3 Teaching - Lecture notes 17 PDF

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TEACHING AND LEARNING Nurse practice acts in most states, and ABA in standard practice say nurse teaching is required for nursing care – it’s for pursuit of wellness. Trends in healthcare make it more important that a nurse be a teacher. Pts are in hospital shorter amount of time. We send them home sick with catheters, IVs, dressings, special diets, Picc Lines, etc. – so teaching is even more important, and time to do it in is more compressed. For example, if someone is coming in for knee surgery, teach them before surgery how to use crutches or walker. Quality of teaching has to be improved. In teaching chapter, they talk about learning domains – you don’t need to memorize all sub definitions – you need main definitions, like psychomotor, cognitive, affective. Teaching Planned method to help someone learn Learning Process by which person acquires or increases knowledge or changes behavior. Occurs in three different domains: Domains of Learning -Cognitive: Storing and recalling of new knowledge in brain – i.e. Pt states how salt effects his blood pressure. If you listen to objectives she has us listening, discussing, describing – we’re processing information. -Psychomotor: When skill is acquired. The Pt demonstrates how to change colostomy bag. The Student demonstrates how to give subq injection. Pt states how to do it, then pt demonstrates how to empty bag. When we go into the lab, we’re applying psychomotor. -Affective: Changes in attitudes and values and feeling. This is the hardest part. The pt adjusts to a mastectomy scar. How do we write that as a goal so we can measure it? Pt looks at it. Pt states how they feel. Pt states show me how to do the dressing change, I need to do this at home. Pt states she’s still beautiful.

PRINCIPLES OF TEACHING AND LEARNING The teaching and learning process is facilitated by a therapeutic relationship. Therapeutic relationship - Requires a non-threatening atmosphere. The Teacher’s attitude will have more of an effect than anything else. If you go in and act like you know it all, and they should do what you say, you’ve lost battle. Praise achievements, and focus on area that needs improvement. Communication - Mandatory for good teaching and learning. Manage verbal and non-verbal feedback. Thoroughly assess pt before teaching. We need to know how pt’s diagnosis affects their learning needs. Teaching and learning is more effective if adult is involved in setting objectives. There has to be a shared ownership of objectives with adults. Children are used to learning what we need them to know. Sometimes

relating material to past life or past experiences is helpful. Telling a pt if they do deep breathing if they play a wind instrument, you have something there to use as an example in teaching. (Assessment, planning, strategies, links)

OTHER CONSIDERATIONS Timing - Need to know how long it will take to teach a pt, and make arrangements to stay with that pt, so it might involve someone else staying with that pt. - When you’re teaching in nursing, always start with important content, and less important to follow. Scheduling - If you’re sick, you don’t want to learn stuff. You can’t plan big, long sessions. You’re better off planning shorter sessions, good for pt and nurse, b/c you can’t go in there and stay for an hour. If you followed around nurse giving meds, good time to teach pt about meds is when they give meds. “Here’s your Lasix, you’re going to be on it when you get home. Be sure to drink your OJ or eat half a banana b/c the Dr. didn’t put you on any K+ supplements. This is your Digoxin. Remember to take your pulse before you take your Digoxin. It has to be more than 60.” They’re engaged at this point, they’re interested, and they can get the content in little increments – which is much better than dropping it all on their head at discharge. Short sessions help pt absorb information. You need adequate space, comfortable chairs, adequate lighting. Environment - Most pts are older, need adequate space, you want good lighting (but not glaring), privacy (not everything is private like dressing change instructions, but if you’re in there talking about safe sex, they probably don’t want an audience. Should be free of distractions. You need learner objectives to evaluate if they’ve learned.

ASSESSING NEEDS Patient – need pt’s permission to talk to family about their issue. You need to determine what pt knows. If you go in and have to do diabetic teaching, and pt has been diabetic for 20 yrs, and you’re a beginning nursing student. They’ll be teaching you. They won’t pay attention if it’s obvious. - We can look at pt’s medical record, and see what they’ve been taught. We can ask them what they already know, what they need to know. We can have a discussion, about condition and situation. We can find out from the family what pt knows or didn’t know. If pt came in for 2 time in 6 mos. And their Blood sugar is 150 – if they’ve got knowledge, they’re not using it. Family – sometimes family needs to be taught. If teaching low Na diet, you need to teach the cook. If you’re teaching someone to read labels, teach the person shopping.

