4
Patient and Caregiver Teaching
Brenda C. Morris
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Adherence Patient Education
Communication Self-Management
Health Promotion
LEARNING OUTCOMES
1. Apply the teaching-learning process to diverse patient 5. Prioritize patient teaching goals for patients and caregivers.
populations. 6. Choose appropriate teaching strategies for patients and
2. Select strategies to support patient learning. their caregivers.
3. Evaluate the role of the caregiver in patient teaching. 7. Choose appropriate methods to evaluate patient and
4. Relate the physical, psychologic, and sociocultural caregiver learning.
characteristics of the patient and caregiver to the teaching-
learning process.
KEY TERMS
caregivers positive reinforcement
health literacy self-efficacy
learning teaching
learning needs teaching plan
motivational interviewing teaching process
This chapter describes the process of patient and caregiver this knowledge. Patients who have the knowledge, skills, and
teaching and strategies that contribute to successful teaching desire to manage their health are less likely to be readmitted to
and learning experiences. The concept of patient and caregiver the hospital.2
(family member or significant other) teaching is central to Teaching may occur wherever you work as a nurse. Although
delivering quality patient care. It is a dynamic, interactive pro- agencies may employ advanced practice nurses and patient edu-
cess that involves a change in a patient’s knowledge, behavior, cators to provide patient teaching programs, you are always
and/or attitude to maintain or improve health. You will find that responsible for patient and caregiver teaching.3 Teaching is a
teaching is a challenging and rewarding role. Teaching patients responsibility that you cannot delegate to assistive personnel
and caregivers is a key nursing intervention that makes a differ- (AP).
ence in their lives. Every interaction with a patient and a caregiver is a potential
teachable moment. On any given day, more informal opportuni-
ties to teach occur than formal opportunities. Take advantage of
ROLE OF PATIENT AND CAREGIVER TEACHING and document all these moments. For example, when you teach
The general goals of patient teaching include health promotion, a patient with asthma how to use a peak flow meter, you do
disease prevention, illness management, and appropriate choice not need a formal teaching plan. However, when your patient
and use of treatment options. In patients with acute and chronic has a specific learning need about health promotion or man-
health problems, your teaching can prevent complications and aging a health problem, you should develop a teaching plan.
promote recovery, self-care, and independence. In the United A teaching plan includes (1) assessment of the patient’s ability
States, 6 in 10 adults have a chronic disease and 4 in 10 adults and readiness to learn, (2) identification of teaching needs, (3)
have 2 chronic diseases.1 Whether patients adequately manage development of learning goals with the patient, (4) implemen-
their health problems and maintain quality of life depends on tation plans for the teaching, and (5) evaluation of the patient’s
what they learn about their conditions and what they do with learning.
49
, 50 SECTION 1 Concepts in Nursing Practice
behaviors. Prochaska and Velicer proposed 6 stages of change in
TEACHING-LEARNING PROCESS their Transtheoretical Model of Health Behavior Change (Table
Teaching is the act of conveying information to facilitate learn- 4.2).5 This model is often used for planning to help patients stop
ing. When a nurse is teaching a patient about health, the nurse smoking, manage diabetes, and lose weight.
becomes the teacher and the patient becomes the learner. Nurses Motivational interviewing is a nonconfrontational commu-
often teach patients using methods such as direct instruction, nication method to motivate patients to change behavior.6 This
coaching, counseling, and behavior modification. Teaching may strategy includes interventions that enhance the patient’s moti-
be formal, such as giving a planned presentation to a group of vation for change (Table 4.3). The techniques used in motiva-
patients and their caregivers, or informal, such as teaching a tional interviewing are linked to the stages of change identified
patient about medications before giving them. by Prochaska and Velicer.5
Learning is the act of acquiring knowledge or skills that may During the process of change, relapse and recycling through
produce a change in behavior. Observation of this change is an indi- the stages are expected. Sometimes patients do not change
cation that learning has occurred. However, learning may not result behaviors. Some return to previous behaviors after a period of
in any observable change. A patient who understands the instruc- change. This may mean that the interventions used did not con-
tion and is fully informed may choose not to change behavior. sider the patient’s stage of change. Identify the patient’s current
Although learning may occur without teaching, a teacher stage of readiness for change and the stage to which the patient
helps to organize information and skills to make learning more is moving. Patients who are in the early stages of change need
efficient. In patient teaching, the teaching-learning process and use different kinds of motivational support than patients at
involves the patient, the patient’s caregiver(s), and you. later stages of change.
For example, a hospitalized patient who smokes cigarettes
Adult Learner may be in the precontemplation or contemplation stage of change.
