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Teaching Plan Simulation Lab: Diabetic Patient

Cassandra L. Breckenridge, Chanel I. Dubreuil, Grace L. McCormack, and Morgan P. Burke

Department of Health Sciences, Sault College

BSCN 3094: Nursing Praxis and Professional Caring VI

Nicky Kerr and Kay Vallee

February 9th, 2023

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Teaching Plan Simulation Lab: Diabetic Patient

Teachers: Cassandra Breckinridge, Chanel Dubreuil, Morgan Burke, and Grace McCormack.

Topic: Providing home health care for a type 2 diabetic male patient.

Targeted Learners: The target learners in this scenario are year three nursing students from Sault College. The learners are young adults aged 20 to 35. The
theory of adult learning is known as Andragogy (Knowles, 1990). Young adults can rely on prior learning, master personal skills, and can resolve immediate
problems (Decelle, 2016). The learners are in the formal operations stage of Piaget’s theory of cognitive development (1952), their thinking involves abstract
and theoretical thinking. Nursing students have the necessary theoretical basis and potentially clinical experience necessary to care for diabetic patients. A
learning need is the ability to care for a diabetic patient and recognize a need for patient education. Many interactions with diabetic patients take place in the
home setting with a goal of increasing independence (Lewis et al., 2018). The nurse is expected to access learning needs, deliver patient education, and make
appropriate referrals (Lewis et al., 2018).
Overall Goal: The goal of the teaching session is to evaluate the learner’s overall wound care/packing abilities and recognition of patient teaching
opportunity.

Simulation Scene Description:

The community health nurse specialty area for this scenario is home health nursing. Home health nurse offers patients the benefits of being cared for in the
comfort of their own home (MacDonald and Jakubec, 2021). Home health nurses work with the client and their family, acting as generalists (MacDonald and
Jakubec, 2021). The community health nursing standard of practice of health maintenance, restoration, and palliation apply to this scenario. Community
health nurses are expected to implement strategic interventions to maximize client self-management, health, and healing while ensuring the maintenance of
function and quality of life (Community Health Nurses of Canada, 2019). Home health nurses under this standard are expected to integrate client and family
choice, build on client’s competencies, and utilize resources available in the community (MacDonald and Jakubec, 2021). The second community health
nursing standard of practice that applies to the simulation is capacity building. The expectation is for nurses to encourage and orient the client to resources
available to address their health issues while creating a supportive environment (Community Health Nurses of Canada, 2019). Home health nurses under this
standard are expected to instruct patient’s and families on wound care, and how to examine the wound to determine if it has deteriorated (MacDonald and
Jakubec, 2021). The first role and responsibility of the community health nurse related to this scenario is the manager of the client’s health status and
condition (MacDonald and Jakubec, 2021). The second is the role of the educator for the client as well as their families the delivery of treatments and
medication and being able to recognize when these are necessary or indicated (MacDonald and Jakubec, 2021).
Compresses and wound packing is a skill from the Student Clinic Practice Self-Assessment checklist. The students participating in the scenario
are expected to assess and perform wound care on a diabetic foot ulcer. Refer to the teaching plan below. An additional skill from the checklist
is health education. The student will provide education on proper foot care as well as insulin administration. Refer to the teaching plan below
for more details. Supplies, materials, and equipment needed to facilitate this scenario include: a mannequin, wound care supplies, medication
cart with insulin vials and injection supplies, and a glucometer.
Scenario: You are the home care nurse taking care of Joseph, a 52-year-old male who has a history of essential hypertension, type 2 diabetes,
and GERD. He has been managing his own diabetes for the past year but requires home health visits for a wound on his foot. His wound
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developed after he step on something sharp while walking around barefoot. He did not notice the initial cut, it then got bigger and became
infected. He requires wound care and packing every week. The last home care nurse visited Joseph last week. She reports she used 2 inches of
packing for the wound, there was purulent drainage, and a pink wound bed. His BG was 5.5. The nurse also stated Joseph asked her some
questions about managing his diabetes, but quickly changed the subject before she could answer. You are required to complete his wound
care, irrigation, and packing. You may also provide patient education.

Objectives Content Outline* Strategy/Activity Required resources Method of evaluation*

