Nursing Process Chapter 21: Teacher and Counselor

Counseling

The interpersonal process of helping patients make decisions that promote their overall well-being. It may be formal or informal. The interpersonal skills of warmth friendliness, openness, and empathy are necessary for successful counseling. An effective counselor needs to be a caring person.

What does teaching provide?

The knowledge that patients need to make informed health care decisions and to implement a plan of care

Evaluating

The nurse and the patients together measure how well the patient has achieved the outcomes specified in the plan of care

Documenting

The nurse is legally responsible for documenting teaching in the patient's record. Documentation of teaching learning process includes a summary of the learning need, the plan, the implementation of a plan, and the evaluation results

A registered nurse assumes the role of nurse coach to provide teaching to patients who are recovering from strokes. One example of an intervention the nurse may provide related to this role is:

The nurse uses discovery to identify the patient's personal goals and create an agenda that will result in change.

Formal teaching

The plan teaching done to fulfill learner outcomes.

Sensory deficits that can affect learning in older adults

The presence of cataracts that cloud vision, decrease in lands at accommodation that necessitates adequate lighting, a decrease in peripheral vision that requires that teaching materials to be kept immediately in front of the learner, or a hearing loss that makes it imperative for the teachers to speak slowly and clearly.

Patient education

The process of influencing the patient's behavior to affect changes and knowledge, attitudes, and skills needed to maintain and improve health. Educated patient experience better health and have fewer complications. This results in fewer hospitalizations and emergency department, clinic, and physician visits. Patient education plans should be developed in collaboration with the entire healthcare team, including members of the hospital team as well as home care agencies, wellness facilities, and long-term-care agencies. The basic purpose of teaching and counseling is to help patients and families developed the self-care abilities they need to maximize their functioning and quality-of-life.

Cognitive learning

Involves the storing and recalling of new knowledge in the brain for example the patient describes house salt intake affects blood pressure. Cognitive learning includes intellectual behavior such as the acquisition of knowledge, comprehension, application using abstract ideas and concrete situations, analysis relating ideas in an organized way, synthesis assimilating judging in the worth of a body of information.

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 understanding of the new health education materials

Health teaching helps...

Maintain and promote health Prevent illness Restore health Facilitate coping

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?

Teach-back tool

The nurse as a teacher

Teaching a plan method or series of methods used to help someone learn. The person using these methods is a teacher

Health literacy

The ability to read, understand, and act on health information

A nurse is counseling a 19-year old male 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?

"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?"

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?

"This agreement will motivate the two of us to do what is necessary to meet your weight goals."

The nurse coaching process includes The following

-establishing relationships and identifying readiness for change -identifying opportunities, issues, and concerns -establishing patient centered goals -creating the structure of the coaching interaction -empowering and motivating patients to reach goals -assisting the patient to determine progress goals

Preventing illness

-first aid -safety -immunizations -screening -identification and management of risk factors

Promoting patient and family compliance

-be certain that the healthcare instructors are understandable and assigned to support the patients goal -include the patient and family as partners in the teaching learning process -use interactive teaching strategies -remember that teaching and learning our processes that rely on strong interpersonal relationships with patients and their families

Key points of effective communication associated with patient teaching include the following:

-be sincere and honest, show genuine interest and respect -avoid giving too much detail, stick to the basics -ask if the patient has any questions -be a cheerleader for the patient. Avoid lecturing -use simple words -vary your tone of voice -keep the content clear and concise -listen and do not interrupt when patient speaks -ensure that the environment is conducted to learning and free of interruptions -be sensitive to the timing of teaching sessions. A shorter session is best for a younger child, and an adult may need to choose an opportune time to learn new information.

Promoting health

-developmental and maturational issues -normal child bearing -hygiene -nutrition -exercise -mental health -spiritual health

Related nursing diagnoses include the following

-Ineffective health maintenance -ineffective therapeutic regimen management -noncompliance -self-care deficit

A nurse is teaching patients of all ages any hospital setting. Which examples demonstrate teaching that is appropriately based on the patients developmental level?

