Chapter 26: Teaching Clients
A patient with attention deficit disorder is admitted to the hospital with type 1 diabetes. Which nursing diagnosis is commonly yet inappropriately used but should be avoided for this type of patient? Assume there are data to support all the diagnoses. 1) Deficient Knowledge (disease process) 2) Impaired ability to learn related to fear and anxiety 3) Difficulty learning related to cognitive developmental level 4) Lack of motivation to learn related to feelings of powerlessness
1) Deficient Knowledge (disease process) Patients who have a learning disability should not have an identified nursing diagnosis of Deficient Knowledge; instead, they should have a diagnosis that accurately identifies their problem, such as Impaired Ability to Learn related to Fear and Anxiety; Difficulty Learning related to Delayed Cognitive Development; or Lack of Motivation to Learn related to Feelings of Powerlessness. Note that these are not NANDA-I diagnoses. KEY: Nursing process: Diagnosis
Prior to discharge, a patient with diabetes needs to learn how to check a finger-stick blood sugar before taking insulin. Which action will best help the patient remember proper technique? 1) Encouraging the patient to check the blood sugar each time the nurse gives insulin 2) Providing feedback after the patient takes his blood sugar for the first time 3) Verbally instructing the patient about how to obtain a finger-stick blood sugar 4) Offering a brochure that describes the technique for checking blood sugar
1) Encouraging the patient to check the blood sugar each time the nurse gives insulin Having the patient check the finger-stick with the nurse each time insulin is administered is the best way to practice the correct technique and gain confidence prior to discharge. Repetition increases the likelihood that the patient will retain information and incorporate it into the daily management of his diabetes care. Although feedback is important, the patient might need it on more than one occasion. Verbal instructions for performing a new skill are most useful when the patient has an opportunity to perform the technique. A brochure is informative and useful for later reference; however, information about performing a new skill is best offered when the patient can see it demonstrated and has the opportunity to practice it with feedback from the nurse. KEY: Nursing process: Interventions
Which intervention by the nurse would be best to motivate a patient newly diagnosed with hypertension to learn about the prescribed treatment plan? 1) Explain that when left untreated, hypertension may lead to stroke. 2) Ask the patient to let you know when he is ready to learn. 3) Encourage the patient to learn about various treatment options. 4) Reassure the patient that adhering to the treatment produces a good outcome.
1) Explain that when left untreated, hypertension may lead to stroke. A patient newly diagnosed with hypertension may not be motivated to learn because he most likely has not experienced physical symptoms or other outward complications. Therefore, the nurse should motivate the patient by pointing out serious risks to the quality of life if the blood pressure control is not achieved. Although readiness to learn is an important consideration, treatment might be delayed too long if the patient does not appropriately perceive the immediacy of the health risk. Simply encouraging a patient to learn about blood pressure and treatment options might not be suitable motivation to engage in active learning and to comply with prescribed treatment. Reassuring the patient and promising a good outcome by complying with medical treatment is not appropriate. Adhering to medical therapy reduces the risk for stroke and other complications; however, this cannot be guaranteed. KEY: Nursing process: Interventions
2. A preschool-age child is scheduled for a tonsillectomy. Which strategy might help lessen the child's anxiety before surgery? 1) Show the child a short, animated video (DVD) about the hospital visit and procedure. 2) Give the child a tour of the hospital a week before the surgery is scheduled. 3) Allow the child to use computer-assisted instruction to teach him about the procedure. 4) Provide one-to-one instruction about the care he will need after surgery.