(Consider learning or
environment) * Tools/materials

By the end of the -How to administer insulin
simulation session, utilizing an insulin pen and/or
the student learner insulin ampules will be
will be able to covered to meet objectives.
explain how to -Insulin injection sites will be
safely administer reviewed prior to simulation.
insulin to the client -Explain to patient
and the family appropriate injection sites
members. and the need to rotate site
-Demonstrated the following:
cleansing site with antiseptic
pad, pinching skin, injected
needle at appropriate angle,
putting needle guard in place
and put into sharps container
- The main resource utilized
will be a Diabetes Canada
Pamphlet called: Getting
started with insulin.
(Perry & Potter, 2017)
Prior to the simulation,
the Diabetes Canada
(2018) pamphlet called;
Getting started with
insulin will be reviewed.
Students will answer
questions in section one of
a Microsoft Forms
https://forms.office.com
-The student will explain
to the patient principles of
insulin injection and will
then demonstrate proper
injection
-Mannequins will be used
to show the appropriate
injection sites.
(Diabetes Canada, 2018)
The method of evaluation will be content
Insulin Pen evaluation. Content evaluation takes place after
OR the skills are taught and integrated in a learning
Insulin needles and experience (Bastable, 2016). In this scenario, the
ampules students will be provided with necessary pre-
1 alcohol swab readings and an information session to explain
Cotton ball what is expected from the students then will be
Medication Cart observed to see how the student performs the
Blood Glucose skills expected. Content evaluation will be used
Monitor to determine to what extent the student
Mannequin achieved the objectives and to what degree the
student learned what was taught (Bastable,
2016).
To evaluate that the learners have achieved the
learning objectives, a post-scenario worksheet
will be supplied to the learners. The learners will
be provided 5 minutes to complete and submit
the worksheet. The worksheet will have several
questions on insulin administration, wound
packing and diabetic foot care to test the
learner's knowledge on the outlined objectives.

________________ Following the post-scenario worksheet, the

By the end of the -Assess wound bed, -Prior to the simulation, instructors will allow the group of students to

simulation session, periwound, and vascular
the student learner supply to affected limb
will be able to - Assess for signs of infection
demonstrate the -Prepared supplies, placing a
proper steps for absorbent pad under the
wound packing for area
the diabetic patient. -Applied sterile gloves
-Irrigating a deep wound,
using a syringe, and cleaning
solution (water/saline)
-Packing a deep wound using
ribbon dressing and apply an
outer dressing
-Provide rationales for each
step of the procedure.
-Chapters 38 and 39 of
Clinical Nursing Skills &
Techniques Perry & Potter 8th
Edition to perform following
best practice
(Perry & Potter, 2017)
(Registered Nurses’
Association of Ontario, 2007)
By the end of the ____________________
simulation session, - How to perform foot care
the student will using safe techniques
verbalize ways that - How to follow
the diabetic client recommended guidelines and
can complete their precautions specific to
foot care. diabetic clients (ex; wear
white socks, avoid walking
barefoot, wash feet daily
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students will review the _____________ debrief by providing time for a guided discussion
Registered Nurses’ Sterile gloves and feedback. The guided discussion will be 2
Association of Ontario Sterile water or minutes in duration and the feedback will be 1
Best Practice Guideline: saline (as per minute in duration.
Assessment and doctor’s order)
management of foot Wound care kit
ulcers for people with Ribbon gauze
diabetes. Students will Scissors and
answer questions in tweezers-
section two of the Mannequin
Microsoft Forms Side table
https://forms.office.com
-Students will assess the
wound
-Student will perform
wound care on mannequin
using appropriate
irrigation and packing
technique
(Registered Nurses’
Association of Ontario,
2007)
__________________
-Prior to the simulation,
students will read pages
1307 to 1309 and review
table 52-14 in the Medical
Surgical Nursing textbook. Hygiene products
Students will answer for cleansing (for
questions in section three sensitive skin*)
of the Microsoft Forms.

with mild soap and water,
dry feet gently especially
between toes, test water
temperature before cleansing
use, examine feet daily, know
where patients can seek care
for non-healing infections or
sores)
(Lewis et al., 2018).
- A community resource for
diabetic education and foot
care is Algoma Diabetes
Education and Care
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https://forms.office.com Water
- As wound care is being Thermometer
completed, the patient Drying towel
expresses questions about
proper steps for foot care
-Back and forth discussion
about diabetic foot care
- Student covers main
points about proper foot
care
- Direct to proper
resources such as Algoma
Diabetes Education and
Care
(Lewis et al., 2018).
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References

Canadian Diabetes Association. (2018). Getting started with insulin.

https://guidelines.diabetes.ca/docs/patient-resources/getting-started-with-insulin-

injections.pdf

Community Health Nurses of Canada. (2019). Canadian community health nursing professional

practice model & standards of practice. https://www.chnc.ca/en/standards-of-practice

Decelle, G. (2016). Andragogy: A fundamental principle of online education for nursing. Journal

of Best Practices in Health Professions Diversity, 9(2), 1263–1273.

Erikson, E. H. (1963). Childhood and society (2nd ed.). W. W. Norton and Company.

Knowles, M. (1990). The adult learner: A neglected species. Gulf Publishing Company.

Lewis, S. L., Bucher, L., Heitkemper, M., & Harding, M. (2018). Medical-surgical nursing in

Canada (4th ed.). Elsevier.

MacDonald, S. A., & Jakubec, S. L. (2021). Stanhope and Lancaster’s community health nursing

in Canada (4th ed.). Elsevier.

Perry, A. G., & Potter, P. A. (2017). Clinical nursing skills & techniques (8th ed.). Elsevier.

Piaget, J. (1952). The origins of intelligence in children. W. W. Norton and Company.

Registered Nurses’ Association of Ontario. (2007). Assessment and management of foot ulcers

for people with diabetes (2nd ed.).

https://rnao.ca/sites/rnao-ca/files/Assessment_and_Management_of_Foot_Ulcers_for_

People_with_Diabetes_Second_Edition1.pdf