Chapter 25: Client Education

1. Chapter 25: Client Education Bonnie M. Wivell, MS, RN, CNS

2. Standards for Client Education • Client education has long been a standard for professional nursing • Nurse Practice Act recognizes that client teaching falls within the scope of nursing practice • JC and other accrediting agencies set standards that require nurses to assess pt. learning needs and provide education about many topics • Education requires collaboration • Need to take into consideration pt’s psychosocial, spiritual, and cultural values as well as the desire to actively participate in the educational process

3. Purposes of Client Education • The goal of educating others about their health is to assist individuals, families, or communities in achieving optimal levels of health • Maintenance and promotion of health and illness prevention • Allows clients to assume more responsibility for their health • Greater knowledge results in better health maintenance habits • More likely to seek early diagnosis of health problems

4. Purposes of Client Education Cont’d. • Restoration of health • Pts recovering from and adapting to changes resulting from illness often seek info about their conditions • Some clients find this difficult and become passive and uninterested in learning • Include family but assess the pt.-family relationship first • Coping with impaired functions • Some pts have to learn to cope with permanent health alterations • Family’s ability to provide support results in part from education • Families can provide assistance with health care management (i.e. giving meds) and with psychosocial support

5. Teaching and Learning • Teaching is an interactive process that promotes learning. It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors or perform new skills • Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills • Teaching is more effective when it responds to the learner’s needs

6. Role of Nurse in Teaching and Learning • Nurses have an ethical responsibility to teach their clients what they and their families need to know • Joint Commission’s “Know Your Rights” campaign • Clients who ask questions and are aware of their rights have a greater chance of getting the care they need when they need it • Clarify info provided by the MD

7. Domains of Learning • Cognitive: intellectual, requires thinking • Knowledge, comprehension, application, analysis, synthesis, evaluation • Affective: expression of feelings and acceptance of attitudes, opinions, or values • Receiving, responding, valuing, organizing, characterizing • Psychomotor: requires integration of mental and muscular activity • Perception, set, guided response, mechanism, complex overt response, adaptations, origination

8. Basic Learning Principles • People process info in the following ways: • Seeing and hearing • Reflecting and acting • Reasoning logically and intuitively • Analyzing and visualizing

9. Motivation to Learn • Attentional set: the mental state that allows the learner to focus on and comprehend a learning activity • Motivation: a force that acts on or within a person that causes the person to behave in a particular way • Compliance is a pt’s adherence to the prescribed course of therapy • Use of theory to enhance motivation and learning • Self-efficacy: social learning theory, refers to a person’s perceived ability to successfully complete a task • Psychosocial adaptation to illness • Grieving allows pts time to adapt psychologically to the emotional and physical implications of illness • Active participation

10. Ability to Learn • Developmental capability • Learning in children • Depends on maturation • Adult learning • Draw on life experiences • Physical capability • Don’t overestimate the pt’s physical development or status (size, strength, coordination, sensory acuity) • Allow for rest • See Box 25-4 on page 368

11. Learning Environment • The number of persons to teach • The need for privacy • Room temperature • Proper lighting • Noise • Room ventilation • Furniture

12. Nursing Process • Assessment • See Box 25-5 on page 370 • Nursing Diagnosis • Deficient Knowledge • Planning • Set priorities • Timing • Organized • Collaborative care

13. Nursing Process Cont’d. • Implementation • Maintain learning attention and participation • Build on existing knowledge • Teaching approaches • Telling, participating, entrusting, reinforcing • Instructional methods • One-on-one discussion • Group interaction • Preparatory instruction • Demonstration • Analogies • Role Play • Simulation

14. Considerations • Illiteracy and other disabilities • Cultural diversity • Use appropriate teaching tools • Special needs of children and older adults

15. Chapter 26: Documentation and Informatics

16. Definitions • Documentation: anything written or printed you rely on as record or proof for authorized persons • Diagnosis-related group (DRG): a series of decision trees designed to cluster groups of pts together by diagnosis, surgical procedure, complications, comorbidities, and age • Hospitals are reimbursed a fixed amount • Reimbursed same regardless of length of stay or cost of treatment • DRG may change based on documentation

17. Confidentiality • HIPPA • Pt education on privacy protections • Ensuring pt’s access to their medical records • Receiving pt. consent before information is released • Providing recourse if privacy protections are violated

18. Standards • ANA standard • “Documentation must be systematic, continuous, accessible, communicated, recorded and readily available to all members of the health care team.”

19. The Health Record • All records basically contain the following • ID and demographics • Informed consent • Admission nursing history • Nursing diagnoses and care plan • Nurse’s notes • Medical history and physical • Medical diagnosis • Orders • Progress notes • Diagnostic studies (lab, radiology, etc.) • Client Education • Summary of operative procedure • Discharge plan/summary

20. Purpose of Records • Communication • Legal documentation • Financial billing • Research • Auditing-Monitoring

21. Guidelines for Quality Documentation and Reporting • Factual • Accurate • Complete • Current • Organized • See legal guidelines in Tale 26-1 on page 388 of text

22. Methods of Recording • Narrative documentation • Problem-Oriented Medical Record • Database = all assessment information • Problem list • Nursing care plan • Progress notes • SOAP • SOAPIE • PIE • Focus Charting • DAR = data, action, response • See Box 26-2 on page 391 for examples

23. More Definitions • Source record = the client’s chart has a separate section for each discipline to record data • Charting by Exception (CBE) = focuses on documenting deviations from the established norm or abnormal findings • Critical Pathways = multidisciplinary care plans that include client problems, key interventions, and expected outcomes within an established time frame

24. Common Record-Keeping Forms • Nursing admission history forms • Flowsheets and graphic records • Client care summary or kardex • Acuity records • Determines hours of care needed • Standardized care plans • Discharge summary forms

25. Reporting • Change of shift • Telephone reports • Telephone or verbal orders • Transfer reports • Incident or occurrence reports

26. Nursing Informatics • ANA defines it as a specialty that integrates nursing science, computer science and information science to manage and communicate data, information and knowledge in nursing practice

27. Advantages of Nursing Information Systems • Increased time to spend with clients • Better access to information • Enhanced quality of documentation • Reduced errors of omission • Reduced hospital costs • Increased nurse job satisfaction • Compliance with JCAHO and other accrediting agencies • Development of a common clinical database

28. Security • Password protection • Locked HIM dept. • Shredding information • Faxes secured

29. Acronyms • Computerized physician order entry (CPOE) • Electronic Health Record (EHR) • Electronic Medical Record (EMR) • Health Information Management (HIM)