Learning Objectives
By the end of this section, you will be able to:
- Identify the purpose of health education and informed consent
- Recognize how to promote patient health through self-care
To begin exploring the education of patients and families, two major concepts are presented: health education and health promotion (i.e., improving health). As active participants in their health care, patients consent to (agree and permit) their care, which often begins by accessing the healthcare system through an appointment with a provider. Care may subsequently be directed, to include consultations, medications, diagnostic testing, treatments, and surgeries. Nurses play a critical role in the education of patients and families as they learn and contribute to their own place in health and wellness decision-making.
Purposes of health education, including maintaining health and wellness, and contributions of self-care to health promotion, guide the specific path of exploration. Health maintenance is supported by factors such as adherence and compliance, and education can be key for patients and their families to understand important pieces of their medical care, such as applicable diagnoses and components of their plans of care. As educators, nurses must consider various aspects of their patient’s lives, which can have positive or negative impacts on their participation in their care. Considerations, such as the patient’s level of medical knowledge, motivation, and coping skills, are significant issues relative to education.
Purpose of Health Education
The purpose of patient education is to give patients the education and self-efficacy they need to maintain or improve health, and the ability to cope with new situations (Fereidouni et al., 2019). For patients who in a state of homeostasis, or physiologic normal balance, education may focus on health promotion and disease prevention.
Patients who are experiencing a current health challenge may be experience stress that affects their ability to learn (Cherry, 2022). Health problems may cause physical changes so dire that the body is merely trying to survive, or the physiological impact of stress itself may interfere with the ability to focus and understand new information (see Chapter 34 Stress, Adaptation, and Homeostasis). Although the purpose of education for this population shifts from promoting health and preventing disease to disease management, teaching remains critically important. For others, health education may need to center around coping with altered function due to a chronic condition. The possibilities of ongoing testing, therapies, and medications can be frightening and confusing, and there are typically numerous topics and approaches the nurse can use to educate under these circumstances.
Another component of patient education is empowering the patient to make informed decisions about their own care. In 1973, the American Hospital Association (AHA) adopted the Patient’s Bill of Rights. The bill has since been updated, revised, and adapted for use throughout the world in all healthcare settings. There are different versions of the bill, but, in general, it safeguards a patient’s right to accurate and complete information, fair treatment, and self-determination when making healthcare decisions. In 2018, the AHA created the Patient Care Partnership, which is an updated brochure of what a patient's rights and responsibilities are during a hospital stay.
Link to Learning
Click here to view The Patient Care Partnership document. This emphasizes the importance of a patient’s right to make informed decisions about their care.
For almost all tests, procedures, and treatments, patients (or their designees) are required to provide consent before they can be completed. As the name implies, informed consent is a process that requires the education of the authorized decision-maker about the benefits, risks, and any alternatives of the procedure (Shah et al., 2023). Patients have legal and ethical rights to understand, guide, and approve of their own healthcare and treatment decisions. This includes being given information about what a test, procedure, or treatment plan is, what it involves, how it is anticipated to aid in diagnosis and/or treatment, risks, benefits, and possible complications.
Healthcare providers such as physicians, nurse practitioners, and physician assistants are responsible for the thorough explanation of the procedure, including risks, benefits, alternatives, and any risks associated with the alternatives, and to ensure the patient or designee understands the whole process (Shah et al., 2023). Persuasion to comply with care through force, or coercion, is not acceptable, and the patient should have ample opportunity to clarify any information and ask questions as a participant in a collaboration of care (Strini et al., 2021).
Nurses tend to have the most interactions with patients and families, and often quickly establish relationships that foster opportunities for education. The registered nurse (RN) follows the scope, standards, and competencies of practice (ANA Scope and Standards of Practice, 2021). This includes being advocates for their patients. With regard to the informed consent process, this can involve collaborating with the prescriber and patient in various ways. This may include providing patients informational handouts and answering questions, arranging the time and space for the specific consent-related education between provider and patient, and contributing to the assessment of the patient’s understanding of the circumstances (Strini et al., 2021). The nurse’s role also includes witnessing the signatures of patient (or designee) and prescriber on the informed consent form. In circumstances where a patient has further questions after signing a consent form, or changes their decision, the provider is contacted by the nurse to inform them of the change in circumstance and facilitate another meeting between the parties.
