Patient Teaching Plan For Medication Safety At Home.

To create a Patient Teaching Plan aimed at educating a specific patient population about a specific health topic. This plan will be used to develop a Visual Teaching Tool in a future assignment , recognize the influence that developmental stages have on physical, psycho social, cultural, and spiritual functioning.   Identify teaching/learning needs from the health history of an individual. 

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Patient Teaching Plan
Patient Teaching Plan

Week 3 Discussion: Failure of Democracy and the Rise of Totalitarianism 1 1 unread reply. 1 1 reply.

Required Resources

Read/review the following resources for this activity:

● Textbook: Chapter 4, 5 ● Lesson ● Minimum of 1 scholarly source (in addition to the textbook)

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Initial Post Instructions, Patient Teaching Plan

During the 1930s, much of the world seemed to give up on their hope for a democratic solution to their problems and instead turned to totalitarianism, both in Europe and in Asia.

For the initial post, select and address ​one​ of the following:

● Germany/Hitler ● USSR/Stalin ● Japan/Tojo

Address the following questions for your selection:

● What effects did the history, politics, and economies of those areas play in their decisions to turn to totalitarianism?

● What role did the Great Depression in the United States play in their plight?

Follow-Up Post Instructions

Respond to at least two peers or one peer and the instructor. At least one of your responses should be to a peer who chose an option ​different ​from yours. Further the dialogue by providing more information and clarification.

Writing Requirements

● Minimum of 3 posts (1 initial & 2 follow-up)

● Minimum of 2 sources cited (assigned readings/online lessons and an outside source)

● APA format for in-text citations and list of references

Chamberlain College of Nursing NR305 Health Assessment

Patient Teaching Plan

NOTE: Please do NOT remove any of the text on this form. Do NOT use any other form but this one. Fill it in and submit in its entirety to aid in its grading.

Your Name: Date:

Purpose: The purpose of this Patient Teaching Project is to develop a patient teaching plan and create a visual teaching tool aimed at promoting health and preventing disease for a specified patient population.


· This Teaching Plan is Part 1 of the Patient Teaching Project. You will use this Patient Teaching Plan to create a Visual Teaching Tool in Part 2 of this project.

Patient Teaching Plan
State the topic you have selected for your Teaching Project.(Please select from the list provided in the Teaching Project guidelines located in Module 4.)Describe in detail why this is an important topic for patient education. Use evidence from the textbook, lesson or an outside scholarly source to support your rationale.
Describe, in detail, the characteristics of the population you are planning to teach with the Visual Teaching Tool.
What are some potential learning barriers for this population of learners?(Barriers might be cultural, physical, educational, or environmental. Refer to the assigned article in the project guidelines for more information.)
Describe how you could develop your Visual Teaching Tool in a way that will address these potential barriers.
Where do you plan to utilize your Visual Teaching Tool?(Examples: primary care clinic, health fair, school, etc…)
Will you be teaching one-on-one, in small groups, or to a large crowd?
Write three specific learning objectives your visual teaching tool will address.Example: At the end of this education, the learner will be able to list 3 benefits of regular physical activity.1.
Write a paragraph describing how you could evaluate whether your visual teaching tool was successful and met the learning objectives. Consider the population’s abilities and the setting.
List any references used to create this Teaching Plan in APA format.(Hanging indent not required.)Remember to also use in-text citations within this document, when appropriate (Author, year).
NR305_W4_Patient Teaching Plan Form Rev. 8/2018 KC 1

Chamberlain College of Nursing



Health Assessment


W4_Patient Teaching Plan Form

Rev. 8/2018



Patient Teaching Plan

NOTE: Please do NOT remove any of the text on this form.

Do NOT use any other form but this one.

Fill it

in and submit in its entirety to aid in its grading.





The purpose of this Patient Teaching Project is to

develop a patient teaching plan and



visual teaching tool

aimed at promoting

health and preventing disease

for a specified patient





This Teaching Pl

an is Part 1 of the Patient Teaching Project.

You will use this Patient Teaching

Plan to create a Visual Teaching Tool in Part 2 of this project.

Patient Teaching Plan



State the topic you have selected

for your Teaching Project.

(Please select from the list


in the Teaching Project guidelines


in Module 4.)

Describe in detail why this is an

important topic for patient

education. Use evidence from the

textbook, lesson or an outside

scholarly source to support your


Chamberlain College of Nursing NR305 Health Assessment

NR305_W4_Patient Teaching Plan Form Rev. 8/2018 KC 1

Patient Teaching Plan

NOTE: Please do NOT remove any of the text on this form. Do NOT use any other form but this one. Fill it

in and submit in its entirety to aid in its grading.

Your Name: Date:

Purpose: The purpose of this Patient Teaching Project is to develop a patient teaching plan and create a

visual teaching tool aimed at promoting health and preventing disease for a specified patient



 This Teaching Plan is Part 1 of the Patient Teaching Project. You will use this Patient Teaching

Plan to create a Visual Teaching Tool in Part 2 of this project.

Patient Teaching Plan


State the topic you have selected

for your Teaching Project.

(Please select from the list provided

in the Teaching Project guidelines

located in Module 4.)

Describe in detail why this is an

important topic for patient

education. Use evidence from the

textbook, lesson or an outside

scholarly source to support your


NR305 Week 4 Patient Teaching Plan Grading Rubric

Criteria Ratings Pts

This criterion is linked to a Learning Outcome

Health Topic (20 points)

Describe in detail why this is an important topic for patient education. Use evidence from the textbook, lesson or an outside scholarly source to support your rationale.

20.0 pts

Excellent rationale for the importance of the topic and clearly supported by related evidence from text, lesson or outside scholarly source

18.0 pts

Good rationale for the need for the importance of the topic and supported by related evidence from text, lesson, or outside scholarly source

16.0 pts

Minimal rational e for patient educati on on the topic and support ed by related evidenc e

8.0 pts

Topic identi fied but no ration ale provi ded

0.0 pts

This sect ion is blan k

20.0 pts

This criterion is linked to a Learning Outcome

Patient Population (15 points)

Describe, in detail, the characteri stics of the population you are planning to teach with the Visual Teaching Tool.

(This may include age, gender, health status, similarities among individuals , or any other important

15.0 pts

Excelle nt descript ion of patient populati on includin g several charact eristics listed in detail

13.0 pts

Good descript ion of patient populati on with several charact eristics listed

12.0 pts

Minimal descript ion of patient populati on, 1-2 charact eristics listed briefly

6.0 pts

Populat ion is poorly describ ed, with no addition al charact eristics listed

0.0 pts

Thi s se cti on is bla nk

15.0 pts

characteri stics.)

This criterion is linked to a Learning Outcome

Learning Barriers (20 points)

What are some potential learning barriers for this population of learners? How can you address these learning barriers in your Visual Teaching Tool design?

(Barriers might be cultural, physical,

20.0 pts

Excell ent descri ption of potent ial learni ng barrie rs; thoro ugh plan for addre ssing barrie rs

18.0 pts

Good descri ption of potent ial learni ng barrie rs; appro priate plan for addre ssing barrie rs

16.0 pts

Brief descri ption of potent ial barrier s and plan for addres sing them is presen t but lacks detail

8.0 pts

Mini mal descr iptio n of pote ntial barri ers; plan for addr essin g barri ers lacki ng

0. 0 pt s

T hi s se cti o n is bl an k

20.0 pts

education al, or environme ntal. Refer to the assigned article in the project guidelines for more informatio n.)

