Comportamiento No Lineal del diseño NEC-15

The Joint Commission’s patient care standards place an emphasis on patient and family education. The goal of these educational standards is to guide hospitals to create an environment in which both the patient and the healthcare team members are responsible for teaching and learning. The medical record should refl ect an interdisciplinary approach toward patient education that begins on admis- sion and continues throughout the hospital stay. Components of teaching documentation are given in Box 3-4. COGNITIVE Activities Lecture Independent study (books, videos, on-line modules) Question and answer Action Words Listening Indentifying Locating Labeling Summarizing Selecting PSYCHOMOTOR Activities Skill demonstration (live, video) Simulation Return demonstration and repeated practice Action Words Assembling Changing Emptying Filling Adding Removing AFFECTIVE Activities Role playing Group activities Question and answer Action Words Advocating Supporting Refusing Defending Debating

F I G U R E 3 - 1 Teaching methods based on the domains of learning.

Morton_Chap03.indd 21

Although it may be diffi cult for critical care nurses to think in terms of teaching plans and inter- disciplinary learning because critically ill patients require so much care just to maintain physiological function, it is important to remember that much of the teaching the nurse does is informal. Every time nurses explain what they are doing and why they are doing it, they are providing a form of education! This type of informal instruction meets the Joint Commission standard for patient education, and should be documented.

B O X 3 - 4

Documentation

• Participants (Who was taught?) • Content (What was taught?)

• Date and time (When was it taught?)

• Patient status (What was the patient’s condition at the time?)

• Patient’s readiness to learn (Was the patient open to receiving the information?)

• Evaluation of learning (How well did the learner appear to understand the information?)

• Teaching methods (How was the patient taught?) • Follow-up and learning evaluation (If teaching was

incomplete, what was the reason? What additional education needs does the patient have?)

twice a day; carvedilol, 25 mg twice a day; digoxin, 0.25 mg daily; amlodipine, 5 mg daily; furosemide, 40 mg daily; and milrinone, 0.50 μg/kg/min. She is also on a low-sodium diet and fl uid restriction. This morning her vital signs are as follows: temp, 98.2°F (36.8°C); BP, 90/52 mm Hg; HR, 120 beats/min; RR, 28 breaths/min; and pulse oximetry, 92% on 2 L by nasal cannula. Telemetry reveals sinus tachycardia with frequent premature ventricular contractions. Crackles are present in both lung bases. Laboratory results are as follows: K+_{, 2.9 mEq/L; BUN, 45 mg/dL;} creatinine, 2.0 mg/dL; brain natriuretic peptide, 50 pg/mL; troponin, 0.02 ng/mL; WBCs, 9.0 × 103 _mL; hemoglobin, 10.0 g/dL; and hematocrit, 30.3%.

During morning report, the nurse coming onto the unit learns that Ms. V. has been refusing the medications, stating that they are making her “feel bad.” She has also been refusing the prescribed low-sodium diet, preferring instead food brought to her by a relative. Much of the food the relative brings is high in calories and sodium.

1. Formulate a teaching plan for Ms. V. and her family. What should the nurse address, and in what order? What measures can the nurse use to evaluate the effectiveness of the teaching plan? 2. What strategies might help the nurse implement

the teaching plan effectively?

3. What is the best way for the nurse to communi- cate through an interpreter?

R e f e r e n c e s

1. Rankin SH, Stallings KD, London F: Patient Education in Health and Illness, 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005, pp 224–250

2. Irnik M, Jett M: Creating written patient education materi- als. Chest 133(4):1038–1040, 2008

3. Michigan Association for Deaf, Hearing, and Speech Services: Hospitals’ responsibilities to the deaf under the ADA. Retrieved November 1, 2006, from http://www.deaf- talk.com/pdf/ hospitalresponsibilites.pdf

4. Riley JB, Cloonan P, Norton C: Low health literacy: A chal- lenge to critical care. Crit Care Nurs Q 29(2):174–178, 2006 5. Redman BK: The Practice of Patient Education: A Case

Study Approach, 10th ed. St. Louis, MO: Mosby Elsevier, 2007, pp 1–26

6. Redman BK: The Practice of Patient Education: A Case Study Approach, 10th ed. St. Louis, MO: Mosby Elsevier, 2007, pp 56–73

Want to know more? A wide variety of resources to enhance your learn-

ing and understanding of this chapter are available on . Visit

http://thepoint.lww.com/MortonEss1e to access chapter review questions and more!

C A S E S T U D Y

M

has been admitted to the critical care unit from the delivery room for an episode of acute pulmonary edema that developed during the birth of her fi rst child. She has recently immigrated to the United States from Central America, and she speaks very little English. Through an interpreter, it is determined that she has received no prenatal care and is taking no medications. She denies any past medical prob- lems, but she has never seen a physician before. She denies using tobacco, alcohol, or drugs.

Physical examination reveals an enlarged heart, presence of an S₃ and S₄, and a murmur of mitral regurgitation. A chest radiograph demonstrates marked cardiac enlargement. A transthoracic echo- cardiogram reveals severe left ventricular enlarge- ment and dysfunction; ejection fraction is estimated at 35% (normal is 50% to 70%). Based on the results of these tests, Ms. V. is diagnosed with peripartum cardiomyopathy.

Ms. V. is currently on the cardiac step-down unit receiving the following medications: enalapril, 5 mg

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O B J E C T I V E S

Based on the content in this chapter, the reader should be able to:

1 Compare and contrast mechanisms of trauma injury.

2 Describe phases of initial assessment and related care of the trauma patient.

3 Discuss the assessment and management of patients with thoracic,

abdominal, musculoskeletal, and maxillofacial trauma.

C H A P T E R

Ethical and Legal Issues in