1.6 Health Teaching

This section will discuss nursing considerations when providing health teaching. Health teaching provides information to clients in simple terms so the client can make informed decisions to make healthy choices, prevent illness and injury, and reduce risky health behaviors. Health teaching includes a wide range of topics such as nutrition, disease prevention and management, and making healthy choices.

General Principles of Health Teaching

There are several general principles to use when providing health teaching to ensure health literacy for all clients^[1]:

• Relevancy: Adults learn best when they perceive the information to be relevant to their current life circumstances.
• Currency: Learners are more likely to be interested in learning the information if it can be used immediately.
• Timing: The best timing for providing health teaching depends on the client’s readiness for learning and their preferences. The client should be involved in deciding the best time.
• Motivation: Clients must be motivated to learn the content presented. Learning is most likely to occur when a client is self-motivated to learn and the instruction is self-initiated. Learners should have an active role in deciding what they want to learn and setting goals for achievement. Using the Transtheoretical Model of change, identify the client’s current stage and use motivational interviewing to help them progress through stages.
• Learning theory principles: People have multiple intelligences and preferred learning styles. Learning involves the three domains of thinking, feeling, and skills. It is important that teaching methods address all three domains for increased effectiveness.
• Move from simple to complex: Based on Bloom’s Taxonomy, begin with “recall of facts” and then move on to increasingly more complex concepts such as “using the information in new situations.” For example, a nurse may design a teaching plan for a client with diabetes by first discussing signs and symptoms of diabetes and then move on to more complex topics such as how to count carbohydrates during meals.
• Repetition is important: During hospitalizations, begin teaching during admission to the hospital and then build on this information during each client interaction until discharge.
• Consider the learning environment: Is the lighting good? Is the room temperature appropriate? Are teaching resources available?
• Current needs of the client: Does the client have any problems reading or writing? Is a medical interpreter needed? Are handouts in a different language or large print required? What is the “need to know” information before they go home?

The role of the nurse in providing health teaching includes answering questions, providing information that is evidence-based, and linking content to the health needs and preferences of the client. Keys to success include engaging with the client, establishing a good rapport, and completing a learner assessment. If the client has performed Internet searches for health-related information, clarify accurate information. Documentation of teaching sessions is always required and should include what was taught, method of teaching, any handouts or other materials provided, and an evaluation of the client’s understanding of the teaching.

Benefits of health teaching and health promotion include improved quality of care, shorter length of hospital stays, decreased chance of hospital readmission and greater compliance with the health care treatment plan.

Teaching as Therapeutic Communication

Effective teaching depends on the effectiveness of the nurse’s communication skills. Make sure to include the following techniques while teaching^[2]:

• Use basic, nonmedical terminology
• Provide an interpreter for English-language learners
• Cover information at a pace the client prefers
• Limit the amount of information provided at each session
• Repeat information across several sessions
• Show or draw images
• Use teach-back techniques (i.e., the client repeats/summarizes the information they learned or performs a return demonstration of a skill they are learning to verify understanding)
• Create a psychologically safe environment where the client can ask questions

Life Span Considerations

Teaching must be designed based on the client’s age and developmental level. Different age groups and developmental levels have unique physical, cognitive, emotional, and social needs, so adapting teaching methods to these stages enhances the learning experience and improves client outcomes. Age-specific considerations are outlined below.

Table 1.6 Lifespan Considerations

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• Use simple, soothing tones and facial expressions to communicate.
• Utilize visual aids like pictures, toys, and colorful objects to capture their attention.
• Encourage sensory exploration and hands-on learning.
• Teach parents and caregivers how to provide care based on developmental level at home.

Family members and caregivers should be included in health teaching as appropriate. Offer resources and community support for family members caring for clients with chronic illnesses or disabilities. Address family dynamics, communication strategies, and caregiving challenges.

Cultural Considerations

Health literacy can be affected by cultural factors such as language barriers, cultural beliefs and values, health beliefs, and family involvement in health care decisions. These and additional cultural considerations are discussed in this section. Health literacy refers to an individual’s ability to understand and use health information to make informed decisions about their health care. In the hospital setting, promoting health literacy is essential to ensure that clients can comprehend medical instructions, participate in their treatment plans, and navigate the complex health care system.

Effective teaching requires empathy, cultural humility, and a commitment to continuous learning. It is important to assess all clients’ abilities to read and write, as well as their preferred language. Keep in mind that clients may be embarrassed about a lack of reading and writing skills. After assessing their skill level, the teaching methods should be adjusted as indicated. Medical interpreter services should be acquired as needed. Additionally, clear language and instructions should be provided without the use of medical jargon, and complex concepts should be broken down into simple steps.

Cultural considerations when providing health teaching include language and communication, beliefs and values, health beliefs and practices, family and community involvement, modesty and privacy, time orientation, and access to care:

• Language and Communication
  • Ensure interpretation services are available for English-language learners.
  • Utilize professional medical interpreters to facilitate accurate communication.
  • Recognize that gestures, facial expressions, and other body language may vary in meaning across cultures.

• Beliefs and Values
  • Incorporate clients’ religious practices that may affect medical decisions and care.
  • Respect clients’ spiritual needs and practices during their care.
  • Be aware of cultural practices and rituals that may impact client care and recovery.

