Transcript 16. Conception Through Adolescence Client Education

Conception Through Adolescence
Client Education
The development of children ages 12 through 18 years old is
expected to include predictable physical and mental
milestones.
During adolescence, children develop the ability to:
 Understand abstract ideas, such as higher math concepts, and
develop moral philosophies, including rights and privileges
 Establish and maintain satisfying relationships by learning to
share intimacy without feeling worried or inhibited
 Move toward a more mature sense of themselves and their
purpose
 Question old values without losing their identity
PHYSICAL DEVELOPMENT
During adolescence, young people go through many changes as
they move from childhood into physical maturity. Early,
prepubescent changes occur when the secondary sexual
characteristics appear.
Girls:
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Girls may begin to develop breast buds as early as 8 years
old. Breasts develop fully between ages 12 and 18.
Pubic hair, armpit and leg hair usually begin to grow at
about age 9 or 10, and reach adult patterns at about 13 to
14 years.
Menarche (the beginning of menstrual periods) typically
occurs about 2 years after early breast and pubic hair
appear. It may occur as early as age 10, or as late as age
15. The average age of menstruation in the United States
is about 12.5 years.
Girls have a rapid growth in height between ages 9.5 and
14.5, peaking at around age 12.
Boys..
Boysmay begin to notice that their testicles and scrotum grow as
early as age 9. Soon, the penis begins to lengthen. By age 16 or
17, their genitals are usually at their adult size and shape.
 Pubic hair growth -- as well as armpit, leg, chest, and facial
hair -- begins in boys at about age 12, and reaches adult
patterns at about 15 to 16 years.
 Boys do not start puberty with a sudden incident, like the
beginning of menstrual periods in girls. Having regular
nocturnal emissions (wet dreams) marks the beginning of
puberty in boys. Wet dreams typically start between ages 13
and 17, with the average at about 14.5 years.
 Boys' voices change at the same time as the penis grows.
Nocturnal emissions occur with the peak of the height spurt.
BEHAVIOR...
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The sudden and rapid physical changes that adolescents go through
make adolescents very self-conscious, sensitive, and worried about
their own body changes. They may make painful comparisons about
themselves with their peers.
Because physical changes may not occur in a smooth, regular
schedule, adolescents may go through awkward stages, both about
their appearance and physical coordination. Girls may be anxious if
they are not ready for the beginning of their menstrual periods. Boys
may worry if they do not know about nocturnal emissions.
During adolescence, it is normal for young people to begin to
separate from their parents and establish their own identity. In some
cases, this may occur without a problem from their parents and other
family members. However, in some families, the adolescent's
rebellion may lead to conflict as the parents try to keep control.
As adolescents pull away from their parents in a search for their own identity,
their friends become more important.
 Their peer group may become a safe haven, in which the adolescent can test
new ideas.
 In early adolescence, the peer group usually consists of non-romantic
friendships, often including "cliques," gangs, or clubs. Members of the peer
group often try to act alike, dress alike, have secret codes or rituals, and
participate in the same activities.
 As the youth moves into mid-adolescence (14 to 16 years) and beyond, the
peer group expands to include romantic friendships.
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In mid- to late adolescence, young people often feel the need to
establish their sexual identity by becoming comfortable with
their body and sexual feelings. Through romantic friendships,
dating, and experimentating, adolescents learn to express and
receive intimate or sexual advances. Young people who do not
have the opportunity for such experiences may have more
difficulty with intimate relationships when they are adults.
Adolescents usually have behaviors that are consistent with
several myths of adolescence:
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The first myth is that they are "on stage" and other people's attention is
constantly centered on their appearance or actions. This normal selfcenteredness may appear (especially to adults) to border on paranoia, selflove (narcissism), or even hysteria.
Another myth of adolescence is the idea that "it will never happen to me,
only the other person." "It" may represent becoming pregnant or catching a
sexually-transmitted disease after having unprotected sex, causing a car
crash while driving under the influence of alcohol or drugs, or any of the
many other negative effects of risk-taking behaviors.
SAFETY..
Adolescents become stronger and more independent before
they've developed good decision-making skills. A strong need
for peer approval may entice a young person to try dangerous
feats, or take part in risk-taking behaviors.
