Patient Education

Question 1

why is patient education important?

Answer 1

• essential component of safe, patient-centered care
• standard for professional nursing practice (included in Board of Nursing’s standards of practice)
• falls within the scope of nursing practice

Question 2

what do we teach?

Answer 2

• health analogies (ex: heart like a pump, kidneys like a filter)
• restoration of health
• coping with impaired functions (new normal)
• promotion of health and illness prevention (flu shot, no smoking)

Question 3

teaching

Answer 3

transmission of intentionally structured and sequenced information to a recipient
- purpose: produce a change in behavior
- utilizes an interactive process that promotes learning

Question 4

learning

Answer 4

purposeful acquisition of measurable factors through an experience or external stimulus
factors:
- new knowledge
- attitudes
- behaviors
- skills
(actively engaged,
2 way: nurse transmits info, patient retains info)

Question 5

beginning of teaching and learning

Answer 5

a person identifies a need for attaining knowledge or acquiring an ability to perform a task

Question 6

nursing actions

Answer 6

• determine: what patients and families need to know
• identify patient’s:
  – existing knowledge
  – learning preferences
  – readiness to learn
• provide the time to teach
• teach needed information
  – patients
  – families
  (if family is going to help take care of them, they need to be taught
  also need to make them understand why something is the way it is - ex: why you need to always check their name and DOB before meds, so we don’t give them the wrong dosage or wrong meds)

Question 7

nursing actions: information essentials

Answer 7

• accurate
• complete
• relevant to the patient’s needs, language, and literacy: 5th-grade reading level
• timely: patient/family are ready, not in pain, not just after surgery

Question 8

nursing goals

Answer 8

• assist the patient: to make informed decisions regarding their care (ex: helping explain consents for surgery, follow their diet)
• promote the patient’s understanding: the positive effects of change through education

Question 9

cognitive domain of learning

Answer 9

description:
- includes intellectual behaviors
- requires: thinking, storage/recall of information
tools:
- one-to-one instruction
- written materials
ex: learning facts about hypertension
(talking about something, reading something and being able to retain it,
ex: discharge packets (read through those before giving to pt so you have some talking points)
can also listen to how doctors explain and teach things (may be helpful))

Question 10

affective domain of learning

Answer 10

description:
- expression of feelings
- development of attitudes, opinions, or values
tools:
- one-to-one counseling
- role play
ex: changing a belief about the dangers of smoking
(more like a counseling session)

Question 11

psychomotor domain of learning

Answer 11

description:
- acquisition of skills
- requires coordination and integration mentally and physically
- hands-on skill (kinesthetic learning)
tools:
- demonstration/return demonstration
ex: self-administration of insulin
(any physical thing that you teach the patient, ex: incentive spirometer, teacher demonstrates and patient tries it after)

Question 12

basic learning principles

Answer 12

• stimulus to learn
• readiness to learn
• ability to learn
• learning environment
  (for adequate learning to happen, these must be there)

Question 13

stimulus to learn: motivation

Answer 13

• the force acts on or within a person to cause the person to behave in a particular way
• person does not want to learn: unlikely learning will occur
  (know what your patient likes, what their goal is (most are getting out of the hospital),
  ex: if you show me that you can walk a little, just ten feet, we can work toward you getting out of the hospital)

Question 14

stimulus to learn: theory

Answer 14

• use a theory: matches a person’s learning needs and personal preferences
• enhances motivation and learning

Question 15

social learning theory

Answer 15

• consider the characteristics of the learner: behavior patterns and environment
  –> self efficacy is the major concept: person’s perceived ability to successfully perform a task
  –> provides guidance to the educator to develop an effective teaching plan
  (observation and imitating the things of the environment)

Question 16

stimulus to learn: culture

Answer 16

• respect the patient’s identity and needs
• regardless of:
  – age
  – religious practices
  – social and/or socioeconomic status
  – physical appearance
  (ex: mennonites have the man speak for the women in the family, so you speak to him even if he’s not the patient,
  ex: patient’s religion prevents them from eating pork, so they never finish breakfast, so with doctor’s orders can change diet to something they will eat)

Question 17

stimulus to learn: active participation

Answer 17

• implies an eagerness to acquire knowledge or skills
• retain 10% of info reading
• retain 90% of info speaking and doing
  (having them involved is going to help them retain the information)

Question 18

readiness to learn: attentional set

Answer 18

mental and physically:
- learner is prepared to learn
positive factors:
- comfortable environment
- presence of family may be useful
obstacles:
- physical discomfort
- anxiety: high
- environmental distractions
- presence of family
(they need to be comfortable to learn)

