Transcript Client Health Education

Health education
Health education
• Helping patients and families make informed
decisions about their health care as well as
the health of their community
• As you might guess, nurses play a very large
role in health education
• Patient education is very important in today’s
health care:
– Patients are being discharged earlier, after shorter
hospital stays
– Chronic illnesses are on the rise, especially
diabetes and all of its related complications
• Patient education is key for helping prevent
disease, manage existing illnesses, restore
health, and help patients cope with impaired
function
Teaching and learning
• Teaching: when the RN provides information
to the patient in the hopes that it will be
retained and acted upon
• Learning: absorption of the material by the
patient, with the possibility of lifestyle
changes
– It is best when nurses match their teaching to the
needs of the patient
– For example- it would not be appropriate to teach
thermal physics in this course- there’s no reason to
cover it, and students would not learn it because
there was no need for that information
– Similarly, patients will often choose to learn what
they need to know and tune out the rest as “fluff”
Key components of health education
• Health education involves the use of
teaching-learning strategies to help ensure
effective learning
• Learners decide whether or not to make
changes in their lifestyles that impact their
health
– Nurses can teach and encourage, but the decision
to change ultimately rests with the patient or family,
not the nurse
– “You can lead a horse to water, but you can’t make
him drink”
• Health education focuses on changing
behaviors that have been shown to improve
health status of patients, families, and
communities
Goals of health education
• To help patients, families, and communities
achieve optimal states of health through their
own initiative
– This means that patients and families take actions
to improve their health, based on the teachings of
the nurse
• Individuals, families and communities are
empowered to make competent, informed
decisions about their health and health care
– Nurses inspire patients and families with the
confidence and provide information but ultimately
allow them to make their own decisions
Ethical considerations
• RNs have an ethical responsibility to teach
their patients
– This does not mean that the patient will necessarily
learn everything that is taught, but the RN has to try
to offer appropriate teaching
• The RN must be an effective teacher to
increase the chance of learning and
compliance by the patient
– This more than simply rattling off facts to the
patient
– The RN must find out what the patient needs to
know and how the patient learns best
– It would not be appropriate to give printed
pamphlets to a blind patient, or a lengthy lecture to
a toddler- the RN does an assessment to determine
the best ways to teach the particular patient
Interpersonal communication
• Patients must feel comfortable with the RN to
admit that they cannot read or do not
understand the material
• The RN can assess non-verbal cues to
determine whether or not the patient
understands the material being presented
• Patients can tell when the RN is not interested
in teaching the material, and will
automatically discount any information as
being unimportant
Patient teaching
• All health care providers are always teaching,
whether they realize it or not
• For example:
– If the RNs enter the patient’s room and start
procedures without washing their hands first, the
patient may come to believe that hand washing is
unimportant
– However- if the RNs use careful, sterile technique
when doing wound care, the patient will come to
believe that it should always be done that way
– Patients observe and imitate just like toddlers
watch their parents, both good and bad practices
Learning assumptions
• Nurses have to consider the developmental
stage, cognitive level, and interests of the
learner
– Obviously, the nurse will use different teaching
approaches with young children than with mature
adults
• Nurses have to consider what kind of material
is to be taught, as well as the skills and
abilities of the learner
– Nurses may have to adapt their teaching style for
patients with disabilities, who are illiterate, or who
don’t speak English
• Children deserve special planning for health
teaching
How to facilitate learning
• Use methods that stimulate a variety of
senses
– If the learner can touch and manipulate equipment
that he will have to learn to use, it will be more
effective than simply having him watch a video
• Actively involve the learner in the learning
process
– Find out what the learner wants and needs to know
– Let the learner set the pace for teaching sessions
– Let the learner participate in the teaching sessions,
by joining in discussions, handling equipment, and
performing return demonstrations.