This criterion is linked to a Learning Outcome

Setting (20 points)

Describe, in detail, the setting where you will utilize your Visual Teaching Tool. Include details as appropriat e, such as room or table set up,

20.0 pts

Exce llent desc riptio n of setti ng; inclu des thor ough cons idera tion of how the teac hing will take plac e

18.0 pts

Goo d des cript ion of setti ng; incl ude s con side ratio n of how the teac hing will take plac e

16.0 pts

Brief desc ripti on of setti ng with little to no disc ussi on of detai ls relat ed to how the teac hing will take plac e

8.0 pts

Mini mal desc ripti on of setti ng with no addi tion al deta ils in rega rds to how the teac hing will take

0 . 0 p t s

T h i s s e c ti o n i s b l a n k

20.0 pts

technical equipment needed, whether teaching will take place in a group or one-on-on e.

(Examples : primary care clinic, health fair, school, home)

plac e

This criterion is linked to a Learning Outcome

Learning Objectives (20 points)

Write three specific learning objectives your visual teaching tool will address.

20.0 pts

Lear ning obje ctive s are clea r, very well- writt en; writt en per assi gnm ent guid eline

18. 0 pts

Lea rni ng obj ecti ves are writ ten per the ass ign me nt gui deli nes and

16.0 pts

Lea rnin g obje ctiv es are pre sent and mak e sen se of the topi c; but are

8. 0 p ts

L e a r ni n g o bj e ct iv e s a r e p

0 . 0 p t s

T h i s s e c t i o n i s b l a

20.0 pts

(Refer to examples in the assignme nt guidelines to complete this section.)

s; and mak e sens e for the sele cted topi c

ma ke sen se for the sel ect ed topi c

not writ ten per the assi gn men t gui deli nes

r e s e n t, b u t a r e o ff -t o pi c o r u n cl e a r

n k

This criterion is linked to a Learning Outcome

Evaluation Plan (15 points)

Write a paragraph describing how you could evaluate whether your visual teaching tool was successful and met the learning objectives. Consider the population ’s abilities and the setting.

15 .0 pt s

Ex ce lle nt ev al ua tio n pl an ; ve ry de tai le d, re ali sti c fo r th e po pu lat io n’ s ab ilit ie s an d se

13 .0 pt s

G oo d ev al ua tio n pl an ; ad eq ua te de tai l; re ali sti c fo r th e po pu lat io n’ s ab ilit ie s an d se

12. 0 pt s

Fa ir ev al ua tio n pl an ; lac ks de tai l, m ay no t be re ali sti c for th e po pu lat io n’ s ab ilit ies an d se

6. 0 pt s

E va lu ati o n pl an is p o or ly wr itt en , an d/ or is n ot re ali sti c fo r th e p o p ul ati o n an d

0 . 0 p t s

T h i s s e c t i o n i s b l a n k

15.0 pts

tti ng

tti ng

tti ng

se tti n g

This criterion is linked to a Learning Outcome

Clarity of Writing Criteria (15 points)

In-text citations in APA format (author, year).

Full sentences with good flow.

Free from spelling errors.

Excellent grammar.

1 5 . 0 p t s

E x c e ll e n t w ri ti n g o v e r a ll , a ll c ri t e ri a m

1 3 . 0 p t s

G o o d w ri ti n g o v e r a ll , 1 c ri t e ri o n n o t m

1 2 . 0 p t s

F a i r w r i t i n g o v e r a l l , 2 c r i t e r i a n o

6 . 0 p t s

P o o r c l a ri t y o f w ri ti n g , 3 c ri t e ri a n o t m

0 . 0 p t s

V e r y p o o r c l a ri t y o f w ri ti n g , m u lt i p l e e rr

15.0 pts

e t

e t

t m e t

e t

o r s

This criterion is linked to a Learning Outcome

Use of Template

0.0 pts

Corre ct templ ate, no points deduc ted.

0.0 pts

Templ ate not used = -12.5 points (10%)

0.0 pts

This criterion is linked to a Learning Outcome

Late Deduction

0 . 0 p t s

0 p o i n t s d e d u c t e d

0.0 pts

Not Submitted on Time – Points deducted

1 day late = 6.25 deduction; 2 days late = 12.5 deduction; 3 days late = 18.75 deduction; 4 days late = 25 deduction; 5 days late = 31.25

0.0 pts

S u b m i t t e d o n t i m e

deduction; 6 days late = 37.5 deduction; 7 days late = 43.75 deduction; Score of 0 if more than 7 days late

Total Points: 125.0



Author Zeena Engelke, RN, MS

Cinahl Information Systems, Glendale, CA

Reviewers Alysia Gilreath-Osoff, RN, BSN, CEN,

SANE Cinahl Information Systems, Glendale, CA

Sara Richards, MSN, RN Cinahl Information Systems, Glendale, CA

Nursing Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Pravikoff, RN, PhD, FAAN

Cinahl Information Systems, Glendale, CA

April 13, 2018

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

Patient Education: Home Care – Teaching Medication Self-Administration

What Is Teaching Medication Self-Administration in Home Care? › Teaching medication self-administration in home care is the process of teaching patients

to safely and independently take their prescribed medications in the home environment. Medication self-administration involves having the patient follow the five “rights” of medication administration: right patient (i.e., self), right medication, right dose, right time, and right route • What: Teaching medication self-administration in home care typically involves

educating and verifying that the patient understands –the name of the medication, its mechanism of action, and what it is used for –correct dose –correct timing of administration –correct route of administration (e.g., oral or via subcutaneous injection) and the proper

technique for self-administering the drug –potential adverse effects and potential interactions with other medication, food, and

supplements –appropriate storage –the importance of communicating information about medication that is currently being

taken to healthcare clinicians, including both prescription and over-the-counter (OTC) medications

• How: A variety of teaching/learning and motivational activities (e.g., face-to-face instruction, telephone communication, written materials, computer-mediated programs) can be utilized to support patients and family members in learning about medication self-administration –Combined strategies (e.g., face-to-face communication and providing a written

pamphlet) have been shown to be more beneficial than verbal instruction only –For patients with a complex medication regimen, offering information in more than one

session allows the patient to process smaller amounts of information and avoid feeling overloaded with information

• Where: Teaching about medication self-administration in home care occurs in the home environment. In some cases, teaching might begin in an ambulatory care setting (e.g., the treating clinician’s office) or prior to discharge from the hospital or a long-term care facility –Patients should receive consistent educational information in all healthcare settings and

in the home throughout the course of patient care • Who: Patient teaching about medication self-administration in home care is provided by

healthcare professionals (e.g., registered nurses, pharmacists, physicians) and should not be delegated to assistive staff members

What Is the Desired Outcome of Teaching Medication Self- Administration in the Home? › Education about medication self-administration can empower patients and allow them to

• understand the name, dose, route, timing, and purpose of each prescribed medicine

• build confidence and skills necessary for successful medication self-administration (e.g., filling pill organizers, drawing up insulin, using safe injection techniques, properly disposing of syringes, using aerosol delivery systems correctly, using cues to promote proper timing of medications, properly storing medication)

• observe for adverse effects of medication when taken with specific other medications, foods, or supplements and seek medical assistance as needed

• engage in lifestyle changes to decrease risk for complications (e.g., maintaining a consistent intake of vitamin K when taking warfarin, regularly checking EPINEPHrine expiration dates, wearing a medical alert bracelet when taking high-risk medications)

• recognize the importance of communicating information about medications that are currently being taken, including prescription and OTC medications, to healthcare professionals and participate in shared decision making about medication self-administration

• cope with the psychosocial and emotional aspects of having an illness that requires medication and adhering to a prescribed medication regimen

