Teaching Plan

Avninder Deol

NorQuest College

NPRT 2102

Cathy Macdonald

February 20, 2021

 Metaparadigm

Person Aspect: This is a case study of Mr. Zulfiquar Ali who was admitted to OSC after right

total knee replacement.

He is 72 years old.

Goals of care R1 which means patient is expected to benefit from and is accepting any available

treatment.

He is a Muslim. He came to Canada in 1991.

He has a degree in business management. He has his own business. He is financially stable. He

lives with son, daughter in law and daughter. He has a good family support.

Environment Aspect: Patient stays in home environment with his family.

He joins his friends on weekends for talk session.

He does his religious practice every day.

Patient stays in calm, and supportive atmosphere.

He is from Pakistan and he enjoys celebrating festivals in home. He run his business with his

friends. His office is near his home.

Health Aspect: Overall health condition is maintained.

 Patient has no health conditions other than arthritis.

 He has arthritis in both knees. Left knee is managed with medicine.

 He had right knee surgery on 15th February. He had a hemovac after surgery. Patient has

no respiratory issues.

 Patient tries to avoid medication because he gets heartburn with medications. No other

health problems noted.

 Patient’s physical mobility is slightly limited because of knee replacement.

  The patient keep himself motivated to walk as much as he can. But the patient stated

concerns that he is unable to walk much. He was complaining about good circulation and

blood clots.

Nursing: Patient was provided with safe and competent care. For example, Physician was

informed about patient’s heartburn and it was controlled with medication.

I will educate the patient on why tinzaparin is important for him and how will he inject it with

proper steps. I will be giving my teaching in calm manner and every step will be explained

thoroughly.

Psychological practices: Patient practice his religious prayers to be mentally calm and well.

Patient stated that he goes to his religious place every weekend for 2 hours.

Social justice: He runs his business of importing school supplies with his son and love to work

through his office.

Strengths:

 Patient always ready to learn about his health. Patient can speak English well.

 He always ready to involve in his care planning. He cooperates with interventions.

 Patient is independent with ADLS. Wants to improve health

 These strengths can be used to involve patient during teaching and performing

interventions. Therefore, patient will stay motivated and interested during teaching and

can learn better.

Barrier

Patient has weak eyesight which can be a barrier to learning as patient will not be able to see the

demonstrations, visuals during teaching which can impact the teaching and learning process.
I will make sure that patient is fully conscious, room is lighted properly and patient is wearing

his glasses during teaching session so that I can bridge the deficit.

Learning style

Patient preferred learning through visuals during I talk. Because he wants to make sure that he is

listening right content and focusing on learning. For example, he preferred wound drainage

pictures with different drainage during I was teaching him on different wound drainage. Patient

will be able to importance of taking tinzaparin and steps of injecting it after teaching sessions.

Included patient

Patient was involved through interventions. Interventions were made by discussion with patient

and patient was ready to complete them. Patient was told that I am going to teach about

tinzaparin, and he stated that he wants to have paper or some kind visuals while I am talking.

Patient was involved when repeated back the teachings and demonstrates the process of injecting

tinzaparin.

Prior knowledge

Patient had little knowledge about tinzaparin that it is blood thinner, but he did not know why he

is taking it. Patient stated,” why I am taking it”.

He said, “I am done with surgery why do I need it now?” Patient stated, “I have not done it

before, so I do not know how to do it?” Patient had deficient knowledge about anticoagulant.

Readiness to learn

Patient always shows the desire to learn even when I take his vital signs, he always asks is it

normal or anything wrong. His behavior is very cooperative when you ask him to repeat back the

information you told him. He will follow instructions told by nurses. I have found that early

morning he do not pay attention because of pain and fatigue caused by stiffness during night.
Otherwise, he listens to me and try to do all interventions. He has lot of patience to listen

everything and then ask questions that he has. His business is his main motivation to keep him

moving as he says,” I have to do work to keep myself fit and I have to get up and walk to do my

work.” Therefore, he feels good when he does things that contributes his better health.

NURSING DIAGNOSIS

Diagnosis: Deficient Knowledge related to lack of knowledge on why and how to use

anticoagulant tinzaparin as evidenced by patient stating, “I have not used it before and

why I am taking it?”

Assessments: 1. Major knee surgery with risks of blood clots

2. lack of knowledge on anticoagulant (do not know why I am taking it).

3. weak posterior tibial pulses.

4. Patient asking questions why I need tinzaparin.

5. patient scared to inject himself and asked one demonstration.

6. Patient aware of tinzaparin that it is blood thinner but confused on why he needs it.

Priority

“The need for safety was acknowledged as a basic human need by Abraham Maslow in his

'Hierarchy of Needs'. Safety needs represent the second tier in Maslow's hierarchy and these

needs include the security of body, of employment, of resources, of the morality of family, and

of health” (Komninos, 2019).