1) Show the child a short, animated video (DVD) about the hospital visit and procedure. To reduce anxiety in a preschool-age child requiring surgery, show a short, animated video showing the area of the hospital where the child will be. The video should include a simple explanation of what is going to happen while he is in the hospital and afterward in a manner that is upbeat and friendly. A tour of the hospital with the sights and smells of sicker people might be more frightening to the young child. It is best to avoid exposure to pathogens before surgery, such as what could be acquired when touring the building. One-to-one instruction is a teaching strategy that is effective with adults and older children. KEY: Nursing process: Interventions
During family therapy, to improve communication skills the nurse teaches family members to rehearse responses to situations involving interpersonal conflict. What is the primary drawback of using this teaching strategy? 1) Some people might have difficulty with an interactive approach when there is conflict among participants. 2) Nurses might rehearse responses that are not effective for resolving interpersonal conflict. 3) Nurses do not use the rehearsal technique because it is an inefficient use of time for participants. 4) This type of interactive teaching strategy is not as effective as dispersing information verbally or in print.
1) Some people might have difficulty with an interactive approach when there is conflict among participants. The teaching strategy described is role-playing. Role-playing may cause participants to feel self-conscious; to be effective, participants must be willing to participate as an observer or role player, particularly in a situation where there is conflict among those involved in the exercise. With role-playing, the participant may be unaware that teaching is occurring. The strategy can therefore be a productive use of time while modeling effective responses and desired behavior. Rehearsing real-life situations common to family dynamics is typically more effective for conflict resolution than reading about the topic or discussing approaches for effective communication. KEY: Nursing process: Evaluation
Which teaching strategy is typically most effective for presenting information to large groups? 1) Distributing printed materials 2) Lecturing using audiovisual format 3) Providing online sources of information 4) Role modeling
2) Lecturing using audiovisual format Lecturing using audiovisual materials appeals to learners who best process information by hearing and seeing. From a practical point of view, a lecture format (traditional classroom or webinar) is efficient and effective with large groups. Although printed materials can help to reinforce information taught during a lecture, this can be problematic for auditory learners or those whose primary spoken language is not English. Online sources of information are ideal for learners who learn best by doing (kinesthetic learners). Role modeling is most effective for individuals or small groups of learners, especially when the relationship between the instructor and learner is meaningful. KEY: Nursing process: Interventions
How can the nurse best provide teaching for a patient whose primary spoken language is not the same as hers? 1) Provide written materials in the patient's primary language. 2) Make arrangements to teach using an interpreter. 3) Provide a demonstration and request a return demonstration. 4) Use visual teaching aids to convey information.
2) Make arrangements to teach using an interpreter. The nurse can best provide teaching for the patient whose primary spoken language is not the same as her own by requesting the aid of an interpreter. An interpreter can help the nurse to communicate clearly and accurately when assessing learning needs; dispersing the information; providing feedback to learners; and determining if teaching is effective. An interpreter also allows the patient to ask questions when necessary and the healthcare provider to respond with meaningful information. Written materials in the patient's primary language can help reinforce teaching. Demonstrating and requesting a return demonstration may be difficult if the patient does not understand the spoken language of the nurse. Visual aids may also be helpful for some learners, but they should not be the primary method for teaching because they do not offer an opportunity for the exchange of information through questions, demonstration, or discussion. KEY: Nursing process: Interventions
The nurse manager is devising a teaching schedule for the staff who are about to begin using a new type of patient bed in the ICU. Implementation is planned in 6 weeks. When is the best time for the manager to schedule the teaching sessions? 1) Immediately 2) One week before implementation 3) Two weeks before implementation 4) Four weeks before implementation
2) One week before implementation People retain information better when they have the opportunity to use it soon after it is presented. Therefore, the nurse manager should schedule teaching sessions 1 week before implementation of the equipment. If classes are scheduled too early, the nurses might forget how to use the equipment before it is implemented. If the teaching is offered immediately prior to use with patients, there would not be an adequate opportunity to practice skills and ask appropriate questions regarding use of the new device. KEY: Nursing process: Planning
