Teaching Project
Teaching Project Summary Paper
NURS 402
Old Dominion University
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At the beginning of this process we where asked to identify two problems within our clinical practice situation. I currently work nights in a detox facility with addicts and alcoholics. I identified two recurrent health issues within this population. The first and most prevalent was fluid volume deficit/dehydration. The second was insomnia. I find myself doing education with the client population on both topics on a weekly basis and really wanted, needed to define my instructional process. The topic I decided on was fluid volume deficit/dehydration. The reason I decided on this topic was, if not addressed, progresses quickly to a client needing to be seen at the local emergency room (ED) for IV fluid administration. Resulting in increased anxiety for the client and increased overall cost of care for the facility. While considering which topic I wanted to focus on, several detox clients where sent to the ED for fluids, so I knew this was the right educational topic to address.
Having made my decision on the topic the next step was finding the Standards of Practice and Performance which fit the substance abuse (SA) clinical setting. This lead me to the International Nurses Society on Addictions (IntSNA) and the Scope and Standards of Practice (SOP) for addictions nursing (2013). The information contained in the Scope and Standards of Practice of Addictions Nursing assisted in guiding the development of my instructional intervention with health teaching regarding addictions as related to the individual, family, and community to include risk and protective factors, patterns of problem use and abuse, spiritual, biological, psychosocial, cognitive components of addiction and its impact. Also, I gained insight on treatments, the recovery process, relapse prevention, physical health, social skills and strengthening family coping skills through the SOP which I can apply to the clinical environment. The IntSNA offers a certification in the specialty of addictions nursing which I am interested in pursuing in the future. The first SOP for Addictions Nursing is to perform an assessment of the individual’s physical health, functions, psychosocial, emotional, cognitive, cultural, environmental, spiritual, and economic situation. The second SOP of diagnosis identifies actual or potential risks to the health of the individual and third SOP identifies the outcome to include the individual’s involvement with improvements of outcomes.
Needs Assessment
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Next, I needed to look at the client population and how to approach the topic of dehydration involving them for positive outcomes. This client population is unique due to maladaptive behaviors. The detox population exhibits dangerous risk-taking behaviors and are at the developmental stage of adolescences. The target audience of learners are individuals who have voluntarily chosen to be treated for withdrawal from alcohol and drugs addiction. The average age ranges between 18 to 70 years old with the largest majority of them being in their late twenties early thirties. Education levels range between high school drop outs and college graduates. Most clients can read and write at minimum, although some are illiterate. Each client’s health status is at a different stage upon admission and their physical readiness varies. The majority of client’s have limited support systems and are at a heightened anxiety level. Many clients are homeless or have unstable living situations. Most are unemployed looking for employment or are unemployable due to criminal records. Relapse is prevalent within this population showing a low level of aspiration. Typical coping mechanisms characteristic of this population is escapism and avoidance of anything uncomfortable or unpleasant. Upon admission the average client is showing signs and symptoms of fluid volume deficit/dehydration during the initial physical assessment.
I looked at past physical assessments, and electronic healthcare data documentation regarding client who had been seen in the local ED for IV fluids due to severe dehydration. My mentor did suggest I look at my ideal group. Possibly identifying the group of nurses staffing detox instead of doing one to one individual education with each client which would give a broader audience effecting the overall outcome. I believe the educational information could apply to either audience in this situation. I considered how difficult it might be to get all the nursing staff together at one time for this instruction then decided to stick with the individual client as my audience due to logistics. I was looking for a face to face with the target audience and had not considered the use of video as a tool to access the nursing staff until after I had completed my initial video. I currently do much of my instruction one to one during medication administration when I have some private time with the client. In the article, Patient-centered care and patient safety: A model for nurse educators, Judith St. Onge and Robin Parnell point to the development of a close personal experience between clinician and the patient leads to greater patient safety and improved outcomes (section 2, para. 2, 2015).
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Teaching Plan
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As I looked at how to approach my teaching plan I reflected on how receptive the average client is to change and how best to proceed. After reviewing the module on how to create a teaching plan I was able to define my purpose and goal. I looked at the three objectives needed to reach that goal. Chapter 10 and 11 in the textbook helped me to understand the direction to take with each objective. I knew I wanted to keep my instruction informal and brief. I was having some difficulty with understanding how to write the objective with the proper four parts to the method. With suggestions from my mentor I was able to write an objective which included the person, the behavior, the situation and the mastery of the skill. I found detox clients were open and receptive when approached in a very low pressure easy going way. It seemed like teaching without letting them know I was teaching them.
