1. Patient Education and Health Promotion
Chapter 9
Patient Education and Health Promotion
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2. Lesson 9.1 Patient Education and Factors Affecting Teaching/Learning
Theory
Discuss the purposes of patient education.
Use patient teaching to promote the national goals of health promotion and disease prevention as listed in Healthy People 2020 and the Canada Health Act.
Describe three ways in which people learn and correlate the importance of these types of learning to teaching.
List and differentiate between conditions and factors that can affect learning.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

3. Lesson 9.1 Title Theory Describe barriers to teaching and learning.
Identify adjustments to the teaching plan needed for teaching the very young patient or the older patient.
Discuss types of resources available to assist in patient teaching.
Name three things that must be included in the documentation of patient teaching.
Describe ways in which teaching can be continued following hospital discharge.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4. Lesson 9.1 Title Clinical Practice
Assess an assigned patient’s learning needs.
Develop a teaching plan based on the patient’s learning needs.
Implement the teaching plan at a prearranged time.
Evaluate the effectiveness of the teaching and the plan.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

5. Purposes of Patient Teaching
Preventing illness or promoting wellness
Nurses teach patients about their:
Disease or disorder
Diet and medications
Treatment and self-care
Prior to discharge, the patient must be taught how to care for himself at home
Patient teaching begins at time of admission
With hospital stays being so short, patient education has become an even higher priority.
A teaching moment occurs when the patient is at an optimal level of readiness to learn and apply a particular piece of information.
Take cues from the patient’s questions or try to stimulate interest in what he needs to know.
What issues or problems could be prevented by effective patient teaching? Medication errors, activity restrictions not followed, etc.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6. Purposes of Patient Teaching (cont’d)
Assessment of learning needs
Prepare a plan, assess learning needs
Factors affecting learning
Cultural values, confidence and abilities, readiness to learn
Form a teaching plan
Collaborate with other health professionals
If you can determine a patient’s mode of learning and tailor your patient teaching to that mode, you will have better results.
How can a nurse determine a patient’s mode of learning? It is important to use a variety of teaching techniques so that the patient both sees and hears the information and performs the action being taught. Additionally, the material being presented (e.g., insulin self-injection) may dictate the method of patient education that will be best to use (kinesthetic), although it should be reinforced with other modes (auditory or visual).
The domains of learning also affect overall teaching effectiveness. If the teaching plan does not address the appropriate domain—affective, cognitive, or psychomotor—then the learning will not be optimal.
What domains of learning might be involved in teaching a patient how to do a dressing change? All three, depending on the patient and magnitude of the process.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7. Modes of Learning Visual learning Auditory learning
Through what they see
Auditory learning
Through what they hear
Kinesthetic learning
By actually performing a task or handling items
Although most people can learn by any of these routes, one route is usually dominant. How can a nurse determine a patient’s mode of learning?
It is important to use a variety of teaching techniques so that the patient both sees and hears the information, and performs the action being taught.
The domains of learning also affect overall teaching effectiveness. If the teaching plan does not address the appropriate domain—affective, cognitive, or psychomotor—then the learning will not be optimal.
What domains of learning might be involved in teaching a patient how to do a dressing change? (all three, depending on the patient and magnitude of the process)
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8. Assessment of Learning Needs
To prepare a teaching plan, assess patient for:
Knowledge of his disease
Diet (if related to disease or condition)
Activity regimen or limitations
Medications (prescription and OTC)
Self-care at home
Prioritize learning needs so you can concentrate on teaching essential knowledge first
It is best to assess the patient’s knowledge about his disease or illness before starting to teach.
Patients are sometimes embarrassed to tell the nurse that they do not know what is being said by the nurse. This happens even for patients with a long-standing diagnosis. Everyone has assumed they understood their condition. Learning issues are perpetuated by patients’ fear of revealing their lack of understanding.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9. Factors Affecting Learning
Assess for factors that might interfere with the patient’s ability to learn
Poor vision or hearing, impaired motor function, illiteracy, and impaired cognition
Age may interfere with the strength or dexterity for performing certain tasks
Illiteracy is a problem that is frequently overlooked in patient teaching.
It is usually recommended that patient teaching materials not be written beyond a sixth-grade reading level.
Patients who are tired, in pain, anxious, or distracted with the environment are less likely to retain the information presented to them.
Physical, occupational, or speech therapists can be helpful in assisting the individual to overcome these types of problems so teaching can begin.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10. Special Considerations for Teaching the Elderly
Provide good lighting
Provide printed teaching materials in large type
Encourage patient to wear glasses if needed
Encourage patient to wear and adjust hearing aids
Use short sentences and pause frequently
Keep medical terms to a minimum
Ask questions at frequent intervals
Memory, especially short-term memory, is often impaired in the elderly. This affects both teaching and information retention.
Suggest different methods that will help elderly patients remember important information, such as a medication dispenser with compartments for each day of the week to help remind them to take pills as directed.
What other methods can help to overcome memory impairments at home? Writing out a schedule for the patient which can be posted on the refrigerator at home.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

11. Readiness to Learn Assess patient’s readiness to learn
Motivation plays a large role in effective learning
Work with patients to show them the advantages of learning what they need to know
The desire to return to independence or to return to the comfort of home is often the motivating factor.
Teaching sessions will be more successful if the patient is comfortable and rested, and there is a minimum of interruptions.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12. Cultural Values and Expectations
Need to work within patient’s values and cultural system
Values and expectations can interfere with patient’s ability to cooperate and learn needed skills for self-care
The patient’s cultural values and personal expectations regarding treatment and recovery may differ from those of the nurse and other health care providers.
It is important to plan patient teaching that respects and demonstrates understanding of cultural and religious beliefs. If not, it is unlikely to be accepted by the patient.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

