Patient Teaching Chapter 8 Do you know everything you need to know about nursing right now? Do you think your patients just know all they need to know about their diagnosis and treatment regimen?

Objectives Identify when patient education begins Describe why it is important to assess the learner prior to educating Identify the three domains of learning styles Discuss age related categories of learners Correctly identify what affects your patients capacity to learn Correctly state the difference between formal and informal teaching

When do you think patient education begins? Patient teaching begins immediately at time of admission – required by law and must be documented! Any time a new procedure, diagnosis, medication, diet, rehab program, plan for medical follow up, signs and symptoms and actions to take, community resources, self care directions.

Why is it important to provide patient education to a newly diagnosed CHF patient? Do all patient understand their diagnosis? Do all patient understand what the doctor tells them in regards to their diet and activity? Do patients want to take 10 different medications a day?

Assessing the Learner In order for the teaching subject to stick with the patient – the nurse needs to assess the following about the patient before education can begin: Preferred learning style Age and developmental style Capacity to learn Motivation Learning readiness Learning needs

Preferred Learning Styles Defined as: the manner in which someone learns new information. How you learn. Three styles are: cognitive domain, affective domain, psychomotor domain

Cognitive Domain Learn new information by reading or listening to facts and description. Some patients will prefer that you give them booklets or pamphlets to learn new information, or they may want you to read the information to them

Cognitive domain Areas which are often taught in the cognitive domain: Diet Medications Sign and symptoms When to call the doctor Listen, identify, locate, label, select

Affective Domain Patient learns something because it is important to them because of their own personal beliefs, values or culture. Jehovah Witness patient wants to learn how to give self injections of Procrit in order to avoid anemia and need for blood transfusion. Advocate, support, promote, refuse

Psychomotor Domain Patient learns by doing – Hands On Example in the hospital would be any technical procedure that you need to teach the patient before discharge: Self injections Changing/emptying colostomy bag Care and draining of JP drain Dressing changes

Teaching in the hospital When we teach in the hospital how many domains should you address for better retention and application? Learners retain: 10% of what you read 20% of what you hear 30% of what you see 50% of what you see and hear 70% of what they teach and talk 90% of what you talk and do

AGE AND DEVELOPMENT LEVEL You can not teach a 5 year old in the same way that you learn new information. There are age related differences in how people learn You must take into account these differences when you teach

Pediatric: Pedagogic learners How children or people with similar cognitive ability learn new information or skills. People with mental impairments may be at one chronological age physically – but at a very different level for learning purposes.

Pediatric learners are: Passive Motivated to learn from punishment or rewards Short term attention span and retention Can only learn about the subject on hand Task oriented If they cant see it – it does not exist

Adult learners: Androgocic learners How you teach adult learners new information. Consider: Technology Want to know the why behind things Want feedback and answers Like a variety of instructional methods INFORMATION SHOULD BE RELEVANT!

Adult learners: Physically mature Often learn new information based on past experience Voluntary learners Active Self directed and independent Problem centered Longer attention span Long term retention Goal oriented Think abstractly

Older adult learners: Gerogogic learners How we teach information to older adults – often there are considerations which we must take into account before this patient is able to learn Any sensory deficits Motivation Any dementia present?

Older adult learners: Undergoing degenerative changes Vast experience Crisis learners Passive/active Need structure and encouragement Motivated by personal needs Self centered learning Attention affected by low energy, fatigue Short term retention unless reinforced Often needs family support

CAPACITY TO LEARN In order for your teaching interventions to be affective, the patient must have the capacity to learn in the manner that you are presenting the material!

Things that affect capacity to learn: Literacy level: Literacy is the ability to read and write Approximately 21% of Americans are illiterate (unable to read/write) Another 27% are functionally illiterate (very minimal skills in reading and math)

Nursing responsibility: Ask: How do you learn best? To teach these patients you may want to use the following interventions: Use verbal and visual methods for instruction Repeat instructions several times in the same order – allows patient to memorize Provide pictures, diagrams, or audiotapes for the patient to review if reinforcement is needed.

Same 88 year old deaf/illiterate patient Use your knowledge of sodium and water from nutrition class and explain how you would teach this patient how these two factors contribute to his shortness of breath.

Things that affect capacity to learn: Sensory deficits are related to a persons ability to see and hear. Many of your elderly patients experience age related deficits in these areas.

Nursing responsibility: Make sure patient is wearing glasses if they are needed Speak in normal tone of voice Teach in a well lighted area Provide magnifying glass Printed material should be in large print Rephrase instead of restate if the patient does not understand

Things that affect capacity to learn: Cultural differences – language is required to teach. Just because the patient does not understand the language does not mean that you do not have to provide instructions.

Things that affect capacity to learn: Attention and Concentration: Teach when the patient is most awake and alert. Keep sessions short Show enthusiasm Involve the patient

MOTIVATION People learn best if they have a reason to learn. Subject needs to be relevant. Hopefully your patients are motivated to learn because they desire to regain/maintain optimal state of health

LEARNING READINESS Refers to the patients physical and psychological well being. If your patient is struggling to breath, is he ready for you to teach him about fluid and salt restrictions? Using your knowledge of basic physiological needs, what is your number one nursing priority at this point? Patient needs to be comfortable in order for them to pay attention to you and the subject that you are teaching.

LEARNING NEEDS Patient teaching needs to be customized to the patient. What do you understand about your diagnosis? Do you understand what the doctor has told you? Do you understand the restrictions and what you are allowed to do? (diet, activity, medications) How can we help you at this time? Do you have any questions that I can help to answer at this time?

How We Teach the Patient: Informal teaching – happens at the spur of the moment, is not planned. Example: teaching about medications when you are completing the medication pass on that patient. Even if it is informal – you still want to DOCUMENT IT!

How We Teach the Patient Formal teaching is planned and certain goals and outcomes are outlined and documented. Example: Glucose testing and injection of insulin. Colostomy care

What nursing diagnosis will you be using frequently on your care plans as it relates to patient education? KNOWLEDGE DEFICIT RELATED TO: What relationship exists between patient compliance to a prescribed medical regimen and overall patient outcome? How would you evaluate the effectiveness of your patient teaching?