Patient Education PDF

Patient Education Melissa Albright MSN, RN This Photo by Unknown Author is licensed under CC BY-NC-ND Created NOV 2021 P&P 10th ed. Ch. 25 & Giddens 3rd ed. Ch. 41 by Melissa Albright Updated July 2022 P&P 11 ed...

Patient Education Melissa Albright MSN, RN This Photo by Unknown Author is licensed under CC BY-NC-ND Created NOV 2021 P&P 10th ed. Ch. 25 & Giddens 3rd ed. Ch. 41 by Melissa Albright Updated July 2022 P&P 11 ed. Patient Education an important role for nurses Reasons why high quality education is important shorter hospitalizations increase demands on nurse’s me Increased number of patients living with chronic illness Need to give acutely ill patients meaningful information Crea ng a teaching plan to meet your pa ents learning needs can: Reduce health care costs, Improve quality of care, Keep patients better informed about their specific health care needs 1  Purposes of Patient Education All state Nurse Practice Acts recognize that pa ent teaching falls within the scope of nursing prac ce The Joint Commission sets standards for patient & family education, require nurses to assess patient's learning needs and provide education about many topics, Ex: meds, nutrition, use of medical equipment, pain, pa ent's plan of care, & health promo on One of the QSEN goals Primary purpose of education is to help individuals, families and communities achieve optimal health. Always consider patients' psychosocial, spiritual, and cultural values, as well as desire to actively participate in the educational process. Must document evidence of pa ent educa on in the medical record We can influence patients, but they must be willing to learn, take advantage of patient/family questions about condition (teaching moments). Patients are now expected to take an active role in health care decisions. Hospital stays are shorter and complex care is performed at home. Healthcare is expensive: patient education can help to decrease the overall cost of healthcare by increasing patient compliance with medical and nursing regimens. This can decrease frequency of medical treatments and admission as well as shorten hospital stays. Role of teaching clients is important because it Empowers autonomy Allows client/family to perform self-care Allows for informed decisions regarding healthcare EXAMPLES: School nurse – contracep on/safe sex 2 Industrial nurse – plant safety Clinic nurse – child development, age-appropriate ac vi es Ambulatory surgery nurse – post-op care Public Health nurse – immuniza ons, prevent spread of disease Comprehensive patient education includes three important purposes Maintenance and Promotion of Health and Illness prevention food, rest, coping, hygiene, safety (not usually addressed when well) early detec on, prevent disease/disability Cancer linked to high-fat diet STDs, mammograms Immunizations (Childhood-Adult) Restoration of Health learn to limit disability, restore func on, cope w/ chronic health problem (heart, diabetes) Coping with Impaired Function pre-op teaching adjus ng to loss of func on (teaching about colostomy bag care, gastric tube feeding, medica on, care of indwelling catheter, self cath. Etc.) assis ve devices altering diet/ac vity changes in body image/role expecta ons psychological changes for caregivers grief/loss/eventual death 2  Concept Attributes and Criteria Teaching is planned. Nurse knows the patient and determines the appropriateness of educa on. Nurse plans the teaching to meet learning outcomes. Learning outcomes are goal-oriented. Outcome is to change behavior or a tude. Pa ent is mo vated to learn. Patient education provides a foundational role and provides competency in the professional nursing prac ce. Patient education is expected as a component of health care in all settings and thus is applicable to all areas of the nursing practice involving pa ent care. It is impossible to separate teaching from learning. Interpersonal communica on is essen al for successful teaching to occur. TEACHING Consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills A teacher provides informa on that prompts the learner to engage in ac vi es that lead to a desired change. LEARNING A process of both understanding and applying newly acquired concepts Purposeful acquisition of new knowledge, attitudes, behaviors, and skills Complex patterns are required if the patient is to learn new skills, change existing attitudes, transfer learning to new situa ons, or solve problems Factors that Affect Client Learning 1. Motivation Desire from within Greatest in Clients who Recognize the need for learning (may need to explain long term affects of untreated illnesses especially if signs and symptoms are not obvious. (ex. s/s of untreated hypertension (kidney damage, vision problems etc.) are not always obvious to the patient. Believe it is possible to improve their