Alternative Rhythms in Patient Education

Alternative Rhythms in Patient Education Alternative Rhythms in Patient Education These are the resources you need for the essay. No outside source please. UOWG NURS2101 Alternative Rhythms in Patient Education Paper Criteria Points Criteria Comments 20 APA Style – Margins, spacing, references, running head, headings, and title page information have no errors. (Each error will receive a deduction of one point up to 10 points) . 25 Grammar, Spelling & Punctuation. No errors in grammar, spelling and punctuation. Sentence structure is well organized and meaning is clear. (Each error will receive a deduction of one point up to 10 points) . 20 Content – Ideas are developed thoroughly and clearly to support position with sound: * logic (+4) **accuracy (+4) ***precision (+4) **** relevance (+4) 25 Organization Clearly stated introduction with purpose statement (+5) Ingredient is developed (+5) Concept is developed (+5) Relation between Ingredient and Concept is developed (+5) Conclusion summarizes essay 5 Premium Grammarly score >95 % = 5 points 90-94.99% = 4 points 85- 89.99%= 3 points < 85% = no points 100 Total Available/Total Earned *Logic – Can be defined as all the aspects of your writing that help the reader move smoothly from one sentence to the next, and one paragraph to another. UOWG NURS2101 Alternative Rhythms in Patient Education Paper **Accuracy – refers to how correct learners’ use of the language system is, including their use of grammar, pronunciation and vocabulary. Accuracy is often compared to fluency when we talk about a learner’s level of speaking or writing. ***Precision – Using active voice. Use of simple verbs. Does not use contractions. Avoids tautology (saying the same thing twice in different words. Example – the nurse used her individual personal stethoscope). ****Relevance – Of ideas. A good paragraph should contain sentences that are relevant to the paragraph’s main subject and point. While the topic sentence sets up the main idea, the rest of the sentences provide details that support or explain this main idea. attachment_1 attachment_2 attachment_3 attachment_4 414 Concept 43 Patient Education Barbara Carranti Education empowers. Patient education is no exception. Effective patient education allows patients and their families the opportunity to control their own health, reduce risk for illness, improve longevity, and enhance overall wellness. Specifically, the goals of patient education are to learn and adapt by forming connections and associations that will facilitate changes in behavior, resulting in enhanced health and well-being or improved treatment of illness. 1 Lamiani and Furey note that the emphasis of patient education frequently focuses on the disease as opposed to the patient, and they stress the importance of incorporating exploration of the patient’s illness experience into the educational plan to ensure high-quality care. 2 The importance of patient education is supported by Healthy People 2020. This science-based program, in existence for more than 30 years, has used evidence to establish objectives to improve the health of Americans. Patient education is the key to achievement of the overarching goals of Healthy People, specifically increasing the quality and years of healthy life and eliminating health disparities. 3 Definition For the purposes of this concept presentation, patient education is defined as “a process of assisting people to learn health-related behaviors so that they can incorporate these behaviors into everyday life.” 4 ,p11 This is a purposeful process whereby the patient is learning health-related information to support healthy lifestyle or behavior change. A similar term, patient teaching, is used interchangeably. The role of the nurse in patient education is to assist the patient in forming goals; assess patient need, motivation, and ability; plan educational interventions to achieve goals; and evaluate patient outcomes toward goal attainment. In short, nurses empower patients. This empowerment is accomplished by providing information to enhance wellness, reducing the risk for illness, and encouraging autonomy by enhancing self-care skills while maintaining a patient-centered approach. UOWG NURS2101 Alternative Rhythms in Patient Education Paper Scope As a concept, patient education can include provision of information in a wide range of formats and can be described from two perspectives: the delivery approach and educational domains. The process varies depending on multiple variables, including the intended outcome and the characteristics of the learner. For example, is the educational intervention intended to teach the patient a skill or impart knowledge related to a known health problem, increase the probability of successful treatment, prepare for discharge, or to promote a healthy lifestyle and enhance well-being? Thoughtful consideration of intended outcomes will enhance the patient’s learning by matching an approach to intended goals. The nurse must ask, “What change in the patient is the desired outcome of this activity?” The type of education offered will require that the nurse match the approach, method, and evaluation to this desired outcome. 