13. Confidence and Ability
Often patients express a lack of self-confidence
Teaching may need to be broken down into very small steps
Assess what patients already know about the skills they need to learn so that you can build on their current knowledge base
Play techniques can be very successful when teaching younger children.
When teaching the elderly, the pace is slowed to allow more time for processing the information.
Teaching patients to do a complicated, multistep procedure at home is best accomplished when it is broken down into smaller steps. Each time patients master a step, they gain confidence and proficiency.
When teaching a patient, what is one thing you should never assume? Never assume that patients are literate.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14. The Patient Education Plan
Preparing the teaching plan includes:
Analyzing assessment data
Establishing behavioral objectives
Creating a plan to assist patient in reaching the goals in a timely and effective manner
Essential that teaching plan be developed collaboratively, with input from all of the disciplines involved in the patient’s care
What is a behavioral objective? Behavioral objectives represent the desired changes or additions to current behaviors and attitudes, and should be meaningful for the patient.
Consistency in teaching is important if the patient is to master and retain the new information.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

15. Resources for Patient Education
Books, audiovisual materials, pamphlets, and hands-on equipment
Local government agencies often provide printed and online listings of community public service programs
Hospital social workers and patient representatives also good sources of information
The Internet has a wide variety of resources available for patient teaching.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

16. Implementing the Plan
Teaching done when visitors, physician rounds, and treatments will not cause interruptions
One-on-one or in a group setting
Patient should be comfortable
Keep teaching session short
Involve patient in the process
You may need to incorporate teaching into daily care
When teaching a procedure, talk about the steps of the procedure, demonstrate the procedure, and then talk patients through each step while they perform it.
The patient needs to receive written or printed information about what has been taught to take home.
Why is it important to give the patient written information? Reinforces the patient education and provides reference materials for when the patient returns home.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

17. Evaluation
Involves obtaining feedback from the patient regarding what was taught
Use this feedback to determine whether effective learning has in fact taken place
A return demonstration of a skill is one way of evaluating the learning that has occurred.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

18. Documentation
Every staff nurse legally responsible for providing patient education: documentation is essential
Patient education flow sheet may be used
Nurse’s notes should include:
Specific content taught
Method of teaching used
Evidence of evaluation with specific results
Teaching often occurs informally while performing a nursing task such as administering medications.
This makes it a challenge to consistently document patient education.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

19. Coordination with Discharge Planning
Specific learning needs should be discussed with all involved parties, including the patient, and the plan for teaching shared
Primary physician’s office
Home health services
Family or significant others
Printed plan must be sent home with the patient
Patients may be discharged home before necessary learning is complete.
A telephone call to the home health agency or to the physician's office helps provide continuity of teaching.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

20. Question 1
As a nurse, Rachel knows that teaching a patient is done to assist the prevention of illness or promotion of wellness. All of the following are true regarding patient teaching except:
it is a process that begins within 48 hours of admission.
the patient must be taught how to care for himself at home before discharge.
nurses teach patients what they need to know about their disease or disorder, diet, medications, treatments, and self-care.
discharge planning requires looking ahead to what the patient will be facing when returning home.
Answer: 1
Rationale: It is a process that begins at the time of admission. With hospital stays being shortened, patient education has become an even higher priority that begins as soon as the patient enters the hospital.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

21. Question 2
Madison is a student nurse who finds it easier to learn by performing a task. This is which type of learning?
Visual learning
Auditory learning
Kinesthetic learning
Affective learning
Answer: 3
Rationale: Kinesthetic learning is learning by actually performing a task or handling items. Visual learning is learning through what you see. Auditory learning is learning through what you hear. Affective learning occurs when subject matter material is presented in a way that appeals to the learner’s beliefs, feelings, and values. Although most people can learn by any of these routes, the learner finds that one route is usually dominant.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

22. Question 3
Henry is a nurse working in a physician’s office setting. If he is teaching a patient to draw up insulin and watches the patient perform this task, he is teaching in which domain?
Cognitive domain
Affective domain
Effective domain
Psychomotor domain
Answer: 4
Rationale: In the psychomotor domain, the learner processes information by performing a task. In the cognitive domain, the learner takes in and processes information by listening to or reading the material. In affective domain, the material is presented in a way that appeals to the learner’s beliefs, feelings, and values. There is no effective domain.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

23. Question 4
Cara is working in a rural health department. She spends most of her day teaching patients and families. She realizes several factors affect learning. Which one of the following choices affects learning?
Cultural values and expectations
Confidence and abilities
Readiness to learn
Environmental factors
All of the above
Answer: 5
Rationale: All of the above factors have the ability to affect learning.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

24. Question 5
Holly is working in a geriatric setting. She understands when teaching the elderly she should:
keep the TV on and turned up loud so the other patients can hear it.
use long sentences and speak rapidly to keep their attention.
use medical terms to describe all procedures and information.
review the information frequently and check for comprehension.
Answer: 4
Rationale: When teaching the elderly you need to keep distractions and noise to a minimum. Keep sentences short and speak slowly when teaching or giving information. If you use medical terms, you should keep them limited, with an explanation for each one. It is essential that you review frequently and check comprehension.
Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.