Ch 25 Flashcards
Importance of a teaching plan
A well-designed, comprehensive teaching plan provides a good fit with each patient’s unique learning needs and ultimately changes behaviors to improve patient outcomes. In due course the information gained helps patients make informed decisions about their care and become healthier and more independent
The primary goal of patient education is
-to help individuals, families, or communities achieve optimal levels of health to help individuals, families, or communities achieve optimal levels of health
Comprehensive patient education includes three important purposes , each involving a separate phase of health care:
health promotion and illness preven- tion, health restoration, and coping.
Teaching
the concept of imparting knowledge through a series of directed activities. It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills
Learning
defined as a “conscious or unconscious permanent change in behavior as a result of a lifelong, dynamic process by which individuals acquire new knowledge, skills, and/or attitudes that can be measured and can occur at any time or in any place through exposure to environmental stimuli”
It is a process of both un- derstanding and applying newly acquired concepts. For example, an adult exhibits learning when he demonstrates how to set up his weekly pillbox correctly. He shows transfer of learning when he demonstrates how to set up his wife’s pillbox. Teaching and learning begin when a person identifies a need for knowing or acquiring an ability to do something. Teaching is most effective when it responds to a learner’s needs. An educator assesses these needs by asking questions and deter- mining a learner’s interests. Interpersonal communication is essential for successful teaching
The Joint Commission’s (TJC’s) Speak Up campaign helps patients understand their rights when receiving medical care and supports them to become more active participants in their care by asking ques- tions
• Speak up if you have questions or concerns. If you still do not under- stand, ask again. It is your body, and you have a right to know.
• Pay attention to the care you get. Always make sure that you are getting the right treatments and medicines from the right health care professionals. Do not assume anything.
• Educate yourself about your illness. Learn about the medical tests that are prescribed and your treatment plan so you can make informed decisions.
• Ask a trusted family member or friend to be your advocate (adviser or supporter).
• Know about your new medicine(s) and why you take them.
• Use a hospital, clinic, surgery center, or other type of health care organization that you have researched or checked carefully.
• Participate in all decisions about your care. You are the center of the health care team. Medication errors are the most common health care mistakes.
Not using the teach-back method can lead to gaps in u
learning objectives
The steps of the teaching process are similar to those of the commu- nication process.
You use patient requests for information or identify a need for information because of a patient’s health restrictions, recent diagnosis of an illness, or a recent injury.
Then you identify specific learning objectives to describe the behaviors the learner will exhibit as a result of successful instruction (The steps of the teaching process are similar to those of the commu- nication process.
You use patient requests for information or identify a need for information because of a patient’s health restrictions, recent diagnosis of an illness, or a recent injury.
Then you identify specific learning objectives to describe the behaviors the learner will exhibit as a result of successful instruction.
Those objectives serve the same role as outcomes when delivering physical and psychological care.
DOMAINS OF LEARNING
Learning occurs in three domains: cognitive (understanding), affective (attitudes), and psychomotor (motor skills) \
The most effective learning takes place when all three of these domains are used
Cognitive learning
Cognitive learning occurs when an individual gains information to further develop intellectual abilities, mental capacities, understanding,
and thinking processes
The revised taxonomy
for cognitive learning includes:
• Remember (formerly Knowledge): Recognizing or recalling knowledge from memory
-Understand (formerly Comprehension): Constructing meaning from different types of messages or activities, such as interpreting, exemplifying, classifying, summarizing, inferring, comparing, or explaining
-Apply: Carrying out or using a procedure through executing or implementing
-Analyze: Breaking materials or concepts into parts, then determining how the parts relate to one another or how they interrelate, or how the parts relate to an overall structure or purpose
-Evaluate: Making judgments based on criteria and standards through checking and critiquing
• Create (formerly Synthesis): Putting elements together to form a coherent or functional whole; reorganizing elements into a new pattern or structure through generating, planning, or producing
Affective learning
Affective learning deals with learning how to express feelings and emotions and to develop values, attitudes, and beliefs needed toward improving health
The simplest behavior in affective learning is receiving, and the most complex is characterizing. Affective learning includes the following:
• Receiving: Learner is passive (not engaged) but is alert and willing to receive information.