-The nurse designs an exercise program for a sedentary older adult Male patient base on the activities he prefers -the nurse includes an eight year old patient and the teaching plan for managing cystic fibrosis -the nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce teaching.

A nurse is planning teaching strategies for patients addicted to alcohol, in the affective domain of learning. What are examples of strategies promoting behaviors in this domain?

-The nurse explores the reasons alcoholics drink and promotes other methods of coping with problems. -The nurse helps patients to reaffirm their feelings of self-worth and relate this to their addiction problem. -The nurse reinforces the mental benefits of gaining self-control over an addiction.

The steps of the teaching learning process

-access learning needs and a learning readiness -diagnose the patients learning needs -develop learning outcomes -develop a teaching plan -implement teaching plan and strategies -evaluate learning

Factors to take into account when teaching

-age and developmental level -Child and adolescent learners -adult learners -Family support network and financial resources -cultural influences and language deficits -Health literacy

Nurse care givers were skilled teachers and counselors can promote the following outcomes

-high-level wellness and related self-care practices -disease prevention or early detection -Quick recovery from trauma or illness with a minimal or no complications -enhanced ability to adjust to developmental lifestyle changes in acute, chronic, and terminal illnesses -Family acceptance of the lifestyle changes necessitated by illness or disability

Facilitating coping

-how the patients physical and mental condition affects other areas of functioning, lifestyle counseling -measures that maximize independence and enhance self-concept -stress management -environmental alterations -Community resources -appropriate referrals -grieve and bereavement counseling

Common teaching mistakes

-ignoring the restrictions of the patients environment -failing to accept the patients have the right to change their mind -using medical jargon -failing to negotiate goals -duplicating teaching that one team member have done -Overloading the patient with information Choosing the wrong time for teaching -Not evaluating the patient has learned -Not review an educational media or relying exclusively on media -Failing to document patient teaching and plan for follow-up for teaching reinforcement

Restoring health

-orientation to treatment center and staff -patients and nurses expectations of one another -the illness and physical condition anatomy and physiology, ideology of the problem, significance of symptoms, and prognosis -the medical and nursing regiments and how the patient can participate in care -self-care practices the patient and family needs to manage the patient's condition independently

Motivation is enhanced when:

-patients view themselves as susceptible to the disease in question -patients view the disease as a serious threat -patients believe they're our actions they can take to reduce the probability of contracting disease -patients believe the threat of taking these actions is not as great as a disease itself

Patient education focuses on three critical areas

-preparation for receiving care -preparation before discharge from a healthcare facility -documentation of patient education activity

Important considerations when implementing a teaching plan

-promote patient learning by using a warm and accepting approach. -considering the physical environment when implementing the teaching plan -review the patient's expectations in role functions as a learner -Access the patients comfort level -be prepared and organized before implementing the teaching plan -make each learning session interesting and enjoyable for the patient

The 3 ask me questions

-what is my main problem? -what do I need to do? Why is it important for me to do this?

Four assumptions about adult learners

1. As people mature, their self concept is likely to move from dependence to independence. 2. The previous experience of the adult is a rich source for learning 3. An adult readiness to learn is often related to a developmental task or social role 4. Most adult orientation to learning is that material should be useful immediately, rather than at sometime in the future.

Contractual agreement

A pact between two people setting out a mutually agreed-on-goals. Contracts between nurses and patients are common in many healthcare settings. The contracts are usually informal and not legally binding. Such an agreement can serve to motivate both the patient and you as a teacher to do what is necessary to meet the patient learning outcomes.

Psychomotor learning

A physical skill involving the integration of mental and muscular activity. For example the patient demonstrates how to change dressings using clean technique.

Learning

A process by which a person acquires or increases knowledge or changes behavior in a measurable way as a result of the experience.

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 assist individuals or groups to realize their potential. Establishes a partnership with a patient and uses discovery to identify the patients personal goals and agenda in a way that will result and change rather than using teaching and education strategies directed by the nurse as expert.