Motor vehicle safety should be stressed, focusing on the roles of
the driver/passenger/pedestrian, the risks of substance abuse,
and the importance of using seat belts. Adolescents should not
have the privilege of using cars and recreational motor vehicles
unless they can show that they can use these vehicles safely.
Other safety issues are:
Adolescents who are involved in sports should learn to use
equipment and protective gear or clothing. They should be
taught the rules of safe play and healthy approaches to
activities that require more advanced skills.
Young people need to be very aware of possible dangers -including sudden death -- which may occur with regular
substance abuse, and with the experimental use of drugs and
alcohol.
Adolescents who are allowed to use or have access to firearms
need to learn how to use them safely, properly, and legally.
PARENT’S TIPS ABOUT SEXUALITY
Adolescents usually need privacy to understand the changes taking place in
their bodies. Ideally, they should be allowed to have their own bedroom. If
this is not possible, they should have at least some private space.
Teasing an adolescent child about physical changes is inappropriate, because it
may cause self-consciousness and embarrassment.
Need to remember that it is natural and normal for their adolescent to be
interested in body changes and sexual topics. It does not mean that a child is
involved in sexual activity.
Adolescents may experiment with or consider a wide range of sexual
orientations or behaviors before feeling comfortable with their own sexual
identity. Parents must be careful not to call new behaviors "wrong," "sick,"
or "immoral”.
INDEPENDENCE AND POWER STRUGGLES
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The teenager's quest to become independent is a normal part of
development. The parent should not see it as a rejection or loss of control
over the child. Parents need to be constant and consistent. They should be
available as a sounding board for the youth's ideas, without dominating the
child's newly independent identity.
Although adolescents always challenge authority figures, they need or want
limits, which provide a safe boundary for them to grow and function. Limitsetting means having pre-set rules and regulations about their behavior.
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Power struggles begin when authority is at stake or "being right" is the main
issue. These situations should be avoided, if possible. One of the parties
(typically the teen) will be overpowered, causing the youth to lose face. This
can cause the adolescent to feel embarrassed, inadequate, resentful, and
bitter.
Parents should be ready for and recognize common conflicts that may
develop while parenting adolescents. The experience may be affected by
unresolved issues from the parent's own childhood, or from the adolescent's
early years.
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Parents should know that their adolescents will repeatedly
challenge their authority. Keeping open lines of communication
and clear, yet negotiable, limits or boundaries may help reduce
major conflicts.
Most parents feel like they have more wisdom and self-growth
as they rise to the challenges of parenting adolescents.
PATIENT EDUCATION..
Patient education is defined as any set of planned educational
activities designed to improve patients’ health behaviors and
health status. Its main purpose is to maintain or to improve
patient health or, in some cases, to slow deterioration.
However, patient and family education goes beyond this main
purpose.
An informed and educated patient can actively participate in his
or her own treatment, improve outcomes, help identify errors
before they occur, and reduce his or her length of stay.
THE BENEFITS OF PATIENT EDUCATION
INCLUDE:
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Increasing the patient's ability to cope with and manage his or her health
Facilitating understandings of health statuses, diagnosis and treatment
options, and consequences of care for patients and their families
Empowering patients to make decisions related to their care
Increasing patients’ potential to follow a health care plan
Helping patients learn healthier behaviors
Promoting recovery and improved function
Increasing patient confidence in his or her self care
Decreasing treatment complications
Other Benefits of Patient Education
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Increases patient understanding of needs. Informed patients
who understand their conditions are more prepared to
understand options for treatment and consequences of care.
Improves coordination of multiple parts of a condition.
Patient education can help improve coordination of care for
patients with complex conditions.
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Increases patient self-management and ability to self-advocate.
Education empowers patients to take an active role in managing their own
health care. For instance, if an asthmatic patient understands that being
around smokers can be harmful to them, they can actively avoid secondhand
smoke and ask others to refrain from smoking around them.
Increases patient motivation and adherence. Informed patients who
understand their conditions and needs are more motivated to follow a care
plan and adhere to guidelines.
Improves outcomes. When patients are more motivated and adhere to
guidelines, they are more likely to achieve better outcomes.
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Increases satisfaction and experience. When patients' experience better
outcomes, satisfaction and patient experience generally increase.
