Summative Interaction Process Analysis (IPA)

Well Elder Discharge Teaching Plan

A discharge teaching plan is a teaching process that is intentionally designed to produce specific learning (Berman & Snyder, 2012). A discharge teaching plan starts with the admission. Health care professionals start teaching on admission to increase patient’s level of wellbeing. It is useful to reduce hospital length of stay and possible future readmission. The goal for a teaching plan is to help patients understand the doctor’s recommendations and learn how to follow instructions to prevent further hospitalization and improve the wellbeing. One of the most important components of a teaching plan is teaching the patients about proper medication administration. Explaining to the patients how to administer prescribed drugs, when to take them, how they work, why they are being prescribed and what adverse effects to expect. Another is teaching back, which is a hands -on demonstration and repetition of learnt subjects to make sure the patient understands what to do after discharge.

My goal for this paper is to teach the patient proper self-care after discharge to prevent further hospitalization and to improve the quality of his life. I’m also planning to analyze the effectiveness of methods I used in my teaching plan for future patient discharge teaching plans.

Client Diagnosis and Educational Needs

My client is 74yrs old M.L. He’s primary diagnosis is hypertension and secondary is hyperlipidemia. He was also diagnosed with diabetes mellitus. When meeting with the patient I have first assessed his knowledge about his health conditions. The patient mentioned that his father died of heart failure. He remembers him not to follow doctor’s recommendations and now he’s terrified that he will die young like his father. M.L. understands the importance of checking the blood glucose daily and administering insulin accordingly. He is lacking the basic knowledge about the newly prescribed medications he’s taking and its side effects. My goal is to teach him about it and prepare written instructions. I’m also planning to review his dietician recommendations and elaborate on the importance of maintaining a healthy life style to prevent the worsening of his condition.

Factors Influencing Learning

Physical Factors

M.L. is a 74yr old male who is alert and oriented. One of the obstacles I have identified is that M.L. is hard of hearing; which could cause him to miss important information when providing him with discharge instructions. He wears hearing aids, so I assisted him to put them on, so he can hear better. Another obstacle was, that TV in the room was on, and volume was up, so I politely asked him to turn it off, so there was no distraction. I also made sure that’s he’s in a comfortable position, so I adjusted the bed and sat down on the chair next to the bed, remain the eye contact at all times. The room was dark, M.L. asked to turn better lighting on, so he can see better when reading discharge recommendations. To make sure M.L. can hear me and comprehends my teaching I have implemented teaching back technique, so I could verify his understanding. I have also closed the door, to provide him with the privacy and quiet, learning friendly environment.

Psychological Factors

M.L. expressed his readiness and motivation for learning during the assessment. He was asking detailed questions and was eager to learn how to improve his health condition. He mentioned that he doesn’t want to die young like his father, but to live long and healthy. I maintained an eye contact with him at all times, and listened to him attentively, so I could address his questions and concerns. I also asked him to interrupt at any moment when having questions, so I could explain. M.L. seemed to be very motivated and ready to learn, he also asked me for pen and paper so he can make his own notes.

Sociological Factors

M.L. listened carefully to my teaching instructions. I provided him with important information about his medications and lifestyle changes he can make to improve his wellbeing. He said that he owns a Greek restaurant and loves to eat. He admitted that his diet hasn’t been great and he was not exercising. M.L. also said that his wife loves to cook, and they often have family feasts with plenty of food, which makes it more difficult to change his lifestyle. He mentioned that he would like his wife to be more involved and willing to change their eating habits, so they can live long and healthy life together.

I have suggested his wife to join our conversation, so she’s aware of discharge recommendations and learns how to improve their lifestyle. One of the suggestions was to do some sports they really enjoy together, so they spend a quality time and benefit their health.

Plan Implementation

Projected Teaching Goals

The projected teaching goals for my client were to focus on minimizing symptoms of hypertension and hyperlipidemia and prevent rehospitalization. The main focus was on administering prescribed medications according to the instructions and understanding the side effects associated with taking it. Another goal was to analyze his diet and give recommendations on healthy foods and ways to develop healthy eating habits. Also, we discussed sports he and his wife can enjoy doing together to improve their wellbeing.

Setting and Teaching Aides

M.L. was assigned to the private room, so the setting was suitable to facilitate learning. I have shut the door, so it was quiet inside. I also turned the TV off to make sure the patient can hear me well. I adjusted the bed, so M.L. was comfortable, I have sat by his bed and adjusted its height, so we kept the eye contact. I made sure the light is on, so M.L. can see better.

I have put on his hearing aids, so he can hear me well. I made sure the potential distractions were minimized.

Since the patient was heard of hearing I paid special attention to maintain the eye contact and speak clearly and slowly. I also asked him to verbalize the understanding and repeat my recommendations in his own words. I also have focused on printed out instructions and highlighted the most important information for him. I had M.L. to teach back about his medication administration and its side effects. I took the time for him to make his own notes to help him remember the most important information we went over.

Teaching Evaluation

To evaluate the effectiveness of my teaching I asked M.L.toteach me back on the topics we have covered to assess his understanding. He stated” I will check my blood pressure daily and take my Lisinopril once a day, around the same time every day. I will watch for side effects like dizziness, headache and chest pain. I will slowly get up to prevent falls”

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M.L. also verbalized his understanding on changing his eating habits to prevent worsening of hyperlipidemia, he said” I will reduce salt intake and make sure I eat more vegetables and fruits. I think I may want to consider becoming a vegetarian to avoid eating meats and animal fats, to reduce my cholesterol level. I think that taking daily walks will help me too. Usually, it’s my wife who takes our 2 dogs for morning walks, but I think I should do it now. I will also chat with my wife about sports we could do together. Loosing couple of pounds would help me maintain good health. We used to be very active when we were younger, and always enjoyed riding a bike, maybe it’s time to do it again?”

I think that my teaching was effective, and the goals have been met. In my opinion the techniques I used were adequate for the patient’s abilities to learn.

M.L. demonstrated willingness to learn, he was making notes during the discharge teaching and was able to teach back, he listened carefully and asked questions whenever clarification was needed. At the end he said, “I will try hard to follow the doctor’s recommendations, because I want to live long, and healthy life”. I think that combining techniques: verbal, written, and teaching back demonstrations were effective during this discharge teaching and I will use them for my future discharge teaching plans.

References

• Berman, A., Snyder, S. (2015). Kozier & Erb’s Fundamentals of nursing. Upper Saddle River,

New Jersey: Pearson Education, Inc.

Appendix A: Teaching Plan