Ch. 27- Teaching Flashcards
teaching is
a system of activities intended to produce learning pg 438
How do nurses teach clients and their families?
one to one teaching- teaching a patient wound care while changing a client’s wound dressings or about diet, heath, and exercise if a patient has cardiac issues. Or the nurse may teach a family member or parent to care for their loved ones pg. 438
How do nurses teach in the community?
community health education programs
red cross, planned parenthood, school nurse, CPR class
pg 438
How do nurses teach health personnel?
in service, staff programs, continuing education. Critical care nurses with experience may be paired with a new graduate nurse. pg 439
A learning need is
a desire or requirement to know something that is presently unknown to the learner. new knowledge or info, new skill, new behavior. pg 439
learning is
a change in human disposition or capability that persists and that cannot be solely accounted for by growth. Learning is represented by a change in behavior. pg 439
Areas for Client Education (4)
Promotion of health, prevention of illness/injury, restoration of health, and adapting to altered health and function
Areas for Client Education: Promotion of health examples
increasing a person's level of wellness growth and development topics fertility control hygiene nutrition exercise stress management lifestyle modification resources within the community pg 439
Areas for Client Education: prevention of illness/injury examples
health screening (BP, blood glucose, PAP, mammogram)
reducing health risk factors (lowering cholesterol levels)
specific protective health measures (immunizations, use of condoms, sunscreen, medication)
first aide
safety (using seat belts, helmets, walkers)
pg 439
Areas for Client Education: restoration of health examples
info about tests, diagnosis, treatment, meds
self-care skills or skills needed to care for loved ones
resources within health care setting/community
pg 439
Areas for Client Education: adapting to altered health and function examples
adaptations in lifestyle
problem-solving skills
adaptation to changing health status
strategies to deal with current problems (home IV skills, meds, diet, activity limits, prostheses)
strategies to deal with future problems (fear of pain with terminal cancer, future surgeries or treatments)
info about treatments/outcomes
referrals to other health facilities/services
facilitation of strong self-image
grief/bereavement counseling
pg 439
Teaching Process VS Nursing Process example
collect data; analyze client’s learning strengths and deficits
VS
collect data; analyze client’s strengths and deficits
pg 439
Teaching Process VS Nursing Process example
make educational diagnoses
VS
make nursing diagnoses
pg 439
Teaching Process VS Nursing Process example
develop teaching plan: write learning outcomes, select content/time frame, and select teaching strategies
VS
plan nursing goals/desired outcomes and select interventions
pg 439
Teaching Process VS Nursing Process example
implement teaching plan
VS
implement nursing strategies
pg 439
Teaching Process VS Nursing Process example
evaluate client learning based on achievement of learning outcomes
VS
evaluate client outcomes based on achievement of goal criteria
pg 439
Attributes of learning: Learning is…
An experience that occurs inside the learner.
The discovery of the personal meaning and relevance of ideas.
a consequence of experience.
a collaborative and cooperative process.
an evolutionary process that builds on past learning and experiences.
a process that is both intellectual and emotional.
pg 440
compliance is…
the individuals desire to learn and to act on the learning; best illustrated when the person recognizes and accepts the need to learn, and then follows through with the appropriate behaviors that reflect the learning. (diabetes)
pg 440
adherence is…
is the degree to which clients follow the agreed on recommendations of heath care providers. pg 440
andragogy is…
the art and science of teaching adults pg 440
pedagogy is…
the discipline concerned with helping children learn. pg 440
geragogy is….
the term used to describe the process involved in helping older adults to learn. pg 440
nurses can use the following andragogic concepts about adult learners as a guide to teach…
as people mature, they move from dependence to independence
an adults previous experiences can be used as a resource for learning.
learning is related to an immediate need, problem, of 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. pg 440
The 3 learning domains identified by Bloom are…
- cognitive domain
- affective domain
- psychomotor domain
All 3 should be used in client teaching.
pg 440
The cognitive domain is the _________ domain.
thinking domain. It includes 6 intellectual abilities and thinking processes beginning with knowledge, comprehending, and applying to analysis, synthesis and evaluation.
ex.) to teach the client why insulin is needed and what to do when not feeling well
pg 440
The affective domain is the ______ domain.
feeling domain. it deals with personal issues such as attitudes, beliefs, behaviors, and emotions.
ex.) helping the client accept the chronic implications of diabetes and maintain self-esteem.
pg 440
The psychomotor domain is the _____ domain.
skill domain.
