Chapter 04: Patient and Caregiver Teaching

The nursing student is assigned to use motivational interviewing to motivate the patient to change dietary eating behaviors. Which statement shows the use of this technique? "Tell me about the concerns you have about changing your diet." "You have a big weakness for ice cream; we will need to change that." "I would not want to change my diet, but I would do it so I don't get sicker." "I feel sorry for you, but you must change your diet if you plan to feel better."

"Tell me about the concerns you have about changing your diet." Rationale: Motivational interviewing uses nonconfrontational interpersonal communication techniques to motivate patients to change behavior. Key aspects include listening instead of telling, adjusting to rather than opposing patient resistance, expressing empathy through reflective listening, focusing on the positive without criticizing the patient, gently persuading with the understanding that change is up to the patient, focusing on patient strengths, avoiding argument and direct confrontation, and helping the patient recognize the "gap" between where the patient is and where the patient hopes to be.

. A patient states, "I told my husband I will go the grocery store to buy fresh fruit, vegetables, and whole grains instead of prepared food snacks." When using the Transtheoretical Model of Health Behavior Change, the nurse identifies that this patient is in which stage of change? a. Preparation b. Termination c. Maintenance d. Contemplation

ANS: A. Preparation The patient's statement indicating that the plan for change is being shared with someone else indicates that the preparation stage has been achieved. Contemplation of a change would be indicated by a statement like "I know I should exercise." Maintenance of a change occurs when the patient practices the behavior regularly. Termination would be indicated when the change is a permanent part of the lifestyle.

A patient with diabetic neuropathy requires teaching about foot care. Which learning goal should the nurse include in the teaching plan? a. The nurse will demonstrate the proper technique for trimming toenails. b. The patient will list three ways to protect the feet from injury by discharge. c. The nurse will instruct the patient on appropriate foot care before discharge. d. The patient will understand the rationale for proper foot care after instruction.

ANS: B. The patient will list three ways to protect the feet from injury by discharge. Learning goals should state clear, measurable outcomes of the learning process. Demonstrating technique for trimming toenails and providing instructions on foot care are actions that the nurse will take rather than behaviors that indicate that patient learning has occurred. A learning goal that states that the patient will understand the rationale for proper foot care is too vague and nonspecific to measure whether learning has occurred.

A patient needs to learn how to instill eyedrops. Which teaching strategy, if implemented by the nurse, would be most effective? a. Peer teaching b. Lecture-discussion c. Printed instructions d. Return demonstration

ANS: D. Return demonstration Demonstration with return demonstration (show back) is best used to teach a patient how to learn to perform a skill. Lecture-discussion, peer teaching, and printed materials are more useful for other learning needs.

Seniors at a community center ask the nurse to suggest computer websites where they can learn more about health. Which websites would most likely provide accurate and current health information for these older adults? Government websites Commercial websites Websites designed for health professionals Websites developed by an anonymous person

Government websites Rationale: Websites sponsored by government agencies (.gov), educational institutions (.edu), and professional organizations or associations (.org) usually provide accurate and current health information. Commercial websites may represent a company or be sponsored by a company for commercial reasons and to sell products. However, commercial websites may have valuable and credible information. Health information on the website should be developed or reviewed by respected health professionals with expertise. Authors should be clearly identified. The website should clearly state whether the health information is intended for the consumer or the health professional.

Which method individualizes learning for a patient's unique needs? Use prepackaged learning materials. Only teach the patient "need-to-know" information. Have the patient arrange topic cards in order of priority. Have the patient watch a video and then read a pamphlet.

Have the patient arrange topic cards in order of priority. Rationale: By allowing a patient to prioritize his or her own learning needs, the nurse can begin with the patient's most important needs and end with the least important. The other choices may be appropriate teaching strategies, but they do not individualize the learning needs.

A 44-yr-old female patient with a long-standing history of type 1 diabetes has brought several printouts from websites to her most recent visit with her primary care provider. What statement could the nurse make to the patient regarding health information on the Internet? It is best to make sure that you avoid websites that are not associated with a government agency. You may have some good information there, but it is best to focus only on the information the doctor provides to you. There is a great deal of misinformation on the Internet, so it is best to focus on printed material rather than electronic sources. I encourage you to find websites that are credible and reliable, and I can give you information on making those decisions if you like.

