Chapter 6: Health Teaching
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Need for Client Teaching
• At no other time in history has client teaching been so
important, owing to the decreased length of stay in all
acute care settings and the increased amount of care
provided in community settings; teaching is a central role
for nurses in all settings.
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Literacy
• Illiteracy is found in every walk of life, among all races
and cultures, and at all socioeconomic levels.
• Minority clients are more likely to have difficulties
communicating with health care providers; more than
20% of Spanish-speaking Latinos do not seek medical
advice because of the language barrier.
• Two-thirds of older clients have inadequate or marginal
literacy skills. One study in a public hospital revealed that
81% of clients over 60 could not read or understand
basic materials such as prescription labels (American
Public Health Association, 2006).
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Health Literacy
• Health literacy is the degree to which individuals have
the capacity to obtain, process, and understand, based
on information and services needed to make appropriate
health decisions (U.S. Department of Health and Human
Services, 2000).
• Lack of health literacy affects both health and health care
and has significant economic implications.
• Increasingly, health literacy is essential to navigate
complex health systems and better manage self-care
(Pawlak, 2006).
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Question
The consequences of inadequate health literacy include:
A.
Poorer health status
B.
Lack of knowledge about medical conditions and care
for the conditions
C.
Lack of understanding and use of preventive services, and
poorer self-reported health
D.
Poorer compliance rates with treatment modalities,
increased hospitalizations, and increased health care
costs
E.
All of the above
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Answer
E. All of the above
The consequences of inadequate health literacy include
poorer health status, lack of knowledge about medical
conditions and care for the conditions, lack of
understanding and use of preventive services, poorer
self-reported health, poorer compliance rates with
treatment modalities, increased hospitalizations, and
increased health care costs (Andrus & Roth, 2002).
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Consequences of Ineffective Health
Education
• Studies show that 20% of clients discharged from
hospitals do not even fill their prescriptions after
discharge, and between 40% and 60% of those who do
fill their prescriptions do not follow the prescribed
regimen.
• Example: Of people who are prescribed high blood
pressure medication, only 50% continue to take it after 1
year, and of those, only 75% take enough to fully control
their blood pressure (Consumer Health Information
Corporation [CHIP], 2003).
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Cost Related to Knowledge About
Medications
• Improved client education could save the U.S. nearly
$100 billion a year in health care and lost productivity by
improving prescription medication compliance and health
outcomes (CHIP, 2006).
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Using Nursing Process When Teaching
• Assessment
• Identification of learning need
• Planning through collaborative development of the
learning plan
– Learning objectives and goals
– Mixed domain strategies employed
• Implementation
• Evaluation of learning process and outcomes
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Readiness to Learn
• Physiologic factors
• Psychosocial factors
• Cognitive factors
• Environmental factors
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Need to Learn
• Learning is facilitated when the client perceives
information as needed or relevant for immediate
application.
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Life Experiences
• Past life experiences
• Differences and similarities between past and present life
experiences
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Question
Masa was diagnosed with type 1 diabetes 2 days ago. You visit
him in his home. He has been going to the clinic on the bus for
insulin shots three times a day the last three days. He learns to
draw up and inject insulin quickly because:
A. He is ready to learn
B. He has a need to learn
C. He has past experiences that allow him to learn quickly
D. He is cognitively gifted
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Answer
B. He has a need to learn
Learning is facilitated when the client perceives
information as needed or relevant for immediate
application. He learns quickly how to administer the
medication, facilitated by the need to avoid the
inconvenience of the long bus rides to the clinic.
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Learning Domains
• Cognitive: critical thinking or knowledge; lectures,
discussions, discovery, reading
• Affective: feelings, values, attitudes, and emotions; role
modeling, role playing, panel discussion
• Psychomotor: acquired physical skill; demonstration,
discovery
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Developmental Considerations
• Just as the need to learn will be different at various age
levels, cognitive abilities, psychosocial considerations,
and life experiences will also differ depending on the
client’s age.
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Question
Which individual would be the most complicated to teach
and would likely have the most difficult time learning to
administer insulin?
A.
A 6-year-old girl
B.