How to facilitate learning
• Establish a comfortable, appropriate learning
environment
– Teaching is not effective when the patient is in pain,
nauseated, preoccupied with upcoming tests or
upset about a new or terminal diagnosis
– Teaching is not effective when there are multiple
distractions that draw attention away from the
material being presented (busy ERs, loud,
interrupting roommates)
• Assess the readiness of the learner, which
may be affected by physical or emotional
factors
– See if the learner is ready to participate in the
teaching session- if not, it is best to delay the
teaching until a later time
How to facilitate learning
• Make the information relevant by connecting
with the existing needs and interests of the
learner
– Focus on what the learner wants and needs to
know, not irrelevant material that will probably be
quickly forgotten
– Relate the material to the learner’s life and condition
so that it has meaning for the learner- it will then be
more likely adopted as a lifestyle change
• Use repetition and review to reinforce
concepts several times
– Use a variety of methods to prevent boredom
– Repeat demonstrations are effective, as they allow
the learner to practice techniques as many times as
needed until proficiency is reached
How to facilitate learning
• Make the learning encounter positive
– If the learner does not respect and appreciate the
teacher as a professional, the information is less
likely to be learned effectively
– Structure the teaching session to include frequent,
positive feedback for the learner
– Use an upbeat, positive attitude
• Start with what is known by the learner and
proceed to what is unknown
– Move from the simple to the complex
– Give the learner credit for what is already known
and understood
– Allow the learner to proceed at his own pace
How to facilitate learning
• Apply the concepts to real settings to
facilitate understanding and application into
the learner’s lifestyle and practices
– Use language that is easily understood by the
learner
– Make the information real and let the learner know
how what you are teaching can impact his health
and daily activities
• Pace the teaching session to the needs of the
learner, not the nurse
– Just because the nurse is done teaching, it
doesn’t mean that the learner understands
the material!
Family health education
• Families must often learn specific tasks to
care for an ill family member
– Patients are now going home with tube
feedings, IV infusions, tracheostomies,
urinary catheters, surgical drains, and
other care needs that family members will
be responsible for
– Teaching by nurses allows patients to stay
at home with their families instead of being
sent to nursing homes and extended care
facilities
• Healthy behaviors are learned (or not) within
the family structure
Assessment
To assess a person’s perceived state of
health or threat of disease,
the nurse examines the following:
• Individual perceptions or readiness for
change
– If the learner isn’t interested, the change probably
won’t happen, despite all the teaching in the world
• The values of health to the individual as
compared to other aspects of living
– Value of avoiding lung cancer vs. enjoyment of
smoking
– Value of avoiding heart disease vs. enjoyment of
fast food and watching TV instead of exercising
Assessment
• Perceived susceptibility to a disease and its
potential complications
– “I won’t get lung cancer because I smoke less than
a pack a day”
– “I don’t drink enough to cause liver damage”
• Perceived seriousness of the disease
threatening the achievement of certain goals
or aims
– “If I have a heart attack, I won’t be able to travel all
over the world after I retire- I better start exercising
and watching what I eat!”
– “I don’t want to bother with a rectal exam any moreprostate cancer is no big deal at my age”
Assessment
• Belief in the diagnosis and therapy plan
– If the patient does not believe in the diagnosis or
therapy plan, teaching will probably not be effective
– For example:
– “What’s the point of doing all these exercises? My
left side is permanently paralyzed after my stroke”
– “I’m not really sure if I should have a lumpectomy or
have a total mastectomy to make sure that the
cancer doesn’t come back”
– “I did some reading about chemotherapy and I
found out that this drug offers the best chance of
remission for my cancer”
– “I don’t really think that there is anything wrong
with my heart- it was just a little heartburn and I feel
fine now”
Assessment
• People who value the perceived benefits will
attempt to make lifestyle and health changes
when:
– Their current lifestyles pose a threat to a personally
valued outcome, such as health or appearance
• “I better stop sunbathing so much or my face will look
like a prune in a few years”
– Particular behavioral changes will reduce the threat
to their valued outcome
• “I better start exercising if I want to be able to keep up
with my grandkids”
– They are personally capable of adopting the new
behaviors
• “I can start grilling my chicken instead of frying it, and
eating frozen yogurt instead of Ben & Jerry’s Chunky
Monkey ice cream.”
When people just don’t learn…
• They are often labeled as “noncompliant” by
health care staff
– This term implies that the individual has not
followed the instructions of the health care
professionals
– Enlisting the learner’s partnership or cooperation is
crucial  the learner has to embrace the lifestyle
change as their own, not simply agree to follow
orders
– Often there are other reasons for noncompliance
• Patients are often unable to read the educational
information that is given to them
• Patients often cannot afford to pay for medications or
treatment supplies
• The treatment plan goes against religious or cultural
beliefs
When people just don’t learn…
• Effective health education requires an
understanding of the influential factors
affecting decision-making
– Values, beliefs, attitudes, or religion
• “I just don’t believe in prolonging life when it’s
someone’s time to pass”
• “I can’t follow my diet this month- I need to fast for
Ramadan”
– Current life stressors
• “I haven’t got time to check my blood sugar before
every meal- I’m just too busy working two jobs trying
to make ends meet”
– Previous experiences with the health care system
• “The visiting nurse was useless last time, so there’s
no point in having one come out again.”
– Life goals
• “I can’t follow my diet very well when I am traveling
for work- which is all the time!”