Psychomotor domain

Adapts Arranges Assembles Begins Changes Constructs Create Demonstrates Manipulates Moves Organizes Rearranges Shows Starts Works

Positive reinforcement

Affirms the efforts of patients who have mastered the new knowledge, attitudes, or skills. Reinforcement may be a simple as a few words of acknowledgment, as spontaneous as a warm hug, or as planned as the entire staff joining to celebrate the patients independent ambulation.

Family support networks and financial resources

Always use the family caregiver as a partner in providing care and view yourself as a health educator who teaches families how to solve problems, rather than as an experiment to solve problems for them. evaluate the families financial resources because the patient may be unable to afford to follow a new treatment regimen.

The newest vital sign NVS

An additional reliable screening tool to access health literacy. It was developed by Pfizer to improve communications between patients and providers and can be administered during initial assessments to access a patient literacy skills involving both numbers and words. It consist of a nutrition label from an ice cream container and a scoresheet for Recording the patient answers to six oral questions referring to the label.

Motivational interviewing

An evidence-based counseling approach that involves discussing feelings and incentives with the patient. Nurses often become frustrated because their patients do not seem to want to get better or to learn how to care for themselves.

Motivation

An internal impulse such as emotion or physical pain that encourages the patient to action for change behavior.

Teach back tool .

Assesses health literacy, seeking to confirm that the learner understands the help information received from the Health professional

Cultural influences and language deficits

Be sure to identify language deficits are barriers and develop strategies to address them, clearly communicating this in the plan of care.

Factors affecting patient learning

By taking into consideration the patient's age and developmental level, family support networks and financial resources, cultural influences and language deficits, and health literacy level, you can individualize the teaching plan and maximize learning.

The COPE model

C: creativity Help the family overcome obstacles to carry out healthcare management and learning how to generate alternatives. O: optimism Help the family caregivers learn how to view the caregiving situation with confidence P: planning Help the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty E: expert information Help the family learn how to obtain expert information from healthcare providers about what to do in specific situations. This information empowers caregivers by encouraging them to develop plans for solving caregiving problems.

Affective domain

Chooses Defends Displays Forms Gives Helps Initiates Justifies Relates Revises Selects Shares Uses Values

Cognitive domain

Compares Define describes Designs Differentiates Explains Gives Identify Names Prepares Plans Solves States Summarizes

Teaching content

Content supported by nursing research is called evidence based and reflects the most accurate and clinically supportive information.

Types of counseling

Counseling maybe situational, developmental, or motivational as well as short or long term.

Negative reinforcement

Criticism or punishment is generally ineffective. Undesirable behavior is usually best ignored. Behavior modification programs that reward desire behaviors and ignored undesired behaviors can be designed for some patients.

A nurse has taught a diabetic patient how to administer his daily insulin. The nurse should evaluate the teaching-learning process by:

Deciding if the learning outcomes have been achieved.

A nurse is preparing to teach a 45-year old male patient with asthma how to use his inhaler. Which teaching tool is one of the best methods to teach the patient this skill?

Demonstration

Psycho motor domain

Demonstration Discovery Audiovisual materials Printed materials

Culturally competitive patient teaching

Develop an understanding of the patient's culture Work with a multicultural team and developing educational programs Be aware of personal assumptions, biases, and prejudice Understand the core cultural values of the patient or group Develop reading materials in the patient's native language Use testimonials of people with the same cultural background as the patient

Readiness to learn

Emotional readiness Emotional health Motivation for learning Self concept and body image Sense of responsibility for self Expirential readiness Social and economic stability Past experiences with learning Attitude toward learning Culture

Revising the plan

Every assessment might indicate that some patient factors were not considered in their original plan, and adjustments might be made accordingly to meet the patients needs. Revision is natural part of the teaching learning process and should not be viewed negatively.

Long-term counseling

Extends over a prolonged period. A patient my need to council of the nurse daily, weekly, or monthly intervals a patient experiencing a developmental crisis, for example might need a long-term counseling. A developmental crisis can occur when a person is going to developmental stage or passage.

