Lewis Ch 4 - Patient and Caregiver teaching

Teaching process

1. Assessment 2. Goal setting 3. Implementation 4. Evaluation

What does a teaching plan include?

1. Assessment of the patient's ability and readiness to learn 2. Identification of teaching needs 3. Development of learning goals with the patient 4. Implementation of the teaching 5. Evaluation of the patient's learning

Teaching strategis

1. Discussion (teach back) 2. Lecture-discussion 3. Demonstration/Return demonstration (show back) 4. Use of teaching resources

Role of caregivers

1. Give or help with direct patient care 2. Provide emotional, social, spiritual and possibly financial support 3 Manage and coordinate health care services

Assessment of caregivers needs

1. How are you coping with your caregiver role? 2. Do you have and problems performing your care giver responsibilities? 3. How much support do you get from outside sources? 4. Are you aware of and do you use community resources? 5. Do you know about the resources that are available for respite? 6. What kind of help or services do you need now and in the near future? 7. How can I or other HCP help you in your caregiving role?

Challanges to Nurse-Teacher effectivenss

1. Lack of time 2. Your own feelings as a teacher 3. Nurse-patient differences in learning goals 4. Rapid or early discharge from the healtch care system

Key Aspects of Motivational Interviewing

1. Listen rather than tell 2. Adjust to, rather that oppose, patient resistance 3. Express empathy through reflective listening 4. Focus on the positive. Do not criticize the patient 5. Gently persuade with the understanding that the change is up to the patient 6. Focus on the patient's strengths to support the hope needed to make changes 7. Avoid argument and direct confrontation, which can cause defensiveness and a power struggle 8. Help the patient recognize the gap between where they are and where they hope to be

Techniques used writing teaching materials

1. Organize the content logically 2. Highlight or place key information in bold or italics 3. Use short, common words of 1 or 2 syllables 4. Define medical words in simple language 5. Keep sentences short 10-15 words 6. Use pictures or drawings 7. Use active voice in the same manner you would normally speak

Learning styles

1. Visual 2. Auditory 3. Physical

In which stage of the Transtheoretical Model of Health Behavior Change does the nurse provide patient support, increase awareness of the condition and describe the benefits of change and risk of not changing? A. Action B. Preparation C. Termination D. Precontemplation

4. Precontemplation The precontemplation stage in the Transtheoretical Model of Health Behavior Change is when the nurse provides patient support, increases awareness of the condition, and describes the benefits of change and the risk of not changing. In the action stage, the nurse reinforces the behavior with rewards, encourages self-reward, and discusses choices to minimize relapses and regain focus. The termination stage entails the evaluation of the effectiveness of the new behavior, no further intervention is needed at this stage. During the preparation phase, the nurse reinforces the positive outcomes of change, provides encouragement, develops a plan, helps set priorities and identifies sources of support.

Which teaching-learning concept describes a patient's stage of readiness to make recommended lifestyle changes? 1. Self-efficacy 2. Adult learning principles 3. Motivational interviewing 4. Transtheoretical Model of Health Behavior Change

4. Transtheoretical Model of Health Behavior Change The model frequently used to describe patient readiness to make a change in health behaviors is the Transtheoretical Model of Health Behavior Change. Self-efficacy is defined as a patient's belief that they can effectively make desired changes. Adult learning principles describe how and why adults learn and guide nurses in choosing teaching topics and strategies. Motivational interviewing is a strategy to help motivate patients to make health changes.

Which of the following stages of change in the Transtheoretical Model of Health Behavior Changes? Select all that apply A. Action B. Learning C. Termination D. Maintenance E. Prior experiences

A. Action C. Termination D. Maintenance Action, termination, and maintenance are some of the stages of change in the Transtheoretical Model of Health Behavior Change. Learning is acquiring knowledge or skills and is not a stage in the Transtheoretical Model of Health Behavior Change. Prior experiences are an example of an adult learning principle.

