Chapter 25: Client Education

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Chapter 25 Client Education

• Bonnie M. Wivell, MS, RN, CNS

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Standards for Client Education

• Client education has long been a standard for
  professional nursing
• Nurse Practice Act recognizes that client
  teaching falls within the scope of nursing
  practice
• JC and other accrediting agencies set standards
  that require nurses to assess pt. learning needs
  and provide education about many topics
• Education requires collaboration
• Need to take into consideration pts
  psychosocial, spiritual, and cultural values as
  well as the desire to actively participate in the
  educational process

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Purposes of Client Education

• The goal of educating others about their health
  is to assist individuals, families, or
  communities in achieving optimal levels of health
• Maintenance and promotion of health and illness
  prevention
• Allows clients to assume more responsibility for
  their health
• Greater knowledge results in better health
  maintenance habits
• More likely to seek early diagnosis of health
  problems

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Purposes of Client Education Contd.

• Restoration of health
• Pts recovering from and adapting to changes
  resulting from illness often seek info about
  their conditions
• Some clients find this difficult and become
  passive and uninterested in learning
• Include family but assess the pt.-family
  relationship first
• Coping with impaired functions
• Some pts have to learn to cope with permanent
  health alterations
• Familys ability to provide support results in
  part from education
• Families can provide assistance with health care
  management (i.e. giving meds) and with
  psychosocial support

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Teaching and Learning

• Teaching is an interactive process that promotes
  learning. It consists of a conscious, deliberate
  set of actions that help individuals gain new
  knowledge, change attitudes, adopt new behaviors
  or perform new skills
• Learning is the purposeful acquisition of new
  knowledge, attitudes, behaviors, and skills
• Teaching is more effective when it responds to
  the learners needs

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Role of Nurse in Teaching and Learning

• Nurses have an ethical responsibility to teach
  their clients what they and their families need
  to know
• Joint Commissions Know Your Rights campaign
• Clients who ask questions and are aware of their
  rights have a greater chance of getting the care
  they need when they need it
• Clarify info provided by the MD

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Domains of Learning

• Cognitive intellectual, requires thinking
• Knowledge, comprehension, application, analysis,
  synthesis, evaluation
• Affective expression of feelings and acceptance
  of attitudes, opinions, or values
• Receiving, responding, valuing, organizing,
  characterizing
• Psychomotor requires integration of mental and
  muscular activity
• Perception, set, guided response, mechanism,
  complex overt response, adaptations, origination

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Basic Learning Principles

• People process info in the following ways
• Seeing and hearing
• Reflecting and acting
• Reasoning logically and intuitively
• Analyzing and visualizing

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Motivation to Learn

• Attentional set the mental state that allows the
  learner to focus on and comprehend a learning
  activity
• Motivation a force that acts on or within a
  person that causes the person to behave in a
  particular way
• Compliance is a pts adherence to the prescribed
  course of therapy
• Use of theory to enhance motivation and learning
• Self-efficacy social learning theory, refers to
  a persons perceived ability to successfully
  complete a task
• Psychosocial adaptation to illness
• Grieving allows pts time to adapt psychologically
  to the emotional and physical implications of
  illness
• Active participation

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Ability to Learn

• Developmental capability
• Learning in children
• Depends on maturation
• Adult learning
• Draw on life experiences
• Physical capability
• Dont overestimate the pts physical development
  or status (size, strength, coordination, sensory
  acuity)
• Allow for rest
• See Box 25-4 on page 368

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Learning Environment

• The number of persons to teach
• The need for privacy
• Room temperature
• Proper lighting
• Noise
• Room ventilation
• Furniture

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Nursing Process

• Assessment
• See Box 25-5 on page 370
• Nursing Diagnosis
• Deficient Knowledge
• Planning
• Set priorities
• Timing
• Organized
• Collaborative care

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Nursing Process Contd.

• Implementation
• Maintain learning attention and participation
• Build on existing knowledge
• Teaching approaches
• Telling, participating, entrusting, reinforcing
• Instructional methods
• One-on-one discussion
• Group interaction
• Preparatory instruction
• Demonstration
• Analogies
• Role Play
• Simulation

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Considerations

• Illiteracy and other disabilities
• Cultural diversity
• Use appropriate teaching tools
• Special needs of children and older adults

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Chapter 26 Documentation and Informatics
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Definitions

• Documentation anything written or printed you
  rely on as record or proof for authorized persons
• Diagnosis-related group (DRG) a series of
  decision trees designed to cluster groups of pts
  together by diagnosis, surgical procedure,
  complications, comorbidities, and age
• Hospitals are reimbursed a fixed amount
• Reimbursed same regardless of length of stay or
  cost of treatment
• DRG may change based on documentation

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Confidentiality

• HIPPA
• Pt education on privacy protections
• Ensuring pts access to their medical records
• Receiving pt. consent before information is
  released
• Providing recourse if privacy protections are
  violated

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Standards

• ANA standard
• Documentation must be systematic, continuous,
  accessible, communicated, recorded and readily
  available to all members of the health care team.

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The Health Record

• All records basically contain the following
• ID and demographics
• Informed consent
• Admission nursing history
• Nursing diagnoses and care plan
• Nurses notes
• Medical history and physical
• Medical diagnosis
• Orders
• Progress notes
• Diagnostic studies (lab, radiology, etc.)
• Client Education
• Summary of operative procedure
• Discharge plan/summary

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Purpose of Records

• Communication
• Legal documentation
• Financial billing
• Research
• Auditing-Monitoring

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Guidelines for Quality Documentation and Reporting

• Factual
• Accurate
• Complete
• Current
• Organized
• See legal guidelines in Tale 26-1 on page 388 of
  text

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Methods of Recording

• Narrative documentation
• Problem-Oriented Medical Record
• Database all assessment information
• Problem list
• Nursing care plan
• Progress notes
• SOAP
• SOAPIE
• PIE
• Focus Charting
• DAR data, action, response
• See Box 26-2 on page 391 for examples

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More Definitions

• Source record the clients chart has a separate
  section for each discipline to record data
• Charting by Exception (CBE) focuses on
  documenting deviations from the established norm
  or abnormal findings
• Critical Pathways multidisciplinary care plans
  that include client problems, key interventions,
  and expected outcomes within an established time
  frame

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Common Record-Keeping Forms

• Nursing admission history forms
• Flowsheets and graphic records
• Client care summary or kardex
• Acuity records
• Determines hours of care needed
• Standardized care plans
• Discharge summary forms

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Reporting

• Change of shift
• Telephone reports
• Telephone or verbal orders
• Transfer reports
• Incident or occurrence reports

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Nursing Informatics

• ANA defines it as a specialty that integrates
  nursing science, computer science and information
  science to manage and communicate data,
  information and knowledge in nursing practice

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Advantages of Nursing Information Systems

• Increased time to spend with clients
• Better access to information
• Enhanced quality of documentation
• Reduced errors of omission
• Reduced hospital costs
• Increased nurse job satisfaction
• Compliance with JCAHO and other accrediting
  agencies
• Development of a common clinical database

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Security

• Password protection
• Locked HIM dept.
• Shredding information
• Faxes secured

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Acronyms

• Computerized physician order entry (CPOE)
• Electronic Health Record (EHR)
• Electronic Medical Record (EMR)
• Health Information Management (HIM)