Link to Learning
You may find it helpful to refer to this short, but thorough overview of patient education at various times throughout the chapter, as specific topics appear.
Maintaining Health
Patient education plays an important role in establishing and meeting patient goals, decision-making, and creation of care plans (Saboktakin et al., 2021). Health maintenance involves helping patients identify their needs and participate in self-care as they learn to manage risk factors and prevent or control existing disease processes and diagnoses (Wang et al., 2022). Maintaining health also contributes to fewer complications from chronic illness or injury, shorter lengths of stay when hospitalized, and fewer readmissions after discharge (Bordonada et al., 2020).
Through patient teaching, nurses can help patients understand health and wellness as it pertains to their individual circumstances, how they can maximize participation in employment and social activities, and perform activity of daily living (ADL), such as toileting, bathing, oral care, and ambulation. Another example of health and wellness maintenance is providing information about vaccinations. Although several immunizations are scheduled in early childhood, for prevention of disease, additional immunization boosters are required at various times throughout the life span for patients with certain chronic diseases. Education about various immunizations—how they work, recommended timing, the need for boosters, how they are administered, possible side and adverse effects—are all topics nurses can teach patients and families.
Link to Learning
A Vaccine Information Statement (VIS) is a document produced by the Centers for Disease Control and Prevention that informs patients, family, and caregivers about the risks and benefits of a vaccine they are receiving. VISs are required by law to be given to the vaccine recipient or caregiver prior to a vaccination dose. Click here to view the current VISs for multiple, routine, and nonroutine vaccinations.
Patient education is important in prevention of illness and injury, as well as in early identification of disease. Screenings, such as blood tests for diabetes mellitus (DM) and hyperlipidemia, and preventive diagnostic tests such as colonoscopy (a fiberoptic scope to visualize the colon) and mammography (radiographic examination of breasts) are important health maintenance activities that can provide early disease detection and prevention. Other preventive measures may include guidance for weight loss, smoking cessation, and mental health treatment.
Over the past decades, patients have become more interested and involved in maintaining their own health and well-being. Although some people take a more passive approach to their health and rely on their healthcare providers’ advice, patients are increasingly understanding that the maintenance of their health requires active involvement. Nurses can help educate patients and family to promote health. Additionally, nurses can provide reputable resources to reinforce education and help alleviate concerns.
Promoting Adherence and Compliance
Education, whether on maintaining existing health or managing risks and challenges to health, is necessary to help patients understand their circumstances, make informed decisions, and be compliant with treatment plans. Nurses can help patients discover their own role in the plan of care through education and the value of adhering to and complying with the plan developed for them. One way to promote adherence and compliance is for the patient to play an active role in the formation of their care plan.
Clinical Safety and Procedures (QSEN)
Quality and Safety Education for Nurses (QSEN) Competency: Patient-Centered Care (PCC)
Disclaimer: Follow agency policies and procedures for patient education and documentation.
Definition: Recognize the patient as collaborator in provision of compassionate care.
Knowledge: The nurse will incorporate patient and family preferences in provision of care planning and education.
Skill: Integrate patient and family in interdisciplinary patient care. The nurse will:
- Inquire and establish patient and family education needs and preferences.
- Share the patient and family’s values and preferences with interdisciplinary team members.
- Provide respectful patient care focused on the patient.
Attitude: The nurse will consider the patient’s viewpoint and awareness of their own care, with respect for needs, values, and preferences.
Adherence and compliance are supported by patient understanding. Whether the education is about a diagnosis, planned procedure, or drug therapy, the more the patient comprehends about what is required of them, the better. This may include providing education on the disease process, pain expectations, and control after a surgery, or explaining how a new medication works in terms that are easy for the patient to understand. Nurses can promote adherence and compliance by ensuring their patient education includes the following (Wang et al., 2022):
- Barriers identified to education
- Participants in education
- Preference for teaching strategy for education
- Timing of education
- Topic of education
Factors Affecting Adherence and Compliance
To adhere to and comply with healthcare plans, patients and caregivers must understand what is being asked of them. It is best if they are active participants in and agree with their plan of care. Consideration for potential hindrance to comprehension of care is important, as is recognizing positive influences. Some factors that can affect adherence and compliance include
- Cultural preferences (e.g., values and customs)
- Feelings and emotions (e.g., patients may be overwhelmed, apprehensive, worried, frightened, exhausted)
- Lack of comprehension of education (e.g., medical and nursing care plans can be complex and difficult to understand)
- Language needs (e.g., patients may speak and understand a language other than the one spoken by health-care providers; delays for translation services)
- Patient care setting may be busy, even chaotic
- Physiological status (e.g., pain, discomfort)
- Unfamiliar terminology, medications, procedures, and laboratory studies
It is crucial for the nurse to be able to identify appropriate teaching moments, whether they be scheduled or spontaneous, and be responsive when a patient or family member asks a question. It is equally important to avoid potential barriers to adequate education in that moment and promote the effectiveness of the education given the challenges of the situation.
