Patient and Caregiver Teaching Nursing for your nursing exam. Patient instruction shouldn’t be thought of as a one-time thing. Instead, it needs to be included in how professionals communicate with patients and caregivers. The doctor should be imparting knowledge during the conversation, regardless of how brief it may be. The learning requirements of both the patient and the caregiver must be met. Additionally, the patient and the caregiver could hold opposing or divergent opinions on the condition and available therapies.
Patient Teaching Nursing Quiz
In each of the nursing situations described below, identify the general goal of the patient and caregiver teaching.
| Nursing Situation | Goal |
|---|---|
| Teaching a new mother about the recommended infant immunization schedule | A |
| Discussing recommended lifestyle changes with a patient with newly diagnosed heart disease | B |
| Counseling a patient with a breast biopsy that is positive for cancer | C |
| Demonstrating the proper condom application to sexually active teenagers | D |
Answer Key:
a. Maintenance of health. b. Management of illness. c. Appropriate selection and use of treatment options. d. Prevention of disease.
What is meant by this statement: “Every interaction with a patient or caregiver is potentially a teachable moment”?
Answer Key:
Stated in your own words, the answer should be something like this: Use every opportunity (interaction [e.g., administering medications]) to assess patients for educational needs, to provide the teaching needed, and to reinforce the teaching that has already occurred. The time for patient teaching is limited, and every opportunity must be used efficiently.
Which statements characterize the teaching-learning process (select all that apply)?
a. Learning can occur without teaching.
b. Teaching may make learning more efficient.
c. Teaching must be well planned to be effective.
d. Learning has not occurred when there is no change in behavior.
e. Teaching uses a variety of methods to influence knowledge and behavior.
Answer Key:
a, b, e. Learning is acquiring a skill or knowledge and may occur from experience rather than teaching. Planned teaching using a variety of methods may increase learning and teaching that is planned helps to make learning more efficient. Teaching may occur as an incidental experience without prior planning. One hopes that the learner's behavior will change as a result of teaching. However, it is the choice of the learner to either change behavior or not.
From the list of principles of adult learning below, identify which one(s) is (are) used in the following examples of patient teaching. Principles may be used more than once, and more than one principle may be used for each example of patient teaching.
Examples Of Patient Teaching
a. The nurse explains why it is important for a patient with Parkinson’s disease to walk with a wide placement of the feet.
b. The nurse asks a patient what is most important to her to learn about managing a new colostomy.
c.The nurse teaches a patient how to reduce the risks of stroke after the patient has had a transient ischemic attack.
d. The nurse provides a variety of printed materials and Internet resources for a patient with impaired kidney function to use to learn about the disorder.
e. When caring for a patient with newly diagnosed asthma, the nurse explains that asthma is a disorder the patient can control and allows the patient to decide when teaching should be done and who else should be included.
f. The patient diagnosed with diabetes mellitus requests to try performing self-monitoring of blood glucose and insulin administration while being taught by the nurse.
g. During preoperative teaching of a patient scheduled for a total hip replacement, the nurse compares the postoperative care with that of the patient’s prior back surgery
Principles
- Learners need to know
- Learner’s readiness to learn
- Learner’s prior experiences
- Learner’s motivation to learn
- Learner’s orientation to learning
- Learner’s self-concept
Answer Key:
a. 1, 2; b. 1, 2, 4, 6; c. 2, 4; d. 5; e. 2, 6; f. 2, 4, 5; g. 3
When a patient with diabetes tells the nurse that he cannot see any reason to change his eating habits because he is not overweight, what action does the nurse determine as the most appropriate at this stage of the Transtheoretical Model of behavior change?
a. Help the patient set priorities for managing his diabetes.
b. Arrange for the dietitian to describe what dietary changes are needed.
c. Explain that dietary changes can help prevent long-term complications
of diabetes.
d. Emphasize that he must change behaviors if he is going to control his blood glucose levels.
Answer Key:
c. This patient is in the pre-contemplation stage of behavior change; he is not considering a change, nor is he ready to learn. During this stage, the best intervention by the nurse is to describe the benefits of change and the risks of not changing. The consequences of not changing should not be presented as threats but rather as a disadvantage of the current behavior. Describing what is involved in behavior change and setting priorities are recommended for later stages of change.
