Patient Education 1125

An enterostomy nurse is providing an in-service session on caring for colostomies. Which statement by a nurse indicates the need for further teaching?

"I can make a small pin hole in the bag to let the gas out, so I don't have to change the appliance frequently." The nurse requires additional teaching if stating that they can make a hole in the drainage bag to let gas out. Any hole in the drainage bag, no matter how small, will destroy the odor-proof seal. Removing or unclamping the bag is the only appropriate method for releasing the gas accumulated in the bag. Odor-relieving tablets, usually made of charcoal, can be placed in the bag to help with the odor.

After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?

"I could use the TENS unit if I feel pain somewhere else on my body." The client needs further instruction when they say they can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician. The TENS unit will decrease the amount of the pain medication used by the client as it increases the blood supply to the injured area and will not interfere with the activities of daily living.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

"I should use my heating pad this evening to reduce some of the pain in my knee." The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse?

"I won't donate blood because I don't want to get AIDS." HIV is transmitted through infected blood, semen, and certain other body fluids. Although a transfusion with infected blood may cause HIV infection in the recipient, a person can't become infected by donating blood. The other options reflect accurate understanding of HIV transmission.

The nurse is caring for a young adult with hepatitis A. The client is crying and saying that they hate the way they look with yellow skin. Which response is most appropriate?

"If you start to get well and feel better, the skin will return to its normal color." The nurse must communicate honestly and give the client factual information about their appearance. Leaving the client alone or telling them not to cry ignores the client's feelings and needs. Make-up wouldn't conceal the jaundiced appearance, so using it might upset the client more.

A nurse determines that a client is in false labor. After obtaining discharge orders, the nurse provides discharge teaching to the client. Which instruction is most appropriate at this time?

"Return to the facility if fever occurs." The nurse should instruct a client in false labor to return to the health care facility if she develops signs or symptoms of infection, such as a fever; if her membranes rupture; if vaginal bleeding occurs; or if her contractions become more intense. The nurse should suggest warm milk or herbal tea, which promote relaxation and rest, instead of coffee or caffeinated tea. Taking a warm tub bath or shower — not applying cold compresses — helps relieve discomfort. A semi-upright position with pillows placed under the client's knees promotes rest.

Formal Education Class Guidelines

- Geared to larger groups of patients - Group should have similar concerns - Perform a needs assessment - Prepare patients ahead of time for what the class will cover - Be creative while planning the class - Plan to use audiovisual aids - Change pace and tone of your talk during presentation - Invite questions and comments- Repeat each question for those who may not have heard the original question - Provide program evaluation questionnaires

A 51-year-old male professional is in the habit of consuming 6 to 8 rum and Cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement?

"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products." The hepatic effects of alcohol use are related to the accumulation of toxic metabolites in the hepatocytes and blood. Damage can continue even after an individual stops drinking. Specific consequences do not usually include HAV, HBV or liver cancer. Cirrhosis represents the culmination, not the beginning, of negative hepatic effects.

Health Promotion examples for Illness related examples (Formal teaching)

* Diabetes education classes • Cancer support groups • Cardiac rehabilitation or disease specific classes

Education formats

* Formal education (classes, lectures, symposia) •Informal encounters (patient-nurse) •Self-directed (reading, internet searches) •In the healthcare setting, all education should involve family / caregivers

Some patients have comprehensive discharge planning needs. We determine them during our admission process. We may find the following and need to coordinate with others to better serve the patient.

- Lack of knowledge of the treatment plan - Social Isolation - Recently diagnosed chronic disease - Major surgery - Prolonged recuperation from major surgery or illness - Emotional or mental instability - Complex home care regimen - Financial difficulties - Lack of available or appropriate referral sources - Terminal illness - Can they perform ADLs

HIPPA provides the following rights to patients:

- To see and copy their health record - To update their health record - To request correction of any mistakes - To get a list of the disclosures a health care institution has made independent of disclosures made for the purposes for treatment, payment, and health care operations - To request a restriction on certain uses or disclosures - To choose how to receive health information

Incident Reporting (Variance or Occurrence report)

- Tools used to document anything out of the ordinary that has the potential to cause harm to a patient, employee, or visitor - Not used for disciplinary of staff person but for quality control to see if the event could be prevented from occurring again. To identify risks - It put all the facts together to help facilitate for the need of staff in services to prevent future problems or even if it is needed for litigation

The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion?