When the nurse is caring for an elderly patient with Alzheimer's disease who is being cared for at home by one of the patient's children, which actions will the nurse include when planning care? Select all that apply. A. Assess the caregivers knowledge of community resources B. Provide caregiver teaching when the patient is napping at home C. Ask the caregiver about attendance at support groups D. Determine the caregivers priorities for teaching E. Insist that the caregiver use an adult day care for respite care

A. Assess the caregivers knowledge of community resources C. Ask the caregiver about at support groups D. Determine the caregivers priorities for teaching Assessment of the caregiver's needs is included in nursing assessment when caring for chronically ill patients. The nurse will assess the caregiver's knowledge of community resources to help with care, ask about any attendance at or interest in support groups, and use the caregiver's learning needs as a guide when planning teaching. Teaching should include both patient and caregiver when possible, since both persons will need education about home care. While respite care may be a good option for some caregivers, the nurse would assess the caregiver's interest in respite care rather than insisting that the caregiver use this service.

Which topics are included in The Joint Commission's accreditation standards regarding the fundamental rights of patients receiving information about their care? Select all that apply A. Diagnosis B. Prognosis C. Treatment D. Privacy of information E. Access to medical records

A. Diagnosis B. Prognosis C. Treatment TJC's accreditation standards identify the patient's fundamental right to receive information regarding prognosis, treatment and diagnosis. HIPAA is a federal regulation that addresses privacy of patient information. HIPAA also allows the patient legal access to their medical records.

Which statement by a hospitalized patient with diarrhea indicates that they patient is ready to learn about hygiene measures to prevent spread of gastroenteritis? A. I need to know how to prevent spreading this my family members B. This diarrhea has made me so tired that I need to sleep all the time C. Maybe I should know how a little more about how I got this terrible disease D. I don't really care how I got gastroenteritis, I just want to get better

A. I need to knw how to prevent spreading this to my family members Adult patients learn best when they have identified a clear "need to know" about a topic and how the learning will help them. A patient who reports fatigue will have a difficult time in learning new information. A patient statement that maybe I should know a little more is the contemplation stage of behavior change and the nurse would reinforce the need for teaching rather than provide content about hygiene measures. A patient who says I don't really care is in the precontemplation stage and the nurse will describe the risks of spreading infection or becoming re-infected rather than offering teaching about hygiene measures.

Which statements are true about teaching in nursing practice? Select all the apply A. It helps to impart knowledge B. It is always a planned activity C. It may be informal in certain situations D. It helps to induce a change in behavior E. It is a combination of instruction and counseling

A. It helps to impart knowledge C. It may be informal in certain situations D. It helps to induce a change in behavior E. It is a combination of instruction and counseling Teaching is imparting information in a deliberately arranged condition that promotes learning. The objective of teaching is to help the patient learn and bring about a change in behavior. It is more informal and is a combination of methods, such as instruction, behavior modification, and counseling. Teaching is not always planned, it can be unplanned and informal, based on the patient's learning needs.

When a patient with cancer-related pain appears reluctant to learn self-face techniques taught by the nurse, which actions will the nurse take? Select all that apply A. Provide brief explanations B. Choose high-priority teaching topics C. Ask the patient about pain level prior to teaching D. Schedule teaching right after the physical therapy treatment E. Refer the patient for follow-up education after hospital discharge

A. Provide brief explanations B. Choose high-priority teaching topics C. Ask the patient about pain level prior to teaching E. Refer the patient for follow-up education after hospital discharge Pain may hinder the learning process; therefore the nurse should provide only brief explanations. The nurse should set teaching priorities so that the most vital self-care techniques are briefly taught first. Learning is difficult when patients are in pain; use of opioids and other analgesics to control pain can enhance learning. Referral for follow-up education after hospital discharge will allow for building on the basic teaching-learning started in the hospital. Physical therapy is likely to tire the patient and decrease learning.

