• Maryniak, K. (2019). Professional nursing practice in the United States: An overview for international nurses, and those along the continuum from new graduates to experienced nurses. Author. • Merriam-Webster. (2022). Teachable moment. https://www.merriam-webster.com/dictionary/ teachable%20moment • Murthy, V. (2021). Confronting health misinformation: The U.S. surgeon general’s advisory on building a healthy information environment. https://www.hhs.gov/sites/default/files/ surgeon-general-misinformation-advisory.pdf • National Healthcare Communication Programme. (n.d.). Building the relationship. https:// www.hse.ie/eng/about/our-health-service/healthcare-communication/module-1-making- connections/nhcp-building-the-relationship-copy.pdf • National Library of Medicine (NLM). (2021). Maximizing your teaching moment. https:// medlineplus.gov/ency/patientinstructions/000460.htm • Petre, B., Margat, A., Servotte, J.-C., Guillaume, M., Gagnayre, R., & Ghuysen, A. (2020). Patient education in the emergency department: Take advantage of the teachable moment. Advances in Health Sciences Education , 25 (2), 511. • Reynolds, L., Attenborough, J., & Halse, J. (2020). Nurses as educators: Creating teachable moments in practice. Nursing Times, 116 (2), 25-28. • Robinson, A., Slight, R., Husband, A., & Slight, S. (2020). The value of teachable moments in surgical patient care and the supportive role of digital technologies. Perioperative Medicine, 9, 2. • Saban, M., Dagan, E., & Drach-Zahavy, A. (2021). The effects of a novel mindfulness- based intervention on nurses’ state mindfulness and patient satisfaction in the emergency department. Journal of Emergency Nursing, 47 (3), 412-425. • Smith, J., & Lane, I. (2015). Making the most of five minutes: The clinical teaching moment. Journal of Veterinary Medical Education, 42 (3), 271-280. • Stoain, C. (2020). Indirect vs. direct communication: Steps in becoming culturally intelligent. Journal of Humanistic and Social Studies, 11 (1), 93-102. • World Health Organization (WHO). (2022). Infodemics and misinformation negatively affect people’s health behaviours, new WHO review finds. https://www.who.int/europe/ news/item/01-09-2022-infodemics-and-misinformation-negatively-affect-people-s-health- behaviours--new-who-review-finds
• Borges do Nascimento, I. J., Pizarro, A. B., Almeida, J. M., Azzopardi-Muscat, N., Gonçalves, M. A., Björklund, M., & Novillo-Ortiz, D. (2022). Infodemics and health misinformation: A systematic review of reviews. Bull World Health Organization, 100 (9), 544-561. • Cambridge Dictionary. (2022). Perception . https://dictionary.cambridge.org/us/dictionary/ english/perception • Centers for Disease Control and Prevention (CDC). (2019). Active listening. https://www.cdc. gov/parents/essentials/communication/activelistening.html • Centers for Disease Control and Prevention (CDC). (2022). National action plan to improve health literacy. https://www.cdc.gov/healthliteracy/planact/national.html • Finta, M. K., & Yeow, R. Y. (2022). To restrain or not to restrain: A teachable moment. JAMA Internal Medicine , 182 (2), 220-221. • Health Care Education Association (HCEA). (2021). Patient education practice guidelines for health care professionals. https://www.hcea-info.org/assets/hcea%20nuidelines_BW%20 1-25-2021.pdf • Horne, L. (2021). Best practices for bedside teaching. American Association for Respiratory Care. https://www.aarc.org/an21-best-practices-for-bedside-teaching/ • Kaban, L. B., & Posnick, J. C. (2022). The teachable moment and mentoring. British Journal of Oral & Maxillofacial Surgery , 60 (1), 11-13. • Keefe, F. J. (2022). Managing acute pain with opioids in the emergency department: A teachable moment? American Journal of Public Health , 112 (S1), S9-S11. • Khullar, D. (2022). Social media and medical misinformation: Confronting new variants of an old problem. JAMA, 328(14), 1393-1394. • King, A. (2018). A literature review investigating the effectiveness of “teachable moments” on positive health behaviour change. https://observatory.derbyshire.gov.uk/wp-content/ uploads/reports/documents/health/Teachable_moments_literature_review(08012018).pdf • Lapum, J., St-Amant, O., Hughes, M., & Garmaise-Yee, J. (2020). Communication for the nursing professional. PressBooks. • Locke, A. (2022). Putting the “teachable moment” in context: A view from critical health psychology. Journal of Health Psychology . https://journals.sagepub.com/doi/ full/10.1177/13591053221101750 • Marshall, L. (2016). Teachable moments. Nursing Management, 23 (2), 13.
