Background of the Patient

Discuss about the Patient Education Teaching Plan.

Mr. Chan is a 64-year-old patient diagnosed with chronic cardiac failure approximately 12 months ago. In last 12, months he visited hospital on several occasions due to acute and chronic episodes of heart failure. He is associated with complications of different systems like fluid retention, mild hypotension and acute breathlessness. Moreover, he is not being able to manage his health condition in proper way. His ability to manage heath condition can be effectively improved through providing health education to him.

It is necessary for the nurse to plan and implement education programme for him. Nurse should be skilled enough to improve learning ability of the patient. Mr. Chan should be able to take care of his multiple conditions like cardiovascular and respiratory conditions after discharge from the hospital. From the literature, it is evident that for the management of health conditions of Chan, along with medication treatment other aspects need to be considered. These include healthy food habit, regular exercise and healthy lifestyle. After completion of the education programme, Chan should be able to implement all the learnings at home for longer duration of time because he is associated with chronic health condition. In the essay, necessary education approaches for Chan are being discussed.

Planning is most important aspect for in patient’s education. Planning is based on the learning needs of patient, learning style and willingness to learn. Needs and requirements of the patient can be identified through interviewing the patient. During interviewing, all the aspects related to patient like life-history, medical history, current and past medications and life-style should be inquired. Final goal to provide education to the patient should be to assure that patient can understand importance of healthy lifestyle, identify risk factors, identify symptoms, understand importance of medication consumption and carry out all the recommendation made by the healthcare provider (Bastable, 2014; Anton and Goering, 2015). Effective education can be provided to the patient by identifying specific problems associated with the patient. Health education planning should comprise of both theoretical education and practical training. Practical training is important aspect in the health education because most of the health practices are based on the practical aspects. Moreover, demonstration of practical can be helpful in improving learning and understanding of the patient. Patient need to be educated in such a manner that patient should remember and perform all the activities even in the absence of nurse or other healthcare professional. This can be achieved by changing attitude and behaviour of the patient. Hence, health education planning should comprise of topics related to the medical field and topics related to change in attitude and behaviour of the patient (Masters, 2014).

Importance of Health Education to the Patient

Significant health issue of Mr Chan is cardiovascular conditions. Hence, education plan for him should be more focused on providing education related to the cardiovascular conditions specifically heart failure. Health education planning should consider varied factors like physical, physiological, social, nutritional and psychological. It is necessary to consider all the factors because heart failure is a multifactorial disease and all these factors have significant impact on heart failure. Education plan for Mr. Chan should comprise of different aspects related heart failure. These aspects include definition and information about heart failure, symptoms of heart failure, diagnostic tests for heart failure and treatment and management strategies for heart failure. This comprehensive education plan can be helpful for him to take care of his health condition independently and in the absence of nurse (Muma and Lyons, 2012).

In the initial phase of the education plan, goals should be set for Mr. Chan’s education and objectives should be decided with respect to the goals of the education plan. Goals and objectives of the education plan can be helpful in the deciding relevant subjects by the nurse for Mr. Chan. Goal of the education plan for Mr. Chan should be improving comprehensive knowledge of Mr. Chan about heart failure and related co-morbidities. Objectives of education plan should include understanding signs and symptoms of heart failure, knowing suitable diet for cardiovascular conditions, performing exercise and physical activity on regular basis (Bastable, 2017).

Behavioural changes are expected at the end of the education programme. Hence, behavioural objective need to be set prior to initiation of the education programme. Behavioural objectives need to be decided based on the performance, condition and criterion. Behavioural objective should comprise of motivation necessary for adherence to medication consumption and effective participation in the self-care. Performance is related to the capability of learner to perform, condition is related to the varied behaviour under different circumstances and criteria refers to the accuracy in performance with respect to the behaviour (Masters, 2014). Learning objectives comprises of three different aspects like cognitive, affective and psychomotor domain. Cognitive, affective and psychomotor domain are related to different aspects like thinking domain, feeling domain and skill domain respectively. In case of Mr. Chan all these domains are applicable. In cognitive domain, he need to understand and think about his eating habits and physical exercise. He should avoid salt consumption and should perform physical exercise on the regular basis. In feeling domain, he should not take much stress about his disease condition because stress can exaggerate his cardiovascular disorder. In skill domain, he should be able to recognise symptoms of his cardiorespiratory impairment and inform the healthcare professional about these symptoms. Informing earliest to the healthcare professionals about the symptoms can be helpful in providing early intervention (Hun, 2012; Bastable, 2014).