A bulk-forming (fiber) laxative, Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation. Bismuth subsalicylate does not relieve constipation.

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing. A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.

Healthy People 2020

A set of disease prevention and health promotion objectives for Americans to meet during the second decade of the new millennium.

Health information and privacy:

All information regarding a patient is considered confidential this includes: - Patient name - Address - Telephone number - Email addess - Social security number - Reason patient is sick - Treatments patient receives - Past health history

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?

Cheeseburger, french fries, coleslaw, and ice cream. Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C.

Paralel

Assess Diagnosis Plan Implement Evaluation

Discharge planning/ follow up

At discharge we educate using teach back method. We do it verbally and written. We teach about procedures, medications, their diagnosis, diets, & follow up appointments. Do they have the phone numbers to call the PCP. If we have to demonstrate something we break it down into smaller sections and then have the patient perform the skill. A telephone call is done to follow up with the patient to see how they are doing.

Focused Charting Examples:

DAR, PIE, SOAP Focus is on the patient needs and what we did for that need along with the response DAR- date action response PIE- problem interventions evaluation SOAP- subjective data, objective date, assessment, plan

Perception/Cognition Related:

Deficient knowledge Readiness for enhanced knowledge Noncompliance (with medication)

Patient Education definition

Encompasses activities designed to produce learning that alters health behaviors or improves health status

A nurse is preparing a client for bronchoscopy. Which instruction should the nurse give to the client?

Do not eat or drink for 6 hours before the procedure. Bronchoscopy involves visualization of the trachea and bronchial tree. To prevent aspiration of stomach contents into the lungs, the nurse should instruct the client not to eat or drink anything for approximately 6 hours before the procedure. It isn't necessary for the client to avoid walking, talking, or coughing.

Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors?

Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist. When combined with a number of drugs, MAO inhibitors can cause life-threatening hypertensive crisis. It's imperative that a client using MAO inhibitors check with the physician and pharmacist before taking any other medications. Activity limitations are unnecessary. Blood disorders aren't a common problem with MAO inhibitors. Aspirin and NSAIDs are safe to take with MAO inhibitors.

Nursing Theory

Dorothea Orem's Self-Care Deficit

Psychosocial theory

Erickson's developmental stages

Exemplars

Formal teaching (class on parenting or different example), informal teaching (cardiac patient), and discharge planning, Oral health across the lifespan

Theories of Health behavior

Health Belief Model (Rosenstock)-Help explain individual decisions to use health screening opportunities • Health Promotion Model (Pender)-Depict persons interacting with their environment as they pursue health• Self-Care Deficit Theory (Orem)-Patient's ability to assume responsibility for own care based on anticipation of resuming this responsibility

Care Coordination/ Transition

Identifies life and health goals with the patient and family to coordinate services and community supports to work towards better health outcomes. - A mechanism to make sure that patients get the right care at the right time in the most efficient and cost effective manner , by the right person in the right setting. - The aim is to link patients with resources in the community to enhance their well being

Health Promotion related to

Ineffective Health Maintenance Risk prone health behavior r/t low self-efficacy Readiness for enhanced self-health management Ineffective self health management Impaired home maintenance Ineffective family therapeutic regimen management

We then welcome the patient to the room as he/she arrives.

Introduce ourselves and explain what is about to happen.

Teaching Process

Learning Needs Teaching plan Teaching Patient's behavior/attitude

Adult Learning principles

Learning is related to an immediate need, problem, or deficit • Learning is voluntary and self-initiated• Learning is person-centered and problem-centered • Learning is self-controlled and self-directed• The role of the teacher is one of facilitator • Information and assignments are pertinent• New material draws on past experiences and is related to something the learner already knows • The threat to self is reduced to a minimum in the educational situation • The learner is able to participate actively in the learning process • The learner is able to learn in a group • The nature of the learning activity changes frequently• Learning is reinforced by application and prompt feedback

Key Points 1-5

Legal implications for nurses regarding teaching include knowing the importance of the Nurse Practice Act & Safeguard of Documentation. Nurses teach through Assessing, Planning, Implementing, and Evaluating. Teaching approach affects learning. Patient education must be ongoing and interactive. Patient education must take into account the patient's plan of care.

