Patient and Caregiver Teaching

KEY POINTS

ROLE OF PATIENT AND CAREGIVER TEACHING

General goals for patient teaching include health promotion, prevention of disease,
management of illness, and appropriate selection and use of treatment options.

There are many challenges to teaching, and as a result, you must consider every interaction
with a patient or a caregiver a potential teachable moment.

A teaching plan includes assessment of the patients ability and readiness to learn as well
as identification of problems that can be resolved with teaching.

TEACHING-LEARNING PROCESS

Learning is defined as a persistent change in a person as a result of an experience in which
you acquired knowledge or skill.

Teaching is an interactive and dynamic process that involves a change in a patients
knowledge, behavior, and/or attitude to maintain or improve health.

Knowles principles of adult learning and the Transtheoretical Model of Health Behavior
are examples of theories that help to explain how and why adults learn.

Required competencies for you to function as an effective teacher include knowledge of
the subject matter and excellent communication skills.
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You need to be attentive to your use of medical terms and the impact of nonverbal
messages on patient teaching.
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Communication skills include active and attentive listening combined with a degree
of empathy.
Some challenges to teaching patients and caregivers are a lack of time, personal
feelings as a teacher, and the circumstances under which the patient is admitted to the
health care system.

Teaching caregivers is important because family members, friends, etc. can promote the
patients self-care and prevent complications after discharge.

Caregivers may experience anxiety, stress, depression, and other emotions that affect their
ability to care for the patient.

Several regulatory mandates require specific teaching to patients.

PROCESS OF PATIENT TEACHING

Assessment

The teaching process is similar to the nursing process and involves development of a plan
that includes assessment, setting patient goals, intervention, and evaluation.

Assessing your patient and caregivers for learning needs involves four main areas:

Physical characteristics (e.g., age, nature of illness, manual dexterity)

Psychologic characteristics (e.g., level of anxiety, depression, self-efficacy)

Sociocultural characteristics (e.g., health literacy, cultural background,
economic resources)

Learner characteristics (e.g., individual learning needs, readiness to learn,
language skills)

Age affects a patients experiences, rate of learning, and ability to retain information.

Pain, fatigue, sensory and cognitive impairments, and certain medications influence the
patients ability to learn.

Depression, denial, and moderate or severe anxiety can negatively affect the patients
motivation and readiness to learn.

An individuals belief in his or her ability to successfully cope with and manage life events
(self-efficacy) affects motivation, thought patterns, behavior, and emotions.

Health literacy is defined as the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to make appropriate
health decisions.
You must tailor your patient teaching to match the patients level of health
and ehealth literacy. This may require the use of translators or translation
programs.
Because of the extent of health illiteracy, it is recommended that all patient
teaching materials be written at the fifth-grade or lower reading level.

Health practices, beliefs, and behaviors are influenced by cultural traditions that can affect
patient teaching.

Learning needs are the new knowledge and skills that an individual must have to be able to
meet a goal. The assessment of learning needs should first determine what the patient
already knows, if the patient has misinformation, and any history of past experiences with
health problems.

Each person has a distinct style of learning. The three learning styles are visual (reading,
pictures), auditory (listening), and physical (doing things).

Planning

Learning goals relate to the intended outcome of the learning process, guide the selection
of teaching strategies, and help evaluate the patients progress.

You, your patient, and the patients caregiver must mutually prioritize learning goals and
develop a plan for the teaching-learning experiences.

Teaching strategies are selected based on patient characteristics (e.g., age, educational
background, learning style, culture), subject matter, and available resources.
The generation in which your patient belongs can provide insight into
various learner characteristics and recommended teaching strategies.
Teaching strategies can include any combination of discussion, lecture-
discussion, demonstrationreturn demonstration, and a variety of learning
resources (e.g., print material, DVDs, computer/Web-based programs, mobile
applications, telehealth).

Implementation and Evaluation

During the implementation phase, use the planned teaching strategies to present the patient
and caregiver(s) information and teach new skills.

Evaluation strategies for teaching include observing the patient directly (show back),
observation of verbal and nonverbal cues, discussion with the patient or caregiver (teach
back), and the patients self-evaluation of progress.