# Situation: A 52-year-old delivery driver was diagnosed with type 2 diabetes mellitus 1 week ago. His glycated hemoglobin (HbA1c) is 8.4%, and he was started on metformin. He finished high school and reads well. He tells the nurse at the hospital's outpatient diabetes clinic, "My father had diabetes and lost a leg. I do not want that to happen to me." The nurse plans a series of teaching sessions for him. The nurse begins diet teaching by asking what he usually eats on a workday and then builds his meal plan from those same foods. A nursing student asks for the idea behind this approach. Which explanation should the nurse give?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630347  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 52-year-old delivery driver was diagnosed with type 2 diabetes mellitus 1 week ago. His glycated hemoglobin (HbA1c) is 8.4%, and he was started on metformin. He finished high school and reads well. He tells the nurse at the hospital's outpatient diabetes clinic, "My father had diabetes and lost a leg. I do not want that to happen to me." The nurse plans a series of teaching sessions for him.

The nurse begins diet teaching by asking what he usually eats on a workday and then builds his meal plan from those same foods. A nursing student asks for the idea behind this approach. Which explanation should the nurse give?

## 보기

1. Learners watch a model and copy the behavior they see rewarded
2. Learners respond to repeated cues until the habit is automatic
3. Learners set their own goals, and the nurse only facilitates
4. Learners link new ideas to what they already know and do **✔ 정답**

**정답: 4**

## 해설

Constructivist learning theory holds that learners build new knowledge on what they already know and do. Starting diet teaching from the foods he already eats connects new advice to familiar experience and makes it easier to use at work.

## 심화 해설

Core learning principle

The correct explanation is that learners connect new information to what they already know and do. This reflects constructivist learning theory, which views learning as an active process in which prior experience becomes the foundation for new understanding. In this case, the nurse begins by exploring the driver’s usual workday foods and then builds the meal plan from those same items. The new dietary advice is therefore anchored in familiar, personally meaningful routines rather than presented as an abstract or unfamiliar list of rules.

Why this matters in diabetes education

Type 2 diabetes mellitus requires sustained self-management across diet, physical activity, body weight, glucose monitoring, and medication-taking behaviors [1]. A delivery driver’s workday is structured around routes, breaks, and limited food access, so recommendations that ignore his existing eating pattern are unlikely to be followed. Starting from his current foods respects his context and reduces the cognitive burden of change. The nurse is not simply telling him what to eat; she is helping him translate general lifestyle advice into feasible, culturally acceptable, and safe daily routines [1].

Distinguishing the learning theories

| Option | Theory | Core idea | Why it does not fit |
| --- | --- | --- | --- |
| 1 | Social learning | Observation and imitation of a rewarded model | No model or observed reward is described in the teaching approach |
| 2 | Behaviorism | Repeated cues shape automatic habits | Focus is on stimulus-response repetition, not linking to prior knowledge |
| 3 | Humanism | Learner sets goals; nurse only facilitates | Nurse actively builds the meal plan from the patient’s foods, not passive facilitation |
| 4 | Constructivism | New ideas connect to existing knowledge and experience | Matches the nurse’s approach of starting from familiar foods |

Key point! The nurse is not abandoning clinical guidance. She still applies diabetes-specific principles such as carbohydrate distribution, portion control, and medication timing, but she introduces them through foods the patient already eats. This preserves the evidence base while making the plan usable in his daily work.

Watch out! Option 3 may sound appealing because patient-centered care is emphasized in nursing, but the scenario shows the nurse actively structuring the teaching from the patient’s current diet. That is a constructivist teaching move, not a purely facilitative one. The distinction lies in who builds the connection: the nurse deliberately links new advice to existing experience.

The patient’s statement about his father’s leg loss reveals strong motivation, but motivation alone does not guarantee behavior change. The constructivist approach works because it lowers the practical barrier between knowing what to do and actually doing it during a delivery shift.References (research sources)

- [1]Nurse-led behavioural support for lifestyle self-management in adults with type 2 diabetes mellitus: an integrative review.Research articleHan M, Pei Y. (2026) · DOI: 10.1186/s12912-026-05304-5

## 임상 시나리오

Constructivist Approach to Diabetes Diet TeachingBuilding new dietary habits on existing food routines
Start diet teaching by asking what the patient already eats on a typical workday, then modify those same foods rather than introducing an entirely new meal plan. This anchors new advice in familiar routines and makes it easier to follow during a delivery driver's unpredictable schedule.

Constructivist learning theory views learning as an active process where prior experience becomes the foundation for new understanding. The nurse helps the patient translate general lifestyle advice into feasible, personally meaningful daily choices.

CautionDo not replace the patient's entire diet with an abstract list of rules. Recommendations that ignore his existing eating pattern and work constraints are unlikely to be sustained. Address hypoglycemia risk if meal timing changes, especially with metformin and irregular work breaks.

## 핵심 개념

- **Constructivist Learning Theory** — A learning theory that learners actively build new knowledge by connecting new information to their existing knowledge and prior experiences.
- **HbA1c** — Glycated hemoglobin, a measure of average blood glucose over the past 2-3 months; used to diagnose and monitor diabetes.
- **Type 2 Diabetes Mellitus** — A chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency, requiring ongoing self-management.
- **Metformin** — First-line oral antihyperglycemic agent for type 2 diabetes that reduces hepatic glucose production and improves insulin sensitivity.
- **Self-Management Education** — A process of helping individuals with chronic conditions gain the knowledge, skills, and confidence to manage their condition daily.

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