Question 19

readiness to learn: psychosocial adaptation

Answer 19

• process: assists the patent after an incident
  – injury
  – illness
  – both
  (this process will help them adapt to their new normal)

Question 20

psychosocial adaptation

Answer 20

grieving:
- allows the patient to:
– accept the reality of their illness or injury
– adapt to the new normal
emotions:
- severe anxiety, stress, or emotional pain can interfere with learning
- a mild level of anxiety can enhance learning, provides motivation

Question 21

ability to learn: developmental capability

Answer 21

• cognitive development affects the person’s ability to learn
• without proper physiological, motor, language, and social development, many types of learning cannot take place

Question 22

ability to learn: children

Answer 22

• the developmental stage of a child determines:
  – capability to learn
  – types of behaviors that children can learn
  (ex: provide something relatable to explain something, ex: CT scan like a donut)
• infant:
  – hold infant firmly while smiling and speaking softly to convey sense of trust
• toddler:
  – use play to teach procedure or activity (e.g., applying bandage to doll)
  – utilize simple words
  (distraction can help them be okay with getting something done,
  ex: doing the temporal thermometer over and over on someone so they allow you to take blood pressure)
• preschooler:
  – use simple explanations and demonstrations
• school-age:
  – teach psychomotor skills needed to maintain health
  – offer opportunities to discuss health problems and answer questions
  (stitches are string bandages, IV is a straw, listen to lung sounds on mom first so kids sees it doesn’t hurt)
• adolescent:
  – use teaching as a collaborative activity
  – allow adolescents to make decisions about health and health problems
  (make decisions ex: pills for 3 days or a shot right now)

Question 23

ability to learn: adults

Answer 23

self-directed:
- critically think
- direct their own thinking
patient-centered:
- collaborate with adults on topics and goals

Question 24

ability to learn: adults

Answer 24

young and middle-aged adults:
- offer information so adult understands effects of health problems
- encourage participation in teaching plan by setting mutual goals
older adults:
- teach when client is alert and rested
- involve adult in discussion or activity
- individualize to the person
(go more in depth about side effects, and consequences of ignoring the education you’re providing,
patient centered goal - ex: want to be able to play guitar again so OT and PT help them get back there)

Question 25

ability to learn: other factors

Answer 25

physical capability:
- influences:
– level of personal involvement
– physical health
– energy
neurosensory issues: older adults start having these
- feel
- see
- hear
- grasp
health literacy:
- affects the patient’s ability to understand basic healthcare information, which is needed to make appropriate healthcare decisions
other literacy issues:
- patient’s ability
– read
– write
– speak the same language as the healthcare provider
special circumstances:
- sedation, a bad previous hospital experience means they don’t want to hear from you because you may be like them, maybe they don’t want to learn from a woman
(literacy = can they read and write)

Question 26

learning environment: affects the person’s attention to instruction

Answer 26

room:
- well-lit
- appropriate furniture
- quiet
- private
- good ventilation
- comfortable temperature
groups:
- appropriate # of participants: 6 or fewer
- right-sized room: not too big or too small
- verify all participants can see and hear one another

Question 27

challenges to teaching and learning

Answer 27

teacher:
- conflicting schedules:
– nurse’s time
– patient’s availability
- lack of space and privacy: (ppl coming in and out of room like OT, doctor, not including patient eating lunch, going to bathroom)
- teaching not seen as priority to the nurse or the organization
- no 3rd party reimbursement for teaching

Question 28

challenges to teaching and learning

Answer 28

learner:
- illness
- fatigue
- other physical conditions
- anxiety
- personal stress
- provider/nurse used medical jargon and uses technical terms
- overwhelming amount of behavioral change needed (amount of changes that have to happen before they can feel good again)
- does not perceive a need for the information
- lack of support from family/caregivers
(these things prevent teaching or learning from occurring)

Question 29

technology-based learning issues

Answer 29

• lack of social interaction
• poor learner motivation
  – lack of interest
  – complicated
• technical difficulties
  – devices
  – software
• lack of access to the internet
  (virtual discharge: can feel impersonal, wifi has to be good at home and hospital,
  doing anything through a screen is going to cut down the social interaction,
  older ppl may not be interested in doing it, or it is complicated)

Question 30

teaching plan elements

Answer 30

• teaching strategies: method(s) used to present the information being taught
• content: all the information needed to reach the intended goal
  – goal: change behaviors to improve patient outcomes
  (strategy: planned method to teach something to a patient)

