Patient and Caregiver Teaching

Patient and Caregiver Teaching 150 150 Tony Guo

Patient and Caregiver Teaching

Role of Patient and Caregiver teaching

  • General goals for patient teaching include
    • Health promotion
    • Disease prevention
    • Illness management
    • Selection and use of appropriate treatment options
  • A teaching plan includes 
    • Assessment of the patient’s ability and readiness to learn 
    • Identification of teaching needs
    • Development of learning goals with the patient
    • Implementation of the teaching
    • Evaluation of the patient’s learning.
  • Every interaction is a potential “teachable moment”
    • Patient and caregiver teaching is challenging
    • Teaching plans provide guidelines
    • Regulatory agencies provide mandates

 

Difference between learning and teaching

  • Learning
    • A persistent change in a person as a result of an experience where he or she acquires knowledge or skill
  • Teaching
    • An interactive and dynamic process that involves a change in a patient’s knowledge, behavior, and/or attitude in order to maintain or improve health

 

Teaching-Learning Process

  • Nurse as Teacher
    • Required competencies
      • Knowledge of subject matter
      • Communication skills
    • Teaching and caregivers has many challenges, including;
      • Lack of time – Can be a barrier to effective teaching. Tell the patient at the beginning of the interaction how much time you can devote to the session. Some teaching should be delivered or reinforced during every contact with the patient or caregiver.
      • Your own feelings as a teacher – Becoming familiar with the various resources for patient teaching that are available at your agency
      • Nurse-patient differences in learning goals – Having realistic discussions about discharge plans, identifying timelines, and exploring home care options can emphasize the need for learning
      • Early discharge from the health care system – Shortened lengths of hospital stays have resulted in patients only having basic teaching plans implemented.
    • Open, relaxed positioning of patient, spouse, and nurse at eye level promotes communication in teaching and learning
  • Caregivers
    • Caregivers are important
    • About 1 in 4 adults provides care to someone on a daily basis
      • Older adult women are the most common, but not the only, family caregivers
      • Needs of the caregiver are vital in the teaching-learning interaction
    • Caregiver Stress
      • Responsibilities increase and change with progression of the illness
      • An experience for which most are not prepared
      • Can lead to burnout, fatigue, social isolation, family conflicts, and potential patient abuse

 

Process of patient teaching

  • Assessment of learning needs involves 4 main areas:
    • Physical factors
      • What is the patient’s age?
      • Is the patient acutely ill?
      • Is the patient fatigued or in pain?
      • What is the primary diagnosis?
      • Are there additional medical problems?
      • What is the patient’s current mental status?
      • What is the patient’s hearing ability? Visual ability? Motor ability?
      • What drugs does the patient take that may affect learning?
    • Psychologic factors
      • Does the patient appear anxious, afraid, depressed, and defensive?
      • Is the patient in a state of denial?
      • What is the patient’s level of motivation? Self-efficacy?
    • Sociocultural factors
      • What are the patient’s beliefs regarding his or her illness or treatment?
      • Is proposed teaching consistent with the patient’s cultural values?
      • What is the patient’s educational experience, reading ability, primary language?
      • What is the patient’s present or past occupation?
      • How does the patient describe his or her financial status?
      • What is the patient’s living arrangement?
      • Does the patient have family or close friends?
    • Learner factors
      • What does the patient already know about his or her health problem?
      • What does the patient think is most important to learn?
      • What prior learning experiences could act as a frame of reference for current learning needs?
      • Is the patient ready to learn? Change behavior?
      • How does the patient learn best (e.g., reading, listening, looking at pictures, doing, playing games)?
      • In what kind of environment does the patient learn best? Formal classroom? Computer/Web-based setting? Informal setting, such as home? Alone or in a group?
      • In what way should the caregiver(s) be involved in patient teaching?

 

  • Assessment
    • Many factors influence ability and readiness to learn
    • Adapt and modify teaching expectations and strategies based on individual and caregiver learning needs
  • Learner Factors
    • Learning needs
      • New knowledge and skills needed to meet goals
      • What you think is important may be different from what patients want to know
    • Learner Factors
      • Readiness to learn
  • Motivation
  • Stages of change
  • Positive reinforcement
  • Learning styles
  • Visual
  • Auditory
  • Physical
  • Diagnosis
  • Planning
    • Setting goals
    • Setting priorities
    • Select teaching strategies based on 3 factors:
  • Patient characteristics
  • Learning style, educational background, culture, language skills, and nature of illness
  • Subject matter
  • Available resources

 

  • Teaching using discussion (“teach back”) and demonstration/return demonstration (“show back”) increases successful learning by the patient

Technology

  • Help patients sift through information to decide if it is valid, reliable, and usable

 

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