Plan for Training

Patient Scenario

The target audience for the mentioned action is the patient named Jane (the pseudonym used to maintain confidentiality and privacy of the individual as mentioned by the NMC Code of conduct (NMC, 2018)). Jane is 3 weeks pregnant who is admitted to the A&E ward due to shortness of breath, chest pain and coughing out of blood-streaked sputum. Jane’s health history mentions she had cardiovascular disease and current health diagnosis lead to determine she is suffering from pulmonary embolism which has recently developed. In order to treat pulmonary embolism in pregnant condition, the only action to be performed is delivery of low molecular weight heparin that would not cause any damage or bleeding during pregnancy. Since Jane lives alone and is a single mother who has recently divorced his husband, she is to be taught the way to self-administer enoxaparin at home to overcome pulmonary embolism.

The study by Barton et al. (2018) mentions that inclusion of sole audience in training do not allow the nurse to learn regarding the positive aspect of team working and collaboration for improving patient outcome. However, it is argued by Santana et al. (2018) that the sole audience leads the nurses to effectively understand person-centred care is to be delivered where enhanced patient education could be focused in empowering them take their own decision as well as participate in care. The presence of single audience leads the nurses experience about the way to interact with each patient and understand the differences to be considered in communication as well as care delivery so that enhanced satisfaction of the patient could be attained (Moran et al., 2018). Thus, it indicates that Jane requires person-centred care to get empowered in takin their own decision due to which she is to be the sole audience in the lesson plan.

Verbal/Practical/ Visual

Jane mentioned to previously involved in administering insulin through insulin pen to her mom when she was alive. This indicates that Jane is not new to the injection training but requires additional support to learn regarding the way self-injection is to be performed with syringe without hesitation and fear. I adopted the Cognitive Learning theory for teaching and training Jane due to its dynamics of making individual improve their existing knowledge to perform action more effectively at present as well as in future (McGaghie and Harris, 2018). The theory helps to make a person understand the reason for learning a certain action and assist in developing deep knowledge of the new information by relating it with the previous information (Stretton et al., 2018). Since Jane has existing information regarding injection delivered to his mother, she may be sceptic to avoid further learning the action. However, through cognitive learning theory she can understand the way new information is required to be understood for enhancing his required improvement in existing skills.

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The teaching methods range from verbal and practical to visual approach. The approaches are used in facilitating learning and each of them has different positive influences in supporting enhanced learning (Immonen et al., 2022). In case of Jane, I implemented the verbal and practical teaching method in facilitating the learning needs and objectives lined to be fulfilled. This is because verbal method in training helps individuals transfer informative instructions to the learners so that they understand the skills and knowledge required in practically executing the task (Van de Wiel, 2017). In contrast, the practical teaching method helps individuals to observe and performed the learned task in mimicked or real-life environments (Mento et al., 2020). Thus, the combination of both approach would lead Jane to understand the reason and way of performing self-administration of enoxaparin through injection without fear or confusion. This is because she would have theoretical information as well as the assistance of practical observation in executing the task in real-life condition.

Patient Bed side

In clinical teaching environment, bedside education is realistic as it promotes person-centred and active participation of the patient in the learning process (Schooley et al., 2020). It is argued by Dreiling et al. (2017) that avoiding bedside teaching leads the nurses to wait for room availability which may not always be present, in turn, creating space and time barrier for the patient. Since Jane was prepared to be discharged from the hospital, bedside teaching was effective as it avoided making delay in the process out of lack of availability of separate room or space in the hospital settings. In delivering teaching by patient bedside, the common obstacles to be faced in interruption from other patients and breach of confidentiality of the patient. This is because bedside training may make nurses to be interrupted by other patients in the ward to provide them care and overhear conversation of the target patient by others (Lau et al., 2017). However, the current training was regarding injection delivery to self, thus the concerns for confidentiality is low as in the process no vital personal information are shared in the room and the conversation is kept strictly near to the patient. In addition, to avoid interference by other patients, communication with other nurses in the ward could be made so that they remain actively aware of the nurse’s duty of educating a patient and support the individual by avoid interference by dividing the roles and responsibilities for the time (Stone et al., 2017).

