9Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 9 Teaching & Counseling

A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching?

a. Promoting health

b. Preventing illness

c. Restoring health

d. Facilitating coping

b. Preventing illness

Teaching first aid is a function of the goal to prevent illness. Promoting health involves helping patients to value health and develop specific health practices that promote and maintain wellness. Restoring health occurs once a patient is ill, and teaching focuses on developing self-care practices that promote recovery. When facilitating coping, nurses help patients come to terms with whatever lifestyle modification is needed for their recovery or to enable them to cope with permanent health alterations.

A nurse is teaching patients of all ages in a hospital setting. Which teaching examples are appropriate for the patient’s developmental level? Select all that apply.

a. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes.

b. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions.

c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers.

d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis.

e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching.

c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers.

d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis.

e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient

Successful teaching plans for older adults incorporate extra time, short teaching sessions, accommodation for sensory deficits, and reduction of environmental distractions. Older adults also benefit from instruction that relates new information to familiar activities or information. School-aged children are capable of logical reasoning and should be included in the teaching–learning process whenever possible; they are also open to new learning experiences but need learning to be reinforced by either a parent or health care provider as they become more involved with their friends and school activities. Teaching strategies designed for an adolescent patient should recognize the adolescent’s need for independence, as well as the need to establish a trusting relationship that demonstrates respect for the adolescent’s opinions.

A nurse is teaching an adult patient how to care for their new ostomy appliance. Which evaluation method is most appropriate to confirm that the patient has learned the information?

a. Ask Me 3

b. Newest Vital Sign (NVS)

c. Teach-Back Method

d. TEACH acronym

c. Teach-Back Method

The Teach-Back Method tool is a method of assessing literacy and confirming that the learner understands health information received from a health professional. The Ask Me 3 is a brief tool intended to promote understanding and improve communication between patients and their providers. The NVS is a reliable screening tool to assess low health literacy, developed to improve communications between patients and providers. The TEACH acronym is used to maximize the effectiveness of patient teaching by tuning into the patient, editing patient information, acting on every teaching moment, clarifying often, and honoring the patient as a partner in the process

A nurse is planning teaching strategies in the affective domain of learning for patients with alcohol use disorders. Which teaching–learning activities will the nurse use? Select all that apply.

a. Preparing a lecture on the harmful long-term effects of alcohol on the body

b. Asking the patient to discuss reasons people with alcohol use disorders drink and exploring other methods of coping with problems

c. Requesting that patients perform a return demonstration for using relaxation exercises to relieve stress

d. Helping patients to reaffirm their feelings of self-worth and relate this to their alcohol use disorder

e. Using a pamphlet to discuss the tenets of the Alcoholics Anonymous program with patients

f. Reinforcing the mental benefits of gaining self-control over a substance use disorder

b. Asking the patient to discuss reasons people with alcohol use disorders drink and exploring other methods of coping with problems

d. Helping patients to reaffirm their feelings of self-worth and relate this to their alcohol use disorder

f. Reinforcing the mental benefits of gaining self-control over a substance use disorder

Affective learning includes changes in attitudes, values, and feelings (e.g., the patient expresses renewed self-confidence to be able to give up drinking). Cognitive learning involves the storing and recalling of new knowledge in the brain, such as the learning that occurs during a lecture or by using a pamphlet for teaching. Learning a physical skill involving the integration of mental and muscular activity is called psychomotor learning, which may involve a return demonstration of a skill.

A nurse is preparing a teaching plan for a patient with asthma on the use of an inhaler. What teaching method is most appropriate for this patient?

a. Demonstration

b .Lecture

c. Discovery

d. Panel session

a. Demonstration

Demonstration of techniques, procedures, exercises, and the use of special equipment is an effective patient-teaching strategy for a skill. Lecture can be used to deliver information to a large group of patients but is more effective when the session is interactive; it is rarely used for individual instruction, except in combination with other strategies. Discovery is a good method for teaching problem-solving techniques and independent thinking. Panel discussions can be used to impart factual material but are also effective for sharing experiences and emotions.

The nurse has taught a patient with diabetes how to administer subcutaneous insulin injections. Which is the best strategy to evaluate if the teaching goal has been met?

a. Ask the patient the insulin dose and times of day they will administer insulin.

b. Observe the patient’s technique in drawing up and administering insulin.

c. Have the patient explain the skill they have just learned.

d. Document the teaching session in the patient’s electronic health record.

b. Observe the patient’s technique in drawing up and administering insulin.

The nurse cannot assume that the patient has actually learned the content unless there is some type of proof of learning. The key to evaluation is ensuring the learner meets the outcomes stated in the teaching plan, in this case, by demonstrating the psychomotor skill.

