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Course: Pediatric Nursing

Topic: Health Teaching

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to

Discuss the process of health teaching as it relates to children and their families
Identify the components of learning needs assessment
Discuss techniques a nurse could utilize to improve learning among children and their families
Explain techniques a nurse can utilize to evaluate learning among children and their families

Note: ‘Client’ refers to ‘Child being cared for by health care professionals’ in this slide deck

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Client Education

According to WHO (1998), ‘Therapeutic Patient Education’ is

‘Therapeutic patient education is education managed by health care providers trained in the education of patients and designed to enable a patient (or a group of patients and families) to manage the treatment of their condition and prevent avoidable complications, while maintaining or improving quality of life.’

Contact info: info@nursesinternational.org

Client education, or client teaching, involves a variety of activities. The nurse is not simply telling the client how to care for themselves when they go home. The nurse must consider each client’s unique needs in order to create a teaching plan that allows clients to make informed decisions about their care and work towards independence. Client education is defined as “A process of assisting consumers of health care to learn how to incorporate health related behaviors (knowledge, skill, attitude) into everyday life with the purpose of achieving the goal of optimal health” (Bastable, 2017, as cited in Cutilli et al., 2021, p. 1). Although nurses are primarily responsible for client education, other health care team members may be involved. A client’s family or other caregivers may also be involved in the teaching and learning process.

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Client Education

A planned learning experience provided to:

Clients of all ages
Client caregivers
Client’s family members

(eviQ Education, n.d.)

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Nurse’s Role in Child and Family Education

Education is a key role included in a nurse’s scope of practice
Relates to the definition of nursing

Provides clients with knowledge, skills, and attitudes to promote health
Provides clients with knowledge, skills, and attitudes to prevent illness
Can be applied to all client populations across all care settings

International Council of Nurses, 2021

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Nurse’s Role in Child and Family Education (Continued)

Compared to other healthcare team members, nurses have better opportunities to

Develop the required rapport with child/family for education
Initiate child and family education early in the care
Provide child and family education throughout the continuum of child care
Continual reinforcement of the important information

Usually the nurse is the first individual to observe changes in child’s condition and identify education needs

Reiger & Yarbro, 2003

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When Does Child and Family Education Occur?

Education should be a part of the child’s plan of care

Enhances effectiveness of both teaching and care
Promotes Client- and Family-centered care
Encourages positive child health outcomes

Child and family teaching can occur anytime and should start during at initial visit or admission to a hospital

Not a one-time only event but occurs throughout hospital stay
Teaching is an active process that involves child and family in planning

Smith & Zsohar, 2013

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Goals of Child and Family Education

Behavior change is the ultimate goal of child and family education
Client and Family-centered education enhances:

Health literacy, confidence of family in caring for child
Autonomy, informed decision making
Communication between child/family and health care providers
Adherence to treatment

Long term outcomes of effective education:

Promotes autonomy, adherence to treatment
Improved child health outcomes, quality of life
Self-management of and satisfaction with child care

Arkansas State University, 2018

University of Wisconsin Population Health Institute, 2019

eviQ Education, n.d.

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Priorities of Child and Family Education

Information must include but is not limited to

What child and/or family needs to do and why
When child and/or family can expect results (if applicable)
Warning signs child and/or family should watch for
What child and/or family should do if problems occur
Who should the child and/or family contact for questions and concerns

Must be individualized based on the client’s needs
‘Keeping it simple’ is critical!

Dugdale & Zieve, 2019a

Aston & Oermann, 2014

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Components of Child and Family Teaching/Education

Assessment

Assess readiness to learn

Identification

Gaps in knowledge and needs of the child and family

Planning

To effectively fill the gaps in the child’s/family’s knowledge

Implementation

Provision of information appropriately

Evaluation

Confirming that education was provided in understandable way

Aston & Oermann, 2014

Dugdale & Zieve, 2019b

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Case Study

A nurse is discharging a 10-year-old child after a surgical procedure. The child has an incision site with dissolvable sutures covered by a dressing. The child is being sent home with a pain medication.

What education should the nurse provide the child and family?