It includes fine and gross motor abilities such as giving an injection.
ex) teaching a client how to self- administer insulin.
Factors Affecting Learning (15)
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 pg 441-443
Factors Affecting Learning: Age and Developmental Stage example
You must consider the 3 learning domains and learner readiness when considering the client’s ability to learn. pg 441
Motivation to learn is the _______ to learn.
desire
Factors Affecting Learning: Motivation
motivation is greatest when a person recognizes a need and believes the need will be met through learning.
ex) clients with heart disease may need to know the effects of smoking before they recognize the need to stop smoking.
ex) adolescents may need to know the consequences of an untreated sexually transmitted infection before they see the need for treatment.
pg 441
Readiness to learn is the
demonstration of behaviors or cues that reflect the learners motivation to learn at a specific time.
Factors Affecting Learning: Readiness
readiness not only reflects the desire or willingness to learn, but also the ability to learn at a specific time.
ex) a client may want to learn self care during a dressing change, but if the client experiences pain or discomfort he/she may not be able to learn.
pg 441
Factors Affecting Learning: Active Involvement
when the learner is actively involved in the process of learning, learning becomes more meaningful. learning is faster and retention is better.
pg 442
Factors Affecting Learning: Relevance
the knowledge/skill to be learned must be personally relevant to the learner.
ex) client diagnosed with hypertension, is overweight, and has symptoms of headaches and fatigue, he is more likely to understand the need to lose weight if he remembers having more energy when he weighed less.
pg 442
Factors Affecting Learning: Feedback
is info regarding a persons performance in reaching a desired goal. has to be meaningful to the learner.
positive feedback- praise, positively worded corrections, suggestions of alternative methods
negative feedback- ridicule, anger, sarcasm
pg 442
Factors Affecting Learning: Nonjudgmental Support
people learn best when they believe they are accepted and will not be judged.
simple to complex learning
simple and complex are relative terms to the patient. start with simple teaching and build up to complex, based on the person’s previous knowledge/experience and understanding. pg 442
Factors Affecting Learning: repetition
repetition of key concepts and fact facilitates retention of newly learned material and facilitates transfer to another setting. pg 442
Factors Affecting Learning: timing
people retain info and psychomotor skills best when the time between learning and active use is short.
ex) showing client how to administer insulin, letting them try before leaving the hospital.
pg 442
Factors Affecting Learning: environment
reduce distraction and provide physical and psychological comfort. Adequate lighting, comfortable temp, good ventilation.
ex) in the hospital, no visitors present or learning to change colostomy bag can be embarrassing if visitors are present.
pg 442
Factors Affecting Learning: emotions
fear, anger and depression can impede learning.
Factors Affecting Learning: physiological events
physiological events such as a critical illness, pain, or sensory deficits inhibit learning.
ex) providing analgesics and rest before teaching
Factors Affecting Learning: cultural aspects
languages and values.
Factors Affecting Learning: psychomotor ability
muscle strength- older client cannot rise from a chair bc of insufficient leg muscle- can’t get out of tub
motor coordination- client with ALS involving the lower limbs can’t use a walker
energy- older adults/ill may have limited energy so learning and practicing skills may need to be times
sensory acuity- sight used for most learning so a visually impaired client may need a support person
pg 443
Barriers to Learning: Explanation and Nursing Implications
Acute Illness
expl- client requires all resources and energy to cope w/illnesses
impl- defer teaching until client is less ill
Barriers to Learning: Explanation and Nursing Implications
pain
expl- pain decreases ability to concentrate
impl- conduct pain assessment before teaching
Barriers to Learning: Explanation and Nursing Implications
prognosis
expl- client can be preoccupied with illness and unable to concentration on new info
impl- defer teaching to better time
Barriers to Learning: Explanation and Nursing Implications
biorhythms
expl- mental and physical performances have a circadian rhythm
impl- adapt time of teaching to suit client
Barriers to Learning: Explanation and Nursing Implications
emotions (anxiety, denial, depression, grief)
expl- emotions require energy and distract from learning
impl- deal with emotions and possible misinfo first
Barriers to Learning: Explanation and Nursing Implications
age- older adults
expl- vision, hearing, and motor control can be impaired in older adults
impl- consider sensory and motor deficits and adapt teaching plan as needed.
