Integrating the Nursing Process and Teaching Process - Patient Education

Question 1

True or false: like the nursing process, the teaching process requires assessment, nursing diagnosis, planning, implementation, and evaluation.

Answer 1

True

Question 2

Focused on data sources that reveal the patient’s learning needs, willingness and ability to learn, and available teaching resources.

Answer 2

Teaching process

Question 3

Especially useful for teaching large groups, where individual learning needs and styles may vary.

Answer 3

Teaching process

Question 4

These two are related and usually take place concurrently.

Answer 4

Nursing process and teaching process

Question 5

True or false: the nursing process is broader.

Answer 5

True

Question 6

Collect data about patient’s physical, psychological, social, cultural, developmental, and spiritual needs from patient, family, diagnostic tests, medical record, health history, learning style, and literature (assessment).

Answer 6

Nursing process

Question 7

Gather data about patient’s learning needs, motivation, ability to learn, and teaching resources from patient, family, learning environment, medical record, health history, and literature (assessement).

Answer 7

Teaching process

Question 8

Identify appropriate health concerns based on assessment findings, including deficits (analysis).

Answer 8

Nursing process

Question 9

Identify patient’s learning needs on the basis of three domains of learning (analysis).

Answer 9

Teaching process

Question 10

Planning:

Develop individualized care plan.

Set diagnosis priorities on the basis of patient’s immediate needs.

Collaborate with patient on care plan.

Answer 10

Nursing process

Question 11

Planning:

Establish learning objectives, stated in behavioural terms.

Identify priorities regarding learning needs.

Collaborate with patient on teaching plan.

Identify type of teaching method to use.

Answer 11

Teaching process

Question 12

Implementation:

Perform nursing care therapies.

Include patient as active participant in care.

Involve family or significant other in care as appropriate.

Answer 12

Nursing process

Question 13

Implementation:

Implement teaching methods.

Actively involve patient in learning activities.

Include family or significant other in participation as appropriate.

Answer 13

Teaching process

Question 14

Evaluation:

Identify success in meeting desired outcomes and goals of nursing care.

Alter interventions as indicated when goals are not met.

Answer 14

Nursing process

Question 15

Evaluation:

Determine outcomes of teaching-learning process.

Measure patient’s ability to achieve learning objectives.

Reinforce information as needed.

Answer 15

Teaching process

Question 16

Patient’s ability to learn, motivation, and needs are analyzed.

Answer 16

Assessment

Question 17

Specifies the information or skills that the patient requires.

Answer 17

Diagnostic statement

Question 18

What the learner will be able to do after successful instruction.

Answer 18

Learning objectives

Question 19

Using teaching and learning principles to ensure that the patient acquires knowledge and skills.

Answer 19

Implementation

Question 20

Based on learning objectives.

Answer 20

Evaluation

Question 21

During this step, the nurse works with the patient to determine the patient’s health care needs.

Answer 21

Assessment

Question 22

During this step, the patient may indicate a need for health care information or the nurse may identify a need for education.

Answer 22

Assessment

Question 23

Identified by both the patient and the nurse and determine the content to be learned.

Answer 23

Learning needs

Question 24

In this step, nurses individualize instruction for each patient.

Answer 24

Assessment

Question 25

In this step, nurses ask specific questions to discover a patient’s unique learning needs.

Answer 25

Assessment

Question 26

During this step,

Ask Patients:

What do you want to know?

What do you know about your illness and your treatment plan?

How does (or will) your illness affect your current lifestyle?

What barriers currently exist that are preventing you from managing your illness the way you would like to manage it?

What cultural or spiritual beliefs do you have regarding your illness and the prescribed treatment?

What experiences have you had that are similar to what you are experiencing now?

Together we can choose the best way for you to learn about your disease. How can I best help you?

What role do you believe your health care provider should take in helping you manage your illness or maintain health?

When you learn new information, do you prefer to have the information given to you in pictures or written down in words?

When you give someone directions to your house, do you tell the person how to get there, write out the instructions, draw a map, or just give the person the address to enter in a smart phone for directions?

How involved do you want your family to be in the management of your illness?

AND

Ask Family Members

When are you available to help and how do you plan to help your loved one?

Your spouse needs some help. How do you feel about learning how to assist him or her?

Answer 26

Assessment

Question 27

Effective questioning and assessment tools help nurses determine these.

Answer 27

Learning needs

Question 28

By listening carefully and using open-ended and closed-ended questions, nurses can often find out these.

Answer 28

Learning needs

Question 29

• Information or skills needed by the patient to perform self-care and to understand the implications of a health problem (healthcare team members anticipate ___ ___ related to specific health problems-for example, teaching an adolescent boy to perform testicular self-examination.)
• Patients’ experiences that influence the need to learn
• Information that family members or significant others require to support the patient’s needs (the amount of information needed depends on the extent of the family’s role in helping the patient.)