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According to the priorities of child and family education, the nurse should include the following information:

What child and/or family needs to do and why

In this situation, some things the nurse should include are what the family and child need to do to care for the incision site and why this is important (reduce risk of infection, poor closure/healing of incision site etc.), and what they can do at home to manage the child’s pain and why it is important (how and when to take the pain medications and nonpharmacologic pain management methods; important because unrelieved pain can cause increased sensitivity to pain and delayed recovery time)

When child and/or family can expect results (if applicable)

In this situation, the nurse might explain how long it will take for the sutures to dissolve, when the dressing can be removed, and when children who have had this kind of surgery usually start feeling better

Warning signs child and/or family should watch for

In this situation, the nurse should educate the child and family on signs of infection at the surgical site, signs of other postoperative complications if applicable, and possible adverse side effects of the pain medication

What child and/or family should do if problems occur

The nurse should educate the family on what to do if any of the problems described above occur (Visit the nearest health facility? Call the nurse? Stop taking the pain medication? etc.)

Who should the child and/or family contact for questions and concerns

The nurse should provide the family with contact information for whoever has been designated to answer their questions. For example, the phone number and/or address of the clinic where the child will be receiving follow-up care.

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Child and Family Education: Assessment

Child and family learning needs

What they already know
What they need to know
What they want to know

Child and family learning abilities

Important for identifying effective teaching methods
Cognitive level of understanding: literacy, language, etc
Learning styles: visual, auditory, or kinesthetic
Physical/mental conditions affecting cognitive abilities

Visual/hearing acuity, speech problems, developmental stage

Amount of information they can handle at a time

Aston & Oermann, 2014

eviQ Education, n.d.

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Child and Family Education: Assessment (Continued)

… learning abilities (continued)....

Three domains of learning

Cognitive (knowledge, thinking, facts)
Affective (emotions, responses, coping)
Psychomotor (performance of tasks, coordination)

Teaching is most effective when nurses consider the domain(s) of learning

Education becomes more holistic in nature

Emporia State University, n.d.

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Child and Family Education: Assessment (Continued)

Child and family readiness to learn:

A continuous process throughout the care
Consider physical, psychological, and cognitive readiness

Physical health limitations- pain, sedation, etc.

Psychological state – anxiety, stress, ability to concentrate, etc.

Readiness to learn is evident when child and family:

Asks question about their care

Expresses concerns about their care

Engages in instructional process

Attentively observes care given to them

Aston & Oermann, 2014

eviQ Education, n.d.

Contact info: info@nursesinternational.org

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Child and Family Education: Assessment Strategies

Informal and targeted conversation with child and family while providing care
Observations during delivery of care
Asking open ended and probing questions about the child’s condition, treatment, and what they want to learn
Asking which time of the day they are more efficient learners
Avoid making assumptions
Developing good rapport with the child and family is essential

Aston & Oermann, 2014

eviQ Education, n.d.

Contact info: info@nursesinternational.org

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Case Study

A nurse assigned to care for an infant with diarrhea and severe malnutrition enters the room to administer a tube feeding.

The mother watches the nurse closely and asks, “How long will my baby need to get food through that tube in her nose?”

The infant starts to cry during the feed and the mother starts to cry as well.

Is the mother demonstrating any signs of readiness of learn? Are there any barriers to learning?

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Child and Family Education: Identification

Based on assessment of child and family learning needs, abilities, and readiness to learn
Identification of:

Gap in the knowledge of child and family, including child’s needs

Focus should be on what child and family needs to know, and not on what is nice to know

Barriers for child and family education
Resources to resolve or mitigate the barriers

Validate identified needs with the child and family

Aston & Oermann, 2014

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Child and Family Education: Planning

Kolling & Shumway-Pitt, 2019

Dugdale & Zieve, 2019a

Dugdale & Zieve, 2019b

Without proper planning, the identified needs cannot be met
Careful planning includes:

Goals/objectives identified in SMART format: Specific, Measurable, Achievable, Realistic, Time-limited
Determining appropriate teaching methods
Determining appropriate environment
Determining time required
Making all preparations ahead of time

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Determining Appropriate Teaching Methods

Based on child and family

literacy
language
culture
physical conditions/constraints
developmental stage

Group session for similar needs like nutrition, skin care, etc
One-to-one session for those with specific needs
Use of different resources

Brochures, posters, charts, models, props
Powerpoint presentations, videos, podcasts

Demonstration of skills, return demonstrations, and teach-back
Written instruction is best way to reinforce verbal instructions
Culturally appropriate language, interpreter

Dugdale & Zieve, 2019b

Dugdale & Zieve, 2019a

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Determining Appropriate Teaching Methods ( continued)

Use of varied resources

Brochures
posters
charts
models,
props
Powerpoint presentations, videos, podcasts

Demonstration of skills

return demonstrations
client teach-back session

Written instruction is best way to reinforce verbal instruction
Use culturally appropriate language/ interpreter

