Ch. 27- Teaching

Question 1

teaching is

Answer 1

a system of activities intended to produce learning pg 438

Question 2

How do nurses teach clients and their families?

Answer 2

one to one teaching- teaching a patient wound care while changing a client’s wound dressings or about diet, heath, and exercise if a patient has cardiac issues. Or the nurse may teach a family member or parent to care for their loved ones pg. 438

Question 3

How do nurses teach in the community?

Answer 3

community health education programs
red cross, planned parenthood, school nurse, CPR class
pg 438

Question 4

How do nurses teach health personnel?

Answer 4

in service, staff programs, continuing education. Critical care nurses with experience may be paired with a new graduate nurse. pg 439

Question 5

A learning need is

Answer 5

a desire or requirement to know something that is presently unknown to the learner. new knowledge or info, new skill, new behavior. pg 439

Question 6

learning is

Answer 6

a change in human disposition or capability that persists and that cannot be solely accounted for by growth. Learning is represented by a change in behavior. pg 439

Question 7

Areas for Client Education (4)

Answer 7

Promotion of health, prevention of illness/injury, restoration of health, and adapting to altered health and function

Question 8

Areas for Client Education: Promotion of health examples

Answer 8

increasing a person's level of wellness
growth and development topics
fertility control
hygiene
nutrition
exercise
stress management
lifestyle modification
resources within the community
pg 439

Question 9

Areas for Client Education: prevention of illness/injury examples

Answer 9

health screening (BP, blood glucose, PAP, mammogram)
reducing health risk factors (lowering cholesterol levels)
specific protective health measures (immunizations, use of condoms, sunscreen, medication)
first aide
safety (using seat belts, helmets, walkers)
pg 439

Question 10

Areas for Client Education: restoration of health examples

Answer 10

info about tests, diagnosis, treatment, meds
self-care skills or skills needed to care for loved ones
resources within health care setting/community
pg 439

Question 11

Areas for Client Education: adapting to altered health and function examples

Answer 11

adaptations in lifestyle
problem-solving skills
adaptation to changing health status
strategies to deal with current problems (home IV skills, meds, diet, activity limits, prostheses)
strategies to deal with future problems (fear of pain with terminal cancer, future surgeries or treatments)
info about treatments/outcomes
referrals to other health facilities/services
facilitation of strong self-image
grief/bereavement counseling
pg 439

Question 12

Teaching Process VS Nursing Process example

Answer 12

collect data; analyze client’s learning strengths and deficits

VS

collect data; analyze client’s strengths and deficits

pg 439

Question 13

Teaching Process VS Nursing Process example

Answer 13

make educational diagnoses

VS

make nursing diagnoses

pg 439

Question 14

Teaching Process VS Nursing Process example

Answer 14

develop teaching plan: write learning outcomes, select content/time frame, and select teaching strategies

VS

plan nursing goals/desired outcomes and select interventions

pg 439

Question 15

Teaching Process VS Nursing Process example

Answer 15

implement teaching plan

VS

implement nursing strategies
pg 439

Question 16

Teaching Process VS Nursing Process example

Answer 16

evaluate client learning based on achievement of learning outcomes

VS

evaluate client outcomes based on achievement of goal criteria

pg 439

Question 17

Attributes of learning: Learning is…

Answer 17

An experience that occurs inside the learner.
The discovery of the personal meaning and relevance of ideas.
a consequence of experience.
a collaborative and cooperative process.
an evolutionary process that builds on past learning and experiences.
a process that is both intellectual and emotional.
pg 440

Question 18

compliance is…

Answer 18

the individuals desire to learn and to act on the learning; best illustrated when the person recognizes and accepts the need to learn, and then follows through with the appropriate behaviors that reflect the learning. (diabetes)
pg 440

Question 19

adherence is…

Answer 19

is the degree to which clients follow the agreed on recommendations of heath care providers. pg 440

Question 20

andragogy is…

Answer 20

the art and science of teaching adults pg 440

Question 21

pedagogy is…

Answer 21

the discipline concerned with helping children learn. pg 440

Question 22

geragogy is….

