1. Chapter Three Patient and Family Education Chapter 3-1 Fourth Edition Linda D. Urden Kathleen M. Stacy Mary E. Lough Priorities in C RITICAL C ARE N URSING Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. Slide 2 Objectives  Adapt and apply teaching-learning theory to the critical care setting.  Perform a learning needs assessment.  Construct a teaching plan for patients in the critical care unit.  Discuss four methods of instruction and the appropriateness of each to the critical care setting.  Describe informational needs of families of critically ill patients.

3. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 3 Adult Learning Principles  Adults:  Must be ready to learn.  Need to know why it is important to learn something.  Are responsible for their own decisions.  Obtain recognition of experience they bring to the learning environment.  Motivation for the adult learner arises out of internal pressures—self-esteem and quality of life.

4. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 4 Box 3-1 Steps in the Patient/Family Education Process  Assessment—information gathering  Education plan development  Implementation  Evaluation  Documentation

5. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 5 Assessment  Gathering information for the purpose of identifying actual or potential learning needs  Identifies gaps in knowledge, attitudes, and skills the patient or family has regarding the illness, environment, or lifestyle

6. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 6 Box 3-2 Assessment Questions for the Critically Ill Patient and Family  What brings you to the hospital? Can you tell me more?  What have you been told so far about your (your family member’s) condition and plan of care?  What is the most important thing for you to know right now?  What would you like to know? What information can I give you right now? (Continued) (Continued)

7. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 7 Box 3-2 Assessment Questions for the Critically Ill Patient and Family (Continued)  Who are your main support people?  Has anything like this ever happened to you (your family) before?  Have you (your family) ever been in an intensive care unit or hospital before?  Do you have any special concerns that we need to address right now?

8. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 8 Factors Affecting Ability, Willingness, and Readiness to Learn  Physiologic stressors  Psychologic stressors  Sociocultural stressors  Financial stressors  Environmental stressors

9. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 9 Development of Education Plan  The education plan must be:  Ongoing.  Interactive.  Consistent with the patient’s plan of care and education level.

10. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10 Box 3-3 Essential Critical Care Information for the Patient/Family  Orientation to the various care providers and the services they deliver  Orientation to the unit environment  Orientation to the unit routines and plan of care  Visiting hours, frequency of monitoring and nurse assessments, venipunctures, daily weights, special shift routines (Continued) (Continued)

11. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11 Box 3-3 Essential Critical Care Information for the Patient/Family (Continued)  Explanations regarding reasons for equipment, monitors, and associated alarms  Explanations of all procedures and expected sensations/discomforts both in and off the unit  Medications given  Drug name, reason for receiving, side effects to report to nurse/others  Immediate plan of care (Continued)

12. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12 Box 3-3 Essential Critical Care Information for the Patient/Family (Continued)  Transition to next level of care  Reason for transfer, environment, staffing, availability of care providers  Discharge plan  Medications, diet, activity, pathophysiology of disease, symptom management, special procedures and associated equipment, when to call health care provider, available community resources

13. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13 Assessment Information  Information gathered from the assessment must be analyzed.  Information is used to:  Prioritize education needs.  Formulate a nursing diagnosis.  Develop an education plan of care.

14. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14 Education Plan of Care  Expected outcomes  Objectives  Content to be taught  Interventions  Available education materials  Appropriate teaching strategies

15. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15 Implementation of Education Plan  Patients in critical care are educated in many informal interactions.  View each encounter with the patient/family as a teaching opportunity.  More formal or structured educational experiences may be required.  Nurse needs awareness of barriers to learning as well as factors that can affect the interaction.

16. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16 Teaching Methods  Lecture  Discussion  Demonstration   Written materials  Audiovisual media  Computer-assisted instruction  Internet websites

17. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17 Evaluation  Evaluate as each intervention is completed  Provide feedback to the patient and family  Evaluate response to the teaching- learning interaction  Level of interest  Willingness to learn  Level of participation

18. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18 How to Evaluate  Verbal questioning  Observation and return demonstration  Evaluation method of choice for skills-learning

19. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19 Documentation What has occurred during a session? Interaction Interaction Material taught Material taught Learner response Learner response (Continued) (Continued)

20. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20 Documentation (Continued) Assessment of Learning Process Learning needs Learning needs Abilities Abilities Preferences Preferences Readiness to learn Readiness to learn Potential barriers to learning Potential barriers to learning

21. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21 Documentation Essentials Evaluation of Learning Process Expected outcome/goals Expected outcome/goals Interventions Interventions Objectives Objectives Who was taught Who was taught (Continued) (Continued)

22. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22 Documentation Essentials (Continued) Evaluation of learning process What was taught What was taught Materials used Materials used Patient/family response Patient/family response Follow-up education or materials needed Follow-up education or materials needed

23. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23 Sedated and Unconscious Patients  Special population of critically ill patients with special needs  May not be able to respond or participate  Effectiveness of teaching process cannot be evaluated  Provide information regarding environment, procedures, sensations, and time of day  May decrease environmental stress

24. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24 Informational Needs of Families in Critical Care  Consider the information and emotional support needs of family members  Greatest need is for information  Flexible visiting hours and informational booklets help meet this need

25. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25 Preparation for Transfer  Fear of the unknown  Explanations to relieve anxiety  Transfer destination  Reason for transfer  Nurse who will assume care of the patient  Expected changes in care  Expected self-care  Visiting hours and notification of family