1. Chapter 25 Client Education
Client education is an important role that student nurses undertake. Nurses contend with multiple factors that affect clients, including shorter lengths of stay and increased demand on the nurse’s time. At times these two factors can compromise your ability to provide quality client education. Creating a well-designed, comprehensive teaching plan that fits your client’s unique learning needs can reduce health care costs, improve quality of care, and keep clients better informed about their individualized treatment plan.

2. Standards for Client Education
The Joint Commission (TJC) sets standards for client and family education.
Successful accomplishment of standards requires collaboration among health care professionals.
The Joint Commission set mandating that nurses and the health team assess the client’s learning needs and provide education. Documentation is a must to ensure compliance and positive client outcomes.

3. Standards for Client Education: TJC
Patient/family receive education specific to patient’s assessed needs, abilities and readiness to learn
Patient education is interactive
Any discharge instructions given to the patient/family are provided to the organization responsible for patient’s continuing care
The organization plans and supports the provision and coordination of patient/family activities and resources

4. TJC Focus Adherence to standards
Evidence of priorities, individualized care
Evidence of patient/family response
Information is understandable, usable to patient
Non-English speaking patients, patients with low literacy skills and patients, with sight, hearing, and processing difficulties
90-100% of all hospitalized patients taught
AEB patient education outcomes documented in pt chart
Continuity of care

5. TJC Hot Buttons Teaching about potential food/drug interactions
Culturally relevant strategies and resources
Age appropriate teaching
Assessment of readiness to learn
Teaching about personal hygiene for patients who can no longer follow normal routine
Teaching about home medications

6. TJC Hot Buttons
Diet teaching for pts who are on a new or modified diet
Proof of teaching through documentation
Policy of how teaching is to be accomplished across the continuum of care

7. Purpose of Client Education
To help individuals, families, or communities achieve optimal levels of health
Client education includes:
Maintenance and promotion of health and illness prevention
Restoration of health
Coping with impaired functioning
Box 25-1 presents topics for health education.
Ask students if they can give examples of each category.
Maintenance and promotion of health and illness prevention: first aid, smoking/alcohol/substance abuse, stress management, nutrition, exercise, health screenings
Restoration of health: anatomy and physiology of body system, medications, nutrition, diagnostic examinations, surgery
Coping with impaired functions: home care, self-care, physical therapy, occupational therapy, speech therapy, prevention of complications, and environmental alterations

8. Teaching and Learning Teaching Learning Objective
An interactive process that promotes learning
Learning
The purposeful acquisition of knowledge, skills, behaviors, and attitudes
Objective
Statement of what learners should be able to do after successfully completing a given course of instruction; there should be a measurable change in behavior..
It is impossible to separate teaching from learning.
As previously discussed in Chapter 24, interpersonal communication is essential for successful teaching to occur.

9. Role of the RN in Teaching and Learning
Patient education has become a professional expectation and a legal duty of nurses
The RN initiates client teaching
LPN can reinforce but can’t initiate
Teach information the client and family needs to make informed decisions regarding their care
Determine what clients need to know
Identify when clients are ready to learn
Evaluate learning
Nurses have an ethical responsibility to teach clients. The Patient Care Partnership of the American Hospital Association indicates that clients have to right to make informed decisions regarding their care. The information given to clients must be accurate, complete, and relevant. Good communication, as discussed in Chapter 24, is of paramount importance.

10. Domains of Learning Cognitive
Includes all intellectual behaviors and requires thinking
Affective
Deals with expression of feelings and acceptance of attitudes, opinions, or values
Psychomotor
Involves acquiring skills that require integration of mental and muscular activity
Learning occurs in three domains. The cognitive domain is the knowledge the patient needs to acquire. It includes acquisition of knowledge, comprehension or ability to understand, application, analysis, relating ideas in an abstract manner, synthesis, recognizing parts of a whole, and evaluation.
The affective domain is often difficult to identity. However, it impacts the positive or negative success of the education process.
The psychomotor domain deals with skills. For a psychomotor skill to be acquired, the client needs to have the knowledge, physical ability, and attitude to learn the skills.

