FON Chapter 9 Teaching and Counseling

A client is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this client?

"What do you see as your biggest hurdle to stopping?" Explanation: When counseling a client, the focus should be on assisting the client to make one's own decisions, finding ways to reach goals, and supporting the client. The nurse should never give advice, such as reducing cigarette consumption over time or using nicotine patches or gum. Asking open-ended questions that encourage the client to speak freely about the topic at hand and help define goals is the best option. Asking the client which options have previously been tried is a closed question and limits the response to a list of things the client has tried and would not encourage the client to share other information important to form a smoking cessation plan, such as a spouse that smokes.

The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way?

uses videos, diagrams, and pictures rather than focusing on verbal teaching Explanation: To address health literacy concerns, the nurse should avoid technical language, limit information to three to five key points, and be specific rather than general. Using medical terminology to help the client feel smarter, providing general teaching instead of specific teaching, and giving instructions in multiple ways are not effective ways to adjust client teaching for those who demonstrate low health literacy.

A nurse is preparing to teach a patient with asthma how to use his inhaler. Which teaching method would be the BEST choice to teach the patient this skill? a. Demonstration b. Lecture c. Discovery d. Panel session

a. Demonstration of techniques, procedures, exercises, and the use of special equipment is an effective patient-teaching strategy for a skill. Lecture can be used to deliver information to a large group of patients but is more effective when the session is interactive; it is rarely used for individual instruction, except in combination with other strategies. Discovery is a good method for teaching problem-solving techniques and independent thinking. Panel discussions can be used to impart factual material but are also effective for sharing experiences and emotions.

The parents of an infant with apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents?

Baseline knowledge of these concepts Explanation: Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method. Infant bonding and the parents' home environment are less relevant to this scenario.

As the nurse enters the room to teach the client about self-care at home, the client states, "I am glad you are here. I need some pain medicine. I can't stand it anymore." What is the best action of the nurse?

Have the client rate pain level, and reschedule the teaching session. Explanation: The client is not ready or able to learn and is reporting a need that first must be met. Assessing the client's knowledge of self-care or redirecting the client to discuss self-care only delays the care that must be done before the client is able to learn. Although providing written materials is an excellent supplement to a teaching session, it does not replace teaching the client. It is best to address the physical needs before attempting to educate the client.

The nurse is preparing to teach a client about postsurgical care after a laparoscopic cholecystectomy. Which factor should the nurse most consider when determining whether the client is ready and able to learn?

Physical condition Explanation: The ability to learn depends primarily on the physical condition, acuity of senses, cognitive abilities, literacy, level of education, and communication skills of the client. The readiness to learn focuses on a client's willingness to engage in the teaching-learning process. Other readiness to learn includes emotional readiness, not emotional health, and experiential readiness such as social and economic stability, culture, attitudes toward learning, and past experiences with learning.

The nurse is conducting a teaching session regarding HIV/AIDS for hotel workers in the community. Which nursing actions are appropriate for providing this type of adult learning? Select all that apply.

1. Identifying the length of the session 2. Beginning with basic concepts about HIV/AIDS 3. Providing adequate lighting and comfortable temperature 4. Identifying the time, place, and content for the next teaching session Explanation: The nurse should identify the length of the session, because it prepares the participants for the demand on their time and attention. The nurse should begin with basic concepts about HIV/AIDS, as this allows for the participants to learn from the simple to the complex. The nurse should providing adequate lighting and comfortable temperature, as these will promote an environment for learning. The nurse should identify the time, place, and content for the next teaching session, because it allows participants to plan ahead and prepare for the next session. The nurse should explain medical jargon, as this allows the nurse to accept some accountability for the participants' comprehension.

The nurse is providing education to a group of clients with diabetes about the benefits of healthy food choices. What type of learning is the nurse using with this client group?

