Educating the patient is a part of the nurse’s patient care system (Zakrisson & Hägglund, 2010). A study mentioned that to reduce the morbidity, the need for the interaction between the patients and health care professionals, preferably the nurses, in imparting the required knowledge to handle the disease is essential. There is a famous saying “It is important to know what sort of person this disease has rather than what sort of disease this person has”. A well educated and motivated person (by the nurse) who dares to fight the disease survives and/or recovers from the disease soon. This outlines the essentiality for a teaching session (Partridge et al., 2000). A study showed that a single 10-minute session on how to control asthma improved the patient’s health as well as controlled asthma. This piece of evidence shows that there is a need for an asthma education program for patients to improve their health profile and control asthma (Schuermans et al., 2018).
The present education plan focuses on three main attributes to control asthma. They are short term (using the inhaler), Long term (Papworth breathing technique) and precautionary measures (by keeping away from the asthma triggers). The Papworth breathing exercise has been proven to ameliorate respiratory symptoms, thereby inducing relation to the patient (Holloway & West, 2007). The practice of Papworth breathing technique over a long period can help the asthma patient to cope up with the breathing problems in future. Inhalers (corticosteroids) are used for short term relief from short-breath which can be very helpful for the patient who has contracted with the allergen or experiencing natural immune reactions. There is a need for educating the patient both with the usage of inhalers and Papworth breathing technique. Another fundamental topic to educate the patient is about asthma triggers. Asthma triggers are the agents that elevate the asthma symptoms and it is always necessary for the patients to remember these triggers and keep away from them.
The clinical report of the patient suggests the following:
“Ms Bella is a 45-year-old Australian female. Bella has been suffering from asthma for a long period and was admitted 3 days ago in the hospital for her chronic condition. She is a smoker and she does not use the inhaler and used to replace tablets instead of inhalers.”
The rationale for the chosen topic will be discussed. The topic “Identification of patient readiness for the teaching session” will describe more on identifying if the patient is both physically and mentally ready for the program. The rationale for setting up the education program in the ward will be discussed in the section “rationale for setting”. The rationale for using various study materials in different forms and their corresponding effects in educating the patients will be discussed. Several strategies to minimize the barriers in teaching is framed, finally, the methodology to evaluate the teaching session is reported.
A study reported that 50% of patients are reluctant to follow the medication for asthma, for which one of the reason was they were not instructed or taught on these medication aspects (Brown & Bussell, 2011). This directly correlates to the inefficiency in the delivery of required inputs to the patient (by the nurse) or there must be a resource deficit/boring teaching session that does not make the patient listen as well as implement the medications and recommendations. From the study, it is clear that there is a need for a well-crafted teaching session for the asthma patient. Considering the risk associated with the disease and the need for conscious efforts from the patient, there needs to be a teaching session conducted for the asthma patient. The main logic behind the topic is that the patient suffers from asthma requires an enormous amount of knowledge on managing themselves so that in future, they would not get into the extreme situation of acute or chronic asthma.
Imparting the practical knowledge on how to handle the inhaler is very important for the asthma patient to get her relieved from the symptoms before it gets worse. Another important rationale for choosing this topic is that the asthma patient has to be made aware of the allergens and other asthma triggers so that they are aware to not get exposed to them. Some of the potential asthma triggers are tobacco, pets, moulds, pollens and dust. Patients have to be educated on breathing exercises for long-term benefits. Considering the amount of risk involved in the disease, the need for educating the asthma patient becomes mandatory for the health care system. Hence the topic was chosen and a teaching session was designed for the asthma patient to educate on inhaler techniques, breathing techniques and about potential allergens to be aware of.
The readiness of the patient to actively listen and participate in the teaching session has to be determined by the nurse considering several factors. Asthma patient often experiences shortness of breath and they require inhaler and/or other medications. It is very essential to first identify if the patient can breathe normally before fixing the schedule. This requires continuous monitoring and in touch with the staffs who monitor the patient. The second important factor is to decide on the time for teaching. Assessing the patient’s readiness in the morning can help better to absorb the content and remember it efficiently. The third important factor is the motivational required by the patient to learn. A highly motivated individual participates in the teaching session more active, resulting in a better learning experience. One way to identify if the patient is motivated is by continuously monitoring his activities and establishing a trend when and how she is motivated.
The teaching session can start with a one-to-one discussion to facilitate better understanding and verifying the patient’s readiness as well as having a temporary bonding between the nurse and the patient. This bonding helps to nurture faith and hope to the patient and helps to progress the entire session smoothly (Pullen & Mathias, 2010). The nurse has to identify if the patient is ready to listen and interact for the next 15 minutes teaching session.
The patient will be first examined if she is ready to take the teaching session. The next step is to ensure that the setting up is as comfortable as possible for the patient. The location or the venue of the teaching session will be in the inpatient setting, more specifically in her ward. This provides more privacy for the learner as well as the comfort of learning in the old/habitat atmosphere.
The teaching session was designed based on a combination of 4 styles of learning namely, one-to-one teaching, demonstration, patient practice and teach-back technique. All these learning styles were incorporated into the teaching session for particular parts of the sessions.
