A Guide For Nurses: Teaching Healthcare Effectively to Patients

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As a nurse one of our principal responsibilities is to educate our patients. Our teaching reaches across a broad gamut: medications (old and new), procedures, wound care, signs and symptoms to be aware of, health habits, how to continue caring for themselves once their home and more. The teaching can occur as spontaneous answers to questions from our patients or more formal educating including a plan and resource materials.

Patients are held in-house for increasingly shorter stays and are going home sicker, precipitating a greater need for instruction and information than ever before. The information you provide them during their hospital stay will hopefully help them gain a full recovery and decrease the risk of readmission. So how do we educate our patients effectively? Taking these factors into consideration will help you to successfully convey the information needed.

Provide a hospitable learning environment: With all the distractions of the hospital it may be difficult to find somewhere that is free from excess noise, disruption, is private and conducive to learning. While we can’t always choose the physical location where the learning will take place, we can try to provide planned learning at a time of day when those disruptions would be minimal; possibly mid-morning after breakfast, morning hygiene, assessments and rounds. Each floor has a different rhythm, choose what will work best for you and your patient.

Help your patients decide who should be involved in the learning process. When considering a pediatric patient, ideally both parents would be present for the information as well as any potential caregivers to the child. However, a teenage mother who has just given birth may not be as receptive to you and what she needs to know to care of herself in the post-partum period, if her own father is present. Embarrassment and modesty may interfere. Without making judgments – help your clients decide who needs to know what.

Establish a baseline of knowledge. What do they already know? Is your patient a young woman newly diagnosed with breast cancer? Her needs will be vastly different than a sixty year older woman who was the care taker of her own mother with breast cancer and now finds herself diagnosed with the disease as well. Make no assumptions in what someone does or does not know. Ask.

Ask your client what they think they need to know. While the saying “we don’t know what we don’t know” (or unconscious incompetence) may apply, asking your patient what they feel they need to know to go home safely may provide you with a different prospective for your teaching plan. This is one way to involve people in the learning process, by allowing them to guide their learning they will be more invested and will increase their willingness to participate, motivation and ability to retain information.

What do they need to know to go home safely? Not only are patients staying in the hospital for shorter stays, our time with patients is limited as well. Staffing, complexity and resource issues all play a part in how much time there will be to educate. Establish your priorities. Decide what is vital for your patient to know upon discharge and get to that information first.

Are there any cultural, religious or beliefs and practices you should be aware of that may impact their learning or the information you are planning to pass on? Considering a family of Mexican heritage, it would be important to bear in mind that traditionally the man is considered the head of the household and any information pertaining to important decisions would need to be conveyed to him directly. Asking your client if there are any beliefs they hold that would interfere with what they are learning would be appropriate.

Assess a patient’s motivation prior to embarking on a teaching plan. With the best plan in place, no learning will happen if your client is wholly unmotivated. Remembering that illness, fatigue, depression and anxiety are all factors in motivation toward learning; they can also be readily present in a health care setting. Working with the patient and the patient’s family and team of health care givers to help promote the motivation to learn is essential.

Understand the different kinds of learners:

Visual learners learn best when presented with graphs and other illustrations, maps, written material, being close to the presenter of the information so that they can interpret their gestures and facial expressions. They like to take notes and ask for repetition of verbal instructions.

Auditory learners do their best when they can listen to a lecture or a fast paced exchange of information. They prefer group discussion where other’s point of view are discussed as well as hearing stories and/or jokes that reiterate the information; they rely on verbal cues (or pneumonic devices) for remembering information.

Kinesthetic learners prefer to “just do it” vs. discussion; they enjoy frequent breaks and hands on experience. They may shake a leg, rock in their seat or find other ways to move when being lectured to. They make hand gestures and prefer role play exercises over discussion groups.

Most people are believed to have a preference of one type of learning over others. While that may be true, information that is presented in all three ways will provide the learner with the most opportunity and the greatest retention. Keep in mind all three types of learners when creating your teaching plan as well as during informal teaching moments. Find out what kind of learner you are by taking this online test.

In considering the different kinds of learners, ask your patient in which way they prefer to learn. Do they learn best by watching a video? Returning a demonstration? Reading a handout? Do they like group discussion? They may not know which way they are most likely to remember what you’re teaching them. If not, observe them as different methods are presented. Do your best to accommodate their learning needs.

Establish special needs of your patient. Outside of the needs of different learners are other learning challenges. Is your patient literate? Are they visually impaired? Hearing impaired? There are some cities in the country with up to a 20% parental illiteracy rate – don’t make the assumption an adult can read. Consider their challenges and provide your patient with information in a way they can most effectively be taught. Learn more about illiteracy here.

Keep in mind that we as people tend to remember only

• 10% of what we read
• 20% of what we hear
• 30% of what we read & hear
• 50% of what we hear and see
• 70% of what we say
• 90% of what we say and do

Certainly these numbers will differ with individuality but the premise is: the more ways a person is exposed to the information the best chance he or she has to retain it.

Leave your judgments at the door. We have established that we all learn in different ways; and when teaching, those different avenues of accepting information need to be valued. We also need to remember that our client’s culture, health choices and lifestyle choices are their own. Giving them more information to help them chose a healthier lifestyle is appropriate; judging them for their choices and decisions is not. It can be very difficult to leave our opinions behind, but it is imperative that we respect our clients. Not forming judgments is an important way to do that.