Humanistic theory

Maslow's Hierachy of Needs

Discharge goals

Mutually set with patient / family •SMART • S = specific • M = measurable • A = achievable • R = relevant • T = timed

Theory of Health Behavior: 3

Nola Pender's Health Promotion Model

Admission

Nurse responsible for ensuring patient's safety, comfort, and wellbeing upon arrival. We set up the room for patient needs such as zeroing out the bed, placing any necessary equipment per patient needs etc. make sure everything works

How nurses teach

Nursing Process Teaching Process Assess Learning needs Diagnosis Knowledge deficit Plan Learning preferences resources Implement Cognitive, Affective, Psychomotor Evaluate Knowledge, Attitude, Skills

Outcomes (Positve/Negative)

Outcomes from Patient Education may be either positive or negative. If Patient Education is optimally functional positive outcomes such as wellness, promotion of self-efficacy, reduced health risk factors, and/or an adaptation to changing health status may occur. If health is affected negatively due to mal-education or no-education, then the negative consequences might include increased health costs, frequent hospital admissions, mal practice suits, non-compliance, and negative health outcomes.

ANA nursing scope and standards of practice

Outlines the expectations of the professional nurse, states the scope of practice, presents standards of care

Examples of Incident Reporting (Variance or Occurrence report)

Patient leaving Against Medical Advice, patient falls, medication errors, IV infiltrations, patient inappropriate behavior, complaints of patient or family that may addressing by manager. The event includes - Names of all involved - Names of witnesses - Complete facts of the incident - Date, time, and place of incident - Characteristics of person involved (alert, ambulatory, asleep, etc) - Any equipment involved - Any resources used

Nursing Process

Physiological an psychological needs Care plan Nursing Interventions Patient's condition

Care Coordination/ Transition can include

Primary care Specialty Care Inpatient Care Mental health services Long term care Medical history Test results Home care Informal caregivers Patient/family education and support Medications/Pharmacy Community resources

Assess willingness to learn

Recognized gap between what is known and what is wanted to be known •Attitude toward learning - • Important or Waste of time? •Health beliefs •Sociocultural background •Religious beliefs

Discharge planning on admission

Registered Nurse is coordinator of care •Family often involved in physical care - • Sterile dressing changes - • Monitoring intravenous medications - • Maintaining high-technology equipment •Short length of stay in acute care means many patients need post-acute care referral - • Rehabilitation hospital - • Nursing home - • Home health care

Theory of Health Behavior:

Rosenstock's Health Belief Model

Activity/Rest related

Self neglect r/t learning disability

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are:

Severe headache and early change in level of consciousness. The main presenting symptoms for ischemic stroke are numbness or weakness of the face, arm, or leg, especially on one side of the body, confusion or change in mental status, and trouble speaking or understanding speech. Severe headache, vomiting, early change in level of consciousness, and seizures are early signs of a hemorrhagic stroke. Foot drop and external hip rotation can occur if a stroke victim is not turned or positioned correctly.

Discharge Planning

Starts at admission! we begin with our assessment of the patient. Finding out their health history and home environment. Their strengths and weakness. WE as care coordinators start this process. We teach patients and their families how to care for whatever their diagnosis is. It could include sterile dressing changes, IV medication, high technology equipment, special diets etc.

Interrelated Concepts

The interrelated concept impact the Patient Education concept and/or the Patient Education concept impacts them. Those listed on the diagram are Safety, Cognition, Human Development, Communication, Clinical Judgment, Health Promotion, Evidence-Based Practice, Quality Improvement, and Teamwork and Collaboration.

A client with diabetes is hospitalized with a TIA. When planning this client's discharge teaching the nurse knows to include which of the following ?

Techniques to control blood sugar within normal ranges. Clients with diabetes are educated in techniques to control blood sugar within normal ranges with diet, exercise, and medications. The scenario does not indicate the need to teach this client about hypoglycemia, hyperglycemia, or how to inject insulin.

