Concepts Patient Education, Holism, Fundamentals of Nursing: Patient Education, Communication: Patient-Nurse Communication, Holism, Caring, & Cultural Diversity in Nursing, Nursing Concepts Patient Education Module, NURSE 3101 - Exam 2, Culture- nurs... S

Concepts Patient Education, Holism, Fundamentals of Nursing: Patient Education, Communication: Patient-Nurse Communication, Holism, Caring, & Cultural Diversity in Nursing, Nursing Concepts Patient Education Module, NURSE 3101 - Exam 2, Culture- nurs... S Purpose of Patient Education -Maintain and promote health and illness prevention -Restore their health -Cope with impaired functions Nurses Role in Patient Education is Key.Why? Nurses have a responsibility to teach patients and their families: -Nurse Practice Acts -The Patient Care Partnership -The Joint Commission *health teaching needs to occur and pt can make informed decisions* from The Joint Commission* -Speak up if you have questions. -Pay attention to the care you get. -Educate yourself about your illness. -Ask a trusted family member or friend to be your advocate. -Know what medicines you take and why you take them. -Use a hospital that has been checked out. -Participate in all decisions about your treatment. Learning consist of what? -Domains of Learning -Facilitating Factors -Interfering Factors: -Barriers -Obstacles **Demonstration assimilation understanding doing** Domains of Learning Cognitive:THINKING....application* Affective: FEELING (deals w/) Psychomotor: ACTIVITY(doing) Domains of Learning: Cognitive- simple to complex Knowledge Comprehension Application** Analysis Synthesis Evaluation Domains of Learning: Affective-simple to complex Affective Receiving Responding Valuing Organizing Characterizing Domains of Learning: Psychomotor-simple to complex Perception Set Guided response Mechanism Complex overt response Adaptation Origination To achieve change in behavior; 2 things -Value of change (teaching) -Intelligence Capacity Domains of Learning: teaching methods Cognitive: discussion (one-on-one or group), lecture, question-and-answer session, role play, discovery, independent project, field experience Affective: role play, discussion (one-on-one or group) Psychomotor: demonstration, practice, return demonstration, independent projects, games Factors that Facilitate Learning +Attentional Set +Motivation +Self-efficacy +Adaption to Illness...HAVE GRIEVED* +Actively participating +Learning environment +Learning style Child Learner is who? Infants - adolescent Adult Learner is who? young adult - older *older; teach when rested & lecture should be short* Factors that Interfere with Learning-Patient Factors: Lack of time Stress of the illness Personal characteristics Extent of behavioral changes needed Lack of support Denial of learning needs Emotional Instability Cognitive Disability Physical Disability Factors that Interfere with Learning-Nursing/Health Care Environment: Lack of time Lack of at policy Low priority Environment Inaccessibility and fragmentation of health care system Absence of third-party reimbursement Utility of patient education Documentation A client needs to learn how to use a walker. Acquisition of this skill require learning in the: a.Affective Domain b.Cognitive Domain c.Attentional Domain d.Psychomotor Domain*** Nursing Process 1.Collect Data related to all areas 2.Identify Nursing Diagnosis 3.Develop a care plan 4.Perform nursing care therapies 5.Identify success in meeting outcomes and goals Teaching Process 1.Gather Data related to learning needs 2.Identify learning needs 3.Establish learning objectives 4.Implement teaching methods 5.Determine outcomes of learning What do you assess for assessment? Assess the Learner Assess the Environment Assess learner needs Determine critical information Readiness to learn Motivation Style of learning Cognitive/Physical Ability Language ability Special needs Instructional materials Assess the learning environment Confidentiality Noise Sufficient Time Instructional Materials A client needs to learn how to administer insulin. The nurse knows the client is ready to learn when the client: a.Can state what insulin is b.Expresses the importance of learning the skill****VALUE c.Can see and understand the markings on the syringe d.Has the dexterity needed to prepare and inject the insulin Nursing Diagnosis Deficient Knowledge Self-care deficit Ineffective health maintenance Impaired home maintenance Ineffective therapeutic regimen Non-compliance Anxiety Planning Goals and Outcomes Setting Priorities Collaborative Care Define goal and outcome of patient education. -Goal of patient education indicates that the patient understands information provided and is better able to manage illness. -Outcome describes the patient's ability to do something upon completion of teaching Setting Priorities +Include the patient when determining needs +Base priorities on immediate needs +Determine the right time to teach the patient -For the pt/family -For the nurse +Organize teaching materials Collaborative Care Patient may need referrals to other health care professionals Nurse is responsible for obtaining a referral Responsible for telling patients about available resources ex: call social worker** A patient with diverticulitis recently had surgery and has a new colostomy. A well written goal for this patient would be: a.The patient will describe how to care for the colostomy by discharge. b.The nurse will obtain a consult for the wound care specialist prior to discharge. c.The patient will be able to state support groups located in the community. d.The patient will DEMONSTRATE how to change the colostomy bag by discharge.