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Clinical Nursing Skills

3.3 Patient Education and Teaching

Clinical Nursing Skills3.3 Patient Education and Teaching

Learning Objectives

By the end of this section, you will be able to:

  • Explain the purpose of patient education and teaching
  • Describe factors affecting patient learning
  • Define the nurse’s role in patient education and teaching

Providing education is a central role for nurses and a basic part of patient care. Patient education involves providing patients, families, and communities with the necessary knowledge and skills to manage their health and prevent disease. This role involves assessing the patient's learning needs, developing customized educational plans, providing education through different methods, evaluating the effectiveness of the teaching, promoting self-care, and advocating for patients.

By fulfilling their role as educators, nurses enable patients to become active participants in their health care, leading to better health outcomes and an improved quality of life. By assessing the patient's readiness to learn, providing them with individualized education, and evaluating their understanding, nurses ensure that patients have the knowledge and skills needed to manage their health and prevent complications. In addition, nurses advocate for their patients to have access to the resources necessary to maintain their health, such as education materials, support groups, and community services.

Purpose of Patient Education and Teaching

Patient education is a vital aspect of nursing that involves providing patients with information and knowledge about their health conditions, treatment options, and self-care strategies. It plays a crucial role in improving patients' health outcomes, communication, satisfaction, cost-effectiveness, and empowerment.

The most successful education happens when patients are engaged with their health care. Research shows that when patients are educated and engaged with their care, there are significant improvements in health outcomes, patient safety, and healthcare quality (Slade & Sergent, 2023). Moreover, patient engagement also leads to lower healthcare costs. Effective patient education helps patients to understand their health conditions, treatment options, and necessary lifestyle changes. This understanding encourages them to comply with their treatment plans and make healthy decisions, reducing the risk of complications.

Patient education empowers patients by giving them the knowledge and skills to manage their health conditions, improving their confidence and self-esteem. In turn, patient education can also save healthcare systems and patients money by reducing the need for costly hospitalizations and emergency room visits. Patient education is essential in nursing and must be carried out with diligence to ensure that patients receive accurate and relevant information.

Promoting Positive Patient Outcomes

The main goal of patient education is to provide patients with the knowledge and skills they need to manage their health effectively, improve their quality of life, and achieve the best possible outcomes. Promoting positive patient outcomes is the primary goal of patient education because it helps patients to take an active role in their health care and make informed decisions and choices about their treatment options. Patient education empowers patients with the knowledge they need to manage their health and well-being, which can result in better treatment adherence, improved disease management, and better health outcomes overall.

For example, when patients understand the importance of taking their medications as prescribed, they are more likely to follow their treatment plan consistently, which can help to control their condition, prevent complications, and improve their overall health status. Similarly, when patients are educated about healthy lifestyle choices, such as proper nutrition, regular exercise, and stress management, they are better equipped to manage chronic conditions like diabetes, hypertension, and heart disease.

Patient Conversations

Providing Patient Education

Scenario: The nurse is caring for a 14-year-old patient who is prescribed antibiotics for a sinus infection. The nurse is providing education on the need to complete all the medication even when the symptoms improve. The nurse wants to reinforce the education and tailor the conversation to this specific patient.

Nurse: What are your favorite movies?

Patient: I like horror movies.

Nurse: Do you ever watch zombie movies?

Patient: Yeah, I like zombies! Sometimes I dress up like zombies with my friends.

Nurse: Well, bacteria are like zombies; you have to take all the medication the way it’s prescribed or else the bacteria zombies will keep coming back.

Patient: I got to really kill it dead, huh?

Nurse. That is exactly right. So remind me how you’re going to do that?

Patient: I’m going to take all of the medication until it’s gone, even when I start to feel better.

In addition to promoting positive patient outcomes, patient education can also help to reduce healthcare costs by minimizing hospitalizations, emergency room visits, and other costly interventions. Educated patients are better equipped to manage their conditions at home, reducing the need for medical intervention and associated costs.

The nurse should be sure to communicate important education topics to the patient using methods that are engaging and appropriate and also be sure to evaluate for effective learning.

Unfolding Case Study

Unfolding Case Study #1: Part 2

Refer back to Unfolding Case Study #1: Part 1 to review the patient data.

