Taylor: Chapter 21 (Teacher and Counselor)

Question 1

What healthcare trends have increased the need for effective teaching and counseling of patients?

Answer 1

1. ) Shorter hospital stays
2. ) Decreased time for interactions between health care professionals and patients
3. ) Dependence on complex technologies
4. ) Health promotion/consumer empowerment
5. ) Cost containment
6. ) Increased chronic illness

Question 2

What is the “Speak Up” Initiative?

Answer 2

• It is an initiative that The Joint Commission (TJC) began sponsoring in 2002 in an effort to educate patients on how to get involed in their care and prevent health care errors
• It now includes 20 brochures and 8 videos (in English and Spanish) that address topics such as…
  
  • Things you can do to prevent infection
  • Pain management recommendations
  • How patients can avoid mistakes with their medications

Question 3

Patient Education

Answer 3

• The process of influencing the patient’s behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health
  
  • Educated patients experience better health and have fewer complications

Question 4

What are the components of successful patient education?

Answer 4

• It must be ongoing and interactive
• It must take into account the patient’s…
  
  • Plan of Care
  • Educational Level
  • Need for Care Across the Continuum (Hospital to Home)
• It should be developed in collaboration with the entire health care team (including members of the hospital team, home care agencies, wellness facilities, and long-term care agencies)

Question 5

What is the basic purpose of teaching and counseling of patients and their families?

Answer 5

• The basic purpose of teaching and counseling is to help patients and families develop the self-care abilities (knowledge, attitude, skills) they need to maximize their functioning and quality of life (or to have a dignified death)
• When done effectively, it is a powerful tool for helping patients achieve health goals
• It provides the knowledge that patients need to make informed health care decisions and to implement a plan of care

Question 6

What are the various components of the patient’s engagement in their own care that can be enhanced through education and counseling? Include examples.

Answer 6

• Preventing Illness: counsel a pregnant woman on health practice that promote optimal fetal development, teach parents how to make their home safe for a toddler, counsel those at risk for diseases
• Restoring Health: preoperative and pospoperative teaching, sexual counseling for a patient recovering from an MI, lifestyle counseling for a patient with an ostomy
• Facilitate Coping: helping patients to come to terms with their illness and whatever lifestyle modifications may be required

Question 7

What outcomes can be promoted by nurses who are skilled teachers and counselors?

Answer 7

• High-level wellness and related self-care practices
• Disease prevention or early detection
• Quick recovery from trauma or illness with minimal or no complications
• Enhanced ability to adjust to developmental lifestyle changes and illness (acute, chronic, or terminal)
• Family acceptance of the lifestyle changes necessitated by illness or disability

Question 8

What is the TEACH acronym for maximizing the effectiveness of patient teaching?

Answer 8

Tune into the patient.

Edit patient information.

Act on every teaching moment.

Clarify often.

Honor the patient as a partner in the education process.

Question 9

What are some of the most common topics for health teaching and counseling?

Answer 9

Promoting Health: developmental and maturational issues, normal childbearing, hygeine, nutrition, exercise, mental health, spiritual health

Preventing Illness: first aid, safety, immunizations, screening, identification and management of risk factors

Restoring Health: orientation to treatment center and staff, patient’s and nurses’ expectations of one another, the illness and physical condition (anatomy/physiology, etiology, significance of symptoms, prognosis), the medical and nursing regimens (and how the patient can participate in care), self-care practices that the patient and family need to manage the patient’s condition independently

Facilitating Coping: how the patient’s physical and mental condition affects other areas of functioning, lifestyle counseling, measures that maximize independence and enhance self-concept, stress management, environmental alterations, community resources, appropriate referrels, grief and bereavement counseling

Question 10

What are the three critical areas that much of patient education focuses on?

Answer 10

1. ) Preparation for receiving care
2. ) Preparation before discharge from a health care facility
3. ) Documentation of patient education activity

Question 11

What are the six different components of Teaching-Learning Process?

