teaching skills and nursing practice why do nurses need teaching skills teaching cli 2920774

Teaching Skills and Nursing Practice Why do nurses need teaching skills?

-Teaching client’s is part of the independent nursing practice

-ANA standard related to promoting health demands skills in teaching clients

-Clients/families need information for decision making

-Shorter hospital stays increase need for teaching about home care needs

-Teaching facilitates compliance and shortens hospital stays and medical complications

-Teaching empowers clients and families(knowledge is power!) Teaching Process that involves a teacher and a learner


•Involves planning and implementing instructional activities

•Requires good communication skills

-Includes providing activities that allow clients to learn

•Goal of teaching activities: to meet learner outcomes

Effective communication skills
-must adequately convey information
-must assess verbal and nonverbal feedback
-accommodate various learning styles

Can combine teaching, counseling, and behavioral modifications together to achieve client learning

Who and What Do Nurses Teach? Who?

•Single client

•Families, caregivers

•Groups of clients


•Nursing assistive personnel

•Nursing students

•New employees

•Disease information
•Information about medications
•Procedures/psychomotor skills
•Disease prevention and health promotion
•Clinical processes

Learning Change in behavior, knowledge, skills, or attitude

•Learning occurs as a result of planned or spontaneously(i.e. patient not using a walker properly) occurring

situations, events, or exposures

•Goal-oriented, intended, and deliberate, involving motivation to learn


•Rote learning-not actively engaged-Without active participation in the learning process (subconscious)

•Active process involving more than giving of information The Three Domains of Learning Cognitive

-Storage and recall of information (e.g., facts about a disease)

(client explains the effect of a med)


-“Hands-on” skill

-Requires thinking and doing(e.g.,self-administration of insulin)

(new mother follows instruction on how to diaper her newborn, imitates the movements of instructor)


-Changing feelings, beliefs, attitudes, and values (e.g., changing a

belief about diet)

(mother changes her mind about leaving her child in a hospital after being taught the benefits) Factors Affecting Client Learning List as many as possible:

-Active involvement


-complex information


-illness may interfere

-anxiety Developmental and Cultural Considerations What do nurses need to consider when planning education for

the following groups?

•Clients with special needs(fatigue easily, may need to plan frequent short teaching sessions)

• Children(gross/fine motor skills need to be assessed)(piaget’s stages: pre-operational 2-7 yr old, concrete operations 7-11 yr old, formal operational 11 yr old)(reduce anxiety and enhance their emotional readiness to learn)



•Cultural Factors(observe family dynamics, observe interactions with the family, customs and taboos that might interfere on what your teaching, do not use slang) Promoting Health Literacy with Patients How would the nurse go about ensuring the patient has an understanding of basic health information and services needed so

the client can make appropriate healthcare decisions?

-Ask questions with How/What instead of yes/no
-Assist client to complete forms
-Organize their info
-Repeat info
-Avoid medical jargon
-Use simple words
-Use many photos and drawings
-Non-English speaking(get interpreter)

Components of a Learning Assessment Assess Client’s(determines the right setting for teaching, what necessary content to teach, learning goals, and teaching strategies)

-Learning needs/knowledge level(what do they know already, what do they not know?)

-Health beliefs and practices(Do they believe they have control over their health or not?)(Do they have an inner locus of control-they feel they have control or an external locus of control-something else is effecting their health not them)

-Physical and emotional readiness(Is this a new diagnosis that they have not processed yet?, are they weeping, crying and anxious?)

-Ability to learn(Fear, anxiety, cognition, medicated, pain)

•Literacy level(can they read and at what level)

•Health literacy(do they understand what is going on with their illness)

•Ability to see(do they need glasses etc), feel, hear(do they have a hearing aid), grasp

•Learning style(read, watch-visual learners, kinesthetic learning)

•Time constraints(how much time do you have to teach?, is it a complicated procedure, do you need a few days in a row?)

•Available resources( community, family member) Components of a Teaching Plan Teaching Plan

•Teaching strategies: method used to present the content being taught

• Content: all information needed to reach your intended goal

• Scheduling and sequencing: how to organize and sequence


•Instructional material: materials/tools used to present Correct Use of Nursing Diagnosis: Deficient Knowledge Use Deficient Knowledge for:(problem or the cause of a problem)

•Primary Problem(only if lack of knowledge is the primary problem)


Deficient knowledge(diabetic foot care) r/t lack of prior experience as evidence by anxiety and many questions about foot care

•Secondary Problem



Ineffective health maintenance r/t deficient knowledge of immunization


Incorrect Use of Deficient Knowledge-

for problems involving the client’s ability to learn(i.e. fear/anxiety) Examples of Teaching Strategies List and describe examples of teaching strategies

-consider the learners differences, needs , learning style

-match with the teaching methods

-visual learners,kinesthetic learners, audio

-how you want the patient to remember things(can use role playing, skits, games)

-concept map Evaluating Learning -Did patient learning occur?

-Can patient repeat what I taught him/her?

• Tests and written exercises
• Oral questions
• Interviews
• Questionnaires
• Checklists
• Direct observation of performance
• Client report
• Client records

-learning occurs through repetition, reinforcement, and practice

Documenting Teaching and Learning -“If it’s not documented it was not done”

• Record client and family responses
• Legal evidence
• Informal Teaching:
– Which occurs during other nursing care activities
can be noted in the nursing notes.
• Formal Teaching:
– Write objective statements about what was taught
and the client skills and behaviors that
demonstrate learning.

5 rights of teaching -Right Time(Is my patient pain free?)

-Right Context (Is the environment quiet?)Distractions are limited

-Right Goal(What does the patient want to learn?)(measurable and realistic)

-Right Content (Are they able to read and understand?)