Adult Learning Principles In the precontemplation stage, the patient is not concerned
Understanding how and why adults learn is important for you about their smoking and not considering quitting. During this
to effectively teach patients and their caregivers. Knowles iden- stage, it is important to help the patient increase awareness of
tified 6 principles of andragogy (adult learning) that are import- risks and problems related to smoking and create doubt about
ant for you to consider when teaching adults (Table 4.1).4 using cigarettes. Ask the patient what they think could happen
if they continued smoking. Give evidence of the problem (e.g.,
Models to Promote Health x-ray changes). Share facts about the risks of smoking. Although
Patients and their caregivers may progress through a series they may not be ready to change behavior while experiencing
of steps before they are willing or able to change their health an acute health problem, the seeds of doubt are sown. In other
TABLE 4.1 Adult Learning Principles Applied to Patient and Caregiver Teaching
Principles Teaching Implications for Nurse Examples
Need to know • Patients need to know why they should learn something, what they need to Your patient and his caregiver ask what they need to know
learn, and how it will help them. about exercise guidelines after a heart attack.
• Ask the patient questions such as, “What do you think you need to learn
about this topic?”
Readiness to • Readiness and motivation to learn are high when facing new tasks. While recovering from a transient ischemic attack, your patient
learn • Health crises provide opportunities for patients to learn and change behavior. tells you that she is ready to learn about the changes she
• Stress and anxiety may interfere with learning, thus requiring frequent needs to take to reduce her risk for stroke.
reinforcement of content.
Prior • Motivation is increased when one already knows something about the Your patient needs to begin injections of enoxaparin. She tells
experiences subject from past experiences. you that she gives her father insulin injections and is ready
• Identification of past knowledge and experiences can help find familiar to learn how to give this medication.
ground to increase patients’ confidence.
Motivation to • Patients prefer to apply learning at once. Your patient is scheduled for discharge in the morning. Both she
learn • Long-term goals may have less appeal than short-term goals. and her caregiver have received instruction on wound care
• Focus teaching on information that the patient views as needed and have watched the procedure. The caregiver tells you that
right now. he wants to perform the wound care today.
Orientation to • Patients seek out various resources for specific learning and prefer choices. Your patient, who is newly diagnosed with diabetes, tells you
learning • When the patient does not recognize the relevancy of the teaching, offer that he is worried about the diet changes he will need to
explanations of the value of the learning. make. Share several options with him to learn about diet
• Teaching should target the specific problem or circumstance. changes (e.g., cooking classes, Web-based tutorials, mobile
applications, individual sessions with the dietitian, brochures).
Self-concept • Patients need control and self-direction (sense of autonomy) to maintain Your patient has a temporary colostomy. She says she is not
their sense of self-worth. ready to look at the stoma. Work out a schedule with her for
• Patients do not learn when we treat them like children and tell them what learning colostomy care that meets her need for control and
they must do. prepares her for self-care.
Patient and Caregiver Teaching
Brenda C. Morris
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Adherence Patient Education
Communication Self-Management
Health Promotion
LEARNING OUTCOMES
1. Apply the teaching-learning process to diverse patient 5. Prioritize patient teaching goals for patients and caregivers.
populations. 6. Choose appropriate teaching strategies for patients and
2. Select strategies to support patient learning. their caregivers.
3. Evaluate the role of the caregiver in patient teaching. 7. Choose appropriate methods to evaluate patient and
4. Relate the physical, psychologic, and sociocultural caregiver learning.
characteristics of the patient and caregiver to the teaching-
learning process.
KEY TERMS
caregivers positive reinforcement
health literacy self-efficacy
learning teaching
learning needs teaching plan
motivational interviewing teaching process
This chapter describes the process of patient and caregiver this knowledge. Patients who have the knowledge, skills, and
teaching and strategies that contribute to successful teaching desire to manage their health are less likely to be readmitted to
and learning experiences. The concept of patient and caregiver the hospital.2
(family member or significant other) teaching is central to Teaching may occur wherever you work as a nurse. Although
delivering quality patient care. It is a dynamic, interactive pro- agencies may employ advanced practice nurses and patient edu-
cess that involves a change in a patient’s knowledge, behavior, cators to provide patient teaching programs, you are always
and/or attitude to maintain or improve health. You will find that responsible for patient and caregiver teaching.3 Teaching is a
teaching is a challenging and rewarding role. Teaching patients responsibility that you cannot delegate to assistive personnel
and caregivers is a key nursing intervention that makes a differ- (AP).
ence in their lives. Every interaction with a patient and a caregiver is a potential
teachable moment. On any given day, more informal opportuni-
ties to teach occur than formal opportunities. Take advantage of
ROLE OF PATIENT AND CAREGIVER TEACHING and document all these moments. For example, when you teach
The general goals of patient teaching include health promotion, a patient with asthma how to use a peak flow meter, you do
disease prevention, illness management, and appropriate choice not need a formal teaching plan. However, when your patient
and use of treatment options. In patients with acute and chronic has a specific learning need about health promotion or man-
health problems, your teaching can prevent complications and aging a health problem, you should develop a teaching plan.
promote recovery, self-care, and independence. In the United A teaching plan includes (1) assessment of the patient’s ability
States, 6 in 10 adults have a chronic disease and 4 in 10 adults and readiness to learn, (2) identification of teaching needs, (3)
have 2 chronic diseases.1 Whether patients adequately manage development of learning goals with the patient, (4) implemen-
their health problems and maintain quality of life depends on tation plans for the teaching, and (5) evaluation of the patient’s
what they learn about their conditions and what they do with learning.