Why Is Teaching Medication Self-Administration Important in Home Care? › Teaching home care patients how to correctly take their own medications helps to promote safe, cost-effective delivery of

medications; self-administrationof medications is an important component of self-care › Errors in medication self-administration can lead to decreased symptom control, increased risk for severe health issues, and a

greater number of emergency department visits, hospitalizations, and nursing home placement, and can significantly increase healthcare costs for preventable complications

› Patient education is required by The Joint Commission (TJC), and medication safety is an integral part of TJC Home Care National Patient Safety Goals. The home care nurse is required to provide patients with written information on medications that are being taken in the home care setting and to educate about their role in providing information about the medications they are taking (e.g., giving a list of current medications to the treating clinician, serially updating the list, carrying medication information in the event of an emergency) (TJC, 2018)

Facts and Figures › Children are at increased risk for having problems with managing medication. In a study of children receiving medications

for asthma,the following were the most common areas of risk (Wilson et al., 2015): • Responsibility in medication administration (i.e., the degree to which the patient takes his/her medication); researchers

reported that about 39% of children take their medication “all of the time,” 7% take their medication “quite a bit of the time,” and 46% are at high risk for not taking responsibility for taking their medication

• Wellbeing of the child’s caregiver, particularly related to coping and stress management • The child’s well-being, including his/her behaviors and emotions • Medication adherence

› A multidisciplinary work group at Johns Hopkins Health System developed and implemented a post discharge home-based, pharmacist-provided medication management service. This service not only enhanced continuity from hospital to home, it ensured that pharmacists identified and resolved medication discrepancies, educated patients about their medications, and provided primary clinicians and community pharmacists with a complete and reconciled medication list. While prevention of readmissions was not a targeted outcome of the project, only 8% of patients who received the service were readmitted within 30 days. On average, the readmission rate for similar patients in the same hospital was 16–17% (Pherson et al., 2014)

› Improper use of dry powder inhalers can result in an insufficient amount of the drug being deposited in the lungs. In a study of patients with chronic obstructive pulmonary disease, educational handouts were given to help patients who were already using inhalers. Researchers found that the handouts alone were effective in improving inhaler technique; vision and health literacy did not impact on the patients’ inabilities to learn proper technique (Alsomali et al., 2017)

› Prescription opioid abuse is epidemic. Opioid diversion to family members and friends is a major source of abused prescription opioids. Nurses play a key role in reversing this opioid abuse by providing essential anticipatory guidance each time a patient receives a medication prescription (Manworren et al., 2015)

› In Spain, researchers studied 45 patients with infective endocarditis (IE) who self-administered parenteral antibiotics in a “hospital-in-home” (HIH) environment. During each self-administration session, a nurse or treating clinician briefly visited the patient. The rate of inpatient readmission was 12.5% and no patients died while in the HIH program (Pajarón et al., 2015)

› In a study of 23,614 patient records, researchers concluded that when patients with a high risk for adverse reactions and a slow immunotherapy buildup phase were excluded, systemic reaction (SR) rates during home immunotherapy were significantly lower than SR rates during office-basedimmunotherapy (Schaffer et al., 2015)

› When prescribing oral cancer agents, clinicians must be aware of factors that affect adherence; these include side effects, forgetfulness, beliefs about medication necessity, established routines for medication self-administration, social support, ability to fit medications in lifestyle, cost, and medication knowledge. Depression and negative expectations can also negatively influence adherence (Irwin et al., 2015)

› In a qualitative study of mental healthcare professionals, researchers found that although health professionals recognize that treatment adherence is a major issue, they frequently do not use evidence-based interventions to address the problem. The researchers concluded that it is necessary for clinicians to challenge their own pre-existing beliefs about treatment adherence to more effectively help patients manage medications (Brown et al., 2015)

What You Need to Know Before Teaching a Patient about Medication Self- Administration in the Home Care Setting › Prior to initiating medication self-administration, the nurse must carefully assess the patient’s ability to safely self-administer

medication. This is often determined using subjective judgment, including subjectively judging the patient’s knowledge of each medication, cognitive ability to follow instructions, ability to read medication labels and package inserts, manual dexterity needed to administer the prescribed medications, ability to administer each medication, and ability to recognize adverse effects and report them to the treating clinician • The Self-Administration of Medication (SAM) tool used to assess a patient’s ability to self-administer medications offers

consistency in evaluation, can be completed in a short time, and is more objective than the perceptions of healthcare clinicians. Other similar tools are available

• Assessing medication self-administration abilities in stroke patients is particularly important. Stroke patients might not be aware of their cognitive deficits and can overestimate their competence related to medication self-administration

› TJC’s focus on medication safety requires that home care nurses accurately and completely reconcile medications in the home environment. This process includes comparing current and newly ordered medicines, communicating about medications with the next clinician who will provide patient care, giving a written list of the patient’s medicines to the patient and family,and educating the patient and family about the list (TJC, 2018). To improve medication safety, TJC suggests that patients should adopt the following: • Properly discarding old or outdated medications (for information about safe disposal of medicines, refer to the

U.S. Food and Drug Administration (FDA) Web site at BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/default.htm)

• Bringing all prescription and OTC medicines and supplements to physician office visits or to a local pharmacy for review • Carrying a list of the names and numbers of healthcare providers and pharmacies used • Carrying a list of all prescription medications and OTC medications and supplements that are currently being taken with

dosages, special instructions, and known allergies › Patients should be taught basic information about drug safety in the home such as the importance of

• keeping drugs in their original, labeled containers • finishing a prescribed medication (e.g., an antibiotic) unless instructed otherwise • not saving drugs for future use and not giving them to another person • keeping drugs out of reach of children • storing medicines at proper temperatures (e.g., refrigerate as needed, store in a clean and dry area, keep away from extreme

temperatures) • reading medication labels carefully and following all instructions • being aware of look-alike, sound-alike drugs

› Home care patients with a complex medication regimen should be taught strategies for organizing their medications and establishing a system of cues for taking them at specific times (e.g., posting a schedule on the refrigerator; creating a medication calendar with pictures of the pills; having someone send text reminders to take medicines; using a self-administration medication documentation sheet to keep track of administration; using pill boxes, egg cartons, or cupcake tins to organize medications; using color-coded sections to designate specific days and times)

› Common concerns about oral medication self-administration include adhering to the routine of taking multiple pills several times a day, coping with having severe or constant adverse effects, and coping with medication-relatedfinancial difficulty

› Older adults often self-administer medications despite being at increased risk for having problems managing their medication. A common mistake is often omission of a prescribed medication

› Medication administration routes that are used in the outpatient setting or in the home care setting each have their own risks and benefits; for example:

• Outpatient parenteral antibiotic therapy (OPAT)was introduced in the U.S. in the 1970s. OPAT is currently practiced worldwide and is a safe and effective option for carefully selected patients

• Home self-administered allergen immunotherapy, which was previously considered controversial, is now thought to be a safe option for carefully preselected patients