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Teaching Strategies for Young Children

Explanations: Simple, concise, concrete
Honest information regardless of unpleasantness
Time explanations (reduces anxiety, excess worries)
Information provision

Toddlers: Immediately beforehand
3-6 years: a couple of days in advance

Foster self-confidence

Assign active role to the child (like self-care activities, holding dressing or tape)
Praise their accomplishments, cooperation, assistance

Educating family about how to coach their child

Ricci et al., 2013

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Teaching Strategies for School-Aged Children

Allow some control in decision-making, offering possible choices
Teach steps involved for particular procedures and time it takes
Allow performing self-care as much as possible
Praise accomplishments and cooperation
Using examples from past experiences

Family can provide information on past experiences
Providing information 3-7 days beforehand, allows them to be mentally prepared

Ricci et al., 2013

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Teaching Strategies for Adolescents

Allow control and involvement in decision-making

Consider their input in all decisions about their care
Collaborate to develop acceptable solutions/strategies to deal with their health issues

Individual appearance and peer acceptance should be considered

Provide rationale

Why it is important
How it affects them

Expect resistance, non-compliance

Work together to achieve positive outcomes

Ricci et al., 2013

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Critical Thinking Question

Think of a medical condition children are frequently hospitalized for where you live.

Imagine that you are the nurse caring for a child with that condition and write a learning objective using the SMART format (Specific, Measurable, Achievable, Realistic, Time-limited) for an education session that you would provide to the family or older child during their hospitalization.

Contact info: info@nursesinternational.org

Where this author lives, many children are hospitalized for asthma. An example of a SMART learning objective for a child with asthma might be: By the end of the shift, the child’s mother will be able to demonstrate the proper way to administer Albuterol to the child using a spacer.

Specific - Who will do what? The mother will demonstrate how to administer Albuterol with a spacer.

Realistic - A single task for the mother to learn over the course of a shift. This could realistically be accomplished.

Achievable - Parents of children with asthma often administer breathing treatments to their children at home. It is not a very complicated task and can be taught to parents in a relatively short period of time. As such, this is an achievable goal for the mother.

Time-limited - When will the mother achieve this learning objective? By the end of the shift.

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Determining Appropriate Environment

Adequate privacy is of utmost importance
Set up a good learning environment:

Lighting, comfortable room temperature
Quiet environment, no disturbance from others

Ensure appropriate size of the room for education session

Consider number of participants, need for skill demonstration

Dugdale & Zieve, 2019b

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Determine Time Required

Make Preparations Ahead of Time

Estimate time frame for the education session

Consider how much information child and family able to grasp at a time
Date/time is optimal for child and family

(Dugdale & Zieve, 2019b)

Secure room, gather audio/visual aids, demonstration equipments
Give information resources to child and family before session

Reduces client’s anxiety, saves time

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Providing Client Education

Obtain client’s consent
Assess client’s readiness to learn throughout the session
Ensure appropriate environment
Use appropriate resources for information provision
Demonstrate caring attitude and behavior through effective communication skills
Review and reinforce the important information
Maintain culturally appropriate distance and eye contact
Partner with the client

Be ‘facilitator of information’ and not a ‘authoritative’ figure

Dugdale & Zieve, 2019b

Aston & Oermann, 2014

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Client Education: Evaluation

Teach-Back Method

Have client repeat information back to you

Return Demonstration

Have client demonstrate skills back (where possible)

Pre-test and Post-test
Feedback from child and family

Was the amount of information adequate/too much? Understandable? Space for improvement in future?

Was the learning objective met?

Were there unexpected questions? Was time adequate?
Was resource adequate/appropriate? Need for another session?

Aston & Oermann, 2014

Dugdale & Zieve, 2019

Cutilli et al., 2021

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Teaching Plan Components: Template

Objectives/ Goals	Content Outline	Teaching Strategies	Time	Resources Needed	Evaluation Method
After a 5 minute teaching session, the client will: Explain the importance of handwashing.	Purpose of handwashing Infection prevention	1:1 Instruction	5 Minutes	Hand- washing pamphlet	Client teach- back

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What Should the Nurse Do?

A nurse is caring for a child newly diagnosed with type 1 diabetes. The nurse has just taught the child’s mother how to calculate the number of units of insulin needed according to the child’s blood sugar and then showed her how to draw up and give the insulin to her child.

What method or methods should the nurse use to evaluate how well the mother understands what she has been taught?