A 24-year-old woman
C.
A 69-year-old man
D.
It is impossible to determine, because the teaching
and learning would depend on the developmental
and cognitive ability of each individual.
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Answer
D. It is impossible to determine, because the teaching and
learning would depend on the developmental and
cognitive ability of each individual.
Just as the need to learn will be different at various age
levels, the cognitive domain and life experiences will also
differ. The young child may have less fear of needles and
be more open to self-injection. The elderly person could
have some cognitive impairment or may have more welldeveloped fine motor skills compared to the 24-year-old.
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Identification of the Learning Need
• The nurse draws inferences based on the information
found in the assessment.
• A list of learning needs emerges, from which priority
needs are identified. When lack of knowledge,
motivation, or skill hinders a client’s self-care, a nursing
diagnosis can be used to name the need or strength.
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Question
Teaching parents and day care providers about the
importance of immunization and teaching about
community resources that provide free or inexpensive
immunization is an example of:
A.
Prevention
B.
Primary prevention
C.
Secondary prevention
D.
Tertiary prevention
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Answer
B. Primary prevention
Teaching, whether it is in the acute care or communitybased setting, occurs at all levels of prevention. An
important goal of teaching is to prevent the initial
occurrence of disease or injury.
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Question
Teaching family or caregivers about community resources
that are available for respite care facilitates coping skills
and falls in the category of:
A.
Tertiary prevention
B.
Secondary prevention
C.
Health promotion
D.
Primary prevention
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Answer
A. Tertiary prevention
Most teaching in the home setting addresses tertiary
prevention, because most home care clients have chronic
conditions or are postsurgical. Tertiary prevention arises
from teaching that attempts to restore health and
facilitate coping skills. Although there is some trend
toward increasing primary prevention, in most
community settings the focus is on secondary and
tertiary prevention.
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Question
An intramural sports after-school program for children who
are obese illustrates which type of prevention?
A.
Primary prevention
B.
Secondary prevention
C.
Tertiary prevention
D.
Health promotion
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Answer
B. Secondary prevention
Secondary prevention is teaching targeted toward early
identification and intervention of a condition.
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Question
A school nurse teaching parents about preventing
childhood injuries is focusing on:
A.
Primary prevention
B.
Secondary prevention
C.
Tertiary prevention
D.
Health promotion
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Answer
A. Primary prevention
An important goal of teaching is to prevent the initial
occurrence of disease or injury.
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Planning
• Planning through collaborative development of the
learning plan
– Learning objectives and goals
– Mixed domain strategies employed
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Planning
• Planning for learning involves developing a teaching plan.
– Some agencies use standardized or computerized
teaching plans.
– Standardized plans must always be individualized to
the clients’ and families’ needs.
– The trend is toward documentation that uses clinical
pathways that outline teaching needs by diagnosis or
procedure, and includes learning outcomes, content,
methods, and strategies for teaching.
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Evaluation
• Evaluation of learning process and outcomes
• Address the following questions:
– What additional data do I need to collect to evaluate
the progress made toward the learning objectives?
– What other learning needs apply to this client and
family?
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Evaluation (cont’d)
• Address the following questions (cont’d):
– Were the objectives met? If not, why not?
– How do I know that my client learned what I planned to
teach?
– Did the timing of the teaching impede or enhance
learning?
– Are the nurse, client, and family satisfied with the
outcome? If not, what would provide satisfaction?
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Documentation
• As a legal record
• As communication
• For determination of eligibility for needed care and
reimbursement for care provided
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Barriers to Discharge Teaching
• Timing
• Past experiences
• Impaired cognitive functioning
– Anxiety and other emotions may impede retention of
information.
– Fatigue, medication, pain, and compromised status
impact learning.
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Barriers to Discharge Teaching (cont’d)
• Cultural differences between nurse and client
• Language differences
• Lack of adherence
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Successful Discharge Teaching
• Uses varied techniques
• Provides follow-up and a link between acute care and
community-based care (i.e., telephone call, clinic visit)
• Provides hands-on practice of skill before discharge
• Promotes self-care
• Provides written instructions
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