Cardiac/Vascular Nurse Exam Secrets Study Guide (33 page)

Learning ability

Learning ability plays an important role in the learning process, as the ability to learn is dependent on an individual’s developmental level, physical wellness, and intellectual thought process. The developmental level of learning depends on the individual’s stage in life.

Literacy level involves reading, comprehension, problem solving, and mathematics. Health literacy is defined as an individual’s level of literacy required to function in a health environment and independent of educational literacy. Language can also influence an individual’s ability to learn, especially if English is a second language. Physical wellness is defined as the level of strength, coordination, and sensory acuity to learn.

Reduced visual acuity

Individuals that present with reduced visual acuity can effectively learn if certain teaching approaches are taken. Practicing clinicians should make sure that an individual with reduced visual acuity has clean glasses and adequate light, and is wearing contacts or using magnifying glasses. In reading documents, make sure the letters used are in large font and of a contrasting color. Black ink on a white paper is the best for individuals with vision problems. The use of auditory tapes or CDs may also be effective in getting information across to patients with reduced visual acuity.

Reduced hearing acuity

Individuals that present with reduced hearing acuity can effectively learn if certain teaching approaches are taken. A practicing clinician should speak slowly and clearly. He/she should get the individual’s attention prior to speaking and use simple sentences. Facing the patient and standing in close proximity is most effective in teaching a patient with reduced hearing acuity. Requesting feedback from the individual will provide information if the patient understands the clinical practitioner and if he or she is getting information across effectively. Additionally, if the patient is still having problems hearing the clinical practitioner, make sure that the individual’s hearing aid is working properly and check to see if the patient hears more effectively in 1 ear versus the other.

Strategies for effective teaching and learning

The role of the clinical practitioner is to facilitate learning, while the role of the patient is to learn. Structured learning environments are more effective than unstructured learning environments. The strategy most effective for teaching depends on the learning and what works best for that individual. Teaching strategies include lecturing, question and answer sessions, demonstrations, role playing, oral or written exams, simulation, illustrations, case studies, books, pamphlets, pictures, film, computer-assisted learning programs, and video tapes/DVDs. Clinical practitioners need to take into account the patient’s learning level and adjust teaching strategies to that learning level. The practitioner should also make sure that the learning material is relevant, relatable, and organized.

Assessment

Assessment, in the patient education process, involves defining learning needs and developing a teaching plan to meet the needs of an individual. Assessment involves understanding an individual’s need to learn, motivation to learn and readiness to learn. If individuals have an internal locus of control, then they will be more proactive in the approach to their health, while an individual with an external locus of control will not be as proactive in the approach to their health. Therefore, practicing clinicians need to take different approaches depending on the patient’s ability to take control of their own health. Practicing clinicians also need to take into account any external factors that may affect an individual’s readiness to learn including cultural or religious beliefs, perceived benefits of changing behaviors, and belief that individuals can effectively influence their own health. Other factors include physical well-being, comfort, sensory, and physical and intellectual maturity.

Strategies for patient education and counseling

The strategy used should be employed based on the patient’s perception. Practicing clinicians should inform the patient the expected goals of these strategies and issue small goals rather than large unattainable goals. Setting out specific goals is much more effective than being vague. Patients are more apt to follow specific recommendations rather than just giving them ideas. New behaviors should be linked to old behaviors and it is typically easier to establish new behaviors rather than eliminate old habits. Follow-up with the patient and having them monitor their goals are essential for the individual to achieve the goals laid out for them. Multiple members of the healthcare staff should be involved in the process, including nurses, doctors, counselors, and nutritionists.

Strategies for effective evaluation and reteaching

Evaluation requires the practicing clinician to assess a patient’s performance, health-related outcomes, and determine competence. Evaluation is used to assess whether a patient is effectively learning and changing their health related behaviors. If the approach is not effective, practicing clinicians can alter their approach to better suit the patient’s needs. Direct and indirect measurements can be used for evaluation assessment. Direct measurement involves observing the patient and recording behaviors. Indirect measurement assumes that learning has occurred, as the patient has reached a predetermined learning level. Oral questioning and written examinations are examples of indirect learning measurements.

Three health self-management issues

Health self-management issues include health maintenance, disease prevention and health promotion. Health maintenance is defined as strategies that help maintain and/or improve health over time. Health maintenance is dependent on 3 factors, which include health perception, motivation for behavioral change, and compliance to set goals. Disease prevention is an effort to limit the development or progression of lifestyle related illness. Disease prevention can be categorized into primary, secondary, and tertiary prevention. Primary prevention measures are employed prior to disease onset and are used in health populations. Secondary prevention measures are used to screen, detect, and treat disease in earlier stages to prevent further progression or development of other complications. Tertiary prevention measures are used to prevent onset of other complications or comorbid conditions. Health promotion strategies include risk reduction strategies applied to general population.

Barriers that might interfere with the patient’s ability to learn

Language: Is English the patient’s primary language? Are interpreters available to help the patient hear and understand the information in his/her native tongue?