› Although oral medication administration is the easiest, most common method, it is contraindicated in patients who have gastrointestinal (GI) abnormalities, including patients with a nasogastric tube (NGT), gastrostomy tube, or poor gag reflux and patients who are unable to swallow or are unresponsive • Home care patients taking oral medicines need to be cautioned about drugs that cause gastrointestinal distress • Patients taking sublingual medicines should be reminded not to swallow them, and patients taking buccal medications

should be taught to allow the medicine to dissolve against the mucous membrane of the cheek and then swallow the saliva › It is common for patients with asthma to use up to three metered-doseinhalers (MDIs) daily, and each meter requires

performing multiple steps for safe and accurate use. Most patients do not use their MDIs correctly and many healthcare professionals lack knowledge about proper technique. Spacer devices can be used with certain MDIs to improve technique and allow the patient to inhale for a longer period. Dry-powder inhalers are recommended as an effective alternative. Although variations exist among types of MDIs, patients should be educated to generally perform the following steps: • Remove the cap and hold inhaler upright • Shake the inhaler • Breathe out slowly and completely • Place the inhaler 1–2 inches away from the mouth or in the mouth • Start to breathe in slowly and press the lever as indicated on the inhaler • Inhale slowly over a period of 3–5 seconds • Hold breath at full inhalation for 10 seconds • Exhale • Repeat if indicated after 1 minute • Rinse mouth with water if using an inhaled steroid

› During the past decade, self-administration and safe handling and disposal of oral chemotherapy agents by patients with cancer have been areas of concern, yet not all clinics, hospitals, and healthcare agencies have implemented standard protocols for teaching patients and family members about these medications • To help patients more effectively manage self-administration of prescribed oral chemotherapy agents, refer to the Oncology

Nursing Society oral adherence toolkit at • Education alone is not enough to promote adherence to oral medication regimens for cancer. Adherence tools, technologies,

and reminder aids can be used to assist patients in adhering to an oral regimen › According to the American Association of Poison Control Centers (,the most common poisons are found

in medications (e.g., pain medicine, including OTC agents, prescribed pain relievers, and illicit drugs; sedatives, hypnotics, and antipsychotics; antidepressants; and cardiovascular drugs). Recent online alerts caution readers to beware of potentially dangerous health effects after using synthetic marijuana and liquid nicotine. Lack of patient concern about the appropriate use of medication (e.g., saving medication for future personal use to avoid having to see a healthcare clinician,giving prescribed medication to others, and taking more medication than prescribed in the hope that it will be curative) can result in adverse reactions, organ failure, and death

› Although certain educational interventions (e.g., providing reading materials, engaging the patient in self-care training) are used most commonly in clinical practice to teach patients about medications and self-administration, counseling and behavioral interventions have been found to be more effective in enhancing medication adherence

› Evidence of the effectiveness of specific medication adherence-enhancinginterventions is limited. Researchers warn that findings should be interpreted with caution • The strongest evidence-based support for improving medication adherence involves policy-level interventions that promote

reduced out-of-pocket expenses, case management, and educational interventions • Among patients with different clinical conditions, medication adherence is highly variable. In a comparative study of the

effectiveness of interventions, the greatest opportunities for medication adherence improvement were seen in patients with asthma, depression, or hypertension

› The most successful strategies for teaching patients about medication self-administration are individualized educational interventions • Patient education and teaching tools (e.g., handouts, books, videos) should be tailored to the patient’s specific needs and


• Visually oriented informational handouts (i.e., those with diagrams and limited wording) should be patient-friendly and easy to read

• All teaching should be patient-centered and evidence-based –Home care patients should be given detailed and accurate medication information; they should be instructed to avoid the

use of advertised medications and products unless they have been reviewed by healthcare professionals • Educational information should be delivered in a culturally sensitive manner and in a language and at a level that is easily

understood by the patient and family • Professional certified medical interpreters, either in person or via phone, should be used when there are language barriers • Simple, nonmedical language should be used for all patients and families, but especially when low literacy levels are

assessed › Preliminary steps that should be performed prior to teaching a patient about medication self-administration in the home care

setting include the following: • Become knowledgeable about the requirements of TJC related to patient education • Review facility/agency protocols specific to patient education, particularly about medication self-administration practices

in the home care setting • Become familiar with facility/agency practices for teaching a patient about medication self-administration • Identify acceptable patient teaching resources that are available onsite and via the Internet

› Verify availability of supplies prior to initiating the educational session (noting that supplies will vary based on patient assessment, below). Supplies can include • a teaching guideline or documentation form outlining key content areas • printed and audiovisual materials about medication self-administration procedures • medication administration equipment (e.g., medications in their original containers, a pill organizer, syringes, alcohol

wipes, MDIs) • information about Internet and community resources that are available to assist patients with self-administration of

medication and with proper storage and disposal of medications • information on how to contact members of the healthcare team with questions or concerns

How to Teach a Patient about Medication Self-Administration in the Home Care Setting › Perform hand hygiene › Don personal protective equipment (PPE), if indicated › Identify the patient per facility protocol › Establish privacy › Introduce self and explain planned education › Assess the patient for

• readiness to learn –Patients can be at different stages of readiness; it is important to individualize your approach based on each individual

learner’s readiness • preferred learning style

–Individuals are auditory, visual, or tactile learners, and learn by hearing (e.g., listening to other patients talk about the challenges of managing the side effects of medications), by seeing (e.g., observing the home care nurse draw up insulin), and by doing (e.g., filling a pill organizer)

–To quickly identify one’s preferred learning style, have the learner think back to the last time he or she learned something, and ask, “How did you go about it?”

• patient-identified learning priorities –When there is incongruence between the patient’s priorities and the healthcare provider’s goals, all will need to explore

why the incongruence exists (e.g., when the patient being treated with an antibiotic decides not to continue to take it because he/she is feeling much better)

• learning barriers –Barriers can include impaired memory or cognitive difficulties; learning disabilities; physical limitations; language; low

literacy; impaired hearing, sight, and/or speech; financial issues; and cultural, psychosocial, and/or emotional concerns

– Patients with a low literacy level can have difficulty calculating dosages and measuring liquids. In the home care setting, the nurse has an ideal opportunity to observe what a patient uses to measure a medication dose and how he/she determines how much to take

– Cultural beliefs and practices should be carefully examined because they can influence ideas about medication use • learning needs and desires

–Many home care patients are preoccupied with the complexity of their care and might need to be encouraged to learn more about medication self-administration

› Plan for timely delivery of relevant information • The plan for medication instruction should be comprehensive, but tailored to meet the patient’s specific learning needs; it

should be divided into information segments that are scheduled at intervals to avoid overwhelming the patient –There should be clear delineation in the healthcare team of who provides what information and at what time throughout

the course of patient care; for example, – an acute care nurse provides the hospitalized patient with written information about drugs, discusses the risks and

benefits of taking the drugs, helps him or her learn how to self-administer the drugs, and emphasizes the importance of timely and consistent use of the drugs

– at discharge to home, a pharmacist who fills prescriptions in the community reinforces the medication instructions, emphasizing the medication name, purpose, dose, route, frequency, and potential adverse effects

– during a follow-up appointment, the home health nurse reconciles the patient’s medications, assesses the patient’s use of the medications, listens to the patient’s concerns about the drugs, and educates about the need to alter patient behavior (e.g., eliminate alcohol consumption to avoid liver damage) and change habits of self-administration as appropriate