I encourage you to find websites that are credible and reliable, and I can give you information on making those decisions if you like. Rationale: The Internet can be a valid and useful source of health information. Patients may require instruction in determining which sites are of highest value. It would be inappropriate to dissuade the patient from using any electronic-based resources or to instruct her not to bring any such information to a visit with her health care provider. Nurses and patients both should ensure that sources are credible, but these sources are not necessarily limited to government websites.

A patient will need to change a dressing on an open leg wound after discharge. Which strategy should the nurse use to evaluate if the patient is able to perform the dressing change? Have the patient complete the dressing change on a model. Ask the patient to write down each step of the dressing change. Observe the patient completing the dressing change on himself. Provide printed instructions with pictures of how to do his dressing change.

Observe the patient completing the dressing change on himself. Rationale: Return demonstration is the best method for psychomotor skill evaluation. Having the patient complete the dressing change on a model may be adequate, but observing the patient completing the dressing change on himself is better. Providing printed instructions will be a helpful teaching strategy but will not allow evaluation of patient learning.

Which techniques would be most appropriate to enhance patient learning? (Select all that apply.) Obtain frequent feedback. Explain all information in great detail. Involve the patient and caregiver in the process. Choose the learning format that is readily available. Emphasize relevance of the information to the patient's life.

Obtain frequent feedback. Involve the patient and caregiver in the process. Emphasize relevance of the information to the patient's life. Rationale: Asking for frequent feedback, involving the patient and caregiver, and emphasizing relevancy of the information to the patient's lifestyle are all appropriate techniques. The nurse would want to avoid giving great detail to patients. Starting simple is best. Use learning materials in multiple formats based on patient preference.

Which teaching strategy is likely to be the nurse's best choice for a person born before 1945? Schedule group teaching sessions. Show video recordings on a television. Provide printed materials with diagrams. Download health information to an electronic device.

Provide printed materials with diagrams. Rationale: Suggested teaching strategies for persons born before 1945 (Veterans): lecture or lecture-discussion or pictures and printed materials such as books. Suggested teaching strategies for persons born between 1981 and 2000 (Millennials): access to the Internet in the patient's room, discussion of reliable websites, download of health information to electronic devices, use of video games and game systems to teach health behaviors. Suggested teaching strategies for persons born between 1961 and 1980 (Generation X): group teaching sessions, support groups, role playing, and web-based education materials. Suggested teaching strategies for persons born between 1945 and 1961 (Baby Boomers): lecture or lecture-discussion (e.g., PowerPoint presentation), use of patient education TV channels, and printed materials.

Which question elicits additional information to evaluate the patient's understanding of caring for a dressed wound? "What will you do if the dressing is soiled?" "Do you want to watch me change your dressing?" "Do you understand how to change your dressing?" "Do you think you can change your dressing at home?"

"What will you do if the dressing is soiled?" Rationale: Open-ended questions provide more information about the patient's understanding than closed-ended questions that only require a "yes" or "no" response.

The nurse plans to provide instructions about diabetes to a patient who has a low literacy level. Which teaching strategies should the nurse use? (Select all that apply.) a. Discourage use of the Internet as a source of health information. b. Avoid asking the patient about reading abilities and level of education. c. Provide illustrations and photographs showing various types of insulin. d. Schedule one-to-one teaching sessions to practice insulin administration. e. Obtain CDs and DVDs that illustrate how to perform blood glucose testing.

ANS: c. Provide illustrations and photographs showing various types of insulin. d. Schedule one-to-one teaching sessions to practice insulin administration. e. Obtain CDs and DVDs that illustrate how to perform blood glucose testing. For patients with low literacy, visual and hands-on learning techniques are most appropriate. The nurse will need to obtain as much information as possible about the patient's reading level in order to provide appropriate learning materials. The nurse should guide the patient to Internet sites established by reputable heath care organizations such as the American Diabetes Association.

A middle-aged patient who has diabetes tells the nurse, "I want to know how to give my own insulin so I don't have to bother my wife all the time." What action should the nurse complete first? a. Demonstrate how to draw up and administer insulin. b. Discuss the use of exercise to decrease insulin needs. c. Teach about differences between the various types of insulin. d. Provide handouts about therapeutic and adverse effects of insulin.

ANS: A. Demonstrate how to draw up and administer insulin. Adult education is most effective when focused on information that the patient thinks is needed right now. All the indicated information will need to be included when planning teaching for this patient, but the teaching will be most effective if the nurse starts with the patient's stated priority topic.

