Teaching Plan to Prevent Bowel Obstruction

Abstract

This paper aims to teach the student’s assigned patient about a topic that they are deficient in knowledge. This topic has been chosen based on the patient’s medical diagnosis and on its importance in relation to the patient. The patient’s background, education, socioeconomic, health beliefs, physical condition, support system, learning style, and emotional state will be talked about in order to get a better understanding of what is necessary to teach the patient about the chosen topic. Afterwards, the method of implementation will be explored. How the student teaches the patient about the chosen topic and why. This will be accompanied with the appropriate teaching tools that will aid in the education of the patient. Finally, the student will go over the criteria in which the patient has understood the teaching and any revisions that needs to be made to the plan.

Teaching Plan Essay

Topic for Educational Need

The topic that was chosen was how to prevent bowel obstructions. This topic was chosen because the patient has a history of gastric issues such as bowel resection, fistulas and Crohn’s disease. Crohn’s disease can be a direct cause of small bowel obstruction. This condition may predispose the patient to bowel obstructions due to the presence of scar tissue also known as adhesions (Harvard, 2017).  This is an important topic because of the life threatening implications that are associated with a bowel obstruction. In the patient’s case, WJ had a small bowel obstruction. To quickly summarize, a small bowel obstruction prevents the absorption of water and electrolytes which distends the intestinal lumen (Huether, McCance, Brashers, & Rote, 2017).   If left untreated it can eventually lead to ischemia, necrosis, perforation and peritonitis (Huether, McCance, Brashers, & Rote, 2017). As one can tell this is not a condition to be taken lightly. This topic was also chosen because of the patient’s statement of never wanting to have this happen again. There are two major goals of this topic: Management of Crohn’s disease and lifestyle changes that can help prevent obstructions.

Assessment of Patient

The patient, WJ is a 62 year old male who has been an engineer for most of his adult life. He has no want for money. He has a son who at the hospital that was there to support him. He is in relatively good shape stating that he once worked out in his youth and road bikes, but no longer doing so anymore. One thing that was interesting was that his work hours were 10-12 hours a day, sitting for most of them. In terms of health beliefs the patient understood the basics of how to live a healthful lifestyle, like eating vegetables, and exercising regularly. Although, he still did things that were not healthful for him even though he knew it was not good for him. For example he stated he loved steaks and ate them quite frequently. He also ate fried foods quite often; his favorite being chicken or seafood. These things may have been a contributor to his condition. In terms of learning barriers it seemed like WJ had none. WJ lived a typical American lifestyle with no major deviations. He had no real apprehension towards any particular form of learning. He had no cognitive issues or anything of that nature. According to WJ he was very receptive to visual learning. When the student spoke to him, WJ was very receptive to teaching and wanted to make changes to his diet in order to prevent another obstruction. WJ stated that he never wanted to go through this again and that he was willing to make changes to stop himself from having bowel obstructions. He stated that he was going to change his diet to fruits, vegetables, and seafood. All these factors show that WJ is ready to learn about how to prevent his condition and that there should not be any major factors that would indicate any apprehension towards teaching.

Method of Implementation

The first most important thing that has to be done for the patient, is a referral to a gastroenterologist and a dietician to recommend a diet based on the patient’s condition. The student would then educate the patient on that diet and include foods the patient must avoid. These would be foods that could potentially aggravate the patient’s Crohn’s disease.  This method was chosen for teaching because these collaborators are experts in that specific field and can create a proper diet for WJ. This is a regimented diet catered to the patient as opposed to attempting to just tell the patient about various healthful food choices. This plan would be implemented immediately teaching the patient during the duration of his stay at the hospital.   The patient would be given the choice of various foods that are apart of that recommended diet to start the teaching process. WJ has expressed the want to exercise, but it is not conclusively a way to aid his specific condition. According to the Canadian Society of Intestinal Research, “While exercise is not harmful to patients who have IBD in remission or with only mild disease activity, individuals who have active or severe disease can find exercise very challenging if not impossible” (2019). What the patient needs to be educated on is how to incorporate light to moderate exercise throughout the day. This is important as physical activity will not only improve overall health but also aid in digestion and constipation. According to a study taken on physical activity and bowel function on rectal cancer survivors, it was found that higher physical activities such as walking and cycling were reported to help bowel function (Krouse et al., 2017). While this study was taken on rectal cancer survivors the results could be applied to a general public. Ultimately this was chosen because it not only pertains to the patient’s condition, but WJ’s overall health. This would be implemented as the patient ambulates or participates with a physical therapist. The final method of teaching would be to teach the patient the importance of logging what he ate and how much exercise he had in a day. The purpose of this teaching is to have the patient be more cognizant of what he actually ate or did that day. This method was chosen because WJ because is a visual learner. Actually reading and seeing what it is that he ate that day in a tangible form is a great way for WJ to see what is necessary for the improvement of his bowel function and prevent obstructions. Things like calories, nutritional intake, fluid intake, and exercise would be the focus of the patient. From the moment he is in the hospital WJ could begin logging his intake or exercise.