Attributes

The Patient Education concept analysis diagram clearly depicts the definition as it is related to the attributes. Improved health behavior, overcoming barriers to learning, actively participating in the process of learning, and improved health status, all indicate when this concept is adequately functioning.

Antecedents

The antecedents identify the events which must happen prior to the concept's optimal existence. These include lack of knowledge, readiness to learn, ability to communicate, access to the educator/education, and the ability to learn. For example, if the patient has an issue with literacy, the education could be impeded if the nurse does not accurately assess the patient's ability to learn and adjust the learning activities accordingly.

The nurse is caring for a client who has been experiencing difficulty voiding since her vaginal birth. The client voices concern to the nurse. What information should be provided to the client?

The birth can cause perineal swelling. Trauma from vaginal birth causes swelling in the perineal area, which can obstruct the flow of urine and cause urinary retention during the early postpartum period.

When a client with an indwelling urinary catheter wants to walk to the hospital lobby to visit with family members, the nurse teaches him how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

The client keeps the drainage bag below the bladder at all times. To maintain effective drainage, the client should keep the drainage bag below the bladder; doing so allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldn't lay the drainage bag on the floor because the bag could become grossly contaminated. The client shouldn't clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above — not below — its point of entry into the drainage bag.

Leaving against medical advice (AMA)

The patient has the right to leave at any time. He/she is educated on the complications and consequences of leaving against medical advice and if they still want to for they have to sign papers before leaving and get the IV out before they leave. This released the hospital and MD of any liability. If they have insurance the insurance will not pay for a readmission.

Theory of Health Behavior

Transtheoretical Model of Health Behavior

The nurse is teaching a client about cancer prevention. The nurse evaluates teaching as most effective when a female client states that she will

Use sunscreen when outdoors. Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.

Focused Charting

Used for narratives it can include a patient's strength, problem or need - Patient concerns - Patient behaviors - Therapies and their responses (medications) - Changes of condition - Significant events such as : a) teaching b) consultations c) monitoring d) management of ADL e) assessment of functional health problems

Must do a medication reconciliation (Last dose taken), valuables and belongings, admission questionnaire, ask about advanced directives (POA), and admission head to toe assessment.

We confirm ID bands, allergies, and code status. Remember we are assessing for discharge needs

World Health Organization (WHO)

a global institution dedicated to the improvement of human health by monitoring and assessing health trends and providing medical advice to countries

A nurse is working with a patient to establish a bowel training program. Based on the nurse's understanding of bowel function, the nurse would suggest planning for bowel evacuation at which time?

after breakfast, Natural gastrocolic and duodenocolic reflexes occur about 30 minutes after a meal; therefore, after breakfast is one of the best times to plan for bowel evacuation.

A nurse is teaching a client how to administer subcutaneous insulin injections. Which injection site should the client use?

anterior aspect of the thigh. Subcutaneous injection sites, which are relatively distant from bones and major blood vessels, include the lateral aspects of the upper arm, the anterior aspects of the thigh, and the abdomen. The deltoid, rectus femoris, and vastus lateralis are I.M. injection sites.

Which are examples of subjective data? Select all that apply.

anxiety, nausea, lightheadedness. Subjective data are those that only the person experiencing them can perceive and report, such as anxiety, light-headedness, and nausea. Objective data are those that someone other than the person experiencing them can observe, such as edema and laceration.

An informatics nurse is preparing a training program for staff nurses in the facility. The facility will be implementing a new electronic health record. To ensure the best results, which type of training would the informatics nurse most likely use?

classroom education, The type of training required depends on the implementation project. For the installation of a new EHR, a classroom model of education will most likely be needed. If you are adding only a new module to a current system, web-based or online training may be adequate. If the change is a simple addition to current functionality, a tip sheet or just-in-time training may suffice.

After teaching a group of students about the functions of the nervous system, the instructor determines that the teaching was effective when the students identify that a function is:

control of body function, The nervous system is responsible for controlling body function, analyzing incoming stimuli, and integrating internal and external responses.