Problem-oriented situations and case examples help to impart the knowledge to the patient effectively (Bäuerle, Feicke, Scherer, Spörhase, & Bitzer, 2017). These case examples and problem-oriented solutions are made into a video and presented in a tablet mode, shared between the nurse and the patient (Visual and auditory mode). The problem-oriented situations and case examples are part of the predesigned learning sequence (As shown in the appendix). An audio and visual presentation helps the learner to learn quickly as well as retain the same for the long term. After teaching the introductory class with Patients Problem-oriented situations and case examples, the patients will be undergoing a 5-minute practical session where they will be thought on how to handle inhaler as well as teaching the breathing technique (Patient practice and demonstration).
Finally, the nurse will request the patient to teach-back whatever the patient has learnt in the session. This approach helps the patients to recall the entire session at once and as well as help her to repeat once in chronological order. This will help the patient to store the information in the long term memory. Moreover, the teach-back approach helps to reinforce or confirming patient education on the topic. This provides an opportunity for the nurse to remind the patient if she has missed any important points.
Having an asthma action plan beside helps the nurse to “supplement” teaching session with more information which will be useful for the patient to understand better (Borgmeyer, Jamerson, Gyr, Westhus, & Glynn, 2005). Moreover, a personalized action plan helps to treat the disease more accurately as the action plan will be customized to match the intensity of the disease and hence the medication would be modified to suit their condition. The teaching session for the patient will be slightly modified based on the action plan to provide a more customized education for the patient.
The rationale for the teaching methodology based on the one-to-one teaching, demonstration, patient practice and teach-back technique and the incorporation of customized action plan helps the patient to educate on the disease and prevent the same in future.
Several strategies are used to minimize teaching risk. The first strategy is to identify a suitable time where the patient can be alone or create a situation to have a one to one discussion without any external members (Including the patient relatives). This helps the patient to learn without any external influence as well as help the nurse to educate the patient more effectively. Also, sometimes, the patients feel comfortable when they are accompanied by their peers and can be allowed based on the case to case basis or find a strategy to avoid the same.
Another important barrier in teaching is the relationship between the patient and the nurse. It is always important to have a relation with the patient by frequently monitoring the patient long before the actual teaching session. This provides a sense of closeness which ultimately reduces the “discomfort” barrier in the learning process. This is called as the Pedagogical discomfort (Zembylas, 2015), a phenomenon where the learner feels discomfort with the learning process.
The third important barrier is the level of physical or mental well being. Since the teaching session is designed in a way to equally involve both physical and mental state, the disease should not be a barrier during the teaching process. One strategy is to identify a suitable time when the patient is active both physically mentally, more preferably during the morning, and conduct the teaching session. As the teaching session has a breathing exercise, it is better to have the session in the morning.
The outcome of the teaching session will be evaluated to understand the success of teaching (as well as learning). The nurse can use a combination of various questions and experimental test to identify if the patient has learned properly (conversely, the nurse has delivered the teaching efficiently and effectively). The theory of bloom taxonomy is helpful to evaluate the understanding of the learner across the three main categories namely, remembering, applying and analyzing. The main outcome of the study is to handle the inhaler properly, recite the main asthma triggers/potential allergens and finally perform the Papworth breathing technique. If the learner can satisfactorily show these outcomes, then it can be concluded that both the learning and teaching process was successful.
Educating an asthma patient is a complex and challenging task. The education session can help the patient to reduce the frequency of hospital visits and maintain a healthy lifestyle. The teaching session helps Ms Bella to protect from the symptoms both for the short term and long term.
Bäuerle, K., Feicke, J., Scherer, W., Spörhase, U., & Bitzer, E. M. (2017). Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year. Patient Education and Counseling, 100(5), 957–965. https://doi.org/10.1016/j.pec.2016.11.023
Borgmeyer, A., Jamerson, P., Gyr, P., Westhus, N., & Glynn, E. (2005). The school nurse role in asthma management: can the action plan help? The Journal of School Nursing : The Official Publication of the National Association of School Nurses, 21(1), 23–30. https://doi.org/10.1177/10598405050210010601
Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575
Holloway, E. A., & West, R. J. (2007). Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: A randomised controlled trial. Thorax, 62(12), 1039–1042. https://doi.org/10.1136/thx.2006.076430
Partridge, M. R., Hill, S. R., Barnes, G. R., Bauman, A., Beasley, R., Clark, N. M., … Worstell, M. (2000). Enhancing care for people with asthma: The role of communication, education, training and self-management. European Respiratory Journal, 16(2), 333–348. https://doi.org/10.1183/09031936.00.16233400
Pullen, R. L., & Mathias, T. (2010). Editorial: Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy, 8(3), 4. https://doi.org/10.1097/01.NME.0000371036.87494.11
Schuermans, D., Hanon, S., Wauters, I., Verbanck, S., Vandevoorde, J., & Vanderhelst, E. (2018). Impact of a single 10 min education session on asthma control as measured by ACT. Respiratory Medicine, 143, 14–17. https://doi.org/10.1016/j.rmed.2018.08.003
Zakrisson, A. B., & Hägglund, D. (2010). The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care. Scandinavian Journal of Caring Sciences, 24(1), 147–155. https://doi.org/10.1111/j.1471-6712.2009.00698.x
Zembylas, M. (2015). ‘Pedagogy of discomfort’ and its ethical implications: the tensions of ethical violence in social justice education. Ethics and Education, 10(2), 163–174. https://doi.org/10.1080/17449642.2015.1039274
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