Chapter 4: Patient and Caregiver Teaching Flashcards by Faith Burgis

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

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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

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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

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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

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Major Constructs of the theory

Stages of change
Processes of change
Decisional balance
Self-efficacy
Temptation

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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

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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

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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

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Experiential

(Cognitive or Affective)
Consciousness Raising
Dramatic Relief
Self-Reevaluation
Environmental Re-evaluation
Self-liberation

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Behavioral

Social Liberation
Counter Conditioning
Stimulus Control
Contingency Management
Helping Relationships

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Nursing competencies for teaching

Knowledge of subject matter and reliable resources
Communication skills
Verbal
Nonverbal (also consider culture)
Active listening
Empathy

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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

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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

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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

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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?

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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

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.”