When the nurse is caring for multiple patients and needs to provide education to each patient, which teaching techniques will the nurse use? Select all that apply. A. Reinforce teaching at each patient encounter B. Develop learning priorities with the patients C. Perform teaching at every contact with the patients D. Avoid teaching content that takes more time to present E. Choose teaching techniques based on how time-consuming they are

A. Reinforce teaching at each patient encounter B. Develop learning priorities with the patients C. Perform teaching at every contact with the patients When caring for many patients at a time, the nurse will teach during every patient encounter, develop learning priorities with the patient, and reinforce teaching frequently. The choice of teaching content will not be determined by hos much time a topic takes to teach, but by prioritization of the topic. Teaching techniques should not be chosen based on how speedily they can be implemented, but by how effective the technique is in teaching the specific content. For example basics of infant care should be taught by demonstration and re-demonstration, even though that may take longer than providing a handout.

What is the PRIORITY patient teaching strategy when limited time is available? A. Setting realistic goals that have high priority for the patient B. Referring the patient to a nurse educator in private practice C. Observing more experienced nurse-teachers to learn how to teach faster and more efficiently D. Providing reading materials for the patient instead of discussing information the patient needs to learn

A. Setting realistic goals that have high priority for the patient

When planning teaching for a patient who is recovering from surgery and often is sedated by postoperative pain medications, which initial teaching strategy will be best for the nurse to use? A. Setting realistic goals that have high priority for the patient B. Providing written materials for the patient to read when feeling better C. Providing the information to the patient's family while the patient is resting D. Referring the patient for ongoing teaching after discharge from the hospital

A. Setting realistic goals that have high priority for the patient

Which techniques will the nurse use when developing written educational material at the recommended level? Select all that apply A. Use short, common words B. Include medical terminology C. Test the reading ability of each patient D. Keep sentences 10 to 15 words in length E. Provide key information first with bold or italics

A. Use short, common words D. Keep sentences 10 to 15 words in length E. Provide key information first with bold or italics Using short, common words, keeping sentences 10 to 15 words in length and providing key information first with bold or italics are techniques that will assist in keeping the reading materials at a fifth grade level. This is the level determined that most patients will understand. Including medical terminology decreases the readability of the document because medical terms are more complex. Testing the reading ability of each patient is unrealistic because the readability of written materials is evaluated before the materials are used with patients.

When a patient who needs teaching says, "I prefer to watch how things are done rather than to read information or instructions about how to take care of myself," which teaching strategy would be best? A. Watching a video about the topic B. Reading an educational pamphlet C. Discussing the health topic with the nurse D. Joining an internet support group on the topic

A. Watching a video about the topic This patient has a visual or auditory learning style and prefers not to learn by reading. The video would be the best teaching strategy. The nurse could also demonstrate how to do a skill with this patient. Offering the patient a pamphlet to read would not be an effective teaching strategy for a patient who has stated a preference for not learning by reading. Discussion with the nurse might be helpful after the patient has watched the video in order to help clarify information, but would not be the best initial teaching strategy. An internet support group would not be the best method for a patient whose preferred learning style is to see how things are done.

Which reading level will the nurse plan to sue when developing parent handouts about healthy nutrition for toddlers? A. Third grade B. Fifth grade C. Eighth grade D. Tenth grade

B. Fifth grade Current guidelines indicate that teaching materials should be written at the fifth-grade level or lower to reach parents with different literacy levels. Materials written at the third grade level would be too basic and might be unable to convey some concepts. Materials written at the eighth grade level would not be easily understandable by some patients. Written materials at the tenth grade level would be too complex for many patients to easily understand.

After providing patient teaching about a new medication, which action will the nurse take to determine whether the teaching has been effective? A. Refer the patient to a pharmacist B. Have the patient restate the information C. Repeat medication instructions several times D. Provide a written handout about the medication

B. Have the patient restate the information One effective method for evaluation of understanding after patient teaching is to have the patient "teach back" the information. Referral to a pharmacist will not evaluate patient understanding, although it may be useful if the patient has questions about the medication that cannot be answered by the nurse. Repeating instructions several times may be useful in the implementation phase of patient teaching, but it does not evaluate patient understanding. Written handouts are a useful teaching strategy, but they do not evaluate teaching effectiveness.

