Chapter 25 Patient Education

Question 1

Join commissions Speak Up program

Answer 1

Helps patients understand their rights when receiving medical care Also tips to help patients become more involved in their treatment

Question 2

SPEAK UP

Answer 2

Speak up if you have questions or concerns
Pay attention to the care you get and make sure it is the correct treatment
Educate yourself about your illness. Learn about medical tests and treatment plan
Ask a trusted family member or friend to be your advocate
Know which medicines you take and why you take them. Medication errors are the most common health care mistakes
Use a hospital, clinic, surgery center, or other type of health care organization that you have researched
Participate in all decisions about your treatment.

Question 3

Intrapersonal variables

Answer 3

Attitudes
Values
Emotions
Cultural perspective
Knowledge

Question 4

Domains of learning

Answer 4

Cognitive (understanding)
Affective (attitudes)
Psychomotor (motor skills)

Question 5

Cognitive

Answer 5

Discussion
Lecture
Question and answer session
Role play
Independent project

Question 6

Affective

Answer 6

Role play (allows expression of values, feelings, and attitudes)
Discussion of topics of interest

Question 7

Psychomotor

Answer 7

Demonstration
Practice
Return demonstration
Independent projects

Question 8

Cognitive learning: Blooms taxonomy

Answer 8

Remember: recognizing or recalling knowledge from memory
Understand: Constructing meaning from different types of messages or activities such as interpreting, classifying, summarizing, inferring, comparing, or explaining
Apply: Carrying out or using a procedure through executing or implementing
Analyze: Breaking materials or concepts into parts
Evaluate: Making judgements based on criteria and standards through checking and critiquing
Create: Putting elements together to form a coherent or functional whole

Question 9

Affective learning

Answer 9

Deals with the expression of feelings and emotions and the development of values, attitudes, and beliefs

Question 10

Psychomotor learning

Answer 10

Development of manual or physical skills

Question 11

Motivation to learn

Answer 11

Is influenced by the belief of the need to know something.

Question 12

Motivational interviewing

Answer 12

Counseling and educational technique focused on patient goals and is goal directed and patient centered
Is often successful with patients who are not motivated to change
Help patients resolve their ambivalence about adopting new self-care behaviors, develop some momentum, and believe that behavioral change is possible

Question 13

Learning theory :
Cognitive Dissonance

Answer 13

Individuals desire consistency and willl make changes that gain consistency.
Example: patient faces stressors associated with myocardial infarction there a lifelong implications. The patient needs to change beliefs, values, attitudes, and values to gain consistency in life during recovery.

Question 14

Learning theory:
Health belief model

Answer 14

A patient will perceive a certain susceptibility and severity of their disease.
Ex: have a patient who has an MI copes with illness will depend on all modifying factors. If the patient does not feel like they are threatened, then the patient might not be receptive to teaching.

Question 15

Learning theory:
Transtheoretical Model of change

Answer 15

Model is used to define how individuals initiate change in their lives, progress through those changes, and process and maintain behaviors.
5 stages: precontemplation, contemplation, preparation, action, and maintenance

Question 16

Learning theory:
Self-Efficacy

Answer 16

Model focuses on the patients belief in his or her own abilities to make and maintain changes and positive outcomes in the patients life. Based on self confidence
Ex: the patient who has MI is discharged home. The patient moves from self-doubt and anxiety to comfort and confidence in his or her abilities break down skills with the encouragement of others

Question 17

Learning theories:
Health promotion

Answer 17

Model is based on the premise that characteristics and experiences of an individual affect actions specific to behaviors and in turn affect outcomes specific to behavior.
Ex: behaviors of a patient who has an MI is driven by prior health promotion behaviors, as well as personal factors.

Question 18

ACCESS model

Answer 18

1. Assessment of a patients lifestyle, health beliefs, cultural traditions, and health practices
2. Communication with an awareness of the many variations in verbal and nonverbal responses
3. Cultural negotiation and compromise that encourages awareness of characteristics of a patient’s culture and one’s own biases
4. Establishment of respect for a patient’s cultural beliefs and values; creating a caring rapport
5. Sensitivity to how patients from diverse backgrounds perceive their care needs and the patterns of communication they use
6. Safety that enable patients to feel culturally secure and avoids disempowerment of their cultural identity.

Question 19

Relationship between psychosocial adaptation to illness, grief, and learning

Answer 19

Denial
Anger
Bargaining
Resolution
Acceptance

Question 20

Denial

Answer 20

Patient avoids discussion of illness, withdraws from others and disregards physical restrictions.

Provide support, empathy, and careful explanations of all procedures while they are being done.

Question 21

Anger

Answer 21

Patient blames and directs anger toward nurse or others

Do not argue with. Listen to concerns. Use good eye contact. Teach in present tense. Reassure family and significant others that patients anger is normal.

Question 22

Bargaining

Answer 22

Patient offers to live better life in exchange for promise of better health

Continue to introduce only reality. Teach only in present tense

Question 23

Resolution

Answer 23

Patient begins to express emotions openly, realizes that illness has created changes, and begins to ask questions

Patient begins to perceive need for assistance and is ready to be responsible for learning.

Question 24

Acceptance

Answer 24

Patient recognizes reality of condition, actively pursues information, and strives for independence

Patient is more easily motivated to learn. Acceptance of illness reflects willingness to deal with its implications.

Question 25

Attentional set

Answer 25

Mental state that allows a learner to focus on and comprehend a learning activity.