11. Basic Learning Principles
Motivation to learn
Addresses the client’s desire or willingness to learn
Ability to learn
Depends on physical and cognitive abilities, developmental level, physical wellness, thought processes
Learning environment
Allows a person to attend to instruction
A client’s learning style will affect their preferences for learning. People process information by seeing and hearing, reflecting and acting, reasoning logically and intuitively, and analyzing and visualizing.
Motivation to learn is determined by the clients’ attitudinal set, their readiness to learn, and their willingness to participate actively.
Ability to learn depends on the client’s developmental level. Children will learn differently than adults. The ability to learn also depends on the client's level of physical development and overall physical health.
The physical environment either makes learning difficulty or a pleasure. The ideal environment must be well lit, have good ventilation, appropriate furniture, and a proper temperature.
Group teaching differs from one-on one-teaching.

12. Integrating the Nursing and Teaching Process
A relationship exists.
The nursing and teaching process are not the same.
The nursing process requires assessment of all data.
The teaching process focuses on the client’s learning needs and ability to learn.
Box 25-3 compares the nursing and teaching process.
In the teaching process during assessment you will analyze the client's needs, motivation, and ability to learn. The diagnostic statement specifies the information or skills the client requires. Next, identify specific learning objectives and implement the teaching plan. Finally, evaluate the learning based on learning objectives.

13. Assessment
Nurses need to assess all factors that influence content, ability to learn, and resources available:
Expectation of learning
Learning needs
Motivation to learn
Ability to learn
Teaching environment
Resources for learning
Health literacy and learning disability
Box 25-5 presents nursing assessment questions that can help you obtain the information you seek.

14. Nursing Diagnosis
Select the nursing diagnosis that reflects the client’s learning needs after the assessment is completed.
Clarifying the diagnosis by domain helps the nurse focus on the subject matter and teaching methods.
Nursing Diagnosis: Deficient Knowledge
Use the NANDA diagnosis.
Decide if the topic falls under the cognitive, affective, or psychomotor domains.

15. Planning
Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a client:
Set priorities
Include client
Select timing to teach
When is pt most attentive?
Organize the teaching material
Order of information
The more specific the plan, the easier it is for nurses to follow.

16. Implementation Maintain learning attention and participation
Active participation
Build on existing knowledge
Pt will be bored if information already know is covered
Select teaching approach
Telling-teaching vital limited information; no opportunity for feedback
Participating-client helps decide content; nurse guides and advises pertinent information
Entrusting – provides client opportunity to perform self-care; return demonstration
Reinforcing – before or after desired learning behavior
Incorporate teaching with nursing care
Implementation depends on the nurse’s ability to critically analyze assessment data when identifying learning needs and developing the teaching plan. Remember, every interaction with your client provides an opportunity to teach.
Proper communication skills will help you implement the teaching plan.
Teaching approaches include: telling, participating, entrusting, reinforcement.
Instructional methods include: group instruction, one-on-one discussion, preparatory instruction, demonstration, analogy, role playing and simulation.
Box 25-9 presents tips on how to deal with the elderly

17. Implementation Select appropriate instructional methods
One on one instruction – at bedside, MD office, home; nurse directly shares information
Group instruction – both lecture and discussion
Preparatory instruction – before tests or procedures to be performed; describe physical sensations of procedure, cause of sensation, normal and not normal
Demonstration and return demonstration
Analogies – nurse translates complex language or ideas into words or concepts client understands
Role play – rehearsing a desired behavior
Simulation – teaching clients problem solving, application and independent thinking

18. Implementation Illiteracy and other disabilities Cultural diversity
Watch medical jargon, keep teaching sessions short, provide teaching material at appropriate educational level (p. 379, box 25-8)
Cultural diversity
Language barriers- provide educational materials in appropriate language; translators
Using different teaching tools
Printed materials: programmed instruction, computerized instruction
Nonprint materials - diagrams, graphs, charts, pictures, physical objects
Audiovisual materials

19. Implementation Special needs of children and older adults Older adult
Visual and hearing changes: offer larger print materials
Reduced short term memory: introduce new information only when one set of information has been learned
Children
If at all possible include family members
Use of medical equipment – lets children become comfortable with the equipment

20. Evaluation
Necessary to determine whether the client has learned the material
Helps to reinforce correct behavior and change an incorrect behavior
Success depends on the client’s performance of expected outcomes
Evaluation is the final step of the teaching plan. At this point, you will discontinue, adjust, or amend the plan.
Documentation is of paramount importance to meet the Joint Commission standards. Additionally, third-party reimbursement may be determined by documentation.