health Are interested in the information they are being given Try to apply the following principles for motivating learners 3  Convey your interest in and respect Creating a warm, friendly environment Help the client to identify a practical need Use rewards and incentive Help the client to realize that health and safety really matter Deterrents Low income (no money for meds, supplies, etc.); Inconvenience, denial, lack of support, anxiety/fear, pain, impaired self-image 2. Readiness Demonstration of behaviors that indicate the learner is both motivated and able to learn at a specific time. May not be ready to learn prior to scheduled procedures d/t anxiety making it difficult to concentrate Physical condition Pain interferes with the ability to concentrate on the teaching. The client needs adequate strength, coordination, energy, and mobility to demonstrate psychomotor learning Patients with impaired hearing or vision require adaptations in your teaching and evaluation strategies Emotions Severe anxiety, stress, and emotional pain interfere with the ability to learn A mild level of anxiety can enhance learning and motivation 3. Timing People retain information better when they have an opportunity to use it soon after it is presented For some concepts, the learner might need more time to absorb and apply information. 4. Active Involvement Learning is more meaningful when the client is actively engaged in the planning and the learning activities 5. Feedback Information about the learner’s performance. Positive feedback encourages learners and boosts morale when it comes to tackling difficult content or devoting the time and effort needed to get the most out of the learning process. This is especially critical when significant behavioral changes are required. 6. Repetition The client is more likely to retain information and incorporate into his life if it is repeated. 7. Learning environment For most people and ideal learning environment is private, quiet, physically and psychologically comfortable, and free from distractions. 8. Scheduling the Session Plan for uninterrupted time to allow you to adequately assess and understand the client 9. Amount and Complexity of the Content The more complex or detailed the content, the more difficult it is for most people to learn and retain. The greater the change the greater will be the challenge for both teacher and client 10. Communication Communication is central to the teaching and learning process Listen carefully to verbal and nonverbal feedback that the client gives Five Rights of Teaching Right Time Is the learner ready, free of pain and anxiety, and motivated? Have you developed a trusting relationship with the learner? Have you set aside sufficient time for the teaching session? Right Context Is the environment quiet, free of distractions, and private Is the environment soothing or stimulating, depending on the desire effect? Right Goal Is the learner actively involved in planning the learning objectives? Are you and your client both committed to reaching mutually set goals of learning that achieve the desired 3  behavioral changes? Are caregivers included in planning so that they can help follow through on behavioral changes? Are the learning objectives realistic and valued by the client; do they reflect the client’s lifestyle? Right Content Is the content appropriate for the client’s needs? Is it new information or reinforcement of information that has already been provided? Is the content presented at the learner's level? Does the content relate to the learner’s life experiences or is it otherwise relevant to the learner? Right Method Do the teaching strategies fit the learning style of the learner? Do the strategies fit the client’s learning ability? Are the teaching strategies varied? 3  Speak up if you have questions or concerns. Pay attention to the care you get. Educate yourself about your illness. TJC’s Ask a trusted family member or friend to Speak Up be your advocate. Know which medicines you take and why. Tips: Use a health care organization that has been carefully evaluated. Participate in all decisions about your treatment. Nurses are legally responsible for providing education to all patients. American Hospital Association (AHA) published the patient cared partnership in 2003 Patients have the right to participate in making informed decisions about their care Information provided must be accurate, complete, and relevant to patient’s needs language and health literacy According to TJC patients who ask questions and are aware of their rights have a greater chance of getting the care they need when they need it. 4  Closely parallels the communication process Depends partly on effective interpersonal communica on Teaching as Communication The learning objective Effective communication involves feedback The steps of the teaching