Chapter 21: Teacher and Counselor
The Joint Commission on Teaching
Addresses an understanding of health status including disease and its treatment, informed decision making, and the promotion of health lifestyles. In 2002, TJC began sponsoring the "Speak Up" initiative. This is an effort to educate patients how to get involved in their care and prevent health care errors. The Speak Up campaign now includes 20 brochures and 8 videos that address topics such as things you can do to prevent infection, pain management recommendations , and how patients can avoid mistakes with their medications.
affective learning
renewed changes in attitudes, values, and feelings
patient education
process of influencing the patient's behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health. This ultimately resorts in less hospitalizations. To be successful, patient education must be ONGOING and INTERACTIVE.
teaching-learning process
process of patient teaching that encompasses critical steps necessary to provide teaching and to measure learning; the teaching-learning process models the nursing process
health literacy
ability to read, understand, and act on health information
psychomotor learning
acquisition of physical skills
positive reinforcement
affirmation of the effort's of the patient
cognitive learning
storing and recalling of new knowledge in the brain
patient education focuses on three critical areas
1. Preparation for receiving care 2. Preparation before discharge 3. Documentation of patient education activity
Acronym ADPIE
A: Assessment D: Diagnosis P: Planning I: Intervention E: Evaluation
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory?
Cognitive learning theory Explanation: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights.
Educational Interventions
Educational Interventions
Outcomes of patient education
High-level wellness and related self-care practice Disease prevention or early detection Quick recovery with minimal or no complications Enhanced ability to adjust to developmental lifestyle Family acceptance of the lifestyle changes
Teach Patient: "School-aged children"
School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible.
Learning tools (1/4) The Ask Me 3
The Ask Me 3 is a brief tool intended to promote understanding and improve communication between patients and their providers. It involves three simple questions that patients should ask their health care providers during every encounter. The Ask Me 3 questions: 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?
Learning tools (2/4) Understanding Personal Perception (UPP)
The Understanding Personal Perception (UPP) tool is an attempt to determine if additional education is necessary. The nurse asks the patient to look at the images on the tool and decide which of the figures most accurately indicates the patient's understanding of the new health education materials. This tool has images ranging from either a bright sun (signifying that the patient completely understands the material) to gray clouds (confusions exists) to dark clouds blocking the sun (new information is not understood) (Murdock & Griffin, 2013)
Teach Patient: Infant
When the patient is an infant, teaching is directed toward the parents. Toddlers and preschoolers may have some degree of understanding about medical tests or procedures, but health teaching continues to be directed toward the parents.
nurse coach
a registered nurse who integrates coaching competencies into any setting or specialty area of practice to facilitate a process of change or development that assists individuals or groups to realize their potential
A nurse is preparing to teach a patient how to use an inhaler. Which teaching tool is one of the best methods? a. Demonstration b. Lecture c. Discovery d. Panel session
a. Demonstration
negative reinforcement
an ineffective teaching strategy that uses criticism or punishment
A nurse is teaching a 50-year-old patient how to care for his new ostomy appliance. Which teaching aid? a. Ask Me 3 b. Newest Vital Sign c. Teach-back tool d. TEACH acronym
c. Teach back tool
situational crisis
change that results when a person faces an event or situation that causes as disruption to one's life
counseling
giving guidance, assisting with problem solving
andragogy
the study of teaching adults
The nurse is working with a panel of clients who have diabetes. Part of the nurse's job description is to provide education to clients about the benefits of healthy food choices. The nurse's education has taught a few of her clients the benefit of healthy food choices. This is an example of what type of learning?
Affective learning Explanation: The education that the nurse provided has influenced the value some of her clients place on their food choices. This is the definition of affective learning.
contractual agreement
pact made between two persons or parties for the achievement of mutually set goals
A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which of the following as a characteristic of an adult learner?
Their readiness to learn is often related to a developmental task or social role. Explanation: An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group
The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: 7-year-old male, diabetes mellitus type 1 with a hemoglobin A1C of 8.3%, BMI of 31.7, BMI percentile of 99. What are the most appropriate learning diagnoses for this first session?
Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. Explanation: The data present for the nurse to use for planning the educational session do not give enough information to determine the parents' concepts on their child's health. Before making judgments on their readiness to learn, the nurse must assess them. There are not enough data to support sedentary lifestyle. When making a diagnosis, do not address actual problems as risks. With the hemoglobin A1C of 8.3%, the nurse knows that the client's glucose control is an actual problem, as is a BMI of 31.7 and a BMI percentile of 99. The assessment data on the client do reflect enough data to make the learning diagnoses of imbalanced nutrition and ineffective health maintenance.
Learning tools (4/4) Teach-back tool
Literally, teach back
Family Support Networks and Financial Resources
No matter what the patient's age, working with the patient's family can be a great help in patient teaching. Assess the family's function and style by talking with them and observing how the patient and family interact. This assessment will yield information about family function, stress, transitions, and expectations. The COPE model is one method of helping family members to become effective problem solvers and support your teaching efforts.
A client is experiencing difficulty in adjusting to a new prosthesis despite conscientious client education by numerous members of the health care team. How should the team respond to the client's lack of learning to this point?
Revise the education plan that has guided education. Explanation: If evaluation of client education indicates that client learning has not met outcomes, it is appropriate to revise the education plan. This does not necessarily entail reducing the detail or referring the client to outside information sources. Exploring alternatives to prosthesis does not address the client's learning needs.
