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Jan 28, 2019 in Nursing

Genetics, Pathophysiology, and Pharmacology for Professional Nursing Essay

A Teaching Plan for Down’s Syndrome

Abstract

This paper explores the dynamics of health education and teaching. By preparing a teaching plan to be used for passing information to the parents of a child with Down syndrome, the writing highlights the factors that should be considered in the teaching process. Down syndrome may be a new issue to the parents and the family, and depending on the culture, various perceptions and misconceptions may exist. The teaching plan, therefore, addresses these issues to ensure that the parents receive the correct information without ambiguity or myths. For this to happen, the existing information from the parents must first be clarified and the knowledge gap identified. This will then result to the setting of clear and specific teaching objectives that will guide the process. This paper aims at designing a teaching plan to be used in providing education to parents of a child with Down syndrome. The teaching plan will first assess the entry knowledge of the parents and hence identify their learning needs. This will lead to the development of learning objectives and implementation of a learning strategy appropriate for the objectives. Evaluation of the process will then follow. The areas explored in the teaching plan are infant care at home, breastfeeding assistance, psychological care for parents, genetic counselling, and cultural consideration.

Keywords: Down syndrome, health education and teaching

Introduction

Down syndrome is a genetic disorder affecting many children in the world. The condition involves a chromosomal defect, where there is an extra chromosome number 21. There are three types of Down syndrome (Nehring, 2010). The most common (95%) is trisomy-21, where an extra chromosome 21 is present. Tans’-locational Down’s syndrome involves an extra chromosome 21 that occurs alone, its represent 3% of all Down syndrome cases (Nehring, 2010). The third type is the Mosaic Down’s syndrome in which the extra chromosome is only present in some cells and its occurrence is 2%. The signs and symptoms of this condition are present at birth and include flattened nose, small limbs, sticking out tongue, small ears, and short neck among others. The incident rate of Down syndrome in the United States is one in every 700 births. Consequently, there are more than 6,000 children born with the condition every year. Caring for a child with Down syndrome is challenging and requires support. The parents are first struck by the diagnosis and, in most cases, lack the knowledge concerning the care of these children. This kind of education should be provided by the healthcare professional (Jahromi, Gulsrud & Kasari, 2008). It is a professional requirement and a duty.

For effective learning to take place, several factors must be considered. First, the instructor must identify what the learner already knows regarding the topic, and then, identify what more is required to build on this. The learning, however, should be focused on what the learner perceives as they needed. Second, the needs ought to be prioritized depending on the learners’ concern and a teacher selects a suitable style to address the needs. The teacher will then provide the information systematically stressing the main points, finally evaluate the learning experience, and obtain feedback. 

Assessing Current Knowledge

The entry behavior of any learner is important to consider. For this reason, the learning will be built on the existing knowledge. In this case, the parents should be engaged in the process and asked how much they know about Down syndrome. The question should be focused on the areas of infant care and feeding, the mode of occurrence of the condition and the diagnosis and treatment. With respect to this, the nurse is to identify issues related to the lack of information and possible cultural myths and misconceptions.

Assessing the Learning Needs

From the assessment of current knowledge, it is now possible to identify the learning needs of these parents. This condition will lead to outlining of the objectives. This process  will require disqualifying any misconceptions and clarifying any myths that the parents might have. In this case, the task of the nurse is to explain in simple language the details of the condition and its occurrence. As a result, it will be possible for the parents to display concerns about the issue as an embodiment of their felt needs, which are to be what the main focus of teaching. In this way, the objectives of the teaching should be identified and prioritized.

Setting and Prioritizing Objectives

Newborn Care at Home 

First, it is necessary to inquire about what the parents know about the care of infants with Down syndrome. This knowledge can be from neighbors who have such children or from the media. This information may not be accurate, but it is crucial in assessing the entry behavior. Thus, the following items are to be included in the teaching:

  • The care of infants with Down syndrome is not very different from normal infant care;
  • There should not be discrimination from other children since the condition is not contagious;
  • Prevention of infant infections ought to be taken more seriously for infants with Down syndrome;
  • The parents are to connect with other couples with a child having similar diagnosis and share experiences and information.

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Breastfeeding Assistance 

Explaination of the general benefits of breastfeeding infants, stressing on the specific importance in infants with Down syndrome, the prevention of infections, and proper growth. Mother’s milk is the natural and the best source of nutrition and protection from diseases. Clarification of the breastfeeding difficulties associated with Down syndrome, such as a child having weak sucking reflex, hence getting tired easily, and has a weak mouth to nipple attachment. The mother should observe from the baby’s elimination pattern to ascertain that one gets enough breast milk. Advice ought to be made regarding the importance of having frequent, persistent and supported breastfeeding to ensure that the infant gets enough breast milk.

