NUR 200 EXAM #4 - Bradley University

teaching

an interactive process that involves planning and implementing instructional activities to meet the intended learner outcomes

to teach, we must adequately do what?

- convey the information

- assess verbal and non-verbal feedback

- accommodate learning styles

learning

changes in behavior, knowledge, skills, or attitude

- occurs as a result of planned situations, events, or exposures

conscious learning

goal-oriented, intended, and deliberate motivation to learn

subconscious learning

without active participation in the learning process

who do nurses teach?

- single client

- families

- peers

- nursing students

- UAPs

what do nurses teach?

RNs must know what we are teaching and why

- disease info

- info about meds

- procedures/psychomotor skills

- disease prevention and health promotion

- clinical processes

is teaching a dependent or independent nursing intervention?

independent

why do nurses need teaching skills?

- teaching clients is part of independent nursing practice

- ANA standard related to promoting health demands skill 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

why do nurses teach?

- client participate in decisions

- hospital stays are short

- cost of healthcare is high

- facilities compliance teaching

what are the 5 rights of teaching?

1. right time

2. right context

3. right goal

4. right content

5. right method

right time (5 rights of teaching)

is there enough time, and is it the appropriate time?

- ex: not right after a cancer diagnosis, not at 2am on nightshift

right context (5 rights of teaching)

moment, more situational

right goal (5 rights of teaching)

agreed upon between RN and the patient

- needs to meet the goal

right content (5 rights of teaching)

are we teaching the right thing?

right method (5 rights of teaching)

are we teaching in their learning styles?

- RNs typically use multiple, must usually demonstration

behavioral learning theory

characterized by explicit identification of information to be taught and immediate reward for correct responses

who are the behavioral theorists

pavlov, skinner, bandura

cognitive learning theory

thinking processes

- bloom is one of the theorists

humanism learning theory

holistic, preferred in nursing

- self-motivated, self-initiated, and self evaluated

bloom's taxonomy

six levels that increase in complexity as it gets higher

- cognitive (thinking)

- psychomotor (movement)

- affective (emotional)

affect refers to

a person's emotional state

positive affect

very happy

negative affect

depressed

cognitive objectives (bloom's taxonomy)

no hand's on, just mental activities

- storage and recall of information

ex: facts about a disease

psychomotor objectives (bloom's taxonomy)

hands on skills, requires thinking and doing

- ex: self-administration of medication

where does teach-back fall into bloom's taxonomy stages

psychomotor

demonstration/return demonstration

RN teaches and then the pt teaches back

affective objectives (bloom's taxonomy)

feeling activities, emotional

- ex: changing a belief about a diet)

what are some barriers to teaching and learning for the nurse?

- competing demands

- conflicting schedules

- no third-party reimbursement

- lack of space

- lack of privacy

what are some barriers to teaching and learning for the client?

motivation, readiness, and timing, active involvement, and feedback

factors for teaching and learning for the client

- repetition

- environment: sit close to pt and close privacy curtain

- scheduling

- type of content (the bigger the change the bigger the challenge)

- communication (easier 1 on 1)

- special needs

- development stage

- culture (be aware of what is normal)

- literacy (do NOT use family as a interpreter)

what should we assess the client for with learning and teaching?

- learning and knowledge level

- ability to learn

- health beliefs and practices

- physical and emotional readiness

- literacy level

- learning styles

nurses teach the client what ______ _____ __ _______

they need to know

with teaching and learning, what should the RN plan?

determine goals and expected outcomes

- set priorities

- organize teaching material

learning contract

an informal agreement about goals that you and the pt want to meet together

learning goals should be

broad scoped, and set down what is expected as the final outcome of the process

- address the 3 domains of learning

learning objectives should be

one dimensional, explaining how you are going to get to the goal

SMART goals are

S: specific

M: measurable

A: achievable

R: relevant

T: timely

lecture

oral information that includes stories, images, discussion, models

one-to-one instruction and mentoring

one teacher and one learner formulating mutual objectives

- role modeling and problem solving (new grad)

tips for teaching children

- encourage a tour of the hospital 1 week in advance

- provide "rewards" after the procedure

nightingale's theory of caring

caring and compassionate matter

watson's theory of caring

transpersonal caring theory

- focused on how we care and how it promotes patient health and wellness

leininger's theory of caring

transcultural nursing theory

- focused on cultural care, values, beliefs, and practices of people in the same culture

benner's theory of caring

RN-patient relationship is not uniform

what are the 5 components of caring

- knowing

- doing for

- being with

- enabling

- maintaining belief

knowing (components of caring)

striving to understand what an event means in the life of your client

- goals

being with (components of caring)

- emotionally present

- actively listening

doing for (components of caring)

what would the patient do for themselves (if they could)

enabling (components of caring)

supporting through coping

- life changes

- unfamiliar events

maintaining belief (components of caring)

faith in ability to get through change (motivation)

how can the nurse be caring?

