NSG/516ED Week 3: Gap Analysis, sample paper

Gap Analysis: Current Versus Evidence-Based Insulin Pen Teaching for Older and Language-Diverse Learners

[Student Name]

University of Phoenix

NSG/516ED: Practicum I (education track)

Week 3 Assignment

[Instructor Name]

[Date]

The practicum site, observations 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 first two practicum papers showed that the center's older patients, and its patients who need an interpreter, have more insulin errors after starting pens, high rates of limited health literacy and physical and emotional barriers to learning. This gap analysis compares current teaching with evidence-based teaching for these learners, measures the gaps and identifies their causes. The educators knew what to teach; the gap lay in how learning was confirmed, in what patients took home and in who was in the room to explain it.

The Desired State

Evidence describes several practices for teaching self-management skills to patients with limited health literacy. The health literacy universal precautions approach recommends assuming that all patients may have difficulty understanding health information, using plain language, confirming understanding with teach-back and providing easy-to-understand written materials (Brega et al., 2015). Talevski et al. (2020), in a systematic review of teach-back, found that it was used across many settings and was associated with improvements in patient knowledge, self-care and some clinical outcomes, and with better health professionals' communication. Insulin delivery recommendations describe the specific technique elements patients must master, including priming, dose selection, injection angle, holding the needle in place for about ten seconds, site rotation and single-use needles (Frid et al., 2016). Diabetes education standards call for individualized teaching that addresses literacy, language, culture and physical limitations (American Diabetes Association Professional Practice Committee, 2025).

Together these sources define the desired state: every patient starting insulin demonstrates each critical pen step, explains key safety points in his or her own words, receives written materials matched to literacy and language, is taught with a professional interpreter when needed, has a caregiver included if the patient wishes and receives early follow-up.

The Current State, Measured

With my preceptor, I observed 15 first insulin visits over three weeks, using a checklist of eight critical pen steps and five safety concepts. The results are summarized below.

Return demonstration of all eight pen steps: 3 of 15 visits (20%). In most visits, the patient performed one practice injection with the nurse guiding each step, but did not demonstrate the full sequence independently.

Teach-back of safety concepts, such as recognizing and treating hypoglycemia: 2 of 15 (13%). The usual check was "Do you have any questions?"

Written materials matched to literacy and language: 0 of 15. All patients received the English manufacturer's pamphlet.

Professional interpreter used when needed: 2 of 6 visits with patients who preferred another language (33%). In the other four, a family member interpreted.

Caregiver invited to practice: 1 of 7 visits in which a caregiver was present (14%).

Follow-up within 72 hours: 0 of 15. The standard follow-up call was made within seven days.

The outcome gap mirrors these process gaps. Currently 38% of patients need unscheduled help within 30 days; the center's leadership agreed on a target of 15% or lower.

Causes of the Gaps

The gaps have different causes, and classifying them determines what an educational intervention can change.

Knowledge gaps. The educators were unfamiliar with teach-back as a structured method; several believed that asking for questions was sufficient. Two were unaware that the hospital's language access policy discourages using family members as interpreters. Education can close these gaps.

Skill gaps. Educators who wanted to use teach-back were unsure how to phrase questions without sounding like a test. Return demonstration takes practice to coach efficiently within a 45-minute visit. Skill practice and coaching can close these gaps.

Resource gaps. No large-print, pictorial or translated insulin pen guides existed, and there were no magnifiers or pen grips for patients with low vision or weak hands. These gaps require new materials, which the patient education department can produce.

System gaps. The follow-up call was scheduled for seven days by a template in the electronic record, and interpreter tablets took several minutes to set up. Visit length was fixed at 45 minutes. These gaps require changes in workflow or scheduling, which the manager controls.

Validating the Findings With Staff

Before prioritizing, I presented the observation results to the three nurse educators and the manager at a staff meeting, framed as a picture of the process rather than of individual performance. The discussion refined the analysis. Educators confirmed that time pressure was a real barrier to full return demonstration, but two noted that visits often ended early when patients seemed confident, which suggested the problem was partly habit rather than time alone. One educator described how she already asked patients to "show me" at the end of visits and offered to share her approach, which identified an internal champion for the project. The dietitians pointed out that hypoglycemia teaching overlapped with their nutrition visits, and suggested coordinating the message so patients heard it the same way twice. The manager agreed that the follow-up call template could be changed to 72 hours for patients in the target group. Validating the gap analysis with the people who do the work made the findings more accurate and built support for the intervention that will follow.

Prioritizing the Gaps

The gaps were prioritized by their likely effect on patient safety and by feasibility within the practicum. Highest priority are confirming learning through return demonstration and teach-back, because they address the errors seen in the data and can be changed through education and coaching, and producing plain-language, large-print, pictorial guides in the three most common languages, because patients need something they can use at home. Next are consistent professional interpreter use and caregiver inclusion, which depend partly on workflow. Lower priority for the practicum, though important, are system changes such as adjusting the follow-up call template, which the manager agreed to consider separately.

What an Educational Intervention Can Close

An educational intervention aimed at the nurse educators, supported by new patient materials, can address the knowledge, skill and resource gaps: teaching the educators structured teach-back and return demonstration, coaching them in practice and giving them materials suited to their patients. It cannot, on its own, lengthen visits or change templates, although it can include a recommendation to the manager. Defining this boundary keeps the project realistic.

Conclusion

Compared with evidence-based practice for learners with limited health literacy and limited English proficiency, current insulin pen teaching at the center rarely confirms learning through demonstration or teach-back, provides no materials matched to literacy or language, underuses professional interpreters and caregivers and follows up later than ideal. The largest and most feasible gaps are knowledge, skill and resource gaps among the educators and in the materials, which a nurse educator practicum project can address. The Week 4 plan will build the intervention around them.

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

Brega, A. G., Barnard, J., Mabachi, N. M., Weiss, B. D., DeWalt, D. A., Brach, C., Cifuentes, M., Albright, K., & West, D. R. (2015). AHRQ health literacy universal precautions toolkit (2nd ed.). Agency for Healthcare Research and Quality. https://www.ahrq.gov/health-literacy/improve/precautions/index.html

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

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350