Answer 22

the term used to describe the process involved in helping older adults to learn. pg 440

Question 23

nurses can use the following andragogic concepts about adult learners as a guide to teach…

Answer 23

as people mature, they move from dependence to independence
an adults previous experiences can be used as a resource for learning.
learning is related to an immediate need, problem, of deficit.
an adult is more oriented to learning when the material is useful immediately, not sometime in the future.
learning is reinforced by application and prompt feedback. pg 440

Question 24

The 3 learning domains identified by Bloom are…

Answer 24

1. cognitive domain
2. affective domain
3. psychomotor domain

All 3 should be used in client teaching.
pg 440

Question 25

The cognitive domain is the _________ domain.

Answer 25

thinking domain. It includes 6 intellectual abilities and thinking processes beginning with knowledge, comprehending, and applying to analysis, synthesis and evaluation. ex.) to teach the client why insulin is needed and what to do when not feeling well pg 440

Question 26

The affective domain is the ______ domain.

Answer 26

feeling domain. it deals with personal issues such as attitudes, beliefs, behaviors, and emotions. ex.) helping the client accept the chronic implications of diabetes and maintain self-esteem. pg 440

Question 27

The psychomotor domain is the _____ domain.

Answer 27

skill domain. It includes fine and gross motor abilities such as giving an injection. ex) teaching a client how to self- administer insulin.

Question 28

Factors Affecting Learning (15)