Noncompliance
• Rather than being a failure of the patient, it
may be a failure of the treatment and teaching
plan
• It is up to the nurse to assess the situation:
– A more effective teaching plan may need to
be developed
– The treatment plan may need to be
adjusted or changed completely
– The patient may need assistance dealing
with stressors or obstacles that are
preventing compliance
Assessing learning needs
•
What are the characteristics and learning
capabilities of this individual (or family)?
•
What are the individual’s (or family’s) needs
for health promotion, risk reduction or heath
problems?
•
What does the individual (or family) know
already, and what skills can already be
performed that are relevant to health
needs?
•
Is the individual (or family) motivated to
change unhealthy behaviors?
•
What are the barriers to and stimuli for
heath behavior change?
Domains of learning- #1
• Cognitive
– The acquisition of knowledge about facts
or concepts, building on or applying
knowledge to new situations
– It is important for patients to not only gain
new knowledge, but to be able to apply it in
real-life situations
– For example: It is not enough for patients
simply to know the signs and symptoms of
hypoglycemia- they need to be able to
recognize the signs and symptoms when
they occur!
Domains of learning - #2
• Psychomotor
– Developing physical skills from simple to
complex actions
– Both mental and physical abilities are
required to perform procedures and skills
– For example, teaching patients to:
• Give themselves injections
• Care for colostomies
• Wound care and dressing changes
• Suctioning
Domains of learning- #3
• Affective
– Recognition of values, religious and
spiritual beliefs
– Family interaction patterns and
relationships
– Personal attitudes that affect decisions and
problem-solving processes
– For example:
• Helping patients deal with the emotional impact
of having a new colostomy- looking at it, fear of
others seeing it or knowing about it
• Teaching patients about the emotional impact of
a disability or having a disabled child
The ADULT model for teaching
A
Establish rapport by eliciting the patient’s
ACTIVE INVOLVEMENT
D
Assess needs by listening carefully as the
patient DISCUSSES CONCERNS
U
Develop a plan by promoting an
UNDERSTANDING OF THE ISSUES
L
Implement the plan by offering patients
opportunities to LEARN NEW
BEHAVIORS
T
Evaluate the plan by identifying strategies
for TRACKING PATIENT PROGRESS
McCann, D. & Blossom, J. (1990). The physician as patient educator. The Western
Journal of Medicine, 153 (1), 44-49.
A: Elicit active involvement!
• It is important to build a rapport with the
patient when starting to teach patients:
• Patients who find their health care providers
to be courteous, friendly, and approachable
tend to absorb the information better and
make the suggested lifestyle changes than
patients who find their health care providers
to be inattentive or indifferent.
• Interest, empathy, and thoughtfulness by the
nurse are associated with increased
attentiveness by patients to educational
information
D: Discuss concerns
• Establish what the patient’s priorities are by
allowing the patient to verbalize their health
care needs and concerns
• If a diabetic patient just wants to learn about
insulin pumps and the nurse wants to teach
about exercise, the teaching session probably
will not be very effective
• The nurse and patient may “negotiate” topics
to be covered. Perhaps the insulin pumps
could be covered in the first session, and
exercise could be covered later.
U: Understand the issues
• Patients are often disappointed in teaching
sessions when the nurse did not provide the
information that the patient needed or wanted.
• The nurse should work with the patient to
develop the agenda for the teaching session
to make sure that the patient receives
meaningful information
• Adherence and recall of information is
improved when both the patient and nurse
agree on the topics and importance of the
material
• Encouraging patients to become involved in
the planning process has a positive impact on
patient learning!
L: Learn new behaviors
• Instructions should be unambiguous, and
important issues should be emphasized
• The nurse’s approach should be friendly and
instructive, but not dictatorial
• But remember- nurses don’t have to do it all!
• Associated health care providers can provide
a good deal of information to patients as well!
– Dieticians can offer suggestions for meal
preparation and diets
– Physical and occupational therapists can
suggest exercises and tips for activities of
daily living
T: Track patient progress
• When health care providers make an attempt
to identify why patients do not make the
suggested lifestyle changes, patients often
relate their difficulties so that further teaching
can occur
• This can then lead to the desired lifestyle
change by the patient!
• Nurses need to monitor the patient’s behavior
closely after the teaching, and document their
observations in the medical record!
Bottom line:
• Teach when the patient is ready!
• Get your patients involved in your teaching!
• Make the teaching an enjoyable experience
for the patient!
• Focus on what they want and need to know!
• Don’t forget that other health care
professionals may be able to give you a hand!
• Make sure to follow up afterward!