Nursing Notes 1700: Intervention
Patient appears to be in distress from frequent coughing fits with expectoration of yellow sputum. Patient is tearful and begins to cry. Son attempts to console patient. Interpreter has been called and will arrive when current assignment is complete. Nurse utilizes a picture board to assist with communication with patient. Oxygen at 2L per nasal cannula applied and warm cloth given to wipe her face. Patient is instructed by nurse to take slow, deep breaths and to sit in an upright position to improve breathing.
Provider’s Orders Chest x-ray
Close observation
3.
Prioritize hypotheses: Based on cues from the patient’s history and assessment, the nurse determines the patient has symptoms that could indicate pneumonia. Indicate what findings are most consistent with a diagnosis of pneumonia: cough, earache, heart rate of 100 bpm, lethargy, fever, negative COVID-19 test, BP 142/88 mm Hg, WBC count 17,000.
4.
Generate solutions: Based on the information provided, what actions should the nurse take next?

Promoting Health Literacy

One of the most important goals of patient education is to promote health literacy, which is an individual's ability to obtain, understand, and apply basic health information and services to make informed decisions about their health. There are several strategies for this, beginning with clear communication between the patient and nurse. The nurse should also assess the patient's health literacy to be able to provide education at an education level that is appropriate for the patient; as well as providing written materials that are written at an appropriate reading level and font size, and are user-friendly. Nurses should use plain and clear language when communicating with patients, avoiding medical jargon or technical terms. They should also check for understanding by asking patients to repeat instructions or explain concepts in their own words. Visual aids such as pictures, diagrams, or videos can be useful in explaining complex concepts or procedures. They can also help patients who have difficulty reading or understanding written materials.

Nurses should involve patients in the education process by asking about their concerns, preferences, and goals. They should also encourage patients to ask questions and provide feedback. They should also be sensitive to patients’ cultural backgrounds and beliefs when providing education. Nurses should tailor their approach to the patient’s cultural norms and values and be mindful of any potential language barriers. For example, just because a patient speaks English well does not mean that it is their language of preference while in a medical setting. The nurse must clarify along with the initial assessment with the patient what their preferred first language is and provide an interpreter when required. The nurse may also provide written educational materials in both languages.

Nurses also play a role in teaching patients how to find their own information on different healthcare issues. Technology can be a valuable tool in promoting health literacy: for example, nurses can use electronic health records or patient portals to provide information and resources. Nurses can also recommend trustworthy online resources for patients to access health information. By providing patients with the knowledge and skills they need to manage their health conditions, nurses can empower patients to take an active role in their healthcare decisions.

Unfolding Case Study

Unfolding Case Study #1: Part 3

Refer back to Unfolding Case Study #1: Part 1 and Unfolding Case Study #1: Part 2 to review the patient data.

Nursing Notes 1700: Assessment
Physical examination: Patient appears disheveled with clothes inappropriate for the cold weather, including short-sleeve shirt and shorts. While waiting for the interpreter, patient appears agitated with frequent coughing episodes. Begins to pace the room as son attempts to console her.
HEENT: Pupils equal, reactive to light and accommodating (PERRLA), mucus membranes moist and intact, pharynx without lesions, palate intact. No thyroid enlargement noted.
Lymphatic: Tonsillar and cervical lymph nodes slightly enlarged. Hard, palpable left axillary lymph nodes, tender to touch. No enlargement of right axillary or inguinal nodes, no pain or tenderness noted.
Respiratory: Rales and rhonchi auscultated bilaterally. No stridor or murmur present.
Cardiovascular: Sinus tachycardia on monitor, no edema, peripheral pulses 2+.
Abdomen: Bowel sounds present in all 4 quadrants, no tenderness present.
Musculoskeletal: Full ROM, no issues noted.
Skin: Pale and dry, no bruising.
Mental assessment: Patient reports (per son) that she is stressed from coughing and anxious about her older mother left alone at home. Patient requests that nurse “hurry and give me some medicine so I can go home.”
Interpreter arrived to room at 2030.
Flow Chart 2000: Assessment
Blood pressure: 148/87 mmHg
Heart rate: 110 beats/minute
Respiratory rate: 26 breaths/minute
Temperature: 102.2°F (37.3°C)
Oxygen saturation: 97% on 2L NC
Pain: 8/10 (ear)
Provider’s Orders Sputum sample
Wean from oxygen before discharge home
Medications:
  • Acetaminophen 1000 mg PO Q6 PRN
  • Amoxicillin 500mg PO twice daily for 10 days
5.
Take action: Based on the information provided and provider orders, what interventions should the nurse implement for the patient?
6.
Evaluate outcomes: After providing information to the patient about the prescribed medications, how would the nurse evaluate the patient’s understanding?

