Do nurses actually teach patients assigned to them?

maxthecat · Dec 10, 2009

In my experience most nurses do actually do patient teaching pretty consistently.

Now how much the patient retains is another matter. People sick enough to be hospitalized are under enough stress that learning and memory are impaired. So it usually takes repeated teaching to make sure that the patient understands and will retain the information given. Again, in my experience, most nurses do repeat teaching during the course of the patient's stay.

Now...it is still up to the patient as to what they are going to do with that teaching. They may nod and repeat back to you the necessary information. They may also have no intention of actually following your recommendations! When questioned by a student as to why they are doing something they "shouldn't," they may feign ignorance. "Oh, I didn't know that. You're the first nurse who told me that." As a nurse I fairly often am told "Oh, you're the first one who told me that." I take those comments with a large grain of salt, because often I KNOW that other nurses have told them the very same thing! So in your career as a nurse, be careful not to jump to the conclusion that your colleagues are dropping the ball and you are the only one doing it right. That might not be the case.

MedSurgeMess · Dec 10, 2009

In my experience most nurses do actually do patient teaching pretty consistently.
Now how much the patient retains is another matter. People sick enough to be hospitalized are under enough stress that learning and memory are impaired. So it usually takes repeated teaching to make sure that the patient understands and will retain the information given. Again, in my experience, most nurses do repeat teaching during the course of the patient's stay.
Now...it is still up to the patient as to what they are going to do with that teaching. They may nod and repeat back to you the necessary information. They may also have no intention of actually following your recommendations! When questioned by a student as to why they are doing something they "shouldn't," they may feign ignorance. "Oh, I didn't know that. You're the first nurse who told me that." As a nurse I fairly often am told "Oh, you're the first one who told me that." I take those comments with a large grain of salt, because often I KNOW that other nurses have told them the very same thing! So in your career as a nurse, be careful not to jump to the conclusion that your colleagues are dropping the ball and you are the only one doing it right. That might not be the case.

'nuf said!

danamobile · Dec 10, 2009

I agree with the writer above me, and have had the same issue with patients not remembering, BUT with a great BUT BUT BUT too... I find that a lot of nurses are cutting corners these days, and I find too, some nurses do 'bare bones' nursing, or some lack education to know what to educate patients on. How can you educate when you don't know yourself?

I say-- do what you've learned and do best practice. If a patient tells you something, ok, grain of salt indeed, but if you SEE a nurse practicing poorly, you need to let someone know or address the issue. I think lack of education at discharge is a negligence--and costly for repeated admissions. I hate to say this (I'm not a pessimist by default), but a lot of times the patients are there for a reason (a lot self inflicted abuse), but it doesn't mean we can give up on the patients-- its always our job and our business to tell them how it is!!!! Good luck :)

nerdtonurse?, BSN, RN · Dec 10, 2009

I try to teach every chance I get. But very few people care to learn.

I might...MIGHT...have made a point to a new onset CHF patient who had a massive amount of fluid around her heart. She didn't understand that she needed to be on a fluid restriction. I clamped off her foley, and handed her the bag with 800ccs of urine in it, and told her, "this is what the lasix pulled off your heart. The bag your heart sits in is like this foley bag; it can't expand. When it gets full, it compresses your heart and you feel like you can't breathe. Remember this bag, and remember, YOUR HEART IS NOT A FISH, so don't make it try to work in a fish tank.

Now, we all know that there wasn't 800 around her heart, she had pretty impressive edema elsewhere as well, but maybe that mental image will help her understand her fluid restriction.

PostOpPrincess, BSN, RN · Dec 10, 2009

It is an imperative to teach.

StNeotser, ASN, RN · Dec 10, 2009

Oh most definitely. I work rehab and people obviously leave with things they didn't have coming in, foley catheters, colostomy bags. We teach both patients and family members how to change them, or give insulin shots. And of course the reasons why they had the surgery and also things that they need to call their MD about. Otherwise the interdisciplinary team doesn't consider the patient ready to go home if they can't do this. Obviously PT & OT spend most of their time teaching too.