• Responding: Requires active participation. This refers to a learner’s active attention to stimuli, verbal and nonverbal responses, and motivation to learn.
• Valuing: Attaching worth and value to the acquired knowledge (e.g., new coping skills) as demonstrated by the learner’s behavior through acceptance, preference, or commitment.
• Organizing: Developing a value system. Learner internalizes values and beliefs involving (1) the conceptualization of values and (2) the organization of a value system.
• Characterizing: Highest level of internalization. Acting and re- sponding with a consistent value system; requires introspection and self-examination of one’s own values in relation to an ethical issue or particular experience.
Psychomotor learning
Psychomotor learning involves the development of manual or physi- cal skills, such as learning how to walk or how to type on a computer
The simplest behavior in the hierarchy is fundamental (depending on the hierarchical model), whereas the most complex is origination. Psychomotor learning includes the following:
• Fundamental: Skills, movements, or behaviors related to walking, running, jumping, pushing, pulling, and manipulating. They are often components for more complex actions.
• Perception: Skills related to kinesthetic (bodily movements), vi- sual, auditory, tactile (touch), or coordination abilities as they are related to the ability to take in information from the environment and react.
• Guided response: Early stages of learning a particular skill under the guidance of an instructor that involves imitation and practice of a demonstrated act.
• Mechanism: Higher level of behavior in which a person gains con- fidence and proficiency in performing a skill that is more complex or involves several more steps than a guided response.
• Complex overt response: Smoothly and accurately performing a motor skill that requires complex movement patterns.
• Adaptation: Motor skills are well developed and movements can be modified when unexpected problems occur.
• Origination: Using existing psychomotor skills to create new movement patterns and perform them as needed in response to a particular situation or problem.
Motivation
Motivation is an internal state (e.g., an idea, emotion, or a physical need) that helps arouse, direct, and sustain human behavior
A patient’s motivation to learn is influenced by a belief in the need to know something. Patients who need knowledge for survival have a stronger motivation to learn than patients who need it for promoting health
Motivational interviewing (MI) is a counseling and educational tech- nique that focuses on a patient’s perceived goals and helps people resolve insecurities and ambivalent feelings (e.g., nonadherence) to find the internal motivation needed to change their behavior (
social learning theory
-Among the various theories, social learning theory is one of the most useful approaches to patient education. It considers the personal characteristics of the learner, behavioral patterns, and the environment and guides the educator in developing effective teaching interventions that motivate and enhance learning
-according to social learning theory, a person’s state of mind and intrinsic motiva- tional factors (i.e., sense of accomplishment, pride, or confidence) reinforce behaviors and influence learning This type of internal reward system allows a person to attain desired outcomes and avoid undesired outcomes, resulting in improved moti- vation.
Self-efficacy
a concept included in social learning theory, refers to a person’s perceived ability to successfully complete a task. When people believe that they can achieve a particular behavior, they are more likely to perform the behavior consistently and correctly. Motivational interviewing techniques incorporate self-efficacy principles.
Self-efficacy beliefs come from four sources: verbal persuasion, vicarious experience, enactive mastery experience, and psychological and affective states
- Assessment of a patient’s lifestyle, health beliefs, cultural traditions, and health practices
- Communication with an awareness of the many variations in verbal and nonverbal responses
- Cultural negotiation and compromise that encourages awareness of characteristics of a patient’s culture and one’s own biases
- Establishment of respect for a patient’s cultural beliefs and values; creating a caring rapport
- Sensitivity to how patients from diverse backgrounds perceive their care needs and the patterns of communication they use
- Safety that enables patients to feel culturally secure and avoids disempowerment of their cultural identity
attentional set
he mental state that allows a learner to focus on and comprehend a learning activity. Before learning anything, patients must be able to pay attention to or concentrate on the informa- tion to be learned. Physical discomfort, anxiety, confusion, and envi- ronmental distractions influence the ability to concentrate. Therefore determine a patient’s level of comfort before beginning a teaching plan, and ensure that the patient is able to focus on the information. As anxiety increases, a patient’s ability to pay attention often decreases. A mild level of anxiety can be conducive to learning. However, a high level of anxiety prevents learning from occurring. At times when a patient is unable to attend, a family caregiver often becomes the recipient of edu- cation. Simple facts, rather than detailed teaching strategies, are most important during these times. For example, a patient in pain is receptive to learning about how to use a patient-controlled analgesia pump but not how to use crutches.