The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patient's long-term response to the teaching? a. Make a referral to the home health nursing agency for home visits. b. Have the patient demonstrate the learned skills at the end of the teaching session. c. Arrange a physical therapy visit before the patient is discharged from the hospital. d. Check the patient's ability to bathe and get dressed without assistance the next day.

ANS: A. Make a referral to the home health nursing agency for home visits. A home health referral would allow for the assessment of the patient's long-term response after discharge. The other actions allow evaluation of the patient's short-term response to teaching.

A patient who smokes a pack of cigarettes per day tells the nurse, "I enjoy smoking and have no plans to quit." When using the Transtheoretical Model of Health Behavior Change, the nurse identifies that this patient is in which stage of change? a. Precontemplation b. Contemplation c. Maintenance d. Termination

ANS: A. Precontemplation The patient's statement shows that he or she is not considering smoking cessation. In the precontemplation stage, patients are not concerned about their cigarette smoking and are not considering changing their behavior.

The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess the patient's readiness to learn, which question should the nurse ask first? a. "What kind of work and leisure activities do you do?" b. "What information do you think you need right now?" c. "Can you describe the types of activities that help you learn new information?" d. "Do you have any religious beliefs that are inconsistent with the planned treatment?"

ANS: B. "What information do you think you need right now?" Motivation and readiness to learn depend on what the patient values and perceives as important. The other questions are also important in developing the teaching plan, but do not address what information most interests the patient at present.

A patient who is morbidly obese states, "I've recently decreased my fat intake, and I've stopped smoking." Which statement, if made by the nurse, is the best initial response? a. "Although those are important, it is essential that you make other changes." b. "You have accomplished changes that are important for the health of your heart." c. "Are you having any difficulty in maintaining the changes you have already made?" d. "Which additional changes in your lifestyle would you like to implement at this time?"

ANS: B. "You have accomplished changes that are important for the health of your heart." Positive reinforcement of the learner's achievements is critical in making lifestyle changes. This patient is in the action stage of the Transtheoretical Model when reinforcement of the changes being made is an important nursing intervention. The other responses are also appropriate but are not the best initial response.

The nurse and the patient who is diagnosed with hypertension develop this goal: "The patient will select a 2-g sodium diet from the hospital menu for 3 days." Which evaluation method will the nurse use to determine whether teaching was effective? a. Have the patient list substitutes for favorite foods that are high in sodium. b. Check the sodium content of the patient's menu choices over the next 3 days. c. Compare the patient's sodium intake before and after the teaching was implemented. d. Ask the patient to identify which foods on the hospital menus are high in sodium for 3 days in a row.

ANS: B. Check the sodium content of the patient's menu choices over the next 3 days. The desired patient behaviors in the learning objective are most clearly addressed by evaluating the sodium content of the patient's menu choices. Other answers address the patient's sodium intake but not the specific goal.

After the nurse provides diet instructions for a patient with diabetes, the patient can restate the information but does not make the recommended diet changes. How would the nurse evaluate this outcome? a. Learning did not occur because the patient's behavior did not change. b. Choosing not to follow the diet is the behavior that resulted from learning. c. The nurse's responsibility for helping the patient make diet changes has been fulfilled. d. The teaching methods were ineffective in helping the patient learn about the necessary diet changes.

ANS: B. Choosing not to follow the diet is the behavior that resulted from learning. Although the patient behavior has not changed, the patient's ability to restate the information indicates that learning has occurred, and the patient is choosing at this time not to change the diet. The patient may be in the contemplation or preparation stage in the transtheoretical model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

The nurse prepares written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. What statement is written at a level appropriate to include in the handouts? a. Polyphagia, polydipsia, and polyuria are common symptoms of diabetes. b. Eating the right foods can help in keeping blood glucose at a near-normal level. c. Some patients with diabetes control blood glucose with oral medications, injections, or dietary interventions. d. Diabetes is characterized by chronic hyperglycemia and the associated symptoms than can lead to long-term complications.

ANS: B. Eating the right foods can help in keeping blood glucose at a near-normal level. The reading level for patient teaching materials should be at the fifth-grade level. The other responses have words with three or more syllables, use many medical terms, or are too long.

