Health Educ 2 PDF

THE EDUCATION PROCESS ​ It is constructive and objective with the purpose of creating effective change in the behavior of bo...

THE EDUCATION PROCESS ​ It is constructive and objective with the purpose of creating effective change in the behavior of both the teacher and the learner in terms of The education process is and learning (Bastable: input, process and output. 2007). It is a cycle that involves a teacher and a learner. A teaching-learning process occurs before the lesson begins and continues after the last lesson ends. This includes the THE NURSING PROCESS following: The nursing process provides the necessary tool 1. ASSESSMENT to enable the nurse to render quality nursing care to ​ It is a process which provides the nurse patients. It helps determine the clients' health needs. It educator with information regarding the emphasizes the need to manage and maximize health by learners' knowledge and skills needed to managing risk factors and encouraging healthy behavior. efficiently and effectively transfer knowledge and skills to the learners. ​ The nursing process is a scientific and systematic, problem-solving approach used to identify, ​ It also refers to the gathering of data about the prevent and treat actual or potential health problems learner or A group of learners' demographic and promote wellness. It provides a framework in which profile, skills, and abilities needed in identifying nurses use their knowledge and skills to express human the most appropriate teaching strategy. caring. 2. PLANNING The nursing process is an orderly, systematic ​ It is a carefully organized written presentation manner of determining the client's problems, making of what the learner needs to learn and how the plans to solve the problems, initiating the plan or nurse educator is going to initiate the teaching assigning others to implement the plan, and evaluating process. the extent to which the plan has effectively resolved the problems identified (Kozier: 2004 ​ It includes culturally-relevant skills for the learner, the A goals of learning. type of teaching-learning setting such as: classroom, PURPOSES OF THE NURSING PROCESS laboratory, clinical, or ward setting. 1.​ Provides a tool to enable the nurse to render ​ It indicates teaching timeline and specific sets quality-nursing. of learner activities. 2.​ Helps identify the client's health care needs, and determine care to clients. priorities of care 3. IMPLEMENTATION AND APPLICATION OF and expected outcomes. THE TEACHING PLAN 3.​ Establishes nursing intervention to meet ​ The point where the theoretical and practical client-centered goals. aspects of the teaching-learning process meet 4.​ Provides nursing interventions to meet the as the teacher applies the plan. needs of clients. ​ This includes procedures or techniques and 5.​ Evaluates the effectiveness of nursing care in strategies that the teacher will use to best achieving client goals. implement the plan. 6.​ Achieves scientifically based, holistic, and individualized care. 4. EVALUATION 7.​ Takes the opportunity of working collaboratively ​ The measurement of the teaching-learning with clients, and other members of the health performance of both the teacher and the care team. learner. 8.​ Achieves continuity of care to the clients. NATURE OF THE NURSING PROCESS STEPS IN THE NURSING PROCESS 1.​ The nursing process is dynamic and cyclic. Each Following are the steps in the nursing process (Kozier: step may be reviewed and revised according to 2004) changing client responses to nursing interventions, which may require revisions in the plan of care. 1.​ ASSESSMENT 1.​ It is planned and goal-directed. The plan of care Assessment includes gathering of data about and nursing intervention is organized carefully one the system, the individual, family, or community and to meet the client's goals of care. recording of all needed information. Data are gathered 2.​ It is an intellectual process. Nurses use knowledge through interview, physical examination, research and in problem solving, decision-making and critical review of records. thinking to assess their client's problems, plan their care, implement plans, and evaluate the PURPOSES OF ASSESSMENT effectiveness of the care given. ​ Predict, detect, prevent, manage or eliminate health problems. CHARACTERISTICS OF THE NURSING PROCESS ​ Clarify expected outcomes. ​ Develop specific plan. 1. SYSTEMATIC ​ Review of Records. Nursing assessment The nursing process has an ordered sequence of involves data gathering about the patient precise and accurate activities. Preceding activities influence activities following them. from a variety of sources. ​ Initiates the intellectual process in sorting 2. DYNAMIC and classifying gathered data, recognizing The nursing process provides active interaction patterns and discrepancies comparing and integration among activities. Current activity is these with norms and identifying client necessary to influence future activities. response to health problems that are 3. INTERPERSONAL amenable to nursing interventions (Kozier: The nursing process ensures that nurses are 2004). ​ client-centered rather than task-centered. The nursing process encourages nurses to work and help clients use 2. PLANNING their strength to meet their own needs. Planning is the formulation of the nursing 4. GOAL-DIRECTED care plan on which the nurse works with the The nursing process is a means for nurses and client to set goals and objectives and predict clients to work together in order to identify specific outcomes. Planning identifies nursing actions for goals related to wellness promotion, disease and illness preventing correcting or relieving health prevention, health restoration and coping with altered functioning. problems and developing specif interventions as stated in the nursing care plan. 5. UNIVERSALLY APPLICABLE The nursing process allows nurses to practice PLANNING IS DONE IN ORDER TO: nursing with well or sick people, young or old, ​ Detect, prevent and manage health regardless of race, creed or religion and in any problems. practice setting. ​ Promote well-being and anticipate potential problems. ​ Allocate and utilize possible resources to achieve desired outcomes.  