Health Literacy
The ability to read and write is described by the word literacy; those who are unable to either read or write are referred to as illiterate. There are many who are literate, perhaps even very well educated, but for whom the language of medicine is foreign and unintelligible. Because of the specific nature of this language, it has been labeled health literacy, which is described as the ability of an individual to locate, comprehend, and make use of health-related material and make healthcare decisions (Healthy People 2030, n.d.).
In anticipation of educating patients and families, it is important to assess both the level of general literacy as well as health literacy to ensure communication is effective. This is also a good time to ask and otherwise assess the audience’s (e.g., patient, family, friends) preference for style and technique of the teaching session. Recipients who have limited literacy of any sort are not likely to make use of, or benefit from, written materials, so establishing their choice(s) for style is important. Different styles of learning, and associated teaching methods to best serve learners, will be further explored later in this chapter.
Because health literacy also involves the ability of individuals to “use information and services” (Healthy People 2030, n.d.), health insurance or other means of accessing care is a part of the concept of health-specific literacy. Navigating through confusing documents and terminology specific to insurance can be daunting, and for those with no insurance, access to other sources like free or discounted care may not be easy to find. Nurses, social workers, case managers, and other navigators are valuable guides for patients as they try to steer their way through confusing paths within health care. Health information can be confusing because it often involves unfamiliar, complicated terminology, and perhaps medical jargon. Plain language and numbers, and considerations for culture, can help improve patients’ ability to locate, understand, and use health information to make health-related decisions.
Like Healthy People 2030, the Agency for Healthcare Research and Quality is a governmental resource that offers a multitude of information about health literacy under headings such as “Health Literacy Improvement Tools,” “Professional Education and Training,” “Patient Education and Training,” and “Research Tools, Data, and Funding” (AHRQ, 2024). Under the patient education heading, there are materials for health literacy assessments, as well as how-to directions for making healthcare information easier to understand. Healthcare providers can complete training modules about informed consent, and there are toolkits for specific topics like universal precautions and engaging patients and families specific to catheter-associated urinary tract infection prevention. For patients, there are videos with recommendations for interactions with the healthcare team, as well as ways to increase participation in one’s own health and self-care. There are also other resources for various patient interactions with the healthcare system.
Link to Learning
The Agency for Healthcare Research and Quality’s About Health Literacy provides information for patients and healthcare professionals. Try clicking the different items on the navigation menu to explore the information and tools available.
Motivation
Some people are driven by intrinsic motivation, or a drive toward achieving personal pleasure or fulfillment (Santos-Longhurst, 2019). Intrinsic motivation theory deals with basic psycho-physiologic necessities such as food, water, autonomy, and belonging as stimuli for health and wellness. Intrinsically motivated individuals are interested in their health and are open to learning about maintaining wellness and preventing illness. These are the easiest patients teach because they are already enthusiastic and ready to learn. However, for many patients, health and wellness have not been a priority or interest, so finding ways to reach and motivate them can be challenging. These people may respond to extrinsic motivation, or a willingness to participate in self-care activities when offered a reward, rather than meeting a psycho-physiologic need (Santos-Longhurst, 2019).
Preventive healthcare visits are an opportune time to introduce health topics, which ideally will lead to questions from the patient and allow them to demonstrate interest. The more interested a person is in a subject, the more likely they are to be motivated to learn more about it. If intrinsically motivated, patients are inclined to take pleasure in such activities as finding ways to improve their diet by finding interesting new nutritious recipes, or to improve strength and balance by exercising regularly (Santos-Longhurst, 2019). For the extrinsically motivated, goals may be based on winning an athletic event like a tennis match, or in losing a clothing size and getting a new outfit as a reward.
