NSG/516ED Week 2: Patient-Population Assessment, sample paper

Patient-Population Assessment: Learning Needs, Health Literacy, and Readiness of Older Adults Starting Insulin Pens

[Student Name]

University of Phoenix

NSG/516ED: Practicum I (education track)

Week 2 Assignment

[Instructor Name]

[Date]

The practicum site, 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.

The Week 1 situation assessment showed that patients aged 65 and over, and those whose preferred language is not English, had more dosing errors and early hypoglycemia after starting insulin pens at the diabetes education center than other patients. This paper assesses that population as learners. An insulin pen asks a patient to read small numbers, turn a stiff dial, hold a needle still for ten seconds and remember a sequence under stress, and each of those demands falls hardest on the patients the current teaching serves least. The assessment uses the readiness-to-learn framework described by Bastable (2019), which examines physical, emotional, experiential and knowledge readiness, and adult learning principles.

Who the Learners Are

Of the 64 adults who started insulin pens in the past six months, 26 were 65 or older, with a median age of 72, and 14 preferred a language other than English, most often Spanish, followed by Vietnamese. Nine were in both groups. Most had type 2 diabetes for more than ten years and were starting basal insulin after oral agents no longer controlled their glucose. About a third lived alone, and many relied on an adult child for transportation and help with medications. Most had completed high school or less; several had limited formal education in their country of origin.

Health Literacy

With my preceptor's approval, I administered the Newest Vital Sign to 20 consecutive patients in the target population during their first visit, using the English or Spanish version. The tool asks six questions about a nutrition label and takes about three minutes; scores of 0 to 3 suggest limited health literacy (Weiss et al., 2005). Twelve of the 20 patients (60%) scored 0 to 3, compared with an estimated one third of the center's overall patients based on a smaller sample of other patients assessed during the same weeks.

Limited health literacy matters for insulin because dosing depends on reading numbers, understanding written instructions and interpreting glucose results. Schillinger et al. (2003) found that when physicians caring for patients with diabetes and low health literacy used an interactive teach-back approach, asking patients to restate new concepts, patients' recall and understanding improved and glycemic control was better in visits where recall was assessed. The finding supports teaching methods that check understanding directly rather than relying on reading.

Physical Readiness

Physical factors affect the ability to use a pen. Observation during visits found that 9 of 26 older patients had difficulty reading the dose window without magnification, 6 had arthritis or reduced grip strength that made dialing or pressing the plunger difficult and 4 had tremor. Several had peripheral neuropathy that reduced sensation in their fingers. These findings suggest a need for magnification, practice with the actual pen, techniques for stabilizing the hand and attention to whether a caregiver should be taught as well.

Emotional Readiness

Starting insulin often provokes fear and a sense of failure. Several patients said insulin meant their diabetes was "the bad kind" or that a relative had lost a leg after starting insulin. Fear of needles and of hypoglycemia was common. Anxiety narrows attention and reduces retention, which helps explain why a single, fast-paced visit is not enough for some patients. Emotional readiness suggests addressing beliefs and fears early in the visit and building confidence through successful practice.

Experiential Readiness

Past experience shapes learning. Most patients had no experience with injectable devices, although a few had watched family members use insulin syringes, which led to confusion about pen priming. Patients who had managed oral medications for years had routines that could anchor the new task, such as taking insulin at the same time as an existing evening pill. Cultural experiences also mattered: several Vietnamese-speaking patients preferred that an adult child be involved in learning, and some Spanish-speaking patients were more comfortable asking questions of a staff member who spoke their language.

Knowledge Readiness

Knowledge readiness refers to the learner's current understanding and cognitive ability. Most patients knew their diabetes medications by color rather than name and had limited understanding of how insulin lowers glucose. A brief cognitive screen was not part of routine practice, but educators reported that several older patients had difficulty remembering multistep sequences within the same visit. Learning needs therefore include both skills, such as dialing and injecting, and concepts, such as recognizing and treating hypoglycemia.

Caregivers as Learners

The population assessment would be incomplete without the family members who often share the work of insulin. Of the 26 older patients, 11 said an adult child or spouse helped with medications, and several caregivers attended the first visit but were not invited to practice with the pen. Caregivers bring their own learning characteristics: many work during clinic hours, some have better English literacy than the patient while others do not, and a few are older adults themselves with similar vision and dexterity limits. When a caregiver will draw up or inject insulin, or check doses, that person is a learner whose readiness must be assessed and whose understanding must be confirmed. At the same time, some patients want to remain independent and prefer that relatives stay out of the teaching, so the patient's wishes decide who is taught. For the intervention, this means asking at the start of each visit who will help at home and offering to teach that person, with the same methods used for the patient.

Adult Learning Principles

Knowles et al. (2015) describe adults as learners who need to know why they are learning something, bring experience that should be used, learn best when content is relevant to immediate problems and are motivated by internal goals. For this population, the implications are to connect each step of pen use to a reason the patient cares about, such as avoiding a fall from low blood sugar, to build on existing routines and to focus on the specific task the patient must perform tonight rather than on everything about diabetes.

Implications for Teaching

The assessment points to several needs that the current uniform, verbal approach does not meet: materials that do not depend on reading, including pictures and large print; teaching in the patient's preferred language with a professional interpreter; hands-on practice with the patient's own pen and magnification if needed; confirmation of learning through return demonstration and teach-back; involvement of caregivers when the patient wishes; and attention to fears and beliefs about insulin. These needs will be compared with current practice in the Week 3 gap analysis.

Conclusion

Among the center's new insulin users, those over 65 or needing an interpreter have high rates of limited health literacy, physical barriers such as low vision and reduced dexterity, fears about insulin and little experience with injectable devices. Assessed through a readiness-to-learn framework and adult learning principles, the population is capable of learning but needs teaching that relies less on reading and speed and more on practice, language access and confirmation of understanding.

References

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

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. B. (2003). Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1), 83-90. https://doi.org/10.1001/archinte.163.1.83

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522. https://doi.org/10.1370/afm.405