Factors influencing the importance of quality education
- shorter hospital stays
- increased demands on nurses’ time
- increase in the number of chronically ill patients
- need to give acutely ill patients meaningful information
Each states’ Nurse Practice Act recognizes ____________ as within the scope of nursing practice
patient teaching
___________ is an essential component of providing safe, patient-centered care
patient education
___________________________ helps reduce healthcare costs and hardships on individuals, families, and communities.
providing education about preventative health care
Education efforts should be patient-centered by considering what factors?
- patient’s education and experience
- their desire to actively participate in the process
- their psychosocial, spiritual and cultural values
What are the three important purposes of education?
- Maintenance and Promotion of Health and Illness Prevention
- Restoration of Health
- Coping with Impaired Functions
Maintenance and Promotion of Health and Illness Prevention through patient education
- promoting healthy behavior through education allows patients to assume more responsibility for their health care.
- when pts are more health conscious, they are more likely to seek early diagnosis of health problems.
Restoration of Health through patient education
- education helps to regain or maintain levels of health
- family caregivers often require as much education as patient
Coping with impaired functions through patient education
- not all patients fully recover from illness or injury
- the family’s ability to provide support results in part from education which begins as soon as you identify the patient’s needs and the family displays a willingness to help
Teaching
A conscious deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills
Learning
purposeful acquisition of new knowledge, attitudes, behaviors and skills
Complex Patterns of Learning Include
- learning new skills
- changing existing attitudes
- transferring learning to new situations
- solving problems
Speak Up initiative includes
- speak up if you have questions/concerns
- educate yourself about your illness
- pay attention to the care you get
- ask a trusted family member/friend to be your advocate
- know your medicines
- participate in all decisions about your treatment
Learning Occurs in 3 Domains:
- Cognitive (understanding; QSEN=knowledge)
- Affective (QSEN=Attitudes)
- Psychomotor (QSEN=Motor Skills)
In cognitive learning, include all intellectual behaviors that requires thinking, such as:
- knowledge
- comprehension
- analysis
analysis
breaking down information into organized parts
Affective Learning
deals with expression of feelings and acceptance of attitudes, opinions or values.
Affective learning includes the following
- receiving: attention
- responding: active participation through listening, reacting verbally and nonverbally
- valuing: attaching worth to an object or behavior
- organizing: developing a value system, resolving conflicts
- characterizing: acting and responding with a consistent value system
Psychomotor Learning
Involves acquiring skills that require the integration of mental and muscular activity.
Psychomotor learning includes the following:
- perception
- set
- guided response
- mechanism
- complex overt response
- adaptation
- origination
Psychomotor Learning: Set
readiness to take a particular action (3 sets: mental, physical, emotional)
Psychomotor Learning: Guided Response
performance under the guidance of an instructor: involving imitation of a demonstration
Psychomotor Learning: Mechanism
gaining confidence in a skill that is more complex
Psychomotor Learning: Complex Overt Response
smoothly and accurately performing a motor skill
Psychomotor Learning: Origination
creating new movement patterns
Before beginning a teaching session, the nurse must always
assess what the patient knows about their illness first
What factors influence a person’s motivation?
- previous knowledge
- experience attitudes
- sociocultural factors
The ability to learn depends on what factors?
- physical and cognitive attributes
- developmental level
- physical wellness
- intellectual thought processes
People process information in the following ways
- seeing and hearing
- reflecting and acting
- reasoning logically and intuitively
- analyzing and visualizing
Attention Set
physical discomfort, anxiety and environmental distractions influence the ability to pay attention (a mild level of anxiety motivates learning, however, a high level of anxiety prevents learning)
Motivation
a force that causes a person to behave in a particular way
Task motive
dosing and administering insulin for a newly diagnosed diabetic
Physical motive
regaining physical normalcy for an amputee
Social motive
parenting classes/techniques
Social Learning Theory
people continuously attempt to control events that affect their lives. This allow them to attain desired outcomes and avoid undesired outcomes resulting in improved motivation.
Self-efficacy
A person’s perceived ability to successfully complete a task. When people believe they are able to execute a particular behavior, they are more likely to perform the behavior consistently and correctly
When nurses implement interventions to enhance self-efficacy, their patients frequently experience
positive outcomes
ex) a child learning how to use an inhaler for asthma (verbal persuasion, vicarious experience, enactive mastery experience, physiological & affective states).