Which patient characteristic enhances the teaching-learning process? A. Moderate anxiety B. High self-efficacy C. Being in the precontemplation stage of change D. Being able to laugh about the current health problem

B. High self-efficacy

The "K" in the acronym "Speak Up" addresses the importance of the patients knowing about which aspect of care? A. Illness B. Medications C. Decisions regarding treatment D. Voicing questions or concerns

B. Medications The "K" in the acronym "Speak Up" encourages the patient to know what medications they take and why they take them, due to the fact that medicine error is the most common health mistake. E is education regarding illness, P is participating in all decisions about treatment and S is for speaking up if there are questions or concerns.

Which is one of the adult learning principles used in planning patient teaching? A. Self-efficacy B. Need to know C. Contemplation D. Motivational interviewing

B. Need to know The need to know is an adult learning principle and is important in helping patients understand why they need to learn self-management and how it will benefit them. Contemplation is a stage in the Transtheoretical Model of Health Behavior Change. Self-efficacy is the belief that one can succeed in a given situation. Motivational interviewing is a model to promote health that uses nonconfrontational interpersonal communication techniques to motivate patients to change behavior.

Which actions would the nursing supervisor take to assist a new staff nurse who is not comfortable with patient teaching and would rather limit nursing activities to direct patient care only? Select all that apply. A. Assign the nurse to give direct patient care only B. Offer the nurse opportunities to develop teaching skills C. Suggest that the nurse transfer to a unit where teaching is not needed D. Reassure the nurse that it takes time and experience to master teaching skills E. Familiarize the nurse with various facility resources that help in patient teaching

B. Offer the nurse opportunities to develop teaching skills D. Reassure the nurse that it takes time and experience to master teaching skills E. Familiarize the nurse with various facility resources that help in patient teaching Opportunities to gain experience in teaching will improve confidence and comfort level with teaching. Teaching, like other nursing skills takes time and experience to master. Familiarity with patient teaching resources will help the nurse develop better teaching strategies and ideas for referrals to other learning resources. Assigning the nurse to give direct patient care only is not possible, since teaching opportunities occur in most patient-nurse interactions and teaching is part of the responsibility of a registered nurse. Suggesting a transfer to a unit where teaching is not needed indicates that the supervisor lacks confidence that the staff nurse can develop teaching skills, in addition teaching of various types occurs in every setting where nurses interact with patients.

Which adult learning principle is a patient with newly diagnosed diabetes displaying when telling the nurse, "I have watched my mother use insulin, so I think I know quite a bit about insulin already"? A. Need to know B. Prior experiences C. Motivation to learn D. Readiness to learn

B. Prior experiences The patient is displaying the principle of prior experiences by sharing the past experience with insulin and expressing readiness to learn. A patient who needs to know will start asking questions in regard to diabetes and insulin administration. The patient who is exhibiting the principle of motivation to learn will express interest in self-administering insulin as soon as possible. A patient who expresses readiness to learn will express a desire to learn more about insulin and diabetes.

When the nurse is caring for a patient following a myocardial infarction, which patient finding might adversely affect patient teaching? A. Presence of patient's caregiver B. Report of fatigue and weakness C. Increase in patient's self-efficacy D. Previous myocardial infarction history

B. Report of fatigue and weakness Fatigue and weakness could affect patient teaching because the patient is less, likely to focus. The presence of a caregiver will positively affect teaching, since the caregiver and patient will both have the same information. Patients will increase self-efficacy are better able to make changes. Previous experience with myocardial infarction will enhance the patients motivation and self confidence.