1.​ IMPLEMENTATION Implementation is the actual IMPLICATIONS OF THE CONCEPTS OF performance of the plan. This helps determine TEACHING AND LEARNING IN NURSING client's progress towards meeting expected PRACTICE outcomes and goals. Nurses document this plan in appropriate forms such as nursing progress notes". Planning of patient care is a complex process involving several individuals. It is designed to achieve specific goals like health promotion or improvement. They put the plan into action in order to: Nursing is synonymous to "care" where the nurse ​ Assess appropriateness of responsibility is beyond care for the patient by doing intervention. his or her clinical duties such as giving comfort ​ Perform interventions. measures and administering treatment modalities. ​ Make immediate changes. These include cleaning of wounds, changing patient's ​ Chart and monitor progress of clients. clothes, ensuring that prescribed medicines are taken on time with the accurate dosage among others 2.​ EVALUATION (Creasia and Parker: 2007). Evaluation involves the collection of pertinent and reliable data about the process Nursing also means teaching the patient and outcome of care. The quality of nursing care proper self-care, health promotion, illness or disease that is provided is analyzed and results are prevention, factors affecting health and illness, and compared with expected outcome criteria. treatment options. Relatively, it is important to have a clear understanding of the essence of teaching in the 3.​ DOCUMENTATION practice of nursing. Teaching plays an essential role in Documentation establishes a the efficient and effective dissemination of information written record of assessment, the care and in developing practical clinical skills of students by provided and the patient's response which is means of demonstration, laboratory activities and an integral part of each step of the nursing similar hands on exercises. process. EDUCATION AND THE NURSING PROCESS DIFFERENTIATED The education process is often confused with the process because both have the same elements such as assessment, planning, implementation and evaluation. The two are however different in terms of focus. Nursing process focuses on planning and implementation of care based on the assessment and diagnosis of physical and psychosocial needs of a client, while the education process focuses on the planning and implementation of teaching-based assessment and prioritization of learning needs, readiness to learn and learning styles of the learners. Chapter 3: ROLES AND RESPONSIBILITIES OF THE services and in developing goals for NURSE AS HEALTH EDUCATOR IN TEACHING meeting health needs of clients. PATIENTS 2.​ Formulates operational plans and policies necessary to achieve health education objectives and services. "Teaching is not a matter of chance, it's a matter 3.​ Conducts and coordinates health needs of choice. It is not something you are destined or assessment and other public health obliged to do but something you have chosen to surveys. do. Blessed are the teachers for they are God's 4.​ Designs and conducts evaluation and gift to everyone."​ diagnostic studies to assess the quality and performance of health education programs. 5.​ Plans and implements health education and promotion programs such as training workshops, conferences, and school or DEFINITION OF A NURSE EDUCATOR AND community projects. HER ROLES 6.​ Prepares and distributes health education materials, such as reports, bulletins, online THE NURSE EDUCATOR IS: websites and visual aids like films, videotapes, photographs and posters. 1.​ The primary source of knowledge of learners in 7.​ Provides guidance to agencies and nursing; organizations in the assessment of health 2.​ The primary catalyst for the learning process; education needs and in the development and and delivery of health education programs. 3.​ A role model for learners, 8.​ Disseminates health program information 4.​ An active facilitator, who demonstrates and to the public by preparing and issuing press teaches patient care to nursing students in releases, conducting media campaigns, and the classroom and clinical settings; or maintaining program-related websites. 5.​ A source of health care information and care 9.​ Promotes and maintains cooperative to clients and working relationship with agencies and 6.​ Is diligent; keeps abreast of developments in his organizations interested in public health or her field through continuing education, care. reading of nursing journals and online materials 10.​ Provides and maintains health education and active participation in workshops and libraries to provide resources for staff and seminars. community agencies. 11.​ Formulates, prepares and coordinates grant applications and grant-related activities to FUNCTIONS OF A HEALTH EDUCATOR obtain funding for health education programs and related work. A health educator is a practitioner 12.​ Documents activities, records information professionally prepared in the field of health education, such as number of programs completed, who demonstrates competence in both theory and nursing actions implemented, and practice and accepts responsibility in advancing the individuals assisted. aims of the health-education process (De Young: 2003). 