patient education chapter 8

reinforce learning when a patient is able to say walk, or ambulate or is working towards a goal say

"You have made an amazing recovery." dont talk about how good the pt staff are etc.

implementation of patient teaching

*should be limitied 20-30 min *best time is outpatient better than inpatient, not in the hospital *Include family and friends with patients permission, support *ideal learning environment is patient has eaten, pain free, quiet environment. *teaching methods are cognitive, affective, psychomotor,

Affective learning

Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight)

cognitive domain

As the client enjoys reading books and magazines, the client's learning style would fall in the cognitive domain, where information is processed by listening or reading facts and descriptions

how do i assess for learning

BASELINE KNOWLEDGE CULTURAL AND LANGUAGE NEEDS PRIORITIES, use ask me 3 (ASK ME 3): what is my main problem what do i need to know why is it important for me to do this? REALISTIC APPROACH

psychomotor learning

Demonstrating a skill, such as insulin injection, is an example of psychomotor learning

motivational interview

ELICIT-PROVIDE-ELICIT (E-P-E) elicit, find out what they already know by asking questions. provide, fill in missing info and correct errors elicit, find out what this info means to the patient ASSESSING IMPORTANCE patient rate importance 0-10 ask why they chose the rating find out what would increase the score summarize the discussion EVOKING CHANGE TALK ask open ended questions to elicit desire, ability, or reason, or need to change.

individualized teaching plans

Gaining insight into the client's own perceptions of health and aging will allow the nurse to tailor the plan of care to the client's personal needs. Knowing his religion etc is important but not individualized. The patients personal perception of health and aging matters when creating an individualized teaching plan, it also gives the nurse a chance to assess and note inadequate knowledge for the plan

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 client rate pain level and reschedule the teaching session. 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 subject only delays the care that must be done before the client is able to learn.

difference between literacy and health literacy

literacy, can they read health literacy, can they understand healthcare information, can patient obtain, understand, process health info to make health decisions. the new 6th vital sign

what teaching strategies can the nurse use to individualize the teaching session

LECTURE, to a group using cognitive and sometime phsycomotor skills, can be combined with discussion DISCUSSION, exchange ideas, individual or group, I am the facilitator DEMONSTRATION, psychomotor, video tapes, repeat practive ROLE PLAY

6 barriers to teaching and learning

MOTIVATION, use motivational interview COMPLIANCE, are they following the plan, can be too authoratative, (non compliant) ADHERENCE, alternative to compliance, agreed on by patient as a partner SENSORY AND PHYSICAL STATE, patient may have poor vision, motor skills, pain LITERACY LEVEL, education can give an estimate, tools to determine literacy are most accurate but not practicle WRAT, (Wide Range Achievement Test) REALM, (Rapid Estimate at Adult Literacy in Medicine) HEALTH LITERACY LEVEL. can they obtain understand info to make a decision.

qualities of the teaching-learning relationship

PATIENT FOCUSED HOLISM, the whole person NEGOTIATION, patient and nurse determine what is known and what needs to be learned. can be a written contract INTERACTIVE, dynamic and nurse can also learn from patient. they discuss, clarrify and revisit specific points

the stages of change with patient teaching

PRECONTEMPLATION - denial/demoralized not making a change within 6 months (not thinking about quitting smoking) CONTEMPLATION - stuck, stalling. seriously thinking about change in the next 6 months, (thinking about quitting smoking in the next 6 months PREPARATION - actively planning change, telling family and friends, (thinking about quitting in the next 30 days) ACTION - begin to modify behavior, overtly making change, (in the process of quitting) MAINTENANCE - struggling to prevent lapse, work to consolidate gains, taking steps to sustain change and resist temptation to relapse, (abstaining from smoking for over 6 months)

3 levels of teaching disease prevention

PRIMARY PREVENTION, stop disease from happening, shots, fluride treatment, car seat, oral contraception, education about drugs. SECONDARY PREVENTION, seek to identify illness at early stage with prompt attention. physical assessment, screening, breast exam, pregnancy test TERTIARY PREVENTION, after disease, halt the disease, rehab, support groups, AA, health education for a new diagnosis

what teaching aids

pamphlets, audiovisual aids, internet, equipment and models

ANA standards for patient education

Scope and Standards of Practice includes a standard of practice for nurses focused on educating patients about their illness, treatment, health promotion, or self-care activities

if a patient cannot read or write the most important tools are to

Using verbal and visual modes of instruction is most appropriate for a client who is unable to read or write. This meets the special needs of the patient

what is included in writing a goal or outcome

WHO DOES WHAT HOW and WHEN = TO ACHIEVE GOAL WHO, the patient DOES, will demonstrat WHAT, dressing change HOW, without cueing WHEN, before discharge = to achieve goal

the most accurate way to assess if the client education has been effective

ask an open ended question. Dont ask yes no questions

American Hospital Association standards for patient education

defining a Patients' Bill of Rights In 2003, the American Hospital Association replaced this document with a plain language brochure for patients, The Patient Care Partnership, Understanding Expectations, Rights and Responsibilities (2006). This brochure emphasizes that patients have not only the right to high-quality hospital care but also the right of involvement in care decisions about diagnosis, treatment, and prognosis

Joint commission

has established standards for patient education that healthcare agencies must meet to receive accreditation.

The affective domain

is a style of processing that appeals to a person's feelings, beliefs, or values.

The psychomotor domain

is a style of processing that focuses on learning by doing.

The interpersonal domain

is a style of processing that focuses on learning through social relationships.

what is learning

is the acquisition of a skill or knowledge by practice, study, or instruction. It can be: cognitive, thinking critically etc affective, emotions or feelings, difficult to measure. I want to lose weight psychomotor, easiest to measure, they demonstrate a skill. Return demonstration.

what would be the most important thing to teach a patient that you are caring for prior to them going home

self administer of meds

cognitive learning

storing and recalling of new knowledge in the brain eg, The patient's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning

what is teaching

the core of effective teaching is to produce capable self-learners, who continue their learning well past the teaching-learning encounters

effective teaching-learning

the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process

how do I evaluate learning

written test or questionaire oral test teach back, "can you explain to me how you will take your meds" return demonstration- psychomotor showing how to give insulin shot check off lists simulation-offer a senario and ask best choice

how do I document patient education

•It communicates the plan and progress to other healthcare professionals. •It fulfills the nursing job description as delineated by local, state, and national licensing agencies. •It provides a legal record. Documentation must contain the subject matter, the patient's response to teaching, and any necessary break in the process (e.g., if, after evaluation, the nurse found it necessary to return to the planning stage). Well-documented patient education is a record of methods that did or did not work, and it can give some indication of patient accomplishments and adherence to healthcare regimens over time.