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Lesson Plan for

12 Patient Education OBJECTIVES 1.

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Identify appropriate topics for a patient’s health education needs.

Describe the similarities and differences between teaching and learning.

Identify the purposes of patient education.

Describe the domains of learning.

Differentiate factors that determine readiness to learn from those that determine ability to learn.

Compare the nursing and teaching processes.

Write learning objectives for a teaching plan.

Describe the characteristics of an environment that promotes learning.

Identify the principles of effective teaching and learning Describe ways to adapt teaching for patients with different learning needs.

Use the nursing process to make a teaching plan of care.

Describe ways to incorporate teaching with routine nursing care.

Identify methods for evaluating learning.

Use the Teach-Back method to confirm learning.

Describe appropriate documentation of teaching and learning.

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TEACHING FOCUS •

Patient education is an important role that student nurses assume. Nurses contend with multiple factors that affect patients, including shorter length of stays and increased demands on nurses’ time. These two factors complicate nurses’ ability at times to provide quality patient education. Therefore, creating a well-designed, comprehensive teaching plan that fits a patient’s unique learning needs reduces health care costs, improves the quality of care, and provides information about the individualized treatment plan.

KEY TERMS • • • • • • •

Affective learning, p. 205 Analogies, p. 218 Attentional set, p. 206 Cognitive learning, p. 205 Health literacy, p. 211 Learning, p. 204 Learning objective, p. 204

• • • • • •

Motivation, p. 206 Psychomotor learning, p. 206 Reinforcement, p. 217 Return demonstration, p. 218 Teach-back p. 220 Teaching, p. 204

Note: Audio glossary available on Evolve.

NURSING CURRICULUM STANDARDS QSEN • Patient-Centered Care o Coping with Impaired Functioning, p. 203 o Box 12-2 Patient-Centered Care, p. 207 Essentials for Nursing Practice, 8e All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.

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Chapter 12 Patient Education _____________________________________________

• • •

o Box 12-3 Teaching Methods Based on Patient’s Developmental Capacity, p. 208 o Patient Expectations, p. 210 o Box 12-6 Patient Teaching, p. 213 o Box 12-7 Teaching Methods Based on Patient’s Learning Needs, p. 218 o Box 12-8 Care of the Older Adult, p. 218 o Box 12-9 Patient Teaching Strategies for the Patient with Limited Health Literacy, p. 219 Teamwork and Collaboration o Collaborative Care, p. 215 Evidence-Based Practice o Box 12-5 Evidence-Based Practice, p. 212 Informatics o QSEN Activity: Informatics, p. 222

CONCEPTS The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).

Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to Potter, Perry, Stockert, and Hall: Essentials for Nursing Practice, 8th Edition.

A full Concept-Based Curriculum Map covering the entire book can be found here.

ATTRIBUTES AND RESOURCES • Development o Box 12-3 Teaching Methods Based on Patient’s Developmental Capacity, p. 208 o Box 12-8 Care of the Older Adult, p. 218 PERSONAL PREFERENCES • Motivation • Motivation to Learn, p. 206 PROTECTION AND MOVEMENT • Sensory Perception o Coping with Impaired Functioning, p. 203 ATRIBUTES AND ROLES OF NURSE • Patient Education o Standards for Patient Education, p. 203 o Purposes of Patient Education, p. 203 o Box 12-1 Topics for Health Education, p. 203 o Teaching and Learning, p. 204 o Table 12-1 Comparison of the Communication and Teaching Process, p. 205 o Domains of Learning, p. 205 o Basic Learning Principles, p. 206 o Table 12-2 Relationship Between Psychosocial Adaptation to Illness and Learning, p.

208 o Integrating the Nursing and Teaching Processes, p. 209 o Table 12-3 Comparison of the Nursing and Teaching Processes, p. 210 o Box 12-6 Patient Teaching, p. 213 o Box 12-7 Teaching Methods Based on Patient’s Learning Needs, p. 218

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o

Box 12-9 Patient Teaching Strategies for the Patient with Limited Health Literacy, p.

