NUR 545 Module 9 Final Project Example

Final Project: A Health Literacy-Informed Assessment and Teaching Plan for a Night-Shift Worker With New Type 2 Diabetes

[Student Name]

Southern New Hampshire University

NUR 545: Advanced Health and Literacy Assessment

Final Project

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Final Project: A Health Literacy-Informed Assessment and Teaching Plan for a Night-Shift Worker With New Type 2 Diabetes

Earlier assignments assessed this patient piece by piece: a history, a focused examination, a teach-back session and a handout. This final project joins them into a single assessment and teaching plan. It summarizes the clinical findings, sets out a literacy profile, prioritizes learning needs and describes a three-visit plan, then evaluates the plan against what happened at follow-up. The project shows that the patient's limited numeracy and night-shift schedule, not his diagnosis, determined the shape of every teaching decision, and that a plan built on a few demonstrated actions produced correct self-care within two weeks where a written plan would likely have failed.

Assessment Summary

Table 1 condenses the assessment into the findings that shape teaching.

Table 1

Assessment Findings Relevant to Teaching

Note. Composite patient.

Literacy Profile

The patient reads short, familiar text but reported often needing help with written health materials, and he answered two of six questions correctly on the Newest Vital Sign, missing every item that required calculation. In the tool's validation, fewer than four correct answers signaled possible limited literacy (Weiss et al., 2005). The practical profile is specific: he can read a label, but he cannot comfortably turn a number into a decision. Limited health literacy is associated with poorer ability to take medications correctly and with more hospital and emergency use (Berkman et al., 2011), so the profile carries real risk. The plan therefore avoids arithmetic entirely, relies on demonstration and uses color and routine in place of numbers.

Prioritized Learning Needs

Needs were ranked by immediate safety first, then by long-term benefit. Table 2 turns each into an objective, a method and an evaluation.

Table 2

Learning Needs, Objectives, Methods and Evaluation

The Three-Visit Plan

Teaching was spread across three visits so that no session asked him to learn more than three things. Visit one, at diagnosis, covered priorities 1 to 3 with the teach-back script and the color card. Visit two, at two weeks, reviews those skills, addresses drinks and the work meal using photographs of what the vending area actually sells and introduces his referral to diabetes self-management education and support. Visit three, at six weeks, adds daily foot checks and confirms the eye examination. National standards recommend self-management education at diagnosis and at other key points in the course of diabetes, and the referral requested a program offering small-group, hands-on sessions rather than lectures (American Diabetes Association Professional Practice Committee, 2025). His daughter joins by his choice, but every skill is taught to him, since he manages his diabetes at work at 3 a.m. without her.

Two workplace details were addressed directly. He needed permission to check his glucose at his meal break, which the employer health nurse arranged, and a place to keep the meter; he chose his lunch bag. These small arrangements made the plan possible.

Two-Week Results

At the two-week visit, the plan was evaluated against each objective. He brought his card with six entries, all from before his work meal. He performed a glucose check without error, washing his hands first unprompted. Asked when he takes each tablet, he pointed to the picture schedule and answered correctly. His pre-meal readings were in the yellow band, averaging about 158 mg/dL, which was expected at this stage, and he had not needed to call. Blood pressure was 136/84 mm Hg. He had replaced both sodas with water on most nights.

One part had not worked. The metformin had caused loose stools for the first week, and on two nights he skipped it. Teach-back uncovered this only when he was asked to describe his week rather than whether he had taken the tablets. The dose was held at 500 mg for another two weeks before increasing, and he was told that the stomach upset usually settles. This finding supports the evidence that teach-back and open questions reveal problems that closed questions miss (Talevski et al., 2020).

Limitations

The plan has limits. It is designed around one patient's schedule and would need adapting for others. Two weeks is too short to judge glycemic control, which will be assessed with a repeat A1C at three months. The color card depends on the meter's range being set correctly and on his continuing to use the same meter. Finally, the plan relies on a supportive employer; a change of job or shift would require it to be rebuilt.

Conclusion

This patient's diabetes plan was shaped less by the disease than by the person: a night-shift worker who reads short text, cannot comfortably use numbers and learns by being shown. By limiting each visit to a few actions, tying each to his work night, replacing numbers with colors and checking every skill with teach-back, the plan produced correct self-care within two weeks and revealed the one problem, a skipped tablet, that a written plan would have hidden. The approach follows the universal precautions principle that clear communication should not depend on a patient admitting difficulty (Brega et al., 2015), and it is the approach this course was designed to teach.

References

American Diabetes Association Professional Practice Committee. (2025). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes 2025. Diabetes Care, 48(Suppl. 1), S86-S127. https://doi.org/10.2337/dc25-S005

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005

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.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522. https://doi.org/10.1370/afm.405