5. Patient Education to Promote Health



Patient Education to Promote Health


Objective



Key Terms


cognitive domain (image) (p. 48)


affective domain (image) (p. 48)


psychomotor domain (image) (p. 48)


imageevolve.elsevier.com/Clayton


An important nursing responsibility is making certain that patients receive correct information about the many aspects of their therapies; thus, patient education is a key component of what nurses do, and understanding the principles of how people learn is critical. Nurses need to instruct patients with the use of correct information that is specific to the individual, and they also must determine if the information is understood. The three domains of learning that all adults use when acquiring new knowledge are the cognitive domain, the affective domain, and the psychomotor domain (Figure 5-1).



Three Domains of Learning


Cognitive Domain


The cognitive domain is the level at which basic knowledge is learned and stored. It is the thinking portion of the learning process, and it incorporates a person’s previous experiences and perceptions. Previous experiences with health and wellness influence the learning of new materials. Prior knowledge and experience are the foundation of the addition of new concepts. Thus, the learning process begins by identifying what experiences the person has had with the subject.


However, thinking involves more than the delivery of new information or concepts. A person must build relationships between prior experiences and new concepts to formulate new meanings. At a higher level of the thinking process, the new information is used to question something that is uncertain, to recognize when to seek additional information, and to make decisions during real-life situations.


Affective Domain


Affective behavior is conduct that expresses feelings, needs, beliefs, values, and opinions. The affective domain is the most intangible portion of the learning process. It is well known that individuals view events from different perspectives. People often choose to internalize feelings rather than to express them. The nurse must be willing to approach patients in a nonjudgmental fashion, to listen to their concerns, to recognize the nonverbal messages being given, and to assess patient needs with an open mind.



image Clinical Goldmine


The development of a sense of trust and confidence in health care providers can have a powerful effect on the attitude of the patient and his or her family members. This can influence the learner’s response to the new information that is being taught. The nurse should be positive and accepting, and he or she should involve the learner in a discussion to draw out his or her views regarding solutions to problems.


Psychomotor Domain


The psychomotor domain involves the learning of a new procedure or skill. It is often referred to as the doing domain. Teaching is usually done by demonstration of the procedure or task with the use of a step-by-step approach, with reciprocal demonstrations performed by the learner to validate the degree of mastery obtained.


Principles of Teaching and Learning


Objectives



Key Terms



During the past two decades, health teaching has evolved from an abstract form of intervention that occurred only if a specific need existed at discharge—and if the health care provider approved of providing the information to the patient—to its current formalized development of learning objectives that direct patients toward achieving goals on the basis of their needs (Box 5-1). Today, health teaching is an important nursing responsibility that carries legal implications if there is a failure to provide and document education. Providing information to patients so that they can understand and manage health-care–related situations is now considered a basic patient right, and it has been mandated by The Joint Commission since 1996.



Focus the Learning


The patient must be allowed to focus on the material or task to be learned. The environment must be conducive to learning (i.e., quiet, well lit, and equipped for a teaching session). The learner requires repetition of new information so that he or she may master it. Nurses may feel obligated to teach the patient or family members everything that they know about a disease or procedure, thereby overwhelming them with information. Instead, nurses must first glean what information is essential, and they then need to consider what the patient wants to know.


Begin with the patient’s questions and proceed from there; otherwise, the individual may not be focused on the presentation. By beginning with the patient’s needs, nurses give the patient some control over the learning and increase active participation in the process, which enhances learning.


Consider Learning Styles


Learning styles vary. Some people can read and readily comprehend directions, whereas others need to see, feel, hear, touch, and think to master a task. To be effective, the nurse must fit the teaching techniques to the learner’s style. Therefore, a variety of materials should be made available for health education. The nurse can select the instructional approach to be used from written materials such as pamphlets, video recordings, motion pictures, models, photographs, charts, and computers. A variety of these materials will supply an audiovisual component that may be essential to the patient’s learning style.


Organize Teaching Sessions and Materials


In most clinical settings, patient education materials are developed by the staff and then reviewed by a committee for adoption. Specific objectives should be formulated for patient education sessions. The objectives should state the purpose of the activities and the expected outcomes. Objectives may be developed in conjunction with a nursing diagnosis statement (e.g., Imbalanced nutrition: Less than body requirements), or they can be developed for common conditions that require care delivery (e.g., care of the patient who is receiving chemotherapy). Regardless of the format used, these instructional materials have established content that is given in outline form, and they are arranged so that one nurse can initiate the teaching and document the degree of understanding, and then another nurse can continue the teaching during a different shift or on a different day. The first nurse should check off what has been accomplished so that the next nurse knows where to resume the lesson.


At the start of each subsequent teaching session, it is important to review what has been covered previously and to affirm the retention of information from the previous lessons. Organizing materials this way standardizes the content, allows for more than one nurse to teach the same patient, allows for the material to be covered in increments that the patient can handle, and makes documentation easier. This information is then readily available for review before the patient is discharged, and it can support the necessity for additional home care when a patient has not mastered self-care needs.


When psychomotor skills are being taught, reciprocal demonstrations are particularly useful to ensure mastery. It helps to allow the learner to practice a task several times. Giving the person immediate feedback about the skills that he or she has mastered and then giving him or her time to practice the skills that are more difficult allow the learner to improve with regard to manual dexterity and mastering the sequencing of the procedure. If appropriate, equipment may be left with the learner for practice before the next session.


Sometimes it is particularly useful to set up a video of skill demonstrations for the patient to view alone at a convenient time. At the next meeting, the video can be reviewed together with the nurse, and important points can be discussed and clarified if the patient expresses confusion or uncertainty. This technique reinforces what has been said, reviews what has been learned, and provides the learner with repetition, which is necessary for learning.


Motivate the Individual to Learn


Before initiating a teaching plan, the nurse should be certain that the patient can focus and concentrate on the tasks and materials to be learned. The patient’s basic needs (e.g., food, oxygen, pain relief) must be met before he or she can focus on learning. The nurse must recognize the individual’s health beliefs when trying to motivate the learner. Because health teaching requires the integration of the patient’s beliefs, attitudes, values, opinions, and needs, an individualized teaching plan must be developed or a standardized teaching plan must be adapted to the individual’s beliefs and needs (Box 5-2).



Box 5-2


Sample Teaching Plan for a Patient With Diabetes Mellitus Taking One Type of Insulin*


Understanding of Health Condition



Food and Fluids



Monitoring Tests



Medications and Treatments



• Teach the name, dosage, route of administration, desired action, and storage and refilling procedures for the type of insulin prescribed.


• Explain the principles of insulin action, onset, peak, and duration (see Chapter 36).


• Demonstrate how to prepare and administer the prescribed dose of insulin.


• Teach site location and self-administration of insulin.


• Give specific instructions that address the reading of the syringe to be used at home.


• Teach the patient how to obtain supplies (e.g., disposable syringes, needles, glucometer, glucose monitoring strips, insulin pen).


• Discuss the usual timing of reactions, the signs and symptoms of hypoglycemia or hyperglycemia, and the management of each complication.


• Validate the patient’s understanding of side effects to expect and of those that require reporting.


• Teach and validate family members’ and significant others’ understanding of the signs and symptoms of hypoglycemia and hyperglycemia as well as the management of each complication.


• Teach a general approach to the management of illnesses (e.g., the actions required if nausea and vomiting or fever occur; stress glucose monitoring before meals and at bedtime; discuss the situations when there is a need to call a health care provider).


Personal Hygiene



Activities



Home or Follow-Up Care


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Jul 11, 2016 | Posted by in NURSING | Comments Off on 5. Patient Education to Promote Health
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