Promoting Self-Care

Nurses have a central role in promoting self-care of patients through education. They teach patients about proper nutrition, exercise, and sleep habits as part of an important self-care plan. They can also teach patients how to manage chronic conditions such as diabetes or hypertension through self-care practices. Nurses can provide guidance on medication management and encourage self-monitoring of factors such as weight, blood pressure, and blood sugar levels. This can help patients identify any changes in their health and take action to prevent complications.

In addition to disease management, nurses have other ways of promoting self-care. Nurses can teach patients techniques to manage stress, such as deep breathing, mindfulness, and exercise. These techniques can help patients reduce stress levels and improve their overall well-being. Nurses can provide emotional support to patients, including active listening, empathy, and validation. This can help patients cope with emotional distress and promote mental health.

Nurses can help patients develop self-care plans that are tailored to their individual needs and abilities. By promoting patient self-care, nurses can empower patients to take control of their health, manage their chronic conditions, and prevent complications. Overall, the nurse's role in promoting self-care as part of nursing education is critical to helping patients and communities achieve and maintain good health.

Factors Affecting Patient Learning

When providing education to patients, nurses must be aware of the multitude and complexity of factors that play a role in how each individual acquires knowledge and skills. As discussed in 3.2 Comprehensive Interview Practices, a trusting nurse-patient relationship and effective patient interview can help the nurse determine the patient’s learning needs and the most effective ways with which to communicate with the patient and provide appropriate education.

Patient Learning Needs

The nurse must determine the needs of the individual patient. This includes both the goal of the education to be presented as well as the various factors that affect a patient’s learning needs. At the beginning of the session, nurses can outline their goals and ask the patient about any specific goals or needs that they might have. Ask the patient for their education preferences; how would they like to be taught; do they prefer videos, brochures, or a website for reinforcement? Patient participation in how the learning session is structured and incorporating their unique preferences can improve their engagement, understanding, and satisfaction.

Patient Age and Developmental Level

A patient's age and developmental level will have a significant impact on their learning needs. Here are some ways in which age and developmental level can affect patient learning:

  • Children: Younger patients have different learning needs compared to adults. Children require simpler and more concrete explanations and visuals to understand complex medical information. They may also need more repetition and reinforcement of information. Depending on their developmental level, they may also require special attention to emotional and psychological support during their treatment.
  • Adolescents: Adolescents require information that is relevant to their age group, such as information about sexual health, relationships, and peer pressure. They may also require a different approach to communication and education, such as interactive and engaging programs that appeal to their interests.
  • Adults: Adults have different learning needs depending on their age and developmental level. Younger adults may be more likely to prefer to have greater access to health information through the internet, mobile apps, and social media. They may seek personalized health resources, online support communities, and virtual healthcare options. And while older adults are becoming more tech-savvy as well, they may require additional support in navigating health-related websites or mobile apps. Printed materials, face-to-face interactions, and assistance from healthcare professionals or family members play a crucial role in meeting their learning needs.
  • Older adults over age 65: Older patients may require special attention to their cognitive, physical, and emotional needs. They may require more time and patience to learn and understand new information, particularly if they have cognitive impairments such as dementia or Alzheimer's disease.

Choosing Effective Educational Materials

When choosing educational materials for a patient, it is important to consider the patient's individual needs and preferences. Here are some factors to consider when selecting educational materials:

  • Learning preference: Patients may prefer to learn information through a variety of avenues. They may want to see it, hear it, watch a video, practice doing it, or even to watch someone perform the action in front of them. The nurse should present information in the patient’s preferred learning styles. When possible, have the patient do a return demonstration of the skill being taught; ask them to explain why a procedure is important to you or have them navigate to a website that provides additional information. The more learning styles a nurse can incorporate in a teaching session, the more opportunities the patient will have to understand the information. Additionally, repetition is key to comprehension and learning.
  • Literacy level: Choose materials that are written at an appropriate reading level for the patient. Use plain language and avoid medical jargon and technical terms that may be difficult for the patient to understand.
  • Cultural background: Consider the patient's cultural background and language preferences when selecting materials. Choose materials that are culturally appropriate and available in the patient's preferred language, if possible.
  • Health literacy: Choose materials that are designed for patients with low health literacy, such as simple illustrations, short sentences, and bullet points. Use teach-back or show-me techniques to assess the patient's understanding and reinforce key concepts.
  • Accessibility: Choose materials that are accessible to the patient, such as large print, audio, or electronic formats.
  • Relevance: Choose materials that are relevant to the patient's specific health condition and needs. Use examples and case studies that are relatable to the patient's situation.
  • Quality: Choose materials that are evidence-based, accurate, and written within the last 10 years. For instance, look for materials developed by reliable healthcare organizations, medical associations, government agencies, or academic institutions by searching in academic databases or Google Scholar.
  • Avoid materials that are biased, outdated, or misleading. A website with a “.org” domain does not mean the information is reliable or credible.