5 UOWG NURS2101 Alternative Rhythms in Patient Education Paper Educational Approaches Patient educational approaches can range from formal educational programming such as group lecture settings to informal, individualized one-on-one teaching and to self-directed learning by the patient that is facilitated by the nurse. 1 Formal patient education courses or classes are useful to address needs common to a group of patients or as individual teaching sessions. Formal courses are often taught using a curriculum/course plan with standardized content. In contrast, informal teaching often occurs in one-on-one sessions with the patient and/or family. Informal sessions may be planned or spontaneous, but they do not follow a specified formalized plan. An informal approach represents a large portion of patient education done by nurses. In fact, the majority of critical education occurs with each patient encounter when medications, diet, or treatment is explained or simply when answering questions about the patient’s issues or concerns. Individual or self-directed education results when a patient or family obtains and/or completes an educational activity independent from the nurse or other health care providers. With the influence of consumerism and the availability of information, a great deal of education can occur through self-directed learning employing written material or media (e.g., Internet and video) designed to assist the patient with information about health topics, a particular disease, treatments, or a specific skill ( Figure 43-1 ). 1 FIGURE 43-1 Scope of Patient Education Concept Because of the increasing dependence on technology in all aspects of life, the use of Internet resources for patient education cannot be ignored. A majority of adults in America use the Internet to find information on many aspects of life, including health, healthy lifestyles, and treatment options. 5 This use of technology expands the role of the nurse in patient education to include teaching on evaluation of 415Internet sources. Patients should be encouraged to search for information sources that list authors and their credentials and contact information. The source of information should also be listed, and any photographs, charts, graphs, or other graphics should contain helpful understandable information. Any links associated with the site should be functional, active links. It is also important that patients be taught to search for government (.gov), educational (.edu), and nonprofit (.org) sites because they are considered to be the most credible sources of information. Finally, sites chosen for use in gathering information should clearly identify how consumers can contact a site administrator and should be secure sites. 6 For this discussion of approaches to patient education to be complete, the educated and motivated consumer should be considered. Many patients will be active consumers of health information and use self-directed approaches to education. Patients may present the nurse with articles, computer printouts, and other materials gathered in an attempt to learn about health promotion, symptoms, diagnoses, and treatments. These materials can be incorporated into the nurse’s assessment of the patient and the educational plan. The tendency to pursue learning opportunities addresses motivation and presents the nurse with an opportunity to ask the patient to discuss what has been learned. This also gives the nurse the opportunity to teach the patient evaluative skills, looking at sources and content of the material for credibility and reliability. Alternative Rhythms in Patient Education7 Learning Domains Patient education can also be conceptualized from the perspective of learning domains—in other words, in terms of the type of learning a patient will need. The three main domains are cognitive, psychomotor, and affective ( Figure 43-2 ). 1 Education intended to increase a patient’s knowledge of a subject, for example, is cognitive in nature, and using methods such as written material, lecture, and discussion is appropriate. Skill teaching or psychomotor teaching requires that the patient have opportunities to touch and manipulate equipment and practice skills. A patient who must learn to change a dressing over a wound is an example. Education that is intended to change attitudes, such as viewing the lifestyle modifications associated with the treatment of coronary artery disease as a positive change rather than a burden, is known as the affective domain in education. 5 FIGURE 43-2 Learning Domains Alternative Rhythms in Patient Education To illustrate this, consider an example of a patient with a new diagnosis of a degenerative neurologic disorder that will require the patient to self-catheterize. The nurse will need to teach the patient the complex psychomotor skill of self-catheterization, and the teaching will be successful when the patient is able to competently demonstrate this skill. Part of this teaching will include physiological information designed to enhance the patient’s understanding of the necessity of this procedure (cognitive learning) as well as assistance with lifestyle alterations and coping to help the patient to adapt and continue to live fully (affective domain). 1 Attributes and Criteria Alternative Rhythms in Patient Education For patient education to occur, there must be an identified need for learning. Although this need may be identified by the nurse, learning will not occur without readiness on the part of the learner. Ultimately, it is patient motivation that determines when, how, and if patient education will occur. 