Chapter 25 Client Education Client education is an important role that student nurses undertake. Nurses contend with multiple factors that affect clients, including shorter lengths of stay and increased demand on the nurse’s time. At times these two factors can compromise your ability to provide quality client education. Creating a well-designed, comprehensive teaching plan that fits your client’s unique learning needs can reduce health care costs, improve quality of care, and keep clients better informed about their individualized treatment plan.

Standards for Client Education The Joint Commission (TJC) sets standards for client and family education. Successful accomplishment of standards requires collaboration among health care professionals. The Joint Commission set mandating that nurses and the health team assess the client’s learning needs and provide education. Documentation is a must to ensure compliance and positive client outcomes.

Standards for Client Education: TJC Patient/family receive education specific to patient’s assessed needs, abilities and readiness to learn Patient education is interactive Any discharge instructions given to the patient/family are provided to the organization responsible for patient’s continuing care The organization plans and supports the provision and coordination of patient/family activities and resources

TJC Focus Adherence to standards Evidence of priorities, individualized care Evidence of patient/family response Information is understandable, usable to patient Non-English speaking patients, patients with low literacy skills and patients, with sight, hearing, and processing difficulties 90-100% of all hospitalized patients taught AEB patient education outcomes documented in pt chart Continuity of care

TJC Hot Buttons Teaching about potential food/drug interactions Culturally relevant strategies and resources Age appropriate teaching Assessment of readiness to learn Teaching about personal hygiene for patients who can no longer follow normal routine Teaching about home medications

TJC Hot Buttons Diet teaching for pts who are on a new or modified diet Proof of teaching through documentation Policy of how teaching is to be accomplished across the continuum of care

Purpose of Client Education To help individuals, families, or communities achieve optimal levels of health Client education includes: Maintenance and promotion of health and illness prevention Restoration of health Coping with impaired functioning Box 25-1 presents topics for health education. Ask students if they can give examples of each category. Maintenance and promotion of health and illness prevention: first aid, smoking/alcohol/substance abuse, stress management, nutrition, exercise, health screenings Restoration of health: anatomy and physiology of body system, medications, nutrition, diagnostic examinations, surgery Coping with impaired functions: home care, self-care, physical therapy, occupational therapy, speech therapy, prevention of complications, and environmental alterations

Teaching and Learning Teaching Learning Objective An interactive process that promotes learning Learning The purposeful acquisition of knowledge, skills, behaviors, and attitudes Objective Statement of what learners should be able to do after successfully completing a given course of instruction; there should be a measurable change in behavior.. It is impossible to separate teaching from learning. As previously discussed in Chapter 24, interpersonal communication is essential for successful teaching to occur.

Role of the RN in Teaching and Learning Patient education has become a professional expectation and a legal duty of nurses The RN initiates client teaching LPN can reinforce but can’t initiate Teach information the client and family needs to make informed decisions regarding their care Determine what clients need to know Identify when clients are ready to learn Evaluate learning Nurses have an ethical responsibility to teach clients. The Patient Care Partnership of the American Hospital Association indicates that clients have to right to make informed decisions regarding their care. The information given to clients must be accurate, complete, and relevant. Good communication, as discussed in Chapter 24, is of paramount importance.

Domains of Learning Cognitive Includes all intellectual behaviors and requires thinking Affective Deals with expression of feelings and acceptance of attitudes, opinions, or values Psychomotor Involves acquiring skills that require integration of mental and muscular activity Learning occurs in three domains. The cognitive domain is the knowledge the patient needs to acquire. It includes acquisition of knowledge, comprehension or ability to understand, application, analysis, relating ideas in an abstract manner, synthesis, recognizing parts of a whole, and evaluation. The affective domain is often difficult to identity. However, it impacts the positive or negative success of the education process. The psychomotor domain deals with skills. For a psychomotor skill to be acquired, the client needs to have the knowledge, physical ability, and attitude to learn the skills.