Answer 29

learning needs

Question 30

Can be impaired by many factors, including body temperature, electrolyte levels, oxygenation status, and blood glucose level.

Answer 30

Ability to learn

Question 31

The nurse assesses the patient’s ___ to learn by considering the following:

• Physical strength, movement, dexterity, and coordination (perform skills)
• Sensory deficits that may affect understanding or the following of instruction
• Reading level (reading level can be difficult to assess because functional illiteracy is often easy to conceal; one way to assess a patient’s reading level and level of understanding is to ask the patient to read instructions from a teaching brochure and then explain its meaning.)
• Developmental level (developmental level influences teaching approaches)
• Cognitive function (cognitive function includes memory, knowledge, association, and judgement.)

Answer 31

ability

Question 32

The patient’s ___ to learn is assessed by studying the following:

• Behaviour (e.g., attention span, tendency to ask questions, memory, and ability to concentrate during the teaching session)
• Health beliefs and perception of a health problem and the benefits and barriers to treatment (e.g., ask a patient with coronary artery disease, “explain how heart disease will affect you over time. What is the value of eating a low-fat diet?”)
• Perceived ability to complete a required healthy behaviour
• Desire to learn
• Attitudes about healthcare providers (e.g., role of patient and nurse in making decisions, such as asking, “in what way can I best help you?”)
• Knowledge of information to be learned (the patient must play an active role in seeking health-related information)
• Pain, fatigue, anxiety, or other physical symptoms that can interfere with the ability to maintain attention and participate (in acute care settings, a patient’s physical condition can easily detract from learning)
• Sociocultural background (a patient’s beliefs and values about health and various therapies may be influenced by sociocultural norms or tradition; educational efforts can be especially challenging when patients and educators do not speak the same language)
• Learning style preference (patients who learn better by seeing and hearing may benefit from a video; patients who learn best by reasoning logically and intuitively may learn better if presented with written material that they can analyze and discuss with others)

Answer 32

motivation

Question 33

Nurses need to assess the following factors when choosing a ___ ___:

• Distractions or persistent noise (a quiet area should be set aside for teaching)
• Comfort of the room, including ventilation, temperature, lighting, and furniture
• Room facilities and available equipment

Answer 33

teaching environment

Question 34

Includes a review of available teaching tools and guidelines.

Answer 34

Resources

Question 35

If a patient requires family support, the nurse should evaluate the readiness and ability of family and friends to learn to care for the patient and review ___ in the home.

Answer 35

resources

Question 36

The nurse needs to assess the following ___ available for learning:

• The patient’s willingness to have family members involved in the teaching plan and care (information about the patient’s healthcare is confidential unless the patient chooses to share it)
• Family members’ perceptions and understanding of the patient’s illness and its implications (family members and patients’ perceptions should match; otherwise, conflicts may arise in the teaching plan)
• Family’s willingness and ability to participate in care (family members must be responsible, willing, and able to assist in care activities, such as bathing or administering medications)
• Healthcare equipment in the home, access to technology, and a suitable rearrangement of rooms
• Teaching tools, including brochures, audiovisual materials, or posters (printed material should present current and easy-to-understand information that matches the patient’s reading level)

Answer 36

resources

Question 37

The nurse interprets data to form an accurate health focus.

Answer 37

Nursing diagnosis

Question 38

Ensures that teaching will be goal-directed and individualized. If a patient has several learning needs, the nursing foci guide priority setting.

Answer 38

Nursing diagnosis

Question 39

By classifying ___ according to the three learning domains, the nurse can focus on subject matter and teaching methods.

Answer 39

diagnoses

Question 40

Examples of nursing ___ that indicate a need for education include the following:

• Health maintenance
• Health-seeking behaviours
• Health self-management
• Mastery of health-related skill
• Deficient knowledge

Answer 40

foci

Question 41

When health care problems can be managed through education, the ___ of patient education are knowledge and skills. For example, an older person may be unable to manage a medication regimen because of the number of medications that must be taken at different times of the day. Education may improve the patient’s ability to schedule and take the medications.

Answer 41

foci

Question 42

Some nursing ___ indicate that teaching is inappropriate. You may identify conditions that hinder learning (e.g., nursing ___ of pain or activity intolerance). In these cases, you should delay teaching until the nursing ___ is resolved or the health problem is controlled.

Answer 42

foci / focus x2

Question 43

After identifying a patient’s learning needs and identifying a nursing focus, the nurse develops a teaching ___, sets goals and expected outcomes, and works with the patient to select a teaching method.

Answer 43

plan

Question 44

Determine which teaching strategies and approaches are appropriate. Patient participation is essential.