219 o Box 12-10 Evaluation, p. 220 o Box 12-11 Teach Back Method of Evaluation, p. 221 o Documentation of Patient Teaching, p. 221 • Health Promotion o Maintenance and Promotion of Health and Illness Prevention, p. 203 CARE COMPETENCIES • Technology and Informatics o QSEN Activity: Informatics, p. 222 • Evidence o Box 12-5 Evidence-Based Practice, p. 212 BSN Essentials • Essential III: Scholarship for Evidence-Based Practice o Box 12-5 Evidence-Based Practice, p. 212 • Essential IV: Information Management and Application of Patient Care Technology o QSEN Activity: Informatics, p. 222 • Essential IX: Baccalaureate Generalist Nursing Practice o Standards for Patient Education, p. 203 o Purposes of Patient Education, p. 203 o Box 12-1 Topics for Health Education, p. 204 o Teaching and Learning, p. 204 o Table 12-1 Comparison of the Communication and Teaching Process, p. 205 o Domains of Learning, p. 205 o Basic Learning Principles, p. 206 o Box 12-2 Patient-Centered Care, p. 207 o Table 12-2 Relationship Between Psychosocial Adaptation to Illness and Learning, p. 208 o Box 12-3 Teaching Methods Based on Patient’s Developmental Capacity, p. 208 o Integrating the Nursing and Teaching Processes, p. 209 o Table 12-3 Comparison of the Nursing and Teaching Processes, p. 210 o Box 12-4 Synthesis in Practice, p. 210 o Table 12-4 Focused Patient Assessment, p. 211 o Box 12-6 Patient Teaching, p. 213 o Box 12-7 Teaching Methods Based on Patient’s Learning Needs, p. 218 o Box 12-8 Care of the Older Adult, p. 218 o Box 12-9 Patient Teaching Strategies for the Patient with Limited Health Literacy, p. 219 o Box 12-10 Evaluation, p. 220 o Box 12-11 Teach Back Method of Evaluation, p. 221 o Documentation of Patient Teaching, p. 221

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Chapter 12 Patient Education _____________________________________________

STUDENT CHAPTER RESOURCES Chap.

12

READ – Textbook (pp. 202-224) REVIEW – Evolve Resources • Interactive Learning Activities • Audio Glossary • Key Points – Print ANSWER – Evolve Resources • Chapter 12, Case Study with Questions • Chapter 12, Review Questions

SG

ANSWER – Study Guide • Chapter 12, Patient Education, Questions 1-38

EAQ

ANSWER – Elsevier’s Adaptive Quizzing • Chapter 12, Patient Education

EAL

REVIEW – Elsevier’s Adaptive Learning • Chapter 12, Patient Education

VCE

PRACTICE – Virtual Clinical Excursions • Lesson 5, Patient Education in Practice

SLS

APPLY – Simulation Learning System • Scenario 2, Bernadette Jackson • Scenario 4, Jesus Garcia • Scenario 5, Lisa Rae • Scenario 6, Nancy Gilbert • Scenario 7, Carl Rogers • Scenario 8, Maurice Arviso • Scenario 9, Mary Bailey • Scenario 12, Lillian Chambers • Scenario 15, Eliana Ruiz • Scenario 16, Howard Reeves • Scenario 17, Kenton Parkers

INSTRUCTOR CHAPTER RESOURCES

Essentials for Nursing Practice, 8e All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.

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_____________________________________________ Chapter 12 Patient Education

TB

Test Bank • To access the ExamView format, go to the Downloads section.

PPT

PowerPoint Presentations (Chapter 12, Patient Education)

IC

Image Collection • Figure 12-1 Nurse instructing a patient with a glucose meter.

• Figure 12-2 Choosing a comfortable, pleasant environment enhances the learning experience. The nurse is explaining the breast self-examination procedure to the patient.

• Figure 12-3 Concept map.

VCE

Virtual Clinical Excursions: Implementation Manual • Lesson 5, Patient Education in Practice

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Essentials for Nursing Practice, 8e All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.

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Chapter 12 Patient Education _____________________________________________

