Patient Education

Patient Education

The process of influencing the patient’s behavior to effect changes in knowledge, skills, and attitudes needed to maintain and improve health

Goal of Patient Education

To develop self-care abilities to maximize their function and quality of life:

• Maintaining and promoting health: exercise programs and diet

• Preventing illness: Vaccinations and teaching how to avoid illness

• Restoring Health: Post-op teaching (ex: exercising lungs to prevent pneumonia)

• Facilitating Coping: Helping patient to deal with permanent health limitations/alterations

Learning

The process by which a person acquires or increases knowledge or changes behavior in a measurable way as a result of the experience

• Study

• Instruction

• Reflection

• Practice

Cognitive Domain

Storing and recalling of new knowledge in the brain

• Brain — intellectual thinking and understanding

  • Patient is understanding the uses/doses of medications from the nurse

Psychomotor Domain

Learning a physical skill involving integration of mental and muscular activity;

• Have to practice it

• Nurses observe patients for precision and proper execution (speed, technique, etc)

Affective Domain

Includes changes in attitudes, values, and feelings

• How we deal with things emotionally; how the patient feels about it

• Example: nurse is teaching about diabetes management — how does the patient feel about these changes?

Visual Learners

Likes pictures, maps, graphs to learn — prefers to see information

• Example: Body changes; showing images or brief hand motions can provide a clearer image of what needs to be understood

Aural Learners

Likes to hear and discuss things and concepts

• Use of tape recorder

• Discussions with students and teachers

• Lectures

• Tutorials

Reader Learners

Readers like anything in print;

• Manuels, lists, textbooks

• Often take notes verbatim

  • Like to write as well

Kinesthetic Learners

Likes to learn from and by experience, uses their senses; learn by DOING

• Field trips

• Lecture with real life examples

• Labs

• Simulations

• Trial and error

Nursing Process: Assessment

Cannot assume the patient knows the information or the skills

• What needs taught and how

• Physical condition — teaching should be done when there is no discomfort/pain or when SOB (cannot ask questions/answer)

• Learning ability — who are you teaching? Cultural/language barriers

• Motivation — leads to better compliance

• Compliance — family support

Learning Ability: Infants

Teaching is directed towards parents

Learning Ability: Toddlers/Preschooler

Incorporate role playing; make use of toys

Learning Ability: School Age Children

Answer questions honestly; very eager to learn, make opportunities for questions or open discussion, individualized learning

Learning Ability: Teenagers

Allow them into the decision making; they have a need for independence/identity, direct conversation toward them, not parents

Learning Ability: Adults

May need to provide more details about treatment; some may be worried about costs; need to understand the impact of their health issues

Learning Ability: Elderly

Prefer learning based on experience; HCP must understand limitations (hearing aids, glasses, etc.)

• Brochure should have large print and should speak clear and loudly if need be

• Be cautious about memory issues — ensure family members are present and also understand

• What has worked and what hasn’t in the past?

Health Literacy

Ability to read, understand and act on health information

• Only ~12% of the US population are proficient in health literacy

• Lower SES

• Minorities — language barriers

Ask Me 3

Tool to promote understanding and improve communication between patients and caregivers:

• What is my main problem?

• What do I need to do?

• Why is it important for me to do this?

Teach Back Method

Allows patient to repeat back key concepts from teaching session to confirm understanding

Teaching Strategies

• Role Modeling — patients watch nurse carefully

• Lecture — more formal

• Discussion/Panel Discussion — individual instruction

• Demonstration — patient must be active; ideal for psychomotor

• Discovery — used for problem solving with people with issue

• Role Playing — used with children, reduces anxiety

• Printed Material — brochure, fact sheet, etc.

• Programmed Instruction — short videos to show patient more information

• Web-Based Instruction — Google, ChatGPT, etc.

Cognitive

Understand information:

• Discussion

• Handouts

• Readings

• Audiovisual

Affective

Emotional clarification:

• Role playing

• Values clarification — assist to clarify values to facilitate affective decision making

Psychomotor

Performing a skill:

• Physical manipulation

• Demonstration

Breast Landmarks

Divide breasts into 4 quadrants

• Upper outer quadrant (axillary) — site of most breast tumors

Breast Lymph Nodes

• Axillary = >75% lymph in body drain into

• Supraclavicular

• Infraclavicular — could also indicate lung cancer

Lymphadenopathy

Enlarged lymph nodes — should typucally NOT be able to palpate lymph nodes

• Could indicate infection, autoimmune disease, or malignancy

• Hard, enlarged, fixed = malignant

  • May indicate cancer

Gynocomastia

Enlargement of MALE breasts due to:

• Hormones in puberty/adolescence — estrogen hormone imbalance or endocrine disorder (should disappear within 18 months)

  • In adults: could also be a pituitary disorder, testicular tumors, or some medications that contain estrogen (steroids, etc.)

• Testosterone deficiency

• Certain medications

Breast Alteration: Edema

Lymph channels blocked by cancer

Breast Alteration: Peau d’Orange

Orange peel appearance caused by metastatic disease blocking lymph nodes

Breast Alteration: Areolas

Red and crusty — indicative of Paget’s Disease

Breast Alteration: Nipples

Drainage from a NON-BREASTFEEDING individual may indicate cancer

• Retraction — recent change may be cancer

Mammography: Age 45-55

Yearly mammogram

Mammography: 55 and Older

Mammogram every 2 years

Mammography: Between Ages of 20-39

Should have a clinical breast exam every 1-3 years; unless there is a familial history of breast conditions

Cancer Statistics

1 in 8 women will get breast cancer; most breast cancer is discovered by women themselves

• Most breath lumps are benign (~80%)

• Early detection = early treatment = excellent change for cure

Self Breast Exam

Same time every month; about one week after menstruation when breasts are not tender or swollen

• After menopause, check first day of every month

Start in axillary and move down