Answer 28

``` Age and Developmental Stage Motivation Readiness Active Involvement Relevance Feedback Nonjudgmental support simple to complex learning repetition timing environment emotions physiological events cultural aspects psychomotor ability pg 441-443 ```

Question 29

Factors Affecting Learning: Age and Developmental Stage example

Answer 29

You must consider the 3 learning domains and learner readiness when considering the client's ability to learn. pg 441

Question 30

Motivation to learn is the _______ to learn.

Answer 30

desire

Question 31

Factors Affecting Learning: Motivation

Answer 31

motivation is greatest when a person recognizes a need and believes the need will be met through learning. ex) clients with heart disease may need to know the effects of smoking before they recognize the need to stop smoking. ex) adolescents may need to know the consequences of an untreated sexually transmitted infection before they see the need for treatment. pg 441

Question 32

Readiness to learn is the

Answer 32

demonstration of behaviors or cues that reflect the learners motivation to learn at a specific time.

Question 33

Factors Affecting Learning: Readiness

Answer 33

readiness not only reflects the desire or willingness to learn, but also the ability to learn at a specific time. ex) a client may want to learn self care during a dressing change, but if the client experiences pain or discomfort he/she may not be able to learn. pg 441

Question 34

Factors Affecting Learning: Active Involvement

Answer 34

when the learner is actively involved in the process of learning, learning becomes more meaningful. learning is faster and retention is better. pg 442

Question 35

Factors Affecting Learning: Relevance

Answer 35

the knowledge/skill to be learned must be personally relevant to the learner. ex) client diagnosed with hypertension, is overweight, and has symptoms of headaches and fatigue, he is more likely to understand the need to lose weight if he remembers having more energy when he weighed less. pg 442

Question 36

Factors Affecting Learning: Feedback

Answer 36

is info regarding a persons performance in reaching a desired goal. has to be meaningful to the learner. positive feedback- praise, positively worded corrections, suggestions of alternative methods negative feedback- ridicule, anger, sarcasm pg 442

Question 37

Factors Affecting Learning: Nonjudgmental Support

Answer 37

people learn best when they believe they are accepted and will not be judged.

Question 38

simple to complex learning

Answer 38

simple and complex are relative terms to the patient. start with simple teaching and build up to complex, based on the person's previous knowledge/experience and understanding. pg 442

Question 39

Factors Affecting Learning: repetition

Answer 39

repetition of key concepts and fact facilitates retention of newly learned material and facilitates transfer to another setting. pg 442

Question 40

Factors Affecting Learning: timing

Answer 40

people retain info and psychomotor skills best when the time between learning and active use is short. ex) showing client how to administer insulin, letting them try before leaving the hospital. pg 442

Question 41

Factors Affecting Learning: environment

Answer 41

reduce distraction and provide physical and psychological comfort. Adequate lighting, comfortable temp, good ventilation. ex) in the hospital, no visitors present or learning to change colostomy bag can be embarrassing if visitors are present. pg 442

Question 42

Factors Affecting Learning: emotions

Answer 42

fear, anger and depression can impede learning.

Question 43

Factors Affecting Learning: physiological events

Answer 43

physiological events such as a critical illness, pain, or sensory deficits inhibit learning. ex) providing analgesics and rest before teaching

Question 44

Factors Affecting Learning: cultural aspects

Answer 44

languages and values.

Question 45

Factors Affecting Learning: psychomotor ability

Answer 45

muscle strength- older client cannot rise from a chair bc of insufficient leg muscle- can't get out of tub motor coordination- client with ALS involving the lower limbs can't use a walker energy- older adults/ill may have limited energy so learning and practicing skills may need to be times sensory acuity- sight used for most learning so a visually impaired client may need a support person pg 443

Question 46

Barriers to Learning: Explanation and Nursing Implications Acute Illness

Answer 46

expl- client requires all resources and energy to cope w/illnesses impl- defer teaching until client is less ill

Question 47

Barriers to Learning: Explanation and Nursing Implications pain

Answer 47

expl- pain decreases ability to concentrate impl- conduct pain assessment before teaching

Question 48

Barriers to Learning: Explanation and Nursing Implications prognosis

Answer 48

expl- client can be preoccupied with illness and unable to concentration on new info impl- defer teaching to better time

Question 49

Barriers to Learning: Explanation and Nursing Implications biorhythms

Answer 49

expl- mental and physical performances have a circadian rhythm impl- adapt time of teaching to suit client

Question 50

Barriers to Learning: Explanation and Nursing Implications emotions (anxiety, denial, depression, grief)

Answer 50

expl- emotions require energy and distract from learning | impl- deal with emotions and possible misinfo first

Question 51

Barriers to Learning: Explanation and Nursing Implications age- older adults

Answer 51

expl- vision, hearing, and motor control can be impaired in older adults impl- consider sensory and motor deficits and adapt teaching plan as needed.

Question 52

Barriers to Learning: Explanation and Nursing Implications age- children

Answer 52

expl- have shorter attention span and vocab differences | impl- plan shorter/more active learning episodes

Question 53

Barriers to Learning: Explanation and Nursing Implications culture/religion

Answer 53

expl- a clients culture or religion ay place restrictions on certain types of knowledge (birth control info) impl- asses the needs when planning learning activities.

Question 54

Barriers to Learning: Explanation and Nursing Implications physical disability

Answer 54

expl- visual, hearing, sensory or motor impairments may interfere with learning impl- plan appropriate teaching ex) audio learning tools for the blind or large print for visually impaired

Question 55

Barriers to Learning: Explanation and Nursing Implications mental disability

Answer 55

expl- impaired cognitive ability may affect the capacity for learning impl- teach according to mental capacity and plan more complex learning for caregivers

Question 56

Assessment Interview: Learning needs and characteristics - combines data from nursing history, physical assessment, and addresses the client's support system. It also considers characteristics that may influence the learning process

Answer 56

``` Primary Health Problem Health beliefs Cultural Factors Learning Style Client Support System pg 445 ```

Question 57

Assessment Interview: Learning needs and characteristics | Primary Health Problems

Answer 57

- tell me about your current health problem. what do you think caused it? -what concerns do you have? - how has the prob affected what you can/cannot do during usual activities? (work, shopping, housework) - what do you or did you do at home to relieve the problem? how helpful was it? - how have treatments started helping your problem? - what, if any, difficulties have the treatments caused? (inconvenience, cost, comfort) - tell me about the tests/surgeries/treatments you are going to have. pg 445

