Client Education

• Client education, also known as health promotion, is a Joint Commission requirement for hospital accreditation

• It is widely recognized as a necessity to improve client care and health status

• Education incorporates information, values, and mindsets related to the client's health concerns

• Client education is increasingly important given the prevalence of chronic illness, decreased hospital facilities, limited economic resources, and high infection rates

• Effective client education allows for safer care at home, a better understanding of health, better healthcare management, and reduced anxiety

• Nurses comprise more than 70% of healthcare teams and play a significant role in client interactions

• In nursing, client education has historically been important, with Florence Nightingale noting it as a nurse function

• Over time, nurses have moved away from only teaching about diseases and now provide education on empowering strategies to utilize available health resources

• Documentation is essential to ensure safety and continuity of care

• Lack of documentation can lead to denial of reimbursement for services

• Incorporating the nursing process into client education ensures precise documentation

• Nurses assess learning needs, create education plans tailored to cultural and literacy levels, implement the plans, evaluate learning, and revise education as needed

• Nurses recognize and protect client rights by educating clients about their rights and confirming their understanding, to ensure effective care and outcomes

• The Practical Nurse (PN) reinforces client education that has been started by the Registered Nurse (RN)

• Client education builds skills and promotes accountability for self-care

• It provides knowledge for healthy lifestyle changes like weight loss and better sleep

• Client education promotes and improves health, and offers knowledge about specific conditions and disabilities

• Education enables clients to advocate for themselves, manage care, and understand medical needs

• Healthcare teams can prepare clients to live healthier lives by providing education

Cognitive Domain

• Involves intellectual learning with six stages
• Knowledge: Recalling learned information
• Comprehension: Understanding and interpreting information
• Application: Using data
• Analysis: Understanding structure through information breakdown
• Synthesis: Combining elements to create a whole
• Evaluation: Deciding the ideal of ideas

Affective Domain

• Focuses on altering beliefs, showing acceptance and adapting to changes
• Clients with a new stoma can alter beliefs about daily routines, body image, or attitudes
• Individuals ask how life changes will occur and will accept the need for consistent care

Psychomotor Domain

• Based on action, involving skills, movement, coordination, and senses
• Five stages for a client undergoing stoma formation
• Guided response/imitation: Observation and assistance
• Mechanism/manipulation: Changing pouch with instruction
• Complex/precision: Changing pouch independently
• Adaptation/articulation: Pouch change without error
• Origination/naturalization: Changing the pouch becomes a part of daily routine

Knowles's Fundamental Principles

• Relevance: Understand relevance in administration of Vitamin K to newborns
• Self-Directed: Clients participate in learning and accept responsibility for their choices
• Life Experience: Build on past personal/academic experiences
• Readiness: Clients must be ready, willing, and able to learn
• Task-Centered: Adults require task or problem-centered learning
• Motivation: Learning requires both internal and external motivation

Factors That Affect Learning

• Client health literacy: Health educators use respectful language at the client's understanding level
• Agency for Healthcare Research and Quality (AHRQ) suggests using Health Literacy Universal Precautions for all clients
• Employ story format, simple language, face-to-face interaction, focused information, and observe nonverbal cues
• Factors that promote learning: perceived benefit, health literacy, non-judgemental support, repetition, and quiet environment
• Factors that hinder learning: fear, anxiety, depression, lack of motivation, environmental distractions, and physical discomfort

Barriers to Learning

• Negative emotions, such as anger, fear and anxiety, can interfere with learning
• Optimal learning environments include a calm setting, privacy, comfortable room temperature, and a respectful demeanor
• Nurses should assess client comfort before initiating teaching
• Impaired cognition may be caused by stress or disability
• Cultural barriers may cause the refusal of treatment
• Nurses should be familiar with client practices and beliefs to avoid issues
• Utilize hospital-based or telephone translators to avoid issues in trust in translation
• Special equipment and one-on-one instruction accommodate visual/hearing impairments

Fine and Gross Motor Skills examples

• Fine motor skills: Opening packages, writing symptoms, administering injections and performing dressing changes

• Gross motor skills: Performing range of motion, walking, and self-propelling a wheelchair

• Non-judgmental support: nurses must adhere to an ethical code, and approach clients with respect, empathy, and non-judgmental views