Which action would the nurse take after noticing that a patient with newly diagnosed diabetes mellitus appears depressed and shows no interest in learning about self-testing of glucose? A. Provide a handout on glucose self-monitoring B. Suggest a diabetes support group to the patient C. Discuss the health hazards related to diabetes D. Avoid discussing the concerns with the patient

B. Suggest a diabetes support group to the patient Since depression can negatively affect the patient's motivation and readiness to learn, the nurse will take actions to decrease depression such as referring the patient to appropriate support groups. When a patient lacks interest and motivation to learn about glucose self-monitoring, providing a handout will not be helpful. Emphasizing the health hazards of diabetes could further aggravate the patient's depression and will not be helpful in changing the patient's motivation or learning readiness. The nurse should encourage the patient to discuss feelings of depression and lack of motivation, which will help lead to development of a plan to address these concerns.

Which teaching intervention will the nurse use when implementing health teaching for a patient with limited literacy? A. Encourage the patient to enroll in adult literacy programs B. Tailor the teaching aids to the patient's literacy abilities C. Discuss studies that describe the impact of literacy on patient outcomes D. Ensure that the patient teaching materials are at a sixth grade reading level or higher

B. Tailor the teaching aids to the patient's literacy abilities When educating an illiterate patient, the nurse should tailor the teaching aids to the patient's literacy abilities. Enrolling in an adult literacy program would help the patient increase the literacy level, but it would not help solve the immediate learning problem. The patient needs a teaching technique that will meet the current health learning needs, not information about the impact of illiteracy. Patient teaching materials should be written at a fifth grade or lower reading level, but in a patient with low literacy, other methods than printed materials are a better choice for health teaching.

When a patient who needs postoperative self-care teaching after a mastectomy states "I do not want to look at it" which action by the nurse would be best? A. Explain why the patient needs to be able care for the surgical site at home B. Determine whether the patient has any previous experience with wound care C. Ask the patient which type of postoperative teaching she would like at this time D. Offer the patient teaching by demonstration and re-demonstration of wound care

C. Ask the patient which type of postoperative teaching she would like at this time Using the adult learning principle of self concept, the nurse will allow the patient to determine the schedule for learning post-mastectomy wound care. An explanation of the purpose of the patient teaching would be appropriate for a patient who is asking for information about post-mastectomy self care. Assessment for previous experience with wound care would be appropriate for a patient who is expressing interest in self-management. offering to teach wound care by demonstration and re-demonstration would be appropriate for a patient who is eager to learn self care for the mastectomy incision, but would indicate lack of respect for this patients feelings about the mastectomy.

The nurse has taught a family caregiver how to administer insulin. Evaluation of the caregiver's learning would include A. Monitoring the patient's glucose reading B. Arranging a follow up with a home care nurse C. Asking the caregivers to show back the ability to administer insulin D. Asking the caregiver what was helpful about the teaching experience

C. Asking the caregiver to show back the ability to administer insulin

Which teaching strategy is best for the nurse to use when teaching a group of patients about breast cancer self-screening techniques? A. Handouts B. Support group C. Demonstration D. Lecture-discussion

C. Demonstration Self-screening for breast cancer is a skill, therefore it is best taught through demonstration. Printed materials such as handouts are useful for non-skill patient teaching, but are not as helpful in teaching a skill. Support groups are useful for patients with chronic illness, but will not be as helpful in learning a skill that is typically done in a standardized manner. Lecture-discussion involves presentation of information and then an exchange of points of view within a group and will not be as helpful in teaching breast self-exam, where point of view will not change how the skill is done.

Which technique is MOST appropriate when using motivational interviewing with a patient who tells you that he is ready to start a weight-loss program? A. Confirm that the patient is serious about losing weight B. Insist that the patient consider an organized group weight loss program C. Focus on the patient's strengths to support their optimism that they can successfully lose weight D. Ask a prescribed set of questions to increase the patients awareness of their dietary behaviors

C. Focus on the patient's strengths to support their optimism that they can successfully lose weight

When developing a health teaching plan for a patient from a different culture, which patient assessment information is most important to obtain? A. National origin B. Religious affiliation C. Patient's cultural values D. Patient's preferred language

C. Patient's cultural values Although all of the information listed above may be helpful to obtain, understanding a patient's cultural values assists the nurse in tailoring the patient teaching to specific cultural needs. National origin is not always an indicator of a patient's culture or health beliefs. Religious affiliation does not always predict cultural health beliefs and practices. The patient's preferred language is always a consideration, but the availability of online or telephone interpretation services makes it possible to provide teaching even when the nurse does not speak the patients preferred language.