1 In addition to an identified need, the following are other major attributes of patient education: Planning is involved. The outcomes are goal oriented. The patient is motivated to learn. Like any other teaching-learning process, patient education requires that the teacher (nurse) know the intended audience and plan appropriately. This is a process that must be in place even in the most routine patient encounters. There must also be a goal, which is usually a change in behavior or attitude of some sort. The learners (patient and/or significant other) not only should be identified as the target of the teaching plan but also should be motivated by the outcome of the behavioral or attitudinal change. The nurse then develops the plan and evaluation to be consistent with the patient needs. The nurse must determine the overall appropriateness of patient education. This requires asking, “Is the timing right, are the involved parties ready, and are the goals clear?” Only after these answers are determined can true education of the patient occur. Theoretical Links The goal of all patient education is to produce change. It is helpful to examine theories of behavior and learning in addition to nursing theory to understand patient need and motivation to change. Alternative Rhythms in Patient Education Theories of Health Behavior The health belief model was developed by Rosenstock in the mid-20th century to help explain individual decisions to use health screening opportunities. It has been adapted many times to explain compliance and behavior as they relate to health. 8 According to the health belief model, individual perceptions of susceptibility to and severity of disease are the primary motivators for making attempts to change health behavior. These motivators are modified by demographic, social, psychological, and structural variables that may heighten or dampen motivation. The primary motivation of patient perception then allows the patient to be open to cues to act, which of course leads to patient education opportunities. 8 For example, a patient who is aware that her risk for breast cancer is high because of genetics may be likely to participate in some form of education about risk for the disease. This education can enhance the patient’s knowledge level to produce lifestyle changes that reduce risk. Simply stated, the health belief model states that for an individual to change behavior related to health and wellness, there first must be a belief that illness can be avoided and that taking a particular action 416can reduce risk. Furthermore, the individual must believe that he or she is capable of making the needed change. Nola Pender’s health promotion model (HPM), developed in 1987 and revised in the late 1990s, is “an attempt to depict the multidimensional nature of persons interacting with their interpersonal and physical environment as they pursue health.” 9 ,p44 The HPM is based on the health belief model that was expanded by Pender to include factors that can influence the patient’s motivation to change behavior, such as previous experience with behavior changes to address the problem, and the patient’s perception of success in these attempts. This model also expands the view of patient motivation by including social supports and competing priorities as factors to consider. Pender’s model is focused on achieving optimum wellness rather than avoiding disease, which Rosenstock’s original model stressed as the primary motivator for changing behaviors. Pender points out, for example, that consideration of the patient’s prior experience with attempting to change health behaviors is a key factor for the nurse when planning strategy, including educational strategy. An obese patient with comorbidities of coronary artery disease and type 2 diabetes will likely be told to lose weight to avoid serious complications. The HPM dictates that part of the nursing assessment would be to ask the patient about prior attempts at weight reduction and perceived success of these efforts. The patient response to these inquiries will assist the nurse in development of educational interventions to address patient need. Pender also emphasizes that how the patient views the benefits and barriers to behavior change as well as the patient’s own perception of ability to succeed will impact the nurse’s plan for education. 9 Nursing Theory There are many theories that can be used as a basis for formulating patient education plans. Dorothea Orem’s self-care deficit theory is based on optimizing the patient’s ability to assume responsibility for his or her own care and that motivation is based on the anticipation of resuming this responsibility. Orem defines self-care as a regulatory function that is “a deliberate action to supply or ensure the supply of necessary materials needed for continued life, growth, development and maintenance of human integrity.” 10 ,p134 Orem addresses the role of family and others in the patient’s social support system as assuming the responsibility of the patient’s care when the patient is unable. Utilization of Orem’s theory can assist the nurse to determine if teaching materials are consistent with factors discovered during the assessment process so that selection can move the patient toward meeting self-care demands. 