Andragogy

Focuses on a specific problem or need and on the immediate application of new material. Adult learners must believe that they need to learn before they are willing to learn. Adults may need to be shown the importance of learning new information, health practices, or skills. When developing a teaching plan for auto results, first identify any learning barrier such as sensory loss, limited physical mobility, inability to comply with the recommended therapeutic regimen.

Short term counseling

Focuses on the immediate problem or concern of the patient or family. You can be a relatively minor concern on major crisis, but in any case, any immediate attention. This type of counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disrupt in life.

The science of teaching pedagogy

Generally refers to the teaching of children and adolescents

Teaching learning process

Helps develop your own teaching and learning skills. The process of patient teaching which resembles the nursing process, consists of several steps that are necessary to provide teaching and to measure learning.

Decisional conflict

Inability to authorize withdrawal of life-sustaining treatment despite believing this to be in the patient's best interest

Affective Learning

Includes changes in attitudes, values, and feelings. For example the patient expresses renewed self-confidence after physical therapy.

Assessment parameters factors that affect learning

Knowledge attitudes and skills needed for the patient and family to manage healthcare independently

Cognitive domain

Lecture or discussion Panel discussion Discovery AudioVision Materials Printing materials Programmed instruction Computer assisted instruction programs

Informal teaching

Most nurse patient interactions include this type teaching.. These are unplanted teaching sessions that are often effective because they deal with the patients immediate learning needs and concerns.

Evaluating teaching

Must occur so that you can come capitalize when your strengths and work on improving weaknesses. It is best to evaluate one's own teaching effectiveness immediately after a teaching session. You can also seek the feedback from patients. You can use a simple questionnaire at the end of a teaching session or after discharge to gain the patient's perception of your teaching effectiveness.

Teacher and counselor

Nurses must be skilled teachers and counselors. Both pros require strong communication skills. Nurses who are skilled educators and counselors can improve patients health and well-being and reduce the demand for professional services.

Noncompliance

Occurs when patients ignore instructions or do not follow them appropriately. It can be associated with a lack of learning readiness and motivation, confusion, disappointment, misunderstanding, fear, inability to learn, or inadequate finances. Noncompliance can hurt the patients health.

Compliance

Patients are considered compliant when they follow the treatment plan and use the information they have been taught.

Learning domains

Patients learn in three domains: cognitive, psychomotor, and affective. These domains influence the nurses selection of teaching and evaluation strategies

Ability to learn

Physical condition Cognitive ability to learn Acuity of senses Developmental considerations Level of education Literacy Communication skills Primary language

Teaching strategies

Plant teaching strategies before the actual teaching sessions so that every content area and learner outcomes can be matched with an effective teaching technique. Role modeling, lecture, discussion, panel discussion, demonstration, discovery, role-playing, audiovisual materials, printed material, programmed instruction, web base instruction and technology.

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?

Preventing illness

Hopelessness

Progression of deliberating symptoms and beliefs that "even God has abandoned me"

Affective domain

Role modeling Discussion Panel discussion AudioVision materials Role playing Printed materials

A nurse is caring for a 42-year old male patient who is admitted to the hospital with injuries sustained in a motor vehicle accident. While he is on the hospital, his wife tells him that the bottom level of their house flooded, damaging their belongings. When the nurse enter 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?

Short-term situational

Referrals

Sometimes a patient needs specialize counseling from a nurse with advanced training or from another healthcare professional. Offer to refer the patient to the appropriate personnel. When making a referral, be sure to address any barriers that might prevent the patient from acting on the referral.

Learning strengths

Successful learning in the past Above average comprehension, reasoning, memory or psychomotor skills High motivation Strong network Adequate financing

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

What does counseling provide?

The resources and support that patients need to participate actively and self-care and to facilitate their coping with what cannot be changed.

The science of teaching andragogy

The study of teaching adults. It has gained more attention adults need to be taught differently than children

TJC "speak up" initiative

This is an effort educate patients on how to get involved in their care and prevent healthcare errors. This campaign now includes 20 brochures and eight videos that Address topics such as things you can do to prevent errors, prevent infection, and how patients can avoid mistakes with their medications.

Learning readiness

the patient willingness to engage in the teaching learning process answer began the challenge of learning.