SLS

Simulation Learning System: Implementation Guide • Scenario 2, Bernadette Jackson Concepts Covered: Vital signs, assessment, older adult, urinary elimination, medication administration (IV), patient safety, patient education, documentation and informatics • Scenario 4, Jesus Garcia Concepts Covered: Assessment, stress and coping, sexuality, bowel elimination, skin integrity and wound care, patient education, documentation and informatics • Scenario 5, Lisa Rae Concepts Covered: Vital signs, assessment, communication, older adult, patient safety, skin integrity, patient education, documentation and informatics • Scenario 6, Nancy Gilbert Concepts Covered: Vital signs, assessment, infection control, oxygenation, skin integrity and wound care, communication, patient education, documentation and informatics • Scenario 7, Carl Rogers Concepts Covered: Assessment, skin and wound care, diabetes management, medication administration (SQ), patient education, documentation and informatics • Scenario 8, Maurice Arviso Concepts Covered: Vital signs, assessment, prioritization, oxygenation, communication, hygiene, patient education, documentation and informatics • Scenario 9, Mary Bailey Concepts Covered: Vital signs, assessment; fluid, electrolyte, and acid base balance; medication administration (IV), patient education, documentation and informatics • Scenario 12, Lillian Chambers Concepts Covered: Vital signs, postoperative assessment, communication, skin integrity and wound care, patient education, documentation and informatics • Scenario 15, Eliana Ruiz Concepts Covered: Assessment, prioritization, medication administration (IM, PR, and SQ), skin integrity and wound care, patient education, diabetes management, documentation and informatics • Scenario 16, Howard Reeves Concepts Covered: Assessment, medication administration (IM and SQ), nutrition, elimination, communication, safety, patient education, documentation and informatics • Scenario 17, Kenton Parkers Concepts Covered: Assessment, oxygenation, communication, ethics, patient education, documentation and informatics

ETC.

Chapter 12: Answer Key to QSEN Activity (below) Chapter 12: Answer Key to Clinical Decision-Making Exercises (below) Chapter 12: Answer Key to Review Questions (below)

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TEACHING STRATEGIES CONTENT FOCUS INTRODUCTION

CONTENT HIGHLIGHTS Emphasize that patient education is one of the most important roles of a nurse.

LEARNING ACTIVITIES •

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STANDARDS FOR PATIENT EDUCATION

Impress upon students that all state Nurse Practice Acts recognize that patient teaching falls within the scope of nursing practice.

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PURPOSES OF PATIENT EDUCATION Maintenance and Promotion of Health and Illness Prevention Restoration of Health Coping with Impaired Functioning

Relate that the ANA supports a focus on promoting health and preventing illness. Discuss the importance of teaching families who are coping with patients with impaired functions.

TEACHING AND LEARNING Role of the Nurse in Teaching and Learning

Explain how teaching and learning are interrelated processes. Discuss the importance of identifying learning objectives.

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•

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• DOMAINS OF LEARNING

Compare and contrast the three domains of learning. Remind students they will have the opportunity for much psychomotor learning during the skills

•

Discuss the role of the Internet as a source of information for patients.

Discuss that patients have a right to be informed about their diagnoses, prognoses, and available treatments to help them make informed decisions.

Discuss The Joint Commission’s role for setting standards in patient and family education.

Discussion Topics: What are some ways to make education patientcentered? Why does patient education need to be documented?

Activity: Have students • work in pairs to discover five areas in which patient education has been shown to promote health or prevent illness.

Have the two students share responsibility and presentation of the findings.

Discussion Topic: What challenges do nurses face in teaching injured or ill patients, and what can be done to overcome them?

Discussion Topic: Why is • it important to understand patients’ preferences for what they wish to learn?

Discuss TJC’s Speak Up Initiatives for patients.

Discuss what domain of learning is most effective for different types of information.

RESOURCES

Box 12-1

Table 12-1

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Chapter 12 Patient Education _____________________________________________

BASIC LEARNING PRINCIPLES Motivation to Learn Readiness to Learn Ability to Learn Learning Environment

sections of upcoming chapters.

•

Explain the importance of these three areas when developing a teaching plan.

Discuss ways to assess a patient’s motivation to learn. Remind students that any condition that depletes a person’s energy also impairs the ability to learn.

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INTEGRATING THE NURSING AND TEACHING PROCESSES Assessment Nursing Diagnosis Planning Implementation Evaluation

Discuss how the nursing and teaching processes are similar.

Assessment of learning needs will influence relevant content and the patient’s ability to learn.

Explain how a nursing diagnosis should reflect the patient’s learning needs.

Discuss setting teaching priorities, timing, and organizing teaching material.

Discuss teaching approaches, instructional methods, and teaching tools. Discuss return demonstration as a method of feedback.

Stress how evaluation indicates success of the teaching plan.

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•

• •

Activity: Have students work in groups of two or three to write a 2-minute demonstration of one type of learning a nurse would teach to a patient (cognitive, affective, or psychomotor). Have the groups perform for the class until all three domains have been shown.

