Client Teaching Chapter 8 Carolyne Richardson-Phillips, MS, RN PNU 145 Fall 2015 Pages

Learning Outcomes The PN Students will be able to: 1.Identify the authoritative bases that mandate client teaching 2.List examples of client teaching provided by nurses 3.Discuss/list benefits that result from client teaching 4.State the four progressive stages of learning 5.Describe the three domains (learning styles) of learning & the activities that go along with each 6.Discuss & compare the three major age-related categories of learners 7.Discuss characteristics unique to older adult learners 8.Identify factors that the nurse should assess before teaching clients also that may interfere and require special adaptations when implementing health teaching 9.Develop a nursing care plan using NANDA approved nursing diagnosis, expected outcomes, interventions, methods of outcome evaluation, and documentation for client teaching 10.Discuss formal and informal teaching methods

Health Teaching Most important use of communication for all nurses An important independent nursing function Not an option for nurses Legislation-legal and professional responsibility Mandated nursing activity: State Nurse Practice Acts: require health teaching Joint Commission on Accreditation of Healthcare Organizations (JACHO) criterion for accreditation American Nurses Association’s Social Policy Statement addresses it. (2003 & revised 2010) Begins soon after admission Early attention to client’s needs important as learning takes place in four progressive stages 1. Recognition of what’s been taught 2. Recall or description of information to others 3. Explanation or application of information 4. Independent use of new learning Teaching delay slows process of optimum learning outcomes

Teaching: Subject Areas Teaching generally focuses on combinations of the following: The plan of care, treatment, services Safe Self-administration of medications (PO, SC -insulin injections, heparin injections, patches, liquids) Directions & practice on equipment For self-care (needles, dressings, oxygen, therapy equipment) Rehabilitation program-Physical, Occupational, Speech therapy- exercises, speech, swallowing

Teaching: Subject Areas Dietary instructions: low NA, low Fat, potassium, increase calcium, Tube feedings Pain assessment process & methods for pain management Available community resources Plan for medical follow-up: Labs, medication, appointments Signs of complications and actions to take

Benefits of Client Teaching Reduced length of stay Cost-effectiveness of health care Better allocation of resources Increased client satisfaction Decreased readmission rates IMPORTANT Documentation of teaching process is essential Provides a legal record that teaching took place Medical Record-who was taught, what was taught, teaching method, evidence of learning by client or others

Assessing: Learner Nurse needs to determine the client’s 1. Preferred learning style 2. Age & developmental level 3. Capacity to learn 4. Motivation 5. Learning readiness 6. Learning needs 7. Sensory deficits 8. Cultural differences

Learning Styles How a person likes to acquire knowledge Nurses: Question client as to what style of learning is best –Present information through a combination of teaching methods Three domains of learning: 1. cognitive 2. affective 3. psychomotor Effective teaching involves behaviors of all the three domains

Learning Styles (cont’d) Cognitive domain: processing information by listening or reading facts & descriptions Involves storing and recalling of new knowledge in brain Ex: listing, identifying, describing, designing, explaining, locating, labeling, comparing, summarizing, selecting Using computer, audiovisual materials Asking questions Thinking” domain knowing, comprehension, applying analysis, evaluation Psychomotor domain- “Skill” learning by doing: Activity: Demonstration, practice, modeling, using computer, assembling, changing, creates, emptying, filling, adding, calculating, removing, measuring Ex: filling a syringe, giving an injection, changing a dressing Affective domain- Emotional response to tasks: appeals to a person’s feelings, beliefs, or values Ex: Gaining self-confidence, advocating, supporting, accepting, promoting, refusing, defending, choosing, helping, initiating

Age & Developmental Level Learning takes place differently, depending on person’s age and developmental level Androgogy: teaching adult learners Physically mature, building experience Active, voluntary learners, Self-directed & independent Seek knowledge for its own sake or personal interest Longer attention span, long-term retention, goal-oriented Gerogogy: techniques to help learning among older adults Undergoing body changes Vast experience, crisis learner, passive/active Need structure & encouragement Motivated by personal need or goal, self-centered Attention affected by low energy level, fatigue, & anxiety Short-term unless reinforced by immediate use Respond to frequent feed back Pedagogy: teaching children or those w/ cognitive ability comparable to children Physically immature, lack experience, compulsory learners, passive Need direction & supervision Short attention span, rote learners, short-term retention Task oriented Motivated to learn by rewards or punishment

Age-Related Categories (cont’d) Older adults-have their own ways Nurse: Before beginning teaching session-may need to clearly explain the purpose (s) or anticipated benefits of new behavior Once understood, older adults may be creative in ways to incorporate the new behavior changes in their life-style Referring to older person’s actual experience in life will help provide a link to new learning Calm attitude, quiet environment, peer teaching or reinforcement group settings-help with learning new material Provide encouragement & praise

Part of Nursing Process Cognitive status: Initial assessment of levels of cognitive function (alert, confused), acute or chronic May show that the client acts in an appropriate manner & states that they understand information taught After 15 minutes ask the client to discuss what has been taught to see if able to recall If there is cognitive impairment (forgetful, confusion), a support person, or caregiver should be present for teaching sessions

Generation “Y” & “X” & “Net Generation” ”X”-born between 1961 & 1981 “Y”-born after 1981-thru 20 th century “Z”-Net Generation-born beginning of 21 st century: Technology & imposed independence have greatly affected learning Technologically literate –Computers, I-Pods/Pads, Cell phones, Skype, Facebook, Pintrest, Twitter