Affective Explanation: The education that the nurse is providing is designed to influence the value that the clients place on their food choices. This is the definition of affective learning. Cognitive learning involves teaching facts about a topic and appealing to logic and reason. Psychomotor involves the client performing physical actions to learn a new skill. Technical is not a domain of learning.

Before starting the education process, the nurse should determine the preferred learning style, age and developmental level, capacity to learn, motivation level, readiness to learn, and learning needs of the client. How does this help the nurse in the client's health education?

By implementing effective teaching Explanation: To implement effective teaching, the nurse should determine the preferred learning style, age and developmental level, capacity to learn, motivation level, readiness to learn, and learning needs of the client, before starting the teaching process. Fulfilling the client's requirements and assisting the client's learning can happen only when effective teaching is implemented. The chances of miscommunication can be reduced once an effective education plan is made.

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate?

Motivational counseling Explanation: The most appropriate counseling for the situation at hand would be motivational counseling. With motivational counseling, the nurse would discuss feelings and incentives with the client. Short-term counseling focuses on the immediate problem or concern of the client or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Long-term counseling extends over a prolonged period. A client might need the counsel of the nurse at daily, weekly, or monthly intervals. A client experiencing a developmental crisis, for example, might need long-term counseling. Professional counseling is a general term.

A client states to the nurse, "I understand that I need a mastectomy for the treatment of my breast cancer, but I am fearful of learning about the drains I will need to empty." When responding to the client, the nurse will need to address which type of learning?

Affective Explanation: This client is clearly expressing a negative feeling about the upcoming treatment: fear. Therefore, the nurse needs to provide teaching that addresses the client's emotional learning needs, or affective learning. Affective refers to emotions or feelings, and affective learning changes beliefs, attitudes, or values. Cognitive learning involves the client's critical thinking and reason. Psychomotor learning involves physically performing a task--learning by doing. Behavioral learning involves learning new, helpful behaviors and unlearning old, unhelpful ones.

A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care?

Asking only the client's parents to be present at the education session Explanation: Peers are often more influential than parents, nurses, or teachers at this age. It is often appropriate to include a close friend in on the education session. The other answers are developmentally appropriate for a 15-year-old.

An occupational health nurse is planning inservice training sessions for the employees. Which teaching topic would be most appropriate to cover with these clients?

Cardiopulmonary resuscitation Explanation: In an occupational health setting, employees range in age from approximately 16 to older than 60 years. Given the vast age range, cardiopulmonary resuscitation education would be appropriate for all ages. Industrial nurses conduct classes on plant safety, and CPR is included in those presentations. Teaching on safe sex would be most appropriate for adolescents, the need for immunizations for parents of young children, and infection control for those working in the health care setting.

A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with a quick recovery. In which domain is the client demonstrating successful learning?

Cognitive Explanation: As the client is able to understand the need for a balanced diet after the session and follows the nutritional chart accurately, the client is demonstrating successful learning in the cognitive domain. Learning in the cognitive domain involves processing information by listening to or reading facts and descriptions. Learning in the affective domain involves appealing to a person's feelings, beliefs, or values. Learning in the psychomotor domain involves learning by doing. Interpersonal is not a domain of learning but a type of communication in which ideas are exchanged between two or more people.

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn?

Cognitive Explanation: Educating a new mother about the physiology of the breast and its role in milk production is an example of cognitive learning, which involves the client's critical thinking and reason. Affective learning involves the client's beliefs, emotions, and values. Psychomotor learning involves physically performing a task--learning by doing. Behavioral learning involves learning new behaviors and unlearning others.

The spouse of a client who has recently been diagnosed with early-stage Alzheimer's disease asks the nurse to recommend websites that may supplement the spouse's learning about this diagnosis. How should the nurse respond to the spouse's request?

Identify and recommend some credible websites appropriate to the spouse's learning needs. Explanation: Web-based resources can be a useful tool in client education, but suitability and accuracy need to be carefully considered. Many online databases exist for health professionals, but these are less likely to be accessible to or appropriate for those outside the health professions. The client has requested online resources, so providing print-based materials is not warranted at this time.