49
, 50 SECTION 1 Concepts in Nursing Practice
behaviors. Prochaska and Velicer proposed 6 stages of change in
TEACHING-LEARNING PROCESS their Transtheoretical Model of Health Behavior Change (Table
Teaching is the act of conveying information to facilitate learn- 4.2).5 This model is often used for planning to help patients stop
ing. When a nurse is teaching a patient about health, the nurse smoking, manage diabetes, and lose weight.
becomes the teacher and the patient becomes the learner. Nurses Motivational interviewing is a nonconfrontational commu-
often teach patients using methods such as direct instruction, nication method to motivate patients to change behavior.6 This
coaching, counseling, and behavior modification. Teaching may strategy includes interventions that enhance the patient’s moti-
be formal, such as giving a planned presentation to a group of vation for change (Table 4.3). The techniques used in motiva-
patients and their caregivers, or informal, such as teaching a tional interviewing are linked to the stages of change identified
patient about medications before giving them. by Prochaska and Velicer.5
Learning is the act of acquiring knowledge or skills that may During the process of change, relapse and recycling through
produce a change in behavior. Observation of this change is an indi- the stages are expected. Sometimes patients do not change
cation that learning has occurred. However, learning may not result behaviors. Some return to previous behaviors after a period of
in any observable change. A patient who understands the instruc- change. This may mean that the interventions used did not con-
tion and is fully informed may choose not to change behavior. sider the patient’s stage of change. Identify the patient’s current
Although learning may occur without teaching, a teacher stage of readiness for change and the stage to which the patient
helps to organize information and skills to make learning more is moving. Patients who are in the early stages of change need
efficient. In patient teaching, the teaching-learning process and use different kinds of motivational support than patients at
involves the patient, the patient’s caregiver(s), and you. later stages of change.
For example, a hospitalized patient who smokes cigarettes
Adult Learner may be in the precontemplation or contemplation stage of change.
Adult Learning Principles In the precontemplation stage, the patient is not concerned
Understanding how and why adults learn is important for you about their smoking and not considering quitting. During this
to effectively teach patients and their caregivers. Knowles iden- stage, it is important to help the patient increase awareness of
tified 6 principles of andragogy (adult learning) that are import- risks and problems related to smoking and create doubt about
ant for you to consider when teaching adults (Table 4.1).4 using cigarettes. Ask the patient what they think could happen
if they continued smoking. Give evidence of the problem (e.g.,
Models to Promote Health x-ray changes). Share facts about the risks of smoking. Although
Patients and their caregivers may progress through a series they may not be ready to change behavior while experiencing
of steps before they are willing or able to change their health an acute health problem, the seeds of doubt are sown. In other
TABLE 4.1 Adult Learning Principles Applied to Patient and Caregiver Teaching
Principles Teaching Implications for Nurse Examples
Need to know • Patients need to know why they should learn something, what they need to Your patient and his caregiver ask what they need to know
learn, and how it will help them. about exercise guidelines after a heart attack.
• Ask the patient questions such as, “What do you think you need to learn
about this topic?”
Readiness to • Readiness and motivation to learn are high when facing new tasks. While recovering from a transient ischemic attack, your patient
learn • Health crises provide opportunities for patients to learn and change behavior. tells you that she is ready to learn about the changes she
• Stress and anxiety may interfere with learning, thus requiring frequent needs to take to reduce her risk for stroke.
reinforcement of content.
Prior • Motivation is increased when one already knows something about the Your patient needs to begin injections of enoxaparin. She tells
experiences subject from past experiences. you that she gives her father insulin injections and is ready
• Identification of past knowledge and experiences can help find familiar to learn how to give this medication.
ground to increase patients’ confidence.
Motivation to • Patients prefer to apply learning at once. Your patient is scheduled for discharge in the morning. Both she
learn • Long-term goals may have less appeal than short-term goals. and her caregiver have received instruction on wound care
• Focus teaching on information that the patient views as needed and have watched the procedure. The caregiver tells you that
right now. he wants to perform the wound care today.
Orientation to • Patients seek out various resources for specific learning and prefer choices. Your patient, who is newly diagnosed with diabetes, tells you
learning • When the patient does not recognize the relevancy of the teaching, offer that he is worried about the diet changes he will need to
explanations of the value of the learning. make. Share several options with him to learn about diet
• Teaching should target the specific problem or circumstance. changes (e.g., cooking classes, Web-based tutorials, mobile
applications, individual sessions with the dietitian, brochures).
Self-concept • Patients need control and self-direction (sense of autonomy) to maintain Your patient has a temporary colostomy. She says she is not
their sense of self-worth. ready to look at the stoma. Work out a schedule with her for
• Patients do not learn when we treat them like children and tell them what learning colostomy care that meets her need for control and
they must do. prepares her for self-care.