As the learning process progresses a valid way to get feedback, ascertain learning progress and retention, is to ask questions. Be sure to give the respondent enough time to formulate their answer. Use the goals you set in the learning plan to direct your questions. The patient will see what information you value and those concepts will be reinforced. For instance: when teaching a patient about a new medication, ask them to remind you of the side effects they should be looking for. Placing value on the side effects of a new medication will reinforce to the learner that those pieces of information are important.

Be open to conversation when caring for your patient. Include time for spontaneous question and answer period when doing simple nursing tasks along their course of treatment. As you help adjust your patient in bed ask open ended questions (a question that does not require a yes or no answer – “Tell me what you’re thinking about what the doctor said this morning?”) regarding their diagnosis, self care, and prognosis and treatment plan. Using those small amounts of contact with the patient as a point of relevance and information transfer can be invaluable to the patient and your schedule.

Listen. When we listen we can hear and understand where our patients are at with the information we are teaching them. Adults in particular (and some children as well!) have a rich history of experience, listening to those experiences, validating their worth and using them to teach new information will be a valuable tool. You can’t do that if you don’t listen.

Break up the time you spend educating if the topic is new, overwhelming and/or life changing. A newly diagnosed diabetic has an enormous amount to learn: understanding the disease process, dietetic concerns, exercise issues, medication (both types and methods of administration), self-care of eyes and feet and more. The complexity and depth of information this patient needs to know is overwhelming and life altering. Sitting down to do it all at once will be unproductive and dangerous. You can learn more about diabetes education here.

Adults speed of learning changes over time. Granting your patient enough time to assimilate the information is equally as important as the preparation and choice of the materials and plan you formulate. It will do little good to decode a client’s learning style and address their unique concerns without providing them with time. More information on adult learning can be found here.

Research suggests that only five to nine pieces of information can be stored in our short term memory at a time. That information has 15 seconds (or less) to be organized and stored before it will disappear. In other words, just because you have told someone something, it means nothing in the matter of their learning.

Utilize your resources. There are times when our client’s needs outreach our own experience and ability. Utilize the specialists your agency offers. Social workers, diabetic education specialists, nutritionists, respiratory therapists to name a few. When needed, call for back up.

Often our patients are in a position where their lives are changing. That can be uncomfortable (at best) for some folks. As a health care worker you bear witness to life changing medical events on a regular basis. Remembering that often not only is the experience new to the patient, the information is as well. For a forty year old male who was admitted after experiencing a heart attack, learning new health habits, nutritional concerns and lifestyle changes that he now faces will come with the uncomfortable realization of drastic change. Just because you do this every day, never forget that for your patient this hospitalization and the learning that takes place therein is quite likely a sentinel event in their life.

Evaluate the success of your teaching. There are plenty of ways to evaluate what the patient has learned from the teaching you provided. Asking questions regarding identified goals, having the patient do a return demo on any skills they learned or having the patient return the teaching to you are all great ways to evaluate the process.

Once evaluation of the client has been completed it’s important to return to those concepts that the patient had difficulty with. One definition of learning is “a change in behavior due to experience or continued practice.” Just because the teaching has been done, doesn’t mean the learning has taken place to the patient’s or nurse’s satisfaction. Remembering that learning occurs because of experience or continued practice will help you to frame a time line for learning that is appropriate for your patient. Identify what needs to be experienced or practiced more and begin again.

Return to the evaluation process once you’ve revisited the information that needed to be learned. For some clients one cycle of teaching and evaluation may be sufficient, for others many more may be needed. The goal remains that the client learns the information they need to improve or sustain their health and reduce the need for a readmission.

Be sure to document your teaching properly; including what information was covered, what resources you used, how you evaluated the client’s learning and any plans for further teaching.

Of course, all of these ideas will not fit every teaching scenario you encounter. A pediatric client’s needs will differ from an older client’s needs. Using these concepts to navigate your way throughthe teaching process will help make you a more effective and productive teacher.

Consider Leigh Hamilton, an orthopedic patient in Michigan. Hamilton was in the hospital for two joint replacements in her knuckles. She did well coming out of surgery and then developed an adverse anesthesia reaction: a severe headache. The headache was treated as Hamilton’s stay was extended from the anticipated outpatient schedule and she was held over into the afternoon shift, eventually being discharged late into the night the day of surgery. She left the hospital with no discharge teaching done at all. Hamilton, a nurse herself, was sick and in pain and did not realize until she was in trouble nearly 24 hours post-op, that she had not received any discharge instructions. By then she had spiraled into a severe pain cycle that could had been avoided had she been elevating and icing her fingers and taking the medication that was recommended by the physician as a part of the post-op instructions she never received. By her first check up 48 hours later, the pain was still severe and she had to undergo a painful bandage change because the first bandage change that should have been done at home 24 hours after surgery had been missed; because of the overlooked discharge teaching.

Whether the nurses assumed Hamilton was a nurse and therefore had an understood amount of knowledge and didn’t need discharge teaching or the teaching was missed because she was held over into the evening shift, an unusual event for that particular floor, thus interrupting the systems in place, is a mute point. The patient suffered greatly because of the gaffe in her nursing care, luckily for Hamilton the damage was not permanent, although no less disturbing. When a patient leaves the care of the hospital only to experience a decline in status, whether readmission becomes a reality or not, a major mistake has occurred.

Hard numbers on readmissions due to inadequate or missing patient teaching are hard to track, but that doesn’t make the importance of the teaching any less imperative. Part of what makes a nurse’s job unique in the health care setting is the task of patient education. Education of the patients is a parameter for professionalism in nursing and should be treated with equal importance as other nursing actions. Teaching is a fundamental piece of the nursing puzzle, without it nursing’s effectiveness as a profession is compromised. For more information on a career as a nurse educator, look here.