Discuss teaching • methods based on a • patient’s developmental • capacity (Box 12-3).

• Discuss how self-efficacy • is often a predictor of healthy behaviors and how interventions can improve a patient’s selfefficacy.

Large Group Activity: Have students work in groups of five to 10 to present a poster or demonstration of ways to enhance the learning environment.

Discuss techniques to teach a group of patients.

Discussion Topic: What • questions can nurses use • to determine a patient’s • learning needs and • preferences?

• Discuss examples of • nursing diagnoses that • indicate a need for • education.

• Discuss health literacy • and functional illiteracy. • Online Activity: Have students read the article “Educating Nursing Students about Health Literacy: From the Classroom to the Patient Bedside” on the ANA website

Fig. 12-1 Box 12-2 Table 12-2 Box 12-3 Fig. 12-2

Table 12-3 Box 12-4 Table 12-4 Box 12-5 Box 12-6 Fig. 12-3 Box 12-7 Box 12-8 Box 12-9 Box 12-10 Box 12-11

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DOCUMENTATION OF PATIENT TEACHING

Discuss how patient teaching must be documented.

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(nursingworld.org; search for the article title). Ask them to write the three questions Chew suggests to test health literacy and one other point they learned from the article.

Discuss the use of analogies, role-playing, and simulation in teaching.

Discussion Topic: What questions can a nurse ask to determine whether learning has occurred?

Activity: Give students one to five nursing diagnoses that indicate a need for education and have them practice writing goals and expected outcomes for them.

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Chapter 12 Patient Education _____________________________________________

IN-CLASS/ONLINE CASE STUDY Jane Moore is a 60-year-old sales clerk who recently retired because of increasing chronic health concerns. At her visit last week to her primary care practitioner (PCP), she learned that her type 2 diabetes is going to require taking insulin at night. She has never had to give herself injections and is reluctant to start. The PCP sent her to the diabetic clinic to learn more about caring for her diabetes and giving injections. Her diabetes had been controlled with diet and metformin up until this visit. She is not compliant with her diet and has recently gained 7 pounds. Mrs. Moore lives alone; her husband died 2 years ago. She has two children who live in the same town and are very close to her. Mrs. Moore is attending a class today on understanding diabetes as a chronic disease that is being taught by Robert, a nursing student from the local university.

1. Robert based his teaching on understanding diabetes on which domain of learning and why? What are the best teaching methods for this domain?

Answer: He based his teaching on the cognitive domain, and the best teaching methods are lecture and discussion.

Rationale: To teach information that allows the learner to acquire knowledge and then further apply it, the best method is to use the cognitive domain, which includes teaching methods such as lecture and discussion.

2. Robert notices that Mrs. Moore is not paying attention to the class he is teaching. What may be some reasons that she does not appear to be listening?

Answer: As an adult learner, she is going to be motivated to learn what she does not already know.

Because she has diabetes, her main need is to learn about giving herself injections.

Rationale: The adult learner is self-directed. The adult is motivated by meeting the learning needs that apply most to his or her needs. The adult bases learning needs on life experiences.

3. Robert meets with Mrs. Moore after the class to further assess her learning needs. He determines that she prefers to read material. What is important to include in her learning plan knowing this?

Answer: He would need to determine her health literacy and any learning disabilities and individualize the plan to this. The education pamphlets he chooses to provide her should be appropriate for her reading level and be based on layman’s terminology. He can ask her questions about the material after she has read it to evaluate the effectiveness of the material.

Rationale: For a learner who prefers written material, it is important to assess his or her literacy level because there is a direct correlation between literacy level and the overall health of the patient. If the patient does not understand the material, then he or she cannot use it. Evaluation of the learning must take place to have a positive learning outcome.

4. At her next visit to the diabetic clinic, Mrs. Moore is scheduled for a one-on-one session to learn to give herself injections. Which domain does Robert need to use to teach this and explain how the teaching session should be done?

Answer: The psychomotor domain is appropriate for this teaching session. Robert should be prepared to demonstrate the skill and then allow Mrs. Moore to do a return demonstration while getting feedback from Robert. Robert should then advise independent practice.

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Rationale: For a skill such as insulin injection, the patient must get hands-on experience to gain the skill.