By taking these factors into consideration, nurses can choose educational materials that are appropriate and effective for their patients. It is also important to provide patients with ongoing support and follow-up to reinforce key concepts and address any questions or concerns they may have.

Patient Learning Readiness

Prior to beginning any educational intervention, the nurse should assess the patient’s physical and emotional state. Patients who are in pain, distressed, or anxious may not be ready to learn. The nurse should also determine the patient's motivation and interest in learning. Patients who are motivated to learn may be more receptive to educational interventions. The nurse can observe the patient's behavior and level of engagement during the educational intervention. Ask questions and use teach-back techniques to assess the patient’s understanding of the material. Follow up with the patient after the educational intervention to reinforce key concepts and address any questions or concerns they may have.

Nurse’s Role in Patient Education and Teaching

Patient education is an essential nursing responsibility. Like a teacher, the nurse is responsible for considering all aspects of the teaching and learning process. There are different strategies, goals, teaching methods and ways to learn. Nurses should employ all available strategies and constantly evaluate the effectiveness of their instruction. Lastly, nurses should document what was taught, how, and when, and record patient response along with any follow up needed.

Effective Teaching Strategies

Benjamin Bloom was a psychologist who first published his taxonomy in 1956 (Krathwohl, 2002). The basis of Bloom’s Taxonomy is that it consists of different levels of learning, arranged according to complexity. In the original Bloom’s Taxonomy, the learner needed to master the skills at the lower levels of learning before moving on to the higher levels. The taxonomy consists of three domains: cognitive, affective, and psychomotor.

In 2001, Bloom's Taxonomy was revised due to several limitations in the original framework. The original taxonomy focused predominantly on knowledge acquisition and recall, with less emphasis on higher-order thinking skills. It also failed to address the concepts of critical thinking, creativity, analysis, evaluation, and synthesis. Its hierarchical structure oversimplified the complex nature of learning by suggesting a linear process is necessary to reach the higher levels. Also, the original taxonomy primarily addressed cognitive skills and overlooked the other domains, affective and psychomotor. To address these shortcomings, the taxonomy was revised to include a broader range of cognitive processes, emphasize higher-order thinking skills, and provide a flexible framework applicable to the affective and psychomotor domains. The revision aimed to better reflect contemporary educational practices and support critical thinking and problem-solving.

Bloom’s Taxonomy (Figure 3.4) offers a framework for nurses who are preparing education for patients. It details the process of learning, which helps the nurse to identify the key learning goals they want to achieve during each patient interaction. Effective teaching strategies consider all three of the learning domains. Bloom’s Taxonomy also helps the nurse as teacher understand the learning process. Nurses should use a variety of teaching methods that cater to different learning styles and provide feedback and support to help students develop their skills and knowledge in all three domains.

A color illustration in the shape of a pyramid showing the elements of Bloom's taxonomy. From the top of the pyramid the taxonomy reads as follows. Create: produce new or original work; design, assemble, construct, conjecture, develop, formulate, author, investigate. Evaluate: justify a stand or decision; appraise, argue, defend, judge, select, support, value, critique, weigh. Analyze: Draw connections among ideas; differentiate, organize, relate, compare, contrast, distinguish, examine, experiment, question, test. Apply: use information in new situations; execute, implement, solve, use, demonstrate, interpret, operate, schedule, sketch. Understand: Explain ideas or concepts; classify, describe, discuss, explain, identify, locate, recognize, report, select, translate. Remember: recall facts and basic concepts; define, duplicate, list, memorize, repeat, state.
Figure 3.4 The revised Bloom’s Taxonomy provides a framework for nurses to create effective teaching strategies based on individual patients’ needs and abilities. (credit: modification of work “Bloom’s Taxonomy” by Vandy CFT, CC BY 2.0)

Cognitive Domain

The cognitive learning domain involves intellectual skills: the understanding and development of information through application, moving up the taxonomy from basic recall to complex evaluation and creation. The cognitive domain is also concerned with mental processes such as thinking, memory, perception, and problem-solving.