A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress?

Positive feedback Explanation: Important keys to success when evaluating learning are consistent, immediate, and frequent positive reinforcement, and teaching a small number of skills at any one time, thus creating a high possibility that the learner will master them. Positive reinforcement is also known as positive feedback, which is what the nurse is providing in this case. Negative reinforcement or feedback would be attempting to change a client's behavior by pointing out and criticizing or even punishing mistakes or undesireable behaviors. Motivation refers to the client's desire to learn or make a change. Health promotion is a topic that may be covered in client teaching and that pertains to optimizing one's health through maintaining peroper nutrition, exercise, and hygiene.

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client?

The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" Explanation: Adults learn best when the information given to them will be used immediately, is presented as important to the client, and when the client's autonomy is preserved. As with all learners, the teaching approach must reflect respect for what the client already knows. By presenting the facts in a way that gives the client control over a health alteration, and by assessing current knowledge, these qualities that are important to forming a learning plan for an adult are met. When education plans take control out of the client's hands (such as stating the doctor wants compliance) or when the lifestyle change is presented as a burden, motivation may be low. If the nurse shows interest in working with and discussing issues with the client, a partnership is formed that can boost motivation.

A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply.

The nurse fails to accept that clients have the right to change their minds. The nurse uses medical jargon frequently when discussing the teaching plan. The nurse ignores the restrictions of the client's environment. Explanation: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds; the nurse using medical jargon frequently when discussing the teaching plan; and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.

A registered nurse assumes the role of nurse coach to provide teaching to patients who are recovering from a stroke. Which nursing intervention directly relates to this role? a. The nurse uses discovery to identify the patients' personal goals and create an agenda that will result in change. b. The nurse is the expert in providing teaching and education strategies to provide dietary and activity modifications. c. The nurse becomes a mentor to the patients and encourages them to create their own fitness programs. d. The nurse assumes an authoritative role to design the structure of the coaching session and support the achievement of patient goals.

a. A nurse coach establishes a partnership with a patient and, using discovery, facilitates the identification of the patient's personal goals and agenda to lead to change rather than using teaching and education strategies with the nurse as the expert. A nurse coach explores the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals.

A nurse is planning teaching strategies based on the affective domain of learning for patients addicted to alcohol. What are examples of teaching methods and learning activities promoting behaviors in this domain? Select all that apply. a. The nurse prepares a lecture on the harmful long-term effects of alcohol on the body. b. The nurse explores the reasons alcoholics drink and promotes other methods of coping with problems. c. The nurse asks patients for a return demonstration for using relaxation exercises to relieve stress. d. The nurse helps patients to reaffirm their feelings of self-worth and relate this to their addiction problem. e. The nurse uses a pamphlet to discuss the tenants of the Alcoholics Anonymous program to patients. f. The nurse reinforces the mental benefits of gaining self-control over an addiction.

b, d, f. Affective learning includes changes in attitudes, values, and feelings (e.g., the patient expresses renewed self-confidence to be able to give up drinking). Cognitive learning involves the storing and recalling of new knowledge in the brain, such as the learning that occurs during a lecture or by using a pamphlet for teaching. Learning a physical skill involving the integration of mental and muscular activity is called psychomotor learning, which may involve a return demonstration of a skill.

A nurse forms a contractual agreement with a morbidly obese patient to achieve optimal weight goals. Which statement best describes the nature of this agreement? a. "This agreement forms a legal bond between the two of us to achieve your weight goals." b. "This agreement will motivate the two of us to do what is necessary to meet your weight goals." c. "This agreement will help us determine what learning outcomes are necessary to achieve your weight goals." d. "This agreement will limit the scope of the teaching session and make stated weight goals more attainable."

b. A contractual agreement is a pact two people make, setting out mutually agreed-on goals. Contracts are usually informal and not legally binding. When teaching a patient, such an agreement can help motivate both the patient and the teacher to do what is necessary to meet the patient's learning outcomes. The agreement notes the responsibilities of both the teacher and the learner, emphasizing the importance of the mutual commitment.