I wanted to create a plan that fit into the detox environment easily and could be adapted by other nurses. I created a double-sided fun and factual hand out describing how the body uses water. One side has the benefits of proper hydration, the signs/symptoms of dehydration and eight clip-art glasses of water for crossing off as drank. The other side includes an equation for figuring out how many glasses of water an individual requires daily per their weight, the colors of urine, and how to fit drinking 8 eight-ounce glasses of water into the day (Appendix B). This hand out was used as part of my cognitive objective. The use of vital signs during the shift assessment, and a return demonstration of the use of the water cooler addressed my skills objective. My mentor helped me to get more focus on the skills objective by having the client give me a return demonstration of the water cooler. I also realized the therapeutic aspects of giving the client time to communicate regarding their thoughts developed a relationship between us.
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Implementation
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The actual day of implementation I had five clients in the detox. Four out of the five clients showed signs and symptoms of dehydration on the first day of their seven day stay. Two had moderate to severe signs and symptoms, a resting pulse of >120, headache, amber colored urine, and fatigue on their initial assessments. Two had mild symptoms with slightly increased pulse rate at 100, body aches and dry mouth. The fifth did not show any signs/symptoms of dehydration at that time. They all were receptive to the informal discussion regarding proper hydration. They found the information included on the hand-out helpful and many were not aware of all the signs and symptoms of dehydration. They were all able to recall three symptoms easily, they were all willing to give me a return demonstration of the use of the water cooler, and they all had some thought and/or prior experiences with some dehydration in the past which they shared.
I believe the learning theory which bests fits the implementation of my teaching plan is the humanistic learning theory because of the face to face, one to one, approach allowing me, the nurse, to meet the client where they are in their own unique place which communicates genuine concern for their well-being. As stated earlier, this population can be emotionally fragile. The humanistic theory is based on a person’s motivation stemming from their own personal needs as related to Maslow’s hierarchy of needs (pp. 86). Also, there is a connection to the operant conditioning theory through reinforcement during the seven days stay in detox (pp. 69). Positive verbal acknowledgement is given influencing the population to voluntarily increase their water consumption. I don’t think any specific cultural considerations directly impact this population other than the prison culture. In the article, the nurse a patient educator, by D. Barrass, she sights R.D. Boyd who stated: “adults learn best when the problems they are studying are important to their own interests” regarding patient-care problem solving and educating adults (Orientation to learning section, para. 2, 1992). One of the many symptoms of the disease of addition is a resistance to mandatory instruction or authority figures. The population responds better to general suggestions allowing everyone a choose to comply voluntarily. This is another reason why I considered the informal, low key approach.
Evaluation
The evaluation process was through assessment of vital signs and the direct reduction of signs/symptoms of fluid volume deficit in each client. Each day a client’s signs and symptoms reduce they receive positive accolades for choosing to consume more water which produced the desired outcome. The five clients I had during the initial implementation of my teaching plan all demonstrated willingness and increased their water consumption daily. They communicated pleasure with improving their own health and their physical awareness which the outcome I was hoping for. One client’s pulse came down to 64, urine became light yellow and clear, their headache resolved, and they regained a normal energy level. Another client’s pulse normalized at 72, constipation resolved, and their energy also rebounded. One client’s pulse remained slightly elevated at around 90, but after future discussion this client stated they have always had an elevated pulse rate. The four clients who initially presented with signs and symptoms of dehydration all resolved with the increase of oral fluids only. Not one of the five clients were sent out to the ED for IV fluids, which is moving in the right direction.
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Summary
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In summary this process has greatly benefited my training abilities. I have gained insight into how individuals learn and process new information through different learning styles. How to present information in a meaningful and beneficial way, and how to evaluate the outcome properly. I have enjoyed the complete process from beginning to end. My only regret is that I didn’t seem to understand to video my direct teaching instruction with my client or at least a stand-in, I did a video of my teaching plan with an explanation of my approach to the client instead (Appendix A). This teaching project has helped me to clarify my approach and has made me a better educator.
References
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Bastable, S. B. (4th Ed.). (2014) Nurse as Educator Principles of Teaching and Learning for Nursing Practice.
Massachusetts: Jones & Bartlett Learning.
Barrass, D. (1992) The nurse as patient educator. British Journal of Nursing. 1(5), 241 – 245.
Retrieved from http://eds.a.ebscohost.com.proxy.lib.odu.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=c8b0d36a-d3c2-
4b32-9dbb-9729e63e1f40%40sessionmgr4010
Boyd, R.D. Apps J.W. et al (1980) Redefining the discipline of adult education. Jossey Bass, San Francisco.
Finnell, D.S. and Allen, K. (2013) Addictions Nursing: Scope and Standards of Practice. The International Nurse Society on
Addictions (IntSNA) and the American Nurses Association (ANA).
St.Onge, J. L. and Parnell, R. B. (2015) Patient-centered care and patient safety: A model for nurse educators. Teaching and
Learning in Nursing. 10, 39-43. Retrieved from http://dx.doi.org/10.1016/j.teln.2014.08.002