IV:
CONCEPT 1:
OBJECTIVES:
. ·-·-·--·--
SOME DIABETIC PATIENTS ARE SPECIALLY PRONE TO FEAR THE FUTURE AND
ANTICIPATE HARDSHIPS AND OBSTACLES IN THE WAY OF NORMAL LIFE.
Self acceptance of the diabetic patient is fundamental to sound
mental health.
1.
Identify the role of emotional stress in diabetes.
2.
Discuss the adjustment of living patterns of the diabetic
patient.
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MAJOR CONCEPT IV:
CONCEPT 1:
OBJECTIVE 1:
Evaluative
Criteria:
SOME DIABETIC PATIENTS ARE SPECIALLY PRONE TO FEAR THE FUTURE AND
ANTICIPATE HARDSHIPS AND OBSTACLES IN THE VJAY OF NORMAL LIFE.
Self acceptance of the diabetic patient is fundamental to sound
mental health.
Following instruction:
the ntirse will be able to identify the
role of emotional stress in diabetes.
(Analysis)
The student will identify at least four points showing the
relationship of emotional stress with diabetes.
SUGGESTED CONTENT OUTLINE
A.
Anxiety levels higher in diabetics
1.
Majority, after realizing that
their world doesn't have to come
to an end, begin to feel much
better
2.
Majority, after they discover
that with proper care and treatment,
they can lead active lives, their
feelings of fear tend to diminish
greatly
3.
Some diabetics find it very
difficult to control their feelings
of anxiety and intense fear
SUGGESTED LEARNING OPPORTUNITIES
The teacher will have a class
discussion on the anxiety levels of the
diabetic patient.
Reasons for the
higher levels of anxiety for diabetic
patients will be listed on the blackboard during the discussion.
The teacher will call on two volunteer
students to participate in role playing.
One student will portray the
patient who verbally and nonverbally
expresses anxiety about the diabetic
condition during interaction with the
nurse.
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-----------·---------------------------
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
4.
There is a direct relationship
between emotional stress and the
diabetic's ability to care for
himself properly and hence his
state of well being.
5.
There are several "musts" that
diabetic must face if he is to
keep his condition under control cannot escape medication and urine
tests and diet cannot be an unrestricted one.
6.
Adult diabetics who repeatedly
develop acidosis are individuals
who are seriously emotionally
disturbed.
This role playing will be observed by
the class so they can feel and see the
anxiety during the interaction. A
question and answer period will follow
to summarize the main points of the
role playing.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Pickard, Harry C., Behavioral Intervention in Human Problems, New York:
Pergamon Press, 1971.
2.
Farberow, Norman L., et al., "Indirect Self Destrictive Behavior in
Diabetic Patients," HospiTal Medicine (May 1970), 123-133.
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·-------------
SUGGESTED RESOURCES
3.
Robinson, Milton, "Emotional Side of Diabetes," New York:
Association, ADA Forecast, 1970 - pamphlet.
American Diabetic
4.
Beck, R., "Alcoholism- the Diabetic Alcoholic," RN (July 1974), 37-40.
PATIENT
1.
"Don't be Afraid of Diabetes," New York:
F. R. Squibb
2.
"Sleeping Pills, Tranquilizers and Diabetes," Indianapolis:
1964.
&
Sons, 1971.
Eli Lilly Co.,
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1--'
-------·-----·----·--·-
MAJOR CONCEPT IV:
SOME DIABETIC PATIENTS ARE SPECIALLY PRONE TO FEAR THE FUTURE AND
ANTICIPATE HARDSHIPS AND OBSTACLES IN THE WAY OF NO~ffiL LIFE.
CONCEPT 1:
Self acceptance of the diabetic patient is fundamental to sound
mental health.
OBJECTIVE 2:
Following instruction: The student will be able to discuss the
adjustment of living patterns of the diabetic patient.
(Understanding)
Evaluative
Criteria:
In her discussion, the nurse will include at least six areas
where assistance is needed for the diabetic patient to adjust
his life to his diabetic condition.
SUGGESTED CONTENT OUTLINE
A.
Assist patient in adjustment to
living patterns
1.
Diabetes cannot be ignored but with little extra attention
it should not significantly interfere with any aspect of his life.
2.
Need to control diabetes and
insure that diabetes doesn't
control him.
3.
Diabetics who deny they have
diabetes, refusing to diet or
follow instructions - these
SUGGESTED LEARNING OPPORTUNITIES
The teacher will have a class
discussion on the various adjustments
required by diabetic patients in their
everyday living patterns.
The class will be divided into five
groups consisting of five students in
each group.
Each group will select a
chairman to conduct their discussion
of a case history of a diabetic patient that each group will be given.
The group members will participate in
the various adjustment patterns of
this diabetic patient.
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tv
-----------
,--------·--------·
--------------------------
--------------
SUGGESTED CONTENT OUTLINE
SUGGESTED LEARNING OPPORTUNITIES
people need reassurance and not
threats.
4.
Diabetics need assistance in school
selection and job placement.
5.
Need social adjustment with
neighbors, friends, co-workers
and general public.
6.
Travel should present no particular
problem to the diabetic.
7.
Encourage patient to express feelings
and problems regarding condition.
The teacher will then have a class
discussion to summarize the results
of each group.
SUGGESTED RESOURCES
TEACHER-STUDENT
1.
Living with Diabetes, 10 minute filmstrip with record, Trainex, Garden Grove,
California.
2.
Cahill, George, "New Hope for Diabetics,"
November 24, 1975.
3.
Bierman, J., and B. Toohey, The Diabetes Question and Answer Book, Los Angeles
Sherbourne Press, Inc., 1974.
u. s.
News and World Report, Inc.,
~
~
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------------------
SUGGESTED RESOURCES
4.
Stuart, s., "Day to Day Living With Diabetes," P.Jnerican Journal of Nursing
(August 1971), 1548-1550.
PATIENT
1.
"Diabetics are Desirable Workers," New York:
- pamphlet.
American Diabetic Association,
2.
Dolger, Henry, How to Live With Diabetes, New York:
Pyrarr1.id, Inc., 1975.
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