13.​Maintains databases, mailing lists, telephone networks, and other A health educator performs the following: information to facilitate the function of health education programs. 1.​ Collaborates with health specialists and civic groups in assessing community health PATIENT TEACHING DEFINED needs and availability of resources and  Patient teaching, as defined by the American their teaching actions have the potential of forging Academy of Family Physicians, is the process of therapeutic relationships with patients, allowing for influencing patient behavior and producing changes in greater patient-nurse autonomy, raise their knowledge, attitudes and skills necessary in accountability for practice, and create change that truly maintaining or improving health. makes a difference in the lives of others. Patient Teaching is a holistic process with the THE ROLE OF THE NURSE goal of changing or affirming patient's behavior to IN CLIENT TEACHING benefit health status. Patient teaching refers to only one component of patient education process which is Health teaching is an essential role of today's giving the patient healthcare information. nurses. Nurses care for their client, prepare them for diagnostic procedures or surgery. Using knowledge of Patient teaching is more than imparting growth and development, and from nursing theories, information. The skilled patient educator assists the nurses teach individuals and their families at various patient in interpreting, integrating, and applying the levels of understanding. Clients and their families need information given. Patient teaching ends with an information as well as emotional support so they can evaluation of patient learning. It is a process that cope with the anxiety and uncertainty of client's illness. occurs overtime, requiring an ongoing assessment of Nurses also work with the client's significant others to patient's knowledge, attitudes and skills. Patient prepare them to assume responsibility for care at home readiness or motivation to change behaviors and the after the client is discharged from the hospital. obstacles that the patient faces to make a behavioral change are important factors to consider (Falvo: 2003). Education is essential to promote health. The nurse applies the principles of teaching and learning to change the behavior of clients and their family PURPOSES OF CLIENT TEACHING members.. Nurses motivate clients and their families to take charge of and make responsible decisions about Nurse Educators teach clients in order to: their own health care. For teaching to be effective, it must incorporate the cultural and family values and 1.​ Increase clients' awareness and clients' health care beliefs. knowledge of their heal status; 2.​ Increase client satisfaction: 3.​ Improve quality of life; FACTORS THAT INFLUENCE CLIENT'S LEARNING 4.​ Ensure continuity of care; 5.​ Decrease patient anxiety; There are several factors that influence learning at any 6.​ Increase self-reliant behavior; age. They include the following: 7.​ Reduce effectively the incidence of 1.​ Stage of Development. When teaching complication of illness; clients, teaching must be adapted to the 8.​ Promote adherence to health care client's developmental level rather than treatment plans; their chronological age. Developmental 9.​ Maximize independence in the level determines the ability of the person performance of activities of daily living; to learn best, whether by reading printed and materials, using computer-based 10.​ Energize and empower consumers to become applications, watching videos, participating actively involved in the planning of their care. in group discussions, play or other methods. Teenagers have different The role of nurses as health educators in turn concerns from older adults. Parents and enhance their job satisfaction when they recognize that grandparents who must assume long term care may often need more information that  may not have existed during their plan to meet the objectives, and gather all childhood years. necessary materials. The nurse must determine the best method to present the 2.​ Cultural values. The nurse's teaching can materials for the intended audience and be most effective if norms, traditions and later summarize all information given in cultural beliefs are considered and order for the client to develop a holistic incorporated into their teaching plan. idea of the subject matter. People have difficulty understanding the subject matter of what is being taught if PRINCIPLES OF CLIENT TEACHING AND LEARNING they disagree with the topic and their tendency to disregard if they could not Education is essential to promote health. The reconcile such things with their personal nurse applies the principles of teaching and learning to realities. change the behavior of clients towards making responsible decisions about their own health care. 3.​ Language used. The ability of the client to Applying the following principles will help nurses understand the language of teaching become effective teachers. determines how much they learn. Clients to whom English is not the primary language 1.​ Assess teaching needs of the client, or may not understand the use of informal teaching that is required in a particular words or medical terms. The nurse must situation. make sure that health instructions must be 2.​ Assess readiness of the client to learn and understood and used by clients in their the relevance of the content must be daily activities. Use clients' own language considered in order for learning to occur. or get an interpreter to help reach out to their understanding. 3.​ Assess what the client knows and begin from what she knows. 4.​ Physical environment. The nurse must 4.