A registered nurse acts as nurse coach to provide teaching to patients who are recovering from a stroke. Which statement directs the nurse in performing this role?

a. The nurse uses discovery to identify the patients’ personal goals and create a plan that will result in change.

b. The nurse is the expert in providing teaching and education strategies to provide dietary and activity modifications.

c. The nurse becomes a mentor to the patients and encourages them to create their own fitness programs.

d. The nurse assumes an authoritative role to design the structure of the coaching session and support the achievement of patient goals.

a. The nurse uses discovery to identify the patients’ personal goals and create

A nurse coach establishes a partnership with a patient and, using discovery, facilitates the identification of the patient’s personal goals and agenda to lead to change rather than using teaching and education strategies with the nurse as the expert. A nurse coach explores the patient’s readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient’s desired goals, and with the patient determines how to evaluate the attainment of patient goals.

A nurse on the rehabilitation unit is counseling a young adult athlete who sustained a traumatic below-the-knee amputation following a motorcycle accident. The patient refuses to eat or ambulate, stating, “What’s the point? My life is over. I’ll never be the football player I dreamed of becoming.” What is the nurse counselor’s best response?

a. “You’re young and have your whole life ahead of you. You should focus on your rehabilitation and make something of your life.”

b.“I understand how you must feel. I wanted to be a famous singer, but I wasn’t born with the talent to be successful at it.”

c.“You should concentrate on other sports that you could play even with prosthesis.”

d. “I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?”

d. “I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?”

This answer communicates respect and sensitivity to the patient’s needs and offers an opportunity to discuss their feelings with the nurse or another health care professional. The other answers do not allow the patient to express their feelings and receive the counseling they need.

A nurse is caring for a patient who is admitted to the hospital with traumatic injuries sustained in a motor vehicle accident. While hospitalized, the patient’s spouse tells the patient that their house flooded, damaging their belongings. When the nurse notes that the patient is visibly upset by this news, the nurse suggests which type of counseling?

a. Long-term developmental

b. Short-term situational

c. Short-term motivational

d. Long-term motivational

b. Short-term situational

Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life, such as a flood. Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A nurse develops a contractual agreement with a morbidly obese patient to achieve optimal weight goals. Which statement best describes the nature of this agreement?

a.“This agreement forms a legal bond between the two of us to achieve your weight goals.”

b. “This agreement will motivate the two of us to do what is necessary to meet your weight goals.”

c. “This agreement will help us determine what learning outcomes are necessary to achieve your weight goals.”

d. “This agreement will limit the scope of the teaching session and make stated weight goals more attainable.”

b. “This agreement will motivate the two of us to do what is necessary to meet your weight goals.”

A contractual agreement is a pact two people make, setting out mutually agreed-on goals. Contracts are usually informal and not legally binding. When teaching a patient, such an agreement can help motivate both the patient and the teacher to do what is necessary to meet the patient’s learning outcomes. The agreement notes the responsibilities of both the teacher and the learner, emphasizing the importance of the mutual commitment.

A nurse in the diabetes clinic initiates education for a patient with a new diagnosis of diabetes. The nurse notes the patient has completed 2 years of college. What action does the nurse select for the initial teaching session?

a. Providing the patient with handouts related to blood-glucose management

b. Demonstrating the use of the blood-glucose monitor and tool to record blood-glucose readings

c. Assessing the patient’s knowledge of diabetes and their ability to interpret the health information

d. Explaining the dietary restrictions including foods that are prohibited

c. Assessing the patient’s knowledge of diabetes and their ability to interpret the health information

While the nurse takes the patient’s level of education into account when providing teaching, the first step is assessing the patient’s knowledge and readiness to learn. The nurse would not provide handouts or AV material without reviewing the information and assessing the patient’s understanding. Discussing or demonstrating psychomotor skills, an intervention, is performed after assessment.

The nurse coach at a cardiac rehabilitation office is meeting with a patient who has learned they have heart failure. Which nursing actions might the nurse coach include in coaching sessions for this patient? (Select all that apply.)

a. Provide education based on the patient’s personal goals.

b. Explore the patient’s readiness for change.

c. Assist the patient to determine progress toward goals.

d. Direct the patient to exercise daily.

e. Identify goals for the patient.

a. Provide education based on the patient’s personal goals.

b. Explore the patient’s readiness for change.

c. Assist the patient to determine progress toward goals.

The nurse coach facilitates change or development that assists the individual to cope with health challenges. The nurse coach establishes a partnership with the patient to support the patient to identify and work toward the patient’s personal agenda and goals; nurse coaches do not use teaching and other strategies directed by the nurse as an expert. A, b, and c are patient-driven, person-centered interventions to educate and empower the patient. D and e are interventions identified and directed by the nurse, not by the patient, which is not part of the coaching process.