process are similar to the steps of the communica on process. Learning Objectives: describe the behaviors the learner will exhibit as a result of successful instruction What do we want the patient to have learned by the end of teaching. Sender nurse is the sender who conveys the message to the pa ent. Receiver The learner (the patient) Patients who are ready to learn are more likely to receive the message will depend on physical health, educa on, stage of development, and previous knowledge A tudes, values, emo ons, cultural perspec ve, and knowledge influence the way informa on is delivered. Feedback Given by both sender and receiver Effective education delivers instruction and provides mechanism for evaluation If feedback demonstrates learning the sender/educator will provide reinforcement 5  Scope of Patient Education Patient education: a process of helping people learn health-related behaviors, so they can incorporate the behaviors into everyday life Self-directed Formal pa ent educa on classes Patient-nurse learning situations Physical environment either makes learning difficulty or a pleasure. ideal environment :well lit, have good ventilation, appropriate furniture, proper temp., quiet, private Group teaching vs one-on one-teaching 6  LEARNING DOMAINS Cognitive: increasing knowledge Psychomotor: developing or improving a skill Affective: changing or influencing attitudes Domains of Learning (Box 25-2, p. 368 – Appropriate Teaching Methods Based on Domains of Learning) Learning domains refer to the type of learning in which a learner will be engaged. Cognitive Knowledge the pa ent needs to acquire Some strategies and tools for teaching cognitive-type content include lectures, reading materials, panel discussions, audiovisual materials programmed instruction, Web-based or mobile application learning and problem-based learning (ex. Case studies and care plans. Blooms Taxonomy Hierarchy that increases in complexity Each simpler skill is a prerequisite to mastery of the next more complex one Remember/ knowledge: Recognizing or recalling knowledge Understand/Comprehension: Constructing meaning (interpreting, exemplifying, classifying, summarizing, inferring, comparing, explaining Apply: executing or implementing Analyze: relating ideas in an abstract manner, synthesis, recognizing parts of a whole, and Evaluate: checking and critiquing Ex: Why check BS each day r/t insulin = Low BS = need sugar, elevated BS = need insulin Ex: Important info about meds, ex. To be given with food – evaluate effectiveness of teaching can they verbalize this?? Ex: Nurse explains to the patient why dressing changes are essential for the prevention of infection 7 Affective emotions/feelings/judgment; difficult to identify and to measure changes Impacts the posi ve or nega ve success of the educa on process Strategies and tools include role modeling, group work, panel discussion ,digital storytelling, role-playing, mentoring, one-to-one counseling and discussion, blogs, interactive applications, and digital and printed materials Includes Receiving: Can be passive but must be willing to receive information Responding: Requires active participation Valuing: attaching worth and value to the knowledge Organizing: Developing a value system Characterizing: highest level of internalization Woman w/ mastectomy won’t look at incision Beliefs, attitudes, values (new mom & health benefits of nursing baby) Ex. learn the ‘value’ of what is being taught Psychomotor/Active Deals w/ skills; muscular movement r/t knowledge Strategies and tools used to teach psychomotor skills include demonstration and return demonstration, simulation modules, audiovisual materials (videos), journaling and self reflection, and printed materials (photographs and illustrations) Easily measured; return demonstrations Ex. Using a walker evaluate effectiveness, pt return demonstrates how to do a dressing change. pa ent needs to have the knowledge, physical ability, and a tude to learn the skills Includes: Fundamental: movement r/t walking, running, jumping, pushing, pulling and manipulating Perception: kinesthetic (bodily movements) visual, auditory, tactile or coordination of abilities Guided response: learning a particular skill under guidance of instructor Mechanism: Higher level of behavior, gaining confidence and proficiency Complex overt response: performance of complex movement patterns Adaptation: modification when a problem occurs Origination: create new movement patterns Learning Styles We all process info differently (visual, auditory, touch) We have preferences for receiving info Try to meet learning style needs of pa ent Active vs. Passive learning: Active = learning involves the learner's participation (ex. Return demonstration) occurs when the learner is a recipient of information Passive = but does not engage in it, ask questions, or