11 Context to Nursing and Health Care Education of patients is integral to professional nursing practice; this fact is illustrated in multiple documents, including the American Nurses Association’s Nursing: Scope and Standards of Practice, 12 each state’s Nurse Practice Act, the Institute of Medicine’s Future of Nursing report, 13 and the Quality and Safety Education in Nursing competencies. 14 Nursing practice has been defined as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of patients, families, communities, and populations.” 12 ,p1 These positive patient outcomes are often achieved through education. UOWG NURS2101 Alternative Rhythms in Patient Education Paper Numerous agencies require that patients and families be provided with information required to make decisions about health care and treatment of illness. 15 Modifications in health care in terms of delivery style and financer expectations have also changed the role of the patient in participating in his or her own care. This new level of patient engagement in health care requires that patient education be a priority for the registered nurse in the provision of patient care. 16 Consumerism has also made more individuals want to take control of their own health and wellness and is promoting more individuals to seek health education opportunities in many venues. Patient education, however, is a cornerstone of nursing practice and is one of the ways in which members of care teams collaborate to achieve quality patient care outcomes. Quality patient education requires appropriate assessment, planning, implementation, and evaluation of this often-complex process. Alternative Rhythms in Patient Education The educational process and the nursing process are essentially the same 4 and include learner assessment, planning, implementation, evaluation, and documentation. Each of these steps is discussed in detail. Learner Assessment Learner assessment begins with a comprehensive assessment of the patient’s learning needs. This may include a formalized written assessment, may be incorporated as part of the health assessment interview, or certainly may be a stated need from the patient. The assessment should include patient resources (education level, literacy level, social support, and financial resources), educational resources, and nursing resources. Assessment data should be used to develop a teaching plan that is appropriate for the patient but also one that will meet the desired goal. To fully individualize the educational plan for a patient, the nurse will consider the age, stage of development, and motivation to change behavior. Psychosocial Development Educational interventions must attend to the patient’s achievement of developmental tasks. Erikson’s theory of development is based on an eight-stage process in which each stage requires the achievement of a particular task. Completion of each stage forms the foundation of the next stage. 17 An understanding of Erikson’s theory of development assists the nurse in patient education by understanding approaches necessary to accomplish the goal. For example, the educational approach taken by the nurse in teaching a patient how to use a metered dose inhaler for delivery of steroids will be different for a school-age child than for a middle-aged adult. Using play-type activities to teach the procedure and identifying a celebrity or other role model who may need a similar treatment will appeal to the school-age patient. The middle-aged adult is more concerned with fitting this treatment into his or her normal life patterns. Finally, it is critical for the nurse to incorporate the patient’s own culture to make the teaching process meaningful. Pedagogy Versus Androgogy An appropriate next step to follow when utilizing Erikson’s theory of development is to ensure that the type of educational method used is appropriate to the individual stage of development. Pedagogy is the methodology used to assist children to learn, or the strategies of traditional teaching. Androgogy conversely describes adult learning. 5 This implies that the strategies used with great success for teaching children in classrooms may not translate to successful outcomes for the nurse teaching adults. The nurse should attend to the developmental level of the individual and tailor learning activities to account for these differences. In general, learning in the adult is focused on an immediate need to address a personal issue or to solve a problem. The nurse is viewed as one who can facilitate that goal rather than simply impart knowledge. All learning activity should be directed toward meeting the learning goals of the adult patient. It is also important to note that most 417adults enter any learning situation with a rich history of experiences that can be, and should be, drawn on by the nurse to enhance present learning. 1 Adults tend to learn best when there is a perceived need to learn the information (internal motivation) and the information perceived is pertinent to address an immediate problem or need, when learning is self-directed using learner-centered strategies with application, and when learning draws on the past experiences of the learner. The nurse further enhances learning in the role of a facilitator and by providing timely feedback. UOWG NURS2101 Alternative Rhythms in Patient Education Paper Hierarchy of Needs Maslow’s hierarchy of needs theory is based on a simple premise that for higher level needs to be addressed, lower level needs must be met. Maslow, a humanist, concluded that if environmental conditions are appropriate to meet basic needs, then individuals will be able to learn and self-actualize. 