Determine a patients level of comfort before beginning a teaching plan

Question 26

1. A patient asks a nurse to provide instruction on how to perform a breast self-exam. Which domains are required to learn this skill? (Select all that apply.)
2. Affective domain
3. Sensory domain
4. Cognitive domain
5. Attentional domain
6. Psychomotor domain

Answer 26

3. Cognitive domain
4. Psychomotor domain

Question 27

A patient suddenly experiences a severe headache with numbness and decreased movement in the left arm. The emergency room physician suspects a stroke and is going to have the patient undergo an emergent angiogram to remove the clot. Which teaching approach is most appropriate?

1. Selling approach
2. Telling approach
3. Entrusting approach
4. Participating approach

Answer 27

2. Telling approach

Question 28

A nurse is caring for a young patient who has been told he has multiple sclerosis. The nurse has planned time to conduct a teaching session that will focus on the disease and principles of management. The nurse chooses to use the EDUCATE model to proceed with instruction. Which of the following are components of the model? (Select all that apply.)

1. State goals of the session for the patient.
2. Repeat the most important information.
3. Practice empathetic skills.
4. Be aware of nonverbal messages.
5. Use a standard question list for the chosen topic.

Answer 28

2, 3, 4

Question 29

EDUCATE MODEL

Answer 29

Enhance comprehension and retention
Deliver patient centered education
Understand the learner
Communicate clearly and effectively
Address health literacy and cultural competence
TE -teaching and education goals

Question 30

Enhance comprehension and retention

Answer 30

Use a question list so that patients can ask questions
Repeat the most important information
Ask patients to repeat info in their own words
Use teach back method

Question 31

Deliver patient centered care

Answer 31

Talk to NOT AT people
Practice empathetic skills especially when the view of the patient is different from that of the provider
Ask patients about their life experiences and build upon them when teaching
Pay attention to the patients worries and fears and try to dispel them
Ask patients to state their goals of medical care to begin a discussion

Question 32

Understand the learner

Answer 32

Find out what the patient already knows before providing info ask “what do you already know about high blood pressure”
Be aware of non verbal messages when delivering verbal communication
Determine the patients barriers to health literacy
Include family members in your education when appropriate
Realize that patients may not be aware that they do not understand what is being communicated to them

Question 33

Communicate clearly and effectively

Answer 33

New communication skills require practice to use them effectively and structure skill development
Present most important info first
Use easy to understand language
Give them time to speak
Consider using audio recordings of patient consultations to improve patient recall of important info

Question 34

Address health literacy and cultural competence

Answer 34

Ask patients “do you need help understanding”
Supplement and reinforce verbal education with simple written and visual materials
Use an interpreter if a patient requires on due to language or disability
Consider using a scripted tool to make patient education clearer and more understandable
Do not just ask the patient “do you understanding” they may just answer yes if they don’t

Question 35

Teaching and education goals

Answer 35

Adequate preparation for teaching and learning
Effective teaching methods
Overcoming barriers to learning
Teaching as an interactive process
Assessment of learning

Question 36

A nurse is teaching an older adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.)

1. Speak in a low tone.
2. Begin and end the session with the most important information regarding melanoma.
3. Provide a pamphlet about melanoma with large font in blues and greens.
4. Provide specific information in frequent, small amounts for older adult patients.
5. Speak quickly so that you do not take up much of the patient’s time.

Answer 36

1, 2, 4

Question 37

A 55-year-old adult male has been in the hospital over a week following surgical complications. The patient has had limited activity but is now finally ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling quite fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient’s condition?

1. Motivation to learn
2. Developmental stage
3. Stage of grief
4. Readiness to learn

Answer 37

4. Readiness to learn

Question 38

A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place?

1. Verbalization of steps to use in splinting
2. Selecting from a series of flash cards the images showing the correct technique
3. Return demonstration
4. Cloze test

Answer 38

3. Return demonstration

Question 39

7. A patient’s cultural background affects the motivation for learning. Using the ACCESS model, match the nursing approach with the correct model component.

Answer 39

1. Assessment — E. Learn about the patients health beliefs and practices
2. Communication — B. Remain aware of verbal and nonverbal responses
3. Cultural — D. Become aware of your patients culture and your own culture
4. Establishment — F. Show respect by creating a caring rapport (relationship)
5. Sensitivity — C. Be aware of how patients from diverse backgrounds perceive their care needs
6. Safety A. Help patients feel culturally secure and able to maintain their cultural identity .

Question 40

A 63-year-old woman is a family caregiver for her 88-year-old mother who has dementia. The caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. The best instructional method a nurse can use for this situation is:

1. Demonstration
2. Preparatory instruction
3. Role-playing
4. Group instruction with other family caregivers

Answer 40

3. Role-playing

patients learn required skills and feel more confident in being able to perform them independently. Rehearsing a desired behavior.
ex: a nurse who is teaching a parent how to respond to a child’s behavior pretends to be a child who is having a temper tantrum. The parent responds to the nurse who is pretending to be the child.

Question 41

A nurse is preparing to teach a patient who has sleep apnea how to use a CPAP machine at night. Which action is most appropriate for the nurse to perform first?

1. Allow patient to manipulate machine and look at parts.
2. Provide a teach-back session.
3. Set mutual goals for the education session.
4. Discuss the purpose of the machine and how it works.

Answer 41

3. Set mutual goals for the education session.

Question 42

Which of the following scenarios demonstrate that learning has taken place? (Select all that apply.)

1. A patient listens to a nurse’s review of the warning signs of a stroke.
2. A patient describes how to set up a pill organizer for newly ordered medicines.
3. A patient attends a spinal cord injury support group.
4. A patient demonstrates how to take his blood pressure at home.
5. A patient reviews written information about resources for cancer survivors.

Answer 42

2, 4

Question 43

LEARN

Answer 43

Listen
Explain
Acknowledge
Recommend
Negotiate

Question 44

RESPECT

Answer 44

Rapport
Empathy
Support
Partnership
Explanations
Cultural competence
Trust