Nursing 619: Teaching Plan

Patient education is very important and is one of the many tasks that nurses incorporate into patient care. Patient education allows the nurse to explain why a certain intervention is done or what a medication may do for the patient, how and when it should be taken and possible side effects. These are just a few of the things covered by patient education. By teaching a patient about his or her care, the nurse also promotes self care which can allow the patient to be more independent rather than relying on others to assist him or her. The goal of patient education is to change or sustain behaviors that will help in maintaining or improving his or her health status (Rankin). In order for this goal to be achieved, it is crucial for the nurse to look at the given health status from the patient’s view (Leddy 2006). If not seen from the patient’s perspective, one may teach the patient in a way in which the patient is expected to obey recommendations or the education may be more focused on the needs of the facility rather than the patient (Rankin).

An 80 year old, white, widowed female is admitted to the hospital with a chief complaint of a cough, shortness of breath and increased sputum production. After a thorough examination, the patient was hospitalized for a medical diagnosis of Pneumonia. The patient’s past medical history consisted of COPD, a history of smoking, Non-Hodgkin’s Lymphoma, a complete heart block with the placement of a pacemaker, gastric outlet obstruction, hypertension and anemia. Some nursing diagnoses for this patient involving her health history include activity intolerance related to dyspnea and shortness of breath, ineffective airway clearance related to a diagnosis of COPD, risk of aspiration related to general weakness, risk for falls related to weakness, fatigue related to generalized weakness and excessive tiredness, nutrition imbalance: less than body requirements related to poor oral intake, impaired swallowing related to generalized weakness, nausea related to discomfort and many others (Newfield 2007).

This patient had reached an education level of eighth grade, her religion is Catholicism, she is retired and lives in a nearby nursing home where her family visits her frequently. The patient states that there is no family history of any illness and that her family is very healthy. Her family consists of her two sons, who are 58 and 54 and two daughters who are of ages 55 and 52, her husband has passed away. This woman had a very active past social life but upon falling ill with Pneumonia, her ability to complete even her activities of daily living without any assistance, is almost impossible. She use to go for walks with friends and take the time to participate in activities offered at the nursing home in which she lives.

The learning needs for this patient include education on the importance of positioning to prevent bed sores, coughing and deep breathing activities, and the importance of ambulating to prevent constipation. I know that these are the main learning needs because of the patient’s diagnosis of Pneumonia and current health status. To prevent complications, I have chosen many of these learning needs and have also chosen some of them based on Coughing and deep breathing along with oxygen therapy and the use of an incentive spirometer are always important in a patient with a diagnosis of Pneumonia to prevent atelectasis (Smeltzer 2008). Ambulation is important to prevent constipation which may lead to further problems such as bowel obstruction and compaction. Positioning is then a major preventative measure for ensuring that a patient does not develop bed sores. Positioning allows for a patient to be turned off of areas where pressure is exerted on the body to prevent tissue breakdown which can result from excessive pressure on a particular region. I would prioritize these learning needs as the education of coughing and deep breathing first, the importance of positioning as second, and the importance of ambulation as third. I would choose to place them in this order because it is in the patient’s best interest to be concerned with her respiratory system and her current respiratory illness in order to prevent any further complications. I also chose to place them in this order because being short of breath and experiencing dyspnea was a major concern for the patient herself therefore I found it important to focus on these issues first. Since Pneumonia was the primary diagnosis for this patient, it seemed most important that we treat the effects of this illness on the patient first. The patient also had a bed sore on her coccyx and I placed that as second because it was an additional issue with this patient that needed to be handled. I then placed ambulation as third simply because it did not rank superior to the other learning needs, and the patient was also receiving a laxative to ease bowel movements. The primary nurse for this patient identified the learning needs coughing and deep breathing and positioning while I identified the need of ambulation to prevent constipation and also to promote better circulation.