Put the following medical terms into phrases that a patient with limited health literacy would be able to understand.
a. Acute myocardial infarction
b. Intravenous pyelogram
c. Diabetic retinopathy
Answer Key:
a. Example: A sudden episode (acute) in which the heart muscle (myocardium) is damaged from a lack of blood supply (infarction)
b. Example: The intravenous (IV) injection of a dye to visually record (-gram) the kidneys (pylon-)
c. Example: Damage (-pathy) to the retina (retino) of the eye as a complication of diabetes
What demonstrates an empathetic approach to patient teaching by the nurse?
a. Assesses the patient’s needs before developing the teaching plan
b. Provides positive nonverbal messages that promote communication
c. Reads and reviews educational materials before distributing them to patients and families
d. Overcomes personal frustration when patients are discharged before teaching is complete
Answer Key:
b. An empathetic approach to teaching requires that the nurse provide positive feedback and try to understand the patient's world. The other options are important but are not directly related to emphaty.
Describe one strategy that could be used to overcome the common barriers to teaching patients and caregivers.
Barrier – Strategy
Lack of time
Your feeling as a teacher
Nurse-patient differences
Answer Key:
| Barrier | Strategy |
|---|---|
| Lack of Time | Set learning priorities with the patient and use every encounter. Let the patient know how much time you have for each session. |
| Your feeling as a teacher | Prepare ahead of time. Use available written materials. Respect the patient’s response to the health problem. |
| Nurse-patient differences | Expectations of teaching may be different for the patient, caregiver, and nurse. The patient may not be ready to learn or understand the urgency of the teaching and the early discharge |
The nurse assesses a 48-yr-old male patient and his family for learning needs related to the myocardial infarction the patient experienced 2 days ago. While doing her assessment, she finds out that the patient’s father died at age 52 from a myocardial infarction. Which assessment area will influence the teaching plan for this patient and family?
a. Learner characteristics
b. Physical characteristics
c. Psychologic characteristics
d. Sociocultural characteristics
Answer Key:
c. Because the patient's father died of a myocardial infarction at a young age, the nurse needs to assess how his anxiety may affect his ability to learn about his treatment and follow-up care. There is no information about the learner characteristics of sociocultural characteristics, although these areas would also need to be assessed.
To promote the patient’s self-efficacy during the teaching-learning process, the nurse should use which strategy?
a. Emphasize the relevance of the teaching to the patient’s life.
b. Begin with concepts and tasks that are easily learned to promote success.
c. Provide stimulating learning activities that encourage motivation to learn.
d. Encourage the patient to learn independently without instruction from others.
Answer Key:
b. To promote self-efficacy it is important that the person is successful in new endeavors to strengthen the belief in his or her ability to manage a situation. To avoid early failure the nurse should work with the patient to present simple concepts related to knowledge and skills that the person already has. Motivation and relevancy are important factors in adult learning but are more often a result of self-efficacy, not a method of promoting it.
Identify the teaching interventions that are indicated when the following patient characteristics are found.
Patient Characteristic -Teaching Intervention
Impaired hearing Patient refuses to see a need for a change in health behaviors
Drowsiness caused by the use of sedatives
Presence of pain
Uncertain of reading ability
Visual learning style
The primary language is not English
Answer Key:
| Patient Characteristics | Teaching Intervention |
|---|---|
| Impaired hearing | Use supplementary illustrations and written materials. Provide audiotapes or audiovisual presentations with headphones that block environmental noise and promote auditory function. |
| The patient refuses to see a need for a change in health behaviors | Support the patient during this time and do not argue about the need for a change in health behaviors. Wait until the patient is ready to learn before beginning teaching |
| Drowsiness caused by the use of sedatives | Evaluate the medication schedule and change it, if possible, to increase alertness. If sedation is the objective of the medication, consider teaching family members or other caregivers. |
| Presence of pain | Provide only brief explanations and wait until the pain has been controlled to present more detailed instruction |
| Uncertain of reading ability | Be sure that educational materials are written at fifth-grade or lower reading levels. Use audiovisual materials with the simple, layperson language. |
| Visual learning style | Provide a variety of written educational materials. Refer the patient to appropriate Internet resources for information. |
| The primary language is not English | Use interpreters and translation software programs. Obtain patient teaching materials in the patient’s primary language. |
On the assessment of a patient’s learning needs, the nurse determines that a patient taking potassium-wasting diuretics does not know what foods are high in potassium. What is an appropriate nursing diagnosis for this patient?
