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List several reasons that describe why client education is one of the most important roles of the nurse.
- 1. To help individuals, families, or communities achieve optimal levels of health
- 2. It is an essential component of providing safe, patient-centered care
- 3. Providing education about preventive health care helps reduce health care costs and hardships on individuals, families, and communities.
- Maintenance & promotion of health & illness prevention
- Restoration of health
- Coping with impaired functions
How can Joint Commission on Accreditation of Healthcare Organizations (JCAHCO) standards of client education help nurses achieve quality of healthcare?
These standards require nurses and the health care team to assess patients learning needs and provide education about many topics, including medications, nutrition, the use of medical equipment, pain, and the patient's plan of care. Successful accomplishment of the standards requires collaboration among health care professionals and enhances patient safety. Educational efforts should be patient-centered by taking into consideration patients own education and experience, their desire to actively participate in the educational process, and their psychosocial, spiritual, and cultural values. It is important to document evidence of successful patient education in patients medical records. Standards such as these help to direct your patient education.
Name three major purposes of client education.
- Maintenance and Promotion of Health and Illness Prevention: As a nurse you are a visible, competent resource for patients who want to improve their physical and psychological well-being. Greater knowledge results in better health maintenance habits. When patients become more health conscious, they are more likely to seek early diagnosis of health problems.
- Restoration of Health: Injured or ill patients need information and skills to help them regain or maintain their levels of health. Patients recovering from and adapting to changes resulting from illness or injury often seek information about their condition.
- Coping with Impaired Functions: Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations. New knowledge and skills are often necessary for patients to continue activities of daily living.
When is teaching most effective?
Teaching is most effective when it responds to the learner's needs
Name five factors that affect a clients ability to learn.
- Many factors impair the ability to learn, including:
- Body temperature
- Electrolyte levels
- Oxygenation status
- Blood glucose level.
Describe and provide three examples of each of the following:
- 1. Cognitive learning (understanding): includes all intellectual behaviors and requires thinking; patients diagnosed with diabetes need to learn how diabetes affects the body and how to control blood glucose levels for healthier lifestyles
- 2. Affective learning (attitudes): deals with expression of feelings and acceptance of attitudes, opinions, or values; patients begin to accept the chronic nature of diabetes by learning positive coping mechanisms
- 3. Psychomotor learning (motor skills): involves acquiring skills that require the integration of mental and muscular activity such as the ability to walk or use an eating utensil; many patients living with diabetes learn to test their blood glucose levels at home. This requires learning how to use a glucose meter
What are some ways in which a client can be motivated to learn?
- Social motives: a need for connection, social approval, or self-esteem. People normally seek out others with whom they can compare opinions, abilities, and emotions. For example, new parents often seek validation of ideas and parenting techniques from others whom they have identified as role models in their social environment or health care workers with whom they have established a relationship.
- Task mastery motives: based on needs such as achievement and competence. For example, a high school senior who has diabetes begins to test blood glucose levels and make decisions about insulin dosages in preparation for leaving home and establishing independence. The ability to successfully manage diabetes provides the motivation to master the task or skill. After a person succeeds at a task, he or she is usually motivated to achieve more.
- Physical motives: Some patients are motivated to return to a level of physical normalcy. For example, a patient with a below-the-knee amputation is motivated to learn how to walk with assistive devices. Knowledge that is necessary for survival, problem recognition, and critical decision making creates a stronger stimulus for learning than knowledge that merely promotes health
Compare the nursing process to the teaching process. Table 25-2 pg 335
- Teaching Process Assessment: Gather data about client's learning needs, motivation, ability to learn and teaching resources from client, family, learning environment, medical record, nursing history, and literature
- Nursing Process Assessment: Collect data about patient's physical, psychological, social, cultural, developmental, and spiritual needs from patient, family, diagnostic tests, medical record, nursing history, and literature.
- Teaching Process Nursing Diagnosis: Identify client's learning needs on basis of the three domains of learning: Cognitive, Affective, and Psychomotor
- Nursing Process Nursing Diagnosis: Identify appropriate nursing diagnoses based on assessment findings.
- Teaching Process Planning: Establish learning objectives, stated in behavioral terms. Id priorities regarding learning needs, Collaborate with client on teaching plan, Id type of teaching method to use
- Nursing Process Planning: Develop an individualized care plan. Set diagnosis priorities based on patient's immediate needs, expected outcomes, and patient-centered goals. Collaborate with patient on care plan.
- Teaching Process Implementation: Implement teaching methods. Actively involve client in learning activities. Include family as appropriate
- Nursing Process Implementation: Perform nursing care therapies. Include patient as active participant in care. Involve family/significant other in care as appropriate.
- Teaching Process Evaluation: Determine outcomes of teaching-learning process. Measure client's achievement of learning objectives. Reinforce info. as needed.
- Nursing Process Evaluation: Identify success in meeting desired outcomes and goals of nursing care. Alter interventions as indicated when goals are not met.
How is a clients ability to learn affected by their developmental capability?
