Chapter 4: Patient and Caregiver Teaching Flashcards
Patient and Caregiver Teaching
Interactive and dynamic process
Challenging and rewarding nursing role
General goals for patient teaching include:
Health promotion
Disease prevention
Illness management
Selection and use of appropriate treatment options
Every interaction is a potential “teachable moment”
Informal and formal opportunities
Teaching plans provide guidelines for specific learning needs
Difference Between teaching & Learning
Teaching
A complex process that facilitates learning through instruction, coaching, counseling, and/or behavior modification
Learning
A change that may occur when a person acquires knowledge, skills, or attitudes.
Patient has right to choose if change occurs
Social change theories:Theoretical basis of teaching/learning
Knowles - Adult learning principles
How and why adults learn
Health Promotion Models
Transtheoretical Model of Health Behavior Change
Motivational Interviewing
Self-Efficacy (Bandura, 1977)
Patient believes they can succeed
Continued support strengthens commitment to change
Transtheoretical Model / Stages of Change
Three dimensions:
Problems to be changed at different levels within context of therapy or intervention
Situational
Cognitive
Interpersonal
Family systems
Intrapersonal
Stages of change represent a temporal or developmental dimension
People use processes of change to modify problem behaviors
Major Constructs of the theory
Stages of change
Processes of change
Decisional balance
Self-efficacy
Temptation
Two crucial points about the Relationship of “Stage” Within TTM
“Stage” is one of the variables of TTM & is not a theory in and of itself
The Stage variable is not a substitute for processes; It provides an integration of the processes
6 Stages of Change
Pre-contemplation: No intention to change in foreseeable future, usually measured as next 6-months
Contemplation: Serious thoughts about change in next 6-months
Preparation: Ready for action; Plans to change within next month
Action: Specific changes made (total abstinence) in last 6-months
Maintenance: Sustained change in behavior for 6-months or more
Termination: Experience no temptation and 100% self-efficacy
Processes of Change
Strategies & techniques to help modify behaviors
One or more processes (experiential or behavioral) used at different stages; facilitate movement from one stage to another
(Bradley-Springer, 1996; Pender et al., 2006; Prochaska et al., 1988)
Research has demonstrated specific processes tend to be used at various stages of change
Experiential
(Cognitive or Affective)
Consciousness Raising
Dramatic Relief
Self-Reevaluation
Environmental Re-evaluation
Self-liberation
Behavioral
Social Liberation
Counter Conditioning
Stimulus Control
Contingency Management
Helping Relationships
Nursing competencies for teaching
Knowledge of subject matter and reliable resources
Communication skills
Verbal
Nonverbal (also consider culture)
Active listening
Empathy
Challenges to teaching for nurses
Lack of time
Personal feelings as a teacher
Nurse–patient differences in learning goals
Rapid or early discharge from the health care system
Awareness/sensitivity of literacy issues
Caregiver learning needs
Vital in the teaching-learning interaction
Cultural considerations important
Include in patient teaching; goal-setting; priorities; specific learning needs
Identify community resources or support groups
Regulatory mandates
The Joint Commission (TJC)
National Patient Safety Goals
American Hospital Association’s Patient Care Partnership
Institute for Health care Improvement’s National Patient Safety Foundation
Encourage Patients to Ask Healthcare providers
What is my main problem?
What do I need to do?
Why is it important for me to do this?