For which patient is the nursing diagnosis Deficient Knowledge most appropriate? 1) Adolescent with Down syndrome and newly diagnosed with cardiac problem 2) Young adult admitted with acute renal failure who requires hemodialysis 3) Middle-aged woman with breast cancer receiving the last round of chemotherapy 4) Older adult with a long-standing history of type 1 diabetes admitted with a foot ulcer
2) Young adult admitted with acute renal failure who requires hemodialysis The young adult patient admitted with acute renal failure who needs hemodialysis will probably have Deficient Knowledge related to his treatment regimen. Patients with chronic illness, such as diabetes or cancer, are most likely to be knowledgeable about the disease and course of treatment; therefore, the nursing diagnosis Deficient Knowledge is less relevant than it is to a patient who is newly diagnosed. The adolescent patient with Down syndrome would have a nursing diagnosis of Impaired Ability to Learn. KEY: Nursing process: Diagnosis
A patient with a diabetic foot ulcer will need to perform dressing changes after discharge. When should the nurse schedule the teaching session(s)? 1)Within 10 minutes after his next dose of oral pain medication 2)After the patient wakes up from a restful nap 3) Before the surgeon débrides the wound 4) Before the patient undergoes flow studies of his affected leg
2)After the patient wakes up from a restful nap For learning to be most effective, teaching must occur when the patient is most ready. A patient's capacity to take in new information is reduced when he is anxious, in this example about testing or treatment, or is tired, or is experiencing pain. Therefore, the best time to teach this patient is when he is rested, such as after a restful nap. Ten minutes is not enough time for oral medication to take effect and relieve pain. KEY: Nursing process: Planning
An older adult patient who underwent bowel resection is recovering from surgery without complication. He ambulates in the hallway and requires little analgesia for pain. During the healthcare team's morning rounds, the surgeon informs the patient that the lesion removed was cancerous. Which factor will likely be the patient's most significant obstacle for learning? 1) The patient's baseline physical condition 2) A negative environmental influence 3) Anxiety associated with the new diagnosis 4) Reduced ability to understand the diagnosis
3) Anxiety associated with the new diagnosis Anxiety associated with the new diagnosis of cancer will most likely be a barrier to learning in this patient. Fear of the unknown, fear of pain, fear of physical discomfort with treatment options, fear of altered role in home or work life, and many other fears accompany the anxiety patients often experience when potentially life-threatening diagnoses are communicated. The patient has been ambulating and requiring minimal amount of pain medication; therefore, his physical condition is probably not the most significant barrier to learning. Simply because the patient is an older adult does not suggest he has reduced capacity to learn. KEY: Nursing process: Planning
Assume all of the following written instructions about digoxin provide correct information for patient care. Which one is best worded for patient understanding? 1) Obtain your radial pulse every morning before taking your digoxin dose. 2) Return to your healthcare provider for monthly laboratory studies of your digoxin levels. 3) Call your provider if you notice that objects look yellow or green. 4) Always take the same brand of medication because certain brands may not be interchangeable.
3) Call your provider if you notice that objects look yellow or green. The nurse should provide written instructions that contain short sentences and easy-to-read words. If instructions are written at too high a reading level, the patient may not understand and make a harmful error in dosing. Calling the provider when objects look yellow or green is the clearest statement for patient teaching because the instruction is short, concrete, and written with easy-to-understand words. Patient instructions must not contain words that require a higher level of reading or medical jargon. The instruction pertaining to being consistent with brand use is too wordy, especially for patients who are ill or for whom English is not a primary language. KEY: Nursing process: Interventions
Which teaching technique is best for teaching a nursing assistant how to perform finger-stick glucose testing? 1)Provide a manufacturer's pamphlet with detailed instruction. 2)Explain the best technique for performing glucose testing. 3) Demonstrate the procedure; then ask for a return demonstration. 4) Suggest that the assistant watch a DVD showing the procedure.
3) Demonstrate the procedure; then ask for a return demonstration. The best way to teach a psychomotor skill is to demonstrate the procedure and then ask for a return demonstration. Supplementary written information or DVD can also be supplied to the patient to reinforce learning. However, they are not the best method for teaching a psychomotor skill; enacting the procedure is more effective. KEY: Nursing process: Interventions
It is a busy day on the medical-surgical floor, and the nurse must teach a patient ready for discharge about his medications. How can the nurse most efficiently utilize her time and provide this education? 1) Write down instructions so the patient can read them at home. 2) Discuss the information while assisting the patient with his bath. 3) Educate the patient about his medications as each one is given. 4) Follow up with the patient after discharge with a phone call.