Edited to add, my mother recently had a carotid stent put in on a day procedure. When she got home she didn't feel "right" so went back to the ER. Her B/P was nearing stroke level - she really wishes someone had told her before she left that it was a possibility. However, she's OK and no harm done. So that does tally with some of your experiences.

orangeroom · Dec 10, 2009

A lot of pt teaching happens at d/c. You'll find that all pt's are given written material that is verbally gone over with them at d/c. In my unit, labor and delivery, a lot of opportunities arise for teaching. Some nurses are better at it then others. Some pt's are better at listening than others as well. For retention to occur, things generally need to be verbalized 3 times. If pt's don't want to hear what is being said, they tune it out. That's why it's best to have family or significant others around when teaching is done.

PurpleLVN · Dec 10, 2009

And its imperative that patients and family members ask questions-whether the training was done or not. The nurse may have been busy, thought doctor or another nurse gave training or simply forgot. I know, I KNOW... this is unacceptable! But I am the ONLY nurse at my radiation oncology practice and I encourage my patients and coworkers to let me know when patients aren't understanding something. Patient education is ongoing..... :nurse:

Virgo_RN, BSN, RN · Dec 10, 2009

After he took a shower, I went in to clean up after him and I could not believe my eyes; there was a "regular" shaving blade lying next to the sink. When I informed him that he should switch to an electrical shaver he was so very surprised. I understand that nurses have an extreme busy job,and keeping up with all the work can be so chalenging but come on. I think that man deserve to know essentials like that!

Was he bleeding profusely from his face? Did you order a stat hemogram to make sure he wasn't losing too much blood?

But in all seriousness, maybe he didn't know, because it's not really that imperative for someone on ASA and Plavix to use an electric shaver. Of all the things he needs to know about his new medication regimen, I don't think this is all that important, especially in the limited time nurses have with the patient. It would be more crucial to describe symptoms of GI bleeding and the need to contact his doctor should he experience any of these signs or symptoms.

NurseKatie08, MSN · Dec 10, 2009

I teach all day every day. I work on a subacute rehab unit Mon-Fri 3-11, and am responsible for the same 8 beds every time I work. I am usually the one that admits my patients (most admissions come during my time--a rare few will come on the weekend or earlier than 3pm.) and I start teaching them about their dx the night they come in. I also teach family members a lot. I've taught a great deal, including importance of fluid restrictions, medications, Lovenox self injection, Insulin injections/diabetic teaching, Coumadin therapy, colostomy appliance changes, foley cath care teaching, dressing changes, etc. The most overwhelming amount of teaching I have ever done was for a patient with a C4 spinal cord injury--I taught her & her family about s/s autonomic dysreflexia, foley care, bowel program, hoyer transfers, meds...etc.

As others have mentioned, often information has to be repeated several times before the patient might understand. Also, if a dx or treatment is new to them (like say, a new colostomy, or new dx of diabetes) it might take them a VERY long time before they are ready to learn.

meadow85 · Dec 10, 2009

I do patient teaching when they ask me how their vital signs were and I explain the numbers on the monitor. When I give them their meds I explain what each one is. I describe what kind of procedures they are going for. I explain their blood results if I need to give blood products. I do teaching with them upon discharge like what meds they need to fill out, home care arrangements, follow-up appointments, diet changes etc. I especially do teaching when administering chemo, I give them the info sheet on each chemo drug I am putting into their bodies and let them know what S&S to expect or look out for. I involve the family as well. Its also important to reinforce as needed. I think we all do it in subtle ways throughout their stay not just when they are discharged. I find patients & families really want to be informed and involved. They ask lots of questions and if I cannot answer them all I refer them to someone who can. They don't know how to navigate the health system as well as we do.