Acronym TEACH
T: Tune into the patient E: Edit patient information A: Act on every teaching moment C: Clarify often H: Honor the patient as a partner in the education process
The purpose of patient education
The purpose of teaching and counseling is to help patients and families develop the self-care abilities (knowledge, attitude, skills) they need to maximize their functioning and quality of life (or have a dignified death). For example, a patient newly diagnosed with diabetes must (1) acquire knowledge about disease as a disease process and related medical management and self care; (2) value health sufficiently to make certain lifestyle modification (attitude); and (3) master certain skills, such as insulin injection.
Teach Patient: Adult
The science of teaching (pedagogy) generally refers to the teaching of children and adolescents. In recent years, however, the study of teaching adults (andragogy) has gained more attention. Thus, andragogy focuses heavily on specific problems or needs and on the immediate application of new material. In general, adult learners MUST believe they NEED to learn before they are WILLING to LEARN.
A nurse who is caring for a morbidly obese male teenager forms a contractual agreement with him to achieve his weight goals. Which statement best describes the nature of this agreement?
b. "this agreement will motivate the two of us to do what is necessary to meet your weight goals." Explanation. 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 as an agreement can help motivate both the patient and the teacher to do what is necessary to meet the patient's learning outcomes.
Nclex Q1 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 Facilitating coping, nurses help patients come to terms
A nurse has taught a diabetic patient how to use an inhaler. The nurse should evaluate the teaching-learning process by: a. determining the patient's motivation to learn b. deciding if the learning outcomes have been achieved c. allowing the patient to practice the skill he has just learned d. 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.
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
learning
increasing one's knowledge; having one's behavior changed in a measurable way as a result of an experience
informal teaching
unplanned teaching sessions dealing with the patient's immediate learning needs and concerns
Domains of learning
"Cognitive" is knowledge 1. Lecture or discussion 2. Discovery 3. Programmed instruction "Psycho-motor" is action 1. Demonstration 2.Discovery 3.Audiovisual materials 4. Printed Materials "Affective" is feelings 1. Role modeling 2. Discussion 3. Panel discussion 4. Role playing
Learning tools (3/4) The Newest Vital Sign (NVS)
An additional reliable screening tool to assess health literacy. It was developed by Pfizer to improve communications between patients and providers and can be administered during initial assessments to assess the patient's literacy skills involving both numbers and words (Pfizer Clear Health Communication, 2012) Read ex. Ice cream nutrition label Questions relate to the nutrition label Score sheet with six oral questions referring to the label. Literacy is interpreted according to the number of correct responses.
Acronym COPE
C: Creativity overcome obstacles and learning how to generate alternatives. O: Optimism help the family caregivers learn how to view the situation with confidence P: Planning help the family learn how to plan for future problems and how to develop plans that reduce uncertainty E: Expert Information help the family learn how to obtain expert information from health care providers about what to do in specific situations. ** This information empowers caregivers
Nursing documentation is inclusive. Which is the best example of documentation of a teaching plan?
Cord care shown to mother, questions answered. Return demonstration observed. Explanation: Documentation of teaching must include who was taught, the topic taught, and some indication of the success of the learning plan. Only the answer with a mother being taught cord care and a return demonstration is complete.
Deficit
If the patient lacks the required knowledge, attitudes, or skills to support health promotion, you should diagnose the deficit. Use diagnoses or problem statements approved by the North American Nursing Diagnosis Association-International (NANDA-I) as a guide when diagnosing learning needs (ch12.) For ex. Deficient Knowledge: Breastfeeding related to inexperience, as manifested by anxiety and multiple questions
Understanding health literacy as a Nurse
Many people are still yet unaware of basic health information, search for health information, adopt healthy behaviors, and make appropriate healthcare decisions. This population is more likely to avoid medical screenings and require ED attention. Federal initiatives such as the Affordable Care Act 2010 and --- the National Action Plan to Improve Health Literacy from DHHS have made health literacy a national priority to improve the health of all Americans. The scope of the problem is challenging, in part because health care information and directions have traditionally been written at a 10th-grade level or higher, while educational material is generally more easily understood when written at a 5th-grade level.
patient education on Age and Developmental Level
People learn throughout life, although what they learn and how learning occurs change according to developmental stages. Three critical developmental areas to consider when developing a teaching plan are the patient's 1. Physical Maturation and Abilities 2. Psycho-social development 3. Cognitive capacity Other concerns related to the teaching-learning process include the patient's 1. Emotional maturity 2. Morals 3. Spiritual development
A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client?
The client describes signs and symptoms of hypoglycemia. Explanation: The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).
Teach Patient: Adolescents
The cognitive processes of adolescents are similar to those of adults, thus the content and strategies of patient teaching resemble those used for teaching adults. There are some important considerations to keep in mind, however. For example, when teaching a sexual active 16-year-old girl about contraceptive methods, you would assess whether the young patient has reached the stage Piaget refers to as: formal operations (the ability to use logical reasoning to solve hypothetical problems). If the patient's intellectual development is delayed and she is still in the period of concrete operations (use of logical reasoning to solve concrete problems), she may be less skilled in thinking abstractly-that is, she may not perceive pregnancy as a real possibility and, therefore, may not fully understand the need for contraception. If SO, you can alter the teaching plan to include online teaching aids that are easily accessible and explain the topic in concrete terms.
A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives?
The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. Explanation: The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.
literacy
ability to read and write
learning readiness
patient's willingness to engage in the teaching-learning process (emotional readiness) and experiential readiness to begin the challenge of learning
formal teaching
planned teaching based on learner objectives
developmental crisis
predictable patterns of behavior and change occurring throughout the lifespan
pedagogy
science of teaching that generally refers to the teaching of children and adolescents
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