Nursing Education and the Nursing Process
Nursing Roles in Patient Education and Teaching
The Nurse as Educator: Nurses play a major role as educators. Teaching is integrated into the scope of nursing practice, and nurses are responsible for helping patients navigate diverse health problems.
Importance of Patient Education: Patient education is key to improving several patient outcomes:
Improvement in quality of life.
Enhancement of self-care abilities.
Reduction of hospital admissions/readmissions.
Promotion of health maintenance and illness prevention.
Increase in medication compliance.
Quality Measures and Metrics: Organizations (e.g., Memphis State) look at hospital admission and discharge rates and the quality of care as specific metrics and performance card measures.
Teaching Focus Areas:
Health Literacy: Understanding the patient's ability to process and comprehend health information.
Restoration of Health: Helping patients recover from illness or injury.
Coping with Impaired Functioning: Assisting patients in rehabilitating and learning to live with physical limitations (e.g., physical therapy as a tertiary intervention).
Lifestyle Management: Promoting adherence to specific instructions, such as taking insulin on time or following a prescribed diet.
Principles and Methods of Effective Teaching
Starting Point: Discharge teaching begins immediately "on admission."
Evaluating Learning: Teaching is an ongoing process similar to the nursing process, where goals must be evaluated to ensure they are met.
Holistic Approach: Nurses must teach the "whole person," including mind, body, soul, and spirit.
Cultural and Linguistic Considerations: Always consider cultural influences and language barriers.
Critical Rule: Use a professional interpreter for language barriers. Do not use family members as interpreters.
Learning Styles: Identify the patient’s preferred way to learn by asking them directly. Common methods include:
Teach-Back: Asking the patient to explain information back to the nurse.
Demonstration/Return Demonstration: Showing a skill and having the patient perform it.
Visual/Audio/Verbal: Using pictures, videos, models, or handouts.
Reinforcement: Learning involves acquiring new knowledge, skills, and attitudes (). Nurses must clarify and reinforce information because patients may not remember up to of what they are told due to the stress of transitions.
Communication Standards:
Use a fifth-grade (5th) reading level for materials.
Use "plain language" and avoid medical terminology.
Identify and address barriers such as cost, time, and energy.
Include the patient, family, and partners in the education process.
Box References and Textbook Content
Box 9-1 (Page 213): Topics for Health Teaching and Counseling (Promoting health, preventing illness, restoring health, facilitating coping).
Box 9-2 (Page 214): Steps of the Teaching-Learning Process:
Assessing needs and readiness.
Identifying learning needs.
Developing outcomes based on the patient's goals (Asking: "What can I do for you today?" "What is your plan of care?").
Page 313: Refers to reflective practice and nursing process models.
Page 364: Refers to the Tanner model and the nursing process.
Domains of Learning
Cognitive Learning (Thinking): Involves the "why" and the theoretical knowledge.
Example: A patient understanding the purpose of a colostomy, signs and symptoms of infection, and dietary restrictions.
Affective Learning (Feeling): Involves emotions, beliefs, and attitudes.
Example: A patient coming to terms with their situation or coping with body image changes after a colostomy.
Psychomotor Learning (Doing): Involves physical skills.
Example: A patient physically changing an ostomy bag, doing dressing changes, or managing tubing.
Integration: Effective nursing care utilizes all three domains to influence healthy behaviors and lifestyle incorporation.
The Nursing Process and Person-Centered Care
Characteristcs of the Nursing Process: Systematic, dynamic, interpersonal, outcome-oriented, and universally applicable.
Person-Centered Care Principles:
All team members are caregivers.
Care is based on continuous healing relationships.
Nurses must establish rapport to make patients comfortable sharing information.
Collaboration with the entire team (doctors, techs, social workers, family).
The patient is the primary source of control.
Nursing Attributes: Open-mindedness, self-awareness (not imposing personal values on patients), and strong clinical thinking/reasoning skills.
Steps of the Nursing Process (ADPIE):
Assessment: Collecting, validating, and communicating patient data.
Diagnosis: Analyzing data to identify strengths and problems. This is a nursing diagnosis (analyzing cues/data), not a medical diagnosis.
Planning: Identifying nursing interventions and determining measurable patient outcomes.
Implementation: Taking action; the nurse carries out the plan.
Evaluation: Measuring the extent to which outcomes were achieved. If goals are not met, the process returns to the beginning to reassess.
Clinical Judgment Models and Standards
The Tanner Model of Clinical Judgment:
Noticing: Similar to Assessment.
Interpreting: Equivalent to Diagnosing and Planning.
Responding: Equivalent to Implementation.
Reflecting: Equivalent to Evaluation.
Reflective Practice:
Reflection-in-action: Thinking on your feet during an event.
Reflection-on-action: Thinking through a situation after the fact to influence future actions.
QSEN (Quality and Safety Education for Nurses): Focuses on competencies for providing safe, high-quality care.
Professional Standards: Practice is guided by organizations like the American Nurses Association (ANA). Nurses should follow evidence-based practice and their specific organization’s policies and procedures.
Questions & Discussion
Question: When does discharge teaching start?
Response: On admission.
Question: What kind of questions should we ask patients?
Response: Open-ended questions, not closed-ended, to get a better understanding of their needs and values.
Question: What should you do if the patient goal is not met?
Response: Reassess, go back to the beginning, and evaluate the interventions/problem.
Question: What is the difference between cognitive, affective, and psychomotor learning?
Response: Cognitive is the "why" or the knowledge; Affective is coping and body image; Psychomotor is the physical demonstration of the skill (e.g., changing the bag).
Question: Who was the first organization to define the nursing process?
Response: The ANA (American Nurses Association).