Learn & teach 9

Patient scenario Patient: Alexander Ramirez, 58 Setting: Medical-surgical unit preparing for discharge tomorrow Diagnosis: Type 2 diabetes mellitus (T2DM) with new basalbolus insulin regimen; diabetic neuropathy; mild non-proliferative retinopathy; hypertension; hyperlipidemia Recent clinical data A1c: 9.8% FBS range this admission: 180260 mg/dL BP: 146/84; BMI: 31 eGFR: 65 mL/min/1.73m2 No formal diabetes education in past 10 years Social/health literacy context Primary language: Spanish; understands basic conversational English Work: Overnight custodian (10 pm6 am), sleeps days Tech: Flip phone (no apps); limited internet access Vision: Needs large print; difficulty reading small labels Health literacy screen (Newest Vital Sign style): 1/6 high likelihood of limited literacy Numeracy: States, Im not good with numbers. Beliefs: Uses cinnamon tea for sugar; concerned insulin means my diabetes got worse Resources: Lives with adult granddaughter who speaks English/Spanish and cooks; tight budget; uses public transit; has a shared fridge space Readiness to learn (010): 5/10, ambivalent; worried about injections Discharge priorities (2448 hrs) Safely draw up and inject insulin; rotate sites Time doses with night-shift schedule Recognize and treat hypoglycemia Basic carbohydrate awareness and plate method Storage of insulin with limited fridge space Plan follow-up with diabetes educator/clinic Available resources today Certified medical interpreter (in person or video) Diabetes demo kit (insulin pens, saline pen for practice), large-print pictorial handouts (English/Spanish) Glucose tablets, meter with voice prompt option Granddaughter can attend teaching for 30 minutes this afternoon You have 20 minutes now and 15 minutes tomorrow morning before discharge Answer the following: Prioritize 2 SMART teaching goals (Refer to Chapter 10 p. 449, table 10-4 in Bastable) for the next 2448 hours. Select 3 teaching methods/strategies that best fit Mr. Ramirezs situation.