3) Educate the patient about his medications as each one is given. Teaching does not have to be performed in a formal session but is often most effective at a teachable moment when the information is perceived as most relevant, such as at the time the medication is given to the patient. Additionally, the information is more memorable when the patient can see the actual dose and identify it with the information presented. A teaching session about wound care would be appropriate during bathing but not medication teaching. Providing the patient written instructions without discussing the information does not allow the patient an opportunity to ask questions or the nurse to verify the patient understands the instruction. The patient should not be discharged without education about his prescribed medications, including what they are for, how to take them, instructions regarding dosing, what side effects can occur, and when to stop taking the medications. KEY: Nursing process: Interventions
Which phrase is stated as a teaching goal (as compared with an objective) for a patient who had bowel resection with creation of a colostomy? The patient 1) empties the colostomy appliance when half filled. 2) performs skin care around the stoma site. 3) will perform ostomy self-care within 3 days after surgery. 4) applies a new ostomy appliance, making sure it adheres properly.
3) will perform ostomy self-care within 3 days after surgery. Performing ostomy self-care is an appropriate goal for a patient who needs to learn colostomy self-care after surgery. Emptying the colostomy appliance demonstrates a behavioral learning objective, not a broad teaching goal. Performing skin care is also a desired skill stated by a learning objective. Applying an ostomy device is another observable learning objective. KEY: Nursing process: Planning
During advanced cardiac life support (ACLS) training, a nurse performs defibrillation using a mannequin. Which teaching strategy is being employed? 1) One-to-one instruction 2) Computer-assisted instruction 3) Role modeling 4) Simulation
4) Simulation ACLS training utilizes this strategy by creating a scenario using resuscitation mannequins and teaching healthcare workers to respond appropriately to life-threatening cardiopulmonary events. The nurse is demonstrating the skill of defibrillation. ACLS certification requires learners to perform the skill back to the examiner. With one-to-one instruction, one instructor orally presents information to one student. With ACLS training, the healthcare team is involved and not just individual nurses. In role modeling, the teacher teaches by example, demonstrating the behaviors (not skills) that need to be acquired by learners. KEY: Nursing process: Interventions
The patient needs to be taught how to find and check his own radial pulse. The nurse should complete this teaching at which of the following times? A.When the patient's family is present to support the patient. B.When the patient recognizes the need to learn the skill. C.Before pain medication is administered when the patient is alert. D.Right before the patient is discharged so he can remember the skill.
B. When the patient recognizes the need to learn the skill. Rationale: The patient will be most motivated to learn when he recognizes why this skill is important to the success of his overall treatment plan (e.g., medication effectiveness).
The patient is given a pamphlet to read about how to manage his newly inserted central venous access device at home. It will be most important for the nurse to assess which of the following aspects of the patient? A.Health beliefs B.Literacy level C.Fine motor abilities D.Ability to hear
B.Literacy level
Which of the following is the most important reason nurses must possess the knowledge and skills needed for patient teaching? A.To complete the documentation forms related to patient teaching accurately. B.To help the hospital meet The Joint Commission standards requiring patient teaching. C.To promote the health, safety, and rights of patients through education. D.To meet the patient rights delineated in the "Patient Care Partnership."
C. To promote the health, safety, and rights of patients through education. Rationale: The ANA's Code of Ethics for Nurses With Interpretive Statements (2015) holds that nurses are responsible for promoting and protecting health, safety, and rights of patients. Patient teaching is essential in fulfilling that responsibility.
The physician prescribes a new drug with which the nurse is unfamiliar. She consults the hospital formulary to learn about the drug. Which learning domain is the nurse utilizing? ____________________
Cognitive Learning through the use of reading materials uses the cognitive domain of learning. Learning a skill through mental and physical activity uses the psychomotor domain. The affective domain involves changing feelings, beliefs, attitudes, and values.