Basic Pharmacology for Nursing 17th Edition by Michelle Willihnganz - Test Bank

Patient Education to Promote Health

2.      Identify the main principles of learning applied when teaching a patient, family, or group.

3.      Describe the essential elements of patient education in relation to prescribed medications.

·   Lecture

·   Guest speaker: nurse educator

·   Evaluation of student knowledge and skills needed to perform all entry-level nursing activities related to patient education and health promotion, including:

·    Identification of the three domains of learning

·    The principles of learning

·    Common beliefs about health and illness

·    Ethnic and cultural influences on health beliefs

·    Patient education associated with medication therapy

·   Assemble materials and supplies needed for each lesson as indicated below.

·   petroleum jelly

·   cognitive domain (p. 49)

·   ethnocentrism (p. 54)

·   health teaching (p. 51)

·   objectives (p. 51)

·   teach back (p. 51)

REVIEW – Textbook

·   Figure 5-1: The three domains of learning (p. 50)

·   Review Questions for the NCLEX^® Examination 1, 4 (pp. 57-58)

REVIEW – Textbook

·   Box 5-1: Teaching Tips (p. 50)

·   Review Questions for the NCLEX^® Examination 2-3 (pp. 57-58)

REVIEW – Textbook

·   Box 5-2: Sample Teaching Plan for a Patient with Diabetes Mellitus Taking One Type of Insulin (p. 52)

·   Figure 5-2: A patient does a return demonstration of an insulin injection after being taught by the nurse (p. 53)

·   Life Span Considerations: Teaching Older Adults (p. 53)

·   Clinical Goldmine (p. 53)

·   Review Question for the NCLEX^® Examination 5 (p. 58)

1.     Differentiate among cognitive, affective, and psychomotor learning domains.

·   Cognitive domain

·    Involves learning and storing knowledge

·   Affective domain

·    Involves feelings, needs, values, and opinion

·   Psychomotor domain

·    Involves learning new skills

TALKING POINTS:

·   The affective domain is involved when the patient develops trust and confidence in the health care provider.

·   The psychomotor domain is involved when patients demonstrate a procedure or skill to validate learning.

·   The nurse is preparing to teach a postsurgical patient who has a new colostomy about proper colostomy care. The patient says, “Just show me how to do it; let me try, and I’ll learn what to do.” Which domain of learning is indicated by this statement?

a)   Cognitive

b)   Affective

c)   Psychomotor

d)   Determined

TALKING POINTS:

·   Answer: c

·   Rationale: The patient’s willingness to see, hear, and do indicates a learning style in the psychomotor, or “doing” domain. Demonstration of the skill with a step-by-step, hands-on approach is usually the best way for this type of learner to be trained in a new skill.

2.     Identify the main principles of learning applied when teaching a patient, family, or group.

3.     Describe the essential elements of patient education in relation to prescribed medications.

·   Focus the learning

·    Repeat information to help master concepts

·    Environment should be quiet and well-lit

·    Provide essential equipment

·    Encourage active participation

·   Learning styles

·    Fit teaching techniques to learner’s style

·    Provide a variety of media for learning such as pamphlets, videos, models, slides, photographs, charts, and computer instruction

TALKING POINTS:

·   Begin teaching patients by answering any questions the patient may have.

·   Organization of material to be learned

·    Use objectives and an outline for teaching

·    Allow time to practice and ask questions

·    Review what has been taught

·   Motivation

·    Provide positive feedback when teaching

·    Determine through patient outcomes when more teaching is needed

·   Readiness to learn

·    Ensure patient’s basic needs are met first

·    Depends on what patient already knows and motivation to learn

·    Make the content relevant

·   Learning pace

·    Depends on learning style

·    Depends on age of patient

·   Psychosocial adaptation to illness

·    During grieving, patient will not be able to learn

TALKING POINTS:

·   Determine if the patient is well enough to benefit from teaching; pain will interfere with learning. Health care beliefs should be incorporated into the overall plan.

·   Older adults need assessments of vision, hearing, short- and long-term memory, and financial ability.

·   Adults need to first understand why they must learn something

·   Assess what the adult already knows and what information is desired

·   Make the content relevant to that individual

·   Assess vision, hearing, short- and long-term memory, and fine and gross motor skills

·   Assess concerns regarding cost

·   Older adults may consider the balance between proposed treatment and quality of life

·   Slow pace of the presentation, allow time to process new information

TALKING POINTS:

·   A new diagnosis or treatment may seem overwhelming, impairing learning.