CHAPTER 5: PUTTING IT ALL TOGETHER
Learning outcome Through case studies, after completing this chapter, the learner will be able to explain how the concepts included in this course
can be used for effective patient education.
INTRODUCTION
Many concepts have been covered in this course. The following case studies provide thought-provoking questions and discus- Case study: Mrs. Jones Mrs. Jones is a 48-year-old Asian American female who is a new patient at an ambulatory cancer clinic. She has stage two breast cancer, hypothyroidism, and relapsing–remitting multiple sclero- sis. Mrs. Jones is at the clinic for a consult on management op- tions, including surgery, chemotherapy, and radiation therapy. She is a homemaker with two children, ages 12 and 14, and is currently separated from her husband. Her sister has accompa- nied her to this appointment and has been helping her with the registration paperwork. ● What are some initial considerations going into the meeting with Mrs. Jones? What are some strategies that will promote rapport development and successful communication? Discussion : The environment should be calm, with adequate lighting and noise levels. Mrs. Jones wants to be addressed as Cathy. The use of empathy is impactful when seeking to develop a relationship with Mrs. Jones. Open-ended questions are impor - tant and encouraging questions and dialogue will also build rap- port. Plain language should be used, as should visual aids and written information. Effective communication skills such as active listening and clear speech are vital. Sitting at the same level as Mrs. Jones and being courteous and responsive while conversing will show respect. A new diagnosis such as cancer can be frightening and emotional for anyone. Mrs. Jones already has a chronic condition (multiple sclerosis), in addition to the cancer diagnosis and changes in fam- ily dynamics. This may be a potential barrier to readiness to learn, depending on how Mrs. Jones is currently coping. This is an area to investigate further. There is a red flag for health literacy in that Mrs. Jones had help with her paperwork. However, the help with her registration may be due to other factors, such as the familial relationship with her sister, stress and anxiety, or a language barrier. Health literacy assessment is required to determine Mrs. Jones’s health literacy level. There should also be exploration of Mrs. Jones’s culture and lan - guage. Her learning style must be assessed. Discussion of who she would like to be involved in her care is required. Mrs. Jones may even want her children included in some aspects, so planning for that future education can be done.
sions to assist the healthcare professional in thinking through how to apply this information to a variety of scenarios.
During the initial communication with Mrs. Jones, she states that she wants her sister involved in her education and care. In the future she would like her children to have education as well as her estranged husband. Mrs. Jones says she is still processing her new diagnosis and is very afraid of dying. She states she really wants to learn but doesn’t want to get overwhelmed. Assessment shows that Mrs. Jones has a low level of health lit- eracy and is an auditory learner. English is her primary language for learning. She also says that she wants to incorporate comple- mentary and alternative medicine into her care plan. Mrs. Jones uses some technology, such as the Internet for searches and her smartphone for texting and video chats. She does not use any apps, and feels she has minimal computer skills. ● What are some strategies that can be used to help educate Mrs. Jones and her family? Discussion : Mrs. Jones will initially benefit from individual educa - tion, with her sister included. Teach-back will be essential for Mrs. Jones, so information will be presented in small chunks and fo - cused on the important pieces that she needs. Reading informa- tion out loud will benefit Mrs. Jones, who has an auditory learning style. The use of technology would not be a good fit for Mrs. Jones. The cancer clinic also has group education for new breast cancer patients, which may benefit Mrs. Jones in addition to individual teaching. As an auditory learner, group settings can also help with learning via discussions. Group education may also provide addi- tional resources and support for Mrs. Jones. Mrs. Jones’s children and husband could participate in individual sessions or group education. ● What important content should be covered with Mrs. Jones during the initial educational sessions? Discussion : Mrs. Jones needs to know what is wrong. In her case, she needs a brief overview of her breast cancer, what stage two means, and what treatment options are available. This requires information about what Mrs. Jones will need to do, and why she needs to do it. Mrs. Jones feels it is important to include comple - mentary and alternative medicine in her treatment plan. She will need to know next steps for her treatments, and the benefits of management.
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