• Health Beliefs and Practices
  • Acknowledge clients’ use of traditional or alternative remedies and incorporate them into the teaching plan as appropriate.
  • Recognize culturally specific beliefs about illness causation and healing practices.
  • Consider dietary restrictions and preferences based on cultural or religious beliefs.

• Family and Community Involvement
  • Understand family involvement in decision-making and caregiving.
  • Respect cultural norms around who is involved in medical decisions.
  • Acknowledge the role of community networks in clients’ health care experiences.

• Modesty and Privacy
  • Respect clients’ preferences for modesty during physical examinations and procedures.
  • Recognize that individuals may be uncomfortable discussing sensitive topics openly. Ask permission before beginning to discuss sensitive topics. A helpful statement is to bring normalcy to the topic followed by asking if this is pertinent to the client. For example, “Erectile dysfunction is a common side effect of some medications. Is this something that has been an issue for you? Would you like to talk more about it?”
  • Be aware of cultural norms related to care provided by health care providers of specific genders.
  • Respect clients’ preferences for caregivers based on their cultural beliefs.

• Time Orientation
  • Adjust communication and scheduling to accommodate different cultural perceptions of time because some cultures have a more flexible view of time than others.

• Access to Care
  • Recognize that cultural beliefs may influence when and how clients seek medical treatment. Clients with present-oriented cultures may have difficulty in being motivated by future results of present actions.
  • Other barriers to care may include location, transportation, availability of medical treatment, financial resources, and understanding of the importance of the medical treatment plan. Collaborate with the client to overcome barriers to access health care services.

By acknowledging and incorporating these cultural aspects into health teaching, nurses can build trust, foster effective communication, and deliver client-centered care that respects individual cultural values and needs.

Teaching Methods Based on Domains of Learning

As previously discussed in this chapter, the three domains of learning are cognitive, affective, and psychomotor. By using a combination of teaching methods aligned with these domains, nurses address the diverse learning styles of their clients. Examples of teaching methods aligned with each domain of learning are provided in the following subsections.^[3]

Cognitive Domain (Knowledge and Intellectual Skills)

The cognitive domain focuses on the acquisition of knowledge, comprehension, critical thinking, and problem-solving skills. Examples of teaching strategies based on the cognitive domain include the following:

• Discussion-Based Learning: Encourage active participation and critical thinking through class discussions, debates, and group problem-solving activities. This can be one-on-one or in groups.
• Question and Answer Sessions: Engage clients by asking probing questions that lead them to think deeply and critically about the subject matter.
• Simulations: Use computer-based or role-playing simulations to immerse clients in realistic scenarios that require decision-making and problem-solving.

Affective Domain (Attitudes, Values, and Beliefs)

The affective domain focuses on developing attitudes, values, beliefs, and emotional responses. Examples of teaching strategies based on the affective domain include the following:

• Reflection and Journaling: Encourage clients to reflect on their experiences, thoughts, and emotions to foster self-awareness and personal growth.
• Role-Playing: Engage clients in role-playing activities that allow their expression of feelings, values, and beliefs.
• Storytelling: Share personal stories or narratives that evoke emotions and provoke discussions about values and attitudes.
• Small Group Discussions: Create a safe space for clients to share their thoughts, experiences, and opinions, promoting peer interaction and perspective sharing.

Psychomotor Domain (Physical Skills and Coordination)

The psychomotor domain involves the development of physical skills, coordination, and motor abilities. Examples of teaching strategies based on the psychomotor domain include the following:

• Demonstrations: Show clients how to perform a specific task or skill, breaking down the steps for clear understanding.
• Hands-On Practice: Provide opportunities for clients to practice physical skills under supervision, gradually improving their proficiency.
• Role Modeling: Demonstrate the desired skills or behavior, serving as a role model for clients to emulate.
• Simulations: Use simulated environments to allow clients to practice skills in a controlled setting and solve simulated problems as they arise.

Teaching Resources

Nurses can employ a variety of teaching resources to enhance communication and learning. These resources help convey information more effectively to clients based on their multiple intelligences and preferred learning styles, which promotes enhanced engagement. Examples of teaching resources are as follows:

• Printed materials: Printed materials include brochures/pamphlets with written information regarding health conditions, treatments, and procedures.

• Visual aids: Visual aids include charts and diagrams, such as visual aids to help explain anatomy, medical processes, and treatment plans. Other examples of visual aids are three-dimensional models of body parts, videos that demonstrate a procedure, or phone apps that offer tracking tools and reminders.

• Demonstrations: Demonstrations include simulating a medication administration or self-care activity. An example would be demonstrating to a client how to do wound care and then having the client return the demonstration on how to take care of a wound.

• Multimedia presentations: Multimedia presentations include PowerPoint presentations during group teaching sessions that support information about a variety of treatment options and health concerns.

• Role-playing: Role-playing includes acting out scenarios related to a variety of topics such as disease management or communication with health care professionals.

• Games and quizzes: Quizzes include games and quizzes to reinforce learning and understanding. Many Internet education modules have interactive quizzing to help learn and reinforce information.

• Group Discussions and Support Groups: Small groups assist clients in connecting with others, sharing experiences, and offering peer support.

• Technology: Technology includes educational apps or digital platforms that clients can use on their smartphone, iPad, or laptop.

Reinforcement and repetition are important. Begin teaching sessions on admission and continue teaching during each care encounter. For example, teach about medication each time a dose is administered. When doing a physical assessment, explain signs and symptoms to watch for and report to the provider. This repetition with consistent, accurate information is important for retention.