With chronic disease management being very complex, we often skim over the values of patient teaching in our nursing education. This is despite the fact that patient teaching and education are essential components of the nursing process (Jones, 2002). Data indicates that when patients are provided with a solid knowledge base about their disease process and treatment, the outcome is more favorable (Boswell, 2007).
In order to teach, the nurse must first have an understanding of the patient education process. The following are part of this process:
- Assessment. The nurse must first identify the patient's needs. In this initial process, she must identify the needs and the problems of an individual patient and his/her family.
- Planning and diagnosing. Based on this assessment of the patients' needs, the nurse then formulates a diagnosis and treatment plan. It should be tailored to the patient's needs and educational level. The end product of this assessment is a diagnosis which will serve as a guide for treatment. This diagnosis is a sound judgment based on data and information (Rankin, 2001).
In the hospital, it is especially important for nurses to begin patient teaching at the time of admission. It is equally important to document this teaching for evaluation and reimbursement purposes. However, in the acute care setting, nurses often report feeling that they do not have enough time for it.
The following is a list of strategies that promote the incorporation of teaching into daily nursing practice:
- Emphasize what is necessary. In the inpatient setting, many patients fear losing their independence (Jones, 2002). Patients will be motivated to learn what is necessary for them to care for themselves; therefore nurses should emphasize these strategies.
- Choose the right time. Remember that when teaching, timing is crucial. For instance, if the patient has just been informed of a diagnosis, he or she will need time to cope with this information. There might be associated feelings of grief, powerlessness, fear, and vulnerability (Jones, 2002). These will cloud the ability to learn.
- Look for teaching moments. Like choosing the right time for teaching, it is equally important to "look for teaching moments." Imagine caring for a patient with end-stage renal disease. A teaching moment would be when the patient receives his tray and there is only a small amount of fluid. In this situation the nurse could ask, "Why is it important for you to monitor your fluid intake?"
- Plan teaching during an uninterrupted time. When teaching the patient, timing is crucial. It is not appropriate to fit everything into the day of discharge. Similarly, it would not be appropriate to provide complex lessons during meal time or visiting hours.
- Use basic principles. It is important to consider the educational level of the patient when teaching. After all, not everyone has had a nursing education. Some patients might not be able to understand complex medical jargon. They may even be illiterate and are unable to read handouts.
- Evaluate the senses. Nurses must evaluate the patient's ability to see and to hear. For example, if a patient has difficulty seeing, it might not be practical to give her a handout on disease management. If the patient has difficulty hearing, it might not be appropriate to guide her with verbal instructions.
- Keep expenses in mind. Many patients, especially elders, live on a fixed income. Therefore, it might not be practical to recommend that they join a fitness center as a means of weight reduction. When recommending a glucometer for the diabetic patient or a scale for the dialysis patient, it is important to consider the cost of each one.
- Clearly define goals and objectives. Before beginning, it is important to have a list of goals and objectives that are formulated by the patient and the nurse. The significance of these should be understood by each person, and they should be evaluated on a continuous basis.
- Remember to document. When teaching a new skill, documentation is important. This allows the incoming nurse or a nursing assistant to see what has been done and where she should start. Likewise, if the patient has difficulty with a certain skill or needs certain assistance, this should be recorded so that accommodations or further instruction can be provided.
Patient education requires that the nurse think critically. No longer are we simply responsible for administering medications and communicating with physicians. We also play a dynamic role in assuring that the patient is able to be independent in managing his disease.
In essence, we are nurse educators. After all, teaching is a vital component of the nursing process. However, the process is not uniform in nature. In order to promote learning, it is valuable to keep these proposed strategies in mind. And as part of our nursing education about the values of patient teaching, we have to remember that the patient population is indeed heterogeneous.
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