Chapter Two

How To Be an Effective Patient Teacher (Part 2 of this chapter)

You can find the first three installments of this series in our Spring 2005 archive, Fall 2005 archive and Spring 2006 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

The practice of novice nurses can best be supported by using realistic teaching plans, critical paths, and teaching tools.  In institutions where teaching programs are not well developed, consult with other health care agencies to learn about teaching programs for specific patient populations.  Information about patient and family teaching can be obtained from organizations such as the Arthritis Foundation, the American Diabetes Association, and the American Cancer Society.

A valuable resource is the Clinical Practice Guidelines developed by the Agency for Healthcare Research and Quality (AHRQ).  These evidence-based interdisciplinary guidelines assist clinicians to prevent, diagnose, treat, and mange clinical conditions, with a focus on patient outcomes.  A patient’s guide (or parent guide for pediatric problems) for each guideline is available in English and Spanish.  The Web site address for AHRQ is www.ahcpr.gov.

Evaluating patient Learning

Plan how you will evaluate learning.  Evaluation, the last phase of the teaching-learning process, is the ongoing appraisal of the patient’s learning progress.  The goal of evaluation is to find out if the patient has learned what you have taught.  Table 5 shows ways of evaluating learning.

Documenting patient teaching

No matter what charting system you use, your documentation system must reflect how you have assessed the patient’s learning needs, what you’ve taught, and the patient’s response to teaching.  Key areas that must be addressed are safe and effective use of medications and medical equipment, potential food-drug interactions, and how to obtain further care.  Good documentation enhances communication about the patient’s  learning process among all health care team members, helps maintain continuity of care, and avoids duplication of teaching.  Here is what you should document:

• Patient and family learning needs
• Patient/family readiness to learn and learning style
• Current knowledge about patient’s condition and health care management
• Learning objectives and goals developed by you and the patient
• Information and skills you have taught
• Teaching methods used – brochures, models, videos, demonstration
• Patient and family response to teaching
• Evaluation of what the patient and family have learned and how learning outcomes were determined

Documenting patient teaching can be done via flow charts, checklists, care plans, progress notes, or computerized documentation.  Whatever method you use, remember that the information must become a part of the patient’s permanent medical record.  At the end of each hospital shift or clinic or home visit, document what part of the teaching plan you completed and what instructions you have given the patient and family.

How to avoid teaching mistakes

Nurses and other health care professionals put a great deal of time and effort into providing patient and family teaching.  However, it’s easy to develop habits that undercut your teaching effectiveness.  Table 6 shows some frequent teaching mistakes, followed by a discussion of how to avoid them.

Teaching success decreases when the restrictions of the patient’s environment are not considered. This problem occurs when we ignore important factors such as lack of family support, financial resources, or cultural issues that influence health care management. Another error occurs when we forget that the patient has the right to change their mind. This problem is most likely to occur when we overly invest in the patient’s progress.

For example, an elderly woman planned to give her own insulin, but changed her mind, deciding that her husband and daughter would be more appropriate. However, the health care team was so committed to make the patient “independent” that they continued to insist on the original plan. Using medical jargon is a common mistake that often promotes confusion and frustration. As the content expert, it is desirable and appropriate for you to have specific teaching goals in mind. However, you must also determine the patient’s goals and negotiate them with the patient to achieve the outcomes you both want. A patient with emphysema may set goals for himself that include giving medications and learning breathing exercises. You agree with these goals, but also push the patient to participate in a smoking cessation program.

If the patient does not share this goal, it’s unlikely he will adopt it as his own. Duplicating teaching that other team members have already done wastes time and frustrates patients. This problem can usually be eliminated by charting teaching you have done, by reading the patient’s medical record to see what others have taught, and by practicing good interdisciplinary communication. Be cautious about overloading the patient with information. Sometimes in our sincere attempts to teach patients everything we think they need to know, we run the risk of giving them more information that they can absorb. Stick to the “need to know” or most important topics rather than “nice to know” background information.

Although you can’t always choose an optimum time for teaching, try to select a time when your teaching efforts are most likely to be effective. Try to avoid times when the patient is stressed or upset. Immediately before or after diagnostic procedures or surgery or when the patient is in pain are not good teaching times. In situations such as these in which the patient is unable to be an active participant, you can direct your teaching efforts to family members.

Not evaluating what the patient has learned is one of the most common mistakes nurses make. We may get so involved in teaching that we forget to evaluate what the patient has learned. Frequently, we teach at a rapid pace, quickly ask for questions, and then leave the room, believing that patients have understood out teaching because they had no questions. In reality, patients may understand so little that they are unable to formulate questions or feel like the nurse doesn’t have time to answer questions.

The JCAHO standard stating that “patient education should be interactive” means that teaching and learning should be a shared process. If you use educational media, review the content in advance and don’t depend on media to the exclusion of personal interaction. Relying totally on media is an inadequate approach to patient teaching because it makes it impossible to individualize patient teaching, to allow the patient to ask questions, or to get valuable feedback from the patient.

By learning more about the process of patient teaching, you can continuously improve your ability to give your patients the tools they need to improve and maintain health. Learning how to accurately assess learning needs and learning readiness, developing and implementing a realistic teaching plan, evaluating the results of learning, documenting teaching effectively, and avoiding common teaching mistakes will help improve your patient teaching skills.