Cognitive development influences the patient's ability to learn. You can be a competent teacher, but if you do not consider the patient's intellectual abilities, teaching is unsuccessful. Learning, like developmental growth, is an evolving process. You need to know the patient's level of knowledge and intellectual skills before beginning a teaching plan. Learning occurs more readily when new information complements existing knowledge. A persons cognitive level of development influences learning and, if not considered, learning will not be successful.
What teaching methods should be utilized when teaching children (Box 25-4)?
- Teaching Methods Based on Patient's Developmental Capacity (Box 25-3)
- Keep routines (e.g., feeding, bathing) consistent.
- Hold infant firmly while smiling and speaking softly to convey sense of trust.
- Have infant touch different textures (e.g., soft fabric, hard plastic).
- Use play to teach procedure or activity (e.g., handling examination equipment, applying bandage to doll).
- Offer picture books that describe story of children in hospital or clinic.
- Use simple words such as cut instead of laceration to promote understanding.
- Use role play, imitation, and play to make learning fun.
- Encourage questions and offer explanations. Use simple explanations and demonstrations.
- Encourage children to learn together through pictures and short stories about how to perform hygiene.
- School-Age Child
- Teach psychomotor skills needed to maintain health. (Complicated skills such as learning to use a syringe take considerable practice.)
- Offer opportunities to discuss health problems and answer questions.
- Help adolescent learn about feelings and need for self-expression.
- Use teaching as collaborative activity.
- Allow adolescents to make decisions about health and setting mutual goals.
- Encourage independent learning.
- Offer information so adult understands effects of health problem.
- Older Adult
- Teach when patient is alert and rested.
- Involve adult in discussion or activity.
- Focus on wellness and person's strength.
- Use approaches that enhance sensorially impaired patient's reception of stimuli (see Chapter 49 ).
- Keep teaching sessions short.
How does teaching adults differ from teaching children?
Adults are able to critically reflect on their current situation and sometimes need help to see their problems and change their perspectives. Because adults become independent and self-directed as they mature, they are often able to identify their own learning needs. Learning needs come from problems or tasks that result from real-life situations. Although adults tend to be self-directed learners, they often become dependent in new learning situations. The amount of information provided and the amount of time that is spent with the adult patient vary, depending on the patient's personal situation and readiness to learn.
What are the learning needs of the adult learner? How can the nurse adapt teaching for the adult learner?
- Relate to real-life experience (pertinent)
- Focus on real world problems
- Relate activities to learner focused goals
- Teach what the learner wants before you continue (collaborate)
- Listen to/ respect opinions of learner
- Encourage learner to share resources with you and others
How would you arrange a room to create an appropriate learning environment? What are some strategies that a successful nurse educator could use to maintain the clients attention?
- The environment for a teaching session needs to be conducive to learning.
- Assess the following environmental factors:
- Distractions or persistent noiseA quiet area is essential for effective learning.
- Comfort of the room, including ventilation, temperature, lighting, furniture, and size
- Room facilities and available equipment
What is a basic principle for organizing teaching material?
- An effective teacher carefully considers the order of information to present.
- Material needs to progress from simple to complex ideas because a person must learn the simple facts and concepts before learning how to make associations or complex interpretations of ideas.
- Begin instruction with essential content because patients are more likely to remember information that you teach early in the teaching session.
- Repetition reinforces learning.
- A concise summary of key topics helps the learner remember the most important information
How does the nurse select the best teaching method for a particular situation?
Choose instructional methods that match a patient's learning needs, the time available for teaching, the setting, the resources available, and your comfort level with teaching.
Name five common instructional methods and when each might be appropriate?
- One-on-One Discussion: When teaching a patient at the bedside, in a physician's office, or in the home, the nurse shares information directly.
- Group Instruction: Groups are an economical way to teach a number of patients at one time, and patients are able to interact with one another and learn from the experiences of others.
- Preparatory Instruction: Patients frequently face unfamiliar tests or procedures that create significant anxiety. Providing information about procedures often decreases anxiety because patients have a better idea of what to expect during the procedure, which helps to give them a sense of control.
- Demonstrations: Use demonstrations when teaching psychomotor skills such as preparation of a syringe, bathing an infant, crutch walking, or taking a pulse. Demonstrations are most effective when learners first observe the teacher and then, during a return demonstration, have the chance to practice the skill. Combine a demonstration with discussion to clarify concepts and feelings. An effective demonstration requires advanced planning
- Analogies: Learning occurs when a teacher translates complex language or ideas into words or concepts that the patient understands. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose. Follow these general principles when using analogies
- Role Play: During role play people are asked to play themselves or someone else. Patients learn required skills and feel more confident in being able to perform them independently.
- Simulation: group discussion you pose a pertinent problem or situation for patients to solve. For example, patients with heart disease plan a meal that is low in cholesterol and fat. The patients in the group decide which foods are appropriate. You ask the group members to present their diet, providing an opportunity to identify mistakes and reinforce correct information.
During the evaluation phase, why should the nurse measure client satisfaction?
Important to determine if patients believe they have the information necessary to continue self-care activities within the home. This is why it is important to evaluate through the patient's eyes, respecting the type of situations patients return to after receiving care. Evaluation reinforces correct behavior, helps learners realize how to change incorrect behavior, and helps the teacher determine adequacy of teaching
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