Basic Learning Principles Motivation to learn Addresses the client’s desire or willingness to learn Ability to learn Depends on physical and cognitive abilities, developmental level, physical wellness, thought processes Learning environment Allows a person to attend to instruction A client’s learning style will affect their preferences for learning. People process information by seeing and hearing, reflecting and acting, reasoning logically and intuitively, and analyzing and visualizing. Motivation to learn is determined by the clients’ attitudinal set, their readiness to learn, and their willingness to participate actively. Ability to learn depends on the client’s developmental level. Children will learn differently than adults. The ability to learn also depends on the client's level of physical development and overall physical health. The physical environment either makes learning difficulty or a pleasure. The ideal environment must be well lit, have good ventilation, appropriate furniture, and a proper temperature. Group teaching differs from one-on one-teaching.

Integrating the Nursing and Teaching Process A relationship exists. The nursing and teaching process are not the same. The nursing process requires assessment of all data. The teaching process focuses on the client’s learning needs and ability to learn. Box 25-3 compares the nursing and teaching process. In the teaching process during assessment you will analyze the client's needs, motivation, and ability to learn. The diagnostic statement specifies the information or skills the client requires. Next, identify specific learning objectives and implement the teaching plan. Finally, evaluate the learning based on learning objectives.

Assessment Nurses need to assess all factors that influence content, ability to learn, and resources available: Expectation of learning Learning needs Motivation to learn Ability to learn Teaching environment Resources for learning Health literacy and learning disability Box 25-5 presents nursing assessment questions that can help you obtain the information you seek.

Nursing Diagnosis Select the nursing diagnosis that reflects the client’s learning needs after the assessment is completed. Clarifying the diagnosis by domain helps the nurse focus on the subject matter and teaching methods. Nursing Diagnosis: Deficient Knowledge Use the NANDA diagnosis. Decide if the topic falls under the cognitive, affective, or psychomotor domains.

Planning Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a client: Set priorities Include client Select timing to teach When is pt most attentive? Organize the teaching material Order of information The more specific the plan, the easier it is for nurses to follow.

Implementation Maintain learning attention and participation Active participation Build on existing knowledge Pt will be bored if information already know is covered Select teaching approach Telling-teaching vital limited information; no opportunity for feedback Participating-client helps decide content; nurse guides and advises pertinent information Entrusting – provides client opportunity to perform self-care; return demonstration Reinforcing – before or after desired learning behavior Incorporate teaching with nursing care Implementation depends on the nurse’s ability to critically analyze assessment data when identifying learning needs and developing the teaching plan. Remember, every interaction with your client provides an opportunity to teach. Proper communication skills will help you implement the teaching plan. Teaching approaches include: telling, participating, entrusting, reinforcement. Instructional methods include: group instruction, one-on-one discussion, preparatory instruction, demonstration, analogy, role playing and simulation. Box 25-9 presents tips on how to deal with the elderly

Implementation Select appropriate instructional methods One on one instruction – at bedside, MD office, home; nurse directly shares information Group instruction – both lecture and discussion Preparatory instruction – before tests or procedures to be performed; describe physical sensations of procedure, cause of sensation, normal and not normal Demonstration and return demonstration Analogies – nurse translates complex language or ideas into words or concepts client understands Role play – rehearsing a desired behavior Simulation – teaching clients problem solving, application and independent thinking

Implementation Illiteracy and other disabilities Cultural diversity Watch medical jargon, keep teaching sessions short, provide teaching material at appropriate educational level (p. 379, box 25-8) Cultural diversity Language barriers- provide educational materials in appropriate language; translators Using different teaching tools Printed materials: programmed instruction, computerized instruction Nonprint materials - diagrams, graphs, charts, pictures, physical objects Audiovisual materials

Implementation Special needs of children and older adults Older adult Visual and hearing changes: offer larger print materials Reduced short term memory: introduce new information only when one set of information has been learned Children If at all possible include family members Use of medical equipment – lets children become comfortable with the equipment

Evaluation Necessary to determine whether the client has learned the material Helps to reinforce correct behavior and change an incorrect behavior Success depends on the client’s performance of expected outcomes Evaluation is the final step of the teaching plan. At this point, you will discontinue, adjust, or amend the plan. Documentation is of paramount importance to meet the Joint Commission standards. Additionally, third-party reimbursement may be determined by documentation.