Objectives
• Adapt and apply teaching-learning theory to the critical care setting.
• Perform a learning needs assessment.
• Construct a teaching plan for patients in the critical care unit.
• Discuss four methods of instruction and the appropriateness of each to the critical care setting.
• Describe informational needs of families of critically ill patients.
Be sure to check out the bonus material, including free self-assessment exercises, on the Evolve web site at http://evolve.elsevier.com/Urden/priorities/.
Adult Learning Principles
Central to successful implementation of an education plan in the critical care and telemetry environment is the incorporation of the principles of adult learning theory.1 Adults must be ready to learn, having moved from one developmental or educational task to the next. They need to know why it is important to learn something before they can actually learn it. Inherent in their attitudes is a responsibility for their own decisions. Consequently, they may resent when others try to force different beliefs on them. Adults bring a wealth of experience to the learning environment that must be recognized and promoted in educational techniques. Because their orientation to learning is life centered, the tasks being taught should focus on current problem resolution. Finally, motivation for the adult learner arises out of internal pressures such as self-esteem and quality of life.
Teaching-Learning Process
The teaching-learning process is a dynamic, continuous activity (Box 3-1). Teaching is not just the passing of facts and information from one person to another. Learning is both growth and development. It is an active process that occurs internally over time and cannot be forced. Learning involves altering behavior to produce changes in one or more of the three learning domains: knowledge, attitudes, and skills.2
Assessment
Assessment is the gathering of information for the purpose of identifying actual or potential learning needs. It identifies gaps in the knowledge, attitudes, and skills the patient or family has regarding the illness, environment, or lifestyle (Box 3-2). Knowing this information will allow the nurse to develop a collaborative, individualized, need-targeted education plan of care. The assessment process does not stop after the completion of the admission assessment; it is continuous and ongoing.
Patients and families may be so overwhelmed by what they see or have already been told that they may be unable to identify their own learning needs. The bedside nurse is responsible for involving both the patient and the family in the assessment process and discovering what they want and need to know. Involving patients and families in this needs assessment process gives value to their needs and assists them in gaining some control over a situation in which they may feel powerless. Active participation and control stimulate the motivation to receive information, as well as make the overall education process more satisfying; in essence, the patient/family will learn more.
Assessing ability, willingness, and readiness to learn is an essential part of developing and implementing an education plan of care. Readiness to learn is the motivation to try out new concepts and behaviors.3 The ability to learn is the capacity of the learner to understand, pay attention, and comprehend the material being taught. Willingness to learn describes the learner’s openness to new ideas and concepts. Several factors affect ability, willingness, and readiness to learn as well as the ability to cope and adapt to the current situation. These factors include physiological, psychological, sociocultural, financial, and environmental aspects.2–4
Development of Education Plan
The education plan must be ongoing, interactive, and consistent with the patient’s plan of care and education level (Box 3-3). Information gathered from the assessment must be analyzed and used to prioritize educational needs, formulate a nursing diagnosis, and develop an education plan of care. The nurse also must consider the patient’s clinical and emotional status when setting education priorities. The education plan should include (1) expected outcomes, (2) objectives, (3) content to be taught, (4) interventions, (5) available educational materials, and (6) appropriate teaching strategies. Refer to the Nursing Management Plan for Deficient Knowledge (Appendix A, p. A-15).
Establish Education Phases and Priorities
It can be a difficult task to prioritize the multitude of learning needs that practitioners are required to address during a period in acute care. Learning needs in the intensive care unit (ICU), the progressive care, or the telemetry setting can be separated into six different categories to help set teaching priorities in each phase of the hospitalization (Table 3-1). Learning needs during the initial contact or first hours of hospitalization can be predicted. Education during this time frame should be directed toward the reduction of immediate stress, anxiety, and fear rather than future lifestyle alterations or rehabilitation needs. The plan should focus on survival skills, orientation to the environment and equipment, communication of prognosis, procedure explanations, and the immediate plan of care.
TABLE 3-1
EDUCATION PHASES AND PRIORITIES
