1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 04: Patient and Family Education in Critical Care

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Learning That Are Unique to the Critical Care Setting Critical Illness and Stress Prolonged Illness and Stress Environmental Stress Cultural and Language Barriers Sensory Barriers

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Aspects of a Cultural Assessment

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Guide to Using an Interpreter See Box 4-2.

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study A 84-year-old man was admitted to the ICU with a diagnosis of aortic aneurysm and had an abdominal aneurysm repair. The client and his wife live in France and are visiting his family here. The client can speak some English. Identify the potential learning barriers. What are ways to overcome the potential learning barriers?

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Study 2 A 34-year-old woman is admitted to the ICU after giving birth. She is diagnosed with HELLP syndrome and has hemolytic anemia, elevated liver enzymes, and low platelet count. She complains of malaise, severe headache, blurred vision, and anxiety. Her husband asks the same questions over and over and makes frequent calls to the unit. Identify the potential learning barriers for the client/family. What are ways to overcome the potential learning barriers?

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching Methods Based on the Three Domains of Learning See Figure 4-1.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A client who had a radical neck dissection refuses to look at or care for the laryngectomy tube. Which of the following learning domains should you first address when teaching this patient? A.Cognitive domain B.Psychomotor domain C.Affective domain D.Wait until the client tells you he is ready.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Affective domain Rationale: Addressing the affective domain first helps the patient to explore his feelings toward the change in body image. The patient needs to adapt his feelings to the physical change before he can receive cognitive and psychomotor training on how to care for the laryngectomy tube. Time constraints and cost effectiveness dictate that the nurse must provide timely patient education, and the client must know how to perform needed self-care before discharge.

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When teaching a client how to perform self-injections of insulin, the best teaching strategy for the nurse to use is to have the client: A.join a discussion group on the steps involving in giving an injection of insulin B.listen to a lecture C.watch a demonstration and return a demonstration D.participate in interactive computer instruction

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Watch a demonstration and return a demonstration. Rationale: The nurse is teaching the client from the psychomotor domain, and the best method of teaching is having the client watch a demonstration on how to give an insulin injection and having the client return the demonstration by giving himself an insulin injection. Lecture and a discussion group would only provide the steps of giving an insulin injection. The interactive computer instruction may also help the client to master the steps.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Six Principles of Adult Learning The need to know The learner’s self-concept The learner’s life experiences Readiness to learn Orientation to learning Motivation to learn

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Guidelines for Appropriate Patient Education Materials for the Older Patient

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Joint Commission Educational Assessment Guidelines

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Details of Teaching Record Documentation

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Sample Patient Education Record See Figure 4-2.

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about written patient education materials is correct? A.Written materials should be written in a passive voice. B.Written materials should be written at a ninth-grade level. C.Written materials should always be reviewed with the patient/family by the nurse. D.Ten percent of U.S. residents are functionally illiterate and cannot use written materials.

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Written materials should always be reviewed with the patient/family by the nurse. Rationale: Written materials should always be reviewed with the patient and family by the nurse because the patient/family may be embarrassed that they can’t read and will not tell the nurse. Written materials should be written in an active voice and at a fifth- to eighth-grade reading level.