At the most basic levels, cognitive learning involves acquiring, remembering, and understanding knowledge. Higher levels of cognitive learning involve the application, analysis, and evaluation of acquired knowledge, culminating in the creation of new knowledge. Effective teaching strategies for cognitive learning include lectures, discussions, demonstrations, and simulations that provide opportunities for students to process and apply new information.

It is important to note that the cognitive domain is not the only domain that is important for learning. Nurses should also consider the affective and psychomotor domains, as well as the individual needs and preferences of their patients when designing and implementing effective teaching strategies.

Affective Domain

The affective learning domain involves our attitudes, values, and emotions toward learning and how they develop (CDC, n.d.). Table 3.4 describes the five levels of affective learning processes in Bloom’s Taxonomy. It begins with the lowest level, receiving, and describes examples of patient behaviors at each of the five levels.

Level Description Examples of Patient Behaviors
Receiving Learners are open and receptive to information, ideas, or experiences They listen respectfully and attentively to others, actively receives information, and shows openness to learning.
Responding Learners actively participate and respond to the stimuli they have received. They demonstrate a willingness to engage and show interest in the information or experience. A patient participates actively in their treatment plan by asking questions about treatments, tests, or options in order to fully understand them. They express their concerns, ask questions, and provide feedback about their progress and comfort level.
Valuing Learners attach personal significance and value to the information or experience. They recognize the relevance and importance of the subject matter to their own values, beliefs, and goals. As the patient receives care and interacts with the healthcare team, they start recognizing the importance of self-care and health promotion. They value the impact of healthy lifestyle choices on their well-being and develop an appreciation for the healthcare providers’ expertise and support.
Organizing Learners begin to organize and prioritize their values, beliefs, and attitudes. They integrate new information or experiences into their existing value system and develop a coherent set of values. The patient begins organizing their values and beliefs related to their health. They prioritize certain aspects of their care, such as adhering to medication schedules, incorporating exercise into their routine, or making dietary changes. They resolve conflicts between their previous habits and the new behaviors recommended for their well-being.
Characterizing by Value or Internalizing Learners internalize the values and demonstrate them consistently in their behavior. They act in accordance with their values and beliefs, displaying a sense of personal integrity and authenticity. At this level, the patient internalizes their health-related values and consistently demonstrates them in their behaviors and decisions. For example, the patient might actively engage in self-management of a chronic illness, advocate for their health needs, and seek out additional resources or support to maintain their well-being even after leaving the hospital.
Table 3.4 The Five Levels of Affective Learning Processes in Bloom’s Taxonomy

Affective learning involves developing attitudes, values, and beliefs and having emotional responses to learning. Effective teaching strategies for affective learning include using positive reinforcement, modeling positive attitudes, and creating a supportive and respectful classroom environment that values diversity and encourages students to express themselves. For example, a nurse has a patient who has just begun a recovery program for substance use disorder. The patient is skeptical about both group and individual therapy and tells the nurse they don’t expect to get much out of it, but they agree to attend meetings. The nurse makes time every day to ask the patient about their feelings and encourage them to share both positive and negative ones. This teaches the patient that their feelings are valid even if they’re not the “correct” ones, and that the patient is in a safe place where they can share without judgment.

Psychomotor Domain

The psychomotor domain involves acquiring physical skills and motor abilities. Effective teaching strategies for psychomotor learning include hands-on activities, role-playing, and practice exercises that allow patients to learn and practice new skills. For example, the nurse can role-play with a small child or older individual with developmental delays.

Evaluating Patient Learning

The goal of using Bloom’s Taxonomy as a teaching tool is to help the patient build up from lower-level skills to higher-level ones. Learning outcomes target knowledge (cognitive domain), attitudes for change (affective domain), and skills (psychomotor domain). Learning outcomes are goals that can be short- or long-term. Success is measured by the patient reaching goals in successively higher levels.

Document Teaching-Learning Process

Patient education is a regular part of patient care and must be documented as such. The nurse should document the steps and details of the teaching-learning process in the patient’s chart. The general steps to be documented begin with the assessment of the patient’s learning needs, followed by the teaching plan. Document the details of the teaching session itself, including the specific education covered, the patient’s reaction to it, and any questions or concerns raised by the patient. Afterward, the nurse should evaluate the teaching session and document the results, including any follow-up that might be needed, in the patient’s chart. Finally, if the patient did not achieve the learning objectives or has new learning needs, modify the teaching plan accordingly and document the changes made.

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