FACTORS AFFECTING LEARNING Developmental: You have to adjust to pt’s developmental stage. Children: they have dolls, they have IVs, dressings, PICC lines, and you take doll into kid that has appropriate thing, and teach child about it through play. One of the surgicenters had coloring book with the OR in it, with lights and gowns. So once they went in, they had a notion of what it looked like.

Adults – need to think they have to learn or they’re not interested. Many adults are afraid of learning process. We’ve convinced the elderly can’t learn new things. We just need a little patience with them. That whole process can be a threat to their self-concept and self-esteem, and they’ll resist learning b/c we convinced them they can’t. Level of education: Even if Dr of nuclear physics is a pt, they might not know where to put a catheter. Always use lay terminology until they indicate they want the higher level language. We’re smart, but when it’s our bodies, we’re not so smart anymore. People are nervous, and afraid. When we’re using lay terminology, keep it on the up and up until you determine you can’t. Physical condition: If pt is in pain, tired, hungry, etc – they’re not ready to learn. If doc just came in and biopsy came in and they have cancer, will they be interested? No. We need to schedule it about what’s going on with the pt. Senses: Can they see, hear, what we’re teaching them? Language is a problem for some pts, so make sure when we’re teaching make sure we have a language line, or someone who can speak language Emotional health: Make sure they’re listening, and ready to learn. You can’t teach a young girl about birth control when she keeps looking out the window to see if her boyfriend is here or not. Motivation: Sometimes a little anxiety is good. If you want to get someone interested in salt and diet, tell them they have high BP. Then they’ll be ready to learn. Communication skills: Don’t hand them a pamphlet if they can’t read it. There are a lot of people that can’t read. Even pamphlets can’t read at 6th grade level. They can read it if it’s printed in something else. Maybe there are videos that will help. On care plan, they say you can’t use teaching, educating, or instructing unless diagnosis is knowledge deficit. It only works if person has a knowledge deficit. Language:

TEACHING PLAN Assessment Planning Interventions - They say on our care plan, that you can’t put teaching, educating, or instructing the pt unless the diagnosis is really knowledge deficit. Teaching only works if person has a lack of knowledge. A lot of times she’ll see: “Teach pt to wash hands before meals.” DUH. They’re 45 yrs old. You can remind them, or bring them water or something. But it’s not the instruction that’s needed in this case, but just a reminder or helping them do it. - The interventions need to be teaching plan. So, i.e. Diagnosis will be knowledge deficit related to selfinjection of insulin. Then you have subjective and objective data to support that. Subjective would be

pt states “I don’t know if I can do this, I’m scared.” Objective data is they’re a Newly diagnosed diabetic, need to take 70/30 everyday, etc. Then goals would be: In psychomotor, pt demonstrates successful injection if insulin. For cognitive goal: pt will state the steps in administering insulin. Pt will state side effects of insulin, or side effects of hypoglycemia. Observable, measurable, time sensitive, realistic. Nursing intervention has content – need to lay out what you’re going to teach – maybe you’ll show them the video of self-injection of insulin. You’re going to give them a brochure – you’ll get them new diabetic kit with insulin syringes for them to take home. You’ll get some saline and orange and you’ll go in and work with the pt to draw it up and practice injection. Talk about injection sites. You have to list out all the content, can’t just list them all out, you have to teach them all the steps. The rationales will be from Cox. -Role modeling: -Discussion: -Demonstration: Implementation Evaluation -Did every step work? What was their response? Could they inject insulin? Were they successful? Were you successful? Cognitive– ask them questions, or state the main points of the lesson. Psychomotor – they demonstrate. Affective - their views, how do they feel, do they apply the knowledge, do they come back in 6 months later with high blood sugar? Documentation - Hospitals have different methods to document teaching/learning. They have multidisciplinary teaching record where you need to document what’s been taught. And was it effective, and did pt learn? Were objectives met? Could be in nurses notes, may be on special form....