Because patient exhibit lack of knowledge on effective use of tinzaparin and prevention of blood

clots, he can face difficulties in reaching Maslow’s hierarchy of needs.

Smart goal:

The patient will be able to verbalize the importance of taking tinzaparin after surgery and

demonstrate the steps of injecting tinzaparin after two teaching session of 10 minutes during my

seven -hour shift.

Expected outcome:

The patient will be able to understand and verbalize the importance of taking tinzaparin and

demonstrates the procedure of injecting tinzaparin step by step with explanation after two

teaching sessions of 10 minutes during my seven -hour shift.

Teaching strategy 1:

” Cognitive learning includes all intellectual behaviors and requires thinking. In the hierarchy of

cognitive behavior, the simplest behavior is remembering, whereas the most complex is creating”

(Potter et al., 2019. P, 327).

I will verbalize to my patient that why needs to take tinzaparin injection of 4500 units daily for

15 days after surgery.

Importance of tinzaparin after surgery?

1. Tinzaparin prevents clotting, allowing normal blood flow through the arteries and veins.

Tinzaparin is used to prevent blood clots in adults after an operation. Prevent blood

clots in adults who have an increased risk of blood clots e.g., due to an acute illness with

limited mobility.

2. After having knee surgery, you have increased chances of blood clotting because knee

joint serves as main role in most of activities performed through legs. This surgery

impacts your mobility by making it very limited. Limited mobility affects circulation

blood circulation through body which will eventually lead to blood clots. Therefore,
 tinzaparin, which lasts longer is used to prevent those blood clots. Because these blood

clots can cause life threatening problems such as blockage in lungs.

Procedure of injecting Tinzaparin

1. Different sites for tinzaparin are stomach, thigh and back of the arm. But most preferred

site is stomach because it is easier to self-administer on abdominal area and the site has

enough fat tissue to have a skin fold in hand.

2. Have all supplies ready: tinzaparin 4500 units syringe, alcohol swab, paper, and pen to

write on which site are you injecting because you must rotate sites every day.

3. Make sure you are in position that you can easily see the site. If you are lying, have

pillow under head to elevate head or have sitting position.

4. Before cleaning the site take syringe out of the case and take orange thing beside needle

cap down and then clean the site which should be two fingers away from umbilicus.

5. Remove the grey coloured needle cap straight and take a good amount of fat tissue in

between your thumb and index finger.

6. Hold the syringe like dart and go straight into skin quickly and start injecting slowly to

avoid burning sensation.

7. After injecting all medication count to ten to make sure whole amount of medication is in

and release the skin fold with taking out syringe.

8. Put the syringe on near hard surface and bend it carefully with orange thing.

9. Discard the syringe in sharps container given in kit from hospital and when it is full take

it to the pharmacy.

(Potter et.al., 2019).

 Rationale: This learning domain provides the opportunity for the patient to listen, ask

questions, and ask to repeat the necessary things. Asking questions and having good

knowledge builds patient’s confident when practicing and performing skill on their own.

Teaching strategy 2:

“Psychomotor learning involves acquiring skills that require the integration of mental and

muscular activity” (Potter et al., 2019. P, 327).

I will demonstrate the whole procedure of injecting tinzaparin safely and effectively step by step

Infront of my patient and allow patient to participate in either by verbalizing some steps or by

asking questions to understand the process thoroughly.

1. Demonstration of all steps of injecting Tinzaparin safely

Rationale: Learning through visuals and proper demonstrations give a person more confidence

in behavior to perform or complete a complex procedure (Potter et.al., 2019).

Comprehension:

Cognitive learning: I will assess my patient’s understanding of topic content by verbally asking

short and valid questions to find out his proficiency in skill.

Psychomotor learning: I will ask my patient to demonstrate the procedure of injecting tinzaparin

safely to know patient’s capability of doing it independently at home.

Affective domain: Patient’s level of consciousness and orientation will be assessed before starting

teaching session to make sure that it is right time and mood for the patient to learn something.

Evaluation and reflection:

The smart goal was met as the patient was able to answer all the questions asked after teaching

session. Small quiz was fun for him because he stated” amazing I am having quiz after a long

time”. Patient was also able to do accurate demonstration of whole process safely and
confidently. Patient seemed excited while performing the skill because it was something new and

different for him to learn and do.

Strengths of plan: Teaching plan went well in this case because of cooperative patient and short

timings of teaching which is why patient did not feel bore or loose interest in learning. Patient

was involved in every teaching strategy to make session interesting.

Future adaptation: This plan will be used in future to teach other patients who prefer cognitive

and psychomotor learning domain

 Reference

Komninos, A. (2019). Safety: Maslow's hierarchy of needs. Retrieved from

https://www.interaction-design.org/literature/article/safety-maslow-s-hierarchy-of-needs

Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A. M., Astle, B. J., Duggleby, W. (Eds.).

(2019). Canadian fundamentals of nursing (6th ed.). Toronto, ON: Mosby/Elsevier

Canada.