Need ideas for teaching...

has the patient become proficient in the skill or knowledge (demonstrated by a change in behavior) that was the basis of your teaching?

• if they have gotten part of it but not all of it, modify the teaching plan to incorporate the changes
  
• if they have gotten all of it, is that the only issue on which they need instruction that is related to the reason you are in there doing skilled care?
  • if no, then start working on what ever other issues seem the most pressing
    
  • if yes, then perhaps the need for skilled services no longer exists

Hi........... wanted to chime in on this...... this is what I used to do....

I would take a copy of the 485 with me.....

I would go down the list of meds..... each visit I would teach everything about one med..... how it worked, side effects... etc....

If say they were on Glucotrol and had a dx of DM..... I would teach about what s/s to report and how to check their blood sugar...... and their med....

Next visit: we would talk about diet.... what to avoid...etc

Next visit: foot care

Next visit: how DM affects different organs

As the cert period went on I would mark through each thing that I taught on the copy of the 485. That way I would know what was taught and what still needed to be taught.

There are some wonderful teaching sheets that you can get off the internet.... the American Diabetes Assoc has tons that you can get too.

Heartcenter online: tons of patient info on different heart problems and meds...

You just have to know where to look...

Does that help??

Excellent ideas carditrans! I find that even pt's with DM and CHF for 10 or 20 yrs can always be taught or reinforced.

Ask pt's to repeat back to you what you taught at previous visit as well.

Skin care- freq. turning/positioning

Home safety,clear pathways,fall precautions.

Diet-Pt. able to verbalize proper foods included in ordere diet.

Edema-Instr. on elevating lower ext. above heart level.

Resp.- Instr. on s/sx upper resp. infection, instr. on use of nebulizer, pacing activities,etc

If you need any more help, give us some dx's and I'll try and come up with some unique teachings ok?

Beez

Sometimes I have seen nurses write "emotional support" as the teaching topic. You can elaborate as much as you feel is necessary, e.g. "emotional support given r/t pt verbalizing concern over lab results discussed at MD visit this AM". One nurse always writes "current events" because she discusses the contents of the news programs on TV or in the paper with the pt. Never saw her change her documentation due to supervisory criticism. If it were me I would try to write something r/t "reality orientation" to make this comment more professional.

:welcome:

Very creative, but..... unfortunately medicare is very strict and does not allow this type of charting. In home health charting is much different than in the hospital. If only I had known!!!!

Beez

It IS difficult, Dutch.. I feel your frustration.

Some patients we have had a long, long time.. and there really is nothing left to teach. We do try to do a lot of meds teaching when we run out of the other stuff... and some of our patients have a LONG list of meds! So that gives us something to work with. And often they will be given a new med, so that's one more item to teach on.

Many of the things mentioned above have already been taught, so I will often just re-emphazise those things. But yes.. you can and DO run out of things to teach.

I sometimes use my books from nursing school to find different things about the different diseases and meds to teach..also your drug book is a great place for finding teaching on meds, sometimes things that you don't even automatically think about. i have also used "reinforcement teaching on__________"; something i've already taught on in the past.

can some one post some web sites that has some good teaching info for patients?? thank you

What is a 485??

Hi........... wanted to chime in on this...... this is what I used to do....

I would take a copy of the 485 with me.....

I would go down the list of meds..... each visit I would teach everything about one med..... how it worked, side effects... etc....

If say they were on Glucotrol and had a dx of DM..... I would teach about what s/s to report and how to check their blood sugar...... and their med....

Next visit: we would talk about diet.... what to avoid...etc

Next visit: foot care

Next visit: how DM affects different organs

As the cert period went on I would mark through each thing that I taught on the copy of the 485. That way I would know what was taught and what still needed to be taught.

There are some wonderful teaching sheets that you can get off the internet.... the American Diabetes Assoc has tons that you can get too.

Heartcenter online: tons of patient info on different heart problems and meds...

You just have to know where to look...

Does that help??

One thing I do with diabetics is go through their pantry/refrigerator and teach or practice label reading and calculating their intake. I find that this really gives them hands-on experience in controlling their diet.

The 485 is the Plan of Care, sent to the MD to sign and goes in the chart as orders, and a copy goes in the field chart so the nurses have them when they visit the pt. It lists all the dx, the meds, and orders, the goals, the frequencies of SN, Aides, PT, and social service visits, along with other information. A new 485 is made up at each recert and sent to the MD to review and sign, then is sent back to the agency.

Our forms have many canned teaching topics. For instance "teaching given new or changed medications". "Skilled observation", "wound care", etc. Sometimes I refer to my old nursing school care plan books. They are full of good stuff.