• It is important to address implicit biases

• Low-Stimulus Environment: this is essential to provide in sessions

• Repetition reinforces information, building self-confidence and knowledge

• Feedback allows application of information to improve health

Teaching Strategies Based on Domains of Learning

• The cognitive domain contains 6 stages and is responsible for intellectual leanring: knowledge, comprehension, application, analysis, synthesis, evaluation
• The affective domain is the emotional domain and contains 5 stages: receiving, responding, valuing, organization, characterization
• The psychomotor domain focuses on physical skills and contains 7 stages: perception, set, guided response, mechanism, complex response, adaptation, origination

Examples of Teaching Strategies

• Lecture: allows the learner to gain knowledge and comprehension

• Question and answer: allows for teach-back and evaluation

• Discussion: allows active participation and peer support

• Role play: allows for engagement of feelings

• Demonstration: allows the learner to see the expectations

• Return Demonstration: allows learner to perform and get feedback

• Games: allows leaner to perform skills in a laid-back manner

• Digital technology has increased in use over past several years

• It promotes the use of web-based sites, multimedia content, and mobile devices in learning

Age and Cultural Diversity Considerations

• Consider each client's background with client education

• Account for age/developmental needs to determine parental, family, peer and psychomotor involvement

• Teaching should occur in brief sessions

• Support children aged 3-6 through play and sensory experiences

• For school-aged children, use logical reasoning using activities such as games and stories

• Focus on guidance rather than lecturing.

• Tailor sessions for older clients by reducing distractions and increasing the time for instruction

• Use certified medical interpreters, instead of family/friends

• Be aware of cultural diversity and self-biases, to provide unbiased care

• Comprehensive plans focus on client needs and health outcomes

• Effective teaching plans include assessing learning needs, motivation, and ability

• Effective learning enables clients to better manage their medical care

Nursing Process Vs Teaching Process

• Nursing process for PNs includes data collection, planning, implementation and evaluation
• Assessment: collect client data and learning needs
• Analysis (RN only): prioritize client needs using clinical judgment
• Planning: collaborate with client to set goals that meet client's learning needs
• Implementation: perform multi-sensory teaching using discussion, teach-back, and printed material
• Evaluation: assess goals and provide feedback

SMART outcomes

• Specific: The outcome is precise between nurse and patient

• Measurable: The outcome is written, determining that it has been met

• Achievable: The client is able to achieve the outcome with abilities

• Relevant: The outcome is geared toward the client's situation

• Timed: The outcome is measurable with a time frame

• Teaching is goal-driven and helps individuals learn, acquire knowledge and change behavior

• Motivation and information technology influences learning

• Nurses provide health education to individuals, families, and communities

• Key factors that influence clients' educational needs are health, education, socioeconomic status and family

• Other factors include emotional status, health perception and developmental level

• Client education is important to promote health, restore health and adapt to permanent conditions

Domains of Learning in practice

• Cognitive learning allows clients to recognize manifestations of hypoglycemia

• Affective learning occurs when clients learn about the lifestyle changes for managing diabetes

• Psychomotor learning allows clients to practice preparing insulin injections

• Address any issues with employment or finances

• Client should be in a small setting

• Teaching for adults are enhanced when goals are mutual to the client

Assessment/Data Collection

• Evaluate learning style
• Identify barriers and concerns
• Determine cognitive ability
• Assess client's culture and health beliefs

Threaded Case Study: Planning

• Prioritize learning with client needs
• Use age appropriate and reliable resources
• Avoid nursing terminology
• Incorporate participation and schedule optimal session times
• Create an environment that is conducive to learning
• Communicate and provide return demonstration or reinforcement of topic

Evaluation

• Ask client to explain information
• Observe return
• Provide support
• Evaluate and reevaluate learning
• Revise the care to meet client needs
• Recognize factors that affect learning and enhance or act as barriers

Factors That Enhance Learning

• Perceived benefit
• Cognitive and physical ability
• Active participation
• Age- and education level-appropriate methods

Barriers to Learning

• Fear, anxiety, and depression
• Physical discomfort, pain and fatigue
• Environmental distractions
• Sensory and perceptual deficits
• Psychomotor deficits