The nurse needs to include caregivers in patient teaching primarily because (Select all that apply) A. Caregivers provide all the care for patients after discharge B. They might feel rejected if they are not included in the teaching C. Patients have better outcomes when their caregivers are involved D. The patient may be too ill or too stressed to fully understand the teaching E. Caregivers are responsible for the overall management of the patient's care

C. Patient's have better outcomes when their caregivers are involved D. The patient may be too ill or too stressed to fully understand the teaching

When the home health nurse manager is teaching staff members about reasons for including caregivers in patient teaching, which rationales will be included? Select all that apply. A. Caregivers provide all the care for patients after discharge B. It is legally required to provide teaching to patient caregivers C. Physical care and emotional support are provided by caregivers D. Caregivers may be responsible for managing the patient's health care services E. Caregivers may need to make changes in the home to accommodate patient needs

C. Physical care and emotional support are provided by caregivers D. Caregivers may be responsible for managing the patient's health care services E. Caregivers may need to make changes in the home to accommodate patient needs Since caregivers may need to learn physical care techniques and to provide emotional support to chronically ill patients, they should be included in patient teaching. Because caregivers are frequently responsible for coordinating various patient care services such as medical appointments and various therapies and treatment, they need to understand the purpose for and importance of these services. Caregivers sometimes need to plan how to rearrange the home setting or arrange for home changes in order to accommodate the patient needs and will need to understand how home changes can best be made. A caregiver may not be the only one providing care for the patient, in many cases, the patient is able to provide self-care or outside health services provide some care. It is not a legal requirement to provide teaching to caregivers.

Which technique is the nurse using when telling a diabetic patient who has improved blood glucose control, "You are doing a great job managing your diabetes?" A. Direct instruction B. Reflective listening C. Positive reinforcement D. Motivational interviewing

C. Positive reinforcement Positive reinforcement involves rewarding desired behaviors with positive feedback. The nurse is praising the patients behavior by recognizing the patients progress and encouraging continued control of diabetes. Direct instruction is a method used to teach a specific skill set such as testing blood glucose using a home monitoring device. Reflective listening involves paraphrasing patient statements and repealing them back to the patient. Motivational interviewing is used to encourage patients who need to change behavior but have not yet made any changes.

When a patient with a new diagnosis of diabetes mellitus states, "I don't think I will be able to care for my diabetes," which action will the nurse take? A. Help the patient deal with difficult goals early in the teaching sessions B. Encourage the patient to master complex skills to promote self-efficacy C. Proceed from simple to complex content to establish a feeling of success D. Inform the patient that repeated failure to acquire skills is a common problem

C. Proceed from simple to complex content to establish a feeling of success Since self-efficacy is enhanced when patients can master content or skills, the nurse will initially teach simpler content and then proceed to more complex self-care needs. Setting difficult initial goals may harm self-efficacy if the patient fails to meet those goals. Gaining simple skills initially will increase patients self-efficacy. Telling the patient that repeated failure to acquire skills is common will further discourage the patient. In addition, this statement is not true, since patients who are taught new skills or content are usually successful when content proceeds from simple to complex.