Elaborate the alternative to suckling, expressed breast milk, in case the child does not get enough from suckling. However, breastfeeding should be stressed as the best feeding method. Statistics show that babies who are not breastfed have a 3-fold risk of suffering from diarrhea and other infections in infancy.

Concerning the probability of having another child with Down syndrome, the nurse is to explain to the parents that there is a high risk for them to have a similar situation and provide information on the carrier concept on genetic conditions. The likelihood is more if the mother is the carrier (12%) as compared to the father being the carrier of the gene defect (3%). This clarification ought to be followed by a directive on the importance of genetic counseling before considering another pregnancy.

The couple will also require information with repect to the diagnostic testing for them. The nurse will have to explain the difference between screening and diagnostic testing. The available blood tests should be detailed to the clients.Tests such as chorionic villi sampling and amniocentesis are to be used specifically to test for Down syndrome during pregnancy. The parents will have to undergo genetic screening, where their blood samples are taken and gene mapping performed to screen for an extra chromosome. Other chromosomal abnormalities can also be screened similarly. The accessibility of these services and the estimated cost ought to be explained.

The nurse should teach on the expected hardships in bringing up these children (Jahromi, Gulsrud & Kasari, 2008). This circumstance requires the medicalpractititoner to help the parents understand the cognitive and psychomotor limitations of the child, and therefore, assist one to develop to the highest level of one’s capability. This approach is aimed at alleviating anxiety and any psychological trauma. The available psychological support methods, including group therapy, genetic counseling, and individual family therapy should be explored. 

 
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From the myths highlighted by the parents, the nurse is to realize the cultural considerations of the couple. Their perception towards the genetic condition and care will help identify the issues for teaching. Correct information will be provided to clear off myths and rumors. From the Bosnian tradition, the responsibility of childcare is the woman’s duty. Thus, teaching ought to focus on ensuring that the care of this child is considered special and requires both parents’ involvement. There is a necessity to emphasize as much as possible on collaborative care of the parents and the whole family (Chang & Kelly, 2007).

Learning Strategies

According to Chang and Kelly (2007), patient teaching requires a variety of learning strategies. Lectures will provide the specific points regarding the condition such as explaining the occurrence and signs and symptoms. Trainings should be arranged in simple and easy to comprehand language. For the lecture, only the facts about the condition are to be given. Discussions will help in clarification of the parents’ level of knowledge on the issue and revealing the general perception of the disease (Buckley & Sacks, 2001). This circumstance will entail questionings and a good communication atmosphere will be established. The discussion will go hand in hand with active listening skills.

Demonstration will be helpful, especially on the topic of breastfeeding. The nurse will have to demonstrate the infant attachment to the breast and support the mother should give the child during breastfeeding. Breast milk expressing will also require demonstration. Charts and pictures will be applied for information regarding the genetic factors with respect to disease, be explained in simple and understandable terms. Breastfeeding charts will also be given as illustrative material. Other audiovisual aids will help in information retention as well (Chang & Kelly, 2007). Videos concerning breastfeeding and the specified care required for a Down syndromechild are to be found as a means to visualization of the message conveyed. A useful source of information on the topic can be found on the official website of the Down Syndrome Association (http://www.downs-syndrome.org.uk). 

Evaluation of the Learning Activity

The learning activity will require knowledge evaluation in order to establish the effectiveness and help planning the activities for further teaching or referrals. The evaluation will be done through questioning to assess how much the parents have understood and retained. These questions will be addressed to both the topic and the application of the knowledge gained in general life situations. For instance, the nurse may ask the mother to do a return demonstration on baby’s positioning, and evaluate and give constructive feedback to her. Moreover, the parents will be encouraged to ask any questions and the medical practitioner will provide accurate answers. The teaching should be reinforced through issuing of pamphlets and informational brochures where all the necessary material on the topic can be found.  The brochures have to be obtained from an authoritative source. What ismore, the information should also be highlighted in a language appropriate for the parents’ comprehension.

The teaching should be summarized by stressing on the main points of the lesson and giving a simple take-home message, emphasizing that Down syndrome is not contagious and the child should be cared for just like any other child, but an adequate family support is required. A document regarding the completation of the teaching process has to be presented to help in ensuring that there is continuity of care. In case the family needed more information, another healthcare provider will not have to start over again (Weiss et al., 2008).

Conclusion

Teaching requires serious planning to ensure that learning takes place. The learner must have a starting point. This has to be identified before commencing on the teaching. For this reason, the lecturer will seek to build a lesson on this circumstance. Using multiple strategies in teaching assists in reinforcing the learning and information retention. When the learner is evaluated through return demonstrations and questioning, the teacher obtains feedback and can use this to further explaination of some points or changing the teaching method.

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