Transcript Chapter 25: Client Education

Chapter 25: Client
Education
Bonnie M. Wivell, MS, RN, CNS
Standards for Client Education
• Client education has long been a standard for
professional nursing
• Nurse Practice Act recognizes that client teaching falls
within the scope of nursing practice
• JC and other accrediting agencies set standards that
require nurses to assess pt. learning needs and provide
education about many topics
• Education requires collaboration
• Need to take into consideration pt’s psychosocial,
spiritual, and cultural values as well as the desire to
actively participate in the educational process
Purposes of Client Education
• The goal of educating others about their health
is to assist individuals, families, or communities
in achieving optimal levels of health
• Maintenance and promotion of health and illness
prevention
– Allows clients to assume more responsibility for their
health
– Greater knowledge results in better health
maintenance habits
– More likely to seek early diagnosis of health problems
Purposes of Client Education Cont’d.
• Restoration of health
– Pts recovering from and adapting to changes resulting
from illness often seek info about their conditions
– Some clients find this difficult and become passive and
uninterested in learning
– Include family but assess the pt.-family relationship first
• Coping with impaired functions
– Some pts have to learn to cope with permanent health
alterations
– Family’s ability to provide support results in part from
education
– Families can provide assistance with health care
management (i.e. giving meds) and with psychosocial
support
Teaching and Learning
• Teaching is an interactive process that
promotes learning. It consists of a conscious,
deliberate set of actions that help individuals
gain new knowledge, change attitudes, adopt
new behaviors or perform new skills
• Learning is the purposeful acquisition of new
knowledge, attitudes, behaviors, and skills
• Teaching is more effective when it responds to
the learner’s needs
Role of Nurse in Teaching and
Learning
• Nurses have an ethical responsibility to
teach their clients what they and their
families need to know
• Joint Commission’s “Know Your Rights”
campaign
– Clients who ask questions and are aware of
their rights have a greater chance of getting
the care they need when they need it
• Clarify info provided by the MD
Domains of Learning
• Cognitive: intellectual, requires thinking
– Knowledge, comprehension, application, analysis,
synthesis, evaluation
• Affective: expression of feelings and acceptance
of attitudes, opinions, or values
– Receiving, responding, valuing, organizing,
characterizing
• Psychomotor: requires integration of mental and
muscular activity
– Perception, set, guided response, mechanism,
complex overt response, adaptations, origination
Basic Learning Principles
• People process info in the following ways:
– Seeing and hearing
– Reflecting and acting
– Reasoning logically and intuitively
– Analyzing and visualizing
Motivation to Learn
• Attentional set: the mental state that allows the learner to
focus on and comprehend a learning activity
• Motivation: a force that acts on or within a person that
causes the person to behave in a particular way
– Compliance is a pt’s adherence to the prescribed course of
therapy
• Use of theory to enhance motivation and learning
– Self-efficacy: social learning theory, refers to a person’s
perceived ability to successfully complete a task
• Psychosocial adaptation to illness
– Grieving allows pts time to adapt psychologically to the
emotional and physical implications of illness
• Active participation
Ability to Learn
• Developmental capability
• Learning in children
– Depends on maturation
• Adult learning
– Draw on life experiences
• Physical capability
– Don’t overestimate the pt’s physical development or
status (size, strength, coordination, sensory acuity)
– Allow for rest
• See Box 25-4 on page 368
Learning Environment
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The number of persons to teach
The need for privacy
Room temperature
Proper lighting
Noise
Room ventilation
Furniture
Nursing Process
• Assessment
– See Box 25-5 on page 370
• Nursing Diagnosis
– Deficient Knowledge
• Planning
– Set priorities
– Timing
– Organized
– Collaborative care
Nursing Process Cont’d.
• Implementation
– Maintain learning attention and participation
– Build on existing knowledge
– Teaching approaches
• Telling, participating, entrusting, reinforcing
– Instructional methods
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One-on-one discussion
Group interaction
Preparatory instruction
Demonstration
Analogies
Role Play
Simulation
Considerations
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Illiteracy and other disabilities
Cultural diversity
Use appropriate teaching tools
Special needs of children and older adults
Chapter 26: Documentation
and Informatics
Definitions
• Documentation: anything written or printed you
rely on as record or proof for authorized persons
• Diagnosis-related group (DRG): a series of
decision trees designed to cluster groups of pts
together by diagnosis, surgical procedure,
complications, comorbidities, and age
– Hospitals are reimbursed a fixed amount
– Reimbursed same regardless of length of stay or cost
of treatment
– DRG may change based on documentation
Confidentiality
• HIPPA
– Pt education on privacy protections
– Ensuring pt’s access to their medical records
– Receiving pt. consent before information is
released
– Providing recourse if privacy protections are
violated
Standards
• ANA standard
– “Documentation must be systematic,
continuous, accessible, communicated,
recorded and readily available to all members
of the health care team.”
The Health Record
• All records basically contain the following
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ID and demographics
Informed consent
Admission nursing history
Nursing diagnoses and care plan
Nurse’s notes
Medical history and physical
Medical diagnosis
Orders
Progress notes
Diagnostic studies (lab, radiology, etc.)
Client Education
Summary of operative procedure
Discharge plan/summary
Purpose of Records
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Communication
Legal documentation
Financial billing
Research
Auditing-Monitoring
Guidelines for Quality
Documentation and Reporting
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Factual
Accurate
Complete
Current
Organized
See legal guidelines in Tale 26-1 on page
388 of text
Methods of Recording
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Narrative documentation
Problem-Oriented Medical Record
Database = all assessment information
Problem list
Nursing care plan
Progress notes
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SOAP
SOAPIE
PIE
Focus Charting
• DAR = data, action, response
• See Box 26-2 on page 391 for examples
More Definitions
• Source record = the client’s chart has a separate
section for each discipline to record data
• Charting by Exception (CBE) = focuses on
documenting deviations from the established
norm or abnormal findings
• Critical Pathways = multidisciplinary care plans
that include client problems, key interventions,
and expected outcomes within an established
time frame
Common Record-Keeping Forms
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Nursing admission history forms
Flowsheets and graphic records
Client care summary or kardex
Acuity records
– Determines hours of care needed
• Standardized care plans
• Discharge summary forms
Reporting
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Change of shift
Telephone reports
Telephone or verbal orders
Transfer reports
Incident or occurrence reports
Nursing Informatics
• ANA defines it as a specialty that
integrates nursing science, computer
science and information science to
manage and communicate data,
information and knowledge in nursing
practice
Advantages of Nursing Information
Systems
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Increased time to spend with clients
Better access to information
Enhanced quality of documentation
Reduced errors of omission
Reduced hospital costs
Increased nurse job satisfaction
Compliance with JCAHO and other accrediting
agencies
• Development of a common clinical database
Security
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Password protection
Locked HIM dept.
Shredding information
Faxes secured
Acronyms
• Computerized physician order entry
(CPOE)
• Electronic Health Record (EHR)
• Electronic Medical Record (EMR)
• Health Information Management (HIM)