A client reports that taking St. John's wort. When reviewing the client's medication history, what would be a cause of concern?

digoxin, St. John's wort, a highly advertised and popular alternative therapy, has been found to interact with oral contraceptives, digoxin (a heart medication), the selective serotonin reuptake inhibitors (used for depression), theophylline (a drug used to treat lung disease), various antineoplastic drugs used to treat cancer, and the antivirals used to treat AIDS. It has not been shown to interact with acetaminophen or ibuprofen. Insulin or other antidiabetic agents interact with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, and celery to cause hypoglycemia.

The nurse knows that a client who is being taught to perform home blood pressure monitoring (HBPM) understands the teaching plan when he makes which statement about the size of the BP cuff? The cuff should:

fit snug around the upper arm with room to slip a fingertip under the cuff and should be 1 in (2.5 cm) above the crease of the elbow. When teaching a client to perform home blood pressure monitoring (HBPM), he or she should be taught that the proper fitting cuff should fit snug around the upper arm with room to slip a fingertip under the cuff and should be 1 in (2.5 cm) above the crease of the elbow.

QSEN (Quality and Safety Education for Nurses)

focus on competency needed to continuously improve quality of care in their work environment Patient centered Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics-Electronic charts

When educating clients in the community on health promotion and prevention of disease, it is important to stress:

health education can benefit individuals and groups. An axiom of health promotion and disease prevention is the fact that health education is highly beneficial. These benefits are not the same for everyone, but everyone can benefit from some sort of health promotion, including older clients. Strenuous exercise is not appropriate for everyone. Education does not always need to happen in a formal healthcare setting.

A group of students are reviewing class material about lymphoid tissue. The students demonstrate a need for additional teaching when they identify this as lymphoid tissue?

histamine, Histamine is a substance released when a cell membrane is injured and is not considered lymphoid tissue. Bone marrow, the thymus gland, and the spleen are lymphoid tissues.

A red blood cell placed in which solution would shrink as water moves out of the cell?

hypertonic, A red blood cell placed in hypertonic solution will shrink and shrivel up as water moves out of the cell. A red blood cell placed in isotonic solution is stable and will retain its shape. A red blood cell placed in hypotonic solution will swell and burst as water moves into the cell.

The Joint Commision

industry-driven organization that ensures quality standards are set, monitored, and maintained by member healthcare facilities through routine and unannounced inspections and performance grading

Patient Education

is the process of influencing the patient's behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health. Research supports the fact that educated patients experience better health and have fewer complications. This results in fewer hospitalizations and emergency department, clinic, and physician visits.

HIPPA authorization rule

items allowed to be disclosed without prior authorization from patient. Otherwise if a health facility wants to release PHI for purposes other than treatment, payment, or routine health care the patient must sign an authorization

Nurse Practice Act

law established to regulate nursing practice

Remember than an incident report

must not be noted in the official patient chart

A 15-year-old child has difficulty falling asleep on a nightly basis. The health care provider suspects a lack of melatonin. What endocrine gland secretes melatonin?

pineal gland, The pineal gland is attached to the thalamus in the brain. It secretes melatonin, which aids in regulating sleep cycles and mood.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

preoperative, Exercises and physical activities occurring in the preoperative phase include deep breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings. The intraoperative phase is when the client is in the operating room. In the postoperative area and postanesthesia care unit areas, clients are monitored and deep breathing exercises begin.

When explaining the structure and function of the cell membrane to a client, the nurse should describe it as being:

primarily responsible for maintaining cellular integrity.The cell membrane, a thin barrier, is essential for maintaining cellular integrity. The cell membrane is not rigid, allowing adjustment to the changing shape of the cells and so it can repair itself. The phospholipid layer of the membrane is bipolar and it is not gas-permeable.

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

risk for infection. Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.

Care Transition

the shift of care rom one setting to another. The goal sis to avoid complications and unnecessary hospital readmissions. Goes with Care Coordination.

Health Promotion examples for Informal patient nurse encounters

• Breastfeeding teaching • Immunization teaching • Genetic screening

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep is unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:

use caution when driving an automobile. The client is describing hypersomnia and is at increased risk for a motor vehicle accident when drowsy while driving an automobile. The client is to avoid alcohol, caffeine, and late-night activities.

