Before initiating computer instruction for a patient the nurse would make which assessment

Once you have assessed your patient's needs, concerns, readiness to learn, preferences, support, and possible barriers to learning, you will need to:

• Make a plan with your patient and their support person
• Agree with the patient on realistic learning objectives
• Select resources that fit the patient

The first step is to assess the patient's current knowledge about their condition and what they want to know. Some patients need time to adjust to new information, master new skills, or make short- or long-term lifestyle changes.

Your patient's preferences can guide your choice of education materials and methods.

• Find out how your patient likes to learn.
• Be realistic. Focus on what your patient needs to know, not on what is nice to know.
• Pay attention to the patient's concerns. The patient may have to overcome a fear before being open to teaching.
• Respect the patient's limits. Offer the patient only the amount of information they can handle at one time.
• Organize the information for easier comprehension.
• Be aware that you may need to adjust your education plan based on the patient's health status and environmental factors.

With any type of patient education, you will likely need to cover:

• What your patient needs to do and why
• When your patient can expect results (if applicable)
• Warning signs (if any) your patient should watch for
• What your patient should do if a problem occurs
• Who your patient should contact for questions or concerns

There are many ways to deliver patient education. Examples include one-on-one teaching, demonstrations, and analogies or word pictures to explain concepts.

You can also use one or more of the following teaching tools:

• Brochures or other printed materials
• Podcasts
• YouTube videos
• Videos or DVDs
• PowerPoint presentations
• Posters or charts
• Models or props
• Group classes
• Trained peer educators

When selecting materials:

• The type of resources that a patient or support person responds to varies from person to person. Using a mixed media approach often works best.
• Keep your assessment of the patient in mind. Consider factors such as literacy, numeracy, and culture as you develop a plan.
• Avoid fear tactics. Focus instead on the benefits of education. Tell your patient what to pay special attention to.
• Be sure to review any materials you plan to use before sharing them with the patient. Keep in mind that no resource is a substitute for one-on-one patient teaching.

In some cases, it may not be possible to get the right materials for your patients' needs. For example, it may be hard to find materials on new treatments in certain languages or on sensitive topics. Instead, you may try having a discussion with the patient on sensitive topics or creating your own tools for the patient's needs.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The next step in the process is to plan and implement an individualized teaching plan. Your teaching plan should include what will be taught, when teaching will occur, where teaching will take place, who will teach and learn, and how teaching will occur. Deciding what will be taught is a decision you and the patient need to make together. Although you begin as the content expert, your goal is to make your patient as competent as he needs to be to manage his or her own health care needs. Start by looking at the information that the patient needs to know and distinguish between what the patient „needs to know“ and what is „nice to know.“ Start with the „need to know“ information and let the patient select where he or she wants to start.

Here are two excellent books on teaching content for a variety of health care conditions:

• Nurse’s Handbook of Patient Education, by Shirin F. Pestonjee (2000, Springhouse).
• Mosby’s Handbook of Patient Teaching, by Mary Conobbio (2000, Harcourt Health Services).

Plan when you will teach, taking the length of hospital stay or number of home health visits available into account. Let the patient tell you what works for him or her and offer as many options as are realistic. Does the patient prefer mornings or have more energy in the evening? Does he or she like short sessions or longer, more in-depth sessions? As you implement your plan, assess how quickly the patient can learn information. During teaching sessions, ask the patient to tell you when he or she is tired and watch for signs of fatigue such as yawning, inability to concentrate, or inattentiveness. Keep teaching sessions relatively short-generally no more than 30 minutes and possibly as short as five minutes. Plan on being able to grab those precious „teachable moments“ when the patient is ready to learn-even when it means throwing your planned timetable out the window.

Plan where you will teach, including considering both comfort and privacy. If the patient may become upset or you must ask intimate questions, find an empty room, wait until the patient’s roommate has left for a while, or use an empty treatment room or office. Whatever setting you use, make sure you try to limit distractions and interruptions. Plan who will teach and who will learn. Will you be the primary teacher or will other health care professionals be involved? Former patients who have been through a similar experience can be helpful. The American Cancer Society has shown that having other patients visit through its „Reach to Recovery“ program can provide breast cancer patients with much needed hope and motivation. You may be teaching people other than the patient, such as a spouse, another caregiver, or a friend or neighbor.

Plan how you will teach. Use data from your assessment about the patient’s preferred learning style to select the method. Remember that global learners like to understand the big picture first and work down to the details. Linear learners want the details first and then expect a bigger picture to emerge. As an example, when teaching a global learner how to do home blood glucose monitoring, you might start with the overall purpose of monitoring and then go on to details. If your patient is a linear learner, start with the first procedure that patient needs to know to operate the machine and end with the bigger picture. If your patient indicated on the assessment that he or she is a visual learner, select teaching materials that involve reading, writing, and watching visual media such as videotapes and slides. Auditory learners need to hear information via spoken explanations and audiocassettes, and they may remember information better in pamphlets if they hear it read aloud. Tactile learners must touch, manipulate, and perform a task to learn. Tactile learners often remember more when they can touch and handle equipment, and they may recall written information best by underlining or highlighting. Table 5 shows some of the teaching methods and materials you may use, depending on the patient’s preferred learning style and which methods and materials are most appropriate for specific situations.

Table 5

Whenever possible, select interactive teaching methods that use as many senses as possible. Keep in mind that patients remember approximately 10 percent of what they read, 25 percent of what they hear, 45 percent of what they see, 65 percent of what they hear and see, 70 percent of what they say and write, and 90 percent of what they say as they perform a task.

Evaluating teaching and learning

Which assessment should be performed by the nurse to determine the patient's motivation to learn?

What will the nurse do prior to initiating teaching with a patient and family members?

Which task is included in the assessment step of the nursing process?

Which techniques can the nurse use for collecting patient assessment data?