·   Slow the pace of presentation.

·   Limit duration of each session.

·   Consider effect of lighting, glare, and noise on learning.

·   Speak clearly without shouting.

·   Provide information in small increments

·    Ability to focus on details is reduced

·   Anticipate inopportune times to initiate teaching

·   Allow time for practice and review

·   Praise efforts and positive aspects

TALKING POINTS:

·   Reality of short hospital stays means that ideal educational environment may not exist.

·   Document teaching performed, and if goals not met, refer to appropriate agency.

·   Space the content, staggering the amount of material presented in one session

·   Repetition enhances learning

·   Consider the patient’s educational level and literacy

·   People tend to remember what is taught first

·   Multiple shorter sessions less likely to overwhelm the learner.

TALKING POINTS:

·   Consider patient’s educational level and ability to read and understand written material.

·   Consider patient’s preference for written material or audiovisual.

·   The nurse may need to “translate” medical terms into terms patient can understand.

·   Culture and ethnic diversity

·    Ethnocentrism—recognize its impact

·    Work with an interpreter

·    Consider the patient’s outlook on health and illness

·    Internet—impact on health information

·   Adherence

·    The degree to which the patient is likely to follow teaching relates to how much value the patient attaches to it

TALKING POINTS:

·   Perform a cultural assessment to determine factors that relate to the beliefs of the patient.

·   Understand that each nurse brings beliefs about health practices that affect relationships with patients.

·   Variables influencing the patient’s response to the therapeutic regimen

·    Perceptions of the benefits, attitude toward health care providers, effect on own lifestyle, family situations, understanding of the illness

·    Cost, family support, presence or loss of control, side effects, convenience, physical ability to shop, open containers

·   Discuss how previous experiences with health and illness influence a person’s ability to learn new things.

PRESENT

·   Divide the class into three groups. Assign each group a learning domain: cognitive, affective, or psychomotor. Have each group identify the features of the domain they have been assigned. Then have the groups present their findings to the class and compare the domains.

DISCUSS

·   Compare learning about medications to learning how to cook Thanksgiving dinner (or whichever holiday is close to class time). Take an informal survey or show of hands. How many students learned by reading the recipe and following pictures? How many learned by calling “1 800 Butterball”? How many learned by just trying various things until they got the recipe right?

DISCUSS

·   As a class, discuss how to address the psychomotor domain when teaching a patient a new skill, such as self-injection of insulin.

REVIEW

·   Review the three domains of learning: cognitive, affective, and psychomotor.

·   Post the following discussion question online and have students comment. Discuss how the affective domain influences learning.

·   Discuss how to foster the most conducive environment for learning. Why might it be best to address a patient’s questions first before presenting all the information on a topic?

DISCUSS

·   Discuss the various ways in which people learn. What modalities are available to address each of these learning styles?

DISCUSS

·   Discuss under which conditions a translator would be useful and ways to optimize use of a translator.

DISCUSS

·   Discuss considerations and adjustments that must be made when teaching children or persons whose native language is not English.

DISCUSS

·   Discuss how different ethnic groups may differ in their health behaviors and willingness to provide health-related information.

DISCUSS

·   Divide the class into small groups. Have students in each group describe their learning styles and the methods by which they prefer to acquire new skills and information. Have each group share its findings. Which learning style is most prevalent in the class?

DISCUSS

·   Discuss the importance of determining a patient’s readiness to learn, ways that can be used to motivate patients to learn, and understanding learning styles.

·   Post the following discussion question online and have students comment. Discuss how patient education materials can be standardized and what advantage this would provide.

DISCUSS

·   Post the following discussion question online and have students comment. Discuss the role of costs and other factors that may impact the patient at discharge.

·   Discuss how to facilitate patient compliance with any follow-up visits or tests.

·   What changes in the style of teaching or teaching plan must be made when caring for older adults?

GUEST SPEAKER

·   Invite a nurse educator to class to talk about his or her role in patient and staff education. What are some challenging aspects of his or her work? Have the students write a brief report based on the presentation.

·   Discuss how the nursing process can be used in developing a plan of care for teaching about medication therapies.

