Transcript 10-1 Assessment of Client`s Response to Illness

Patient Education
and Drug Therapy
Copyright © 2006, 2001 by Mosby, Inc.
Slide 1
Successful Teaching





Positive reinforcement for desired behaviors
Feedback about progress toward goals
Individualization: learning needs are
determined for specific client and pace of
teaching is mutually negotiated
Facilitation: nurse assists client to take action,
such as making personalized medication
schedules
Relevance to client and family needs
Copyright © 2006, 2001 by Mosby, Inc.
Slide 2
Assess Client’s Ability to Manage
Medication Regimen




Competence in self-care and mobility
Social support mechanisms
Cultural issues, health beliefs, and attitudes
Factors influencing ability, motivation, and
interest in learning:





cognitive or sensory impairment
communication (including language spoken)
developmental stage
health behaviors; perception of current health status
knowledge and educational level
Copyright © 2006, 2001 by Mosby, Inc.
Slide 3
Assess Readiness to Learn

Readiness is paramount to learning and
should be assessed before beginning



Physically—comfort level both personally and
environmentally
Emotionally—upset, overwhelmed, worried
Mentally—motivated, anxiety level (mild is good),
educational level, cognition barriers
Copyright © 2006, 2001 by Mosby, Inc.
Slide 4
Learning Domains

Before teaching consider which method you
want to use:



Cognitive—learning verbal or written
communication and being able to recall it either
verbally or in written form.
Psychomotor—learning new procedures or skills
Affective—incorporating what is learned into
lifestyle and making permanent changes.
Incorporates attitudes, values, beliefs, and
emotions related to learning information.
Copyright © 2006, 2001 by Mosby, Inc.
Slide 5
Common Nursing Diagnoses Related
to Client Self-Administration of Medications





Deficient knowledge
Noncompliance
Ineffective therapeutic regimen management
Impaired memory
Risk for injury
Copyright © 2006, 2001 by Mosby, Inc.
Slide 6
Goal Setting



Before teaching also consider what you want
the patient/family to do and what you want the
outcome(s) to be.
Goals statements usually begin with the
words, “Patient will….” and should be specific
and contain a verb that is measurable, such
as “state” or “perform.” (see handout)
For example, “Pt will state 2 side effects of
blood pressure medicine.”
Copyright © 2006, 2001 by Mosby, Inc.
Slide 7
Implementing the Teaching Session




Focus the learning—good environment and
equipment, keep on track with what pt needs
Use variety of materials to appeal to different
ways of learning—touch several senses.
Be organized—check lists initiated by one
nurse and continued by others allows info to
be taught in phases.
Motivation—if pt knows reasons and benefits,
and receives praise, he/she is more
motivated
Copyright © 2006, 2001 by Mosby, Inc.
Slide 8
Implementation cont’d


Space content—watch for anxiety or
restlessness—may need to slow down or
reschedule. People remember what is
learned first best. Multiple short sessions are
best
Use repetition—multiple practice sessions
may be hampered by short hosp stay—can
educate before admission or f/u with HH or
reliable family.
Copyright © 2006, 2001 by Mosby, Inc.
Slide 9
Cultural Considerations






Explore meaning of illness—biomedical,
natural forces, supernatural forces
Communication—eye contact, personal
space, people to include
Avoid prejudices and stereotypes
Using interpreters
Who makes decisions in family?
Is pt taking folk or home remedies or those
suggested by shaman or medicine man?
Copyright © 2006, 2001 by Mosby, Inc.
Slide 10
Literacy Issues

If client cannot read, written materials are not
helpful. Sometimes pts are truthful and
sometimes they aren’t. How do you tell if
someone can’t read?

Not filling out hosp menu
 Not reading newspaper, if available
 Professing fatigue and asking family to read
instructions
 “I forgot my glasses.”
 I’ll read them when my wife (husband) gets here.”
 Not recording results at home
Copyright © 2006, 2001 by Mosby, Inc.
Slide 11
Literacy cont’d

If nurse suspects pt cannot read or has
limited skills:
 Include pictures or icons on materials
 Med charts with pictures of times of day
med is needed. Pictures or drawings of
the med, or an actual pill pasted to
instructional sheet is helpful.
 Elicit family assistance
Copyright © 2006, 2001 by Mosby, Inc.
Slide 12
Developmental Issues
Children need to be taught
according to their level of
understanding. Nurses need to
understand child development
 For older adults, see handout

Copyright © 2006, 2001 by Mosby, Inc.
Slide 13
Specific Implementation Techniques






Explain responses to therapy—”We expect
this med to do…….”
Pt should know changes that may be caused
by meds (urine color, sunburn)
Precautions necessary—operating
machinery, ortho BP, labs
What to do if pill is missed
Have pt keep records if they are necessary to
evaluate therapy
Take as prescribed—don’t’ try to self-regulate
Copyright © 2006, 2001 by Mosby, Inc.
Slide 14
Specifics cont’d







Tell pt who to call for questions or concerns
Include family member
Tell how foods may be involved
ETOH and smoking may alter action and
absorption—check with MD
Use written material for back-up. (handout)
Keep meds in original container, don’t put
pills together, store correctly
Keep out of reach of children—some pts
need standard lids
Copyright © 2006, 2001 by Mosby, Inc.
Slide 15
Specifics cont’d








Check with MD/pharmacist about OTC drugs
Bring meds with you for MD visits or hosp
Report SE—may not just be “old age”
Prepare a weeks supply in container—helps
to know if med was taken & when refill is
needed
Read label each time
Wear medic alert for allergies, blood thinners
# of Poison Control
Do not borrow or lend meds
Copyright © 2006, 2001 by Mosby, Inc.
Slide 16
Evaluation


Evaluate learning acc’d to learning domain;
cognitive, psychomotor, affective
Must have 4 things:




specific content taught
method used to present material
method used to evaluate learning
response of patient
Copyright © 2006, 2001 by Mosby, Inc.
Slide 17
Documentation


Documentation helps next nurse know what
has been taught and what needs to be done.
Don’t forget to document all teaching no
matter how small. JCAHO has found lack of
documentation of patient and family’s
knowledge of self-care to be most common
nursing documentation deficiency.
Copyright © 2006, 2001 by Mosby, Inc.
Slide 18
Assessment of Compliance with
Medication Therapy



Patient can make own choices—just because
health professional said it doesn’t mean
patient will do it.
Noncompliance is not always willful. Lack of
understanding, poor instruction, complicated
task, sensory deficits, lack of transportation,
cost, etc.
Sometimes it is willful. Patient feels better,
doesn’t believe he needs it, can’t accept dx,
believes med contaminates body or causes
dependence, or is suffering intolerable SE.
Copyright © 2006, 2001 by Mosby, Inc.
Slide 19