**** Implementation -Instructional Methods -Effective Teaching Strategies Instructional Methods include: +Lecture +Group Discussion +One-to-one teaching +Demonstration and return demonstration +Gaming +Simulation Teaching Effectively -Project an attitude of acceptance and sensitivity -Present information enthusiastically -Include humor -Use anecdotes and examples -Give positive reinforcement -Be Organized! -Elicit and give feedback -Use questions -Use repetition and pacing -Summarize important points -Utilize visuals and large print as needed Effective Teaching for Low Literacy Patients -Be sensitive -Use simple terminology -Limit written materials -Utilize audiovisuals -Return Demonstration -Keep sessions short -Focus on most important information Effective Teaching Cross Cultures -Posses cultural competence -Listen to the patient -Explore customs or taboos -Conflicts in values from different generations -Observe the interactions between patient and family members -Consider communication abilities -Be aware of cues for interaction **ASK COWORKERS/TRANSLATORS* An older adult is being started on a new antihypertensive medication. In teaching the client about medication the nurse: a.Speaks loudly b.Presents the information once c.Expects the client to understand the information quickly d.Allows the client time to express himself or herself and ask questions******* A 70 year old client has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. The best teaching method would be: a.Simulation b.Gaming c.Group Discussion d.One-to-one teaching***** Evaluation of Teaching-Qs -Did pt achieve the stated goals? -Did the pt change or adopt a new behavior? -Did the pt actively participate and value the session? -How well can the pt answer questions on the topic or demonstrate the new skill? If pt continues to have problems: -What barriers prevented learning from occurring? -Was the instruction method appropriate for the pt's needs? -Were the supportive materials adequate for the pt? -Did the pt have enough time to absorb the information? Documentation of Teaching -The Joint Commission: "a hospital has to show evidence that patient teaching as been a part of patient care" -Disease specific teaching -Discharge teaching: Medications, diet, activity, treatment, follow up care Effective Documentation -Used Standardized Forms -Document formal and informal teaching (FORMAL-TEACHES ALL/ INFORMAL-TEACHES AT AN OPPORTUNITY) -Describe the response of the learner -Put copies of education materials in chart -Update teaching plan Holism •Treats the whole person Mind body and spirit Belief of Holistic Health - People are unique and interact with the environment •Health includes a spiritual component for self-healing, balance and integration •Illness is an imbalance... Examples of health and holism Components •Biological—Dealing with physical illness •Psychosocial—stuck in a hospital/nursing home.. Away from family and friends •Spiritual—not able to attend church •Cultural—not able to participate in cultural practices What are some cautions and health risks associated with alternative modalities?? •Chiropractic Manipulations - Vertebral artery dissection and stroke, pediatric subarachnoid hemorrhage, paralysis, and misdiagnosed meningitis •Interference of herbal medications with prescription medications •Acupuncture - bilateral pneumothoraces (collapsed lungs) leading to death, transmission of hepatitis C •Colon cleansing: amebiasis, ruptured colon Spirituality concepts •Spirituality- anything that pertains to the person's relationship with nonmaterial life force or a higher power •Faith—a confident belief in something for which there is no proof or evidence •Religion—term used to describe cultural or institutional guidance •Hope—ingredient in life responsible for a positive outlook Spirituality is about: • hope and strength • trust and respect • meaning and purpose • forgiveness • belief and faith in self, others, and for some this includes a belief in a deity/higher power • peoples' values and keeping an open mind what are some spiritual barriers?? •Lack of awareness of spirituality •Lack of awareness of your own belief •Fear that your knowledge base in insufficient •Just a basic FEAR Spirituality is the journey to Religion •The "map" that outlines essential beliefs, values and codes of conduct into a manner of living •Spiritual support is to assist the patient to feel a balance and connection with a higher power •Many of the world's religions hold common beliefs •It is the tradition or system of worship providing rituals, answers and norms Implementation of Spiritual Care •Offer a supportive presence •Facilitate patient's practice of religion •Nurture spirituality •Pray with/for a patient Tangibility of spirituality Spiritual needs and psychosocial needs are much less tangible than physical needs. They are more abstract, complex and more difficult to measure Facilitation of Religion •Offer patient with religious services within your facility •Respect privacy during prayer.. Post note on the door.. •Arrange for priest, minister, rabbi or other spiritual leader to visit Assess meanings of cultural artifacts that patients bring.. Do not remove without consent What kind of questions can nurses ask regarding religion/spirituality? •Do you have any religious beliefs that will impact your care? •Are there treatments that may interfere with your beliefs? •Would you like us to contact any religious leaders for you? What are our goals for spiritual distress issues? •Pt will report a decreased spiritual distress •Identify factors in life that challenge any spiritual beliefs •Identify spiritual supports •Express satisfaction with compatibility of spiritual beliefs Diet related to religion with native americans Earth is a living organism—when Earth is harmed, humankind is harmed. Health is a state of harmony with nature Diet related to religion with jahova witnesses taking blood into one's body is morally wrong". No transfusions or blood components. RT diet..some don't eat meat if it is not bled properly Diet related to religion with Mormons Body is a gift from God. God has spoken against the use of caffeine, tobacco, alcohol, and illegal