Discussion Guidelines: The nurse should determine why the patient is unwilling to learn. He may be overwhelmed by the diagnosis and trying to adjust to the new situation psychologically. He may be in denial about the seriousness of his condition and not willing to learn for that reason. He may not comprehend the consequences of having diabetes. He may be facing other challenges, such as altered family processes and lack of support. He may be unable to pay for blood testing supplies. Or he may think that making lifestyle changes is not worth the trouble. Once the nurse determines the cause of the lack of motivation, she can address the issues. She can stress the positive in the changes the patient needs to make, such as not feeling fatigued as a result of low blood sugar, not feeling excessively thirsty, and not having to use the bathroom all the time.

5.      Identify the types of information that should be discussed with the patient or significant others to establish reasonable expectations for the prescribed therapy.

6.      Discuss specific techniques used in the practice setting to facilitate patient education.

·   Lecture

·   Evaluation of student knowledge and skills needed to perform all entry-level nursing activities related to patient education and health promotion, including:

·    Identification of the three domains of learning

·    The principles of learning

·    Common beliefs about health and illness

·    Ethnic and cultural influences on health beliefs

·    Patient education associated with medication therapy

·   Assemble materials and supplies needed for each lesson as indicated below.

·   cognitive domain (p. 49)

·   ethnocentrism (p. 54)

·   health teaching (p. 51)

·   objectives (p. 51)

·   teach back (p. 51)

REVIEW – Textbook

·   Review Question for the NCLEX^® Examination 6 (p. 58)

4.     Describe the nurse’s role in fostering patient responsibility for maintaining well-being and adhering to the therapeutic regimen.

5.     Identify the types of information that should be discussed with the patient or significant others to establish reasonable expectations for the prescribed therapy.

6.     Discuss specific techniques used in the practice setting to facilitate patient education.

·   Patients have right to make their own life choices

·   Positive reinforcement helps patients succeed

·   Response and compliance depend on numerous variables

·    Beliefs and perceptions

·    Effects on lifestyle

·    Acceptance/denial of illness

·    Stress

TALKING POINTS:

·   Evaluating a patient’s ability and willingness to comply with a regimen is complex.

·   Ultimately, goal is to assist patients to achieve as much control as possible over their illness.

·   Patients’ needs are frequently changing.

·   Make sure that patients know the reason for the medication and its adverse effects.

·   Areas assessed through the Case Management Adherence Guidelines include the patient’s motivation and knowledge level of prescribed medications. It also assesses social support systems.

·   Response and compliance depend on numerous variables

·    Comprehension and understanding

·    Multiple physicians

·    Costs of treatment

·    Family support

·    Control over disease

·    Side effects

·    Expectations and fears

·    Physical limitations

·   Challenges to nursing

·    Poor adherence increases costs unnecessarily

·   Case Management Adherence Guidelines, Version 1

·    Tool used to help identify those at risk for nonadherence

·   Ethnography

·    Used to observe how patients follow health care regimen at home

TALKING POINTS:

·   Areas assessed through the Case Management Adherence Guidelines include the patient’s motivation and knowledge level of prescribed medications. It also assesses social support systems.

·   For learning to take place, the patient must perceive the information as being relevant.

·   Start with simple and attainable goals to build the patient’s confidence.

TALKING POINTS:

·   Correlate the teaching with the patient’s perspective of the illness.

·   Discuss which signs and symptoms will be altered by the medication.

·   Assess patient’s expectations as therapy progresses.

·   Patients with chronic illnesses may have different expectations from those with acute illnesses.

·   Patients should be taught how to assist in monitoring their conditions.

·   Written records help monitor therapy.

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·   Goal is to assist patients achieve greatest degree of control possible

·   Offer support and encouragement

·   Assist patient to explore options rather than give up

·   Needs are constantly changing

·   Provide written records

·   Write out information in a manner the patient can read and understand

TALKING POINTS:

·   Discuss cooperative goal-setting.

·   Patients frequently use the Internet as their source of information.

·   Patients can purchase medications online.

·   Nurses should provide patients with tools to evaluate websites for validity.

·   Discharge teaching needs to be summarized and placed in the chart.

·   Document goals not met and referrals to community-based agency.

·   Write out information so that patient can read and understand.