A motivated patient is more apt to be receptive to teaching, which is a good time to discuss risks and prevention. It is during such visits that topics like diet and exercise can be introduced as ways to decrease risks or actual development of hyperlipidemia, hypertension, or DM.
Link to Learning
The video Motivational Interviewing (MI) can be helpful in motivating patients toward behavior change. This video provides details about MI and how nurses can incorporate this into practice.
Acute episodes of injury or illness add potential barriers to patient and family education. Although such acuity may provide its own element of motivation (by providing a specific topic of interest), barriers such as pain, anxiety, and a battery of diagnostic tests can pull away the patient and family’s focus. They also may be overwhelmed and unable to come up with questions. In such circumstances, nurses typically try to triage education, for example, focusing on physiological care priorities, explaining the most important items, and identifying the main concern of the patient and their loved ones.
Coaching is a motivational technique used frequently by employers, but it can apply to patient education as well. Like athletic coaches, nurses help patients identify a particular problem or issue, set goals, and assist them with creating solutions. The patient is an active participant and gets the support of the nurse as they take the necessary steps. The relationship between the patient and their nurse “coach” tends to build as the interactions are established and enhanced over time. Some recommendations for motivational coaching include (Practice, 2023):
- Establish accountability through progress checks, reassurance, and support if and when needed.
- Help patients honestly identify and prioritize their goals.
- Offer tools including specifics for activities (e.g., exercise, diet, nutrition), schedule for exercise, and a detailed plan for follow-up.
- Present new ideas, such as ways to implement positive techniques and habits.
- Set SMART (specific, measurable, attainable, relevant, and timely) goals so patients understand all aspects of the goal and how they can be reached.
Facilitating Coping
Nurses spend considerable time with patients, often in intimate circumstances. Patients learn to trust nurses and come to respect their input. By recognizing distress in a patient or family, nurses can assess the cause and facilitate coping through teaching, shedding light by helping the patient and/or family understand more about the circumstance, and providing options or methods to help patients manage more effectively. In many facets of life, knowledge is associated with power; health care is no exception. As patients receive diagnoses, their abilities to manage and cope with challenges and possibly bad news can be threatened. Patient teaching facilitates coping by providing the necessary knowledge to help weather the storm of reactions such as worry, anxiety, and feelings of helplessness (Bordonada et al., 2020).
Patients can be empowered to redirect maladaptive coping mechanisms and focus instead on techniques that are more productive. Nurses can facilitate coping by, for example, helping a patient concentrate on health maintenance by adhering to a new drug regimen, rather than emphasizing possible long-term effects that may or may not happen. Nurses can provide education and information about such strategies, including distraction, focused deep breathing, and various complementary therapies such as aromatherapy, pet therapy, cognitive behavioral therapy, and music therapy. Replacing activities that are stress inducing with those that are stress reducing facilitates positive coping and reduces stress (Shostak et al., 2024).
Preparing for Positive Health Outcomes
Educating patients effectively contributes to improved participation of patients in their health care and tends to result in enhanced ability for self-care (Bagheri et al., 2022). Confusion is possible with unclear communication during a teaching session. Clear communication and effective education contribute to positive patient outcomes. Multimodal approaches like adding images, audio, and video to oral, lecture-type delivery and written supplements are generally well-received by learners (Stanford, 2019).
An approach to teaching and learning that incorporates factors such as language, culture, age, and learning style (i.e., one’s preferred method of learning: auditory, visual, written, or kinesthetic), can improve patients’ interest and their ability to comprehend and retain information provided (Table 17.1). Teaching children and adults shares some principles, but there are differences, with considerations for attention span, vocabulary, and experience, as well as psychomotor abilities and skills.
| Learning Style | Definition |
|---|---|
| Auditory |
|
| Kinesthetic |
|
| Visual |
|
| Written |
|
When anticipating patient and family education, preparation is invaluable. Taking a moment to plan provides an opportunity to identify barriers to education. Positive outcomes are improved in some cases by educating not only the patient but family or friends, or a caregiver. This can be especially apparent with infants and very young children, and those who are cognitively impaired. Reinforcement from teaching multiple people can prove helpful in achieving positive outcomes.