demonstrate mastery of learning. (giving information about a medication, procedure, dx etc. but not verifying that the patient understands) 7  Basic Learning Principles Motivation to Learn Use of Theory Cultural factors Active Participation Readiness to learn Ability to learn Developmental Capability Learning in Children Adult Learning Health Literacy and Learning Disabilities Physical Capability Learning Environment A patient's motivation to learn is influenced by a belief in the need to know something Patient’s who need knowledge for survival have a stronger motivation to learn than those who need knowledge for health promotion Mo va onal Interviewing: counseling and educa onal technique that focuses on a pa ent's perceived goals Review Table 25.1 learning theories Behavioral learning theory Characterized by identification of information to be taught and immediate reward for correct responses. Has roots in psychology and belief that the environment influences behavior. Pavlov, Skinner, and Bandura are behavioral theorists Cognitive theory Sees learning as a complex cognitive (mental) activity. Learning is an intellectual or thinking process in which the learner structures and processes information. Recognizes the importance of developmental stage and social, emotional a affective influences on learning Bloom is major cognitive theorists Humanism Focuses on the learner’s affective, cognitive, and attitudinal qualities Emphasizes the learner’s active participation and responsibility in the learning process. Learning is self-motivated, self-initiated, and self evaluated, and its purpose is self-development and achievement of the learner’s full potential Cultural Factors: Religion, health beliefs, language, sex-role beliefs affect teaching and learning. 8  When providing education use short, easy sentences that are free of medical jargon. Jehovah’s Witnesses don’t accept blood transfusions Many cultures believe women only ones to prepare food/care for the sick. Include them in plans. May need home health nurse to get involved. Muslims don’t donate organs Na ve Americans & Chinese use folk medicine Die cian can help w/ cultural food beliefs Six ACCESS model components 1. Assessment of a patient's lifestyle, health beliefs, cultural traditions and health practices 2. Communication with an awareness of variations in verbal and nonverbal responses 3. Cultural encourages awareness of characteristics of a patient’s culture and one’s own biases 4. Establishment of respect for patient’s cultural beliefs 5. Sensitivity 6. Safety enables patient to feel culturally secure Active participation Learning occurs when a patient is motivated to be actively involved in the educational session Readiness to learn Affected by stages of grief Table 25.2 pg. 372 Psychosocial Adaptation to Illness, Grief and Learning Ability to Learn Developmental Capability Must consider a patient’s intellectual ability Assess patient's level of knowledge and intellectual skills Learning in Children Assess physiological, motor, language, and social development All children learn in different ways When working with children use strategies to gain trust, reduce their anxiety, promote cooperation and enhance their emotional readiness to learn Adult Learning Different form teaching children Adults are often able to identify their own learning needs Can pull from previous experiences and apply new knowledge to solve problems What do they know already about their disease process Baseline Knowledge what do they have to know? Determine what pa ent/family needs to know/do to func on independently What do they already know start with that build on that Health Literacy and learning Disabilities WHO: Health Literacy: the cognitive and social skills that determines the ability of individuals to gain access to understand and use information in ways that promote and maintain good health. CDC: Health literacy pertains not only to a patient's ability to read and comprehend health-related information but also to having the skills to problems solve, articulate, and make appropriate health care decisions One of the most important predictors of health outcomes Will affect the methods for teaching and so will learning disabili es Many people need printed health information at a fifth-grade level or lower Ex: if unable to read, then printed materials are the best means for teaching Physical Capability Patient’s physical ability to perform psychomotor skills should be assess by PT or OT. Any condi on that depletes energy impairs the ability to learn 8  Interpersonal skills are crucial People process information by: seeing and hearing, reflecting and acting, reasoning logically and intui vely, and analyzing and visualizing. 