18 This is an important concept in all types of teaching and is clear in all levels of education. A school-age child has limited ability to concentrate if the child is hungry. A college student has limited ability to concentrate and learn after an all-night study session. Of course, this extends to patients as well. For example, inadequate oxygenation, safety deficits, and food, water, and elimination needs must be addressed before the patient can adequately learn. A patient who needs to learn a complex skill must have the needs of pain management and comfort met before he or she attempts to meet learning needs. The motivation for patient education may also be linked to survival, representing a much more basic level of need. For example, a patient learning to self-administer insulin for the first time may feel a great sense of accomplishment at mastering this complex task, but the ability to self-administer this drug is truly a matter of survival for the diabetic patient. Generational Differences Generational differences are also a consideration when approaching patient education. Much has been reported about differences in the learning styles between generations, relating not only to the age of the patient but also to the era in which the individual was raised, as well as the social and political experiences of a group. 19 Educational approaches may need to differ for those born before 1946; members of this age group usually are self-motivated and do not seek feedback for their performance. On the other hand, members of Generation Y are dependent on technology and desire immediate feedback. 20 This generational factor, perhaps more than any other, will dictate how the nurse approaches patient education. Alternative Rhythms in Patient Education Literacy Level The ability to read and understand the written word is, of course, critical if the educational process is to include any written material. Based on the 2003 National Assessment of Adult Literacy, 43% of adults in the United States had literacy skills at the basic or below basic level. 21 It is also important to consider the patient’s ability to understand and interpret health-related information and instructions—the individual’s level of health literacy. 4 Although assessment of literacy levels can be very difficult in adult patients because of the stigma and shame often associated with limited reading ability, patients may give cues to limited literacy, such as avoiding reading materials provided (the patient may state “I forgot my glasses”) or demonstrating repeated inability to follow written instructions. If there is a suspicion that the patient may not be able to read written material or that the information is written at a level that the patient cannot understand, the nurse must use alternate methods of instruction to ensure patient understanding. Although beyond the scope of this text, several methods exist for the nurse to quickly evaluate written material for readability for those with limited reading skills. Barriers There are a number of barriers to learning that must be considered as part of learner assessment. The lack of available social support systems, which may impair the patient’s motivation to learn or ability to participate in classes or programs, is one common barrier. Lack of support may also limit the patient’s ability to practice new skills. Additional patient-related barriers include cultural differences, lack of financial resources or time, and frequent interruptions. It may be within the patient’s or the nurse’s ability to control or remove these barriers to enhance patient learning and outcomes. Barriers on the part of the nurse to participate in patient education include lack of time and multiple competing demands. The teaching role of the professional nurse is often not prioritized because of issues with staffing, payment, and perception of effectiveness of educational efforts. Furthermore, the nurse’s professional motivation and confidence in education skills may pose a barrier to patient education. Again, assessing the nurse’s attitudes can assist in identification of these professional barriers and development of interventions to overcome them. 1 Planning Planning is the determination of what methods will be used to meet the educational need. This includes deciding if the outcome is a cognitive (knowledge) change, a psychomotor (performance of a skill) change, or an affective (feeling or attitude) change. Determining the type of outcome dictates the approach as well as the goal. For example, a patient diagnosed with type 1 diabetes may need to learn about the overall pathophysiology of the disease so that he or she can appreciate the physical and lifestyle impact. However, the patient also needs to develop practical psychomotor skills (e.g., injection and testing) to cope with this disease. The nurse must plan not only to describe what diabetes is but also to demonstrate blood glucose testing and self-injection of insulin, allowing for practice and re-demonstration from the patient and perhaps significant others as well. The teaching