Tools of Teaching

Since WJ is a visual learner, many of the teaching tools made will be catered to this style of learning. One tool that can be used for WJ’s diet plan is a brochure or pamphlet showing all the different types of food he can and cannot eat. The purpose of this tool is to create a simple and concise explanation of what WJ needs to eat. What’s important is that the patient could take this home for further reading. The pamphlet would focus on common foods that the patient can and cannot eat with pictures as he is a visual learner. What he needs to eat and why needs to be simple for WJ because his career as an engineer has long work hours which leaves little time for dietary discretion.  Another tool that could be used is a video with exercise demonstrations like a workout video. This is entirely visual which is in line with WJ’s learning style.  It would be brief to maintain the patient’s attention. Finally, for the logging of WJ’s daily nutritional intake and exercise would be accomplished by showing the patient various smartphone apps that WJ can use. There are many of these apps such as MyFitnessPal or Samsung Health which the patient could learn how to use for his logging. The current era allows for conveniences like smartphone apps that can simply the process of logging daily activities. As WJ is a visual learner, being able to see what he ate, how much he ate, and the nutritional component of what he ate would make him more aware of  his choices.

Evaluation

Learning is evaluated through a variety of different ways. In WJ’s case, as far as diet goes, a simple oral test before discharge can determine if the patient understands what he can and cannot eat. The student could ask what foods should the patient eat, and what should the patient stay away from? Listing out foods is not enough though. The patient should have a basic understanding as to why these foods are good for his condition or not. In the patient’s case which foods are good for Crohn’s disease and which would exacerbate the symptoms. The student will know that the patient has understood the teaching if he can verbally expound on these topics.   Evaluation of the patient’s understanding of exercise would tested through a written test. The patient would have to explain three exercises under these criteria. How long should he perform said exercise? What intensity should said exercise be performed at? How often should these exercises be performed? These are just a few types of questions that would be on the written test. If these are answered correctly then the patient has proven understanding. A return demonstration of how to use the smartphone app would be paramount to the evaluation of the patient’s learning. WJ would have to show how to search for which foods he ate that day, log which exercise he had performed, and include how much water he drank. WJ would also have to show how to navigate the app and find out what he consumed that day including the nutritional components of his meals. It doesn’t have to in-depth, but he does need to know if he ate too much sodium for example.

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Revisions may be necessary if patient fails any of the tests or return demonstrations. If the patient has not understood which foods to eat or avoid, then further explanation would be necessary.  In this case, talking to the patient directly and addressing concerns or requests would be a revision of the plan if understanding has not been reached. More time could be given to the patient to read over information as well.  If the patient refuses to exercise or shows apprehension towards it, then offering alternatives to traditional exercise would be a simple revision. Instead of jogging or swimming the student could promote dancing, or participating in charitable walks. An alternative to logging foods and activities on a smartphone app could be to write it down on a journal. The student could also create a paper log that the patient could use to document food intake. In the even the patient has no idea how to use the smartphone app the student could do a physical demonstration of how to use the app.

References

• GI Society. (2019). Physical activity and GI health. Retrieved from: https://badgut.org/information-centre/a-z-digestive-topics/physical-activity-and-gi-health/
• Grodner, M., Escott-Stump, S., & Dorner S. (2016). Nutritional foundations and clinical applications. St. Louis, MO: Mosby.
• Harvard Health Publishing. (May, 2017).  Bowel obstruction. Retrieved from: health.harvard.edu/a_to_z/bowel-obstruction-a-to-z
• Krouse, R.S., Wendel, C.S., Garcia, D.O., Grant, M., Temple L.K.F., Going, S.B., Hornbrook, M.C., Bulkey, J.E., McMullen, C.K., Herrinton, L.J. (November 2017). Physical activity, bowel function, and quality of life among rectal cancer survivors. Quality of life research, 26(11), 3131-3142. DOI: https://doi.org/10.1007/s11136-017-1641-2