Answer 11

1. ) Assess Learning Needs and Learning Readiness
2. ) Diagnose the Patient’s Learning Needs
3. ) Develop Learning Outcomes
4. ) Develop a Teaching Plan
5. ) Implement Teaching Plan and Strategies
6. ) Evaluate Learning

Question 12

What are the steps of the Teaching-Learning Process for Assess Learning Needs and Learning Readiness?

Answer 12

1. ) Use all appropriate sources of information
2. ) Identify the knowledge, attidues, or skills needed by the patient and family
3. ) Assess the patient’s emotional and experiential readiness to learn
4. ) Assess factors affecting the patient’s ability to learn (age, development level, family support networks, financial resources, cultural influences, literacy, language barriers)
5. ) Develop critical pathways or teaching plans that span car e delivery settings from hospital to home to take advantage of optimal learning readiness
6. ) Identify the patient’s strengths
7. ) Use anticipatory guidance

Question 13

What are the steps of the Teaching-Learning Process for Diagnose the Patient’s Learning Needs?

Answer 13

1. ) Be realistic
2. ) Validate with patient or family through conversations, questionnaires, and checklists

Question 14

What are the steps of the Teaching-Learning Process for Develop Learning Outcomes?

Answer 14

1. ) Identify specific, attainable, measurable, and short-term outcomes for patient learning.
2. ) Make sure that proposed behavioral changes are realistic and explored in the context of the patient’s resources and lifestyle
3. ) Decide which domain of learning is involved (cognitive, psychomotor, affective)
4. ) Prioritize
5. ) Include the patient AND family; unless the patient values these outcomes, little learning is likely to occur

Question 15

What are the steps of the Teaching-Learning Process for Develop a Teaching Plan?

Answer 15

1. ) Select content, content sequencing, and appropriate teaching strategies/activities
2. ) Relate the teaching content to the patient’s learning style, interests, resources, and patterns of everyday living
3. ) Pay careful attention to time constraints, scheduling, and the physical environment
4. ) Decide on group vs. individual teaching and formal vs. informal methodologies
5. ) Formulate a verbal or written contract with the patient

Question 16

What are the steps of the Teaching-Learning Process for Implement Teaching Plan and Strategies?

Answer 16

1. ) Prepare the physical environment, with attention to comfort and privacy
2. ) Communicate effectively with individuals, small groups, and/or large groups
3. ) Gather all audiovisual materials and equipment
4. ) Deliver the context in an organized manner using the selected teaching strategies
5. ) Be flexible
6. ) Keep teaching sessions short
7. ) Vary strategies for sensory stimulation, which promotes learning
8. ) Relate the material to the patient’s life experiences, which will help them assimilate new knowledge
9. ) Plan how you will evaluate learning
10. ) Assess verbal and nonverbal feedback

Question 17

What are the steps of the Teaching-Learning Process for Evaluate Learning?

Answer 17

1. ) Evaluate whether the learner outcomes were met (observe a return demonstration, ask the patient to restate instructions, ask the patient questions to determine whether reinforcement is needed, use written test/questionnaires, consult with the patient’s family, consider patient feedback and comments)
2. ) Reinforce and celebrate learning.
3. ) Evaluate teaching (self-evaluation, patient questionnaires)
4. ) Revise the plan if the learner outcome is not met (alter content and teaching strategies, use motivational counseling, reschedule teaching sessions)
5. ) DOCUMENT the teaching-learning process (patient and family learning needs and barriers to learning, mechanisms used to vercome learning barriers, patient and family readiness to learn, current knowledge on condition and health status, learning outcomes agreed on by the nurse/patient/family, ID of learning outcomes, information and skills taught, teaching methods used, patient and family response, need for follow up)

Question 18

What are five critical developmental areas to consider when creating a teaching plan?

Answer 18

1. ) Physical maturation and abilities
2. ) Psychosocial development
3. ) Cognitive capacity
4. ) Emotional maturity
5. ) Spiritual development

Question 19

How should teaching be tailored towards infants?

Answer 19

When the patient is an infant, teaching is directed toward the parents

Question 20

How should teaching be tailored toward toddlers and preschoolers?