• High-quality teaching tools (e.g., clear, concise drug information sheet written at a 5th grade reading level; a DVD about the safe use of digoxin; a Website about the national Drug Take-Back program for safe medication disposal) should be identified in advance to support teaching and learning –The assessment of the patient’s learning characteristics, along with his/her clinical needs, should guide the selection of

appropriate teaching tools • When appropriate, patient education should be scheduled when family members or caregivers are available to support the

patient in learning › Implement the patient education plan

• Discuss and set mutually achievable goals for learning about medication self-administration with the patient –Anticipate a planned approach to teaching and learning, but be prepared to be flexible and individualize information based

on the patient’s changing needs and desires • Emphasize the name, dose, route, timing, purpose, and adverse effects of each medication, and educate about safety

concerns related to medication self-administration –Make the education situation as realistic as possible; if feasible, schedule home visits to coincide with the patient’s

medication self-administration times –Allow sufficient time for the patient to practice skills and talk about any concerns –If the patient is not able to safely administer his/her medication regimen, arrange for family members or other caregivers

to support the patient as needed • Promote collaborative partnerships between the patient and members of the healthcare team to achieve the highest levels of

medication adherence –Use open-ended requests that allow the patient to explain or demonstrate and that enable the healthcare provider to verify

the patient’s understanding (e.g., “Tell me [or show me] how you take your medication”) –Ask specific questions about the patient’s medication regimen (e.g., “What time do you take the medicine?”, “How many

pills do you take?”, “What is the name of this green pill?”) –Observe facial expressions and other cues that indicate that the patient does not understand the prescribed medication

regimen • Use a variety of teaching and learning strategies for best results

–Direct communications (e.g., face-to-face conversation, telephone calls) are fundamental in helping patients learn about medication self-administration

–Written materials (e.g., a booklet, fact sheets) have received mixed reviews – The effectiveness of print materials varies based on comprehensibility, visual appeal, legibility, text style, size, and

layout –Some computer-mediated medication programs have been customized for older adults (e.g., with enlarged text size,

high color contrast between the text and the background, slower animations to allow for processing information, extra

wide scroll bars). These programs allow the nurse to enter patient-specific information (e.g., medication regimen, blood pressure readings) so that the information can be tailored to meet the patient’s specific learning needs; such programs can be effective in reducing medication errors and increasing adherence in older adults

–Internet resources are readily available to most patients, although healthcare professionals disagree as to the value of Internet information – One strategy to enhance Internet use by patients is to provide a list of relevant Websites that are thought to be accurate,

current, and understandable › Evaluate the patient’s response to education

• Continually assess learning throughout the continuum of care • Use a teach-back method to evaluate learner understanding

–Have the patient repeat medication information and/or demonstrate medication self-administration while allowing the educator to listen, observe, and clarify the information or skill demonstration, as needed

–Remember that specific information is better recalled than general information • Use a self-efficacy (i.e., the extent to which a person believes he or she can achieve a desired outcome) rating to evaluate a

learner’s confidence in understanding information or performing a skill (e.g., ask “On a scale of 1–10, how certain are you that you will be able to check your blood glucose level and draw up and give yourself the correct amount of insulin?”) –If the patient’s response is < 7, the plan will need to be readjusted (e.g., reteach until the patient’s response is ≥ 7, involve

family members or other caregivers more extensively in teaching and assisting with medication administration) › Update the patient’s plan of care, as appropriate; document the following in the patient’s medical record, and communicate

any concerns with the multidisciplinary healthcare team so that information can be reinforced, and the learning plan can be continued or modified accordingly: • All patient education provided about medication self-administration,including specific teaching and learning strategies

implemented • Assessment findings regarding readiness to learn, preferred learning style, learning needs and desires, and learning

priorities of the patient • Any identified barriers to learning and methods used to help overcome these barriers • Patient’s response to learning, including demonstrated level of understanding and/or ability to perform necessary skills • Plan for continuation of patient education, including whether specific information should be reinforced or taught again

using a different teaching method

What to Expect After Teaching a Patient about Medication Self-Administration in the Home Care Setting? › Patients who receive education about medication self-administration will

• understand the name, dose, route, timing, and purpose of each prescribed medicine • build confidence and skills necessary for successful medication self-administration • observe for potential medication side effects and adverse reactions, and seek medical assistance as needed • initiate and maintain appropriate lifestyle changes to decrease risk for complications • recognize the importance of communicating information about prescription and OTC medications to healthcare

professionals, and participate in shared decision making about medication self-administration • experience the delivery of consistent and ongoing educational information across the healthcare system • perceive that they have received education about medication self-administration in a culturally sensitive manner and in a

language and at a level that is understandable to them

Red Flags › Many cases of hospital and nursing home admissions, malpractice suits, treatment failures, and medical emergencies are the

result of inaccurate medication use by patients › Unless supported by the patient, use of family members, friends, and nonprofessional staff as interpreters is a violation of the

patient’s right to confidentiality › Scientific studies do not support the use of tall man letters when presenting drug names to patients (ISMP, 2016)

What Do I Need to Tell the Patient/Patient’s Family? › Educate patients and their family members about the need for accurate and timely medication self-administration and the

importance of adopting home routines that promote medication safety

References 1. Alsomali, H. J., Vines, D. L., Stein, B. D., & Becker, E. A. (2017). Evaluating the effectiveness of written dry powder inhaler instructions and health literacy in subjects diagnosed

with COPD. Respiratory Care, 62(2), 172-178. doi:10.4178/respcare.04686 (R)

2. Brown, E., & Gray, R. (2015). Tackling medication non-adherence in severe mental illness: Where are we going wrong? Journal of Psychiatric & Mental Health Nursing, 22(3), 192-198. doi:10.1111/jpm.12186 (R)

3. Institute for Safe Medication Practices (ISMP). (2016). FDA and ISMP lists of look-alike drug names with recommended tall man letters. Retrieved February 23, 2018, from (PP)

4. Irwin, M., & Johnson, L. A. (2015). Factors influencing oral adherence: Qualitative metasummary and triangulation with quantitative evidence. Clinical Journal of Oncology Nursing, 19(3), 6-30. doi:10.1188/15.S1.CJON.6-30 (RV)

5. The Joint Commission. (2018). Home care: 2016 National Patient Safety Goals. Retrieved February 23, 2018, from NPSG_Chapter_OME_Jan2018.pdf (PP)

6. Manworren, R. C., & Gilson, A. M. (2015). Nurses’ role in preventing prescription opioid diversion. American Journal of Nursing, 115(8), 34-40. doi:10.1097/01.NAJ.0000470398.43930.10 (GI)

7. Pajarón, M., Fernández-Miera, M. F., Allende, I., Arnaiz, A. M., Gutiérrez-Cuadra, M., Cobo-Baustegui, M., … Sanroma, P. (2015). Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: A safe and effective model. European Journal of Internal Medicine, 26(2), 131-136. doi:10.1016/j.ejim.2015.01.001 (R)

8. Pherson, E. C., Shermock, K. M., Efird, L. E., Gilmore, V. T., Nesbit, T., LeBlanc, Y., & Swarthout, M. D. (2014). Development and implementation of a postdischarge home-based medication management service. American Journal of Health-System Pharmacy, 71(18), 1576-1583. doi:10.2146/ajhp130764 (QI)

9. Schaffer, F. M., Naples, A. R., Ebeling, M., Hulsey, T. C., & Garner, L. M. (2015). The safety of self-administered allergen immunotherapy during the buildup and maintenance phases. International Forum of Allergy & Rhinology, 5(2), 149-156. doi:10.1002/alr.21443 (R)

10. Wilson, C., Rapp, K. I., Jack, L., Hayes, S., Post, R., & Malveaux, F. (2015). Asthma risk profiles of children participating in an asthma education and management program. American Journal of Health Education, 46(1), 13-23. doi:10.1080/19325037.2014.977412 (R)

Educating Patients: Understanding Barriers, Learning Styles, and Teaching Techniques

Linda Beagley, MS, BSN, RN, CPAN

Health care delivery and education has become a challenge for providers.

Linda Beagley, M

cator, Swedish Cov

Conflict of intere

Address corresp

nant Hospital, 51

e-mail address: lbe

� 2011 by Ame 1089-9472/$36.