Generation “X” & “Y” & Net Generation (cont’d) Crave stimulation & quick responses Want immediate answers & feedback Become bored with repetition/memorizing Like variety of instructional methods Respond best when information is relevant Prefer visualizations, simulations, & other participatory methods

Capacity to Learn: Adaptations Need some intellectual ability Before teaching plan initiated: essential to determine client’s level of literacy – client’s ability to read & write Clients are afraid/embarrassed to admit Usually have ways to cover up or compensate learning deficits Clients may be: Illiterate: cannot read/write Functionally illiterate: can sign name & perform simple math tasks but read below a 5 th grade level Health literacy: degree to which clients have capacity to obtain, process, understand basic health information & services needed to make appropriate health decisions Useful approaches Use verbal, visible modes for instruction Reinforce information through repetition Provide pictures, diagrams, tapes Keep language to their level Obtain feedback

Sensory Deficits Older adults-visual & auditory deficits Helpful approaches: Visual deficits Make sure wearing glasses Speak in normal tone of voice-Do not need to talk loudly Use at least a watt-light bulb Provide magnifying glass Obtain reading items in large print (12-16 point), black print on white paper Avoid using materials printed on glossy paper

Sensory Deficits (cont’d) Hearing impaired Lower voice pitch: most have problems with higher pitch sounds- Don’t need to always talk loud Use chalkboard, cards, writing pads, to communicate Rephrase rather than repeat when does not understand Try to select words that do not begin with “F”, “S”, “K”, and “SH” (formed with high-pitched sounds)-Difficult to hear Make sure client has hearing aide or other device for hearing (batteries etc) Can insert stethoscope into ear & speak into the bell with a low voice

Cultural Differences Need to modify approaches if client does not speak or understand English May require a translator Assess cultural/religious restrictions on certain types of knowledge Need to realize that client may understand information but may not be implemented in the home d/t culture If client speaks some English: Speak slowly, not loudly Use simple words & short sentences Avoid technical words, medical terms, slang May have to ask questions that require a Yes or No answer If client looks confused--- REPEAT it without changing the words Give time to respond Use body language-pantomime, point

Attention & Concentration Affect the duration, delivery, & health teaching methods Helpful approaches Assess client for alertness & if Comfortable Use short teaching sessions Use client’s name frequently (for attention) Show enthusiasm Use colorful materials Use gestures/demonstrations Involve the client to become active/involved in the teaching skills Vary tone and pitch of voice

Motivation Whether the client wants to learn Learning-optimal- has a purpose for acquiring new information Greatest when a client recognizes a need and believes the need will be met through learning Communication skills-by the nurse can obtain information that will indicate motivation or lack of motivation

Learning Readiness Readiness: refers to the client’s physical & psychological well-being Physical Readiness: Is the client able to focus on things other than physical status, pain, fatigue, immobility? Emotional Readiness: Is client emotionally ready to learn self-care activities? Is the client anxious, depressed, grieving? Cognitive Readiness: Is the client able to think clearly? Is there an alteration of consciousness?

Learning Needs Teaching and learning- better accomplished when both individualized Nurse needs to communicate with client to find out what learning needs that the client requires and wants –Questions to ask? What does being healthy mean to you? What things in your life interfere with being healthy? What don’t you understand as fully as you would like? What activities do you need help with? What would you like to be able to do before being discharged? How can we help you with this at this time?

Informal & Formal Teaching Informal teaching Unplanned: occurs spontaneously at the bedside-without organization of a plan & time Potential for reaching goals, providing adequate information & ensuring comprehension – may be in jeopardy Formal teaching: requires a plan of care Development of teaching plan serves as a model for client teaching Plan - needs time, organization, content Potential teaching identified upon admission Updated as client progresses If on-going education needed at home-Telehome care- visiting client electronically in home for purpose of seeing & communicating

Informal & Formal Teaching (cont’d) Written Teaching Plan: accomplished in a series of steps Nursing Process includes: Assessment: nurse collects data, analyze client’s strengths and deficits Diagnosis: Knowledge deficit Goal: What client would like to achieve Plan: How is this is to be accomplished? Interventions/Implementation: What material is to be used to help accomplish this goal/plan Evaluation: Ongoing-How is this plan working? Documentation

Informal & Formal Teaching (cont’d) Documentation of teaching process is essential Document in chart/computer Actual information & skills taught, teaching strategies used, time framework & content for each class, who was taught, teaching outcomes & methods of evaluation, document responses of client & others to teaching activities Provides a legal record that teaching took place Communicates the teaching to other healthcare professionals If not documented: DID NOT OCCUR Evaluation done before client is discharged – how was the teaching- Is more needed?

Discharge Instructions Teaching process completed Review diet-nutrition, medications, self-care, activity, medical appointments Set-up for visiting nurse, therapy, O2, lab work and future needs Verify that all discharge goals are met Verify client and family members understand treatments, procedures & discharge instructions

Health Teaching in the Community Nurses-teaching activities-voluntary or part of nurses’ work role Maybe aimed at large groups Nutrition classes, CPR, cardiac risk factors (BP, Cholesterol), bicycle or swimming safety programs, Flu-Pneumonia Maybe aimed at small groups or individuals Childbirth classes, family planning Program Examples: Community Education Programs American Red Cross Planned Parenthood Hospice

References Fundamentals For Nursing: Review Modules, ATI Nursing Education, 2013 Images retrieved from web site on June 13, 2015 from googleimages.com Timby, B. K. (2013). (10 th ed.). Fundamental Nursing Skills and Concepts. Philadelphia, PA: Lippincott Williams & Wilkins