Hearing impairment: Is there a known, or suspected, hearing deficit? Is hearing equipment in use and functioning? Improve communication by facing the patient and using short sentences.

Sight impairment: Is there a known, or suspected, sight deficit? Are eyeglasses clean and in use? Accommodate for the use of a magnifying glass and provide high-contrast, large-print material as needed. Offer auditory rather than written teaching supplements when available.

Pain: Is the patient adequately medicated in order to pay attention and think clearly, but not drowsy?

Physical restriction: Is the patient physically able to perform the tasks you are teaching him/her about?

Intellectual development: Is the patient developmentally able to understand the concepts being presented?

Motivation: Is the patient ready to learn, or is anger, denial or other emotion impairing his/her readiness and receptiveness to new information?

Ways to recognize low health literacy

The patient may:

• Express frustration or inaccurate knowledge about how and where to find needed healthcare services.
  
• Express frustration or difficulty following through with treatments, including medications or testing.
  
• Be unable to provide an accurate personal health history or fill out detailed health surveys.
  
• Have little or no knowledge and regard for preventative measures and the consequences of risky behaviors and may express belief in healthcare misconceptions.
  
• Appear disinterested in provided materials, often expressing that someone else outside of themselves will meet their healthcare needs.
  

These concerns can be addressed by:

• Assuring that communication is provided in the patient’s primary language and at a level appropriate to his/her developmental and learning level.
  
• Avoiding the use of medical jargon and complex explanations that can be misunderstood and frequently assessing the amount of learning.
  
• Prioritizing information according to its perceived value to the patient.
  
• Providing multiple learning methods and supplemental materials as needed to reinforce learning.
  

Self-efficacy theory of learning

Self-efficacy learning models are based on the core belief within the patient that change can be accomplished. This belief can be supported through educational efforts in four key ways.

Personal mastery is the most vital component. Personal mastery is directly based on the patient’s belief that a new skill can be mastered or a solution to a problem found.

Vicarious experience allows the patient to observe and learn from demonstration by others, either patient or nurse. Role models with similar experiences as teaching agents are particularly helpful.

Verbal persuasion provides positive reinforcement in the patient’s efforts toward change and expresses the third party’s (including the teacher or care provider) belief that a skill can be mastered by the patient.

Physiologic feedback provides tangible evaluation methods (physical appearance of a bandage, lab results, resolution of nausea, etc) the patient can utilize to see if his/her work has succeeded or failed.

Conditions and motivations that encourage learning

There are three domains of learning that need to be addressed. Cognitive: actual knowledge of facts; affective: attitudes and feelings associated with the subject; and psychomotor: hands-on skills and actions.

Learning in these three areas is based on the patient’s motivation and ability to learn as well as the environment in which he/she is expected to learn. A desire to learn and change must be present, and knowledge must be presented in a manner that enables and sparks the individual’s ability to learn. Knowledge and learning opportunities must be presented in an atmosphere that is respectful, encouraging and comfortable for the patient.

Signals that a patient needs expanded teaching and discharge planning

• Patients older than 70
  
• Anyone living alone, in another state or country, or whose housing arrangements are in question
  
• Anyone suspected of being abused or neglected
  
• Patients with multiple admissions
  
• Patients transferring from other care centers
  
• Patients with new or multiple diagnoses
  
• Anyone with a terminal illness or diseases requiring long-term intensive treatments and other significant life changes
  
• Patients with known or potential financial burdens related to care or basic needs
  
• Patients with few visitors or family/support system problems
  
• Those with little or no English-speaking ability or with learning disabilities
  
• Substance abusers
  

Maslow’s hierarchy of needs

Basic physiological and survival needs must always be met first. Learning cannot take place in an environment of personal emergency. Basic health needs that preserve life are addressed at this stage.

Patient concerns progress from there to include fears for safety and security including pain control.

When these areas are addressed the patient is then ready to begin taking an active role in his/her current health care.

The next step is a more active interest in promoting current and future health and wellness. Focus is still on problem solving and affirming positive health practices. Then, a desire to reach fulfilling life goals can be addressed.

Individual versus group teaching sessions

Lecture can be appropriate for teaching large groups, but when used in small groups it has better results when coupled with discussion and/or question and answer.

Discussion alone is appropriate for a one-on-one instruction setting. Question and answer time should only be used in a single-learner setting when prior knowledge has been given and absorbed by the learner, or as a method to assess how much learning may have taken place.

Demonstration and practice work best in small groups or individual settings. Practicing skills can include return demonstration or role playing in either setting.

Supportive teaching tools such as written material or audio-visual treatments are helpful in both group and individual learning environments and provide reinforcement of material in different methods to accommodate various learning styles.

Patient and family teaching

Invasive treatment procedures

Preoperative: Provide information regarding the procedure, including who will be present in the room and his/her function, what sights and sounds are typical, sensations and amount of discomfort both during and after the procedure, and an estimate of the amount of time required for the procedure.

Review consents and other documentation including living will/advanced directives.

Postoperative: Review the procedure and its outcomes, provide visual documentation of the procedure including before and after images of the area(s) treated.