Importance of Quality Patient Education due to:
1. Shorter hospital stays 2. increase # of ill patients 3. increase demand on nurses' time 4. need to give acute pts meaningful information
Well-designed, comprehensive teaching plans fit pt's unique learning needs to:
1. reduce health care costs 2.

improve quality of care 3. change behaviors to improve pt outcomes

Purpose of Patient Education
1. Maintainence & Promotion of Health and Illness Program 2. Restoration of Health (get back to baseline) 3. Coping with Impaired Functions
Maintenance & Promotions of Health & Illness
1.

Nurses resources in school,clinic, workplace who provide info that enable pts to assume healthier behaviors. 2. When pts become more halth conscious they seek early diagnoses of health problems.

Restoration of Health
1. Ill pt need inormation & skills to help them regain their levels of health. 2.

Nurse learn to identify pt's willigness & motivation to learn. 3. Include famlily but don't expect the to do it.

Coping wih impaired Functions
1.

Many learn to cope with permanent health alterations. 2. New knowlede & skills taught for ADLs 3. Comparing desired with actual state enables you to plan effective teaching programs.

Teaching
is an interactive process that promotes learning.
Learning
purposeful acquisition of new knowledge, attitudes, behaviors and skills.

Role of Nursing in Teaching & Learning
Nurses have an ethical responsibility to teach their patients. Teach information that pts and family need.
Teaching As Communication Process
Need effective interpersonal communication. Teacher & learner become involved and increase learner's knowledge & skills.
Steps of Teaching Process
1.

identify a need - use pt request or perceive need based on diagnosis 2. identify specific learning objective - what pt will ne able to do after instruction 3. nurse sender who conveys the message 4. pt is the receiver/learner 5. feedback & evaluation - mechansim to eval success, with positive reinforcement

Domains of Learning
1. Cognitive 2.

Affective Learning 3. Psychomotor Utilize 1 or all 3

Cognitive Learning
includes all intellectual behaviors, requires thinking: *knowledge (easiest) *comprehension *application *analysis *synthesis - break down create something new *evaluation - (hardest)
Affective Learning
hardest of all 3. Deals with expression of feelings and acceptance of attitutudes, opinions, or values: *receiving (simplest) *responding *valuing *organizing *characterizing (most complex)
Psychomotor Learning
involves acquiring skills that require integration of mental and muscular activity: *perception (simplest) *set *guided response *mechanism *complex *adaptation *origination (most complex)
How People Learn:
*motivation - influences your teaching approach *motivation influenced by previous knowledge, experience, attitudes & sociocultural factors *physical and cognitive attributes *developmental level *physical wellness *intellectual thought process *learning style affets preferences for learning
Motivation to Learn Based On:
*Attention Set *Motivation *Use of Theoy to Enhance Motivation & Learning *Active Participation *Self efficacy
Attention Set
*Physical discomfort, anxiety & environmental distractions influence the ability to attend. *Mild level of anxiety motivates learning *High level prevents learning *Manage pt's anxiety before educating to improve comprehension
Motivation
force that acts within person to cause the person to behave in a particular way: 1. social motive - need to connect, approval or self-esteem 2.

task mastery motive - based on achievement and competence 3. physical motive - return to level of normalcy *none have an effect unless the person believes health is important

Self-Efficacy
concept included in social learning theory which refers to person's ability to sucessfully complete a task.
Social Learning Theory
states people continuosuly attempt to control events that affect their lives
Use of Theory to Enhance Motivation
use various interventions based on theory when developing pt education plans, attitudes and vales not easy to change by simply teaching facts
Psychosocial Adaptation to Illness
Pt needs to grieve. Readiness to learn related to stage of grieving.

When pt enters stage of acceptance, stage compatible with learning introduce teaching plan.

Emotional response to Illness
1. Denial - pt avoids discussion, provide support & careful explanations of all procedures 2. Anger - pt blames & complains, dont argue, listen, teach in present tense 3. Anxiety 4.

Depression 5. Acceptance - pt recognizes reality of condition, activly persues info, focus teaching on future skills & knowledge

Active Participation
learning occurs when pt is actively involved in educational sessions. For example after parking lot demo, pt able to determine which type of car seat fits their car and easist to use.
Ability to Learn
1. Development Capability - know pt's level of knowledge and intellectual skills before beginning teaching plan. 2.