Barriers to Learning: Explanation and Nursing Implications
age- children
expl- have shorter attention span and vocab differences
impl- plan shorter/more active learning episodes
Barriers to Learning: Explanation and Nursing Implications
culture/religion
expl- a clients culture or religion ay place restrictions on certain types of knowledge (birth control info)
impl- asses the needs when planning learning activities.
Barriers to Learning: Explanation and Nursing Implications
physical disability
expl- visual, hearing, sensory or motor impairments may interfere with learning
impl- plan appropriate teaching ex) audio learning tools for the blind or large print for visually impaired
Barriers to Learning: Explanation and Nursing Implications
mental disability
expl- impaired cognitive ability may affect the capacity for learning
impl- teach according to mental capacity and plan more complex learning for caregivers
Assessment Interview: Learning needs and characteristics
- combines data from nursing history, physical assessment, and addresses the client’s support system. It also considers characteristics that may influence the learning process
Primary Health Problem Health beliefs Cultural Factors Learning Style Client Support System pg 445
Assessment Interview: Learning needs and characteristics
Primary Health Problems
- tell me about your current health problem. what do you think caused it?
-what concerns do you have? - how has the prob affected what you can/cannot do during usual activities? (work, shopping, housework)
- what do you or did you do at home to relieve the problem? how helpful was it?
- how have treatments started helping your problem?
- what, if any, difficulties have the treatments caused? (inconvenience, cost, comfort)
- tell me about the tests/surgeries/treatments you are going to have.
pg 445
Assessment Interview: Learning needs and characteristics
Health Beliefs
-how would you describe your health generally?
- what things do you usually do to keep healthy?
-what health problems do you think you may be at risk for bc of family history, age, diet, occupation, inadequate exercise, or other habits such as smoking?
- what changes would you be willing to make to decrease your risk for these problems/improve health?
pg 445
Assessment Interview: Learning needs and characteristics
Cultural Factors
-what language do you use most often when speaking/writing?
-do you seek the advice of another practitioner?
- do you use herbs/other meds/treatment commonly used in your cultural group? does your primary care provider know?
- what advice/treatments given previously conflicted with values/beliefs?
- when a conflict arose, what did you do?
pg 445
Assessment Interview: Learning needs and characteristics
learning style
-note the clients age/dev. level
- level of education?
- where do you obtain health info? (doc, nurse, mag, book, pharmacist, online?)
- how do you best learn new things? reading, talking, watching a movie/demo, computer, listening, being shown, on your own/in a group?
pg 445
Assessment Interview: Learning needs and characteristics
client support system
- would you like a family member/friend to help you learn about the things you need to do to care for yourself?
- who do you think would be interested in learning with you?
pg 445
Signs of Readiness to learn
physical readiness- is client able to focus or are they distracted by pain, fatigue or immobility?
emotional readiness- is the client emotionally ready to learn or are they extremely anxious, depressed or grieving over their issue?
cognitive readiness- can the client think clearly or are the effects of anesthesia and analgesia altering their level of consciousness?
pg 446
Special Teaching Consideration: Older Adults
- Health promotion is a priority- safety habits, exercise, nutrition, regular checkups, understanding meds
- set achievable goals- involve client and family
- If developing written materials: large print, bulleted, 6-8th grade reading level on buff paper
- increase time for teaching and allow for rest make sure info is organized with minimal distractions
- repeat info
- use demonstrations when possible
- determine where they receive health info from (tv, magazine)
- use examples they can relate to
- be aware of sensory deficits
- use a setting they are most comfortable, group or one on one
- if noncompliance is a problem, figure out why! lack of finances, transportation, poor access to medical care, etc.
play to their strengths with respect and use positive reinforcement.
pg 446
Special Teaching Consideration: Children- preschool 3-5 yrs old
- concerned about fear of pain and bodily harm. Reassure them. choose word carefully ex) fix instead of cut or bandage instead of dressing.
- allow them to play with replicas or dolls to learn about body parts
- give praise and approval to motivate
pg 446
Special Teaching Consideration: middle and late childhood 6-11 yrs old
are able to think logically but abstract thought is limited
- like to be actively involved in learning process
- teaching for health promotion often occurs through school nurse
pg 446
Special Teaching Consideration: adolescent 12-19 yrs old
have a strong need to belong to a group, friendship, peer support
- need to develop a mutually respectful and trusting relationships with them
pg 446
health literacy is the
ability to obtain, process, and understand the basic health info and services to make appropriate health decisions. pg 447
ex) comprehending script labels, interpreting appointment slips, completing health insurance forms, etc.
