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)