Learning in Children - be creative, use aids that are developmentally appropiate 3. Adult Learning - responsible for changing their own behavior. Assess what pt knows & teach what pt wants to know, set mutual goals. 4.

Physical Capability - do not overestimate pt's development or status.

Learning Environment
Room well lit, good ventilation, appropiate furniture, and comfortable temperature, quiet setting with infrequent interruptions. Group teaching - room small enough so everyone can see each other's verbal and nonverbal responses.
Assessment Teaching Process
gather data abt pt's learning needs, motivation, ability to learn, teaching resources frm pt & fam, learning environment, medical record, nursing history and literature.
Diagnosis Teaching Process
id pt's learning needs on basis of 3 domains of learning
Planning Teaching Process
establish learning objectives stated in behavioral terms. Id priorities re:learning needs.

Collaborate w/pt. id teaching method to use.

Implementation Teaching Process
involve pt in learning activities, include family caregiver
Evaluation Teaching Process
determine outcomes of teaching-learning process. Measure pt's acheivement. reinforce info as needed
Health Literacy
cognitive and social skill that determine motivation & ability to use information to promote good health.

Includes pt's reading, math, comprehension, ability to make health-related decisions & consumer of health

Risk for Low Health Literacy
elderly minority immigrant low income chronic mental/physical health conditions
Functional Illiteracy
inability to read above 5th grade level
Races for Low Health Literacy
Hispanic - lowest African/Native American/Alaska Native White and Asian Pacific Islander - highest
Lower Health Literacy Scores
older adults men no English before entering school below poverty level no h.s. education
A patient needs to learn to use a walker. Which domain is required for learning this skill? A) Affective domain B) Cognitive domain C) Attentional domain D) Psychomotor domain
Psychomotor domain
The nurse is planning to teach a patient about the importance of exercise.

When is the best time for teaching to occur? (Select all that apply.) A) When there are visitors in the room B) When the patient's pain medications are working C) Just before lunch, when the patient is most awake and alert D) When the patient is talking about current stressors in his or her life

When the patient's pain medications are working Just before lunch, when the patient is most awake and alert
A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A) Teach the patient's spouse B) Focus on knowledge the patient will need in a few weeks C) Provide only the information that the patient needs to go home D) Convince the patient that learning about her health is necessary
Provide only the information that the patient needs to go home
The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A) Provide information using a lecture B) Use simple words to promote understanding C) Develop topics for discussion that require problem solving D) Complete an extensive literature search focusing on eating disorders
Develop topics for discussion that require problem solving
A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A) The patient will verbalize the steps involved in breast self-examination within 1 week.

B) The nurse will explain the importance of performing breast self-examination once a month. C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. D) The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

The patient will perform breast self-examination correctly on herself before the end of the teaching session.
A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? A) Telling approach B) Selling approach C) Entrusting approach D) Participating approach
Telling approach
The nurse is teaching a parenting class to a group of pregnant adolescents.

The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A) Role play B) Discovery C) An analogy D) A demonstration

Role play
An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A) Speaks loudly. B) Presents the information once. C) Expects the patient to understand the information quickly. D) Allows the patient time to express himself or herself and ask questions.

Allows the patient time to express himself or herself and ask questions.
A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A) Describing difficulties a family member has had in taking insulin B) Expressing the importance of learning the skill correctly C) Being able to see and understand the markings on the syringe D) Having the dexterity needed to prepare and inject the medication
Expressing the importance of learning the skill correctly
A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections.

Which teaching method does the nurse use? A) Simulation B) Demonstration C) Group instruction D) One-on-one discussion

Demonstration
When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A) Telling B) Analogy C) Demonstration D) Simulation
Analogy
A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A) How to use an inhaler during an asthma attack B) The need to avoid people who smoke to prevent asthma attacks C) Where to purchase a medical alert bracelet that says she has asthma D) The importance of maintaining a healthy diet and exercising regularly
How to use an inhaler during an asthma attack
A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A) Simulation B) Restoring health C) Coping with impaired function D) Health promotion and illness prevention
Health promotion and illness prevention
A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A) A teaching plan.

B) A learning objective. C) Reinforcement of content. D) Enhancing the children's self-efficacy.