- be honest and transparent

- advocate for client preferences

- give clear expectations

- keep family informed

- ask permission before doing something

if you are uncomfortable with something, the RN should use the ____ model to raise a concern

CUS

- C: concerned

- U: uncomfortable

- S: safety

how to implement caring?

- presence

- spiritual/cultural/family care

- touch

- listening

- client knowledge

comfort

to strengthen greatly

nursing role in providing comfort

- assess self-care abilities

- provide assistance with ADLs

- promote self-care in ADLs

- delegate appropriate parts of hygiene care

sleep

altered state of consciousness

rest

mild to no activity, stress free, leads to feeling refreshed

what can sleep deprivation cause?

- decreased immune function

- decreased learning ability

- increased stress and anxiety

- increased incidence of illness

- poor recovery and healing

how does sleep have restorative benefits?

- increases mental performance

- restores energy

- improves ability to cope

- strengthens the immune system

circadian rhythm

biorhythm based on the day-night pattern in a 24 hour cycle

reticular activating system

reticular and cortical neurons, neurotransmitters associated with excitatory/inhibitory sleep mechanisms

NREM

restful phase of sleep

- deep and slow wave sleep

REM is when

sleep when the brain becomes active like you are awake

- mental and emotional restoration

- dream sleep

beta waves

wakefulness

alpha waves

drowsy stage

theta waves

transitioning into a deep sleep

- sleep more in children than adults

delta waves

deep sleep

what are the 5 stages of sleep?

1. Stage W

2. NREM 1

3. NREM 2

4. NREM 3

5. REM

stage W

stage 1 of the sleep cycle

- wakefulness with drowsiness

- nodding off

- elongated eye blinking

NREM 1

stage 2 of the sleep cycle

- falling asleep

- light sleep

- awakened easily

NREM 2

stage 3 of the sleep cycle

- light sleep

- easily aroused

- VS decrease

NREM 3

stage 4 of the sleep cycle

- deep sleep

- difficult to arouse

- VS decrease more

- snoring

- less vivid dreams

REM

stage 5 of the sleep cycle

- active sleep with frequent awakenings

- eye movements

- vivid dreaming

- VS increase

which stage of sleep helps with healing, growth, and muscle repair?

NREM 3

which stage of sleep is essential for mental and emotional restoration?

REM

infants and sleep factors

sleep more than they are awake

toddlers and sleep factors

- trouble falling asleep

- frequent awakenings

- nightmares

- heavy snoring

school aged children and sleep factors

sleep disturbances due to stress, excitement, and social concerns

adolescence and sleep factors

sleep disturbances due to demands at school, studying, alcohol and nicotine use, caffeine drinks

young and middle and sleep factors

sleep disturbances due to pushing themselves at work, travel schedules, family needs, financial issues

older adults and sleep factors

sleep disturbances due to medications, depression, discomfort, nocturia, pain

factors that affect sleep quality

- physical activity

- diet (high saturated foods can inhibit sleep)

- nicotine

- caffeine

- alcohol (frequently waking up)

- medications (antidepressants, amphetamines affect non-REM sleep)

- illness

- environmental factors (noise + light)

opioids can

suppress REM and cause frequent awakenings

ambien

a hypnotic medication that decreases the quality of sleep

dyssomnias

sleep disorders characterized by insomnia or excessive sleepiness

insomnia

dissatisfaction with sleep quantity due to inability to fall asleep, remain asleep, or go back to sleep

sleep-wake schedule

abnormalities in sleep-wake schedule

- ex: jet lag, shift work

restless leg syndrome

CNS disorder characterized by uncontrollable movement of the legs while resting or before sleep

hypersomnia

excessive sleeping

- ex: when you doze, nap, or fall asleep during the day when they want to be awake

sleep apnea

sleep with numerous pauses in breathing and frequent awakenings

- snoring, gasping, restlessness, tired during the day, dry/sore throat

narcolespy

chronic disorder caused by the brain's inability to regulate sleep-wake cycles normally

- sudden, uncontrollable urge to sleep lasting from seconds to minutes

parasomnias

pattern of waking behavior that appear during sleep

night terrors

sudden arousals in which the person is physically active, often hallucinatory, and experience strong emotions

- occurs when overly tired

sleepwalking

occurs 1-2 hours after asleep, person leaves bed and walks about with little awareness of surroundings

sleep talking

occurs during NREM, just before REM

- speech is disorganized and hard to understand

bruxism

grinding and sliding of teeth

- erodes tooth enamel and loosens teeth

nocturnal enuresis

bedwetting past the stage at which toileting training has been established

- occur during NREM when the child can't be aroused

secondary sleep disorders

these can cause sleep issues

- depression (less time in REM)

- hyperthyroidism (hard to fall asleep)

- hypothyroidism (decrease in stage 3 sleep)

- pain