It is sometimes necessary to educate patients and family members under conditions that are not optimal or conducive to teaching, and misunderstandings or inadequate education may influence a patient’s adherence and compliance with the plan of care. Consider, for example, a patient who is pregnant and experiencing hyperemesis gravidarum (i.e., severe nausea and vomiting during pregnancy). As the nurse is attempting to teach the patient about dehydration and hypotension (low blood pressure), the patient’s concentration is impaired by waves of nausea or interrupted by vomiting. If asked later about concepts presented, in an attempt to evaluate the teaching, it is likely the patient will not be able to recall information taught, and the education will need to be repeated.
Patient Conversations
Problem-Solving: Worried for Mom
Scenario: A nurse in a primary care physician’s office receives a phone call from a patient’s daughter. She has several concerns about her mother.
Nurse: Please tell me a little more about why you’re calling today.
Patient’s daughter: I’m worried about my mom. She’s living in her own apartment in a community for mostly older folks. Her dementia is getting worse, and she’s been falling.
Nurse: Can you tell me more about the circumstances around her falls?
Patient’s daughter: She hears voices sometimes. She says they’re next door, or in the hall outside, or in her apartment. Last time she fell, she said she could swear someone was knocking on her door. She fell on her way to the door.
Nurse: Does your mom use a cane or walker?
Patient’s daughter: Yes, a walker.
Nurse: When she went to answer the door, did she use her walker?
Patient’s daughter: I don’t think so.
Nurse: Does she sometimes think she can “make it” without the walker?
Patient’s daughter: Yes. Or she is napping and rushes to get up, then forgets it.
Nurse: I see your mom takes metoprolol.
Patient’s daughter: Yes. She has high blood pressure. And heart failure. She takes a water pill.
Nurse: Okay. Does she drink enough water?
Patient’s daughter: I try to get her to drink more. She sips but doesn’t usually finish a whole glass. She says she’s worried because of her early kidney failure.
Nurse: For her blood pressure and heart failure, she needs less water, but with the water pill and metoprolol, she may become dehydrated—especially because she doesn’t drink much. If she’s dehydrated, there’s a risk of her blood pressure dropping or not adjusting when she gets up suddenly. Keeping her fluids balanced, her blood pressure just right, and her heart and kidneys working is quite a balancing act. She needs enough water, but not too much. Often, we say 8 ounces an hour through the day, but let’s check with the doctor as to how much she should have in a day with all that’s going on. Then, we’ll talk about some ways to get her to drink more water, how to get up gradually, and find ways to encourage her to use her walker.
Patient’s daughter: Oh, that’s a good idea. That information helps me to understand Mom’s particular situation. And the doctor’s specific recommendation as far as amounts to drink will be helpful. I can explain it better to Mom if I understand it better. I didn’t realize how delicate the balancing act is between her heart, blood pressure, and water.
Promoting Health Through Self-Care
One notable method of health promotion is helping patients realize the importance of self-care. A common misunderstanding about self-care is that it provides a rationale for overindulgences, offering justification for behaviors, such as overeating, substance use or abuse, or overspending (Bottaro, 2023). Self-care involves people placing their health and wellness as priorities, through such healthy choices as exercise, sleep, adequate fluid intake, and a balanced, nutritious diet based on whole foods (Bottaro, 2023).
Self-care and the inability to maintain such care for oneself in times of infirmity or illness are represented by Orem’s self-care deficit nursing theory, originally presented more than half a century ago (Hartweg et al., 2021). Orem described self-care as individuals’ activities toward health maintenance and wellness. The theory makes connections between patients and nurses, particularly when patients experience a deficit or inability to sustain self-care activities. During such times of disability, nurses collaborate with patients, and members of the multidisciplinary team, to provide care (Hartweg et al., 2021).
