mod 2 ch 25 teaching and education Flashcards
stages of grief
denial/disbelief anger bargaining resolution acceptance
denial/disbelief
Pt BX:
avoids discussion, withdraws from others, suppresses and distorts info
Learning implications for RN/Family
- empathy, careful of all procedural explanations
- be accessible for discussion
- as RN, explain situation to family/others
- teach in resent tense
rationale:
- pt not prepared to deal
- any attempt to convince pt will be more withdrawal or anger
- provide only absolute required info
anger
BX:
- pt blames or directs anger to rn or others
learning implications:
- do not agree w/pt, listen to concerns, good eye contact
- teach present tense
- reassure family this pt anger is normal
rationale:
pt need op to express anger, still not prepared to face it
bargaining
pt bx:
pt offers live better life in exchange for promise better health
learning implications:
- introduce reality only and teach present tense
rationale:
pt still unwilling to accept limitations
resolution
pt bx:
pt expresses emotions opening, illness created change and asks questions
learning:
encourage express feelings, what wants to learn, and share info for future and make formal discussion times
rationale:
perceive need for assistance and ready for responsible learning
acceptance
pt bx:
recognized reality, pursues info and strives for independence
learning:
teach future skills/knowledge and present occurrences, involve family in teaching
rationale:
more easily motivated, reflects willingness to deal w implications
domains learning
cognitive - gains info to further develop understanding
- done by discussion (one-on-one, or group), lecture, questions/answer, role play, independent projects
affective - expression of feeling and emotions and develops values, attitudes and beliefs.. attach emotion to learning
- role play, discussion (one-on-one, group)
- receiving, responding, valuing, organizing, characterizing
psychomotor - manual physical skills
done by demonstration, practice, return demonstration, independent projects, games
Hierarchy
- fundamental - simpler components for complex action
- perception - coordinated bodily movements
- guided response - imitation and demonstration
- complex overt response - smoothy and accurate performance
- adaption - skills well developed and modified when unexpected problem occurs
- origination - create new with current knowledge
motivation to learn
influenced by belief of need to know something, knowledge for survival
motivation must come from pt rather than hcp
motivational interviewing
counseling and ed technique focus on pt goals and goal directed and pt centered
change must come from pt not HCP
self-efficacy
person’s perceived ability to accomplish a task, when they believe they can, they’re more likely to perform bx consistently and properly
improves lifestyle choices
cultural factors (6 ACCESS)
- Assessment: pt lifestyle, health beliefs, cult traditions, health practices
- communication: awareness of many variations in verbal/nonverbal responses
- cultural: negotions and compromises encourages awareness of pt culture and one’s own biases
- establishment respect for pt cultural beliefs and values – caring rapport
- sensitivity: pt from diverse backgrounds perceive care needs and patterns of comm the use
- safety: enables pt feel culturally secure avoids disempowerment for cultural identity
instructional methods
- verbal one-on-one - most common, share info directly w/pt, done informally allows pt to ask questions, not effective for full understanding
- – USE EDUCATE Model - group instruction - multiple pts able to interact and learn from others’ experiences, both lecture and discussion, shows higher knowledge grasp, longer retention
- preparatory instruction- provide info about procedures, gives pt knowledge and sense of control, reduces anticipatory anxiety (reappraisal)- reframing emotional event in less emotional terms
- demonstration - use w psychomotor skills and use return demonstration
- analogies - supplement verbal ed with pictures or ideas - makes info real and understandable
- role-playing - learn required skills and feel more comfortable performing them
- simulation - teaching problem-solving, application
teaching pt w literacy or learning disability
- establish trust
- face pt, eye level
- speak slowly and encourage questions
- simple terminology
- keep teaching short and to point, incremental
- provide written materials/visual aides plain language 5th grade or lower
- relate to personal experience or real-life situations
- ask pt for feedback, return demonstrations
- reinforcement most important at end
EDUCATE
E - enhance comprehension and retention D - deliver pt-centered education U - understand the learner C - communicate clearly and effectively A - Address health literacy and cultural competence TE - teaching and educational goals
EDUCATE
E - enhance comprehension and retention
- use question list so pts can use to ask questions
- repeat most important info
- ask pts to repeat info
- provide info in several ways for full understanding
- use teach-back
EDUCATE
D - deliver pt-centered education
- talk to, not at
- practice empathetic skills
- ask pt about life, pay attention to pt worries and fears
- ask pt to state goals
EDUCATE
U - understand the learner
- find out pt knowledge first
- be aware nonverbal messaging
- determine pt barriers to health literacy
- include family in education
- realize pt may not be aware they don’t understand what being communicated to them
EDUCATE
C - communicate clearly and effectively
- requires practice
- present most important info first
- use easy to understand language
- pt must be given opp to ask questions before discharge
- consider audio recording of pt consult to improve pt recall
EDUCATE
A - Address health literacy and cultural competence
- ask, do you need help understanding
- have verbal ed w/written and visual materials
- use interpreter if needed
- consider using scripter tool for clear and understandable ed
- do not just ask, do you understand…
EDUCATE
TE - teaching and educational goals
- PREPARE
- effective tools
- overcome learning barriers
- teach as interactive process
- assessment of learning
purpose pt education
primary goal- help indiv, family, or communities achieve optimal levels of health through active participation and decision making to provide safe pt-centered care
helps reduce health care costs for indiv
cognitive learning
6 bxs:
- remember (knowledge) - recognize and recall
- understanding (comprehension)- use in activities
- apply- execute and implement
- analyze- break materials into parts, see how they relate and interrelate
- evaluate- evaluation
create (synthesis)- making whole, creating new processes with info, producing
attentional set
mental state allows learner to focus on and comprehend learning activity
- before learning, pt must be able to pay attention to or concentrate on info to be learned
ability to learn
pt’s developmental level and cognitive and physical capabilities influence the ability to learn
health literacy
cognitive and social skill determine abiity of indiv gain access to, understand, and use info in ways to promote and maintain good health, results in unsafe health is literacy low
- low health literacy can lead to more ED visits, along with more admissions and readmissions
teaching approaches: telling
used when limited time, pt is highly anxious but vital for info, simple instructions must follow
teaching approaches: participating
set objectives and become involved in process together.