Psychosocial Adaptation to Illness: Stages of Grieving
- denial/disbelief
- anger
- bargaining
- resolution
- acceptance
active participation
learning occurs when the patient is actively involved in the educational session
Adult Learning
- are able to critically reflect on current situation
- often able to identify their own learning needs
- often become dependent in new learning situations
- are ultimately responsible for changing their own behavior
- setting mutual goals improves the outcomes of patient education
The learn motor skills, a patient needs to possess
certain levels of strength, coordination and sensory acuity
The following physical characteristics are necessary to learn psychomotor skills:
- size
- strength
- coordination
- sensory acuity
Physical Characteristics necessary to learn psychomotor skills: Size
height and weight match the equipment to use (crutches)
Physical Characteristics necessary to learn psychomotor skills: Strength
ability to follow a strenuous exercise program
Physical Characteristics necessary to learn psychomotor skills: coordination
dexterity for complicated motor skills (using utensils, changing a bandage
Physical Characteristics necessary to learn psychomotor skills: sensory acuity
senses needed to receive and respond to messages taught (visual, auditory tactile, gustatory and olfactory)
Nursing Process vs Teaching Process
Nursing: requires assessment of all sources of data to determine patient’s total health care needs.
Teaching: focuses on patients learning needs and willingness and capability to learn
When determining a patient’s motivation to learn, assess the following factors
- behavior
- health beliefs/sociocultural background
- perception of severity/benefits and barriers to treatment
- perceived ability to perform health behaviors
- desire to learn
- attitudes about health care providers
- learning style preference: visual, auditory, kinesthetic (hands-on)
When assessing the ability to learn, assess the following factors
physical strength sensory deficits patients reading level patients developmental level patients cognitive function pain, fatigue, anxiety or other physical symptoms
When assessing teaching environment, assess the following environmental factors
distractions or persistent noise
comfort of the room
room facilities and available equipment
Resources for Learning
Willingness to have family involved.
Family’s perceptions and understanding of the illness.
Family’s willingness and ability to participate.
Resources: Financial and material.
Teaching tools-AV materials, brochures, printed materials.
Health literacy
The cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health
Health Literacy includes
Patients’ reading and mathematical skills
Comprehension
Ability to make health-related decisions
Successful functioning as a consumer of health care.
Persons most likely to be at risk for low health literacy
The elderly (age 65yrs and older).
Minority populations.
Immigrant populations.
Persons of low income (approximately ½ of Medicare/Medicaid recipients read below the 5th grade level).
People with chronic mental and/or physical health conditions.
Functional Illiteracy
The inability to read above the 5th grade level.
Many Americans read and understand information that is
3-5 years below their last year of formal education.
Nursing Diagnosis
Deficient Knowledge (Affective, Cognitive, Psychomotor)
Ineffective Health Maintenance
Readiness For Enhanced Health Management
Ineffective Family Therapeutic Regimen Management
Ineffective Self-health Management
Noncompliance With…Medication, Exercise Etc…
Maintaining Attention and Participation
persons learn better when more than one of the senses is stimulate
Building on existing knowledge
learning is more effective when information builds on a learner’s existing knowledge
Incorporating Teaching with Nursing Care
explain as you go - “just-in-time teaching” “real-time teaching”
Teaching Approaches
telling, participating, entrusting and reinforcing
Teaching Approaches: Telling
When teaching limited information-preparing a patient for an emergent procedure. Little opportunity for feedback with this method.
Teaching Approaches: Participating
Opportunity for discussion, feedback, mutual goal setting, and revision of the teaching plan.
Teaching Approaches: Entrusting
Provides the patient the opportunity to manage self-care. The patient accepts responsibilities and performs tasks correctly and consistently
Teaching Approaches: Reinforcing
A learner who receives reinforcement before or after a desired learning behavior is likely to repeat the behavior.
Feedback is a common form of reinforcement.
Instructional Methods include
One-on-one Discussion
Group Instruction
Preparatory Instruction (for tests/procedures)
Demonstration (especially for psychomotor skills (return demonstration))
Analogies
Role Play
Simulation
Take Special Consideration of what factors?
Health literacy
Disabilities
Cognitive capabilities: synthesis/analyze instructions
Stressors on the older adult
When in the implementation phase, make sure to ..
- create a safe, shame-free environment
- utilize teaching tools
- acknowledge cultural diversity: language, beliefs, values, customs
Documentation for Patient Education
- supports QI efforts
- meets TJC’s standards and promotes third party reimbursement
Check tables and pages listed on powerpoint
….