A postoperative patient and caregiver need discharge teaching. Which actions included in the teaching plan can the nurse delegate to unlicensed assistive personnel (UAP)? a. Evaluate whether the patient and caregiver understand the teaching. b. Give the patient a pamphlet to reinforce teaching done by the nurse. c. Plan for the discharge teaching session with the patient and caregiver. d. Show the caregiver how to accurately check the patient's temperature.

ANS: B. Give the patient a pamphlet to reinforce teaching done by the nurse. Providing a pamphlet to a patient to reinforce previously taught material does not require nursing judgment and can safely be delegated to UAP. Demonstration of how to take a temperature accurately, determining the best time for teaching, and evaluation of the success of patient teaching all require judgment and critical thinking and should be done by the registered nurse.

A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes is scheduled for discharge the second day after admission. When implementing patient teaching, what is the priority action for the nurse? a. Provide detailed information about dietary control of glucose. b. Teach glucose self-monitoring and medication administration. c. Give information about the effects of exercise on glucose control. d. Instruct about the risk for cardiovascular disease with hyperglycemia.

ANS: B. Teach glucose self-monitoring and medication administration. When time is limited, the nurse should focus on the priorities of teaching. In this situation, the patient should know how to test blood glucose and administer medications to control glucose levels. The patient will need further teaching about the role of diet, exercise, various medications, and the many potential complications of diabetes, but these topics can be addressed through planning for appropriate referrals.

The nurse has assessed that a patient with newly diagnosed colon cancer does not have basic knowledge about colon cancer. The nurse should initially focus on which learning goal for this patient? a. The patient will state ways of preventing the recurrence of the cancer. b. The patient will explore and select an appropriate colon cancer therapy. c. The patient will demonstrate coping skills needed to manage the disease. d. The patient will choose methods to minimize adverse effects of treatment.

ANS: B. The patient will explore and select an appropriate colon cancer therapy. Adults learn best when given information that can be used immediately. The first action the patient will need to take after a cancer diagnosis is to explore and choose a treatment option. The other goals may be appropriate as treatment progresses.

An older Asian patient seen at the health clinic is diagnosed with protein malnutrition. What action should the nurse plan to implement first? a. Suggest the use of liquid supplements as a way to increase protein intake. b. Encourage the patient to increase the dietary intake of meat, cheese, and milk. c. Ask the patient to record the intake of all foods and beverages for a 3-day period. d. Focus on the use of combinations of beans and rice to improve daily protein intake.

ANS: C. Ask the patient to record the intake of all foods and beverages for a 3-day period. Assessment is the first step in assisting a patient with health changes. The other answers may be appropriate for the patient, but the nurse will not be able to determine this until the assessment of the patient is complete.

A 28-yr-old female patient is in the contemplation stage of the behavior change model regarding her tobacco use. The nurse should: reinforce the stated need for change. reinforce the positive outcomes of change. increase the awareness of the need for change. help the patient plan to deal with potential relapses.

reinforce the stated need for change. Rationale: The nurse should reinforce the stated need for change in the contemplation stage. The nurse should reinforce the positive outcomes of change in the preparation stage. The nurse should increase the awareness of the need for change in the precontemplation stage. The nurse should help patients plan to deal with potential relapses in the action stage.

The nurse plans to teach a patient and the care giver how to manage high blood pressure. Which action should the nurse take first? a. Teach the caregiver how to use a manual blood pressure cuff. b. Give written information about hypertension to the patient and caregiver. c. Ask the patient to select information from a list of hypertension teaching topics. d. Have the dietitian meet with the patient and caregiver to discuss a low-sodium diet

ANS: C. Ask the patient to select information from a list of hypertension teaching topics. Because adults learn best when given information that they view as being needed immediately, asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach to home management of health problems. The other actions may also be appropriate, depending on what learning needs the caregiver and patient have, but the initial action should be to assess what the learners feel is important.

A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse, is most likely to be effective? a. Assure the patient that the nurse is an expert on management of heart failure. b. Delay teaching until the patient is seen by a home health nurse after discharge. c. Discuss the importance of medication control to avoid long-term complications. d. Explain to the patient at each meal about the amounts of sodium in various foods.

ANS: D. Explain to the patient at each meal about the amounts of sodium in various foods. Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (e.g., learning about the sodium amounts in various food items) and when demonstration and practice of skills are available. Although a home health referral may be needed for this patient, teaching should not be postponed until discharge. Adult learners are independent. The nurse should act as a facilitator for learning, rather than as the expert. Adults learn best when the topic is of immediate usefulness. Long-term goals may not be very motivating.

