PCC-1 Exam 3 Module 9 Flashcards
Factors of readiness to learn (motivation, ability, environment)
Motivation – a person’s desire or willingness to learn. Effected by previous knowledge, experience, attitudes, and sociocultural factors. *(Health Care providers make the worse patients)
Ability – depends on the physical and cognitive attributes, developmental level, physical wellness, and intellectual thought processes.
Environment- Effected by the # of people, need of privacy, temperature, lighting, noise, ventilation, furniture set up.
Pg. 14 in Powerpoint
Health Literacy and knowledge assessment
Health literacy: the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.
Health literacy includes patients’ reading and mathematics skills, comprehension, and decision-making and functioning skills with regard to health care.
Health Literacy is a strong predictor of a person’s health status. Results from a 2015 survey by the U.S. Department of Education, National institute of Literacy found that 32 million American adults have a below-basic level of health literacy. Studies show that patient with low literacy levels are 1.5 to 3 times more likely to expereicne adverse health outcomes and are at an increased risk for hospitalization that those at lower literacy levels. AT RISK = above the age of 65, minority populations, immigrant populations, low income, those with chronic mental of physical health conditions.
The nurse should provide client education at the 6th grade reading level or below. Assess by asking patient to read a medication label, explain back simple step by step plans, describe back instructions on a written hand out.
Nursing Diagnosis: patient education-
Deficient knowledge (affective, cognitive, psychomotor)
Ineffective health maintenance
Impaired home maintenance
Ineffective family therapeutic regimen management
Ineffective self-health management
Noncompliance (with medications)
Nursing Diagnosis –
Deficient Knowledge = the diagnostic statement describes the specific type of learning needed and it’s cause
Ex. Deficient knowledge regarding (surgical procedure) related to lack of recall and exposure to information
Ineffective Health Management = used when you can eliminate health care problems through education
Ex. Ineffective Health Maintenance related to deficient knowledge regarding scheduling of medications
Learning Domains
Cognitive Learning – acquiring knowledge and skills. Includes all intellectual behaviors and requires thinking
Affective learning – development of values, attitudes, and beliefs. Deals with expression of feelings and acceptance of attitudes, opinions, or values.
Psychomotor learning – acquiring motor skills (client must “physically do something”). Involves acquiring skills that require integration of mental and muscular activity.
Learning Domains Continued
Different teaching methods are appropriate for each domain of learning.
Cognitive: discussion (one-on-one or group), lecture, question-and-answer session, role play, discovery, independent project, field experience- typical classroom type learning
Affective: role play, discussion (one-on-one or group)
Psychomotor: demonstration, practice, return demonstration, independent projects, games
Teaching Methods
- Telling – limited info, when client is anxious, specific task, no feedback
- Participating – discussion, feedback, mutual goal setting, revision of plan
- Entrusting- client self manages care and the nurse observes and assists
- Reinforcement – use of a stimulus (positive or negative) Timing is essential so a clear correlation is made between the behavior and the stimulus.
Incorporating teaching – Teach more effectively while delivering nursing care. Ex. Medication teaching while administering medication
Teaching Methods Continued
- One-one-One – most common at bedside, give info, client can ask questions, use models and diagrams, can be unstructured
- Group – economical, learn from experiences of others, discussion, share ideas, review common experiences. Leader guides participation.
- Preparatory instruction – (tests or procedures) reduce anxiety. Describe common physical sensations and causes. When results will be available.
- Demonstrations- psychomotor skills – use return demonstration (requires planning and organization)
- Analogies = supplements verbal instructions with familiar images that make complex information more real and understandable.
- be familiar with the concept
- know the patient’s background, experience, culture
- keep analogy simple and clear
- Role Play – Patient learn a required skill by performing independently. The nurse offers feedback.
- Simulation – teach problem solving, application, and independent thinking
Learning Evaluations
Questions to ask when evaluating client education –
1. were the client’s goals or outcomes realistic and observable? 2. Is the client able to perform the behavior or skill in the natural setting (home)? 3. How well is the client able to answer questions about the topic? 4. Does the client continue to have problems understanding information or performing a skill? If so, how can you change the interventions to enhance knowledge or skill performance?
