NFDN 1002 Assignment 2: Teaching Plan
One of the most crucial aspects of the nursing process is developing a teaching plan. The patient’s active participation in the care process and compliance with instructions are the goals of patient teaching. The paper describes a teaching plan for Mr. Goldblum, a 72-year-old male with an ischemic stroke who has difficulty swallowing, speech and cognition.
Patient education is a continuous process until the participants attain their goals, change their goals, or recognize that the goals will not enable them to meet their learning objectives (Anekwe & Rahkovsky, 2018). A stroke is a life-changing event that needs adjustments; therefore, comprehensive teaching is crucial.
Assessment Data and Learning Needs
The teaching plan will cover impaired communication and impaired swallowing. Due to the chronic pattern of stroke, the patient and family need to be trained on the patient’s various deficits, how to improve them, and the need to be patient because the patient may never fully recover to the pre–stoke state (Pierpoint & Pillay, 2020). For example, they are trained on the need for thickened fluids for dysphagia and to protect the airway.
The rationale for this is the request by the patient to take regular fluids despite having difficulty swallowing. Training to improve communication is a crucial need to enhance the achievement of the understanding of the priority need. Alternative communication techniques help to overcome the problem of speech disturbance (Mitchell et al., 2021). The family members later learn to use the tools to enhance communication.
Priority Learning Need and Diagnosis
Improvement in swallowing is the priority patient need. Difficulty swallowing compromises the airway by causing aspiration, which may lead to death. The nursing diagnosis is insufficient knowledge on the management of post-stroke impaired swallowing related to a lack of understanding of the interventions evidenced by the patient’s insistence to take regular foods.
The goal is that at the end of the ten sessions, the patient demonstrates feeding methods and decisions that are appropriate to his situation with aspiration prevented. The outcome is the collaboration of the patient with the multidisciplinary care team in making appropriate feeding decisions.
Domains of Learning
The best suitable teaching methods will include psychomotor and cognitive learning. Psychomotor learning will include training the patient and the caregiver on the optimal position that prevents aspiration and methods of improving swallowing. The maneuvers are head turned to the weak side for unilateral pharyngeal paralysis, head back for decreased posterior propulsion of tongue, and lying down on either side for reduced pharyngeal contraction.
The patient will be taught how to coordinate the muscles and sensory stimulation techniques to improve swallowing. Cognitive learning will emphasize scheduling of the meals, the preferred food consistency, and other characteristics such as temperature and type.
Barriers to Learning
Communication impairment is a crucial barrier to learning. Difficulty understanding will impede cognitive learning because the patient will not understand the rationale of the feeding decisions we are making for him. Speech difficulty will impair feedback from the patient regarding the teaching and raise any clarifications or concerns. The danger to this is imposing interventions that the patient is uncomfortable with.
The training will be done in the patient’s room, in the presence of the caregiver or family. The sessions will be held daily from 8:30 – 9:30 am for one hour for ten days. Later the patient will be referred to an occupational therapist, and early morning is chosen because the patient will not be fatigued. The session will be one hour because the process requires patience. The teaching resources A pen and paper are needed for the patient to write down what he cannot articulate.
The patient and caregiver will be taught about meal scheduling for cognitive learning. The patient should have a minimum of thirty minutes before meals to reduce fatigue and enhance swallowing. The caregiver should be patient with him and avoid distractions during feeding. Alcohol-free moisturizers will be indicated before and after meals to counteract the effects of dry mouth.
They will teach appropriate food temperature is either cold or warm to stimulate salivation and that water should be chilled. The level of deficit determines food consistency, and for this patient level, three thickened fluids are indicated for enhanced swallowing. The food shall be placed on the unaffected side of the mouth.
Psychomotor training will include patient positioning, helping the patient with head control, and manual stimulation of the lips to close or open by applying lips or chin pressure. Applying ice on the weak parts of the tongue and stroke the cheek with a tongue blade to improve tongue movement and control. The patient will be scheduled for an exercise program that effectively increases appetite levels by releasing endorphins from the brain.
Evaluation of Learning
Evaluation of the psychomotor domain learning will be by demonstrating appropriate patient positioning and having control. Secondly, the effectiveness of the training will be marked by the caregiver demonstrating appropriate stimulating methods for the lips, tongue, and cheeks (Steigleder et al., 2019). The patient understanding will mark the effectiveness of cognitive learning, the rationale for the level III feeds, and agreeing to take them.
Secondly, the patient and caregiver will be active participants in formulating the treatment plan. During this process, they will demonstrate understanding by strategically scheduling feeding times and types of feeds, choosing appropriate food temperatures, and using the moisturizer. A quiz capturing the teaching areas will gauge their level of understanding.
Analysis of the Teaching process
A patient teaching plan increases patient understanding of a condition and benefits nurses by allowing them to plan their time efficiently. Patient education aids in managing chronic diseases by informing and involving patients in care guides and lifestyle modifications. The patient adopts positive coping mechanisms, and the family is empowered on how to take care of the patient and undertake therapy sessions with them.
A teaching plan helps systematically deliver concepts and skills in a way that does not overload the patient. The nurse does the prior organization of sessions and contents to be covered. Training, especially for chronic patients, ensures the patient’s compliance with the management plan even on discharge.
Breaking down information in a manner that the patient understands without distortion or omission challenges using a teaching plan (Steigleder et al., 2019). Secondly, the patient’s state regarding age, culture, cognitive awareness, and attitude affects the patient’s reception of the training.
Teaching planning is an integral part of a nurse’s patient diagnosis. The plan is tailored- based on patient presentation. The teaching plan addresses post-stroke impaired swallowing training incorporating psychomotor and cognitive domain learning. The setting and contents are pre-determined to provide a sense of direction for the nurse. Patient cognitive impairment is the primary barrier to goal achievement. Patient education empowers them and the caregivers to participate actively in the care process.
Anekwe, T. D., & Rahkovsky, I. (2018). Self-management: a comprehensive approach to the management of chronic conditions. American Journal of Public Health, 108(S6), S430-S436. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302041r
Mitchell, C., Gittins, M., Tyson, S., Vail, A., Conroy, P., Paley, L., & Bowen, A. (2021). Prevalence of aphasia and dysarthria among inpatient stroke survivors: describing the population, therapy provision and outcomes on discharge. Aphasiology, 35(7), 950-960. https://doi.org/10.1080/02687038.2020.1759772
Pierpoint, M., & Pillay, M. (2020). Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors. South African Journal of Communication Disorders, 67(1), 1-13. http://dx.doi.org/10.4102/sajcd.v67i1.625
Steigleder, T., Kollmar, R., & Ostgathe, C. (2019). Palliative care for stroke patients and their families: barriers for implementation. Frontiers in Neurology, 10, 164. https://doi.org/10.3389/fneur.2019.00164