Domains of Learning

• Cognitive learning - Discussion - Lecture - Question/answer - Role play, discovery • Affective learning - Role plan - Discussion • Psychomotor learning - Demonstration - Return demonstration - Practice

The Teaching Process

• Assessment • Nursing Diagnosis • Planning • Implementation • Evaluation

Nursing Diagnosis

• Deficient knowledge • Ineffective health maintenance • Impaired home maintenance • Ineffective family therapeutic regimen management• Ineffective self-health management • Noncompliance (with medication)

Assess readiness to learn

•Emotional state •Adaptation to illness •Emotional maturity •Past life experiences •Personal and/or family learning goals

Discharge evaluation

•Telephone call •Questionnaire about hospitalization is common but NOT the same as an inquiry about how the patient is doing post-discharge

Cognitive theory

Piaget's Theory of Cognitive Development

Health Promotion examples for Illness related examples (Self directed patient education)

• Internet resources • Self help books • Instructional videos

Informal Patient nurse encounter

•Charlotte Avery is an 82-year old woman who is retired and cares for two great-grandchildren. When Mrs. Avery fainted in her home three days ago, her nine year-old great-grandchild called 911. It was later found that Mrs. Avery's diabetes was out of control. Her provider told her she would no longer be able to control her diabetes with diet and oral medications alone. She must now learn to monitor her blood glucose and self-administer insulin.

Diagnoses for Mrs.Avery

•Knowledge deficit: diabetes management •Knowledge deficit: medication regimen •Knowledge deficit: treatments and procedures

A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."The nurse should instruct the client to avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes) for 30 days after a stapedectomy. Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client's first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client?

"You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram

Health Promotion examples for Formal patient education

- Smoking cessation - Childbirth classes - Weight reduction classes

Discharge Teaching Plan

-Begins on Admission -Formal discharge plan required if patient has:• Lack of knowledge of the treatment plan, Social isolation, Recently diagnosed chronic disease, Major surgery, Prolonged recuperation from major surgery or illness, Emotional or mental instability, Complex home care regimen, Financial difficulties, Lack of available or appropriate referral sources, Terminal illness -Guidelines for Discharge Planning -Evaluation of Discharge Planning

Objectives

1. Describe what the concept means (including definition, antecedents and attributes). 2. Identify conditions that place an individual at risk for patient education 3. Identify when patient education is occurring or has developed. 4. Discuss exemplars of patient education .5. Apply the nursing process with collaborative interventions and evaluation for individuals experiencing patient education

Discharge teaching

All patients - • Summary of hospitalization (diagnosis, major test results, major treatments) - • Medications - • Treatments - • Diet - • Smoking cessation - • Activity - • Follow up with primary care provider - • Referrals, if any

Teaching methods for Mrs. Avery

Diabetes management •Provide a quiet environment that supports discussion of feelings •Assess patient's desire to self-administer injections •Provide constructive feedback in the learning process

Evaluation method

Direct observation / return demonstration • Written tests, pretest and/or posttest, oral tests, interviews, • Teach-back. This is evidence-based and patient-centered. It requires active listening and engagement of both nurse and patient. "Gold standard" of evaluation • Checklist • Rating scales • Anecdotal notes • Physiologic measurements • Simulation. Present a short scenario and ask patient 'what would you do'. Similar to teach back but may not be relevant

Key Points 6-10

Education level, and need for care reaches across the continuum from the hospital to home care long-term. Patient education plans should be developed in collaboration with the entire health team, including members of the hospital team (eg, dietitians, respiratory therapists, social workers, pharmacists) as well as home care agencies, wellness facilities, and long term care agencies. The adult learning principles are a guide for nurses to use when teaching adults. Motivation to learn is influenced by multiple factors, all of which need to be considered to make learning optimal. Clear cut goals are necessary for setting the criteria for success when teaching. Teaching requires evaluation in order to be sure needs/objectives are met.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?

Six small meals daily with 120 mL fluid between meals. After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified?

Wear rubber gloves when in contact with soaps.The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry.