health literacy
-the cognitive and social skills that determine the ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.
The Centers for Disease Control and Prevention (CDC) define personal health literacy as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others
Health literacy pertains not only to a patient’s ability to read and comprehend health-related information but also to having the skills to problem solve, articulate, and make appropriate health care decisions
-Research shows that not only is health literacy a strong predictor of a person’s health status, but it is also a stronger predictor compared with several other factors, includ- ing age, income, employment status, educational level, and race
Health literacy pertains not only to a patient’s ability to read and comprehend health-related information but also to having the skills to problem solve, articulate, and make appropriate health care decisions
Because health status is dynamic, assessment is an ongoing activity. Assess the following:
• Information or skills needed by a patient to perform self-care and
to understand the implications of a specific health problem. For example, you teach a young man who has just entered high school how to prevent sexually transmitted infections (STIs).
• Patient experiences (e.g., new or recurring problem, past hospital- ization) that influence the motivation and need to learn.
• Information that family caregivers require to support the patient’s needs. The amount of information needed depends on the patient’s health status and extent of a family member’s role in helping the patient.
Motivation to Learn. Ask questions to identify and define a patient’s motivation. These questions determine whether a patient is prepared and willing to learn. Assess the following factors:
• Behavior (e.g., attention span, tendency to ask questions, memory,
and ability to concentrate during the teaching session).
• Health beliefs and sociocultural background: Norms, values, expe- riences, and traditions all influence a patient’s beliefs and values about health and various therapies, communication patterns, and
perceptions of time (see Chapter 9).
• Perception of the severity and susceptibility of a health problem
and the benefits and barriers to treatment.
• Identification of patient outcomes for learning, which must origi-
nate from the patient and not be imposed from outside by health care providers.
• Perceived ability to perform needed health behaviors.
• Desire to learn.
• Attitudes about health care providers (e.g., role of patient and
nurse in making decisions).
• Learning style preference: As the nurse, any educational effort will
be more effective if the chosen method of instruction aligns with your patient’s preferred learning style
Examples of nursing diagnoses that indicate a need for education include the following:
•Decisional Conflict
• Lack of Knowledge (Affective, Cognitive, Psychomotor)
• Impaired Health Maintenance
• Impaired Ability to Manage Dietary/Exercise Regimen
• Self-Care Deficit
Organizing Teaching Material.
An effective educator carefully con- siders the order of information to present. When a nurse has an ongoing relationship with a patient, as in the case of home health or case manage- ment, an outline of content helps organize information into a logical sequence. Material needs to progress from simple to complex because a person must learn the simple facts and concepts before learning how to make associations or complex interpretations of ideas.
-Staff nurses in acute care settings often focus on the simpler, more essential concepts, whereas home health nurses can better address complex issues.
-Begin instruction with essential content because patients are more likely to remember information that you teach early in a teaching ses- sion.
-A concise summary of key content helps the learner remem- ber the most important information (Bastable, 2019). Using instruc- tional materials that contain the same summaries is very helpful.
Reinforcement
Reinforcement requires the use of a stimulus to in- crease the probability of a desired response. A learner who receives reinforcement before or after a desired learning behavior is more likely to repeat that behavior. Reinforcers are positive or negative. Positive reinforcement such as a smile or verbal praise promotes desired behav- iors. Although negative reinforcement such as frowning or criticizing can decrease an undesired response, it may also discourage participa- tion and cause the learner to withdraw. The effects of negative reinforcement are less predictable and often undesirable.