C H A P T E R 8 ● Client Teaching 105
English or if English is a second language (see Chap. 6, Nursing Guidelines 6-1). Language barriers do not jus- tify omitting health teaching. In most cases, if neither the nurse nor the client speaks a compatible language, a translator is used.
Attention and Concentration
The client’s attention and concentration affect the dura- tion, delivery, and teaching methods employed. Some helpful approaches include the following:
• Observe the client, and implement health teaching when he or she is most alert and comfortable.
• Keep the teaching session short.
• Use the client’s name frequently throughout the instruc- tional period; this refocuses his or her attention.
• Show enthusiasm, which you are likely to communicate to the client.
• Use colorful materials, gestures, and variety to stimulate the client.
• Involve the client in an active way.
• Vary the tone and pitch of voice to stimulate the client aurally.
Motivation
Learning is optimal when a person has a purpose for acquiring new information. Relevance of learning depends on individual variables. The desire for learning may be to satisfy intellectual curiosity, restore independence, pre- vent complications, or facilitate discharge and return to
the comfort of home. Less desirable reasons are to please others and to avoid criticism.
Learning Readiness
When capacity and motivation for learning exist, the nurse can determine the final component, learning readi- ness. Readiness refers to the client’s physical and psy- chological well-being. For example, a person who is in pain, is too warm or cold, is having difficulty breathing, or is depressed or fearful is not in the best condition to learn. In these situations, it is best to restore comfort and then attend to teaching.
Learning Needs
The best teaching and learning take place when both are individualized. To be most efficient and personalized, the nurse must gather pertinent information from the client.
Second-guessing what the client wants and needs to know often leads to wasted time and effort.
The following are questions the nurse can ask to assess the client’s learning needs:
• What does being healthy mean to you?
• What things in your life interfere with being healthy?
• What don’t you understand as fully as you would like?
• What activities do you need help with?
• What do you hope to accomplish before being dis- charged?
• How can we help you at this time?
Informal teaching is unplanned and occurs sponta- neously at the bedside. Formal teaching requires a plan.
Without a plan, teaching becomes haphazard. Further- more, without some organization of time and content, the potential for reaching goals, providing adequate information, and ensuring comprehension is jeopar- dized. Potential teaching needs generally are identified at the client’s admission, but they may be amended as care and treatment progress.
A student nurse may work with a staff nurse or instruc- tor in developing a teaching plan. Usually one or more nurses carry out certain specific parts of a teaching plan (Fig. 8-3). This approach is the most desirable so that a client is not overwhelmed with processing volumes of new information or learning skills that are difficult for novices to perform. Skill 8-1 serves as a model when an adult client needs teaching.
106 U N I T 3 ● Fostering Communication
GENERAL GERONTOLOGIC C O N S I D E R A T I O N S
Refer to Table 8-1 for gerogogic learner characteristics.
Refer to Nursing Guidelines 8-1 for recommendations when teaching clients with sensory impairments.
During initial assessment of levels of cognitive function, clients may interact in a socially appropriate manner and may indicate that they understand material being taught. Asking a client to recall what has been discussed after approximately 15 minutes have passed may help determine what information has actually been retained. A mental status examination may be indicated (see Chap. 13). If there is cognitive impairment, a support per- son or caregiver should be present for the teaching sessions.
Most people are “creatures of habit” and are reluctant to make changes without understanding the benefit. Older people may be creative in methods to incorporate needed changes in health behavior if the purposes or anticipated benefits are made clear at the beginning of the teaching session.
Beginning the teaching session with a reference to the older person’s actual experience will help provide a link to which the new learning can connect.
A calm demeanor and quiet environment can decrease anxiety or distractions that prevent new learning. Peer teaching or reinforcement in support group settings may be helpful.
Stating a belief that the older person can actually make the rec- ommended health behavior changes and providing encour- agement may increase the client’s perception of self-efficacy with resultant increased learning.
CRITICAL THINKING E X E R C I S E S
1. How would the nurse teach techniques for toothbrush- ing differently to a child; a person from the Y, X, or Net generations; a young adult; a middle-aged adult; and an older adult?
2. What teaching strategies could the nurse use to teach toothbrushing within the cognitive, affective, and psy- chomotor domains of learning?
3. Give two examples of how you could determine whether a client actually learned information you taught such as toothbrushing.
NCLEX-STYLE REVIEW Q U E S T I O N S
1. Which of the following is essential before teaching the mother of a 6-year-old about nutrition?
1. Assess the child’s height and weight.
2. Obtain a food pyramid pamphlet.
3. Develop a plan for 1 week’s menus.
4. Collect various nutritional recipes.
2. After teaching a client how to perform breathing exer- cises, the best method for evaluating the effectiveness of the teaching is to
1. Request that the client explain the importance of breathing exercises.
2. Ask the client to perform the breathing exercises as they were taught.
3. Ask the client if he is performing the breathing exercises as required.
4. Monitor the client’s respiratory rate several times a day.
3. Which of the following teaching aids is developmentally appropriate when preparing a preschool child for a diag- nostic test such as a bone marrow puncture?
