Chapter Three

Meeting Individual Needs (Part 1 of this chapter)

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

Chapter Objectives

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

1. Discuss three developmental areas that should be assessed to provide age-appropriate education
2. Identify teaching strategies useful when teaching patients of different age groups
3. State four adult learning principles
4. Discuss how to assess the impact
5. Identify three strategies for family teaching
6. Describe the influence of culture on health care beliefs
7. Name three strategies for working with patients of different cultures
8. State how to assess a patient’s literacy level

Providing age-appropriate education

JCAHO standards require that teaching must consider the patient’s age and developmental level.  Three important developmental areas to assess are the patient’s physical maturation and abilities, psychosocial development, and cognitive capacity.  Specific developmental issues characterize each age group.  During the first 12 to 18 months, an infant is totally dependant on others. To meet basic needs and teaching is directed towards the parents.  The toddler period, between 1 to 3 years, is a significant time for physical and emotional development. Although toddlers are capable of some degree of understanding when they have medical tests or procedures, health teaching continues to be directed primarily towards the parents.

During this age, it is helpful for one nurse to establish a relationship with the child and family and to be consistently involved in learning activities. Toddlers have a very limited ability to pay attention, so teaching must be done in very short sessions – between 2 and 5 minutes.

Compared to adults, children have shorter attention spans and a greater need for nurturing and support, and learn more quickly through creative participation.  Information should be presented in an abbreviated format in a short time period.  School age children between 6 and 12 are capable of logical reasoning.  They should be included in the teaching/learning process whenever possible.  Explain procedures, as well as the reason for them, in a simple, logical, and optimistic way.  Table 7 outlines principles to consider when teaching pre-schoolers and school age children.

The cognitive processes of an adolescent are similar to adults, so similar content and teaching methods can be used.  However, social development and peer group acceptance are much more important issues for teen-agers than they are for adults.  Adolescence is marked by the onset of puberty and a significant amount of personal exploration.  Although you may still include the family in teaching, focus the teaching on the adolescent patient as she or he is increasingly independent and therefore in more control of the extent to which recommendations will be carried out.

Teaching adolescents about sexuality requires special sensitivity and understanding.  In addition to sex education, other important teaching areas are alcohol and drug abuse and good health habits such as optimum nutrition and regular exercise as the basis for life-long health.  Regardless of the topic, teaching adolescents is more effective when you establish trust by respecting the adolescent’s opinions, showing empathetic understanding, and answering questions honestly.

When teaching young and middle-age adults, incorporate the following four principles of adult learning into your teaching plan.  First, adults value self-direction. They view themselves as capable of making decisions, taking responsibility for the consequences of their choices, and being able to manage their own lives. Adults are motivated to learn when they perceive that they have a need to learn.  Try to acknowledge your adult patient’s desire to express his or her own needs and to make choices.  Second, adults bring a variety of learning experiences to each learning situation. Acknowledge and build on the adult’s previous learning and knowledge base by relating new knowledge to prior knowledge.  Third, adult learning readiness is strongly influenced by social roles and developmental tasks.

Relate new learning to the adult patient’s ability to become successful in important roles, such as parent, spouse, or worker.  Fourth, adults have a very present centered time perspective and learn best when they can apply new knowledge immediately and learn how to problem solve.  Adult learners want to know the bottom line.  As patients, they want to know how to perform specific survival skill tasks and how to adopt their current lifestyle to include healthy behaviors.

When teaching older adults, its important to remember that health promotion is an important activity throughout the life span, and learning capacity usually remains at an efficient level well into the 80s.  Older adults are never too old to stop smoking, start exercising, or change their dietary habits.  It’s vital to assess any learning barriers such as sensory loss, limited physical mobility and endurance, or potential inability to follow recommended teaching.  Careful assessment of elderly patients is essential as they may have difficulty following recommendations due to physical limitations or financial barriers.

Use specific teaching strategies to provide health teaching for older people.  Take more time to teach, and present information in small increments so that the patient has enough time to assimilate and integrate conceptual information.  Reduce environmental distractions, both to compensate for any age related sensory loss and to help the patient with attention and concentration.  When teaching any activity or skill, let the older patient set the pace.  Musculoskeletal and nervous system changes that produce joint stiffness and reduced reaction time may affect many routine psychomotor tasks such as opening a medicine bottle of using an inhaler.  Don’t rush the older patient or set time limits on task performance.  Return demonstrations are vital for older patients to ensure that they are able to perform psychomotor skills independently.

With advancing age, the patient’s memory may be better for information that is read.  Pay particular attention to the language you use.  Some elderly patients function at a very high cognitive level and will prefer that you  use and explain medical terms;  others will prefer that you keep instructions short and simple.  In working with a frail elder who has many chronic health problems, you may feel overwhelmed trying to teach the patient and family how to handle daily management.  Yet these patients and families need the most education and support you can provide.  Through careful assessment of the individual older patient’s needs, and by compensating when needed to overcome changes seen with advancing age, you can plan and implement effective patient teaching for this age group.