Chapter Two

How To Be an Effective Patient Teacher (Part 1 of this chapter)

You can find the first two installments of this series in our Spring 2005 archive and Fall 2005 archive.

Chapter Objectives

When you finish this Chapter, you will be able to:

1. Identify five steps in the teaching – learning process
2. List three ways to assess learning needs and readiness for learning
3. Describe two methods of developing learning objectives, planning and implementing patient teaching, and evaluating learning
4. Name three principles for documenting patient teaching
5. Discuss nine common teaching mistakes and how to avoid them.

Introduction

Learning how to be an effective teacher is an important part of your professional development.  Effective patient teaching requires the same analytical and problem-solving skills as other clinical interventions.  The purpose of this chapter is to improve your abilities as a patient teacher by outlining the steps of the teaching-learning process; to suggest ways of assessing learning needs and readiness for learning; to discuss methods of developing learning objectives, planning, implementing, and evaluating teaching; to review principles for documenting patient teaching; and to recognize common teaching mistakes and ways of avoiding them.

The teaching-learning process

The process of patient teaching refers to the steps you follow to provide teaching and to measure learning.  The five steps involved in the teaching-learning process are:

• Assessing learning needs and learning readiness
• Developing learning objectives
• Planning and implementing patient teaching
• Evaluating patient learning
• Documenting patient teaching and learning

The teaching-learning process is very similar to the nursing process steps of assessment, diagnosis, care planning, care implementation, and evaluation.  Your first step in the process of patient teaching is to assess what the patient and family already know, what they want and need to learn, and what will be the best way to teach them.  Determining learning needs, preferred learning style, and learning readiness are all requirements included in JCAHO standards for patient and family education. 

Start the process by talking with patients to determine what they see as their health care goals, what their priorities for learning are, how ready they are to learn, and what their preferred learning style is.  To assess learning style, ask patients about something they recently learned and how they learned it- by reading about it, listening to information, or by actual hands-on learning.  Determining learning readiness is a crucial part of your assessment. 

This part of the process begins when someone- the patient, a family member, or you- identify the need to learn a new skill or to know more information.  If the patient identifies the need-“What exactly will this operation involve?” or “How will I manage this when I go home?”- he or she is demonstrating learning readiness.  If you, rather than the patient, identify the need, your job will not only be to teach the information in a way that the patient is able to understand and use, but also to convince the patient that the information is important to his health and well being.  Pain, fatigue, or physical or emotional stress may be barriers to learning readiness.  By incorporating your teaching plan into a written critical pathway that spans care delivery setting from hospital to home, teaching and learning can be spread out over time to take advantage of optimum learning readiness.

After you’ve talked with the patient, interview the family members.  Family members can be included in the assessment when they visit the patient, or by telephone.  Conversations with the patient’s family can provide missing information, enrich your understanding of what you’ve heard from the patient, or alter your view of the patient’s home situation  You can also use questionnaires and checklists to obtain information about learning needs, learning styles, and learning readiness.  Written materials can also help you assess the patient’s literacy level and ability to understand written information.

Developing learning objectives

The next step in the patient education process is to develop learning objectives.  Unlike goals, which are general and long term, learning objectives are specific, attainable, measurable, and short-term statements.  For example, for a newly diagnosed diabetic patient, a goal will be to learn how to maintain blood glucose levels between 70 and 150 mg/dl.  Reaching this goal may be overwhelming unless it’s broken down into specific objectives that lead up to the overall goal.  For this patient, an objective such as “After this session, you will be able to list 5 symptoms of low blood sugar” is a realistic objective.

Decide which domain of learning is involved. There are three separate learning domains-cognitive, psychomotor, and affective-each of which is described in a classification of “taxonomy” that proceeds from simple to complex learning.  The cognitive domain refers to learning new knowledge, the affective domain refers to adopting new values and attitudes, and the psychomotor domain refers to learning new skills. An example of teaching in the cognitive domain is teaching a diabetic patient how to recognize the signs and symptoms of high and low blood sugar and what actions to take if these conditions occur. 

Learning how to take a blood pressure, change a dressing, or walk with crutches is an example of psychomotor learning.  Learning to accept altered activity levels due to a chronic disease or to quit smoking are examples of learning in the affective domain.  To help a patient learn a new health care behavior, you may need to teach in all three domains.  Your role as a patient teacher is to select content from each domain and use teaching strategies that help the patient to learn simple to complex skills.  As you develop objectives, use action words that are measurable such as list, state, explain, and demonstrate.  Avoid using terms that cannot be measured or easily observed, such as understand or appreciate.

Planning and implementing patient teaching

After you and the patient have agreed on learning objectives, plan how you will implement your teaching plan.  You need to plan for what will be taught, when teaching will occur, where teaching will take place, who will teach and learn, and how teaching will occur.  Decide what to teach and in what sequence teaching will occur.  Many existing patient education programs are not useful, because patients are not in hospital long enough to participate in complex or ambitious learning activities.  Instead of starting with an anatomy lesson, focus on survival skills.  Table 3 shows critical learning needs that are an essential part of discharge preparation.

Plan when you will teach, taking the length of hospital stay or number of clinic or home visits available into account. Keep teaching sessions relatively short-generally no more than 30 minutes and possibly as short as five minutes.  Plan on being able to use those precious “teachable moments” when the patient is ready to learn-even if it means throwing your planned timetable out the window.  Plan where you will teach, including both comfort and privacy.  Whatever setting you use, make sure that you limit distractions and interruptions.  Plan how you will teach.  Use data from your assessment about the patient’s preferred learning style to select your teaching approach.  Remember that global learners like to see the big picture first and work down to the details.  Linear learners want the details first and then expect a bigger picture to emerge. 

For example, when teaching a global learner how to do home blood glucose monitoring, you might start with the overall purpose of monitoring and then go on to the details.  If your patient is a linear learner, start with the first thing the patient needs to do to operate the monitor and save the bigger picture for later.  If your patient indicated on the assessment that he is a visual learner, selecting teaching materials that emphasize reading, writing, and watching visual media such as videotapes.  Auditory learners and patients with low literacy skills benefit from spoken explanations and audiotapes and they may remember information better in pamphlets when they’re read aloud.  Hands-on or kinesthetic learners learn faster when they can tough and handle equipment.  Table 4 shows examples of teaching methods and materials.