8  ASSESSMENT/ RECOGNIZING CUES Nursing process ≠ Teaching Process The nursing process = assessment of all data The teaching process = assessment of patient’s learning needs and ability to learn Table 25.3, p. 375 – Compares the nursing and teaching process. Through the Patient’s Eyes Determine a pa ent's expecta ons for learning and any teaching encounter Assess paten's preferences, values, and needs Learning Needs Iden fy gaps in knowledge Determine informa on that is cri cal for pa ent’s to learn Need to asses the following Information or skills needed by a patient to perform self-care and to understand specific health problem Pa ent experiences that influence the mo va on and need to learn Informa on that family caregivers require to support the pa ent’s needs Motivation to Learn Asses the following: Behavior Health beliefs and sociocultural background Perception of the severity and susceptibility of a health problem and the benefits and barriers to treatment. Iden fica on of pa ent outcomes for learning Perceived ability to perform needed health behaviors Desire to learn A tudes about health care providers Learning style preference Readiness and Ability to Learn 9  Cogni ve func on (memory, knowledge, associa on and judgment Cogni ve domain of learning currently mastered by the pa ent (blooms taxonomy) Psychomotor domain of learning currently mastered Sensory deficits Pa ent’s reading level Pa ent’s developmental level Pain, fatigue, depression, anxiety or other physical or psychological symptoms that interfere with the ability to maintain a en on and par cipate Environmental Factors Distrac ons or persistent noise Comfort of the room including ven la on, temperature, ligh ng, furniture and size. Room facili es and available equipment. Resources for learning Who is the pa ent’s primary family caregiver Is support necessary Pa ent’s willingness to have family caregivers involved in the teaching plan and provide health care Family caregiver’s percep ons and understanding of a pa ent’s illness and its implica ons Family caregiver’s willingness and ability to par cipate in care Resources including financial or material such as the ability to obtain health care equipment Teaching tools including brochures, audiovisual materials, or posters Health Literacy Rapid Es mate of Adult Literacy in Medicine (REALM) (handout is in course shell just FYI) Assess for learning disabili es 9  Deficient knowledge (affective, cognitive, psychomotor) Ineffec ve health maintenance Impaired home maintenance Nursing Diagnosis Ineffec ve family therapeu c regimen management Ineffective self-health management Noncompliance (with medica ons) A er the assessment is completed select the nursing diagnosis that best reflects the pa ent’s learning needs. [Review Box 25.5, pg. 377 Nursing Diagnostic Process, with students.] Decide if the topic falls under the cogni ve, affec ve, or psychomotor domains. REMEMBE Pain/ac vity intolerance (barriers to learning) Iden fy their ‘Learning Needs’ Deficient knowledge Recommended that it is used only if poor understanding or incorrect information is the primary problems. Used to describe conditions in which the patient needs new, additional, or extensive knowledge Do not use deficient knowledge for problems involving the client’s ability to learn. Impaired ability to learn r/t fear and anxiety Impaired ability to learn r/t delayed cognitive development Lack of motivation to learn r/t feelings of powerlessness. 10  Maslow’s Hierarchy of Needs Lower-level needs must be met before attempting to address higher level needs. This Photo by Unknown Author is licensed under CC BY-SA How does Maslow’s hierarchy relate to a patient’s mo va on to learn? Remember just like everything else ABC then safety Priorities (no time to teach everything) Teach when pa ent most interested in learning (Readiness) Realis c Approach (look for those “teaching moments”) Don’t overload teaching session… shorter, more frequent sessions for elderly Consider patient’s energy level/presence of pain/Emotional state/Problem-solving skills??? A patient’s learning style will affect their preferences for learning. 11  Planning Outcomes Setting priorities Timing Organizing Teaching Material Teamwork and Collaboration This Photo by Unknown author is licensed under CC BY-SA. Outcomes 1st determine what the patient already knows Develop learning objectives Identify what a patient needs to achieve to gain a better understanding of a health care topic and to better manage illness Set priorities Include a patient when determining priorities for patient education Make sure timing is correct Organize teaching material The more specific the plan the easier it is for nurses to follow Learning contract Usually, informal Statement of understanding between teacher and learner about how to achieve mutually set teaching and behavior goals Teaching goals Broad in scope and set down what is expected as the final outcome of the teaching and learning process Should address all three domains of learning. Ex. Client will demonstrate ability to perform newborn care, Pt will perform ostomy self-care w/in 3 days of surgery Learning objectives Single, specific, one-dimensional behaviors that must be completed to accomplish the goal. Short term Generally completed in one or two sessions. 