Planning and Implementation of Health Education Program for the Patient

Learning by Mr. Chan mainly based on readiness to learn. Readiness can be categorised into different aspects like physical, cultural and experimental readiness. Physical readiness is related to the patient’s health status, physical capability to learn, complexity of topic and capability to withstand physical stress. Emotional readiness is based on the psychological status due to disease condition, motivation required to learn and anxiety due to disease condition. Experimental readiness depends on the educational and cultural background of the learner. It also depends on the knowledge and cognitive ability of the learner. While preparing education plan, ethical issues need to be considered because healthcare education providers are mainly responsible for both ethically and legally for learner’s activities, attitude and behaviour. Healthcare education providers also should provide education to the patients both in ethically and morally appropriate manner (Shafiei et al., 2014; Bastable, 2014).

It is very important for the health education providers to prepare education plan in such a manner that it should be easily understandable by the patient. Most of the patients like Mr. Chan might not be aware of the medical terms. Hence, health educator need to prepare health education plan in a simplified manner. It is evident that understanding care instructions can be helpful in improved patient outcome. Improved patient outcome through proper education can be helpful in reducing mortality rate, reducing length of hospital stay, reducing hospital cost, improving quality of life and reducing hospital readmissions (Jones et al., 2011).

Standardised protocol should be prepared for providing education to Mr Chan. This educational protocol should be person specific. In this protocol, all the needs and requirements of Mr. Chan should be addressed effectively (Wingard, 2005). Education should be provided by the trained RN. Along with teaching and learning process, counselling can be helpful in improving outcome of the education process to the patient. RN should incorporate inputs from the physician, dietician, pharmacist and physical trainer in providing education to Mr. Chan (Utley, 2010).

Effective education can be provided to Mr. Chan by understanding his learning style. Understanding his learning style can be helpful in providing information to him in a way through which he can consume most of the information. Mr. Chan is associated with chronic condition. Hence, he might be facing problem in remembering timings of medication consumption, consuming appropriate diet, maintaining healthy lifestyle and maintaining emotional balance. It would be difficult for the nurse to break these barriers and provide education to patients like Mr. Chan (Forren, 2017). In such scenario, nurse need to learn learning style of Mr. Chan. Nurse need to think like patient and need to educate him which is suitable for his thinking. There are four types of common learning styles. These include auditory, kinesthetic, visual/verbal and visual/nonverbal. Nurse to identify individual or mixed learning styles which fit to his Mr. Chan’s needs. Considering age of Mr. Chan, nurse need to implement mixed learning style for him. Visual/verbal and visual/nonverbal style would be more fit to his needs because due to his older age his auditory and visual capability might be slightly impaired. Hence, combined efforts might prove more productive for him. Moreover, Mr. Chan need to be educated in sessions instead of educating him in one session because he might not be able to concentrate and grasp all the information in single session. Furthermore, Mr. Chan is associated with multiple conditions. He need to be educated for multiple conditions. It would be better, if nurse provide him education for different aspects in different sessions. Otherwise, he might mix-up learning of different aspects and get confused (Bastable, 2014). Nurse need to identify effective tools and resources which can complement his learning style and can be helpful in achieving his self-care goal. In recent times, internet-based resources made significant contribution for educating patients. Younger patients are more inclined towards internet-based resources; however older patients like Mr. Chan also exhibited interest in internet-based resources. Moreover, internet-based resources are helpful in improving interest and adherence to the learning. Visual/verbal and visual/nonverbal learners exhibit more response to the charts, graphs, images and reading activities. All these learning aids can be made easily available through internet. Visual aid for learning comprises of brochure and video. It has been established that video proved more beneficial in influencing self-learning behaviour. Attention of Mr. Chan would be more in video and images can be helpful in improving his remembrance capability (Harmon et al., 2016).

