Teaching Strategies

Explanation or description (Lecture) 1-to-1 Discussion Answering Questions Demonstration Discovery Group Discussions Practice Printed and audiovisual materials Role-playing Modeling Computer Learning Resources Cognitive Affective, Cognitive Cognitive Psychomotor Cognitive, Affective Affective, Cognitive Psychomotor Cognitive Affective, Cognitive Affective, Psychomotor All types of learning

Barriers To Learning
Acute Illness Pain Prognosis Pt requires all resources and energy to deal with illness Pain decreases ability to concentrate Client can be preoccupied with illness and unable to concentrate on new information Mental and physical performances have a circadian rhythm Emotions require energy and distract from learning Pt may not be fluent in the nurses language Vision, Hearing, and motor control can be impaired in older adults. Children have a shorter attention span and vocabulary differences May be cultural or religious restrictions on certain types of knowledge. (i.e. Birth Control) Visual, hearing, sensory, or motor impairments may interfere with a clients ability to learn Impaired cognitive ability may affect clients capacity for learning Defer teaching until client is less ill. Conduct pain assessment before teaching. Defer teaching to a better time.

Biorhythms

Adapt time of teaching to suit client Deal with emotions and possible misinformation first. Obtain services of an interpreter or nurse with appropriate language skills Consider sensory and motor deficits. Adapt teaching plan. Plan shorter and more active learning sessions Assess clients cultural/religious needs when planning learning activities Plan activities appropriate to learners physical abilities.

Emotion (anxiety, depression, denial, grief) Language

Age: Older Adults

Age: Children Culture/Religion

Physical Disability

Mental Disability

Assess clients capacity for learning and plan teaching activities to complement the clients ability while planning more complex learning for the clients caregivers.

Factors affecting learning.

Age and developmental stage. Motivation Readiness Active Involvement Relevance Feedback Nonjudgmental Support Simple to Complex Learning Repetition Timing Can influence clients ability to learn. Does client have desire to learn? The demonstration of behaviors that reflect the learners motivation to learn at a specific time. If actively involved in process of learning, it becomes more meaningful. Is it relevant to the client? Information regarding performance in reaching a desired goal. People learn best when they believe they are accepted and will not be judged. Learning is facilitated by material that is logically organized and proceeds from simple to complex. Repetition of key concepts and facts facilitates retention of newly learned material. Info and psychomotor skills are retained best when the time between learning and active use of learning is short. Longer time is more prone to forgetting. Optimal environment helps reduce distraction and provides physical and psychological comfort. Fear, anger, and depression can impede learning. Critical illness, pain, or sensory deficits inhibit learning. Includes language and values. Be aware of client ability when planning teaching. (i.e. muscle strength, motor coordination, energy, sensory acuity.)

Environment Emotions Physiological Events Cultural Aspects Psychomotor Ability

Andragogy: Art and science of teaching adults. (Learning is influenced by past experiences, any immediate needs, if the material is useful immediately, and reinforced by application and prompt feedback.) Pedagogy: Discipline concerned with teaching children. Geragogy: Used to describe the process involved in helping older adults learn. Teaching, like the nursing process, consists of six activities: Assessing the learner, diagnosing the learning needs, developing a teaching plan, implementing the plan, evaluating learning outcomes and teaching effectiveness, and documenting instructional activities. Vital Signs: Focus on what is NORMAL. Check pain when assessing vital signs. 3 Types: Acute: Has identifiable cause, rapid onset, varies in intensity, is of short duration, and generally disappears with healing. Chronic: Extends beyond healing, lacks identifiable pathology, disrupts sleep and ADLs. Cancer: May be acute, chronic, or intermittent, is usually related to tumor recurrence or treatment. Most effective pain management combines pharmacological and non-pharmacological agents.

BP: 100-120 Systolic and 60-80 Diastolic (Chart BP reading and the site) Factors affecting BP: Age, gender, daily variation, position, exercise, weight, sympathetic stimulation, meds, smoking, ethnicity. Pulse: 60-100 bpm (Chart site, rate, rhythm, and quality.) Factors affecting pulse: Age, exercise, position changes, meds, temperature, sympathetic stimulation. Temp: 96.8F 100.4F (36C-38C) (Chart the site and the reading) Respirations: 12-20 breaths/min (Chart rate, rhythm, and depth) Factors affecting respirations: Exercise, anxiety, acute pain, smoking, meds, body position, neuro injury, hemoglobin function. Pulse Ox: Known as SaO2 or SpO2. Normal is 95% to 100% (Chart the percentage) Factors affecting Pulse Ox: O2 therapy, hemoglobin level, hypotension, temperature, and meds. Height/Weight: Used to assess nutritional/developmental status. Weigh at same time, same clothes, void prior to weighing. Can be used to assess fluid retention. Apnea Absence of spontaneous respirations. Bradypnea An abnormally low rate of breathing (Less than 12/min) Tachycardia Heart rate greater than 100 bpm. Hypertension Elevated b/p over 120/80. Fever Elevated body temp (above 98.9) Eupnea Normal respirations of 12-20/min. Ten pulse sites: (Use different sites to assess for circulation during an assessment.) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Temporal Carotid Apical Brachial Radial Ulnar Femoral Popliteal Posterior Tibial Dorsalis Pedis

Apical Pulse: 5th intercostal space at left mid-clavicular line. (PMI = Point of maximal impulse) Critical Thinking Attitudes: 1) Independence requires that individuals think for themselves. 2) Fair-mindedness fair-minded, assessing all views with the same standards. 3) Insight into egocentricity open to the possibility that their biases or social pressures could unduly affect thinking. 4) Intellectual Humility Means having an awareness of the limits of ones own knowledge.

