Flashcards on Patient Education

The lack of available social support systems, which may impair the patient's motivation to learn or ability to participate in classes or programs, is one common barrier. Lack of support may also limit the patient's ability to practice new skills. Additional patient-related barriers include, cultural differences, lack of financial resources or time, and frequent interruptions. Barriers on the part of the nurse to participate in patient education include lack of time and multiple competing demands. The role of the professional nurse is often not prioritized because of issues with staffing, payment, and perception of effectiveness of educational efforts. Further, the nurse's professional motivation and confidence in education skills pose a barrier to patient education. Again, assessing the nurse's attitudes can assist in identification of these professional barriers and development of interventions to overcome them.

teaching adults. As ppl mature they move from dependence to independence. An adult's previous experiences can be used as a resource for learning. Learning is related to immediate need, problem or deficit. An adult is more oriented to learning when the material is useful immediately, not sometime in the future. Learning is reinforced by application and prompt feedback.

The three main domains are cognitive, psychomotor, and affective.1 Education intended to increase a patient's knowledge of a subject, for example, is cognitive in nature and using methods such as written material, lecture, and discussion is appropriate. Skill teaching or psychomotor teaching requires that the patient have opportunities to touch and manipulate equipment and practice skills. A patient who must learn to change a dressing over a wound is an example. Education that is intended to change attitudes, such as viewing the lifestyle modifications associated with the treatment of coronary artery disease as a positive change rather than a burden, is known as the affective domain in education. Cognitive-thinking, knowledge based (test). Six intellectual abilities and thinking processes: knowing, comprehending, applying, analysis, synthesis, and evaluation.

how you feel about something, motivation, emotions (hold to honesty standard). Specify the degree of a person's depth of emotional responses to tasks. Includes emotional and social goals such as feelings, interests, attitudes and appreciations.

how you do it, demonstration. "skill" fine and gross motor abilities.

Methods- direct observation, written or oral tests, interviews, checklist rating scales, anecdotal notes, physiologic measurements, simulation, evaluation. Tools- printed materials, videos, posters, physical models, flip charts, tv, computer instruction.

Formal Patient Education Programming: Cancer support groups, Cardiac education, Coumadin classes, Diabetes education, Disease-specific classes, Group preoperative teaching, Ostomy support group. Formal guidelines: large groups of patients- know target audience, group with similar concerns, perform a needs assessment, prepare patients ahead of time for what class will cover, be creative, use audiovisuals aids, change pain and tone during presentation, invite Q's and comments, repeat Q's, provide evaluation questionnaires Informal Patient-Nurse Encounters: Discharge teaching, Disease-specific diet teaching, High-tech home care teaching, Medication teaching, Symptom control, Targeted written materials, Wound care Self-Directed Patient Education Activities: Common literature, Instructional videos specific to condition or treatment, Internet resources , Self-help books Health Promotion Formal Patient Education Programming: Childbirth classes, Drug abuse avoidance, Elder care classes, Parenting classes, Risk reduction activities, Smoking cessation programs, Strength/endurance building, Weight reduction classes, Wellness education programs Informal Patient-Nurse Encounters: Advanced care planning, Age-specific screening needs, Breastfeeding, Counseling, Genetic screening, Health counseling, Immunization teaching, Preventing sexually transmitted diseases Self-Directed Patient Education Activities: Common literature , Exercise videos , Instructional videos specific to health-related topic, Internet resources , Self-help books , Television Must assess patient: readiness to learn- emotional state, stage of adaptation, emotional maturity, past life experiences, patient and family goals. Willingness to learn- health beliefs, sociocultural background, religious beliefs. Ability to learn- physical condition, intellectual status, learning style, the support system, socioeconomic status Discharge teaching; begins on admission. Assess needs of who you will be teaching, give guidelines, evaluate plan. Discharge documentation: description of client's condition at discharge, when to notify physician, current meds, treatments, diet, activity level, restrictions, return appt, referral summaries.