In care procedure, the self-introduction of the nurses along with compassionate as well as empathetic way of interaction support in establishing a communicative and trustful environment for the patient. This is because the patient remains aware of the nurse who is taking their care and understand they value their needs as well as health condition to be improved leading to pave way for development of the therapeutic relationship (Torous and Hsin, 2018). Thus, I self-introduced myself to Jane and communicated in a compassionate as well as empathetic way in developing trusted therapeutic relationship. According to NMC Code of Conduct, the nurses are to seek consent regarding each delivery of care so that patient’s rights and dignity is always respected (NMC, 2018). As argued by Loeff and Shakhsheer (2021), failure to access consent of care from patients leads to misconduct by the nurses. This is because providing care beyond consent leads the care considered to be irrational and forceful at times. Thus, consent from Jane was taken in the language she understands regarding her participation to being trained for self-administration of enoxaparin.

Implication, benefits and side-effects of Enoxaparin

Jane was provided brief explanation of the purpose and mechanism of action of enoxaparin. She was informed that enoxaparin is low molecular weight heparin that assist in dissolving blood clots in the pulmonary area. It binds with the antithrombin which is circulating anti-coagulant to develop a complex that inactive the clotting factor Xa irreversibly assist in dissolving and avoiding blood clots (Ząbczyk et al., 2020). In pregnancy, enoxaparin is preferred to be used than unfractioned heparin as the later leads to develop heparin-induced thrombocytopenia and osteoporosis (Martinelli et al., 2020). She mentioned regarding alternative of any form of oral medication if available for the condition. The heparin could not be orally provided as its size and polytonic charge makes it incapable to be absorbed in the body and injecting drugs subcutaneously in pregnancy helps in avoiding the medication to overcome placental barrier and each the baby to cause any damage (Doherty, 2017). Thus, the comparative benefits of enoxaparin are mentioned to Jane to inform her the reason of the medication been preferred over others and reason to be taken only through injection. The information led Jane to verbally provide consent in learning way of injecting enoxaparin.

Jane expressed no fear regarding syringe or needle for self-injection as she mentioned she has accepted various injections before due to cardiovascular issue in the hospital. However, she expressed slight anxiety and nervousness in self-inserting the needle on the body to administer enoxaparin. The issues were coped by making her learn deep breathing and counting while inserting injection in the body to administer the medication. Since Jane has no family members at the present to help her in the act, thus a social worker was recruited for the time being who could visit her for the first two to three weeks to make her develop expertise in self-injection technique.

Leaflet and Visual guide

An informative pictorial leaflet along with an explanation video showing the self-injection process is shared with Jane to help her visualise and remember the actions to perform self-injection of enoxaparin. This is because the leaflet and video also act as a reference to personally learn the action without the repeated need of nurses to be practically present in supporting the administration of medication (Habibzadeh et al., 2018). As mentioned by Al-Naimi et al. (2021), the presence of a pictorial leaflet along with straightforward video illustration helps in creating a reciprocal interpretation of the facts. The reciprocal interaction is regarded as enhanced way of information sharing through explanation and recapping of the training session for the patient. Thus, verbal video presentation with informative leaflet was provided to jane.

Patient demonstration of enoxaparin injection

In case of Jane, I as a student nurse assessed her confidence level and competency in performing the injection training to examine her learning level. This is executed to fulfil my role as a nurse in patient education which mentioned that aim in the process include effective promotion of patient empowerment, medication education, and self-care along with independence efficiency in patients (Reynolds et al., 2020). Jane’s self-efficacy has effective influence on her positive outcome of health. In order to evaluate Jane’s self-efficacy, her ability to demonstrate the mentioned objectives are evaluated. The evaluation mentioned she expressed positive ability in performing self-injection of enoxaparin which is evident from her behavioral capability represented by overcoming emotional and physical barrier identified during the learning process. In case any performance outcome was determined to be negative, time was allocated to reeducate Jane regarding the aspect to improve his self-efficacy of self-injection.

Recapping Training

The recapping of training involves revising the achieved learning and evaluating the learning level of Jane to understand her improvement in knowledge regarding self-injection. The recapping of the training is directed towards Jane where through communicative learning and interaction each point educated during the process are asked to be answered by the patient. As asserted by Yasin et al. (2019), questioning strategy is effective learning way in determining learning efficiency of individuals. This is because it helps the individual reiterate the lesson learned, in turn, contributing to improve their confidence in executing the learned action. In addition, recapping training is important to determine that all the objectives are holistically and accurately fullfed and they are not just ticked boxes (Yasin et al., 2019). As argued by Reda et al. (2021), dissatisfaction regarding medication communication have negative effect on the patient’s efficiency in performing administration of medication. This is because they show confusion regarding the learned actions to be executed. Thus, recapping is essential for ensuring enhanced medication compliance by the patients. Moreover, it proves that lesion plans, and objectives are effectively achieved, and the training is successfully delivered.

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