1. Dolls or puppets 2. Pamphlets or booklets 3. Colored diagrams 4. Commercial videotapes FIGURE 8-3
•
The nurse performs teaching about diabetes at thebedside. She promotes multisensory stimulation by giving the client explanations and encouraging her to watch the technique for testing blood sugar as it is being performed. (Copyright B. Proud.)
C H A P T E R 8 ● Client Teaching 107
Skill
8-1• TEACHING ADULT CLIENTS
(continued) Assessment
Find out what the client wants to know.
Establish what the client should know to remain healthy.
Determine the client’s learning style.
Planning
Collaborate with client on content, goals, and realistic time frame.
Develop a written plan that builds from simple to complex, familiar to unfamiliar, and normal to abnormal.
Divide information into manageable amounts.
Select teaching strategies and resources that are
compatible with the client’s preferred style for learning.
Use a variety of instructional methods from the cognitive, affective, and psychomotor domains.
Review the content that will be used during teaching.
Implementation
Teach when the client appears interested and physically and emotionally ready to learn, if possible.
Provide an environment that promotes learning.
Identify how long the teaching session will last.
Begin with basic concepts.
Review previously taught information.
Use vocabulary within the client’s personal level of understanding.
Explain any and all new terms.
Involve the client actively by encouraging feedback and handling of equipment.
Stimulate as many senses as possible.
Invent songs, rhymes, or a series of key terms that correspond with the teaching content.
Use equipment as similar as possible to what the client will use at home.
Personal interest facilitates learning.
Clients are not always aware of what information is vital to maintain their health and safety.
Teaching is more effective when techniques support the client’s preferred learning method.
Adult learners tend to prefer collaboration and active involvement in the learning process.
Adult learners learn best by applying information from present knowledge or past experiences.
Too much information at once tends to overwhelm learners.
Adult learners generally prefer one learning style, but multiple approaches enhance learning.
Adults tend to retain more knowledge when a variety of instructional techniques are used.
Preparation and knowledge evoke self-confidence.
Learning takes place more easily when the client can focus on the task at hand.
Learning is best in a well-lit room with a comfortable temperature. Distractions and interruptions interfere with concentration.
Clarifying prepares the client for the demands on his or her time and attention.
Learning that builds from simple to complex is best.
Repetition increases retention of information.
Teaching at the learner’s level preserves dignity. The nurse is accountable for ensuring the client’s comprehension.
Clients sometimes are embarrassed to admit they do not understand.
Adult learners prefer active rather than passive learning situations.
Involvement of more than one sense enhances learning.
Creativity stimulates the right hemisphere of the brain where information is retrieved more easily.
Becoming familiar with equipment is the best preparation for self-care at home.
SUGGESTED ACTION REASON FOR ACTION
TEACHING ADULT CLIENTS
(Continued)Providing this opportunity helps the client clarify information and prevents misunderstandings.
Reviewing reinforces important concepts.
The ability to recall or apply information and to demonstrate skills is proof of short-term learning.
Planning the next meeting provides a time frame during which the client may review and practice what has been taught.
Immediate application reinforces learning and promotes long-term retention.
Documentation provides a written record of the client’s progress and avoids omissions or duplications during future teaching sessions.
Collaboration keeps the client focused on expected outcomes.
Evaluation is the basis for revising the teaching plan.
Implementation (Continued) Allow time for questions and answers.
Summarize the key points covered during the current teaching.
Determine the client’s level of learning.
Identify the time, place, and content for the next teaching session.
Arrange an opportunity for the client to use or apply the new information as soon as possible after it was taught.
Document the information taught and evidence demonstrating the client’s understanding.
Review with the client the progress made toward goals.
Evaluate the need for further teaching.
Evaluation
• The planned teaching content was covered.
• The client participated in the teaching process.
• The client recalled at least 50% of the concepts with accuracy.
Document
• Date and time
• Content taught
• Evidence of the client’s learning
SAMPLE DOCUMENTATION
Date and Time Explained the times for taking two drugs that require self-administration after discharge. States, “I take the yellow pill once in the morning before breakfast and I take one blue pill three times a day when I eat
breakfast, lunch, and supper.” SIGNATURE/TITLE
108 U N I T 3 ● Fostering Communication
109
9
Chapter Recording and
Reporting
W O R D S T O K N O W
auditors
beneficial disclosure change of shift report chart
charting
charting by exception checklist
computerized charting continuous quality
improvement documenting flow sheet focus charting Kardex