Teach back – is a closed loop communication technique that assesses that client retention of the information imparted during the teaching session. Ask the patient to explain the teaching provided. Client understanding is confirmed when the client can accurately restte the information in his or her own words.
See through the patient’s eyes.
Have the patient’s learning needs been met?
Evaluate a patient’s learning by observing performance of expected learning behaviors under desired conditions.
Discontinue, adjust, or amend the plan.
Patient outcomes:
Legal responsibility
Documentation
Teaching Technique for patients with special needs or low literacy
Teaching a Patient with Literacy or Learning Disability
Literacy and other Disabilities - Impaired ability to analyze instructions, synthesize information, problem solve. Promote a safe, shame-free environment. Consider sensory deficits.
- Establish trust, speak slowly, encourage questions, short sessions, appropriate teaching materials, appropriate analogies, model appropriate behavior, visual aids, Teach back, positive reinforcement.
Teach Back – to determine understanding about a topic or ability to demonstrate a procedure. Determines level of understanding of instructional topic. Always revise you instruction or develop a plan for revised patient teaching if the client is not able to teach back correctly.
Cultural Diversity – Assess and determine a patient’s beliefs, values, and customs as they relate to health. Box 25-7 p.350 P&P
- use a trained and certified healthcare interpreter to provide health care information when a client can not understand english
Teaching tools- Table 25-3 p.352 P&P. Select the right tool depending on the instructional method, learning needs, and ability to learn.
- Printed Materials = easy to read, info accurate and current, use for complex concepts - Physical objects = teach concepts or skills, allows for the manipulation of objects used later in skill
Special needs – Developmental needs of children, physical and psychological needs of older adults (sensory, memory)
Assess family dynamics (high incidence of elder abuse)
Box 25-8 p. 352 P&P Focus on Older adults – casual, personalized, lighting, large font, eliminate noise, sufficient time, use of prosthesis, concrete examples, step-by-step, short sessions, summarize.
6 Rights of Medication Administration
The right patient The right medication The right route The right time The right dose The right documentation
Components of a medication order
Patient’s Full Name & Medical Record Number
Date and Time order was written
Medication Name
Dosage
Route of Administration
Time and Frequency of Administration
Signature of prescribing health care provider
Patient’s with the same name need to be identified carefully with their medical record number. Labels for same name should be placed on the charts and prn medications to ensure patient safety.
Clarify start and stop dates
Medication Name – chemical name (molecular structure), Generic name (official publicized name), Trade name (marketed name) – Be familiar with Generic & Trade names
Dosage = the strength of the medication- Nurse must understand pharmacokinetics (absorption, distribution, metabolism and excretion)
Route – know accepted abbreviations, clarify orders, look it up * tPA Activace
Time & Frequency – achieve a therapeutic range of a medication occurs between the toxic concentration and minimum effective concentration. Figure 32-2 p.614 P&P
Signature – make sure the signature is legible so you can call for clarification.
Error Prone Abbreviations
Pg. 622 in P&P
Interventions to avoid medication error
Follow 6 Rights
Read the label 3 times comparing with MAR
Use at least 2 Pt Identifiers
Do not allow any other activity to interrupt medication administration
Double-check all calculations and verify with another RN
Do not interpret illegible handwriting; clarify with prescriber
Question unusually large or small doses
Document all medications as soon as they are given
Nurse’s Response to a medication error
Client’s Safety is TOP Priority Assess Client Notify Physician Report to Nurse Manager Do not fear repercussions Reflect Opportunity to prevent future errors File Incident Report Do not document in medical record Report near misses
Telephone and verbal orders
Accepted only if the physician cannot attend the patient and if the order is:
Recorded in the medical record verbatim with date and time of the order
Verified by reading back to and confirming with the physician
Complete
Countersigned by the physician as soon as possible
If the nurse can not understand the order, a second nurse or supervisor should be asked to listen to the order