·   The nurse is supposed to perform postoperative teaching for a patient who is scheduled to be discharged the next day. The patient appears fatigued, in pain, and irritable. The nurse knows that there will be little time for teaching on the day of discharge. What is the nurse’s best course of action?

a)   Deliver the teaching now because there won’t be enough time tomorrow.

b)   Allow the patient to nap, and return to perform the teaching in one hour.

c)   Teach the family member who is present, so he or she can share the information with the patient after discharge.

d)   Determine the patient’s need for analgesia and rest, and return to perform the teaching after the patient feels better.

TALKING POINTS:

·   Answer: d

·   Rationale: After the patient’s basic needs are assessed and met, he or she will be better able to focus on the educational material and be prepared for discharge. It is important for the patient to verbally demonstrate learning as well as perform any skill autonomously.

·   An older adult patient is being prepared for discharge after experiencing a stroke with some residual damage. The patient and family are scheduled to receive a large amount of information from the nurse regarding proper care and safety at home. What is the nurse’s best course of action?

a)   Present the patient and family with all of the information a few days before discharge.

b)   Present the patient and family with all of the information the day before discharge.

c)   Break the teaching content down into manageable sections and present them individually in the days before discharge.

d)   Have a home health nurse teach the patient and family at home a week after discharge.

TALKING POINTS:

·   Answer: c

·   Rationale: Discharge teaching is an ongoing process and should not wait until the patient is ready to go home. The patient and family need to learn about home care before discharge, and the content should be presented in small sections and repeated as necessary because repetition enhances learning. The patient’s readiness to learn and educational level also must be taken into consideration.

·   The nurse is preparing a patient for discharge after a surgical procedure. Which method is best for teaching the patient about his or her prescribed drugs?

a)   Prescription blank handwritten by the physician

b)   Magazine ads featuring the prescribed medications

c)   Verbal explanations along with drug summary sheets

d)   Unit-dose packages from this morning’s medications

TALKING POINTS:

·   Answer: c

·   Rationale: Typically, verbal explanations are best as long as the patient is able to hear adequately. Drug summary sheets are prepared at a reading level appropriate for most people. Prescription forms are not a good teaching tool for medications; patients typically don’t get to keep prescription forms after filling them at the pharmacy. Unit-dose packages are inappropriate because they may not represent the same manufacturer of the drugs that the patient will be taking, which may lead to confusion.

·   The nurse who is new to a large urban hospital has found that many of the hospitalized patients are of different cultural groups in the area. Which approach is best for the nurse to take in caring for these patients?

a)   Care for all patients the same way because it is more efficient.

b)   Ask not to be assigned to these patients due to the nurse’s lack of experience.

c)   Develop a plan of care that is individualized to each patient’s needs.

d)   Follow a more experienced nurse around for several months to gain more experience.

TALKING POINTS:

·   Answer: c

·   Rationale: Nurses must be prepared to care for patients from different cultures and develop an awareness of and respect for cultural diversity. Many resources are available for education, and this should be a part of the orientation of new nurses. The nurse may find that asking individuals about preferences is helpful and respectful.

·   Discuss how to explain the need for finishing an entire regimen of antibiotic and for not abruptly stopping certain medications.

IDENTIFY

·   Ask students to look over the list of potential variables affecting a patient’s adherence to a medical regimen. Ask them to identify which issues would be the hardest for them to deal with. Ask students (with confidentiality assured) to discuss relatives or friends who have not been adherent to the medical regimen, and the health consequences.

IDENTIFY

·   Have students identify several factors that affect the patient’s readiness to learn, and write the factors on the board. Then divide the class into small groups, and have each group outline nursing interventions to promote the patient’s readiness to learn for each factor.

IDENTIFY

·   Divide the class into small groups. Have each group identify barriers to learning and compliance in the following situations and develop patient teaching materials to improve learning and compliance.

·    A homeless patient with diabetes

·    A Mexican seasonal laborer with chest pain

·    A 24-year-old woman diagnosed with breast cancer, whose mother died of breast cancer 2 years ago

Then have the groups share their materials with the class.

·   Post the following discussion question online and have students comment. Discuss the importance of patient education with regard to medical therapy.

DISCUSS

·   Post the following discussion question online and have students comment. Discuss possible legal implications of inadequate patient education with regard to prescribed medications.