​ The nurse should consider language consider privacy and confidentiality of barriers, literacy, ethnic, or cultural information when discussing sensitive background, age and emotional status of issues such as sexuality, drug addiction or the patient. Otherwise, teaching and domestic violence, among others. Focus learning can be difficult, placing the patient group discussions can also facilitate at risk. interactive process regarding health 5.​ Interactive discussions increases learning. concerns or issues affecting all members of The client should be actively involved in the the group, like sharing experiences they can teaching-learning process and not act as a expect while in the hospital or at home. passive listener or viewer. A discussion format in which all can participate 5.​ Previous experiences. Clients who had past stimulates more learning than hearing a experiences similar to the current health straight lecture. problem may need less education since 6.​ Demonstrate tasks to be done for active they became familiar with the health care practice. Repetition of skills increases activities, they had been taught earlier. retention and promotes a feeling of However, they may have additional competence. concerns which requires more health teachings. 7.​ Praises and positive feedback motivates learning. This is important when the client is trying to master a task, such as capillary 6.​ Knowledge and skill of the teacher. The blood glucose test and self insulin injection teacher must determine the objectives of for diabetic clients. the subject matter to be taught. Develop a  8.​ Role modeling is an effective method for communication must be purposeful, goal directed and demonstrating behavior. Nurses must be focused. aware that their behavior is scrutinized carefully at all times and that it may be GUIDELINES FOR THERAPEUTIC COMMUNICATION copied later. 9.​ Conflicts and frustrations impede learning, As the health professional who is close to the and should be recognized by the nurse and client, the nurse informs families of treatments and resolved for learning to progress. procedures, making sure that the families understand the process and are involved directly in making 10.​ Structured teaching and presentation of decisions and activities related to their care. The nurse simple tasks must be done before complex tasks in order to enhance learning. For should be sensitive to the clients' values, beliefs and example, the nurse teaches the client how customs. The following are guidelines to therapeutic to care for the umbilical cord, which is communication. simple task, before teaching how to bathe and shampoo the newborn, which is more 1.​ A peaceful and calm environment provides difficult for inexperienced parents. privacy, reduces distractions and minimizes interruptions. 11.​ A variety of teaching methods is necessary to illustrate concepts and maintain interest of clients. Posters, videos, models, online 2.​ Begin interactions by introducing oneself and printed materials can supplement and nurse's role. This will describe the lectures and discussion. nurse's purpose and sets the discussion process. For ex. "My name is Crestita Tan, I 12.​ Present information in small segments over am here to complete the health a period of time for better retention and instructions that was started yesterday.. appreciation. Short hospital stay do not support this practice, making follow-up care particularly important. 3.​ Therapeutic communication should be focused and directed towards meeting the Complex procedures need to be taught well. needs of clients. Injection techniques, handouts, visual aids, and actual equipment should be used. The client should For example, Focusing interactions demonstrate the learned procedure in order that the -"How do you feel about the treatment nurse can evaluate the effectiveness of the teaching received today? Redirect conversations- process. The substance or content and skills taught "Thanks for showing me the beautiful should be documented in appropriate health records. family pictures, I understand you are Using these principles ensures that the nurse meets the having a bit of trouble with your kids'. required standard of care in any nursing situation. 4.​ Communicate more powerful messages THERAPEUTIC COMMUNICATION to the client through non-verbal behaviors rather than spoken words. The nurse have to carry out many roles and ​ Eye movements and facial one of the most important role required of the nurse is expressions can confirm or the skill in therapeutic communication. Nursing care contradict what is said. becomes personal, humane and sensitive to clients' ​ Repetitive hand gestures such needs if the nurse can effectively communicate and as tapping the fingers or reach out to clients. In this way, therapeutic twirling hair may indicate  frustration. Body posture, statement is not clear. For stance and gait can convey instance, the nurse might say `` energy, depression or I'm not sure, I understand you." discomfort. ​ Emotions are part of ​ Voice tone, pitch, rate and communication, and nurses volume may indicate joy, anger must often reflect feelings that or fear. are expressed verbally and non ​ Grooming also conveys verbally. The nurse might messages about the nurses' suggest, "You looked forward to self-Image. going home today but ​ Talking to a young child may disappointed that you needed require that the nurse sit or to stay longer for more squat to get to the diagnostic workup." child's level. ​ Cultural differences greatly influence communication. In 5.