Answer 44

Expected outcomes or learning objectives

Question 45

Answer 45

Question 46

Answer 46

Question 47

Answer 47

Question 48

Answer 48

Question 49

Answer 49

Question 50

Identify the expected outcome of instruction and establish learning priorities.

Answer 50

Learning objectives

Question 51

Help nurses manage time and resources.

Answer 51

Objectives

Question 52

Either for a short term or a long term.

Answer 52

Objective

Question 53

Meet the patient’s immediate learning needs, such as needing knowledge about an upcoming test.

Answer 53

Short-term objectives

Question 54

Often broad and help a patient adapt to a long-term challenge.

Answer 54

Long-term objectives

Question 55

These, which will guide the teaching plan, include the same criteria as outcomes in a nursing care plan:

• Singular behaviours
• Observable or measurable content
• Timing or conditions under which the objective is measured
• Goals mutually set by the nurse and patient

Answer 55

Learning objectives

Question 56

Focuses on a single behaviour that will determine the patient’s ability to meet health care outcomes.

Answer 56

Objective

Question 57

Contains an active verb, describing what the learner will do after the objective is met (e.g., “will administer an injection”).

Answer 57

Behavioural objective

Question 58

Measurable and observable and indicate how learning will be evidenced (e.g., “will perform three-point crutch gait”).

Answer 58

Behavioural objectives

Question 59

Describes precise behaviours and content. Nurses should avoid vague or nonspecific objectives that do not explain what the learner is to do.

Answer 59

Behavioural objectives

Question 60

Conditions and ___ frames should be realistic and designed for the learner’s needs (e.g., “will identify the side effects of medication by discharge”). It also helps to consider conditions under which the patient or family will perform the behaviour (e.g., “will walk from bedroom to bathroom, using crutches”).

Answer 60

time

Question 61

Teaching plan is prioritized according to the patient’s immediate needs, nursing diagnoses, learning objectives, main concerns, anxiety level, and the time available to teach.

Answer 61

Setting priorities

Question 62

True or false: concentration decreases with prolonged sessions.

Answer 62

True

Question 63

True or false: you can assess a patient’s level of concentration by observing nonverbal cues such as poor eye contact or slumped posture.

Answer 63

True

Question 64

True or false: a child in whom diabetes has been newly diagnosed will require more visits to an outpatient centre than will an older person who has been managing diabetes for 15 years.

Answer 64

True

Question 65

Helps organize information into a logical sequence. Material should progress from simple to complex. A person needs to learn simple facts and concepts before learning associations or complex concepts.

Answer 65

Outline

Question 66

True or false: essential content should be taught first because people are more likely to remember information that is taught early. Repetition reinforces learning. Summarizing key points helps the learner remember important information.

Answer 66

True

Question 67

Nurses should engage the patient’s interest by changing the tone and intensity of their voice, making eye contact, using gestures, asking questions, and encouraging participation with activities such as ___-___.

Answer 67

role playing

Question 68

A patient who has had multiple sclerosis must begin a new medication that is given subcutaneously. On assessment, the nurse asks the patient about experience with injections. The patient explains that she gave her father insulin injections for many years. The nurse can then individualize the teaching plan by ___ on the patient’s previous ___ and experience with insulin injections.

Answer 68

building / knowledge

Question 69

The way that the teacher delivers information. It is based on the patient’s learning needs.

Answer 69

Teaching method

Question 70

The following are example of ___ ___:

• Establish trust with the patient before beginning the teaching-learning session
• Limit teaching objectives
• Use simple terminology to enhance the patient’s understanding
• Avoid medical jargon. If necessary, explain medical terms by using basic one- or two-syllable words
• Schedule short teaching sessions at frequent intervals; minimize distractions during teaching sessions
• Begin and end each teaching session with the most important information
• Present information slowly, pacing to provide ample time for the patient to understand the material
• Repeat important information
• Provide many examples that have meaning to the patient; for example, relate new material to a previous life experience
• Build on existing knowledge
• Use visual cues and simple analogies when appropriate
• Ask the patient for frequent feedback to determine whether the patient comprehends information
• Demonstrate procedures such as measuring dosages; ask for return demonstrations (which provide opportunities to clarify instructions and time to review procedures)
• Provide teaching materials that reflect the reading level of the patient; use material that is written with short words and sentences, large type, and simple format (in general, information written on a grade 5 reading level is recommended for adult learners)
• Provide teaching materials that reflect health literacy of the patient; use material that avoids jargon, acronyms, and unnecessary medical terminology and defines medical terms that are necessary
• Model appropriate behaviour and use role-playing to help patient learn how to ask questions and ask for help effectively
• Pace the delivery of material so that patients can progress at their own speed
• Include family members or other caregivers in the education process

Answer 70

teaching strategies

Question 71

Sometimes patients’ needs are highly complex. In these cases, nurses need to identify appropriate health education ___ within the healthcare system or the community.