At a previous visit, the parents of an infant with cystic fibrosis received instruction in the administration of pancrelipase. At a follow-up visit, which finding in the infant suggests that the parents require more teaching about administering the pancreatic enzymes?

fatty stools. Pancreatic enzymes normally aid in food digestion in the intestine. In a child with cystic fibrosis, however, these natural enzymes cannot reach the intestine because mucus blocks the pancreatic duct. Without these enzymes, undigested fats and proteins produce fatty stools. If the parents were administering the pancreatic enzymes correctly, the child would have stools of normal consistency. Noncompliance doesn't cause liquid or bloody stools

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to:

rest in an air-conditioned room., Fatigue is a common symptom in clients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Muscle relaxants, ordered to reduce spasticity, can cause drowsiness and fatigue. Frequent rest periods and naps can relieve fatigue. Other measures to reduce fatigue in the client with MS include treating depression, using occupational therapy to learn energy-conservation techniques, and reducing spasticity.

Teaching Plans (Activities and Content_

•Activities - • Cognitive = knowledge (mental skills) • Affective = attitude (growth in emotional areas)• Psychomotor = skills (manual or physical) •Content - • What the patient needs to know • What the patient wants to know •Teaching methods •Teaching tools

Nursing Interventions

would include Patient Education, would be implemented proactively or when negative consequences occur. The process of Patient Education would consider the Antecedents to optimize its effectiveness. When the process attains the measurable Attributes then positive outcomes should occur.

Discharge teaching documentation

• Description of client's condition at discharge • When to notify physician • Current medications (including new prescriptions)• Treatments (wound care, etc.) • Diet • Activity level • Restrictions • Return appointment • Referral summaries (home health instructions, equipment, etc.)

Goals, Outcomes, and Evaluation

• Goals are necessary for setting criteria for success• Conditions and time frames need to be realistic• Consider the plan -make it specific • Reinforce learning through feedback • Documentation is important legally

Health Promotion examples for Self directed patient education

• Internet resources (WebMD) • Exercise videos • Common literature (magazines, journals)

Health Promotion examples for Illness related examples (Informal patient-nurse encounters)

• Medication teaching • Wound care • Discharge teaching

Standards and Resources for patient education

• Nurse Practice Act • Healthy People 2020 • ANA : Nursing: Scope and Standards of Practice • The Joint Commission • World Health Organization (health literacy) • QSEN (Quality and Safety Education in Nursing competencies)

Assessment

• Readiness to learn - Emotional state, Stage of adaption, Emotional maturity, Past life experiences, Patient and family goals • Willingness to learn, Health beliefs, Sociocultural background, Religious beliefs • Ability to learn - Physical condition, Intellectual status, Learning style, The support system, Socioeconomic status

Teaching Plans SMART goals

• S = Specific • M = Measurable • A = Attainable / Achievable • R = Relevant • T = Timely •Goals include what is to be taught, why, and how it will be evaluated

Planning and Implenting

• What conditions must exist for learning to optimally occur? -Consider both the patient and the environment What would the nurse need to consider when planning to teach newborn care?

Motivation

• What influences the ability to learn? • How does anxiety affect learning? • What is the social learning theory and how does it affect learning? • What is self-efficacy and how does it affect learning? • How does learning in children occur? • How does adult learning occur?

Specific Assessment Questions

• What questions would you ask your patient regarding readiness to learn, learning styles, motivation, and ability to learn? • What would you need to consider regarding the health of the patient?

Informal encounters

•Allows for individually tailored information •Especially helpful with learners with a variety of learning preferences •Consistent with patient-centered care •Allows instant modification of content to meet learner needs •Face to face is most common •Takes advantages of 'teachable moments'

Using teaching tools

•Appropriate for age, literacy level, education, language •6-8 grade reading level is desired •Use lay terminology (avoid medical jargon and abbreviations) •Use printed material to reinforce teaching and as a take home resource •Do not overwhelm with too much information at one time

Discharge Assessment

•Begins on admission - • Many patients do not consider how they will maintain their health once discharged - • Their priority is 'now'; not 'later' •Includes patient and family / caregiver •Medical treatment plan •Available resources, including insurance