Question 31

scheduling and sequencing

Answer 31

• present simple before complex information
• present nonthreatening before difficult topics
• verify enough time for the topic
• short time frames
  (have an idea of what you’re going to teach them, where you’re going)

Question 32

instructional material

Answer 32

• tools that are used to introduce information and reinforce learning
• select the appropriate method for the patient’s learning style
  – psychomotor: have the equipment you need like crutches
  – cognitive: pamphlet
  – affective: connecting them with counselor

Question 33

teaching tactics

Answer 33

• keep the patient actively involved to support their attention and learning
• build on current knowledge
• teach while performing nursing care
• telling: instructions are given, such as preparing a patient for a procedure
• participating: cooperative effort by the nurse with the patient to learn the best process (ex: discussing with them whether they want to walk (if they can) or use wheelchair)
• entrusting: nurse becomes an observer as the patient performs a skill
• reinforcing: nurse offers a smile or words of affirmation, children - a prize or sticker
  (teaching them when you give them tray about diet, teaching about how to clean around wound while doing that)

Question 34

techniques of instruction: number of students

Answer 34

• one-to-one: one teacher presents to an individual patient
  – as a part of this type, teach while nursing care is provided
• group:
  – efficient: more than one student
  – students can interact with one another
  – most effective/least distractions: 6 or fewer students

Question 35

preparatory

Answer 35

provides information prior to a procedure
- describes physical sensations and their cause
- prepares the patient for common experiences
- as applicable, verifies the patient knows when results will be available and who will contact them
(ex: it’s going to be loud, you’ll have a weird taste in your mouth and you’ll feel like you’re going to pee your pants)

Question 36

demonstration/return demonstration

Answer 36

most effective when the patient observes the nurse
- then, during a return observation, the patient has a chance to practice the skill

Question 37

analogy

Answer 37

familiar images make complex ones easy to understand
- be knowledgable about the concept
- know the patient’s background, experience, and culture
- keep the comparison simple and clear

Question 38

simulation

Answer 38

problem-solving, application and thinking
- a situation is presented for a patient to solve a problem or make appropriate choices

Question 39

printed materials

Answer 39

patient’s literacy must be assessed beforehand
- the information is available in the form of fact sheets, discharge instructions, or detailed booklets

Question 40

digital

Answer 40

sources of information:
- video or flash format
- computer animations
- audio clip online
- CD/DVD
- film/slides
- computer-generated material
follow with reinforcement:
- question-and-answer session
- discussion of the material
- printed material

Question 41

online

Answer 41

information:
- presented via credible listservs and websites such as the CDC, Mayo Clinic, and others
sources:
- multiple electronic platforms
– multimedia
– search engines
– electronic libraries
- others

Question 42

unique situations

Answer 42

• adaptations: based on the special need
• nurses need theoretical knowledge about the condition
• teaching should include: family members, caregivers, other significant persons
• these individuals can reinforce learning and assist with implementation of presented education
  (have to understand what is going on with the patient so that you can teach them about it)

Question 43

literacy or learning disabilities

Answer 43

• establish trust:
  – speak slowly
  – encourage questions
• short sessions:
  – to the point, simple terminology
  – minimize distractions
  – use visual aids
• most important information at the beginning
• teach in increments

Question 44

evaluation strategy: teaching effectiveness

Answer 44

• observe and evaluate patient’s ability to perform desired behaviors
• teach back: determines patient’s and family caregiver’s level of understanding of instructional topic –> always develop a plan for revised patient teaching if patient and/or family is not able to teach back correctly
• ex: I want to make sure I explained everything clearly. If you were trying to explain to your husband how to take this medicine, what would you say?
• ex: show me how you would use this inhaler so I can make sure I explained it well.
• ex: I want to be sure I mentioned the main side effects of this new medicine. Could you tell me 2 things to watch out for?

Question 45

for some older adults

Answer 45

• allow sufficient time to process and comprehend new information
• only present the most significant information to avoid overwhelming the learner
• use repetition to reinforce content
• instructions or teaching a new skill: give concise, step-by-step directions
• provide regular positive reinforcement
• assess understanding of each step before moving ahead
• keep teaching sessions short
• allow for frequent breaks
• conclude with brief summary: allow sufficient time for questions/feedback
• schedule follow-up sessions: ensure learning with additional time

Question 46

guidelines for printed materials (possibly older adults)

Answer 46

• direct and clear information (ex: talk to your doctor about your diabetes)
• 2-3 main points
• simple steps
• Times New Roman is a good choice for the typeface
• large font: 12 point or larger
• white space rests the eyes

Question 47

purpose/goal of patient education

Answer 47

ultimately, the patient achieves a better level of health and functioning