Answer 20

• Toddlers and preschoolers may have some degree of understanding about medical tests or procedures, but health teaching continues to be directed toward the parents
• For patients in this age range, it helps for one nurse to establish a relationship with the patient and family and to be consistently involved in patient-teaching activities
• Information should be simplified to include only the most basic facts, WITH concrete examples or demonstrations
  
  • e.g. a 4 year old girl diagnosed with diabetes could be told she needs a shot every day to keep her from getting sick or feeling “funny”; she could be allowed to play with the syringes and to give shots to a doll
• Preschool children are often eager to deomstrate a skill they have been taught and may ask many questions, but make sure to keep explanations short
  
  • They have shorter attention spans and a greater need for nurturing, support, and creative participation in learning activities

Question 21

How should teaching be tailored towards children?

Answer 21

• School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible
• Teaching strategies that include clear explanations and reasons for procedures, stated in a simple and logical manner, are most successful
• These children are open to new learning experiences but need learning to be reinforced by either a parent or HCP at they become more involved with their friends and school activities

Question 22

How should teaching be tailored to adolescents?

Answer 22

• The content and strategies resemble those used for teaching adults as their cognitive processes are similar to adults
• HOWEVER, determine whether they are in Piaget’s concrete operations stage OR formal operations stage
  
  • Formal Operation Stage: they can use logical reasoning to solve hypothetical problems
  • Concrete Operation Stage: less skilled at thinking abstractly; can only solve concrete problems (e.g. may not perceive pregnancy from unprotected sex as a real possibility; online teaching aids that explain things in concrete terms are more helpful)
• Peer group acceptance is CRITICAL
• Teaching strategies must recognize their need for independence and to establish a trusting relationship that demonstrates RESPECT for the adolescent’s opinions

Question 23

What is the difference between pedagogy and andragogy?

Answer 23

• Pedagogy: the science of teaching that generally refers to the teaching of children and adolescents
• Andragogy: the study of teaching adults
  
  • Focuses on a specific problem/need and on the immediate application of new material

Question 24

What are Knowle’s four assumptions about adult learners that necessitate the need for adults to be taught differently than children?

Answer 24

1. ) As people mature, their self-concept is likely to move from dependence to independence
2. ) The previous experience of the adult is a rich resource for learning
3. ) An adult’s readiness to learn is often related to a developmental task or a social role
4. ) Most adult’s orientation to learning is that material should be useful immediately, rather than at some time in the future

Question 25

How should teaching be tailored to adults?

Answer 25

• Adult learners must believe that they need to learn before they become willing to learn
  
  • Nurses often must use their counseling skills to motivate patients to participiate in the teaching-learning process
• Adults may need to be shown the importance of learning new information, health practices, or skills
• The material should address a specific problem or need AND the material should be immediately applicable

Question 26

How should teaching be tailored to older adults?

Answer 26

• First identify any learning barriers to be overcome (sensory loss, limited physical mobility, inability to comply with the recommended therapeutic regimen)
  
  • Sensory deficits that can affect learning include cataracts (cloud vision), decrease in lens accommodation (adequate lighting needed), decrease in peripheral vision (keep teaching materials directly in front of learner), or hearing loss (speak slowly and clearly)
• Incorporate extra time
• Keep teaching sessions short
• Accomodate sensory deficits
• Reduce environmental distractions
• Try to give instruction that relations new information to familiar activities or information

Question 27

Describe the COPE model for helping family members to become effective problem solvers and to help support your teaching efforts.

Answer 27

Creativity (help the family overcome obstacles to carrying out health care management and learning how to generate alternatives)

Optimism (help the family caregivers learn how to view the caregiving situation with confidence)

Planning (help the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty)

Expert Information (help the family learn how to obtain expert information from HPCs about what to do in specific situations to empower caregivers by encouraging them to develop plans for solving caregiving problems)

Question 28

How should family support networks be incorporated into the nurse’s role as a teacher?