What would the priority teaching goal for a middle aged Hispanic woman about methods to relieve symptoms of menopause? A. Prevent the development of future disease B. Maintain the patient's current state of health C. Provide information on possible treatment options D. Change the patient's beliefs abut herbal supplements

C. Provide information on possible treatment options

When preparing to teach a patient from a different culture who is non-English speaking, which principles would the nurse consider? Select all that apply. A. Patient teaching requires the use of on-side medical interpreters B. It is mandatory to provide printed teaching material C. Teaching materials are available in different languages D. Teaching materials should be written at at tenth grade or lower reading level E. Teaching should be provided in the patient's own language

C. Teaching materials are available in different languages E. Teaching should be provided in the patient's own language In the United states, printed teaching materials are usually available in several languages and any oral or written teaching should be provided in the patient's own language. Printed materials are an important aid in patient education but are not mandatory. Patient education can also be done through electronic media or through lecture-discussion. Interpretation is best done by medical interpreters, not by family or friends, but interpreters can be accessed through translation phone services as well as through on-side interpreters. Teaching materials should be written at the fifth grade or lower reading level so that most patients will understand the materials.

Which is one of the several important agencies providing specific regulatory manages related to teaching hospitalized patients? A. Medicare B. Single-Item Literacy Screener (SILS) C. Department of Health and Human Services (DHHS) D. American Hospital Association's (AHA) Patient Care Partnership

D. American Hospital Association's (AHA) Patient Care Partnership Agencies that have provided specific regulatory mandates related to teaching hospitalized patients include the AHA's Patient Care Partnership. A SILS is an assessment tool used to determine a patient's health literacy. Medicare is a federally funded health insurance program. The DHHS protects health and provides essential human services.

Which action will the nurse take when a patient asks the nurse about the relationship between high BP and high serum potassium and the nurse is unsure of the answer? A. Teach the patient about the effects of high BP B. Educate the patient about the effects of high serum potassium C. Explain that the relationship between hypertension and hyperkalemia is complicated and unnecessary to understand D. Ask for clarification of the question and let the patient know that research is needed before answering the question

D. Ask for clarification of the question and let the patient know that research is needed before answering the question When the nurse is unsure of the answer to a patient question, the best actions are to admit to not knowing, clarify the question, seek more information, and return to the patient with the information. Teaching about high BP alone does not address the patient's question. Teaching about high serum potassium alone will not address the patient's concern. While it is true that the relationship between hypertension and hyperkalemia is complex, the statement that it is unnecessary to understand is disrespectful to the patient and will lead to patient distrust of the nurse.

Which action by the nurse is best when providing discharge teaching for a 60 year old patient with a new diagnosis of coronary artery disease? A. Provide written handouts on cardiac disease B. Refer the patient to a cardiac support group C. Use the lecture-discussion format for teaching D. Ask the patient about preferred learning style

D. Ask the patient about preferred learning style Since the assessment for preferred learning styles and teaching strategies should be done prior to planning patient teaching, the nurse's first action will be to ask the patient about learning style. Providing written handouts may be appropriate, but the nurse needs more information about the patient's literacy prior to using handouts. referral to a support group is helpful for many patients, but more patient data are needed to be sure that this patient is comfortable in group situations. Many in the boomer generation do like lecture and discussion as a format for learning, but more information is needed about this patient before choosing this teaching strategy.

When a patient with a long-standing history of type 1 diabetes has brought a number of printouts from websites to a recent visit with the health care provider, which information about health information on the internet would the nurse provide? A. It will be best to avoid websites except for those website that are associated with government ageny B. Websites may have good information, but it is best to focus only on the information the health care provider provides to you C. There is a great deal of misinformation on the internet, so it is best to focus on printed material rather than electronic sources D. I encourage you to find websites that are credible and reliable, and I can give you some information on making those distinctions if you like

D. I encourage you to find websites that are credible and reliable, and I can give you some information on making those distinctions if you like. Nurses should assist patients in finding accurate and evidence-based health information using the internet. Although websites sponsored by the government are reliable, other websites such as those supported by health-related organizations, also provide accurate and credible information. While the patient should certainly listen to what the health care provider says, other health information can also be useful and the nurse would encourage use of other credible resources. Printed information is not more accurate that information found online

Which principle of adult learning is demonstrated when patients prefer to seek out various resources for specific learning and to have choices? A. Self-concept B. Prior experiences C. Readiness to learn D. Orientation to learning

D. Orientation to learning A patient who prefers to seek out various resources for specific learning and prefers to have choices is demonstrating orientation to learning. Self concept refers to patients needs for control and self-direction in order to maintain their worth. Readiness to learn occurs when a patients shows high motivation when facing new tasks. Motivation that is increased when a patient already knows something about the subject from past experiences is known as prior experience.