The International Self-Care Foundation (ISF) created a framework called the “Seven Pillars of Self-Care.” These pillars sort healthy (or positive) behaviors into natural groups that are similar to topics discussed in prior sections: health promotion, illness prevention, and health literacy. The ISF noticed synergistic relationships within these groups, whereby patients’ positive responses to a healthy behavior may be associated with a similarly affirmative reaction to other self-care behaviors. Table 17.2 describes the Seven Pillars (ISF, 2023).
| Pillar | Description (Example) | |
|---|---|---|
| 1 | Knowledge and health literacy | Individuals’ ability to find and understand health information and services for health-related decision-making |
| 2 | Mental well-being, self-awareness, and agency | Awareness of physiological status (e.g., body mass index, blood pressure, metabolic functions [via laboratory results], screenings [e.g., colonoscopy, mammography]) |
| 3 | Physical activity | Regular participation of moderate physical activity (e.g., walking, bicycling) |
| 4 | Healthy eating | Diet containing balanced and nutritious components of appropriate calorie content |
| 5 | Risk avoidance or mitigation | Limitation or avoidance of negative behaviors (e.g., ultraviolet protection, smoking cessation, moderation of alcohol, vaccinations) |
| 6 | Good hygiene | Handwashing, oral care, safe and careful food preparation and storage |
| 7 | Rational and responsible use of products and services | Understanding health care: plans, drugs, diagnostics, potential side and adverse effects |
Link to Learning
This video presents information and examples of self-care, activities, and relative benefits. Watch the video and think about self-care activities you participate in, or how to incorporate self-care into your days.
Illness Prevention
Health promotion is closely tied to illness prevention, because maintaining wellness naturally helps people avoid illness. The U.S. Department of Health and Human Services Office of the Assistant Secretary for Health established measurable health objectives for public health, with the first Healthy People initiative appearing in 1980 as Healthy People 1990 (health.gov). Since that time, Healthy People has been updated each decade, with goals identified for the upcoming 10 years. Healthy People recognizes public health issues and prioritizes them in an effort to improve health. With Healthy People 2030, there are 10 objectives identified, with associated volumes of data, and a number of tools available.
One goal of Healthy People 2030 is to “help people get recommended preventive health care services” (OASH, n.d.). This goal recognizes how critical education is to ensuring comprehension of the relevance of preventive care for patients and family members. It includes several objectives reflecting screenings, organizations that offer services focused on illness prevention, medication adherence, and access to care. When possible, it is ideal to prevent occurrence of disease.
Education can influence a patient’s overall compliance with the plan of care and encourage illness prevention (Bagheri et al., 2022). For example, a patient newly diagnosed with hypertension may be educated on the importance of a heart-healthy diet, medication adherence, and the importance of exercise. These practices will help control hypertension and prevent heart disease.
Factors Affecting Self-Care
As patients are informed about self-care and its influence on their health, wellness, and prevention of illness and injury, there are factors that nurses planning educational interventions must consider. Common factors affecting self-care include the knowledge, skills, and attitudes of the patient, readiness to learn, ability to learn, and learning environment.
Knowledge, Skills, and Attitudes
A deficit in knowledge, lack of skills, or unhealthy attitude can all have a negative effect on self-care and compromise the patient’s ability to care for themselves effectively. These can have multiple causes, but most commonly occur because of:
- conflicting information from multiple sources
- cultural or spiritual beliefs
- lack of ability to perform tasks
- lack of engagement or motivation
- lack of time
- severe anxiety or stress
It is important to assess a patient’s current knowledge, attitude, and ability to perform skills in order to address barriers and develop a successful self-care plan. This may include treatment modifications to comply with cultural beliefs, ADL aids to assist with self-care, creation of schedules to allow for adequate time, and positive reinforcement.
Learning Readiness
Optimal learning takes place when the recipient is ready to learn. This can include openness to new ideas and information and good physical condition without pain, anxiety, or worry. If a patient is not ready to learn, they won’t be able to absorb any of the self-care information being taught.
Ideally, nurses can identify teaching moments when patients express an eagerness, or at least interest, in learning. This may be apparent by questions from the patient or family member. If such a moment does not present itself, communication with the audience during the planning stage may help. Patients tend to respond well when they know what is happening, so letting them know an approximate time assists with readiness to learn. Also, if pain management is ongoing, analgesia administration before teaching promotes learning.
Patient Conversations
Preparing a Patient to Go Home
Scenario: Mr. Reggie Washington had abdominal surgery and is scheduled for discharge to home the following day. There are several self-care items the nurse will teach him about before discharge. To prevent overwhelming him, the nurse decides to teach one subject at a time and plans to educate him about changing the abdominal dressing with its next scheduled change.