Journal of PeriAnesth

Nurses and other professionals are challenged daily to assure that the

patient has the necessary information to make informed decisions.

Patients and their families are given a multitude of information about

their health and commonly must make important decisions from these

facts. Obstacles that prevent easy delivery of health care information

include literacy, culture, language, and physiological barriers. It is up

to the nurse to assess and evaluate the patient’s learning needs and read-

iness to learn because everyone learns differently. This article will

examine how each of these barriers impact care delivery along with

teaching and learning strategies will be examined.

Keywords: patient education, barriers, culture, literacy, perianesthesia nursing.

� 2011 by American Society of PeriAnesthesia Nurses

EDUCATING PATIENTS HAS become a challenge for health care providers because the patient

length of stay has decreased and the need to deliver

complex information has increased. A new version

of the melting pot society requires special efforts

by health care professionals to ensure that the pa-

tient understands the information given to him or

her. Barriers that inhibit patient education are liter- acy, language, culture, and physiological obstacles.

Assessing and evaluating the learning needs of

the patient are essential before planning and im-

plementation of an educational plan. Presenting

a well-formulated plan will increase the likelihood

of a successful recovery for the patient. In this

article, barriers will be dissected and strategies

examined to determine what will best suit the edu- cational needs of the patient.

S, BSN, RN, CPAN, is a PACU Clinical Edu-

enant Hospital, Chicago, IL.

st: None to report.

ondence to Linda Beagley, Swedish Cove-

40 N. California Ave, Chicago, IL 60625;

rican Society of PeriAnesthesia Nurses



esia Nursing, Vol 26, No 5 (October), 2011: pp 331-337

Adult Learning

To effectively educate patients, health care pro-

viders must have an understanding of the princi-

ples of adult learning. Malcolm Knowles, who

began to study adult learners in the 1960s, is

known as the father of adult learning principles be-

cause of his extensive writing on adult education. The term andragogy, the art and science of teach-

ing adults, is synonymous with that of Knowles.

He deduced that adults learn differently than chil-

dren. His studies determined five assumptions on

learning: self-concept, experience, readiness to

learn, orientation to learning, and motivation to

learn. 1 According to Knowles, as a person ma-

tures, his self-concept moves from one of being a dependent personality towards one of being

a self-directed human being. Humans accumulate

a growing reservoir of knowledge, followed by

a readiness to learn, which increasingly is oriented

towards developmental tasks related to social roles

with immediate application of their new knowl-

edge. Knowles’ final assumption reflects the moti-

vation of learning as moving from external to internal.

1,2 Table 1 compares and summarizes

Knowles’ assumption regarding the adult (andra-

gogy) and the child (pedagogy) learner.


Table 1. Assumptions Differences of Pedagogy and Andragogy1,2

Assumptions Pedagogy Andragogy

Self-concept Dependency Self-directed

Experience Happens to learner Rich resource

Readiness Biologic and academic development Evolving social and life roles

Orientation to learning Logical; directed by teacher Life centered; task/problem centered

Motivation External approval of teacher Internal drive; life goals


Literacy Barrier

Literacy is defined as ‘‘an individual’s ability to

read, write and speak in English and compute

and solve problems at levels of proficiency neces-

sary to function on the job and in society, to

achieve one’s goals, and to develop one’s knowl-

edge and potential.’’ 3 Illiteracy does not discrimi-

nate; it can be found in all populations, and

a person’s grade level is not an accurate gauge

for reading ability. 4 Having any level of illiteracy

can cause a number of problems with activities

of daily living, such as analyzing a transportation

schedule, following directions, understanding rec-

ipes, and completing job applications. Low liter-

acy is described as those people who have the ability to read, write, and understand information

only at the seventh grade reading level. According

to the US Department of Health and Human Ser-

vices (DHHS), 3 demographics does play a role in

literacy; certain groups demographically have

a higher prevalence of low literacy. Table 2 out-

lines this population.

Low literacy and low health literacy are related but

not interchangeable. Health literacy is defined in

Healthy People 2010 as ‘‘the degree to which indi-

viduals have the capacity to obtain, process, and

understand basic health information and services

needed to make appropriate health decisions.’’ 5

Low health literacy is content specific. An individ-

Table 2. Demographics of Low Literacy3

Fewer years of education

Lower cognitive ability


Some racial or ethnic groups from the South or




Low income status

ual may be able to read and write in certain con-

texts but struggle to comprehend the unfamiliar

vocabulary and concepts found in health-related

materials or instructions. 5 According to the US

Department of Education, which conducts a na-

tionwide survey of adult Americans to evaluate lit-

eracy skills, 5

an estimated nearly one half of

Americans (90 million) have difficulty understand-

ing and acting on health information. These stud-

ies have linked low health literacy with delayed

diagnosis, poor disease management skills, and

higher health care costs. These same individuals demonstrate a limited understanding of their dis-

ease processes resulting in worse health care out-

comes. 6 Unnecessary health care costs ranging

from $106 to $238 billion are attributed to limited

health literacy. 7

Factors associated with health literacy are depen-

dent on the skills, preferences, and expectations of health information providers. At times, health

care professionals may be oblivious to the effect

of limited health literacy on patients and the health

care system. In one study 7 of 240 health care pro-

viders and students, researchers found fewer than

12% of participants were aware of their degree of

limited health literacy. Twenty-five percent were

found to have a common misconception that health literacy could be determined by race, eth-

nicity, culture, age, or socioeconomic status. 7 To

heighten matters, responders inaccurately be-

lieved that patients with a higher level of education

were not at risk for having limited health literacy

(7.4%). In health care, nurses comprise the largest

group of providers and are responsible for ensur-

ing patient education. The researchers recom- mend health literacy education for nurses during

the education process.

Cutilli 8 completed a systematic review of the liter-

ature for the purpose of analyzing and evaluating

the research on health literacy and the elderly.


Age becomes an important demographic marker

with an inverse relationship to health literacy.

Cutilli found that as the patient’s age increases,

the health literacy level decreases. This is an

important element because of the aging popula- tion in the United States and the projected trend

of aging. By 2030, it is estimated that 20% of the

population will be 65 years and older. 9


Federal Interagency Forum on Aging 9 reports older

Americans are proportionately more likely to have

below basic health literacy than other age groups.

Thirty-nine percent of people aged 75 years or

older have below average health literacy skills compared to 23% of people aged 65 to 74 years

and 13% of people aged 50 to 64 years.

Language and Culture Barrier

The United States has been known as a melting pot

of diversity over the last 100 plus years. Some

changes, however, have occurred from those early years. Ethnicities are found in large urban neigh-

borhoods, as well as the suburbs and rural areas

of the country. The diversity now existing across

the country has presented many challenges for

health care providers. In 2001, DHHS published

national standards on culturally and linguistically

appropriate services. These DHHS standards 10


quired health care institutions to demonstrate cul- tural competency while caring for patients in

a manner responsive to their beliefs, interpersonal

styles, attitudes, language, and behaviors of the in-

dividual and required that care be provided in

a manner that demonstrates respect for individual

dignity, personal preference, and cultural differ-


Health care providers must be knowledgeable of

cultural competencies. Nurses should have aware-

ness of biases and prejudices by examining gener-

alizations they might use routinely about cultures

other than their own. Any biases must be con-

fronted. A commitment to learn more about the

cultures that have been generalized in the past

must be made. 11

Second, core cultural values need to be examined and understood about the

varying populations that frequent the institution.

Cultures have several core values on which all

other values are based. 12

This foundation is a start-

ing point for health care providers in understand-

ing different cultures.