Education Plan for Mr. Chan’s Cardiovascular Conditions

In addition to the learning style, importance also need to be given to the learning theory based on the patient education. As there is existence of diversity of patients, different learning theories are available. Learning theory need to be selected based on the patient’s characteristics and preferences. Selection of appropriate learning theory can be helpful in improving engagement of the patient in the active learning. Health belief model and the transtheoretical model of change can be most suitable in case of Mr. Chan. Health belief model can be effectively implemented in case of Mr. Chan because it is a psychological model and can be helpful in explaining and predicting health behaviours. This model mainly focuses on the attitudes and beliefs of the patient. It is necessary to change attitude and behaviour of Mr. Chan because from the case study it is evident that he is not able to manage his health condition properly. This model can be helpful in addressing both long-term and short-term health behaviours. Mr. Chan is experiencing both long-term and short-term health issues. Through health belief model, patient can avoid negative health condition and positive expectation can be made from the patient to take recommended action. Health belief model is based on the perceived susceptibility, perceived severity, perceived benefits, and perceived barriers (Bond et al., 2012). In case of Mr. Chan, Health belief model can be helpful in the improving eating habits and lifestyle changes which are necessary for his both cardiovascular and respiratory conditions. Transtheoretical model is also relevant to Mr. Chan because this model is based on the different stages like precontemplation, contemplation stage, preparation, action stage and maintenance stage. Education and improvement in the health condition in case of Mr. Chan also can be brought in step-wise manner based on his health needs. Needs and requirements of Mr. Chan include improvement in eating habits, regular exercise and healthy lifestyle. These changes can be brought in him in stepwise manner; hence, transtheoretical model can be effectively implemented for providing education to Mr. Chan. Nurse need to assess performance and improvement of Mr. Chan in each stage of transtheoretical model. If required nurse need make necessary changes after completion of each stage. It can be helpful in getting desired outcome at the time of completion of educational process (Ye et al., 2011).

In addition to the intellectual and skill related factors like learning style and learning theories, other factors like environment of learning, timing, delivery mode of teaching and types of educational material plays significant role in planning education for patient. Environment and time should be convenient to both nurse and patient. Nurses are always used to work in the crowded and noisy environment. However, patient might prefer calm and quiet place for learning (Bergh et al., 2012). Considering need of patient, nurse should provide education to patient at the place of patient’s choice. Quiet place can be helpful in reducing anxiety and nervousness of the patient. Both patient and nurse need to spare sufficient time for learning and teaching process. Nurse need to manage other assignments effectively to focus mainly on educating Mr. Chan. Mr. Chan should get confidence that nurse is taking special efforts and spending time for educating him. It can be helpful in improving his engagement in the learning process. Standardised time duration and schedule need to fixed for providing education to Mr. Chan. Standardised timing is important aspect in providing education for Mr. Chan because it can be helpful in improving efficiency and reducing burnout in teaching and learning process. Education should be provided in the broken small schedules instead of providing in the single session of long duration. Nurse need to plan teaching for Mr. Chan in well advance prior to discharge. Hence, nurse can get enough time for evaluation of the teaching and learning process. Nurse need to make sure that, Chan is healthy and active enough to participate in educational process. Otherwise, nurse would lose time and energy because Mr. Chan would not give full attention in learning process.

Goal and Objectives of the Education Plan

There are three purposes of evaluation of the learning process. These include accountability, development and knowledge generation. Through accountability, results or outcome in the patient can be measured. Through development, teaching process can be strengthened and learners can be empowered. Through knowledge generation, detailed education programme can be implemented. Evaluation of the patient teaching and learning process comprises of gathering, summarizing and interpreting the information gained by the patient. This information can be helpful in the deciding the effectiveness and efficiency of the teaching and learning process implemented for patient. Evaluation is the final and most important step because success of education programme implemented by the nurse reflects in the evaluation step. In the evaluation programme, activities implemented by the nurse and information gained by the patient can be evident. In the evaluation step, whether patient achieved self-care goal or not can be demonstrated. Evaluation is a continuous process and it can be applicable to all the steps like assessment, planning and implementation of the education programme. Education programme can be continuously monitored through evaluation (Kaariainen and Kyngas, 2010). Continuous monitoring is necessary because negative points observed during the monitoring process can be corrected at the earliest. It can be helpful in reducing failure rate of the education programme and increasing its effectiveness. Response of the learner to the education programme can be assessed in the evaluation process and based on the response of the learner effective amendments can be made to the education programme. Knowledge and skills gained by the learner can be understood (DeYoung, 2014).

Evaluation of teaching process can be done in three steps. These steps include learning evaluation, transfer evaluation and impact evaluation. In learning evaluation, patient’s ability to teach back can be evaluated. Teach-back method can be effectively implemented in learning evaluation for evaluation of patient’s learning abilities. In this method, learners need to explain or demonstrate their learnings or gained information to the nurse. In case, nurse not satisfied with the demonstration by the learner, nurse need to think of changing learning style or nursing theory or both and should repeat the teaching process for the patient. Transfer evaluation can be helpful in assessing patient’s ability to implement knowledge and skills acquired during learning in the actual practice. In impact evaluation, health assessment of patient can be done to assess improvement in health as a result of learning. All the three steps of evaluation are necessary in the evaluation plan (Christie et al., 2014; Bastable, 2017). Nurse can educate Chan about the types of healthy food; however, in case, Chan is not consuming this healthy food in actual practice. In such scenario, it should be considered that only first step of learning is successful. There are varied evaluation methods are available for evaluating education process. These include checklists, confidence logs, cost effectiveness, focus group, interviews, nominal group techniques, pre and post testing, questionnaires and system log. In case of Chan checklists, interviews and questionnaires can be used because these methods can be implemented on the individualised basis and predetermined different questions can be asked. These methods are also associated with advantage like Moderate–high preparation and analysis time (Seyedin et al., 2015).

