Teaching only takes a minute if patient’s ready
Watch and listen to clues
Got a minute? Sometimes that’s all it takes to educate patients when they are receptive to teaching. Times like these often are referred to as teachable moments and are easy to recognize.
Practitioners can recognize a teachable moment by one of many cues, says Fran London, MS, RN, a health education specialist at Phoenix Children’s Hospital. Cues include:
- Questions: The learner asks a question, such as "What’s that pill for?"
- Concern: The learner expresses a concern. For example, he or she might say, "I’ll never be able to do that!"
- Lack of understanding: The learner makes a statement that is incorrect such as, "I don’t want morphine. I don’t want to become a drug addict."
Educators often can tell by looking at people that they are ready to learn. The learners’ eyes light up and their ears seem to perk up, says Naomi Holtz, RN, BSN, a health education specialist at St. Luke’s Regional Medical Center in Sioux City, IA. "They are eager and able to absorb what you have to offer and may be more motivated than usual to change some of their unhealthy behaviors," she says.
When a nurse is caring for a patient at the bedside, he or she may ask a question, such as "Why are my feet swelling?" When patients ask questions, they are receptive to learning, and the nurse or health care provider can explain that their heart is not pumping like it should, so they have extra fluid in their system. At that point, they can be given some interventions that they can do to help with the problem. "It’s good to give patients little, easily digestible bits of information and then, if possible, reinforce them frequently," she says.
What educators need to know is that when a teachable moment arises, they need to respond immediately, says London. If a learner has a question, answer it, or if a learner has a misperception, correct it, she advises. An educator may have to use a delaying tactic, such as giving the patient a handout to read and promising to return in 30 minutes to discuss it. However, acting on the teachable moment immediately in some way keeps the moment open, says London.
Many factors can create a teachable moment. It may be a symptom a patient is experiencing or an external experience. It can come in a classroom setting, the emergency department, a clinic, at the bedside, or during a formal teaching setting. For example, there may have been a fatal house fire in the neighborhood, so a person is very receptive to teaching about fire safety at that point, says Holtz.
"Once you recognize a teachable moment, you need to figure out how best to respond," says London. One consideration is how to individualize the presentation of the information to meet the needs of the learner. If a patient has poor eyesight or poor literacy skills, it would be inappropriate to respond with a handout, she says.
"You need to know your patients before you teach them," says Theresa Towne, RN, MSN, an inpatient educator at Bayhealth Medical Center in Dover, DE. At Bayhealth, an initial assessment is done when a patient is admitted to the hospital that includes barriers to learning, such as the inability to speak English and ways the patient prefers to learn.
It’s always important to really listen to what the patient is saying. "Have a good ear as to what they really need to know," says Towne.
Often the learner tells you what he or she needs to know either directly or indirectly, she says. Learning needs can be assessed as well by evaluating the understanding the learner has of self-care skills such as medication or diet.
Although patients need to have their concerns and questions addressed, other education often can be tagged onto the teaching when appropriate. For example, St. Luke’s has a teaching plan for patients with hepatitis C that covers such topics as medications, fatigue, and nutrition. However, the patient may be experiencing a lot of fatigue, and that is all he or she wants to discuss. In such cases, the educator can incorporate nutrition into the discussion about fatigue by explaining that if the patient eats the recommended healthy foods, some of their fatigue could be alleviated.
Whenever teaching takes place, whether it is an extended session or a teachable moment, it should be evaluated and documented. "Just because we said it, or gave a handout, there is no guarantee that the learner got it or got it right," says London. Educators should ask the learner to teach the information back to them or demonstrate the skill independently.
It may take several teaching sessions from several different approaches before the learner understands. That’s why all teaching, whether formal or informal, should be documented, says London. The purpose of documentation is to communicate the learner’s status to the health care team so each can build on one another’s progress and to have a record of the learner’s informed consent and readiness for self-care, she explains.
It’s important that educators never ignore a teachable moment. Instead of learning the information they are after, patients might learn the environment at the health care facility is not responsive to patients and the information is not available. Then when educators want to teach, they may find that patients are not ready to learn. Teaching could become a time consuming chore. "Taking advantage of teachable moments may both save time and improve outcomes," says London.
Sources
For more information about teachable moments contact:
- Naomi Holtz, RN, BSN, Health Education Specialist, St. Luke’s Regional Medical Center, 2720 Stone Park Blvd., Sioux City, IA 51104. Telephone: (760) 279-8941. E-mail: [email protected].
- Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1397. E-mail: [email protected].
- Teresa Towne, RN, MSN, Inpatient Educator, Consumer Health Education Department, Bayhealth Medical Center, 640 S. State St., Dover, DE 19901. Telephone: (302) 744-7135. E-mail: [email protected].
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