Question 58

Assessment Interview: Learning needs and characteristics | Health Beliefs

Answer 58

-how would you describe your health generally? - what things do you usually do to keep healthy? -what health problems do you think you may be at risk for bc of family history, age, diet, occupation, inadequate exercise, or other habits such as smoking? - what changes would you be willing to make to decrease your risk for these problems/improve health? pg 445

Question 59

Assessment Interview: Learning needs and characteristics | Cultural Factors

Answer 59

-what language do you use most often when speaking/writing? -do you seek the advice of another practitioner? - do you use herbs/other meds/treatment commonly used in your cultural group? does your primary care provider know? - what advice/treatments given previously conflicted with values/beliefs? - when a conflict arose, what did you do? pg 445

Question 60

Assessment Interview: Learning needs and characteristics | learning style

Answer 60

-note the clients age/dev. level - level of education? - where do you obtain health info? (doc, nurse, mag, book, pharmacist, online?) - how do you best learn new things? reading, talking, watching a movie/demo, computer, listening, being shown, on your own/in a group? pg 445

Question 61

Assessment Interview: Learning needs and characteristics | client support system

Answer 61

- would you like a family member/friend to help you learn about the things you need to do to care for yourself? - who do you think would be interested in learning with you? pg 445

Question 62

Signs of Readiness to learn

Answer 62

physical readiness- is client able to focus or are they distracted by pain, fatigue or immobility? emotional readiness- is the client emotionally ready to learn or are they extremely anxious, depressed or grieving over their issue? cognitive readiness- can the client think clearly or are the effects of anesthesia and analgesia altering their level of consciousness? pg 446

Question 63

Special Teaching Consideration: Older Adults

Answer 63

- Health promotion is a priority- safety habits, exercise, nutrition, regular checkups, understanding meds - set achievable goals- involve client and family - If developing written materials: large print, bulleted, 6-8th grade reading level on buff paper - increase time for teaching and allow for rest make sure info is organized with minimal distractions - repeat info - use demonstrations when possible - determine where they receive health info from (tv, magazine) - use examples they can relate to - be aware of sensory deficits - use a setting they are most comfortable, group or one on one - if noncompliance is a problem, figure out why! lack of finances, transportation, poor access to medical care, etc. play to their strengths with respect and use positive reinforcement. pg 446

Question 64

Special Teaching Consideration: Children- preschool 3-5 yrs old

Answer 64

- concerned about fear of pain and bodily harm. Reassure them. choose word carefully ex) fix instead of cut or bandage instead of dressing. - allow them to play with replicas or dolls to learn about body parts - give praise and approval to motivate pg 446

Question 65

Special Teaching Consideration: middle and late childhood 6-11 yrs old

Answer 65

are able to think logically but abstract thought is limited - like to be actively involved in learning process - teaching for health promotion often occurs through school nurse pg 446

Question 66

Special Teaching Consideration: adolescent 12-19 yrs old

Answer 66

have a strong need to belong to a group, friendship, peer support - need to develop a mutually respectful and trusting relationships with them pg 446

Question 67

health literacy is the

Answer 67

ability to obtain, process, and understand the basic health info and services to make appropriate health decisions. pg 447 ex) comprehending script labels, interpreting appointment slips, completing health insurance forms, etc.

Question 68

Newest Vital Sign (NVS) health literacy test is used for what?

Answer 68

to determine the health literacy of the patient using an ice cream label and 6 questions. takes about 3 minutes and tests reading and math skills. clinical alert- the majority of people at the lowest reading level report that they "read well". 1 point for each correct answer. score of 0-1: high likelihood (50%+) of limited literacy score of 2-3: possibility of limited literacy score of 4-6: adequate literacy pg 447-449

Question 69

"Ask me 3" is what?