A challenging aspect is the ability to communicate

effectively to the patient whose native language is

not English. Thoroughly assessing the patient’s

comprehension and the need for a translator is vi-

tal. Every attempt must be made to provide a qual- ified translator whether the translator is physically

present or available via a telephone translation

line. Family members as translators may not be

able to translate important terms needed in obtain-

ing informed consent or education. Furthermore,

caregivers must provide written education mate-

rials for the patient to take home. Many concepts

are not easily translated, and it is imperative to have a fluent translator translate the written

word into the targeted language. 11

An estimated 40 different languages are spoken by

the patients who use the services at one Midwest

community hospital. Managing multiple languages

and cultures has proven to be a challenge. The hos-

pital intranet offers resources for many of the cul- tures including common practices, values, and

beliefs. Another unique attribute for this hospital

is the diverse nursing population. In the surgical

arena, every effort is made to pair similar culture/

language of the patient to the health care provider.

This luxury of a diverse nursing population is not

common for many facilities, creating a need to

rely on telephone language lines or hospital- employed interpreters.

Madeleine Leininger’s theory of cultural care diver-

sity and universality defines culture as a guide

whereby the individual’s thinking, as well as his de-

cisions and actions, is patterned and usually passed

on from one generation to another. 12

A person

uses culture as a framework in viewing the world, including health and the need for health care. Be-

cause patients can feel a sense of losing control,

they have a tendency to hold onto family beliefs

when they become ill. Successful teaching plans

are congruent with patient and family values. 4

Nursing care that incorporates cultural values

and practices can be positively related to patient

satisfaction, and patient compliance to treatment will be greater. Conflict will result if nursing care

is in discord with the patient’s belief systems.

Knowing one’s patient is important for delivery of

care. A recent Swahili refugee was admitted to

have a cholecystectomy. She had been treated

with tribal medicine, which resulted in several


healed burn scars on her abdomen. Arousing from

anesthesia, the patient relayed through her inter-

preter that she wanted to see what was removed

during surgery. The nurse tried to explain that

the patient’s gallbladder had been removed and sent to pathology. The patient continued to insist

that she needed to see the gallbladder. For this pa-

tient, it was imperative to visualize the gallbladder

to confirm that she was healed from her illness.

The nurse recognized the needs of the patient,

contacted the surgeon, and between the two of

them, they were able to have the patient see her

gallbladder through pictures taken during surgery.

Another example of the importance of cultural

awareness is demonstrated in the story below.

The diabetic educator consults with patients

who have gestational diabetes frequently in the

clinic. A Muslim patient and her husband were

scheduled for education. In this patient’s culture,

the educator was not permitted to address the patient directly and was to speak only to the

husband. To acknowledge the patient’s cultural

beliefs, the educator instructed the husband,

who then instructed the patient in her presence.

The educator used several different teaching tech-

niques to quantify that the patient could safely ad-

minister insulin to herself.

In the American culture, the patient is the key deci-

sion maker in health care. 13 The patient may consult

with other family members, but ultimately, the pa-

tient makes the final decision. 14 Traditionally, Amer-

ican families have been defined as having a mother,

father, and child/children. Familial hierarchy can be

different for some cultures. How is the ‘‘family’’ de-

fined for this patient? Is it the immediate nuclear family or the family that may include extended fam-

ily members,closefriends,or neighbors?Identifying

who isthe healthcare decision makerfor the patient

is important. 4,13

For some cultures, the decision

maker is the head of the household or the entire

extended family. All key players must be involved

in any decisions because they will either reinforce

or block health care behaviors.

The nurse must be aware of both verbal and non-

verbal communication behaviors. There are vast

differences in culturally defined communication

behaviors. Before discussion of personal informa-

tion, it is important to understand cultural prac-

tices related to nonverbal communication during

conversation, communication practices related to

the opposite gender, and cultural practices of so-

cial conversation. 4 Gender-specific topics could

be taboo for some cultures. For some, direct eye

contact is a sign of disrespect. Be aware of cultures in which disagreement is perceived as impolite-

ness. The patient may be agreeing with what the

health provider is saying purely out of civility

rather than out of agreement. 13,15

Physical and Environmental Barriers

Physiological factors play a role in how the patient is

ableto process health information. As a person ages,

visual clarity and auditory acuity will decrease, mak-

ing it difficult for the person to receive information.

Many times, a patient may refuse to wear corrective

devices. Altered mental capacity because of patho- logic disease processes, such as Alzheimer disease,

or pharmacologic interventions, such as medica-

tions, can create a barrier for effective teaching.

Increasedagingmay causedeclineincognitive capa-

bilities in processing information, memory, and

comprehending abstractions. 16

As the adult ages,

the ability to reason and process information occurs

at a slower rate and reaction or response time in- creases significantly after the age 65. Managing

multiple messages simultaneously is harder to do.

Short-term memory loss and the quantity of new

information may limit the length of the teaching

session and amount of information given. The

capacity to draw conclusions from inference

decreases in the older adult. Vague terms of

‘‘adequate,’’ ‘‘several times a day,’’ and ‘‘often’’ can have multiple meanings. Directions should be spe-

cific to time and order with quantities defined.

Physical conditions can limit mobility and the pa-

tient’s ability to sit and be receptive to learning.

Many times, patients seek out health care be-

cause of pain or not feeling well. Uncontrolled

pain will block the patient’s ability to receive in- formation. Anticipation, anxiety, and fear are all

contributing factors in diminishing reception of

knowledge. In the perianesthesia area, pain and

anxiety are obstacles that must be identified

and controlled for the patient to comprehend


Because of busy schedules, environmental barriers are challenging at times. Poor lighting, noise levels,

and room temperatures can inhibit the learning

Table 3. Learning Styles With Teaching Strategies

Learn Styles Teaching Strategies

Visual Visual material

Handouts—easy to read

Variety of technology—computers,

overhead, video, TV, Internet

Auditory Rephrase key points

Vary speed, volume, and pitch

Write down key points

Positioned to hear the message clearly

Use multimedia—tapes, music

Kinesthetic Frequent breaks to move around

Learner writes own notes

Provide tactile activities

Product samples


process. These barriers are difficult to control be-

cause of capped thermostats and controlled light-

ing. Noise levels are under careful consideration

because of the complaints of patients who have

not been able to rest because of noise while hospi- talized. Hospitals have responded by instituting

quiet times during the day. Physical space for the

health care professional to share information

with the patient that is private, quiet, and with

minimal distractions can be at a premium,

although necessary for effective learning. Lastly,

time to devote to adequate teaching is a large bar-

rier in today’s health care environment. Profes- sionals are asked to do more with less, including

time. Patients’ length of stay has shortened be-

cause of many factors, giving the nurse less time

with the patient to accomplish important teaching


Learning Styles

Besides understanding barriers that impact the re-

ception of education, the nurse must be aware of

how an individual learns. Learning patterns are de-

veloped as a child and the ‘‘learner’’discovers what

works best for his or her individual learning style. Assessment of the patient is essential for effective

teaching, which may require more than one learn-

ing style for comprehension. Learning patterns in-

clude visual, auditory, and kinesthetic. 17

A visual

learner prefers to see what he or she is learning.

Pictures and images help the learner understand

ideas and information better than an explanation.