Process of Patient Teaching
Assess ability & readiness to learn
Identify learning needs
Develop learning goals & outcomes with patient
Implement teaching methods
Evaluate the patient’s (caregiver’s) learning
Teaching process: Assessment
Assessment of learning needs involves four main areas:
Physical factors
Age, sensory, dexterity, pain, meds
Psychologic factors
Anxiety, depression, defense mechanisms
Sociocultural factors
Learner factors
Assessment of Sociocultural factors
Health Literacy versus Illiteracy
Tailor patient teaching
Primary language/medical interpreter
5th Grade or lower reading level
Culture
Consider values, beliefs, practices, and decision-making authority
Definition of Health Literacy
“The degree to which individuals have the capacity to obtain, process, understand & act on basic health information & services needed to make appropriate health decisions & follow instructions for treatment”
Ability to read, comprehend, analyze information
Understand instructions
Weigh risks/benefits
Make decisions/take action
Definition of Health Literacy
“The degree to which individuals have the capacity to obtain, process, understand & act on basic health information & services needed to make appropriate health decisions & follow instructions for treatment”
Ability to read, comprehend, analyze information
Understand instructions
Weigh risks/benefits
Make decisions/take action
Low Health Literacy Associated With:
Increased use of E. D. and hospitalizations
Decreased use of Cancer Screening, Flu vaccine
Decreased ability to use medications correctly
Higher mortality in older adults
Levels of Health Literacy
Below Basic
Circle data on appointment slip
Understand simple pamphlet about pre-test instructions
Basic
Understand simple patient education booklet
Intermediate
Determine healthy weight from BMI chart
Interpret prescription & OTC drug labels
Proficient
Define medical term from complex document
Calculate share of employee’s health insurance costs
International Assessment of Adult Competencies (PIAAC)
Most current indicator of nation’s progress in adult skills in literacy, numeracy, and problem solving in technology-rich environments
“Clues” to Low Health Literacy
Requests family to always be present
Opens bottles to identify medications
Excuses:
“Forgot glasses”
“Will read it later”
Refers to medications by color & shape rather than name
Cannot teach-back
Frequently misses appointments
Poor adherence to recommended lifestyle changes
Postpones decision making
Watches / mimics behaviors of others
Pretends to read material
Does not fill out forms
Has no questions about information received
Asks staff for help to complete tasks
Asks help from other patients
Eyes wandering over a page, slow to read
Evidence-based Tools…
Create a Shame Free Environment
Visual sketches, maps, diagrams, pictures, cartoons
Audio-tapes, video-tapes, interactive CDs, Reputable interactive internet sites
Involve family members
Encourage questions
Provide information in small, repeated increments
Consult with cultural experts & interpreters
Documentation
Individual Learner factors
Learning needs
Current knowledge, new knowledge and skills needed, past experiences
Patient needs—prioritize topics
Readiness to learn
Needs, attitudes, and beliefs; motivation
Learning style
Visual, auditory, physical; ehealth literacy
Planning for teaching
Learning goals
Should be clear and measurable
Relate to the intended outcome of the learning process
Guide the selection of teaching strategies
Help evaluate the patient’s progress
Are parallel to patient outcomes in the nursing care plan
Review Table 4-8 (Next slide), Writing Learning Goals, in the textbook.
Setting priorities
Selection of Teaching strategies
Patient characteristics
Learning style, age, educational background, culture, language skills, and nature of illness
Subject matter
Available resources
Technology
Help patients/caregivers sift through information to decide if it is valid, reliable, usable, and from reputable sites
Telehealth increasing—remote communication using technology for consultation, monitoring, and education
Implementation
Planned teaching strategies
Guide patient and caregiver information
Teach new skills
USE Plain, Simple Language
Patient education materials should be written at ____ grade, or lower reading level (Harding et al., 2020, p. 53)
Be sensitive to gaps in provider-patient communication
Nurse / Doctor: “Your foot infection is so severe, however, we are going to be able to treat it locally”
Patient: “I hope I don’t have to travel far. I’m afraid of flying”
Pay attention to patient’s own terms & use them back
Say “Blood pressure pill” instead of “Anti-hypertensive”
Avoid vague terms
Say “Take one hour before you eat dinner”
instead of “Take on an empty stomach”
Evaluation of teaching
Determine if learning/goals achieved
Techniques and strategies
Long-term evaluation—follow-up and referrals after discharge
Documentation of the process is essential from assessment through evaluation
Allows for consistency among health care team members in different settings
Teach-Back Technique
Clinician Assesses Patient Recall & Comprehension
Clinician Clarifies & Provides Individualized Explanations
Clinician Re-assesses Patient Recall & Comprehension
Clinician Explains New Concept
________________
Patient Recall & Comprehension
Example Teach-Back “Scripts”
“I want to make sure I have explained everything. What questions do you have?”
“If you were trying to explain to your husband how to take this medicine, what would you say?”
“Let’s review the main side effects of this new medicine. What are the two things that I asked you to watch out for?”
“Show me how you would use this inhaler.”