Assessment: Learner assessment begins with a comprehensive assessment of the patient's learning needs. This may include a formalized written assessment, may be incorporated as part of the health assessment interview, or certainly may be a stated need from the patient. The assessment should include patient resources (education level, literacy level, social support, financial resources), educational resources, and nursing resources. Assessment data should be used to develop a teaching plan that is appropriate for the patient, but also one that will meet the desired goal. To fully individualize the educational plan for a patient, the nurse will consider the age, stage of development, and motivation to change behavior. Patient educational approaches can range from formal educational programming such as group lecture settings; to informal, individualized one-on-one teaching; to self-directed learning by the patient that is facilitated by the nurse.1 Formal patient education courses or classes are useful to address needs common to a group of patients or as individual teaching sessions. Formal courses are often taught using a curriculum/course plan with standardized content. In contrast, informal teaching often occurs in one-on-one sessions with the patient and/or family. It may be planned or spontaneous, but does not follow a specified formalized plan. An informal approach represents a large portion of patient education done by nurses. In fact, the majority of critical education occurs with each patient encounter when medications, diet, or treatment is explained, or simply when answering questions about the patient's issues or concerns. Individual or self-directed education results when a patient or family obtains and/or completes an educational activity independent from the nurse or other health care providers. With the influence of consumerism and the availability of information, a great deal of education can occur through self-directed learning with the use of written material or media (e.g., Internet, video) designed to assist the patient with information about health topics, a particular disease, treatments, or a specific skill Because of the increasing use of technology in all aspects of life, the use of Internet resources for patient education cannot be ignored. A majority of adults in America use the Internet to find information on many aspects of life, including health, healthy lifestyles, and treatment options.5 This use of technology expands the role of the nurse in patient education to include teaching on evaluation of Internet sources. Patients should be encouraged to look for information sources that list authors and their credentials and contact information. The source of information should also be listed, and any photographs, charts, graphs, or other graphics should contain helpful understandable information. Planning: determination of what methods will be used to meet the educational need. This includes deciding if the outcome is a cognitive (knowledge) change, a psychomotor (performance of a skill) change, or an affective (feeling or attitude) change. This dictates the approach as well as the goal. For example, a patient diagnosed with type 1 diabetes may need to learn about the overall pathophysiology of the disease so that he or she can appreciate the physical and lifestyle impact. However, the patient also needs to develop practical psychomotor skills (e.g., injection, testing) to cope with this disease. The nurse must plan not only to describe what diabetes is but also to demonstrate blood glucose testing and self-injection of insulin, allowing for practice and redemonstration from the patient and perhaps significant others as well. The domain of learning should match the teaching methodology used. Implementation: carrying out the plan is an area in which flexibility is key. The nurse will need to determine the length of educational sessions, content to be covered, and methodology for teaching. These plans may be influenced by numerous unpredictable factors such as patient condition and competing priorities. The nurse must adjust the teaching session to accommodate the priorities of the patient. Evaluation: of learning outcomes should be consistent with the domain of learning as well. Psychomotor skills, for example, require that the patient be able to do something, such as perform a skill. Using a survey or other measurement tool to evaluate a skill will not adequately measure this outcome. Surveys and questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Because the goal of patient education is behavior change, the evaluation of the process may need to be conducted over time and be dependent on multiple sources of data.

relationships btwm responses and environment. Positive reinforcement, imitation, modeling. Behaviorist theory- ID what is to be taught and immediately ID and reward correct responses. Applying behavioristic theory will: provide sufficient practice time including both immediate and repeat testing and return demonstration. Provide opportunities for learners to solve probs by trial and error. Select teaching strategies that avoid distracting info and evoke desired response. Praise learner for correct behavior and provide pos feedback @ intervals throughout learning experience. Provide role models of desired behavior.

learning is largely a mental or intellectual or thinking process. Emphasis on importance of social, emotional and physical contexts in which learning occurs. Cognitive theory: recognize developmental level of learner and acknowledges learner's motivation and environment. Provide a social, emotional and physical environment conducive to learning. Encourage a pos teacher-learner relationship. Select multisensory teaching strategies since perception is influenced by the senses. Recognize that personal characteristics have an impact on how cues are perceived and develop appropriate teaching approaches to target different learning styles. Assess a person's developmental and individual readiness to learn and adapt teaching strategies to learner's developmental level. Select behavioral objectives and teaching strategies that encompass the cognitive, affective and psychomotor domain of learning.

Humanism- focuses on both the cognitive and affective qualities of the learner. Learning is to be self-motivated, self-initiated and self-evaluated. Humanistic learning theory- nurse focuses on feelings and attitudes of learners, on importance of individual in identifying learning needs and in taking responsibility for them and on self-motivation of learners to work toward self-reliance and independence. Applying humanistic theory will: convey empathy in nurse-client relationship. Encourage learner to est goals and promote self-directed learning. Encourage activity learning strategies to assist the client's adoption of new behavior. Use active learning strategies to assist client's adoption of new behavior. Expose learner to new relevant info and ask appropriate Q's to encourage learner to seek answers.

acquire knowledge, attitudes and skills that: provide autonomy for patients, promotes wellness, promotes participation in care, avoids preventable diseases., maximize health, improve quality of life, prevention, pain management, utilize resources, coping skills, staff development, medication safety.