To be effective in this particular teaching situation, it would be necessary for the teacher to know information about the topics being taught to the patient. In order to educate a patient on coughing and deep breathing, one would need to know how to cough and deep breath, ways in which to splint a patient’s stomach in case of abdominal pain or surgery, the duration in which deep breathing and coughing should be done, the anatomy and physiology of the respiratory system and oxygenation. To educate a patient on positioning, one would need to know ways to position, which areas on the body are considered to be more at risk for bed sores or are known as bony prominences, when positioning should be done, how to maintain a patient in a specific position, and also the importance of frequent position changes to promote supportive treatment for Pneumonia (Smeltzer 2008). When educating a patient about ambulation to prevent constipation, it is important for the educator to know the anatomy and physiology of the gastrointestinal system, ways to assist a patient with ambulation, how to transfer a patient, different ambulatory devices that can be used to assist a patient with ambulation, the duration in which a patient should ambulate and how many times, and the patient’s limits to ensure that the patient will not be harmed in any way.

Some assessments that should be done prior to educating a patient in order to develop an effective teaching plan include the readiness to learn, the type of learner the patient is, the stage of change the patient is at, an impairments or barriers that may inhibit learning. Readiness to learn is very important when it comes to determining when patient teaching should be done. If a patient is not ready to learn then it is not the appropriate time to educate him or her on the issue because they will not be receptive. To assess whether or not a patient is ready to learn the nurse can examine if a patient is experiencing anxiety, how open the patient is about the information that would be provided, assessing where the patient is, and the attitude the patient exhibits when approached about new issues or teaching topics (Leddy 2006). Knowing what type of learner the patient is, is crucial in determining how to best present the learning needs to the patient in order to effectively teach the learner. It is good to know whether a patient is a verbal learner, a visual learner, or some other form of learner that way material can be presented in a way that will allow the patient to understand. The stage of change can have a very strong impact on patient learning. If a patient is at a point in the illness trajectory when he or she feels very ill, the patient is not likely to be receptive to education. It is best to provide education when a patient is feeling relatively healthy so that he or she is more attentive to the education rather than how he or she may be feeling (Leddy 2006). Any impairments a patient may have can strongly inhibit his or her learning. If a patient is deaf or blind, it is important to provide the correct tools to enhance learning. When a nurse is unknowing of such factors, he or she may educate the patient on a particular issue and may believe that the patient was listening and understanding when in fact, the patient was confused with the education because the impairment kept him or her from properly learning the information being provided. Barriers may also create an issue with patient education. A typical barrier may include a difference in languages. If a patient speaks a language other than the one that the nurse speaks, then it is up to the nurse to find a way to teach the patient so that he or she understands. The nurse may find a translator who speaks both the nurse and the patient’s language or may find teaching material that is in the patient’s language. A barrier such as this may lead to miscommunication between the patient and care giver which may lead to complications with the patient’s health because he or she did not properly understand the teachings of the nurse.

The 80 year old woman showed a strong readiness to learn shown by the initiative she took to ask questions about things she did not understand, and she also showed a very positive attitude towards her health and her care. It turned out that this patient was more of a verbal learner and learned best through explanations and asking questions about the things she needed clarification with. She was at a stage of change in her illness where she was having a good day and was very attentive to her care givers showing that it would be an appropriate time to provide education. The only impairment that this patient had was the fact that she wore reading glasses, but since she was not much of a visual learner, this didn’t seem to cause an issue. There were no barriers because the patient spoke English.

The one outcome that the patient found to be very important to achieve was that she had no difficulty breathing and experienced no shortness of breath. I believe that with one teaching session on the importance of coughing and deep breathing, the outcome that the patient is looking to achieve could very well be met. I do believe though, that the outcome would only last for so long and that the patient would need reinforcement to continue with the strategies she was taught to enhance her breathing and prevent further complications. Once teaching has ended and the patient has continued to follow through with the education she received about coughing and deep breathing for a short time, the motivation to continue with such exercises may diminish. This is why it is important for teaching to be reinforced and even taught over again if necessary. I think that the patient reaching her outcomes would be short lived and would only continue if the patient were to follow through with the skills she has learned.