Contact info: info@nursesinternational.org

In this situation, the nurse should use multiple methods of evaluation to really assess the mother’s level of understanding. First, the nurse could ask the mother to teach back how to calculate the number of units of insulin needed based on the child’s blood sugar. The nurse could also give the mother several different blood sugar values and have the mother calculate the correct dose of insulin. The nurse should then have the mother give a return demonstration of drawing up and giving the insulin. This is important because the nurse may notice errors that wouldn’t be evident if the mother was simply asked to verbally teach back how to do it (For example, the mother says “I would fill the syringe with insulin to the number 4 mark to give my child 4 units of insulin” which sounds correct. However, when watching the mother actually fill the syringe with insulin the nurse notices that the mother is sliding the wrong part of the plunger to the 4 mark and therefore not drawing up the correct dose of insulin. This error would not have been caught without asking for a return demonstration)

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others

AHRQ, 2020

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Cultural Considerations in Health Teaching

Client learning preferences may differ based on several cultural factors:

Language spoken
Inclusion of family members
Use of eye contact
Cultural preferences for learning
Client perception of relationship with clinicians

A qualified medical interpreter should be used where possible and appropriate

Smith & Zsohar, 2013

Contact info: info@nursesinternational.org

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References:

Arkansas State University. (2018, March 22). The nurse’s role in patient education. https://degree.astate.edu/articles/nursing/nurses-role-patient -education.aspx

Aston, K., & Oermann, M.H. (2014). Patient education in home care: Strategies for success. Home Healthcare Now, 32 (5); 288-294. https://www.nursingcenter.com/journalarticle?Article_ID=2460148&Journal_ID=2695880&Issue_ID=2460020

Contact info: info@nursesinternational.org

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References:

Cutilli, C., Christensen, S., Aloupis, M., Arvanitis, M., Chancler, C., Cornett, S…& Wolf, M. (2021). Patient education practice guidelines for health care professionals. Health Care Education Association. https://www.hcea-info.org/patient-education-practice-guidelines-for-health-care-professionals

Dugdale D.C & Zieve D. (2019a, January 10). Choosing effective education materials. A.D.A.M., Inc. https://medlineplus.gov/ency/patientinstructions/000455.htm

Dugdale, D.C, & Zieve, D. (2019b, January 10). Maximizing your teaching moments. A.D.A.M., Inc. https://medlineplus.gov/ency/patientinstructions/000460.htm

Contact info: info@nursesinternational.org

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References:

Emporia State University. (n.d.). Student Affairs Learning Domains. Retrieved on September 22, 2021 from https://www.emporia.edu/about-emporia-state-university/leadership-faculty-staff/student-affairs/dean-students/learning-and-assessment/co-curricular-learning-development-model/learning-outcomes-assessment-guide/co-curricular-learning-process/learning-domains/

eviQ Education (n.d.). Patient education resource. Government of New South Wales. https://education.eviq.org.au/patient-education-resource

International Council of Nurses. (2021). Nursing definitions. https://www.icn.ch/nursing-policy/nursing-definitions

Contact info: info@nursesinternational.org

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References:

Kolling, D. & Shumway-Pitt, K. (2019, February 4). GCS lesson planning 101.Under Creative Commons Attribution-ShareAlike 4.0 International License. https://granite.pressbooks.pub/lessonplanning101/chapter/chapter-one-measurable-goals-and-objectives/

Rieger, P.T., & Yarbro, C.H. (2003). Role of the Oncology Nurse. In: D.W. Kufe , R.E. Pollock , R.R. Weichselbaum , et al.(Eds). Holland-Frei Cancer Medicine (6th ed.). BC Decker. https://www.ncbi.nlm.nih.gov/books/NBK13570/

University of Wisconsin Population Health Institute. (2019, May 23). Health literacy interventions. https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/health-literacy-interventions

Contact info: info@nursesinternational.org

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References:

University of Wisconsin Population Health Institute. (2019, May 23). Health literacy interventions. https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/health-literacy-interventions

Smith, J.A., & Zsohar, H. (2013). Patient-education tips for new nurses. Nursing, 43(10), 1-3. https://journals.lww.com/nursing/Fulltext/2013/10000/Patient_education_tips_for_new_nurses.24.aspx

WHO (1998). Therapeutic Patient Education: Continuing education programmes for health care providers in the field of prevention of chronic diseases. Report of a WHO Working Group. Accessed from: https://apps.who.int/iris/handle/10665/108151

Contact info: info@nursesinternational.org

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