: active process, involves both parties, desired outcome=change in behavior, teacher acts as facilitator. First assess learning styles- visual, auditory, kinesthetic

role modeling, lecture, discussion, demonstration, discovery, role playing

interruptions, lack of privacy, multiple stimuli. Sociocultural- language, value system, educational background, support system. Psychological- emotions such as anxiety, fear, anger and depression, decreased coping. Physiological- pain, fatigue, oxygen deprivation

handouts/pamphlets, storytelling, PPTs, discussion, Q and A, videos

age and developmental stage, motivation, readiness, active involvement, relevance, feedback, nonjudgmental support, simple to complex learning, repetition, timing, environment, emotions, physiological events, cultural aspects, psychomotor ability (muscle strength, motor coordination, energy, sensory activity)

Assessment: needs to incorporate date from nursing history and physical assess and addresses client's support system. Also considers client characteristics that may influence learning process-readiness to learn, motivation to learn, and reading and comprehension level.

age, understanding and perceptions of health prob, health beliefs and practices, cultural factors, economic factors, learning style and client's support systems.

state the client behavior or performance; reflect observable, measurable activity; may add conditions or modifications as required to clarify what where when or how behavior will be performed; include criteria specifying time by which learning should have occurred

start with something the learner is concerned about. Discover what the learner knows and then proceed to the unknown. Address early on any areas of anxiety. Teach basics before proceeding to variations or adjustments. Schedule time for review of content and questions the client may have to clarify info.

client contracting- establish learning contract w/ client specifying outcomes and date to be met. Group teaching; computer learning resources; discovery/problem solving; behavior mods; transcultural teaching.

respectful teacher/learner relationship; teacher uses previous learning in present situation and facilitates learning of new skills; optimal time for learner; clear communication; layperson's vocabulary; pace appropriate for client; calm environment free from distractions; teaching aids; teaching using the learner's senses; learners discover content for themselves; repetition reinforces learning; use "organizers" to connect material; anticipate behavioral changes that indicate the learner is learning as appropriate for client and situation.

obtain teaching materials in client's language; use visual aids; use concrete rather than abstract words; allow time for Q's; avoid use of medical jargon; if understanding another's pronunciation is a prob, validate brief info in writing; use humor cautiously; don't use slang or colloquialisms; don't assume that a client who nods, uses eye contact or smiles is understanding what is taught; invite and encourage questions during teaching; when explaining procedures or functioning related to personal areas of the body it may be appropriate for person of same sex to do procedure; include family in planning and teaching; consider client's time orientation; ID cultural health practices and beliefs.

cognitive learning: done by the client- direct observation of behavior, written measurements, oral questioning, self-reports/monitoring. Psychomotor: observing how well the client does something Affective: hard to evaluate, listen to responses/attitudes for changes in values/attitudes

the extent to which an individual's behavior (for example, taking medications, following diets, or making lifestyle changes) coincides with medical or health advice; commitment or attachment to a regimen.

Known as the "feeling" domain and is divided into categories that specify the degree of a person's depth of emotional response to tasks; includes feelings, emotions, interests, attitudes, and appreciations.

- the art and science of helping adults learn.

includes the careful identification of what is to be taught and the immediate identification of and reward for correct responses.

the "thinking" domain, includes six intellectual abilities and thing processes beginning with knowing, comprehending, and applying to analysis, synthesis, and evaluation.

the extent to which an individual's behavior coincides with medical or health advice.

the term used to describe the process involved in stimulating and helping elderly persons to learn.

ability to read, understands, and acts on provided health information.

- the nurse focuses on the feelings and attitudes of learners, on the importance of the individual in identifying learning needs and in taking responsibility for them, and on the self- motivation of the learners to work toward self- reliance and independence.

copying the behaviors and attitudes of another person.

a change in human disposition or capability that persists over a period of time and cannot be solely accounted for by growth.

- a desire or a requirement to know something that is currently unknown to the learner.

- observing the behavior of people, who have successfully achieved a goal that one has set for oneself and, through observing, acquired ideas for behavior and coping strategies.

the desire to learn.

the discipline concerned with helping children learn.

giving rewards such as praise for a learner's achievements.

the "skill" domain; includes motor skills such as giving an injection.

- behavior or cues that reflect a learner's motivation to learn at a specific time.

system of activities intended to produce learning.