Answer 69

an educational tool developed by the National Patient Safety Foundation. All clients should ask their health care providers during all interactions these 3 questions. 1. what is my main problem? 2. what do I need to do? 3. why is it important for me to do this? pg 448

Question 70

When verbally teaching clients it is important to use these communication techniques to enhance understanding:

Answer 70

- use plain, nonmedical language - speak clearly and at a moderate pace - limit info to 2-3 important points at a time - repeat key points - use graphics- drawings/models - encourage questions (what do I need to go back over? what questions do you have?) - use "teach back" (nurse has client say in their own words what is important) and "show back" (nurse asks client to perform return demo) techniques. pg 448

Question 71

Clinical Alert

Answer 71

when using the teach back method, you don't want the client's to feel like they're being tested. Place responsilibity on yourself. Ask: what info was most helpful? What will you now do differently? pg 448

Question 72

Deficient Knowledge is the

Answer 72

absence or deficiency of cognitive info related to a specific topic. - When this diagnostic label is used, either the client is seeking health info or the nurse has identified a learning need. The area of deficiency should always be included in the diagnoses. ex) deficient knowledge- low- cal diet- related to inexperience with newly ordered therapy ex) deficient knowledge- home safety hazards- related to denial of declining health and living alone pg 448

Question 73

Developing Written Aids: tips, techniques

Answer 73

- language at or below 6th grade level - use active, not passive voice (take your medicine before breakfast, NOT medicine should be taken before breakfast) - use plain language; ex) use instead of utilize or give instead of administer - use the 2nd person (you) rather than 3rd person (the client). - use a large type size (14-16 point font) - write short sentences - avoid using all capital letters - place priority info first and repeat more than once - use bold for emphasis - use simple pics, drawings, or cartoons, if appropriate - leave plenty of white space - focus material on desired behavior rather than on medical fact - make it look easy to read pg 449

Question 74

tips for teaching clients with a low literacy level

Answer 74

- use multiple teaching methods- pics, read important info, small group discussion, role-play, etc. - emphasize key points in simple terms - avoid acronyms (CAT scan, HDL) - limit info in a single teaching session - associate new info with something the client already knows - reinforce info thru repetition - involve client in teaching - use teach back method - avoids handouts with many pages and classroom lecture format pg 450

Question 75

Readiness for enhanced knowledge is

Answer 75

a pattern of cognitive info related to a specific topis or its acquisition that is sufficient for meeting health- related goals and can be strengthened. - when this diagnostic label is used, the client may/ may not have an altered response or dysfunction at the time but may be seeking info to improve health or prevent illness. pg 450

Question 76

readiness for enhanced knowledge (Exercise and activity)

Answer 76

related to a desire to improve health behaviors and decrease risk of heart disease. this may be used for a client who has knowledge of cardiac risk factors, has identified a personal health problem and wants to minimize risk through exercise. pg 450

Question 77

readiness for enhanced knowledge (home safety hazards)

Answer 77

a desire to minimize risk of injury. -parents of a toddler who are seeking additional info to ensure that their home is safe. or child of an elderly parent may be seeking to make the home free of fall risk hazards. pg 450

Question 78

Noncompliance

Answer 78

indicates that the behavior of the person/caregiver fails to coincide with health promotion or therapeutic plan agreed on by the person/family/community and health care professional. may lead to ineffective outcomes. pg 450 is associated with the intent to comply but situational factors make it difficult.

Question 79

etiology

Answer 79

the 2nd part of a diagnosis statement

Question 80

risk for (specify)

Answer 80

related to deficient knowledge (specify).

Question 81

risk for impaired parenting

Answer 81

related to deficient knowledge skills in infant care and feeding

Question 82

risk for infection

Answer 82

related to deficient knowledge sexually transmitted infections and their prevention

Question 83

anxiety diagnosis example: risk factors

Answer 83

related to deficient knowledge bone marrow aspiration

Question 84

other nursing diagnoses about knowledge deficit...

Answer 84

``` risk for injury ineffective breastfeeding ineffective coping ineffective health maintenance etc. ``` pg 450

Question 85

selected teaching strategies examples

Answer 85

page 453 table 27-3