Chapter 21

Teacher and Counselor

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Aims of Teaching and Counseling

Maintaining and promoting health

Preventing illness
Restoring health
Facilitating coping

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Teaching Outcomes

High-level wellness and related self-care practices

Disease prevention or early detection
Quick recovery from trauma or illness with minimal or no
complications
Enhanced ability to adjust to developmental life changes
and acute, chronic, and terminal illness
Family acceptance of lifestyle necessitated by illness or
disability

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Focus of Patient Education

Preparation for receiving care

Preparation before discharge from health care facility
Documentation of patient education activity

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Teaching Acronym

T Tune into the patient.

E Edit patient information.
A Act on every teaching moment.
C Clarify often.
H Honor the patient as partner in the education
process.

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Factors Affecting Patient Learning

Age and developmental level

Family support networks
Financial resources
Cultural influences
Language deficits
Health literacy level

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Critical Developmental Areas

Physical maturation and abilities

Psychosocial development
Cognitive capacity
Emotional maturity
Moral and spiritual development

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Knowles (1990) Four Assumptions about

Adult Learners
As a person matures, ones self-concept is likely to move
from dependence to independence.
The previous experience of the adult is a rich resource for
learning.
An adults readiness to learn is often related to a
developmental task or a social role.
Most adults orientation to learning is that material
should be useful immediately, rather than at some time
in the future.

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Teaching Plans for Older Adults

Identify learning barriers.

Allow extra time.
Plan short teaching sessions.
Accommodate for sensory deficits.
Reduce environmental distractions.
Relate new information to familiar activities or
information.

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COPE Model for Family Support

C creativity
O optimism
P planning
E expert information

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Providing Culturally Competent

Patient Education
Develop an understanding of the patients culture.
Work with multicultural team.
Be aware of personal assumptions, biases, and
prejudices.
Understand the core cultural values of the patient or
group.
Develop written material in native language of the
patient.
Use testimonials of persons with same cultural
background as the patient.

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Health Literacy
Health literacy- the ability of a client to read, understand,
and act on health and healthcare information
Low health literacy affects all aspects of the population,
especially minorities and lower socioeconomic patients
Ask Me 3 Questions:
What is my main problem?
What do I need to do?
Why is it important for me to do this?

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Three Learning Domains

Cognitive
storing and recalling of new knowledge in the brain
Psychomotor
learning a physical skill
Affective
changing attitudes, values, and feelings

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Key Points to Effective Communication

Be sincere and honest.
Avoid too much detail and stick to the basics.
Ask for questions.
Be a cheerleader for the patient.
Use simple vocabulary.
Vary the tone of voice.
Keep content clear.
Listen and do not interrupt.
Ensure that the environment is conducive to learning and
free of interruptions.
Be sensitive to the timing of teaching sessions.
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Assessment Parameters

Knowledge, attitudes, and skills needed to be

independent
Readiness to learn
Emotional, motivational
Ability to learn
Physical, developmental
Learning strengths
Skills, previous knowledge

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Sources of Information

Primary: patient
Secondary: medical records, patients family

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Promoting Compliance

Be certain that instructions are understandable and

support patient goals.
Include the patient and family as partners in the process.
Utilize interactive teaching strategies.
Develop interpersonal relationships with patients and
their families.

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Teaching Strategies
Lecture
Discussion
Panel discussion
Demonstration
Discovery
Role playing
Audiovisual materials
Printed materials
Programmed instruction
Web-based instruction and technology
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Sample Teaching Strategies

Cognitive domain: lecture, panel, discovery, written
materials
Affective domain: role modeling, discussion, audiovisual
materials
Psychomotor domain: demonstration, discovery, printed
materials

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Considerations for Successful

Patient Teaching
Forming contractual agreements
Considering time constraints
Scheduling
Group vs. individual teaching
Formal vs. informal teaching
Manipulating the physical environment

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Nurse Coaching Process

Establishing relationships and identifying readiness for
change
Identifying opportunities, issues, and concerns
Establishing patient-centered goals
Creating the structure of the coaching interaction
Empowering and motivating patients to reach goals
Assisting the patient to determine progress toward goals

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Obtaining Feedback About Learning

Effectiveness can be determined by questioning, return
demonstration, direct observation
Reinforcing and celebrating learning
Positive reinforcement
Evaluating teaching
Self-evaluation, patient feedback
Revising the plan

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Documentation of the
TeachingLearning Process
Summary of the learning need
The plan
The implementation of the plan
Evaluation results

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Guidelines to Patient Counseling

Make everyone feel comfortable in the situation and

surroundings.
Counseling may be formal or informal.
Use interpersonal skills of warmth, friendliness,
openness, and empathy.
Caring is fundamental in the counseling role.

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Types of Counseling

Short-term
for situational crisis
Long-term
for developmental crisis
Motivational interviewing
Talking, problem solving

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