Answer 28

• No matter the patient’s age, the family can be a great help in teaching
• Assess the family’s function and style (by talking with them and observing how the patient and family interact)
  
  • This assessment will yield info about family function, stress, transitions, and expectations
• Informal conversations with both the patient and family can provide data that will help in developing the teaching plan

Question 29

How should the family caregiver be incorporated into the nurse’s role as a teacher?

Answer 29

• Almost 1/3 of American families have a caregiver who provides unpaid assistance for an older adult family member
• The family caregiver needs to be involved in collaboration with hospital staff regarding discharge planning
• When teaching long-term family caregivers, include info about the disease process and resources available in the community that can help them with disease management and education (focus on planning, caregiving, decision making, and problem solving)
• Always view the family caregiver as a partner in providing care and view yourself as a health educator who teaches families how to solve problems, rather than as an expert meant to solve problems for them

Question 30

How should you incorporate knowledge of the family’s financial resources into your role as a teacher?

Answer 30

• Evaluate the family’s financial resources (the patient may be unable to afford to follow a new treatment regimen)
• If needed, refer patients and families to community-based support groups and funding sources

Question 31

What are six important strategies for providing patient education in a culturally competent manner?

Answer 31

1. ) Develop an understanding of the patient’s culture
2. ) Work with a multicultural team in developing educational programs
3. ) Be aware of personal assumptions, biases, and prejudices
4. ) Understand the core cultural values of the patient or group
5. ) Develop written materials in the patient’s native language
6. ) Use testimonials of people with the same cultural background as the patient

Question 32

How should nurses address cultural influences and language deficits in their roles as teachers?

Answer 32

• You should seek info from a variety of sources, such as the nursing literature and textbooks that describe the health practices and values of other cultures
• Be sure to ID language deficits/barriers and develop strategies to address them, CLEARLY communicatng this in the plan of care
• DO NOT assume that a family member is adequately translating info critical to the patient’s learning
• In 2012, TJC initiated a new accreditation requirement that hospitals MUST accomodate the oral AND written communication needs of all patients (includes translated, clearly stated patient education info)

Question 33

What is a great resource that TJC has recommended for offering free, easy-to-read, health information in multiple languages?

Answer 33

HealthInfoTranslations.org

• More than 300 education topics in multiple languages

The National Library of Medicine on Medline Plus

• Has patient education materials in multiple languages that include tutorials with animated graphic materials and accompanying handouts

Question 34

What is health literacy?

Answer 34

• Health Literacy: the ability to read, understand, and act on health information
• Only approx. 12% of Americans are proficient in health literacy
• Even though this is true of all populations, minority and groups of lower SES more commonly lack health literacy skills
• Those with low health literacy are more likely to avoid medical screenings and require emergency department attention

Question 35

How is the general lack of health care literacy in the U.S. being addressed?

Answer 35

• Federal initiatives such as the Affordable Care Act of 2010 and the National Action Plan to Improve Health Literacy from the DHHS have made health literacy a national priority to improve the health of all Americs
• Health care info and directions have traditionally been written at a 10th grade level BUT educational material is generally more easily understood when written at a 5th-grade level

Question 36

What is the Ask Me 3 brief tool?

Answer 36

• It is a tool that is intended to promote understanding and improve communication between patients and their providers
• It involves three simple questions that patients should ask their health care providers during every encounter…

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

• Providers need to answer these questions in a clear, forthright manner and in plain language without medical jargon
  
  • Incorporation of visual models and involving patients in a “teach back” demonstration verifies their understanding of the info provided

Question 37

What is the Understanding Personal Perception (UPP) tool?

Answer 37

• It is a tool used to attempt to determine if additional education is necessary
• The nurse asks the patient to look at the images on the tool and ecide which of the figures most accurately indicates the patient’s understanding of the new health education materials
• The tool has images ranging from either a bright sun to dark clouds blocking the sun

Question 38

What is the Newest Vital Sign (NVS) tool?

