Health care professionals put a great deal of time and effort into providing patient and family teaching. However, even the best of us develop habits that undercut our effectiveness as patient teachers. Table 7 shows some frequent teaching mistakes.
Table 7
|
Common Teaching Mistakes |
Source: Adapted from: Rankins, S.H., & Stallings, K.D. (1996). Patient Education: Issues, Principles, Practices, 3rd ed., 315-318. |
When we ignore the restrictions of the patient’s environment, teaching is not likely to be successful. This problem occurs when health care professionals ignore important factors such as lack of family support, educational level, the patient’s financial assets, or cultural or ethnic issues that influence the patient’s health care management. Another error occurs when we forget that patients have the right to change their minds. This problem is most likely to occur when you overly invest yourself in the patient and his or her progress. For example, an elderly woman planned to give her own insulin, but then changed her mind, deciding that her husband and daughter would be more appropriate. However, the health care team was so invested in making the patient „independent“ that they continued to insist on the original plan. Another impediment to effective teaching occurs when we are unable to learn from our own mistakes. We as nurses tend to be task oriented and may have a tendency to believe there is only way to approach things in situations in which other solutions would work better. For example, many nurses-and other health care professionals-continue to use medical jargon with patients when all indications indicate suggest that patients don’t understand the terms used.
Although it is desirable and appropriate for you to have specific patient teaching goals in mind, you must also determine the patient’s goals and negotiate them with the patient to achieve the outcomes you both want. For example, a patient with emphysema may set goals for himself or herself that include administering medications and learning breathing exercises. You may agree with these goals, but also push the patient to participate in a smoking cessation program. But if the patient does not share this goal, it is unlikely he or she will make it his own. Both you and the patient will be frustrated.
Duplicating teaching time that other health care team members have already done wastes time and frustrates the patient. This problem can usually be eliminated by charting teaching you have done, by reading the patient’s medical record to see what teaching others have done, and by practicing good interdisciplinary communication. Be cautious about overloading the patient with information. Sometimes, in our sincere attempts to teach our patients everything we think they should know we run the risk of giving them more information than they can absorb.
To be effective, make sure that you choose an appropriate time for teaching. Obviously, some times are better than others. Although you can’t always choose the optimum time, try to select a time when your teaching efforts are most likely to be effective. Try to avoid times when the patient is stressed or upset. For example, a new mother who has just been told that her baby has a serious birth defect or a patient who has just received news about a poor prognosis should not be compelled to participate in a teaching session. In addition, immediately before or after diagnostic procedures or surgery, or when the patient is in pain is not a good teaching time. In situations such as these in which the patient is not likely to be an active participant, you can direct your teaching efforts to family members.
Not evaluating what the patient has learned is one of the most common mistakes health care professionals make. We often spend most of our time familiarizing ourselves with the material to be taught, and then get so involved in our teaching that we forget to evaluate and gather feedback on the patient’s comprehension of what we have taught. In addition, we may forget to plan time for the patient to ask questions. Often, we teach at a rapid pace, quickly ask for questions, and then leave the room, believing that patients have understood our teaching because they did not ask questions. In reality, the patients probably understood so little that they were unable to formulate questions or felt that the nurse did not have time to answer questions. The JCAHO standard stating that „patient education should be interactive“ means that teaching and learning should be a dialogue. Plan ways in which you can assess patient comprehension, both through question and answer sessions and through return demonstration of skills and techniques.
If you use educational media, review the content beforehand, and don’t depend on media to the exclusion of personal interaction. Although you may have access to sophisticated patient teaching media and other materials, it is important that you carefully evaluate their appropriateness for specific patients and audiences. For example, one nurse assumed that a film on breast-feeding sponsored by breast-feeding advocates would be appropriate to show new mothers. However, the film suggested that effective mothering and mother-infant bonding could only be achieved through breast-feeding. Unfortunately, the mothers were a group of women who had little family or social support for breast-feeding. The women became upset and frustrated with the information, lessening the nurse’s effectiveness in presenting additional content.6 Relying totally on media is an inadequate approach to patient education. Using media exclusively without involving the patient in face-to-face interaction makes it impossible to individualize patient teaching, to allow the patient to ask questions, or to get feedback from the patient.
Although patient teaching seems rather simple and straightforward, it is a sophisticated process that demands a high level of skill. Effective patient teaching demands the same problem-solving skills as other clinical interventions. The process of patient teaching is very similar to the nursing process, starting with assessment and ending with evaluation and adjustment of plans as necessary to meet desired goals. By learning more about the process of patient teaching, you can continuously improve your skills as a teacher.