Decreases patient attrition. Educated patients who achieve positive
outcomes and have positive experiences are more likely to stay with their
current provider and recommend that provider to friends.
Decreases complications. When patient outcomes improve as a result of
patient education, the likelihood of complications decreases, as well.
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Decreases unnecessary phone calls, visits, readmissions. When patients
are informed and educated, they are less likely to call with questions or
come in for unnecessary visits.
Decreases malpractice risk through engagement and expectation
setting. When patients are more engaged, adherent and satisfied, the risk of
malpractice claims is greatly reduced.
ORGANIZATIONS THAT PROVIDE TARGETED AND
APPROPRIATE PATIENT AND FAMILY EDUCATION CAN
REAP OTHER BENEFITS AS WELL, INCLUDING:
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Increased customer satisfaction
Compliance with regulatory standards
Improved efficiency through cost-effective care
Better informed patients and a lessened chance for malpractice
claims
EDUCATION PROVIDERS
|May include:
physicians,
physician assistants,
pharmacists,
registered dietitians,
registered nurses,
advanced practice nurses,
health librarians,
hospital discharge planners,
medical social workers,
psychologists,
disease or disability advocacy groups,
special interest groups,
health advocates and pharmaceutical
companies.
Patients education techniques
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Computer-aided teaching: Computer or other output devices allow patients to
view and to hear patient education materials in the hospital and some of these
materials can be reviewed at home. Manuals are often made available to accompany
the computerised programs. And there is usually a test to evaluate learning once the
program is completed.
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Video education: Video education is very similar to computer-based training. But, it
is more difficult to evaluate learning. A written post-test could be used after the
video is reviewed. But, it is important with both of these media to consider the
patients’ educational level, language, and hearing/seeing abilities.
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Demonstration: Demonstration is another effective patient-teaching
technique. Patients can be showed how to complete a task or how a process
works in a one-on-one setting, and then they can do the task more
effectively at home. However, in an acute care setting this might be more
difficult to do. The pace is much faster, but case managers or patient care
assistants can be used to assist the nurse if needed. And, demonstration does
ensure that patients fully understand the teaching, and it allows them to get
feedback and ask questions in a safe arena.
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Written material: Written material seems so easy and routine. But, it can
be effective. For instance, material with pictures can offer instructions or
explanations. Written material related to prescribed medicines is also a
necessity. And, it can offer instructions in a step by step fashion. Once
again, it is important to evaluate the patients’ literacy level, language, and
sight before handing out routine teaching materials.
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Discharge instructions: At the time of discharge, patients can be equipped
with a set of instructions with follow-up appointments, medication teaching,
and phone numbers. Many discharge instructions can easily be printed using
PHR and EMR software systems. These instructions usually give phone
numbers (of whom to call with questions) and follow-up appointment
instructions.
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Discharge prescriptions: Prescriptions for discharge medications are
usually included in these instructions. It is important to verify that the
patient knows the names, the purpose, and the dosage instructions for these
medications. If needed, verify with the case manager that the patient can
afford these medications; and if needed, call them into their pharmacy
before discharge.
Evaluating patient learning
Effective patient teaching also requires evaluation and
documentation. Learning can be evaluated in the following
ways:
 Asking questions: Simply ask the patient questions to see
whether they is information that needs reinforcing.
 Observe return demonstration: Watch the patient perform a
task (i.e. self inject insulin) to see if the technique is correct.
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Assess the data: Ask the patient to record his blood pressure,
blood glucose, or weight at home. And, review the records at
the next visit. These records will demonstrate how effective
the current treatments have been.
Talk with the patient/family: At the next visit, or before
discharge, talk with the family to see how the patient has been
doing, or before they leave the hospital, engage in open
dialogue about barriers or concerns. This is very similar to the
idea of “asking questions, “ but both methods are useful.
Documenting patient teaching
There are many computerised systems out there. And some
offices might still use hand-written documentation. Whatever
method you use remember that the information must become a
part of the patient’s permanent medical record. You can
include in the documentation:
 Information and skills you have taught
 Teaching methods used – brochures, models, videos,
demonstration
 Patient and family response to teaching
 Evaluation of what the patient and family have learned and
how learning outcomes were determined