5. Robert uses the teach-back technique to verify that his teaching session with Mrs. Moore was successful. Review pg. 221 in the text, then open your charting software and document Robert’s one-onone teaching session with Mrs. Moore.

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Chapter 12 Patient Education _____________________________________________

CHAPTER 12: ANSWER KEY TO QSEN ACTIVITY Many apps are available to help Latinka. Smoking-cessation apps include LIVESTRONG MyQuit Coach— Dare to Quit Smoking and Quit It Lite—stop smoking now. My Fitness Pal allows patients to set weightmanagement goals and track their nutritional intake, exercise, and progress toward their goals. Body Mass Index (BMI) Calculator allows patients to determine their body mass index, and the MapMyFitness apps helps patients track their exercise routines such as walking, hiking, biking, and running.

Because so many apps are available, it is important for Ashley to evaluate the quality of each app, including the relevance to Latinka’s needs, the accuracy of the information provided, and how easy it is to use. Involving Latinka in the evaluation and decision-making process helps her select the apps that will most likely help her reach her health goals.

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CHAPTER 12: ANSWER KEY TO TEXT CLINICAL DECISION MAKING EXERCISES Note: Answers to these questions can be found on the Evolve site. Click here.

1. Several diagnoses could apply at this time. One diagnosis is Readiness for Enhanced Knowledge (new medication) related to inexperience with new medicine. This is important because educational needs surrounding patient safety in the administration of new medications are important learning needs.

2. The cognitive domain is involved the most. It includes acquisition of knowledge, comprehension, application, analysis, synthesis, and evaluation. Learning about a new medication schedule requires all these intellectual behaviors. The affective domain is also involved because Latinka needs to learn positive ways to cope with nicotine withdrawal.

3. Latinka may be having difficulty understanding this information because of language issues and health literacy. Ashley needs to reassess Latinka’s learning preferences, cultural preferences, and health literacy level to enhance learning, Ashley should schedule individual teaching sessions with Latinka and provide information using vocabulary that Latinka can understand. Visual aids such as pictures and use of real-life examples also enhance learning.

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Chapter 12 Patient Education _____________________________________________

CHAPTER 12: ANSWER KEY TO REVIEW QUESTIONS 1. Answer: 1. Learning about side effects requires intellectual comprehension of information. (p. 205) 2. Answer: 2. This action combines nursing care and teaching; the other actions follow appropriate teaching techniques but do not incorporate teaching and nursing care. (p. 217) 3. Answer: 3. Requiring students to be active in their learning and solve real-life problems enhances successful teaching outcomes. (pp. 217, 219, Box 12-7) 4. Answer: 1. Return demonstration reflects patient understanding. (p. 220, Box 12-11) 5. Answer: 3. This approach gives the patient the ability to accept responsibility for tasks and manage selfcare. (p. 217) 6. Answer: 4. This follows teaching principles to use when teaching older adults. An older adult should be spoken to in a normal tone of voice and given time to learn. Repetition of instruction is commonly needed. (p. 218, Box 12-8) 7. Answer: 3. School-age children need to be guided in their learning; independent learning occurs most effectively in adulthood. (p. 208, Box 12-3) 8. Answer: 2. Before successful teaching can occur, the nurse needs to assess successful learning methods and learning needs. This helps the nurse design successful teaching plans. (pp. 206, 207) 9. Answer: 1. Psychomotor skills are needed to use computers. (p. 209) 10. Answer: 2, 3, 4. Appropriate timing of teaching enhances achievement of outcomes; the patient is more able to pay attention to teaching; and including family in teaching sessions enhances success if the patient wants the family to be involved. Assessment of the patient’s feelings and beliefs should occur before the teaching session. (pp. 206-209)

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CHAPTER 12: ANSWER KEY TO POWERPOINT SLIDE CASE STUDY Slide 16 What are Latinka’s learning needs?

Latinka needs to learn about nutrition, exercise, and how and where to shop for healthy foods. Latinka needs to understand the nutritional make-up (calories, fat, fiber, etc.) of foods including the ethnic foods she eats. Latinka’s ability and motivation to learn and possible cultural barriers need to be evaluated to make the teaching effective.

Reference: p. 203-204, 206, 211 Slide 25 How can Ashley tailor her plan for Latinka based on this information?

Many times, people who are successful at sticking to an exercise plan exercise with other people.

Therefore Ashley helps Latinka develop an exercise routine that includes her children and friends.

Reference: p. 210, 213

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