Transcript Thelan`s Critical Care Nursing

Chapter Three
Priorities in
CRITICAL CARE
NURSING
Patient and Family
Education
Fourth Edition
Linda D. Urden
Kathleen M. Stacy
Mary E. Lough
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Chapter 3-1
Objectives
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Adapt and apply teaching-learning theory to the
critical care setting.
Perform a learning needs assessment.
Construct a teaching plan for patients in the
critical care unit.
Discuss four methods of instruction and the
appropriateness of each to the critical care
setting.
Describe informational needs of families of
critically ill patients.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Adult Learning Principles
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Adults:
 Must be ready to learn.
 Need to know why it is important to learn
something.
 Are responsible for their own decisions.
 Obtain recognition of experience they bring to the
learning environment.
Motivation for the adult learner arises out of internal
pressures—self-esteem and quality of life.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Box 3-1
Steps in the Patient/Family Education Process
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Assessment—information gathering
Education plan development
Implementation
Evaluation
Documentation
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Slide 4
Assessment
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Gathering information for the purpose of
identifying actual or potential learning
needs
Identifies gaps in knowledge, attitudes,
and skills the patient or family has
regarding the illness, environment, or
lifestyle
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Box 3-2
Assessment Questions for the Critically Ill Patient and Family
What brings you to the hospital? Can you tell
me more?
 What have you been told so far about your
(your family member’s) condition and plan of
care?
 What is the most important thing for you to
know right now?
 What would you like to know? What information
can I give you right now?

(Continued)
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Slide 6
Box 3-2
Assessment Questions for the Critically Ill Patient and
Family (Continued)
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Who are your main support people?
Has anything like this ever happened to you (your
family) before?
Have you (your family) ever been in an intensive
care unit or hospital before?
Do you have any special concerns that we need
to address right now?
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Factors Affecting Ability, Willingness,
and Readiness to Learn
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Physiologic stressors
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Psychologic stressors
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Sociocultural stressors
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Financial stressors
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Environmental stressors
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Development of Education Plan
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The education plan must be:
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Ongoing.
Interactive.
Consistent with the patient’s plan of care and
education level.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Box 3-3
Essential Critical Care Information for the Patient/Family
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Orientation to the various care providers
and the services they deliver
Orientation to the unit environment
Orientation to the unit routines and plan of
care
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Visiting hours, frequency of monitoring and
nurse assessments, venipunctures, daily
weights, special shift routines
(Continued)
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 10
Box 3-3
Essential Critical Care Information for the Patient/Family
(Continued)
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Explanations regarding reasons for
equipment, monitors, and associated alarms
Explanations of all procedures and expected
sensations/discomforts both in and off the
unit
Medications given
 Drug name, reason for receiving, side
effects to report to nurse/others
Immediate plan of care
(Continued)
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 11
Box 3-3
Essential Critical Care Information for the Patient/Family
(Continued)
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Transition to next level of care
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Reason for transfer, environment, staffing,
availability of care providers
Discharge plan
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Medications, diet, activity, pathophysiology of
disease, symptom management, special
procedures and associated equipment, when
to call health care provider, available
community resources
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 12
Assessment Information
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Information gathered from the assessment
must be analyzed.
Information is used to:
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Prioritize education needs.
Formulate a nursing diagnosis.
Develop an education plan of care.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 13
Education Plan of Care
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Expected outcomes
Objectives
Content to be taught
Interventions
Available education materials
Appropriate teaching strategies
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Slide 14
Implementation of Education Plan
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Patients in critical care are educated in
many informal interactions.
View each encounter with the patient/family
as a teaching opportunity.
More formal or structured educational
experiences may be required.
Nurse needs awareness of barriers to
learning as well as factors that can affect
the interaction.
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 15
Teaching Methods
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Lecture
Discussion
Demonstration
Written
materials
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Audiovisual media
Computer-assisted
instruction
Internet websites
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Slide 16
Evaluation
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Evaluate as each intervention is completed
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Provide feedback to the patient and family
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Evaluate response to the teachinglearning interaction
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Level of interest
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Willingness to learn
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Level of participation
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Slide 17
How to Evaluate
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Verbal questioning
Observation and return demonstration
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Evaluation method of choice for skills-learning
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 18
Documentation
What has occurred during a session?
•
Interaction
• Material taught
• Learner response
(Continued)
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 19
Documentation (Continued)
Assessment of Learning Process
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Learning needs
Abilities
Preferences
Readiness to learn
Potential barriers to learning
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 20
Documentation Essentials
Evaluation of Learning Process
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Expected outcome/goals
Interventions
Objectives
Who was taught
(Continued)
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 21
Documentation Essentials (Continued)
Evaluation of learning process
•
What was taught
• Materials used
• Patient/family response
• Follow-up education or materials needed
Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 22
Sedated and Unconscious Patients
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Special population of critically ill patients
with special needs
May not be able to respond or participate
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Effectiveness of teaching process cannot be
evaluated
Provide information regarding
environment, procedures, sensations, and
time of day
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May decrease environmental stress
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Slide 23
Informational Needs of Families
in Critical Care
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Consider the information and emotional
support needs of family members
Greatest need is for information
Flexible visiting hours and informational
booklets help meet this need
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Slide 24
Preparation for Transfer
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Fear of the unknown
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Explanations to relieve anxiety
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Transfer destination
Reason for transfer
Nurse who will assume care of the patient
Expected changes in care
Expected self-care
Visiting hours and notification of family
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Slide 25