a. Risk for cardiac dysrhythmias related to low potassium intake
b. Deficient knowledge related to not knowing what foods are high in potassium
c. Imbalanced nutrition: less than body requirements related to lack of intake of potassium-rich foods
d. Deficient knowledge related to lack of interest regarding dietary requirements when taking diuretics
Answer Key: b. The nursing diagnosis should specify the exact nature of the knowledge deficit so that the objectives, strategies, implementation, and evaluation related to the identified problem. The problem is deficient knowledge, and a nursing diagnosis stating that the knowledge deficit is related to a lack of interest is in error. The statement “risk for cardiac dysrhythmias” is a collaborative problem rather than a nursing diagnosis.
Write a learning goal for the patient taking potassium-wasting diuretics who does not know what foods are high in potassium.
Answer Key:
Example: By the time of discharge the patient will identify foods that are high in potassium from a given list of common foods.
Which teaching strategies should be used when it is difficult to reach the desired goals of the session (select all that apply)?
a. DVD
b. Role play
c. Discussion
d. Printed material
e. Lecture-discussion
f. Web-based programs
Answer Key:
a, c, d, f. DVDs, discussion, printed materials and Web-based programs can be left with the patient, then discussed or “taught back” later to be sure that all goals are met. Role play and lecture discussion may take more time than is available to meet the goals.
When selecting audiovisual and written materials as teaching strategies, what is important for the nurse to do?
a. Provide the patient with these materials before the planned learning experience.
b. Ensure that the materials include all the information the patient will need to learn.
c. Review the materials before use for accuracy and appropriateness to learning needs and goals.
d. Assess the patient’s auditory and visual ability because these functions are necessary for these strategies to be effective.
Answer Key:
c. If audiovisual and written materials do not help the patient to meet the learning goals, they are a waste of time and expense. The nurse should ensure that these materials are accurate and appropriate for each patient. Audiovisual materials are often supplementary materials that are used either before or after other presentations of information and do not have to include all of the information the patient needs to learn to be of value. Patients with auditory and visual limitations may find these materials useful because they can adjust the volume and size of the images.
A patient with a breast biopsy positive for cancer tells the nurse that she has been using information from the Internet to try to decide on her treatment choices. In counseling the patient, the nurse knows that (select all that apply)
a. the patient should be taught how to identify reliable and accurate information available online.
b. all sites used by the patient should be evaluated by the nurse for accuracy and appropriateness of the information.
c. most information from the Internet is incomplete and inaccurate and should not be used to make important treatment decisions.
d. the Internet is an excellent source of health information, and online education programs can provide patients with better instruction than is available at clinics.
e. the patient should be encouraged to use sites established by universities, the government, or reputable health organizations, such as the American Cancer Society, to access reliable information.
Answer Key:
a, e. When using the Internet as a teaching strategy, the nurse will assist the patient or caregiver in accessing trustworthy sites. The nurse personally cannot evaluate all sites that a patient or caregiver uses. The Internet is a valuable source of health information, but it is also unregulated and much information is unreliable or inaccurate. As a result, both nurses and patients should learn to evaluate sources and identify accurate information. Reliable sources include universities, government health agencies, and reputable health care organizations.