Discharge planning

•Begins on admission •Formal discharge plan may be required •Guidelines for discharge planning •Evaluation of discharge planning

Teaching Plans

•Carefully organized, written presentation •Includes learning objectives •Includes teaching methods / how instruction will be provided •Based on identified learning needs •Tailored to individual learning style

Discharge planning purpose

•Continuity of care •Ensure patient needs are met as patient moves between levels of care •Includes assessment of patient, family, and resources •Health insurance coverage is a factor in post-discharge plans

Teaching methods for Mrs. Avery (Psychomotor skills)

•Demonstrate correct procedure for drawing medication and subcutaneous injection. Observe return demonstration •Demonstrate procedure for fingerstick and use of Glucometer. Observe return demonstration

Sample documentation

•Discharged per wheelchair with granddaughter to automobile. Able to walk in the hall. Has given self insulin correctly with supervision. Referral to home health care agency for follow - up teaching. Has appointment with provider in one week.

Documentation example

•Discharged to home via wheelchair with sister to private vehicle. Abdominal dressing intact. Able to demonstrate emptying of Jackson Pratt drain and verbalize when to call provider. Has all personal belongings. Provided with copy of discharge instruction

Learning goals for Mrs.Avery

•Knowledge: Diabetes management •The patient will discuss her feelings about taking insulin = • Goal addresses affective domain •Knowledge: Medication regimen •The patient will list the differences between regular and intermediate-acting insulin• - Goal addresses cognitive domain

Learning goals for Mrs. Avery (psychomotor)

•Knowledge: Treatments and procedures •The patient will correctly demonstrate self-injection of insulin - • Goal addresses psychomotor domain

Formal discharge plan

•Lack of knowledge of treatment plan •Social isolation / lives alone •Geographic isolation •Recently diagnosed chronic disease •Financial difficulty •Terminal illness •Major surgery •Prolonged recovery expected •Emotion or mental instability •Complex treatment regimen •Lack of resources (personal, family)

Discharge documentation

•Location discharged to •Description of patient condition at discharge •Method of discharge •Accompanied by ..•Mode of transportation •Belongings •Copy of discharge teaching

Self directed

•Maximizes readiness to learn •Content may not be accurate or evidence based •Much information is testimonial / personal experience •Can be confusing with too many resources to select meaningful learning

Oral health across the lifespan Overview

•Oral health is directly related to systemic health, yet many Americans have limited to no access to dental health professionals •Early childhood dental caries is an infectious, vertically transmitted, preventable disease •Oral health and systemic health are related •Patients can improve their oral health with guidance, screening, and referral

Formal education pt 2

•Perform a needs assessment •Group should have similar concern and learning style •Prepare ahead of time for what the class will cover •Be creative

Assess ability to learn

•Physical condition and physiologic barriers to learning •Intellectual status •Learning style (visual, auditory, tactile) •Support system• Socioeconomic status - • Higher income patients generally have less anxiety about hospitalization - • Anxiety can interfere with learning.

Formal Education pt.5

•Plan to use audiovisual aids •Change pace and tone during presentation •Invite questions and comments •Repeat information using different terminology for those who may not have understood •Provide program evaluation questionnaires

Teaching tools

•Printed materials •Videos •Physical models •Posters and flip charts •Closed circuit television •Computer assisted instruction

Teaching methods for Mrs. Avery (Prescribed medications)

•Provide video explaining effects of insulin and mechanism of action •Provide multiple choice test, and provide instructions •Describe differences in types of insulin, and provide handout

Smiles for life learning modules

•Relationship of oral and systemic health •Child oral health •Adult oral health •Acute dental problems •Pregnancy and women's oral health •Caries risk assessment, fluoride varnish, and counseling •The oral exam •Geriatric oral health

Smiles for Life

•Smiles for Life is the nation's most comprehensive and widely used oral health curriculum for primary care clinicians •There are eight modules, about 60 minutes each •Intent is to expand access to oral care to vulnerable populations •Learn more at https://www.smilesforlifeoralhealth.org/

Formal education

•Supports several learners •Time efficient •Resource efficient •Promotes group sharing of information and experiences pre and post teaching sessions • Limited opportunity for personalization