Answer 71

resources

Question 72

Examples of ___ for patient education are diabetes education clinics, cardiac rehabilitation programs, prenatal classes, and support groups. Nurses should obtain a referral if necessary, encourage patients to attend these sessions, and reinforce information taught.

Answer 72

resources

Question 73

The nurse responsible for developing the teaching plan incorporates all pertinent information into the plan, including topics for instruction, ___ (e.g., equipment, teaching booklets, and referrals to education programs), recommendations for involving family, and objectives of the teaching plan. A plan may be detailed or in outline form.

Answer 73

resources

Question 74

A plan should provide continuity of instruction, particularly when several nurses are involved in a patient’s care. The more specific the plan is, the ___ it is to follow.

Answer 74

easier

Question 75

True or false: in an acute care setting, plans are concise and focused on the primary learning needs of the patient because time for teaching is limited.

Answer 75

True

Question 76

True or false: a home care teaching plan or outpatient clinic plan may be more comprehensive because nurses may have more time to instruct patients and patients are often less anxious in outpatient settings.

Answer 76

True

Question 77

Depends on a nurse’s ability to analyze assessment data when identifying learning needs and developing the teaching plan.

Answer 77

Implementation

Question 78

Evaluates the learning objectives and determines the best teaching and learning methods to help the patient to meet expected goals and outcomes.

Answer 78

Implementation

Question 79

Example of Nursing Interventions Based on Patient’s Learning Needs

A___ data

Mr. Kennedy, aged 67, has a 15-year history of type 2 diabetes. He is in the hospital because of an infected foot ulcer that necessitates frequent dressing changes. Mr. Kennedy used to take oral hypoglycemic agents to control his blood glucose levels. However, he now needs to start home insulin injections because of the infection and wound. He must also learn how to change his dressings. Mr. Kennedy is anxious about his discharge and requests information about a local diabetes support group and Internet resources. The case manager indicates that Mr. Kennedy will be discharged soon.

C___ Interventions

• Ask Mr. Kennedy about what he believes he needs to know before his discharge
• Encourage Mr. Kennedy to help establish learning outcomes and goals
• Provide Mr. Kennedy with teaching materials regarding insulin preparation and administration, and how to recognize and manage hypoglycemia and hyperglycemia
• During teaching sessions, give Mr. Kennedy examples of what problems he might experience at home and ask him how he would respond to the situations (e.g., “if the wound’s drainage increases and it looks like there is pus, what would you do?”)
• Provide Mr. Kennedy with the URL for the Canadian Diabetes Association

A___ Interventions

• Encourage Mr. Kennedy to attend a support group meeting, if possible, to facilitate learning from others’ experiences
• Encourage Mr. Kennedy to verbalize his feelings and fears about this change in his health status
• Have Mr. Kennedy role-play how he will respond to his friends when they ask him about his health status
• As he acquires new skills and behaviours, provide Mr. Kennedy with feedback and positive reinforcement

P Interventions

• Demonstrate insulin preparation and injection techniques
• Demonstrate use of blood glucose meter and recording of blood glucose measurements
• Demonstrate dressing changes
• Ask Mr. Kennedy to perform return demonstrations of insulin preparation and injection, blood glucose testing, and dressing changes

Answer 79

A-ssessment

C-ognitive

A-ffective

P-sychomotor

Question 80

A teaching approach is different from a ___. Because a learner’s needs and motives can change over time, nurses must be ready to modify teaching approaches.

Answer 80

method

Question 81

This approach is useful when limited information must be taught (e.g., preparing a patient for an emergency diagnostic procedure). The nurse outlines the task to be done and the patient’s role and gives instructions-or example, explaining the insertion of an intravenous line and the need for the patient to remain still. This method provides no opportunity for feedback.

Answer 81

Telling approach

Question 82

The approach entails two-way communication. The nurse needs to pace instruction according to the patient’s response. Specific feedback is given to the patient who learns successfully. For example, when the patient learns a step-by-step procedure for changing a dressing, first the patient learns to remove the old dressing, then to clean the wound, and finally to apply a new dressing.

Answer 82

selling

Question 83

This approach involves setting objectives and becoming involved in the learning process together. The patient helps decide content and the nurse guides and counsels the patient with pertinent information. Opportunities are provided for discussion, feedback, mutual goal setting, and revision of the teaching plan. For example, a patient’s request for information about improving physical fitness leads to a discussion with the patient in which the nurse identifies key areas of interest, such as weight loss and improving cardiovascular fitness. Together with the patient, the nurse identifies goals and learning strategies.

Answer 83

participating