A nurse is caring for a patient who is admitted to the hospital with injuries sustained in a motor vehicle accident. While he is in the hospital, his wife tells him that the bottom level of their house flooded, damaging their belongings. When the nurse enters his room, she notes that the patient is visibly upset. The nurse is aware that the patient will most likely be in need of which type of counseling? a. Long-term developmental b. Short-term situational c. Short-term motivational d. Long-term motivational

b. Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life, such as a flood. Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching? a. Promoting health b. Preventing illness c. Restoring health d. Facilitating coping

b. Teaching first aid is a function of the goal to prevent illness. Promoting health involves helping patients to value health and develop specific health practices that promote wellness. Restoring health occurs once a patient is ill, and teaching focuses on developing self-care practices that promote recovery. When facilitating coping, nurses help patients come to terms with whatever lifestyle modification is needed for their recovery or to enable them to cope with permanent health alterations.

A nurse has taught a patient with diabetes how to administer his daily insulin. How should the nurse evaluate the teaching-learning process? a. By determining the patient's motivation to learn b. By deciding if the learning outcomes have been achieved c. By allowing the patient to practice the skill he has just learned d. By documenting the teaching session in the patient's medical record

b. The nurse cannot assume that the patient has actually learned the content unless there is some type of proof of learning. The key to evaluation is meeting the learner outcomes stated in the teaching plan.

A nurse is teaching patients of all ages in a hospital setting. Which examples demonstrate teaching that is appropriately based on the patient's developmental level? Select all that apply. a. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes. b. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions. c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers. d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis. e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching. f. The nurse continues a teaching session on STIs for a sexually active male adolescent despite his protest that "I've heard enough already!"

c, d, e. Successful teaching plans for older adults incorporate extra time, short teaching sessions, accommodation for sensory deficits, and reduction of environmental distractions. Older adults also benefit from instruction that relates new information to familiar activities or information. School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible; they are also open to new learning experiences but need learning to be reinforced by either a parent or health care provider as they become more involved with their friends and school activities. Teaching strategies designed for an adolescent patient should recognize the adolescent's need for independence, as well as the need to establish a trusting relationship that demonstrates respect for the adolescent's opinions.

A nurse is teaching a 50-year-old male patient how to care for his new ostomy appliance. Which teaching aid would be most appropriate to confirm that the patient has learned the information? a. Ask Me 3 b. Newest Vital Sign (NVS) c. Teach-back method d. TEACH acronym

c. The teach-back tool is a method of assessing literacy and confirming that the learner understands health information received from a health professional. The Ask Me 3 is a brief tool intended to promote understanding and improve communication between patients and their providers. The NVS is a reliable screening tool to assess low health literacy, developed to improve communications between patients and providers. The TEACH acronym is used to maximize the effectiveness of patient teaching by tuning into the patient, editing patient information, acting on every teaching moment, clarifying often, and honoring the patient as a partner in the process.

A nurse is counseling a 19-year-old athlete who had his right leg amputated below the knee following a motorcycle accident. During the rehabilitation process, the patient refuses to eat or get up to ambulate on his own. He says to the nurse, "What's the point. My life is over now and I'll never be the football player I dreamed of becoming." What is the nurse counselor's best response to this patient? a. "You're young and have your whole life ahead of you. You should focus on your rehabilitation and make something of your life." b. "I understand how you must feel. I wanted to be a famous singer, but I wasn't born with the talent to be successful at it." c. "You should concentrate on other sports that you could play even with prosthesis." d. "I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?"

d. This answer communicates respect and sensitivity to the patient's needs and offers an opportunity to discuss his feelings with the nurse or another health care professional. The other answers do not allow the patient to express his feelings and receive the counseling he needs.