5) Intellectual Courage to Challenge the Status Quo and Rituals: with an attitude of courage, nurse is willing to consider and examine fairly their own ideas or views, especially those with which they might have a negative reaction. 6) Integrity Requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to others. 7) Perseverance CT is a lifelong endeavor, persevere in finding effective solutions to client and nursing problems. 8) Confidence Belief that well-reasoned thinking will lead to trustworthy conclusions. Cultivate an attitude of confidence in the reasoning process and examine emotion-laden arguments using the standards for evaluating thought. 9) Curiosity Be filled with questions; dont be afraid to examine traditions to be sure they are still valid. Universal Intellectual Standards Clarity What is an example of this? Accuracy How can I find out of this is true? Precision Can I be more specific? Relevance How does that help me with the issue? Depth What makes this a difficult problem? Breadth Do I need to consider another point of view? Logic Does that follow from the evidence? Significance - Which of these facts is the most important? Fairness Am I considering the thinking of others?

Health promotion for young adults. (20-40 years)

Routine physical exam (1-3 years for females, 5 years for males) Immunizations as recommended, such as tetanus-diphtheria boosters every 10 years, meningococcal vaccine if not given in early adolescence, Hep B vaccine. HPV vaccine for women up to 26 years old who have not yet received or completed the vaccine series. Regular dental assessments (every 6 months) Periodic vision and hearing screenings. Professional breast exam every 1-3 years. Pap smear annually within onset of sexual activity. Screening for cardiovascular disease (e.g. cholesterol test every 5 years if results are normal, blood pressure to detect hypertension, baseline ECG at age 35.) TB skin test every 2 years. Smoking: History and counseling, if needed. Motor vehicle safety reinforcement. Sun protection measures. Workplace safety measures. Water safety reinforcement (no diving in shallow water, life jackets, etc.) Importance of adequate iron intake in diet.

Nutritional and exercise factors that may lead to cardiovascular diseases (obesity, cholesterol and fat intake, lack of vigorous exercise. Encouraging personal relationships that promote discussion of feelings, concerns, and fears. Setting short and long term goals for work and career choices.

Health promotion for middle-aged adults (40-65 years)

Physical exam (every 3 to 5 years until 40, then annually) Immunizations as recommended, such as tetanus booster every 10 years, and current recommendations for influenza vaccine. Regular dental assessments (every 6 months) Tonometry for signs of glaucoma and other eye diseases every 2 to 3 years or annually if indicated. Breast exam annually by primary care provider. Testicular exam annually by primary care provider. Screening for cardiovascular disease (e.g. cholesterol test, blood pressure to detect hypertension, and ECG as directed by primary care provider.) Screenings for colorectal, breast, cervical, uterine, and prostate cancer. TB test every 2 years. Smoking: history and counseling, if needed. Motor vehicle safety reinforcement, especially if driving at night. Workplace safety measures. Home safety measures: keeping hallways and stairways lighted and uncluttered, using smoke detectors, using non-skin mats and handrails in the bathrooms. Importance of adequate protein, calcium, and vitamin D in diet. Nutritional and exercise factors that may lead to cardiovascular disease (obesity, cholesterol and fat intake, lack of vigorous exercise.) An exercise program that emphasizes skill and coordination. The possibility of a midlife crisis: encourage discussion of feelings, concerns, and fears. Providing time to expand and review previous interests. Retirement planning (financial and possible diversional activities), with partner if appropriate.

Health Risks for Middle-aged adults. Health Risks for Young-adults.

Injuries Cancer Cardiovascular Disease Obesity Alcoholism Mental Health Alterations Injury and Violence Suicide Hypertension Substance Abuse STIs (AIDS, syphilis, etc.) Eating Disorders Malignancies

Culturally responsive care requires the nurse to develop self-awareness and gain the attitudes, knowledge, and skills to incorporate the clients cultural perspectives into the plan of care. Culturally sensitive: Being knowledgeable about cultures prevalent in ones area of practice.

Culturally competent: Understanding and addressing the entire cultural context of each client within the realm of care delivery. Culturally congruent: Refers to care that is in synch with the clients values, lifestyle, and meanings. Culturally appropriate: Applying knowledge of a clients culture to care delivery. When assessing a client, the nurse considers the clients cultural values, beliefs, and practices related to health care. When teaching a client, the nurse must consider values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status. Tone of Voice Asian Italian & Middle Eastern Eye Contact American Many Asians use soft tone of voice to convey respect. Many Italian and Middle Eastern individuals use a loud tone of voice. Americans use direct eye contact, lack of eye contact is indicative of deception or embarrassment. Usually avoid making direct eye contact with nonrelated members of the opposite gender. Eye contact may be seen as rude, hostile, or sexually aggressive. May believe that direct eye contact is disrespectful May believe that direct eye contact leads to soul loss or theft. May use touch during conversations with intimate partners or family members. May view frequent touch as a sign of concern, interest, and warmth. Tend to keep their distance during communication except intimate or family relationships These cultures prefer closer personal contact and less distance between individuals during communication.