Some behavioral objectives for achieving the patient’s desired outcome include assuming a sitting position, taking a deep breath by using slow breathing techniques, and exhaling slowly. Once the patient knows how to breathe deeply, she will inhale deeply and slowly, exhale slowly, take a short breath and let out a cough from deep in the lungs (Smeltzer 2007). The patient will perform deep breathing every 15 minutes with a short rest after each group of five deep breathes. Coughing should be performed by the patient two or three times after each deep breathe and deep breathing should be performed every two hours while the patient is awake (Smeltzer 2007). The patient will be able to demonstrate the ability to cough and deep breathe to the educator and the patient will know whether she is doing the procedure correctly based on how well the patient feels her breathing is after participating in these techniques. If the patient feels that her breathing is no longer difficult and she does not experience any shortness of breath, then the patient has achieved the outcome she had wished to accomplish. These objectives are behavioral meaning that if the patient initiates the correct behaviors, then her respiratory status is very likely to improve and she will no longer experience the shortness of breath or dyspnea she had before, nor will she develop any complications.

To educate the patient on the importance of coughing and deep breathing and how it is done, I did a demonstration for her. Since my patient was a verbal learner I found it best to explain things to her with words. I also found it important to do a demonstration so that I could physically show her what was being expected as an outcome from the teaching session. I also found this to be a good way to clarify anything that may have been unclear or caused confusion with her because of my choice of words and her understanding or interpretation. The teaching strategy that I had used is based on the behaviorist model of teaching or learning in that a behavior is being changed or added into a patient’s lifestyle to enhance her health (Leddy 2006).

To evaluate whether or not the outcome was achieved, I would monitor the patients respiratory rate, note any use of accessory muscles, assess lung sounds, watch for any dyspnea or shortness of breath during activity, and monitor the patient’s oxygen saturation levels. I would evaluate the quality of my teaching by paying particular attention to the terms I used while teaching, I would note anything I may have said that was confusing or hard to understand I would also determine the quality of my teaching when asking for a return demonstration by the patient. If the patient is unable to explain what I had taught her and is unable to demonstrate the procedures correctly, then I would know that I was unclear in my teaching and that I may need to change the way I explain something. If the outcomes had not been met, and coughing and deep breathing did not turn out to be an effective learning or teaching experience, I would move onto teaching the patient about the incentive spirometer. I could also continue to monitor the patient’s use of coughing and deep breathing and reinforce teaching each time it was necessary for the patient to complete such tasks.

The objectives for this patient were met. The patient was able to meet performance objectives as a result of the learning experience and teaching session. Once the patient had been taught more about coughing and deep breathing, she was able to complete them both on her own and when necessary. She also began to feel much better about her breathing when she engaged in the techniques and no longer found herself to be experiencing as much difficulty breathing or shortness of breath. As I approached and carried out this assignment of teaching a patient about coughing and deep breathing, I thought about the best ways to teach the patient the technique and what would be the most helpful if I were in her situation. I thought about the many ways in which she could be taught about coughing and deep breathing, the ways in which I would know she understood what she was being taught, whether or not I should go into detail about the anatomy of the respiratory system and how these techniques would help the patient and many more things. I looked for information on how to perform coughing and deep breathing, when to perform, for how long and teaching techniques for this particular process. I did not encounter any problems because the facility I was in had plenty of information about coughing and deep breathing that assisted me in my teaching strategies nor did I have any problems with my patient and teaching her. Some concerns I did have though were that my teaching would not be effective or that I wouldn’t know how to explain the procedure correctly or I would be wrong about something and give the patient the wrong information.

Although I had some concerns about teaching this patient, I do feel as though my teaching was successful. The outcomes that had been previously made were met and the patient was able to continue the process of coughing and deep breathing on her own when necessary. Next time, to improve my approach or success with teaching such an intervention, it would be best to spend more time with the patient finding out what he or she wants to know more about and how I can best address those issues that may arise. I think that this will allow me the chance to interact more with the patient about what he or she wants rather than what the healthcare facility or health care givers believe may be best for this patient at his or her current health stage. Overall though, I have learned much more about the importance of patient education and how it can make the difference between health and illness.



References
Leddy, S., Hood, L. (2006). Leddy and pepper’s conceptual bases of professional nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, sixth edition.
Newfield, S., Hinz, M., Tilley, D., Sridaromont, K., Maramba, P. (2006). Cox’s clinical applications of nursing diagnosis: adult, child, women’s, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Company, fifth edition.
Rankin, S., Stallings, K., London, F. Patient education in health and illness. Lippincott Williams & Wilkins, a Wolters Kluwer Company.
Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. (2008). Brunner and suddarth’s textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Company, eleventh edition: volume 1.