Chapter 2
Thoughtful practice
37
between physical fitness
and health? Develop a plan to
assist the man to maintain muscle tone and promote
well-being.
ONLINE RESOURCES
A wide range of additional
resources to enhance teaching and learning and
to facilitate understanding of this chapter may be found
online at
, including videos,
animations, journal articles, review questions, quizzes
and the e-book. Subscribers may also access Lippincott’s
extensive online point-of-care procedure guide LNPS,
which provides a wealth of evidence-based, reliable
information.
REFERENCES AND SELECTED READINGS
Books
Alfaro-LeFevre, R. (2011).
Critical thinking, clinical reasoning and clinical judgment:
A practical approach
(5th ed.). Philadelphia: W.B. Saunders.
Andrews, M. M. & Boyle, J. S. (2011).
Transcultural concepts in nursing care
(6th ed.). Philadelphia: Lippincott Williams & Wilkins.
Bastable, S. B. (Ed.). (2008).
Nurse as educator: Principles of teaching and learning
for nursing practice
(3rd ed.). Boston: Jones & Bartlett Learning
Carpenito, L. J. (2012).
Nursing diagnosis: Application to clinical practice
(14th ed.).
Philadelphia: Lippincott Williams & Wilkins.
CLINICAL REASONING EXERCISES
1
A female university student with a 2-year history of
irritable bowel syndrome makes an appointment to speak
with the nurse practitioner at the university health centre
to discuss her increased use of antidiarrhoeal medication.
The student states, ‘I’ve been very busy with my studies and
several activities this semester, and I haven’t been eating
right.’ What health promotion components guide the nurse
in assessing the student’s situation? What is the evidence
base for offering information and health programs to help this
young adult make appropriate health decisions and establish
positive health behaviours? Identify the criteria used to eval-
uate the strength of the evidence for this practice.
2
After falling from a piece of machinery at a construc-
tion site, a 40-year-old man is recuperating at home after
being in the hospital. A community nurse visits three
times a week to perform abdominal wound care. During a
visit, the man complains that he misses his daily exercise
routine and asks when he will be able to resume exercising.
Determine the factors that influence his ability to engage
in exercise. What factors support the overall relationship
PATIENT EDUCATION
A guide to patient education
Assessment
1. Assess the person’s readiness for health education.
a. What are the person’s health beliefs and behaviours?
b. What physical and psychosocial adaptations does the
person need to make?
c. Is the person ready to learn?
d. Is the person able to learn these behaviours?
e. What additional information about the person is needed?
f. Are there any variables (e.g., hearing or visual impairment,
cognitive issues, literacy issues) that will affect the choice
of teaching strategy or approach?
g. What are the person’s expectations?
h. What does the person want to learn?
2. Organise, analyse, synthesise, and summarise the collected
data.
Nursing diagnosis
1. Formulate the nursing diagnoses that relate to the person’s
learning needs.
2. Identify the learning needs, their characteristics and their
aetiology.
3. State nursing diagnoses concisely and precisely.
Planning and goals
1. Assign priority to the nursing diagnoses that relate to the
individual’s learning needs.
2. Specify the immediate, intermediate and long-term learning
goals established by teacher and learner together.
3. Identify teaching strategies appropriate for goal attainment.
4. Establish expected outcomes.
5. Develop the written teaching plan.
a. Include diagnoses, goals, teaching strategies and expected
outcomes.
b. Put the information to be taught in logical sequence.
c. Write down the key points.
d. Select appropriate teaching aids.
e. Keep the plan current and flexible to meet the person’s
changing learning needs.
6. Involve the learner, family or significant others, nursing team
members and other healthcare team members in all aspects
of planning.
Implementation
1. Put the teaching plan into action.
2. Use language the person can understand.
3. Use appropriate teaching aids and provide Internet resources
if appropriate.
4. Use the same equipment that the person will use after
discharge.
5. Encourage the person to participate actively in learning.
6. Record the learner’s responses to the teaching actions.
7. Provide feedback.
Evaluation
1. Collect objective data.
a. Observe the person.
b. Ask questions to determine whether the person
understands.
c. Use rating scales, checklists, anecdotal notes and written
tests when appropriate.
2. Compare the person’s behavioural responses with the
expected outcomes. Determine the extent to which the goals
were achieved.
3. Include the person, family or significant others, nursing
team members and other healthcare team members in the
evaluation.
4. Identify alterations that need to be made in the teaching plan.
5. Make referrals to appropriate sources or agencies for
reinforcement of learning after discharge.
6. Continue all steps of the teaching process: assessment,
diagnosis, planning, implementation and evaluation.
CHART
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