Behavioural Objectives for Improved Patient Outcome

Conclusion:

Nurse should be conscious about the patient teaching and learning process. Effective assessment and planning education process can be helpful for the nurses to make rational decisions about the education process. Standardised framework for planning and evaluation of the education process can be helpful in improving efficiency of nurse in providing education and patient’s ability in learning. Chan is associated with complex health issues like cardiovascular and respiratory issues. Hence, nurse should consider multiple factors for providing effective education to him. Nurse need to understand his needs, learning style, environment, suitable time and mode of delivery. It can be helpful in improving success rate of education programme. Through, providing effective education programme, quality healthcare delivery can be achieved in case of Mr. Chan.

References:

Anton, M., and Goering, E. M. (2015). Understanding Patient’s Voices: A MultiMethods Approach to Health Discourse. Netherlands: John Benjamins Publishing Company.

Bastable, S. (2014). Nurse as educator: principles of teaching and learning for nursing practice (4th edition). Sudbury: MA; London: Jones and Bartlett. Chapter 2- ethical, legal and economic foundation of the education process.

Bastable, S. B. (2017). Essential of patient education (2nd edition). Sudbury: MA; London: Jones and Bartlett.

Bergh, A.L., Karlsson, J., Persson, E., and Friberg, F. (2012). Registered nurses’ perceptions of conditions for patient education–focusing on organisational, environmental and professional cooperation aspects. Journal of nursing management, 20(6), 758–70.

Bond, G., Aiken, L., and Somerville, S. (2012). The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychology, 11, 190–6.

Christie, D., Thompson, R., Sawtell, M., Annan, F., and Viner, R. (2014). Structured, intensive education maximising engagement, motivation and long-term change for children and young people with diabetes: a cluster randomised controlled trial with integral process and economic evaluation – the CASCADE study.  Health Technology Assessment,  18(20), 1-202.

DeYoung, S. (2014). Teaching Strategies for Nurse Educators. Pearson.

Forren, J., O. (2017). Drain’s Perianesthesia nursing: A Critical care approach (7th edition). US. Riverport Lane.

Harmon, K. C., Clark, J. A., Dyck, J. M., and Moran, V. (2016). Nurse Educator’s Guide to Best Teaching Practice: A Case-Based Approach. Springer.

Hun, D.D. (2012). The New Nurse Educator: Mastering Academe. Springer Publishing Company.

Kaariainen, M., and Kyngas, H. (2010). The quality of patient education evaluated by the health personnel. Scandinavian Journal of Caring Sciences,  24(3), 548–56.

Jones, J. M., Papadakos, J., Bennett, C., Blacker, S., Catton, P., and Harth, T. (2011).  Maximizing your Patient Education Skills (MPES): A multi-site evaluation of an innovative patient education skills training course for oncology health care professionals. Patient education and counselling, 84(2), 176–84.

Masters, K. (2014). Role Development in Professional Nursing Practice. Burlington. MA: Wall Street.

Muma, R., and Lyons, B, A. (2012).   (2nd edition). Sudbury. MA: Tall Pine Drive.

Seyedin, H., Goharinezhad, S., Vatankhah, S., and Azmal, M. Patient education process in teaching hospitals of Tehran University of Medical Sciences.  Medical Journal of The Islamic Republic of Iran, 29, 220.

Shafiei, E., Baratimarnani, A., Goharinezhad, S., Kalhor, R., and Azmal M. (2014). Nurses’ perceptions of evidence-based practice: a quantitative study at a teaching hospital in Iran. Medical Journal of The Islamic Republic of Iran, 28, 135–0.

Ye, H.J., Hu, L.J., Yao, Y.Y., and Chen, J.H. (2011). The effects of two health education models on psychological and nutritional profile of patients waiting for kidney transplantation. Zhonghua Nei Ke Za Zhi, 50(10), 845–7.

Utley, R. (2010). Theory and Research for Academic Nurse Educators: Application to Practice. Jones & Bartlett Learning.

Wingard, R. (2005). Patient education and the nursing process: meeting the patient’s needs. Nephrology Nursing Journal, 32(2), 211-4.