methodology used should match the domain of learning. UOWG NURS2101 Alternative Rhythms in Patient Education Paper Implementation of Educational Plan Implementation or carrying out the plan is an area in which flexibility is key. The nurse will need to determine the length of educational sessions, content to be covered, and methodology for teaching. These plans may be influenced by numerous unpredictable factors, such as patient condition and competing priorities. The nurse must adjust the teaching session to accommodate the priorities of the patient. Alternative Rhythms in Patient Education Evaluation Evaluation of learning outcomes should be consistent with the domain of learning as well. Psychomotor skills, for example, require that the patient be able to do something, such as perform a skill. Using a survey or other measurement tool to evaluate a skill will not adequately measure this outcome. Surveys and questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Because the goal of patient education is behavior change, the evaluation of the process may need to be conducted over time and be dependent on multiple sources of data. Returning to the example of teaching a patient diagnosed with type 1 diabetes, the nurse will likely include cognitive information about disease pathology to appropriately manage the condition. This patient will probably need to master the psychomotor skill of blood glucose monitoring and insulin injection. The nurse will also be concerned 418with the affective dimension of the diagnosis of chronic disease. Evaluation of all of these dimensions will require that the nurse observe the skills for level of mastery, discuss the “why” of diet and exercise with the patient on multiple occasions, evaluate the impact of the patient’s daily decisions on disease management, and use repeated assessment of the patient’s acceptance of the condition to fully evaluate behavior change. No discussion of patient education would be complete without consideration of patient adherence. There are many factors that block patient adherence, such as lack of understanding, literacy, financial problems, lack of environmental or interpersonal support, previous experiences with treatment or self-management, and motivation. 3 These issues should be included in the assessment process and addressed in the educational plan for the patient in an attempt to enhance compliance. Documentation To ensure consistency in care, documentation of patient education is included in the patient record. This documentation should be comprehensive and include not only a description of the information that the patient was taught but also an assessment of the patient’s motivation, ability to learn (any physical or cognitive issues that may inhibit the process), developmental level, and resources (personal and financial, if appropriate). A detailed plan should be included in the documentation so that other professionals can reinforce the process if education is to be continued across care settings. This should include goals and progress toward them. Finally, the patient response to the educational plan and adjustments to accommodate changes in patient condition or other factors should be included to ensure consistent, successful patient education outcomes. Interrelated Concepts Patient education as a concept is central to the role of the nurse in the delivery of quality patient care ( Figure 43-3 ). The professional roles and attributes of Collaboration and Communication are essential in the development, planning, and delivery of patient education, whereas the nurse’s role as an educator is central to his or her Professional Identity. The nurse works not only with the patient but also with teams of providers in determining care needs, and quality patient education is one of the results of this skilled collaborative effort. To accomplish this, the nurse’s knowledge of Technology and Informatics along with the ability to teach patients and families the use of health care technology are critical when transitioning care from the acute care facility into the home. The result of current changes in health care requires the nurse to engage Leadership skills not only to assist patients and families but also to prepare the consumer for this evolution of health care. UOWG NURS2101 Alternative Rhythms in Patient Education Paper FIGURE 43-3 Patient Education and Interrelated Concepts Professional nursing concepts are represented in blue; health care recipient concepts are represented in red. The role of the nurse in Health Promotion, an area in which nurses generally take the lead, is also a critical professional dimension that is related to patient education. The nurse’s knowledge and skill in recognizing opportunities to improve wellness, health, and function through lifestyle modification are used in all patient encounters and are a critical professional role in the education of patients. Patient education incorporates the patient’s attributes and resources. The nurse approaches each patient encounter as an opportunity to educate. This involves a determination of the patient’s developmental level (Development) as well as an analysis of the dynamics of relationships (Family Dynamics) to assist in determination of supports and stressors. The patient’s cultural background (Culture) and

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