Nurse: Mr. Washington, the surgeon is expecting you to go home tomorrow.
Patient: I can’t wait! I don’t get good sleep here.
Nurse: I’d like to start teaching you and your wife about changing the bandage on your surgical wound, so you’ll have a couple times to get used to it before you leave the hospital.
Patient: My wife will be here in about an hour.
Nurse: Let me get you your next dose of pain medicine now. That way, you can take it and have a little nap before she gets here. When she arrives, I’ll get things together and we’ll go through the first dressing change. The pain medicine will still be in your system at that time, which will help you tolerate the dressing change.
Patient: That sounds like a plan.
Nurse: I’ll show you where you can watch a video about bandage changes, too. You and your wife can watch it as many times as you want, and I’ll show you how you can even look at it from home if you need a refresher.
Ability to Learn
Literacy or cognitive function deficits can influence a person’s ability to perform self-care, and they create a challenge when trying to educate the patient about the importance of self-care. For example, a patient may not be able to learn healthy relaxation techniques to reduce stress, if they are unable to comprehend the information being given to them. Additionally, patients with cognitive function deficits may lack the problem-solving capacity to recognize their own signs and symptoms of agitation or stress and perform appropriate self-care interventions.
Physical deficits can also have a negative effect on a patient’s ability to learn. Patients with visual, auditory, movement, or mobility deficits may benefit from the incorporation of assistive devices when learning self-care skills. Neurological function, including gross and fine motor movements, are especially important if the education involves intricate skill acquisition and demonstration, such as for wound dressing changes.
Learning Environment
It is difficult to learn in an environment filled with distractions. There are times when such a setting is unavoidable, but whenever possible, arranging for patient and family education to be held in a comfortable environment fosters learning. Patient education frequently happens in a patient’s room, with the patient in bed or a chair. If there is time for planning and there are different options for locations, considerations for ideal teaching and learning should include the following (Kuipers et al., 2021; Timme, 2022):
- Appropriate resources (e.g., audio-visual equipment)
- Comfortable seating
- Comfortable temperature and ventilation
- Minimal distractions (e.g., noise, activity)
- Privacy
- Sufficient lighting
- Visibility of the educator and any visual or task aids
Nurses, patients, and family create relationships and a collaborative environment for care, including teaching and learning. Positive relationships and interactions cultivate constructive discussion within the teaching session (Kuipers et al., 2021). This includes bidirectional active listening: the audience pays attention to the educator during presentation of information or demonstration of actions, and there is the opportunity for patients and their family members to ask questions, with the nurse actively listening and then answering the questions or clarifying any confusion.
Unfolding Case Study
Unfolding Case Study 3: Part 3
Refer to Chapter 16 Legal and Ethical Considerations for Unfolding Case Study Parts 1–2 to review the patient data. The nurse is caring for a 58-year-old female with metastatic lung cancer who is a patient on the oncology unit of the hospital. The patient’s health has been deteriorating for the past few months and she has expressed an interest in discussing palliative care options. Initially, the patient requested her family not be notified about her interest in palliative care; however, she has since changed her mind and her three children are present at the bedside waiting for the palliative care team to make their rounds to discuss her options.
| Past Medical History | Patient has been receiving chemotherapy intermittently over the past 2 years. She reports one brief period of remission 6 months ago; however, the cancer returned shortly after. Medical history: COPD [chronic obstructive pulmonary disease], 1 pack/day smoker for more than 30 years, GERD [gastroesophageal reflux disease]. Social history: Three adult children, no known medical conditions. Husband of 35 years passed away 5 years ago in a car accident. Family history: Both parents deceased from natural causes. No current medications and no known allergies. Last chemotherapy round ended 2 months ago. |
| Nursing Notes | 1400: Assessment Palliative care team arrived at 1230 to discuss options with patient and family. Patient’s two daughters were visibly distraught during the conversation and made several comments indicating they would prefer their mother to undergo more chemotherapy in place of palliative care. Patient’s son was agreeable to palliative care and stated his support for his mother to make her own healthcare decisions. Patient visibly upset about the situation and stated, “See, this is exactly why I didn’t want to get my kids involved!” Patient has requested time to talk with her children and that the palliative care team come by again tomorrow for more discussion. |