opportunity for feedback, discussion, goal setting, and revision.
teaching approaches: entrusting
give pt opp for self-care
provides knowledge and skill that enables pt to accept responsibility to perform tasks
teaching approach: reinforcement
use stimulus to increase desired response before and after desired learning bx
timing is essential!
older adult education
- teach when well rested and alert
- casual and relaxed env
- short term goals
lighting - avoid blues and greens
- present info slowly and clearly
- encourage use of prosthetics and ensure proper fit
- relate to past experiences
teachback
closed-loop comms assesses pt retention of into during teaching session
- A patient asks a nurse to provide instruction on how to perform a breast self-exam. Which domains are required to learn this skill? (Select all that apply.)
- Cognitive domain
5. Psychomotor domain
- A patient suddenly experiences a severe headache with numbness and decreased movement in the left arm. The emergency room physician suspects a stroke and is going to have the patient undergo an emergent angiogram to remove the clot. Which teaching approach is most appropriate?
- Telling approach
- A nurse is caring for a young patient who has been told he has multiple sclerosis. The nurse has planned time to conduct a teaching session that will focus on the disease and principles of management. The nurse chooses to use the EDUCATE model to proceed with instruction. Which of the following are components of the model? (Select all that apply.)
- Repeat the most important information.
- Practice empathetic skills.
- Be aware of nonverbal messages.
- A nurse is teaching an older adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.)
- Speak in a low tone.
- Begin and end the session with the most important information regarding melanoma.
- Provide specific information in frequent, small amounts for older adult patients.
- A 55-year-old adult male has been in the hospital over a week following surgical complications. The patient has had limited activity but is now finally ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling quite fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient’s condition?
- Readiness to learn
- A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place?
- Return demonstration
- A patient’s cultural background affects the motivation for learning. Using the ACCESS model, match the nursing approach with the correct model component.
- Assessment
- E. Learn about the patient’s health beliefs and practices. - Communication
- B. Remain aware of verbal and nonverbal responses. - Cultural
- D. Become aware of your patient’s culture and your own cultural biases. - Establishment
F. Show respect by creating a caring rapport.- - Sensitivity
- C. Be aware of how patients from diverse backgrounds perceive their care needs. - Safety
- A. Help patients feel culturally secure and able to maintain their cultural identity.
- A 63-year-old woman is a family caregiver for her 88-year-old mother who has dementia. The caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. The best instructional method a nurse can use for this situation is:
- Role-playing
- A nurse is preparing to teach a patient who has sleep apnea how to use a CPAP machine at night. Which action is most appropriate for the nurse to perform first?
- Set mutual goals for the education session.
- Which of the following scenarios demonstrate that learning has taken place? (Select all that apply.)
- A patient describes how to set up a pill organizer for newly ordered medicines.
- A patient demonstrates how to take his blood pressure at home.
Affective domain?
The “feeling” domain
Includes values, beliefs, feelings and attitudes association with information received
Begins with receiving and responding to information
Willing to listen, discuss feelings
Moves to client attaching worth to information - shown by choosing a particular action from among alternatives
Higher levels - integrates value into everyday life and changes lifestyle
Psychomotor domain?
The “skill” domain
Includes physical and motor skills
Uses cues from the environment
Must have physical, mental, & emotional readiness
Performance of skill moves from imitation to creation of new way to perform skill
Cognitive domain?
The “thinking” domain
Ability to make sense of and use information
Begins with acquiring knowledge - memory & recall
Move to comprehending and applying knowledge - understanding, repeat back own words, abstract ideas applied to a situation, i.e. call when have symptoms of adverse effect
Higher levels - able to analyze, synthesize, and evaluate based on knowledge obtained