The auditory learner needs to hear the message or instructions being given. This type of learner

wants to be talked through a process rather than

reading about it first. The kinesthetic learner

does not like lecture or discussion, preferring the

movement of the skill or task. Demonstration

and return demonstration works best with kines-

thetic learners. 17,18

Once the learning style is established, the nurse

adapts the teaching materials to the preferred

style. For the visual learner, the nurse will have ma-

terials for the patient to read or watch. The infor-

mation should be well organized, interesting,

appealing, and easy to read. With today’s advance-

ment of technology, there are many choices to of-

fer the visual learner, including computers, live video feeds, close circuit television, photography,

and the Internet.

For the auditory learner, the nurse should rephrase

important points and questions in several different

ways to communicate the intended message. Vary-

ing the speed, volume, and pitch helps create an

interesting aural texture. An environment where the patient and family can hear the message is im-

portant while encouraging the patient to write key

elements. A quiet space, preferably with the ability

to close the door along with minimal distractions,

assists the teacher to maximum the learning for an

auditory learner. To assist the auditory learner, in-

corporate multimedia of sounds, music, or speech.

Kinesthetic learners prefer frequent breaks so that

they can move around. The nurse should encour-

age the patient to take notes while providing tacti-

cal and hands-on activities. Providing samples

will allow the kinesthetic learner to practice

what he or she is learning, verifying comprehen-

sion through return demonstration. Table 3 sum-

maries learning styles with teaching strategies.

In the perianesthesia arena, more than one type of

teaching strategy may be necessary to successfully

deliver the message and establish comprehension.

For example, the follow-up telephone call was indi-

cating negative outcomes for several patients who

were to remove their urinary catheter at home. The

patient teaching before going home for this patient population had become labor intensive, yet urinary

catheters were still being removed without deflat-

ing the catheter balloon, causing harm to the

patient and unhappy surgeons. Brainstorming,


a group of nurses looked to see how those in the

unit could improve the education process and out-

comes. The result was to continue to demonstrate

to the patient and significant other how to deflate

the balloon and remove the catheter. A return dem- onstration was verified by both the patient and the

family member, each practicing using the syringe

and inserting it into the catheter port (without re-

moving the catheter). The department also devel-

oped a step-by-step handout with pictures for the

patient to take home. All three learning styles

were instituted to ensure a positive change of no

longer having patients remove the urinary device with the balloon intact.

Teaching Methodologies

Teaching methodologies are multiple, and not all will work in the perianesthesia setting. The most

common method is lecture, in which the presenter

gives information to the learner and learning is pas-

sive. Discussion allows for participation and for

the ability of the learner to ask and answer ques-

tions and share feelings. Demonstration is a useful

technique using both psychomotor and social

skills of the learner. In health care, demonstration with return demonstration is commonly used

when a new technique or skill is to be learned by

the patient. An example of demonstration was the

urinary catheter instructions and patient demon-

stration previously mentioned.

Another common method of teaching is the use of

printed instructions. Printed health care informa- tion should avoid technical language: use short

simple sentences and write at a level that most pa-

tients will understand. 4 The recommendation for

written instructions is that they be at the fifth

grade level. Avoidance of glossy paper and small

fonts also assists the learner.

The Internet can be a friend or foe when obtaining health care information. Hospitals are setting up

Web sites for patients to obtain information. In

one pre-surgical testing department, the nurse

gives the scheduled surgical patient a Web site

where he or she can learn more about anesthesia

before coming to the hospital. Health care profes- sionals also need to establish that the patient is ob-

taining reliable information on the Internet and

steer the patient to government and academic sites

that are proven to be more trustworthy. 19


tients can watch health-related stations on their

televisions. 11

On the obstetric unit, patients can

access the television to learn about a variety of is-

sues related to the mother and care of the new baby. The disadvantage of watching a television

station or already-taped segment is the inability

to ask and have questions answered immediately.

The nurse must be diligent in following up with

the patient to answer questions and reinforce the

teachings from the video.


For effective delivery of health information and ed-

ucation, the nurse must be aware of the barriers that can impede the patient’s ability and readiness

to learn. Awareness of the potential barriers of lit-

eracy, culture, language, and physiological factors

will help the nurse determine what tools he or

she may need to assist in the delivery of informa-

tion. Awareness of one’s biases and prejudices

and overcoming them will assist in the education

process. The nurse assesses the patient’s under- standing by looking at both verbal and nonverbal

cues that the patient is displaying. Using more

than one way of delivering the message will pro-

mote the patient’s learning. A family member pres-

ent during key moments will assist and help the

patient to remember the information. The astute

nurse will be more successful in overcoming bar-

riers if she or he is aware of patient’s needs and areas where additional assistance is needed.


1. Knowles M. Andragogy: An emerging technology for adult

learning. The Modern Practice of Adult Education. New York,

NY: Association Press; 1970:37-55.

2. Smith MK. Malcolm Knowles, informal adult education,

self-direction and andragogy, the encyclopedia of informal

education. Available at:

Accessed May 9, 2011.

3. U.S. Department of Health and Human Services. Literacy

and health outcomes. Available at: Accessed

November 11, 2008.


4. Chang M, Kelly AE. Patient education: Addressing cultural

diversity and health literacy. Urol Nurs. 2007;5:411-417.

5. National Network of Libraries of Medicine. Health literacy.

Available at:

#A1. Accessed August 25, 2011.

6. Schwartzber J, Cowett A, VanGeest J, Wolf M. Communica-

tion techniques for patients with low health literacy: A survey of

physicians, nurses, and pharmacists. Am J Health Behav. 2007;


7. Jukkala A, Deupree J, Graham S. Knowledge of limited

health literacy at an academic health center. J Contin Educ

Nurs. 2009;7:298-302.

8. Cutilli C. Health literacy in geriatric patients: An integra-

tive review of the literature. Orthop Nurs. 2007;1:43-48.

9. Federal Interagency Forum on Aging-Related Statistics.

Older Americans 2008: Key indicators of well-being. Available


Documents/OA_2008.pdf. Accessed May 9, 2011.

10. U.S. Department of Health and Human Services. 2001

National Standards for Culturally and Linguistically Appropriate

Services in Health Care. Available at: http://minorityhealth.hhs

.gov/assets/pdf/checked/finalreport.pdf. Accessed April 11, 2010.

11. Comerford-Freda M. Issues in patient education. J Mid-

wifery Womens Health. 2004;49:203-209.

12. McFarland M. Culture care theory of diversity and univer-

sality. In: Marriner-Tomey, Raile-Alligood, eds. Nursing Theo-

rists and Their Work, 6th ed. St. Louis, MO: Mosby; 2006:472.

13. Singleton K, Krause E. Understanding cultural and lin-

guistic barriers to health literacy. Online J Issues Nurs. 2009;


14. Galanti G. Applying cultural competence to peri-

anesthesia nursing. J Perianesth Nurs. 2006;2:97-102.

15. Loxton M. Patient education: The nurse as source of ac-

tionable information. Topics in Advanced Practice Nursing

eJournal. 2003;3(2).

16. Speros C. More than words: Promoting health literacy in

older adults. Online J Issues Nurs. 2009;14(3).

17. Russell S. An overview of adult learning processes. Urol

Nurs. 2006;26:349-352.

18. Clark DR. Visual, auditory and kinesthetic learning styles

(VAK). Available at:�donclark/hrd/styles/ vakt.html. Accessed May 9, 2011.

19. Bergeron B. Online patient-education options. General

Medicine. 2004;6:54.

  • Educating Patients: Understanding Barriers, Learning Styles, and Teaching Techniques
    • Adult Learning
    • Literacy Barrier
    • Language and Culture Barrier
    • Physical and Environmental Barriers
    • Learning Styles
    • Teaching Methodologies
    • Conclusion
    • References

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