Which statement by a student nurse who is discussing effective patient discharge teaching indicates a need for further teaching? A. Patients that have no problems reading may experience health illiteracy B. Patient teaching materials should be written at a fifth-grade level or lower C. Patients with limited reading ability may have trouble understanding health information D. Patient education materials should be written in English to ensure teaching consistency

D. Patient education materials should be written in English to ensure teaching consistency The statement "patient education materials should be written in English to ensure teaching consistency" indicates a lack of understanding of patient teaching principles. Patient education materials should be written and provided using the patients primary language. The other statements by the student are correct. Although patients may have high general literacy ability, they may not be able to understand health information, leading to health illiteracy. Health education materials should be written at a fifth-grade or lower reading level. Patients with limited reading ability may have problems understanding health information.

A patient tells the nurse that she enjoys talking with others and sharing experiences but often falls asleep when reading. Which teaching strategy would be MOST effective with this patient? A. Formal lecture B. Journal writing C. Web-based program D. Small group discussion

D. Small group discussion

Action

Patient behavior- Begins to change behavior through practice. Tentative and may experience relapses Nursing implications- Reinforce behavior with reward, encourage self-reward, discuss choices to help minimize relapses and regain focus. Help patient plan to deal with potential relapses.

Termination

Patient behavior- Change has become part of lifestyle. Behavior is no longer considered a change. Nursing implication- Evaluate effectiveness of the new behavior. No further intervention needed.

Precontemplation

Patient behavior- Is not considering a change and is not ready to learn Nursing Implication- Provide support, increase awareness of condition. Describe benefits of change and risks of not changing

Maintenance

Patient behavior- Practices the behavior regularly. Able to sustain the change Nursing implication- Continue to reinforce behavior. Provide more teaching on the need to maintain change.

Preperation

Patient behavior- Starts planning the change, gathers information, sets a date to start change, shares decision to change with others Nursing implication- Reinforce the positive outcomes of a change, give information and encouragement, develop a plan, help set priorities, and identify sources of support

Contemplation

Patient behavior- Thinks about a change. May state recognition of need to change. Says "I know I should" but identifies barrier Nursing implication- Introduce what is involved in changing the behavior. Reinforce the stated need to change

Place the stages involved in changing health behavior in the correct order according to the Transtheoretical Model of Health Behavior Change A. Action B. Maintenance C. Termination D. Contemplation E. Preparation F. Precontemplation

Precontemplation Contemplation Preparation Action Maintenance Termination According to the transtheoretical model a change takes place in several stages. A patient may not feel the need to quit smoking during the precontemplation stage. The contemplation stage starts when the patient begins thinking he or she might quit smoking. In the preparation stage, the patient starts planning to quit smoking, gathers relevant information and may set a date to quit smoking. The action stage starts immediately when the patient stops smoking. The patient may regress during this stage. The patient will be in the maintenance stage if he or she continues to not smoke. In the termination phase the patient makes it a permeant change in his or her lifestyle.

SPEAKUP

S-Speak up if you have questions or concerns. P- Pay attention the care you get E- Educate yourself about your illness A- Ask a trusted family member or friend to be your advocate K- Know the medicines you take and why you take them U- Use a hospital, clinic surgery center or other healthcare facility that has been carefully checked out P- Participate in all the decisions about your treatment

Health literacy

The degree to which a person can obtain and understand basic health information needed to make appropriate health decisions

Learning needs

The new knowledge and skills that a person must have to meet a goal