NSG/516ED Week 1: Current Situation Assessment, sample paper

Current Situation Assessment: Insulin Pen Teaching for Older Adults at a Hospital-Based Diabetes Education Center

[Student Name]

University of Phoenix

NSG/516ED: Practicum I (education track)

Week 1 Assignment

[Instructor Name]

[Date]

The practicum site, staff, patients and figures are a composite written for a model paper. Practicum hours and logs are recorded separately and are not part of this paper.

My nurse educator practicum takes place at the outpatient diabetes education center of a composite 240-bed community hospital, under the preceptorship of a registered nurse who is a certified diabetes care and education specialist. This paper describes the current situation at the center, with attention to how adults beginning insulin are taught to use insulin pens, and identifies the educational concern my practicum project will address. The center teaches insulin pen use the same way to every patient, and the patients least able to learn that way are returning with the same problems.

The Setting

The center is part of the hospital's ambulatory services and is recognized by a national diabetes education accreditation program. It employs three registered nurses and two registered dietitians, all certified diabetes educators or working toward certification, plus a part-time pharmacist and a medical assistant. It receives referrals from primary care practices and endocrinologists across a county where about 22% of adults are 65 or older and about one in five residents speaks a language other than English at home. The center offers group self-management classes, individual visits for insulin starts and pump or sensor training, and telephone follow-up.

Diabetes self-management education and support is recommended for all people with diabetes, especially at key times such as diagnosis, when not meeting targets and when complicating factors or transitions arise, including starting insulin (American Diabetes Association Professional Practice Committee, 2025). The center's mission statement emphasizes accessible, individualized education, which aligns with the project's direction.

Current Practice for Insulin Starts

Adults starting insulin receive one 45-minute individual visit with a nurse educator. The nurse explains the insulin prescribed, demonstrates the pen, supervises one practice injection into a pad, reviews hypoglycemia symptoms and treatment and gives the patient the manufacturer's pamphlet, which is written in English at about a tenth-grade reading level. The patient receives a follow-up phone call within a week.

Observation during my first week showed that teaching is thorough in content but mostly verbal, fast-paced and uniform. The educators are skilled and caring, but the visit follows a fixed sequence regardless of the patient's age, vision, dexterity, health literacy or language, and understanding is checked by asking whether the patient has questions rather than by having the patient explain or demonstrate each step. Nurse educator texts emphasize assessing each learner's readiness, abilities and literacy before choosing teaching methods, and verifying learning by observation rather than assumption (Bastable, 2019). Practical elements known to affect pen technique, such as priming, holding the needle in the skin for a count after injection and rotating sites, are mentioned but not always practiced (Frid et al., 2016).

What the Local Data Show

With my preceptor and the center's manager, I reviewed aggregate, de-identified data for the 64 adults who began insulin pen therapy at the center in the past six months. Of these, 24 (38%) needed an unscheduled call or visit within 30 days because of dosing or technique problems, such as not priming the pen, dialing the wrong dose or reusing needles. Seven patients visited the emergency department for hypoglycemia within 60 days of starting insulin. Problems were concentrated among patients 65 or older, who made up 41% of those starting insulin but 67% of those needing unscheduled help, and among patients who preferred a language other than English.

These data describe a pattern, not a cause, and later weeks will examine the population and the gap more carefully. They are strong enough to show that the current approach does not serve every learner equally.

Stakeholders

Five groups will be affected by any change to insulin start teaching. The nurse educators deliver the teaching and would adopt any change; their support depends on the change fitting into a 45-minute visit. The center manager controls scheduling and materials budgets. Referring clinicians want patients who can use insulin safely. The hospital's patient safety committee tracks emergency visits for hypoglycemia as a quality measure. Most important are the patients and their family caregivers, who must perform the injections at home. The center's patient advisory group, which includes two older adults who use insulin, has agreed to review materials.

The Teaching Environment and Resources

The physical and material environment shapes how teaching can change. Individual visits take place in three small consultation rooms, each with a desk, two chairs, an injection practice pad and a wall-mounted monitor that is rarely used. Lighting is adequate, but the rooms are close to a busy waiting area, and conversations are interrupted by noise. Teaching supplies include demonstration pens for the two most commonly prescribed insulins, sharps containers and the manufacturers' pamphlets. There are no large-print or pictorial instructions, no translated materials and no magnifiers for patients with low vision, although the patient education department can produce translated and large-print handouts through its review process. Interpreter services are available by video tablet, but educators report that setting up the tablet takes several minutes, so they often rely on family members to interpret, a practice that the hospital's language access policy discourages. These details matter because a teaching method that depends on reading, rapid verbal instruction or a family interpreter will reach some learners and miss others.

Strengths, Weaknesses, Opportunities and Threats

The center's strengths are experienced, certified staff, a supportive manager and an existing follow-up call system. Weaknesses include uniform, verbal teaching, English-only written materials and no structured check of understanding. Opportunities include the hospital's interpreter services, a health literacy initiative led by the hospital's patient education department and a new electronic record template that can document teaching methods. Threats include limited visit time, staff turnover among medical assistants and cost constraints on new materials.

Constraints on the Project

A practicum project must fit the site's resources and the time available. The project cannot lengthen visits substantially or require new staff. It must use materials that can be produced within the patient education department's budget and approved through its review process. It must respect the center's accreditation standards for documentation. These constraints point toward a change in teaching method and materials rather than a new program.

Problem Statement

At this diabetes education center, older adults and patients with limited English proficiency starting insulin pen therapy experience more dosing and technique errors and more early hypoglycemia than other patients, suggesting that the current uniform, verbal teaching approach does not meet their learning needs. The next weeks of the practicum will assess this population's learning characteristics, analyze the gap between current and desired performance and plan an educational intervention.

Conclusion

The diabetes education center has skilled staff, supportive leadership and a mission of individualized teaching, but its insulin start process teaches every patient the same way. Local data show that the oldest patients and those who need language support struggle most after starting insulin. Understanding the setting, the stakeholders and the constraints lays the foundation for an educational project that the center can realistically adopt.

References

American Diabetes Association Professional Practice Committee. (2025). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes-2025. Diabetes Care, 48(Suppl. 1), S86-S127. https://doi.org/10.2337/dc25-S005

Bastable, S. B. (2019). Nurse as educator: Principles of teaching and learning for nursing practice (5th ed.). Jones & Bartlett Learning.

Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., Smith, M. J., Wellhoener, R., Bode, B. W., Hirsch, I. B., Kalra, S., Ji, L., & Strauss, K. W. (2016). New insulin delivery recommendations. Mayo Clinic Proceedings, 91(9), 1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010