1. Client will empty ostomy bag when ½ full 12 2. Client will perform skin care around ostomy site 3. Client will apply ostomy device making sure it attaches correctly. 12  Implementation Teaching Approaches Telling Participating Entrusting Reinforcement Instructional Methods Verbal One-on-One Discussion Group instruc on Preparatory Instruction Demonstra on Role playing Analogy Simulation Printed materials No single correct way to teach Maintain learning a en on and par cipa on. Build on exis ng knowledge. Select teaching approach. Incorporate teaching with nursing care. (Encourage client to check blood sugar prior to the nurse administering insulin.) Select appropriate instruc onal methods. Illiteracy and other disabili es. Cultural diversity. Using different teaching tools. Special needs of children and older adults. TJC recommends “teach back” and “show back” techniques to assess and ensure patient understanding. Implementation depends on the nurse’s ability to critically analyze assessment data when identifying learning needs and developing the teaching plan…. Mee ng priority needs first Remember, every interaction with your patient provides an opportunity to teach. Teaching approaches include: telling, par cipa ng, entrus ng, reinforcement. Box 25.8, p.384 presents tips on how to deal with the elderly ALWAYS Consider Amount of me available for teaching Emphasize important information at the beginning of teaching 13  Uninterrupted (An cipate possible interrup ons and plan for them) pa ent’s energy level, comfort level, anxiety level Family/caregiver present??? (Don’t assume family wants to help w/ pt.. care at home) Appropriate me EX: should NOT be done just before surgery (distracted) Appropriate setting: temperature, light, quiet, privacy, facing pt., si ng near pa ent’s willingness and readiness to learn Family present: when a pa ent has mental problem (cogni ve deficit) (Alzheimer's / Demen a) Instructional methods No single correct way to teach Teaching Method: depend on the assessed learning style, literacy level, and available resources. adapt your ‘method’ A variety of methods are more effec ve (see, hear, touch) Verbal/One-on-One Discussion One-way communication; good for facts; watch for boredom, anxiety, distractedness Discussion good for clarifying, ques ons; requires par cipa on; works w/ affec ve & cogni ve Benefits Gives the teacher the opportunity to establish a relationship with a learner, convey interest in his learning needs, and tailor the teaching to the learner’s need as the session proceeds. Mentoring allows reluctant learners to ask questions Enables the teacher to obtain frequent feedback, material can be repeated and clarified as needed. Useful for teaching in all three domains Limita ons Can be labor intensive and reaches the fewest numbers of learners. May overwhelm learners if a large quantity of information is given in a short period of time Tends to isolate the learner from peers who may share the same learning needs Can be hampered by personality conflicts Group Instruction/Lecture Efficient and effective with large groups, use audiovisual (i.e. PowerPoint) Benefits Cost-effective Useful for conveying basic concepts and information Presenter can use media-rich formats to reach learners with auditory and visual learning styles Lectures can be recorded for future use Deeper understanding Longer retention Increased social support More active participation Limitations Does not allow for individualization of teaching Passive learning technique May not be geared to the level of the learner Boredom is common Not a good strategy or promoting critical thinking Group Discussion Benefits A Lerner-centered and effective method for teaching the affective and cognitive domains Many students enjoy a learning environment with opportunities with interaction with peers Social involvement can enhance content. Limitations Less effective with large groups Teacher must be comfortable with less structure and with unpredictable learner responses Not well suited for teaching in the psychomotor domain. 