​ Active listening requires that the nurse some cultures such as Chinese attend to what is being said as well as and Southeast Asian, prolonged to the non verbal clues. Behavior that eye contact is considered convey the nurse's interest and sincere confrontational while Middle desire to listen and understand which Eastern or Native Americans include the following: are sometimes uncomfortable with touch or are disturbed by ​ Eye contact signals readiness to unsolicited touching (Kozier interact. 2008).However, Filipinos are ​ Calm and relaxed posture, with very comfortable with touch the upper portion of the body and the feelings of safety and inclined toward the client. security are enhanced by ​ Encouraging non verbal cues touch. such as nodding, smiling and leaning closer. Verbal cues THERAPEUTIC COMMUNICATION TECHNIQUES include "Go on, uh huh."Tell me about that," or "Can you give Therapeutic communication techniques involves me an example." responding as well as listening, and the nurse must ​ Touch can be a powerful learn to use responses that facilitate rather than response when words would block communication. Communication techniques focus on both content of the message and the feelings that break a mood or fail to convey accompanies the message. These techniques include the depth of feeling clarifying, reflecting, being silent, questioning and experienced between client directing. In addition, the nurse be aware of blocks to and nurse. communication such as conveying lack of interest, ​ Clarifying communication conveying sense of haste, closed posture as in hands involves a unique process of closed over chest, interruptions, providing false the client receiving the reassurance, inappropriate self-disclosure, giving message as intended by the unsolicited advice and failure to acknowledge comments nurse. The nurse can ask or feelings. (Wong et al 2010) questions if the meaning of the DOCUMENTATION OF CLIENT TEACHING b.​ Assesses the clients' functional ability to aid in the formulation of nursing Communication among members of the health diagnoses. care team is essential if this is to be coordinated and consistent to the principles of client teaching. Although c.​ Identifies ways of individualizing communication takes place through word of mouth, teaching, such as the client's readiness, another method used is documentation of patient language, and physical capability. teaching. d.​ Designs assessment forms to high-risk Such documentation not only communicates patients, in order to pinpoint potential what is taught to the client but also communicates the problems that identify specific learning client's level of understanding, and further needs. reinforcement of information may be necessary (Le Fevre 2005). Such information prevents redundancy 2. Problem List and can assist in the evaluative process. a.​ The patient's chart has a list of actual and potential health problems Characteristics of Documentation in Client identified individually or Teaching collaboratively. It also includes medical 1.​ Covers all aspects of patient care; and nursing diagnoses; 2.​ Critical for communication among team members; b.​ The nurse has to enter the data next to 3.​ Provides a legal record; each problem as it is identified and 4.​ Supports quality assurance efforts; when the problem is resolved. 5.​ Promotes continuity of care; and Standardized care plans may be 6.​ Facilitates reinforcement. generated based on nursing diagnoses. Good documentation reflects the following: 3. Care Plan or Critical Pathway 1.​ Initial assessment and reassessment of An individualized care plan for each patient pertinent data; assessment of medical and nursing diagnoses, 2.​ Nursing diagnoses and client learning needs; patient goals, interventions and desired outcomes. 3.​ Interventions provided; 4.​ Client's response and outcomes of care; 4. Flow Sheets (Optional) 5.​ Discharge plan of care; and Flow sheets contain observations and lists of 6.​ Ability of the client and family to manage needs patients name and data in a clear, concise, check-off after discharge format to encourage fast and immediate documentation. Findings or patient responses Review of the components of documentation outside of normal limits must be recorded in the system illustrates how documentation of client nurses' notes. teaching can be integrated into the patient record. The components are as follows: The method of charting assumes that all abnormal findings or variances are charted, referred 1. Admission Assessment to as "charting by exception." If flow sheets are ​ The nurse educator: used to record patient teaching, data entered a.​ Make a complete patient profile and should be the documentation of patient's history. understanding of what was taught rather than the subject matter being taught. 5. Progress Notes  Narrative notes show the patient's progress perceived by all health care professionals involved in patient care. Evaluation of the patient's responses to nursing interventions should be evident. Every problem is referenced with a number corresponding to the problem list. Patient teaching can be effectively documented in the progress notes section of the medical record. Patient teaching is a problem solving process hence, documentation includes a clear statement of needs or problems, significant data and the plan of care. It is also important to document the outcomes of care. Narrative notes also encourage charting in patient's own words to illustrate outcomes of patient education and evidence of individualized care. 6. Discharge Summary Summaries or reports written at the time of discharge or transfer of the client to another health care facility serve as needed source of information for other health care providers about the patient's needs for reinforcement of health teaching and continued learning. Notes and telephone consultations can be used to communicate assessments and ongoing learning needs of clients to continuing care providers.