·   Discuss how to involve the patient in providing feedback about the efficacy of prescribed medications.

CREATE

·   Have students work individually to create educational materials for the nursing staff of a local hospital about how to use interpreter services. How should the staff communicate with a non–English-speaking patient? When should they call an interpreter? Have the students present their educational materials to the class.

DISCUSS

·   Discuss why it is important to explain what responses the patient might have from each medication he is taking.

DISCUSS

·   Discuss how patient expectations might differ with acute versus chronic illnesses.

DISCUSS

·   Divide the class into small groups. Have each group discuss how to apply the health teaching process to the following situations:

·    A patient with diabetes who is noncompliant with his oral hypoglycemic medications

·    An older retired patient on Medicare who has to start taking a new, expensive medication for blood pressure control

·    A Chinese patient who believes that her pneumonia is the result of an evil eye

·    A Korean woman who refuses to breast-feed because she believes that formula is more healthy than breast milk

Then have each group discuss its solutions with the class.

·   Post the following discussion question online and have students comment. Discuss how to adapt the teaching plan to the patient’s needs at every step of the instruction.

DISCUSS

·   Post the following discussion question online and have students comment. Discuss why expectations may change throughout the course of therapy.

·   Divide students into groups. Have one student play the role of a patient who insists she has a disease she researched on the Internet and is insisting on a particular medication. Have another student play the role of a nurse attempting to clarify and correct misinformation. The other students in the group can critique the interaction, and comment on the nurse’s ability to remain professional and use appropriate verbal and nonverbal communication.

DISCUSS

·   Discuss necessity of documenting a patient’s level of understanding of instructions given.

DOCUMENTATION

·   Ask students to practice documenting a patient’s education and his level of understanding. The patient should have been educated on taking digoxin 0.125 mg daily and furosemide (Lasix) as needed for ankle edema, along with a potassium supplement if he takes furosemide. At the end of the hospital stay, the patient still cannot state reasons he needs to take the furosemide or potassium. He has not been able to find a pulse to count his heart rate prior to taking the digoxin. He cannot remember that he should NOT take the digoxin if his pulse rate is fewer than 60 beats per minute. The nurse is attempting to contact family members and a home health agency.

CREATE

·   Using the above situation, ask students to make a poster to assist the patient to remember his medications.

·   Discuss ways the Internet has affected patient teaching. In which ways has it affected patients’ conversations with health care providers?

RESEARCH

·   Ask students to conduct an online search in class using various sources of patient information on the Internet. Use the disease “diabetes mellitus” and search using nonmedical search engines (Google and Yahoo!). Compare the findings to Health on the Net foundations and Kramesonline.com.

Discussion Guidelines: The nurse should assess the reasons for the patient’s noncompliance. The patient appears overwhelmed and possibly frustrated by the experience. It is also possible that she does not understand the importance of IV fluid infusion for hydration. The nurse should determine the patient’s learning style, understanding of her condition, and support systems. The nurse needs to make sure that the patient understands how to perform the procedure. The nurse should leave written instructions with the patient and some phone numbers where the patient can get professional support by means of telephone triage. The nurse should ask the patient to practice connecting herself to the IV in the nurse’s presence until she feels comfortable with the procedure.

Patient Education to Promote Health

·   TB Questions 1, 4, 6, 11

·   Open Book Quiz, Question 5

Evolve Student Resources

·   INRQ 4, 6

Study Guide

·   SG Review Questions 1-7

·   TB Questions 5, 9

·   Open Book Quiz, Quesitons 1, 2

Evolve Student Resources

·   INRQ 1, 5, 7, 8, 9,

Study Guide

·   SG Review Questions 8-10

·   TB Questions 3, 10, 12, 17

Evolve Student Resources

·   INRQ 1, 10

Study Guide

·   SG Review Questions 11-13

·   TB Questions 7, 14

Evolve Student Resources

·   INRQ 2, 3, 4

Study Guide

·   SG Review Questions 14-16

·   TB Question 15

·   Open Book Quiz, Question 4

Evolve Student Resources

·   INRQ  8

Study Guide

·   SG Review Questions 17-19

·   TB Questions 2, 8, 13, 15, 16

·   Open Book Quiz, Question 3

Study Guide

·   SG Review Questions 20-22