While admitting a patient to the medical unit, the nurse determines that the patient has a hearing impairment. How should the nurse use this information to plan teaching and learning strategies? a. Motivation and readiness to learn will be affected. b. The family must be included in the teaching process. c. The patient will have problems understanding information. d. Written materials should be provided with verbal instructions.

ANS: D. Written materials should be provided with verbal instructions. The information that the patient has a hearing impairment indicates that the nurse should use written and verbal materials in teaching along with other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patient's decreased hearing does not necessarily imply that the family must be included in the teaching process.

Which actions best demonstrate the nurse's awareness of learning styles and the role that they play in patient and caregiver teaching? (Select all that apply.) Assess patients' preferred learning styles before teaching. Prioritize the learning style with which the patient is most familiar and comfortable. Use materials that appeal to a variety of learning styles, including the styles identified by the patient. Provide written instructions to younger patients while using visual and audio aids when teaching older patients. Provide visual and audio aids to younger patients while using written instructions when teaching older patients.

Assess patients' preferred learning styles before teaching. Prioritize the learning style with which the patient is most familiar and comfortable. Use materials that appeal to a variety of learning styles, including the styles identified by the patient. Rationale: Assessing patients' learning styles and using a variety of materials that appeal to different learning styles are sound teaching strategies. It would be simplistic to choose materials solely based on patients' ages or to limit teaching to his or her own learning preference.

Based on adult learning principles, which situation indicates that the patient is ready to learn about performing a subcutaneous injection at home? The patient is requesting pain medication. The patient is falling asleep while watching the teaching DVD. The patient asks to practice before injecting himself with the needle. The patient is nervous and says he cannot do it as he picks up the syringe.

The patient asks to practice before injecting himself with the needle. Rationale: The patient wanting to practice before injecting himself is demonstrating the learner's orientation to learning by seeking out a resource for this stage of learning. The patient requesting pain medication and the tired patient demonstrate that they are not ready to learn. The nervous, unconfident patient needs encouragement and needs more teaching. Other adult learning principles include the learner's need to know, prior experiences, and motivation to learn.

A male patient repeatedly asks about the purpose and potential side effects of each oral medication that he has received during his time in the hospital. How should the nurse best interpret the patient's questions? The patient has an auditory learning style. The patient is identifying his learning needs. The patient is exhibiting a high level of health literacy. The patient has anxiety related to his diagnosis and treatment.

The patient is identifying his learning needs. Rationale: The patient most likely is revealing his learning needs related to his medication regimen. It would be inaccurate to conclude that he has an auditory learning style and concluding that he has anxiety would be premature. It would be incorrect to conclude that because he has numerous questions about an aspect of his care that he necessarily has a high level of health literacy.

The patient says she prefers to learn how to care for herself by watching how things are done rather than reading information or instructions. Which teaching strategy would be best for this patient? Viewing a videorecording Talking about her care with the nurse Using a text with color pictures demonstrating the skill Using the Internet to find blogs written by patients with similar care needs

Viewing a videorecording Rationale: This patient has a visual or audio learning style and prefers not to learn by reading. The videorecording would be the best teaching strategy. Onine videos made by patients may contain unreliable information. The nurse could also demonstrate how to do a skill with this patient.

Which teaching strategy would be best suited for a 20-yr-old patient? Lectures or books Websites or podcasts Television or pamphlets Role playing or support groups

Websites or podcasts Rationale: The 20-yr-old patient is likely to be a multitasker who prefers interactive and virtual environments and has a short attention span. The Internet, websites, podcasts, and video game systems are recommended to teach health behaviors to Millennials. Veterans (born before 1946) prefer lecture and book strategies. Baby Boomers (born 1946-1964) prefer lecture and discussion, educational TV, or printed materials. Generation X (born 1965-1980) prefers group teaching, support groups, role playing, and Internet-based education materials.

The nurse plans teaching for adult patients who are scheduled to be seen in the primary care office this week. A general goal of patient teaching includes: decreased pain. health promotion. disease identification. increased quantity of life.

health promotion. Rationale: General goals of patient teaching include health promotion, prevention of disease, management of illness, and appropriate selection and use of treatment options. Improvement of quality (not quantity) of life is the major focus of patient teaching. A general goal of patient teaching is disease prevention (not identification of disease). Decreased pain and suffering is a specific goal.