13  Individuals who dominate can be problematic when crowding out less confident participants Those who are disruptive or intentionally sabotage the activity can interfere in successful group discussion Preparatory Instruction Providing information regarding procedures and tests lessens anxiety Demonstration/Return Demonstration psychomotor video/audio can be used live demo best repeated practice leads to quicker success; evaluate return demo to determine success Benefits Most effective in teaching psychomotor skills Can be used in small groups if enough equipment is available When task/skill is performed correctly, return demonstration can increase self-confidence Allows for targeted questions and answers Limitations Does not work well with large groups or for those who do not learn best by observing others Many not be well suited for participants who learn at different rates Time-consuming and labor-intensive Involves preparation time to set up equipment Space must be suitable for the demonstration format Demonstrator must have specialized expertise if technical skills are involved Role playing Most effective for small groups or individuals acting out feelings/knowledge; great for affective domain work through past, present, anticipated feelings, new situations Dolls used w/ kids (how illness affected family, doll for each member) Printed material or resources Benefits Allows for standardized information to be presented to each client but with some room for individualization Hard-copy documents are a good way to reinforce material taught in lecture Handouts allow the teacher to cover just the main ideas while using the time more efficiently for face-to-face instruction Printed materials are portable Can be helpful to reinforce material covered in lecture or to those whose primary language is not English Limitations Assumes literacy, proficiency in the dominant language, motivation to read continent, organization to keep track of materials and visual acuity to decipher the print. Materials must be written at a 6th grade reading levels with words that most people understand. Know what’s available health-related groups; geared to pt. needs; clearly written; up-to-date provide literature before teaching session; give them me to think about ques ons Can’t use video/audio/computer aids in isola on rooms. Glucometer use aid that will be like the one they’ll have at home 13  Barriers to Learning Education Language Cultural level too high difficulties differences Culturally Lack of Lack of social inappropriate motivation support materials Common barriers to patient learning: Educa onal materials and approaches that are at too high of a level for the pa ent’s understanding Language difficul es Cultural differences from teacher Culturally inappropriate teaching materials Factors that interfere with motivation (e.g., not believing that what is being taught will be helpful; not believing in the ability to learn the material) Lack of social support for health behaviors being learned pain can create a barrier to learning 14  Barriers to Teaching Perception of low priority Lack of time Teaching Competing ability priorities Teaching Environment materials Common barriers to nurse teaching: Lack of me and compe ng priori es Availability of a conducive environment: Ideal environment must be well lit, have good ventilation, appropriate furniture, and a proper temperature. Availability of teaching materials Confidence in teaching ability Percep on of teaching as a low priority or nonessen al to the professional role 15  Evaluation and Documentation Learning outcomes are consistent with learning domain. Necessary to determine the patient’s learning Helps to reinforce change in behavior or a tude Success depends on the patient’s achievement of outcomes Documenta on This Photo by Unknown Author is licensed under CC BY-SA Includes information taught and the patient’s motivation, ability to learn, developmental level, and resources. Evaluation is the final step of the teaching plan. At this point, you will discon nue, adjust, or amend the plan. Client is the best source for feedback Oral questions, interviews, questionnaires, and checklists allow clients to evaluate their own progress and determine future learning needs Direct observation of client performance are anecdotal, descriptive notes that you make of the learner’s performance Client’s reports and records allow the nurses to evaluate data and give feedback. Provide criteria and clear expectations to help the client documentation Tests, checklists and written exercises can be used to measure retention and progress toward meeting cognitive objectives ** Clients will not remember everything you teach them. Documentation is of paramount importance: to meet the Joint Commission standards AND third-party reimbursement may be determined by documentation. What did the pa ent learn? Documenta on usually part of pa ent’s care plan A con nuous process, not just at the end of teaching Outcome statement = pa ent behavior + criteria + me + condi on (if needed) Ex. The pa ent will par cipate in ADLs by washing his face every morning. You need to be able to measure the learning to know & evaluate pa ent's understanding Have patients demonstrate or teach back in order to determine if teaching is effective Measurable specific time frame 16