Answer 38

• It is an additional reliable screening tool that is used to assess health literacy
• It was developed by Pfizer to improve communications between patients and providers
• It can be administered during initial assessments to assess the patient’s literacy skills involving both numbers and words
• It consists of a nutritional label from an ice cream container and a score sheet for recording the patient’s answers to six oral questions referring to the label

Question 39

What are the three different domains in which patients learn?

Answer 39

• Effective teaching often involves the promotion of behaviors in all three domains
  1. ) Cognitive: involves the storing and recalling of new knowledge in the brain (acquisition of knowledge, comprehension, application, analysis, synthesis, and evaluation)
  2. ) Psychomotor: involves the integration of mental and muscular activity
  3. ) Affective: includes changes in attitudes, values, and feelings (e.g. the patient expresses renewed self-confidence after physical therapy)

Question 40

What are the key point of effective communication associated with patient teaching?

Answer 40

1. Be sincere and honest; show genuine interest and respect
2. Avoid giving too much detail; stick to the basics
3. Ask if the patient has any questions
4. Be a “cheerleader” for the patient; avoid lecturing
5. Use simple words
6. Vary your tone of voice
7. Keep the content clear and concise
8. Listen and do not interrupt when the patient speaks
9. Ensure that the environment is conducive to learning and free of interruptions
10. Be sensitive to the timing of teaching sessions (a shorter session is best for a younger child and an adult may need to choose an opportune time to learn new information)

Question 41

What four elements should be considered in each assessment of the patient learning needs?

Answer 41

1. ) Identify what new knowledge, attitudes, or skills are necessary for patients and families to learn in order to manage their health care
2. ) Focus on learning readiness (the patient’s willingness to engage in the teaching-learning process and their emotional readiness to begin the challenge of learning)
   * Barriers to learning readiness include a patient’s denial of being ill, lack of physical endurance, lack of human or financial resources, a perceived benefit of continuin in the sick role, and a disparity of values between the patient and the HCP
3. ) The patient’s actual ability to learn
4. ) The patient’s strengths (the personal resources that you can help the patient to tap)

Question 42

What are the factors that affect learning?

Answer 42

1. Knowledge, attitudes, and skills needed for the patient and family to manage health care independently
2. Readiness to learn: emotional readiness (emotional health, motivation, self-concept and body image, sense of responsibility for self), experiential readiness (social and economic stability, past experiences, attitude, culture)
3. Ability to learn: physical condition, cognitive ability to learn, acuity of senses, developmental considerations, level of education, literacy, communication skills, primary language
4. Learning strengths: successful learning in the past, above-average comprehension/reasoning/memory/motor skills, high motivation, strong network, adequate financing

Question 43

How does motivation play into the learning process?

Answer 43

• When assessing a patient’s learning readiness, consider the patient’s motivation
• Motivation is an internal impulse (such as emotion or physical pain) that encourages the patient to take action or change behavior

Question 44

What health beliefs does the health belief model identify as critical for the development of patient motivation?

Answer 44

• Patients view themselves as susceptible to the disease in question
• Patients view the disease as a serious threat
• Patients believe there are actions they can take to reduce the probability of contracting the disease
• Patients believe the threat of taking these actions is not as great as the disease itself

Question 45

What factors make patients more likely to comply?

Answer 45

When patients understand their…

1. Diagnosis
2. Treatment Rationale
3. Medication Regimen
4. The Benefits of Compliance

• Increased patient compliance results directly from effective patient teaching

Question 46

What factors are associated with noncompliance?

Answer 46

1. A lack of learning readiness and motivation
2. Confusion
3. Disappointment
4. Misunderstanding
5. Fear
6. Inability to Learn
7. Inadequate Finances

• Noncompliance can hurt the patient’s health

Question 47

What are four teaching strategies that the nurse can employ to promote patient and family compliance?

Answer 47

1. Be certain that health care instructions are understandable and designed to support patient goals
2. Include the patient and family as partners in the teaching-learning process
3. Use interactive teaching strategies
4. Remember that teaching and learning are processes that rely on strong interpersonal relationships with patients and their families