-Right Method(Fit the learning style) The client needs to be taught how to find and check his own radial pulse. The nurse will complete this teaching b. when the client recognizes the need to learn the skill

Rational: The client will be most motivated to learn when he recognizes why this skill is important to the success of his overall treatment plan (e.g., medication effectiveness).

The client is given a pamphlet to read about how to manage his newly inserted central venous access device. It will be most important for the nurse to assess the client’s d. ability to see

RationalIf the client has vision problems, the nurse will have to find another strategy to convey the information.

Nurses must possess the knowledge and skills needed for patient teaching so that c.They can promote the health, safety, and rights of clients through education. he nurse is teaching a patient newly diagnosed with type 1 diabetes mellitus about how to best manage his blood sugar. Which outcome in the patient’s plan of care is associated with the cognitive domain of learning? The patient:

1) identifies signs and symptoms of hypoglycemia.

2) nods affirmatively with direct eye contact.

3) demonstrates fingerstick glucose monitoring.

4) independently self-administers insulin. Answer:

1) identifies signs and symptoms of hypoglycemia.

Cognitive behavior includes recall and comprehension, which is demonstrated by stating information, such as indicators of hypoglycemia. Nodding with eye contact is an action that exhibits the listener is dealing with the information with emotion (respect), which shows affective domain. Affective learning is the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes. Willingness to hear and showing attention falls within the affective domain. Demonstration of skills depicts the psychomotor domain, such as performing a test to check blood sugar or injecting insulin.

When teaching nursing students about how to provide culturally sensitive care to a diverse group of patients, which teaching strategy is most likely to promote affective learning?

1) Demonstration

2) Computer-assisted instruction

3) Concept mapping

4) Role-modeling Answer:

4) Role-modeling

Affective learning involves changes in feelings, beliefs, attitudes, and values. It is considered the “feeling domain.” Strategies for promoting affective learning include role-modeling, panel discussion, support group, one-to-one instruction, audiovisual materials, and possibly printed materials. Strategies for cognitive learning include concept mapping, panel discussion, and computer-assisted instruction. Strategies for psychomotor learning include demonstration, simulation, audiovisual materials, and printed materials.

A nurse strives to teach a spouse how to monitor a patient’s blood pressure. Which teaching method is best?

1) Provide the patient and spouse with written instruction about how to obtain blood pressure.

2) Demonstrate the technique for taking blood pressure, and then request a return demonstration.

3) Schedule the spouse for a class about high blood pressure, including monitoring technique.

4) Provide the spouse with a patient education brochure about blood pressure monitoring. Answer:

2) Demonstrate the technique for taking blood pressure, and then request a return demonstration.

The best way to teach a psychomotor skill, such as obtaining blood pressure, is through demonstration and return demonstration. Cognitive learning, which includes storage and recall of information, is most often taught through lecture and print and audiovisual materials.

How might the nurse improve health literacy between patients and healthcare providers?

1) Ask patients simple yes or no questions.

2) Speak with passive voice instead of active.

3) Avoid medical jargon and technical terms.

4) Provide information printed in English. Answer:

2) Speak with passive voice instead of active.

Health literacy is the ability to understand basic health information and services needed to make appropriate healthcare decisions. A gap in health literacy results when a healthcare provider uses terminology that is unfamiliar or misunderstood by the patient, thus resulting in an unintended message or lack of meaningful information. Therefore, healthcare providers should avoid unnecessary medical jargon and technical terms. Speak using common words, short sentences, and structuring sentences with active rather than passive voice. To be sure the patient understands your questions clearly, ask questions that involve “how” and “what” rather than “yes” and “no.” Patients with limited language proficiency might use words of agreement “yes” or disagreement “no” simply because of reduced vocabulary and poor understanding of the question. Do not assume that a client who smiles, nods, and says “yes” really understands what you are teaching. The client may be embarrassed to ask questions or may feel that it will embarrass you. An interpreter might help communication when language is the barrier.

Why is patient education important in today’s healthcare environment?

1) Primarily it is offered to increase patient confidence for self-care.

2) Nurses do patient teaching to transfer responsibility for care to patients.

3) Patient education contributes to rising healthcare costs.

4) More healthcare is delivered in the home and outpatient settings. Answer:

4) More healthcare is delivered in the home and outpatient settings.

With shorter hospital stays and complex care increasingly being given in homes and the community, teaching is essential to protect patient well-being and safety in the outpatient environment. The primary goal of patient education is to increase the knowledge and skills needed for quality self-care or for providers delivering care in the outpatient setting. Although patients often feel more confident in the home care they will perform after receiving patient education, the primary objective is to facilitate healing and prevent complications. Patients participate in healthcare decisions. Patients have a responsibility for their own health and the care needed to prevent illness, maintain health, treat disease, and evaluate the response to medical treatment. The cost of healthcare is rising. Patient education can help to decrease the overall cost of healthcare and prevent complications leading to rehospitalization.

The nurse working in a hospital with a diverse population strives to offer culturally sensitive care. What nursing action would be most appropriate?

1) Act as if familiar with cultural practices or values even if uncertain.

2) Allow patient to include cultural practices in plan of care unless harmful.

3) Use common, slang phrases as they are familiar to many people.

4) Incorporate humor into interactions with patients to put them at ease. Answer:

2) Allow patient to include cultural practices in plan of care unless harmful.

Find ways to incorporate the client’s current healthcare practices and beliefs into the plan of care unless there is potential for harm. When the nurse is unfamiliar with the patient and family’s cultural practices, she should admit lack of knowledge, seek clarification, and express willingness to learn. She should not fake it. The nurse should avoid using slang expressions because they can take on different meanings in different cultures. Slang can lead to miscommunication and offensive messages. Avoid using humor; jokes often do not translate well because of subtle meaning changes.

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