NU 345 Unit 7 teaching plan for one person example

Teaching Plan: Independent Colostomy Care for a 62-Year-Old Man Before Discharge

Student Name

Department of Nursing, Herzing University

NU 345: Health Assessment and Promotion Across the Life Span

Instructor Name

March 3, 2026

Teaching Plan: Independent Colostomy Care for a 62-Year-Old Man Before Discharge

The Learner and His Readiness

Mr. D., a composite 62-year-old retired machinist, had an emergency sigmoid colectomy with an end colostomy for a perforated diverticulum three days ago. He lives with his wife, who has arthritis in her hands. He is expected to go home in three to four days. Readiness was assessed before any content was planned. What he knows: nothing about ostomies beyond seeing one on a relative. What he believes: "This bag is the end of my normal life. I won't be able to go fishing or see my grandkids without worrying." Whether he wants to learn now: on day two he would not look at the stoma; on day three he asked how long it would take to learn to change the bag. What might prevent learning: grief about his changed body, pain when he sits forward, reading glasses left at home, and the fact that his wife cannot manipulate small clips. His readiness has changed from avoidance to willingness, which is the point at which teaching can begin.

Learning Needs, Stated as Abilities

By discharge, Mr. D. will be able to: (1) empty the pouch into the toilet when it is one-third full, independently; (2) change the pouch and skin barrier, including measuring the stoma and cutting the barrier to size, with no more than verbal cues; (3) describe what a healthy stoma and surrounding skin look like and identify two signs that need a call to the nurse; (4) state which foods may cause gas or blockage and what to do if output stops; (5) name where to obtain supplies and who to call with questions. Each is written as something he will do or say, so that learning can be observed.

Methods Matched to the Learner

Adult learners are motivated by problems they need to solve and draw on their experience (Knowles et al., 2015). Mr. D. is a machinist who is used to working with his hands, following steps, and fitting parts precisely. Teaching therefore uses demonstration followed by his own practice, not lectures or pamphlets alone. Measuring the stoma and cutting the barrier is framed in terms he knows well: "It's like fitting a gasket; too tight and it rubs, too loose and it leaks." A one-page picture guide with large print is provided because his glasses are at home until his wife brings them. Each session is short, 15 to 20 minutes, scheduled after pain medication and before meals, when the pouch is less likely to be full.

Self-efficacy, a person's belief that he can carry out a behavior, predicts whether he will attempt it, and it grows most from successful practice (Bandura, 1977). The sessions are sequenced so that he succeeds early: emptying the pouch first, which is simple, then the full change.

Sequence of Sessions

Session 1, day three afternoon: the nurse empties the pouch while Mr. D. watches and describes each step; then he empties it with guidance. Session 2, day four morning: he empties the pouch alone; the nurse demonstrates a full pouch change while he watches and handles the supplies. Session 3, day four afternoon: he changes the pouch with the nurse guiding each step; his wife observes and practices emptying using an adapted closure she can manage with her hands. Session 4, day five: he changes the pouch alone while the nurse observes without helping; they review the skin, diet, and when to call. Session 5, day of discharge: final return demonstration, with the wound, ostomy, and continence nurse present to confirm the home supply order and the follow-up visit.

Addressing His Beliefs

Knowing how to change a pouch will not help if he believes his life is over. The nurse arranged a visit from a volunteer from the local ostomy association, a man in his 60s who fishes and travels with a colostomy, and talked with Mr. D. about returning to fishing, intimacy, and time with his grandchildren. He was also told that his colostomy may be reversible in several months, depending on his surgeon's assessment.

Evaluation

Learning is judged by performance, not by whether content was covered. Objectives 1 and 2 are evaluated by return demonstration in sessions 4 and 5, using a checklist. Objectives 3 to 5 are evaluated with teach-back, in which Mr. D. explains in his own words what he would do, which confirms understanding in a way that asking whether he has questions does not (Brega et al., 2015). If he cannot perform a step independently by discharge, home health nursing visits for ostomy care are arranged and the discharge teaching is documented as incomplete for that objective.

References

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191

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.; AHRQ Publication No. 15-0023-EF). Agency for Healthcare Research and Quality.

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.