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Download 10-1 Assessment of Client`s Response to Illness
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Patient Education and Drug Therapy Copyright © 2006, 2001 by Mosby, Inc. Slide 1 Successful Teaching Positive reinforcement for desired behaviors Feedback about progress toward goals Individualization: learning needs are determined for specific client and pace of teaching is mutually negotiated Facilitation: nurse assists client to take action, such as making personalized medication schedules Relevance to client and family needs Copyright © 2006, 2001 by Mosby, Inc. Slide 2 Assess Client’s Ability to Manage Medication Regimen Competence in self-care and mobility Social support mechanisms Cultural issues, health beliefs, and attitudes Factors influencing ability, motivation, and interest in learning: cognitive or sensory impairment communication (including language spoken) developmental stage health behaviors; perception of current health status knowledge and educational level Copyright © 2006, 2001 by Mosby, Inc. Slide 3 Assess Readiness to Learn Readiness is paramount to learning and should be assessed before beginning Physically—comfort level both personally and environmentally Emotionally—upset, overwhelmed, worried Mentally—motivated, anxiety level (mild is good), educational level, cognition barriers Copyright © 2006, 2001 by Mosby, Inc. Slide 4 Learning Domains Before teaching consider which method you want to use: Cognitive—learning verbal or written communication and being able to recall it either verbally or in written form. Psychomotor—learning new procedures or skills Affective—incorporating what is learned into lifestyle and making permanent changes. Incorporates attitudes, values, beliefs, and emotions related to learning information. Copyright © 2006, 2001 by Mosby, Inc. Slide 5 Common Nursing Diagnoses Related to Client Self-Administration of Medications Deficient knowledge Noncompliance Ineffective therapeutic regimen management Impaired memory Risk for injury Copyright © 2006, 2001 by Mosby, Inc. Slide 6 Goal Setting Before teaching also consider what you want the patient/family to do and what you want the outcome(s) to be. Goals statements usually begin with the words, “Patient will….” and should be specific and contain a verb that is measurable, such as “state” or “perform.” (see handout) For example, “Pt will state 2 side effects of blood pressure medicine.” Copyright © 2006, 2001 by Mosby, Inc. Slide 7 Implementing the Teaching Session Focus the learning—good environment and equipment, keep on track with what pt needs Use variety of materials to appeal to different ways of learning—touch several senses. Be organized—check lists initiated by one nurse and continued by others allows info to be taught in phases. Motivation—if pt knows reasons and benefits, and receives praise, he/she is more motivated Copyright © 2006, 2001 by Mosby, Inc. Slide 8 Implementation cont’d Space content—watch for anxiety or restlessness—may need to slow down or reschedule. People remember what is learned first best. Multiple short sessions are best Use repetition—multiple practice sessions may be hampered by short hosp stay—can educate before admission or f/u with HH or reliable family. Copyright © 2006, 2001 by Mosby, Inc. Slide 9 Cultural Considerations Explore meaning of illness—biomedical, natural forces, supernatural forces Communication—eye contact, personal space, people to include Avoid prejudices and stereotypes Using interpreters Who makes decisions in family? Is pt taking folk or home remedies or those suggested by shaman or medicine man? Copyright © 2006, 2001 by Mosby, Inc. Slide 10 Literacy Issues If client cannot read, written materials are not helpful. Sometimes pts are truthful and sometimes they aren’t. How do you tell if someone can’t read? Not filling out hosp menu Not reading newspaper, if available Professing fatigue and asking family to read instructions “I forgot my glasses.” I’ll read them when my wife (husband) gets here.” Not recording results at home Copyright © 2006, 2001 by Mosby, Inc. Slide 11 Literacy cont’d If nurse suspects pt cannot read or has limited skills: Include pictures or icons on materials Med charts with pictures of times of day med is needed. Pictures or drawings of the med, or an actual pill pasted to instructional sheet is helpful. Elicit family assistance Copyright © 2006, 2001 by Mosby, Inc. Slide 12 Developmental Issues Children need to be taught according to their level of understanding. Nurses need to understand child development For older adults, see handout Copyright © 2006, 2001 by Mosby, Inc. Slide 13 Specific Implementation Techniques Explain responses to therapy—”We expect this med to do…….” Pt should know changes that may be caused by meds (urine color, sunburn) Precautions necessary—operating machinery, ortho BP, labs What to do if pill is missed Have pt keep records if they are necessary to evaluate therapy Take as prescribed—don’t’ try to self-regulate Copyright © 2006, 2001 by Mosby, Inc. Slide 14 Specifics cont’d Tell pt who to call for questions or concerns Include family member Tell how foods may be involved ETOH and smoking may alter action and absorption—check with MD Use written material for back-up. (handout) Keep meds in original container, don’t put pills together, store correctly Keep out of reach of children—some pts need standard lids Copyright © 2006, 2001 by Mosby, Inc. Slide 15 Specifics cont’d Check with MD/pharmacist about OTC drugs Bring meds with you for MD visits or hosp Report SE—may not just be “old age” Prepare a weeks supply in container—helps to know if med was taken & when refill is needed Read label each time Wear medic alert for allergies, blood thinners # of Poison Control Do not borrow or lend meds Copyright © 2006, 2001 by Mosby, Inc. Slide 16 Evaluation Evaluate learning acc’d to learning domain; cognitive, psychomotor, affective Must have 4 things: specific content taught method used to present material method used to evaluate learning response of patient Copyright © 2006, 2001 by Mosby, Inc. Slide 17 Documentation Documentation helps next nurse know what has been taught and what needs to be done. Don’t forget to document all teaching no matter how small. JCAHO has found lack of documentation of patient and family’s knowledge of self-care to be most common nursing documentation deficiency. Copyright © 2006, 2001 by Mosby, Inc. Slide 18 Assessment of Compliance with Medication Therapy Patient can make own choices—just because health professional said it doesn’t mean patient will do it. Noncompliance is not always willful. Lack of understanding, poor instruction, complicated task, sensory deficits, lack of transportation, cost, etc. Sometimes it is willful. Patient feels better, doesn’t believe he needs it, can’t accept dx, believes med contaminates body or causes dependence, or is suffering intolerable SE. Copyright © 2006, 2001 by Mosby, Inc. Slide 19