drugs Subculture Group of people who are members of a larger cultural group. Certain ethnic, occupational or physical characteristics are not common to the larger culture Stereotyping one assumes that all members of a culture or ethnic group act alike Cultural assimulation Minorities living within a dominant group lose the characteristics that made them different Cultural imposition Belief that everyone should conform to the majority belief system Ethnocentrism Belief that one's ideas, beliefs, and practice are superior. The Judgment of others using their culture as the standard. Cultural conflicts People become aware of differences and feel threatened. The response: ridiculing beliefs and traditions of others to make themselves feel more secure Cultural blindeness Ignores differences and proceeds as if they don't exist Basic characteristics of culture Dynamic - complex, shared- to share your culture with others to make it stronger, adapted - adapting to ones beliefs, learned - to learn ones cultural beliefs How do nurses provide culturally competent care? •Make sure to involve your patient and family in a plan of care •Collaborate with other members of the team to allow for a multi-disciplinary approach •Close any communication gaps •Do not assume •Respond to any special needs i.e dietary restrictions, eye contact, gender roles, alternative modalities, tissue/organ donation rituals, hearing aides, glasses Pain and Culture? •Cultures vary in when to recognize pain, what words to use in expressing pain, when to seek treatment and what treatments are desired. •Russians, Asians, and Native Americans tend to be stoic, whereas Italians, Puerto Ricans and the Jewish culture tend to be more expressive Cultural variables in pain assessment •Recognize cultural variations in tolerance and metabolism or analgesics and CNS depressants •Assess the meaning of cultural artifacts that clients bring with them. Do not remove these without the client's consent CONCEPTS OF GROWTH AND DEVELOPMENT •Growth is the physical changes that occur over time.. •Development is the process of adapting to one's environment over time PRINCIPLES OF GROWTH AND DEVELOPMENT •Usually follows orderly, predictable pattern—but timing may be unique •Continuous and complex •Proceeds in a core to periphery pattern. •Simple tasks then complex tasks What can affect growth and development Predetermined genetic base •Environmental factors •Psychosocial experiences Developmental theories •An attempt to explain developmental stages that are common to all of us •Provides a framework that aids us in understanding and planning for the needs of the patient 8 stages according to the ages of the children and parents 1.Beginning family (childless) 2.Childbearing family 3.Family with preschool children 4.Family with school-aged children 5.Family with teens and young adults 6.Family launching young adults 7.Post-parental family 8.Aging family Beginning family goal Accepting separation from parents, responsibility for self, commitment to relationship Childbearing family goal Commitment to new roles Family with preschool children Accepting a new generation of family into system Family with school children goals Increase flexibility of family boundaries to include children's independence and parents dependence Family with teens and young adults Increase in family boundaries • "letting go" allowing for child autonomy while providing direction and guidance Family launching young adults To accept a multitude of exits and entries into the family system CHARACTERISTIC OF FAMILIES •Management •Flexibility •Communication •Boundaries •Emotional support •Socialization Family health assessment •Family composition •Family history •Environmental data •Family stressors •Health beliefs, values and behaviors •Abuse or fear within the home Things that can alter family health Lifestyle Psychosocial Environmental Developmental Biologic How to PROMOTION OF FAMILY WELLNESS Family-Centered care Promotion of family wellness Address both the individual and the family Biological age theory Address the anatomic and physiologic changes Psychosocial age theory Provide insight into the behavior, personality and attitudes Developmental age theory Aging is the result of development Sociological age theory Factors such as relationships and activity determine meaning of life as one ages What is health promotion Process of enabling people to increase control over, and to improve, their health Helping individuals to reach a state of complete physical, mental and social well-being Motivated by the desire to increase well-being Related to individual lifestyle choices Health promotion models •Pender's Health Promotion Model 3groups of variables affect health promotion •Wellness Wheels (Wheel of Wellness) Spokes as different dimensions of health •Model of change Change occurs in six stages Trans theoretical model of behavior change Precontemplation •Contemplation •Determination (Preparation) •Action •Maintenance •Termination Precontemplation •Unaware of problem or need to change •May be uninformed •Resistant to information Contemplation Decision-making process •Intention occurs •Pros vs. Cons •Contemplate and procrastinate Determination/preparation Decision to change is made •Plan is prepared •Ready for action •Gradually setting goals •May experience nervousness Action Implementation stage •Life-style modifications •Engaged in efforts to change Maintenance Allows changed behavior to be reinforced •Commitment to new behaviors •Maintenance is persistent change •Coping with relapse Termination Completes the maintenance •Behavior has changed •No danger of relapse Factors Affecting Health Status, Beliefs, and Practices -Risk factors for illness high blood pressure,age, smoking etc. •Basic human needs - Maslow •Self-concept- past experience rationale •Community factors Community factors -Social support systems •Community healthcare structure