Middle Eastern

Asian Native American Touch American Italian & Latin American Use of Space Anglo-American/North Europeans Italian, French, Spanish, Russian, Latin American, Middle Eastern

Cultural health related practices: Asian: Coining and cupping are traditional medical practices. Should not be misinterpreted as abuse. Fevers may be treated by wrapping the ill person in warm blankets and having him or her drink warm liquids. (Hot/Cold theory) Hot liquids, such as tea, may be preferred. Ice water should be provided upon request only. Rich tradition of herbal remedies. Providers should be sure to discuss the use of home or herbal remedies to avoid drug interaction. May use traditional Chinese medicine. Compliance with traditional treatment may be very different from expected compliance with modern medicines. Care should be taken to fully

explain instructions, such as taking antibiotics for entire course, even after symptoms have disappeared. Traditional foods: Wheat (northern), rice (southern), noodles, fruits, land and sea vegetables, nuts/seeds, soy foods (tofu), nut/seed oils, fish, shellfish, poultry, eggs, sweets, rarely eat red meats, tea, beer. African American:

Menstruation may be viewed as the bodys way of clearing dirty and excess blood. To little flow may be viewed as bad blood staying in the body; too much may be viewed as weakening the body. This can influence views of birth control. Have rich tradition of herbal remedies. Providers should be sure to discuss the use of home remedies to discuss possible drug interactions. May avoid dairy products due to high incidence of lactose intolerance. Check for family history. Focus on present time may interfere with use of preventive medicine and follow-up care. Traditional foods: Rice, grits, cornbread, hominy, okra, greens, sweet potatoes, apples, peaches, buttermilk, pudding, cheddar or American cheese, ham, pork, chicken, catfish, black-eyed peas, red and pinto beans, peanuts, soft drinks, fatback, chitterlings, banana pudding. Hispanic (Latin American/Mexican):

Certain foods or medications upset hot/cold body balance. Try offering alternative foods or liquids for medications. Provide ice water upon request only, or ask client whether he or she would like ice water. Postpartum rest is valued. Sponge baths may be preferred after giving birth. Family members may want to spend as much time with the client as possible and provide nontechnical care. Strong beliefs in fate and external control over events may lead to fewer adherences to medical regimens. Traditional foods: Rice, maize, tortillas, tropical fruits, vegetables, nuts, beans, legumes, eggs, cheese, seafood, poultry, infrequent sweets and red meat.

Asians

Hispanics The Latino who avoids hot foods when experiences a stomach disturbance may be eating foods that are consistent with the bland diet that is normally prescribed by the primary care provider.

Hot/Cold Theory. Cold disease = Hot foods. Hot disease = Cold foods. Cold disease = Hot foods. Hot disease = Cold foods.

Yin = Cold. Yang = Hot. Cancer = cold. Childbirth is seen as a cold condition. To reduce a fever, many cultures believe the best way to treat a fever, infection, is to increase elimination of toxins through sweat baths. Clients from these cultures may want to cover up with several blankets, take hot baths, and drink hot beverages.

Spirituality
Spirituality: Defined as that most human experiences that seeks to transcend self and find meaning and purpose through connection with others, nature, and/or a Supreme Being, which may or may not involve religious structures of traditions. Religion: is typically an organized system of beliefs and practices. Offers a means for accessing and expressing spirituality, and provides support for believes in responding to lifes ultimate questions and challenges.
Spiritual Distress Refers to a disturbance in the belief of value system that provides strength, hope, and meaning to life. Defining characteristics are: (pg 1060) Expresses lack of hope, meaning, and purpose in life, forgiveness of self. Expresses being abandoned by or having anger toward God. Refuses interaction with friends, family. Sudden changes in spiritual practices. Requests to see a religious leader. No interest in nature, or reading spiritual literature.

Nursing Dx regarding spiritual issues

Spiritual Distress (pg 1066): Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, or a power greater than oneself. Readiness for Enhanced Spiritual Well-Being: Recognizes that this is ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature and/or a power greater than oneself that can be strengthened. Risk for Spiritual Distress: At risk for an impaired ability to experience and integrate meaning and purpose in life through connectedness with self, other persons, art, music, literature, nature, and/or a power greater than oneself.

Nursing Dx regarding religious issues Impaired Religiosity: Impaired ability to exercise a reliance on religious beliefs and/or participate in the rituals of a particular tradition. Risk for Impaired Religiosity: At risk for impaired ability to exercise a reliance on religious beliefs and/or participate in the rituals of a particular religion. Readiness for Enhanced Religiosity: Ability to increase reliance on religious beliefs and/or participate in rituals of a particular faith tradition.

Maslows Hierarchy