Patient Education. Qualities of a Teaching-Learning Relationship. Domains of Knowledge. Cognitive: learning facts; decisionmaking

Transcription

1 Nurse Caring Concepts 1A Patient Education Week 10, October 20, 2003 Qualities of a Teaching-Learning Relationship Client focused Holistic Mutually negotiated Interactive, dynamic process Domains of Knowledge Cognitive: learning facts; decisionmaking Affective: emotions; values, beliefs & attitudes Psychomotor: physical or motor skill 1

2 Purposes of Client Education Wellness Promotion: Disease Prevention: early detection or prevention Restoring Health or Function: limit disability & facilitate recovery Promotion of Coping: to chronic illness or disability. cope with grief & loss Assessing Learning Needs Baseline knowledge: what is already known Learning Style: preferred method Sociocultural: values, beliefs, language Priorities: what should be taught first Socioeconomic: support system, finances Realistic approach: don t teach too much at a time Assessing Learning Readiness Motivation: genuine desire to learn Compliance/noncompliance history Sensory abilities: vision, hearing etc Biophysical: pain & fatigue are barriers Literacy Level: ability to read, tell time Psychologic: fear & anxiety are barriers 2

3 Adult Learner Principles Learning is self-directed Learning is built on previous knowledge Learn is practical & can be immediately applied Learning is purposeful Learn better by doing Will resist learning if incongruent with self-concepts Older Adult Learning Principles Motivation to learn may decrease if believed life near end Intelligence may increase but capacity to learn affected by changes in function (slowed reaction time & ability to acquire, store & recall information) May have short term memory loss Need more time for psychomotor learning Nurse-Teacher Stressors Lack of Time Lack of knowledge Disagreement with patient Powerlessness & frustration 3

4 Possible Teaching Topics Basic anatomy & physiology Signs & symptoms of concern Characteristics of illness that could alter lifestyle Prognosis/goals of treatment Hospital environment & staff orientation Diagnostic tests, prep & results meaning Performance of procedures Prescribed meds, administration guidelines & potential adverse effects Teaching Process Assessment Diagnosis Outcome Identification: Planning Select Teaching Strategies Implementation Evaluation Teaching Nursing Diagnoses All nursing dx have pt/family teaching interventions suggested NANDA that specifies a learning need: Deficient Knowledge:... experiences deficiency in cognitive knowledge or psychomotor skills concerning treatment... Is really more appropriate as r/t factor than a NANDA 4

5 Teaching Diagnosis Example Risk for Ineffective Individual Management of Therapeutic Regimen r/t deficient knowledge of diabetes mellitus, management & signs/symptoms of complications Teaching Nursing Dx Examples Acute pain r/t deficient knowledge of pain management AMB statement, I am afraid I will become addicted to the pain medication so I will just tough it out. Anxiety r/t deficient knowledge regarding surgical procedure AMB statement, I wish I had a better idea of how long it will take me to recover and how I will feel Planning: Learning Goals Specify: Who will be the learner? What is the behavior learner will exhibit to demonstrate learning? Under what conditions is behavior to be demonstrated? What is criteria used to measure success? 5

6 Learning Goal Examples STG: Client will perform dressing change to right foot using correct aseptic technique in front of RN today LTG: Client reports that she feels able to perform dressing changes independently at home LTG: Client reports that she is performing dressing changes independently at home Learning Goal Examples STG: Client will select 2000 mg sodium diet from hospital menu for breakfast, lunch & dinner with 90% accuracy today LTG: Client will state intent to eat a low sodium diet after discharge LTG: Client reports that he is eating a low sodium diet at home Planning the Content Content: subject matter to be taught Provide specific info you will teach or write see attached & attach content Use any legitimate reference from texts, journals, hospital patient education resource or website Teaching Resource examples: pamphlets, drawings, posters, videos, slide shows, games, computers, equipment 6

7 Planning the Teaching Strategies Choose appropriate teaching strategies based on: Patient characteristics (e.g., learning style) Subject matter Available resources Care plan needs to state the teaching strategy that you will use Teaching Strategies Lecture: efficient Discussion: allows participation Group Teaching: RN-facilitator Demonstration/Return Demonstration: most common strategy employed by RNs Role Playing: effective to change attitude Audiovisual Material: good adjunctive strategy Printed material: good adjunctive strategy Implementation RN presents learning materials to client Use therapeutic communication & strategies to enhance teaching/learning Ongoing assessment to determine: how actively client can participate if teaching plan needs to be modified 7

8 Learning Enhancement Environment relaxed & non-threatening Respectful attitude Involve pt and family in planning Build on previous experience; emphasize relevancy of learning Time learning according to age & ability Individualize teaching Allow pt & family to pace learning Evaluation Evaluation ongoing & occurs throughout hospital stay to evaluate pt s mastery of concept, skill or behavior change STG: Did client achieve goal (pass test, verbalize signs/symptoms, give demo)? LTG: Does client state willingness to use learning after discharge? LTG: Is client using learning at home? RN or outside agency often follow up Nsg Dx Risk for Ineffective Mgt of Therapeutic Regimen r/t deficient knowledge of leukemia re: s/sx & prevention of complications & community resources Goal STG: Client will describe s/sx of leukemia complications to RN with 100% accuracy at the end of the teaching session Teaching Plan Intervention 1 Discuss basic pathophysiology of leukemia to pt and provide pamphlet (see attached) 2 Describe potential complications of leukemia (& importance of reporting to MD): Infection (fever, cough, dysuria), Anemia (dyspnea, weakness) Bleeding (nosebleeds, bloody stools, cloudy urine, bruises, bleeding gums) 3 Provide written information about Leukemia Society (see attached) Evaluation GOAL MET 1 Interested in process of leukemia, will read handout later 2 Discussed s/sx: pt had experienced many already 3 Plans to contact leukemia support group 8

9 Nsg Dx Ineffective Airway Clearance r/t deficient knowledge of how to clear secretions 2 COPD AMB inability to cough productivel y Goal STG: Pt will demonstrate for RN (without coaching) breathing exercises 3 times & will cough productively Teaching Plan Interventions 1 Demonstrate and have pt return demonstrate breathing exercises: Diaphragm exercise: place fingers on lower ribs, inhale, pushing out against light pressure of fingers. Lung apex exercise: apply light pressure just below clavicle as you inhale, while exhaling, apply sternal pressure with heel of hand 2 Demonstrate huff cough technique: inhale deeply and say huff 3-4 times while exhaling 3 Explain not to perform breathing exercises just before (may reduce appetite) or after (may cause vomiting) eating Evaluation GOAL MET 1 Pt able to perform both types of exercises 2 Coughed effectively & produced yellow-white sputum 3 Stated why not to perform exercises & cough near mealtime Clinical Assignment You may either: Write a teaching care plan Incorporate a teaching intervention into each diagnosis in your patient s care plan Be sure to include the content that you plan to teach Good luck and have fun teaching! 9