Identify what short-term evaluation technique is appropriate to assess whether the patient has met the following learning goals.
| Learning Goal | Evaluation Techniques |
|---|---|
| The patient will demonstrate to the nurse the preparation and administration of subcutaneous insulin injection to himself with the correct technique before discharge. | |
| Before discharge, the patient will identify five serious side effects of Coumadin that should be reported to the health care provider. | |
| The patient’s wife will select the foods highest in potassium for each meal from the hospital menu with 80% accuracy. | |
| The patient will verbalize “no shortness of breath” when ambulating unassisted with the walker every three times a day. | |
| The patient’s caregiver will state that he or she is ready to change the patient’s dressing today. |
Answer Key:
| Learning Goal | Evaluation Techniques |
|---|---|
| The patient will demonstrate to the nurse the preparation and administration of subcutaneous insulin injection to himself with the correct technique before discharge. | Direct observation |
| Before discharge, the patient will identify five serious side effects of Coumadin that should be reported to the health care provider. | Ask a direct question or use a written measurement tool (ask the patient to write down the serious side effects that must be reported to the doctor. |
| The patient’s wife will select the foods highest in potassium for each meal from the hospital menu with 80% accuracy. | Direct observation with the observation of verbal and nonverbal cues |
| The patient will verbalize “no shortness of breath” when ambulating unassisted with the walker every three times a day. | Direct observation with the observation of verbal and nonverbal cues |
| The patient’s caregiver will state that he or she is ready to change the patient’s dressing today. | Talk with a member of the patient’s family and then observe the dressing change to validate the caregiver’s self-evaluation. |
What is the best example of documentation of patient teaching regarding wound care?
a. “The patient was instructed about the care of wound and dressing changes.”
b. “The patient demonstrated the correct technique of wound care following instruction.”
c. “The patient and caregiver verbalize that they understand the purposes of wound care.”
d. “Written instructions regarding wound care and dressing changes were given to the patient.”
Answer Key:
b. A statement that documents what the patient does as a result of teaching indicates whether the learning objective has been met and provides the best documentation of patient instruction. “Understand” is not a measurable behavior and does not validate that learning has occurred.
Which teaching strategies should the nurse plan to use for a baby boomer patient (select all that apply)?
a. Podcast
b. Role-playing
c. group teaching
d. Lecture-discussion
e. A game or game system
f. Patient education TV channels
Answer Key:
d, f. Baby boomers grew up sitting quietly in rows at school with the teacher lecturing or watching a movie and then discussing the information. They are used to learning with these methods, although some individuals may be comfortable with the other methods as well.
An 88-yr-old male patient with dementia and a fractured hip is admitted to the clinical unit accompanied by his daughter who is his caregiver. She looks tired and disheveled. About 6 months ago she moved in with her father to keep him safe when he started wandering away from his home. She has no money as a result of her inability to work. She has inadequate information and is concerned about what will happen to her father after this hospitalization. Her brother calls on the phone to tell her what to do but does not come to visit or help out. There is conflict in the family related to decisions about caregiving. She has no respite from caregiving responsibilities and is socially isolated with the loss of friends from an inability to have time for herself. What are the best coping strategies to teach this daughter (select all that apply)?
a. Keep a journal.
b. Get regular exercise.
c. Join a support group.
d. Go on a weight-loss diet. e. Use humor to relieve stress. f. Take time to read more books.
Answer Key:
a, b, c, e. With the stressors this daughter is experiencing, the best strategies to help her cope are to keep a journal; get regular exercise; join a support group to share feelings and learn she is not alone, and use humor for both herself and her father. A weight-loss diet could increase stress at this time. Reading more books could distract her but also take her away from her father's needs, so this is not the best strategy.
A 68-yr-old female patient was admitted with a stroke 3 days ago. She has weakness on her right side. She states, “I will never be able to take care of myself. I don’t want to go to therapy this afternoon.” After listening to her, which statement would be included as part of a motivational interview?
a. “Why not?”
b. “If you go to therapy, I’ll give you a back rub when you get back.”
c. “I know you are tired, but look how much easier walking was today than it was last week.”
d. “Well, with that attitude, you will have trouble. The doctor ordered therapy because he thought it would help.”
Answer Key:
c. Adjusting to rather than opposing the patient's resistance as well as expressing empathy and reinforcing the positive outcome of attending therapy previously will encourage her to continue therapy. The other options are argumentative and confrontational, focus on the negative rather than the patient's strengths, and do not help the patient to recognize the “gap” between where she is and where she hopes to be.
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