A learning objective.
A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A) Cognitive B) Affective C) Adaptation D) Psychomotor
Cognitive
Patient Education (Potter Perry/PPT)
.

..

Patient Education (promotes ___) (reduces ___)
Promotes optimal levels of health Preventative education helps reduce health care costs and hardships
3 Types of Patient Education
Maintenance and Promotion of Health and Illness Prevention Restoration of Health Coping with Impaired Functions
Nurse must establish ___ before teaching
Report with patient/learner
3 Types of Learning *Domains*
Cognitive Affective Psychomotor
Cognitive (1/3 Domains of Leaning) (type of learning)
Intellectual *understanding* of knowledge
Affective (2/3 Domains of Leaning) (type of learning)
Expression of *attitudes* and acceptance of attitudes, opinions, or values (ex. value clarification)
Psychomotor (3/3 Domains of Leaning) (focuses on) (to ensure effective learning..

)

Focuses on acquiring *skills* that require integration of mental and muscular activity (ex. using a fork) Request *return demonstration* to validate effective learning
3 Types of Basic Learning *Principles*
Motivation to Learn Ability to learn Learning Environment
Motivation to Learn (1/3 of Basic Learning Principles) (motivation is..) (requires these three things.

.)

Patient's desire or willingness to learn 1. Attentional Set 2. Motivation 3.

*Self-Efficacy*

Attentional Set (1/3 of Motivation to Learn) (attentional set refers to..) (___, ___, and ___ can limit attention set)
Mental state of *paying attention* Discomfort, *anxiety* (can motivate learning in small doses), environmental distractions
Motivation (2/3 of Motivation to Learn) (motivation is..

) (3 types of motivaiton and examples)

The force that acts on or within a person 1. Social (seek approval from role models) 2. Task-Mastery (senior learns diabetes testing to gain independence) 3. Physical (patient with leg amputation wants to learn how to walk again)
Self-Efficacy (3/3 of Motivation to Learn) (means to..

) (4 sources and examples of self-efficacy are..)

Believe in yourself 1. Enactive *Mastery Experiences* (pt completes skill) 2. Vicarious *(Demonstrative) Experiences* (demonstration) 3. *Verbal Persuasion* (express belief in pt's ability) 4.

*Physiological State* (positive effects from skill promote repeated use)

Ability to Learn (2/3 of Basic Learning Principles) (some conditions may ___)
Some conditions may fatigue a patient and require the teaching to be postponed
Factors that affect Ability to Learn include.. (6 types [1 big one])
1. Physical Strength 2. Sensory Deficit 3. Reading Level 4.

Developmental Level 5. Cognitive Function 6. Pain, Fatigue, *Anxiety*

Learning Environment (3/3 of Basic Learning Principles) (importance) *(6 requirements)* (when using groups...

)

Allows a person to focus on the learning task *Lighting, Ventilation, Furniture, Temperature, Noise, Privacy* Position groups so everyone is facing each other
Nursing Process and Teaching Process (relation)
Nursing Process and Teaching Process are *NOT* the same
Nursing Process focuses on..
Focuses on the patient's total health care needs
Teaching Process focuses on..

Focuses on the patient's learning needs and ability to learn
Nursing Process: Assessment (identify ___) (example)
Ask questions to *identify motivation to learn* (mobilization aid is motivating to move and regain a sense of freedom)
Assess *Health Literacy* (definition) (identify ___) (high-risk demographic)X5
Cognitive and social skills that determine motivation and ability of individuals to access, understand, and use information Identify and accommodate to patient's learning style Elderly, minorities, immigrants, low-income, and people with chronic mental and/or physical health conditions
Appropriate Time to Implement Teaching is when..
During a similar activity (ex. teach proper skin care techniques when performing skin care)
The Ideal Teaching Duration is..
10-15 minutes
Reinforcement can be.

.. (3 types and examples of reinforcement..

)

*Positive* or Negative 1. Social (ex. smiles, compliments, words of encouragement) 2. Material: works well with children (ex.

food, toys, music) 3. Activity (ex. acquiring more *freedom*)

In order for therapy to have an effect the patient must.. (example)
No therapy has an effect unless a person believes that health is important (ex. patient with lung disease who continues to smoke)