Newest Vital Sign (NVS) health literacy test is used for what?
to determine the health literacy of the patient using an ice cream label and 6 questions. takes about 3 minutes and tests reading and math skills.
clinical alert- the majority of people at the lowest reading level report that they “read well”.
1 point for each correct answer.
score of 0-1: high likelihood (50%+) of limited literacy
score of 2-3: possibility of limited literacy
score of 4-6: adequate literacy
pg 447-449
“Ask me 3” is what?
an educational tool developed by the National Patient Safety Foundation. All clients should ask their health care providers during all interactions these 3 questions.
- what is my main problem?
- what do I need to do?
- why is it important for me to do this?
pg 448
When verbally teaching clients it is important to use these communication techniques to enhance understanding:
- use plain, nonmedical language
- speak clearly and at a moderate pace
- limit info to 2-3 important points at a time
- repeat key points
- use graphics- drawings/models
- encourage questions (what do I need to go back over? what questions do you have?)
- use “teach back” (nurse has client say in their own words what is important) and “show back” (nurse asks client to perform return demo) techniques.
pg 448
Clinical Alert
when using the teach back method, you don’t want the client’s to feel like they’re being tested. Place responsilibity on yourself. Ask: what info was most helpful? What will you now do differently?
pg 448
Deficient Knowledge is the
absence or deficiency of cognitive info related to a specific topic.
- When this diagnostic label is used, either the client is seeking health info or the nurse has identified a learning need. The area of deficiency should always be included in the diagnoses.
ex) deficient knowledge- low- cal diet- related to inexperience with newly ordered therapy
ex) deficient knowledge- home safety hazards- related to denial of declining health and living alone
pg 448
Developing Written Aids: tips, techniques
- language at or below 6th grade level
- use active, not passive voice (take your medicine before breakfast, NOT medicine should be taken before breakfast)
- use plain language; ex) use instead of utilize or give instead of administer
- use the 2nd person (you) rather than 3rd person (the client).
- use a large type size (14-16 point font)
- write short sentences
- avoid using all capital letters
- place priority info first and repeat more than once
- use bold for emphasis
- use simple pics, drawings, or cartoons, if appropriate
- leave plenty of white space
- focus material on desired behavior rather than on medical fact
- make it look easy to read
pg 449
tips for teaching clients with a low literacy level
- use multiple teaching methods- pics, read important info, small group discussion, role-play, etc.
- emphasize key points in simple terms
- avoid acronyms (CAT scan, HDL)
- limit info in a single teaching session
- associate new info with something the client already knows
- reinforce info thru repetition
- involve client in teaching
- use teach back method
- avoids handouts with many pages and classroom lecture format
pg 450
Readiness for enhanced knowledge is
a pattern of cognitive info related to a specific topis or its acquisition that is sufficient for meeting health- related goals and can be strengthened.
- when this diagnostic label is used, the client may/ may not have an altered response or dysfunction at the time but may be seeking info to improve health or prevent illness.
pg 450
readiness for enhanced knowledge (Exercise and activity)
related to a desire to improve health behaviors and decrease risk of heart disease.
this may be used for a client who has knowledge of cardiac risk factors, has identified a personal health problem and wants to minimize risk through exercise.
pg 450
readiness for enhanced knowledge (home safety hazards)
a desire to minimize risk of injury.
-parents of a toddler who are seeking additional info to ensure that their home is safe. or child of an elderly parent may be seeking to make the home free of fall risk hazards.
pg 450
Noncompliance
indicates that the behavior of the person/caregiver fails to coincide with health promotion or therapeutic plan agreed on by the person/family/community and health care professional. may lead to ineffective outcomes.
pg 450
is associated with the intent to comply but situational factors make it difficult.
etiology
the 2nd part of a diagnosis statement
risk for (specify)
related to deficient knowledge (specify).
risk for impaired parenting
related to deficient knowledge skills in infant care and feeding
risk for infection
related to deficient knowledge sexually transmitted infections and their prevention
anxiety diagnosis example: risk factors
related to deficient knowledge bone marrow aspiration
other nursing diagnoses about knowledge deficit…
risk for injury ineffective breastfeeding ineffective coping ineffective health maintenance etc.
pg 450
selected teaching strategies examples
page 453 table 27-3
