TEACHING AND LEARNING

STRATEGIES

TEACHING AND LEARNING

STRATEGIES
Basic Guidelines
Develop a well-defined objective
Assess clients readiness to learn
Start with what the client is concerned about

TEACHING AND LEARNING

STRATEGIES
Basic Guidelines
Assess and start with what the client already
knows; proceed from the known to the unknown
Start with the simple proceeding to the complex
Schedule a review of the content

CONCEPT!
Areas of Learning Domain
Knowledge cognitive
Skills motor
Attitude emotional

TEACHING STRATEGIES
1. Explanation and Description
Address cognitive aspect of learning
2. One-to-one Discussion
Addresses affective and cognitive learning
3. Answering Questions
Cognitive
4. Demonstration
Motor
5. Discovery
Cognitive and Affective
***Learning is more effective if the learner discovers the
content for himself. (That is, through experience!)

TEACHING STRATEGIES
6. Group Discussion
Affective and Cognitive
Sharing feelings during group dynamics
7. Practice
Motor
8.Printed and Audiovisual Material
9. Role-playing
For pediatric and psychiatric nursing settings
10. Modeling
What you say is what you do
11. Computer Assisted Learning Programs
Online review

NURSING PROCESS

COMMUNICATION

COMMUNICATION
Exchange of ideas, information, feelings, data
between two communicators
Communication is the basic component of Human
Relationships

ELEMENTS OF COMMUNICATION
1. Message
Data
2. Sender
Encoder
3. Receiver
Decoder
4. Feedback
5. Context
Setting
Overall environment where the
communication takes place

MODES OF COMMUNICATION
1. Verbal
Oral
Spoken
Written communication
Text communication
Cable communication
Telex communication
Facsimile communication

MODES OF COMMUNICATION
2. Non-verbal communication
Facial expression
Grimacing
Posture
Gait
Adornment
Make-up
Gestures

FACTORS AFFECTING COMMUNICATION

Ability of the communicator
Perceptions
Proxemics
Distances between communicators
Intimate Distance
Actual physical contact to 1.5 feet
Personal Distance
1.5 feet to 4 feet
3 feet to 4 feet for interview
Social Distance
4 feet to 12 feet
Public Distance
12 feet and beyond

FACTORS AFFECTING COMMUNICATION

Territoriality
One person believes that the space and all the
things in that space belongs to him
Do not enter abruptly; this may result in breach
of privacy
Roles and relationships

THERAPEUTIC COMMUNICATION
IN NURSING
Using Silence
Supplement with non-verbal communication
Provide General Leads
Examples:
go on
tell me more
Open-ended questions

THERAPEUTIC COMMUNICATION
IN NURSING
Use Touch
But assess the culture of the patient
If the patient is a child, touch the patient on the
top of the head
If the patient is an elderly, touch the patient on
the hand
If the patient is of the same age level, touch the
patient on the shoulder
Offering yourself
For autistic child
Stay nearby or stay beside the patient

THERAPEUTIC COMMUNICATION
IN NURSING
Presenting Reality
Example:
You are in the hospital
Reflecting
Example:
What do you think will make you happy
Never agree nor disagree
Reflect it back or throw it back

NON-THERAPEUTIC COMMUNICATION
Stumbling blocks to effective
communication
Stereotyping
Generalizing
Agreeing and Disagreeing
No confrontation
No argument
Being defensive
Moralizing or Passing Judgment
Giving Common Advise
Examples:
If I were you
You should have done it

DIRECTIVE TYPE OF INTERVIEW

Structured
Uses closed-ended questions calling for specific
data
When used:
When you need to elicit specific data
When there is little time available

CONCEPT!
Characteristics of Closed-ended questions:
Yes or No questions
Asks when or asks for the time when event
happened
Asks how many
Point with finger when asking to provide clarity
Therefore, they call for highly specific answers

NON-DIRECTIVE TYPE OR
RAPPORT-BUILDING INTERVIEW
Uses more open-ended questions
Advantage is that it
volunteer information

allows

the

patient

to

TYPES OF INTERVIEW QUESTIONS

Open-Ended Questions
Closed-Ended Questions
Neutral Questions

TYPES OF INTERVIEW QUESTIONS

1. Open-Ended Questions
Questions not answerable by yes or no
Questions that elicit information or explanation

TYPES OF INTERVIEW QUESTIONS

2. Closed-Ended Questions
Questions answerable by yes or no
Leading Questions
Phrasing of question suggests what answer the
interviewer is expecting

TYPES OF INTERVIEW QUESTIONS

3. Neutral Questions
Phrasing allows patient to answer with least
pressure
Usually NOT addressed to patient personally (i.e.
what is your opinion about)
Raised as a general topic

PLANNING THE INTERVIEW SETTING

Concepts:
Before
the
interview,
determine
information you already know or
information is available

what
what

An interview is a planned conversation with a

purpose
An interview is a two-way process

PLANNING THE INTERVIEW SETTING

Concepts:
When is it done?
When patient is available
When patient is comfortable
Recommended distance from the patient is three
(3) to four (4) feet.

STAGES OF THE INTERVIEW

1. Opening Stage
Key Concept!!!
This is the most important part of the
interview
Rationale
What was said and done during the opening
stage sets the tone all throughout the
interview

THE INTERVIEW
2. Body of the Interview
Occurs when patient responds to questioning

THE INTERVIEW
3. Closing Stage
How to close the interview:
Summarizing Technique

THE NURSING PROCESS

Definition:

The Nursing Process is a systematic, organized,

rational
method
of
planning
and
providing
individualized, humanistic nursing care

PURPOSES OF THE NURSING PROCESS

To identify health status
Actual health problems
Potential health problems
To establish plans
To deliver specific nursing care

CHARACTERISTICS OF
THE NURSING PROCESS

Goal-oriented and client-centered

Cyclical (no absolute beginning and

dynamic (moving) rather than static

Plan of care organized according to client

problems rather than nursing goals

end),

CHARACTERISTICS OF
THE NURSING PROCESS

Basis of prioritizing nursing activities would be

the problems and not the goals

Follows a logical sequence

Universally applicable (to any type of patient)

Interpersonal and collaborative

Work with patients and relatives
Work with colleagues and other members of
the health team

CHARACTERISTICS OF
THE NURSING PROCESS

Adaptation of problem-solving techniques and

principles

Problem-oriented,
information

Allows creativity of nurse and patient

flexible,

open

to

new

BENEFITS DERIVED FROM

THE NURSING PROCESS
Concepts:
Both the nurse and the patient benefit from the
nursing process
Patient obtains greater benefit
Remember:
Nursing process is
PATIENT-CENTERED
CENTERED

CLIENT-CENTERED or
and
NOT
NURSE-

BENEFITS DERIVED FROM

THE NURSING PROCESS
Improves quality of care
Ensures continuity and appropriate level of care
Facilitates client participation through planning
with patient
Enables nurse to maximize resources

BENEFITS DERIVED FROM

THE NURSING PROCESS
Feedback allows nurse to evaluate care
Serves as a framework for accountability through
documentation
Promotes a positive working atmosphere through
collaboration
Helps the nurse define roles to those outside the
profession

BENEFITS DERIVED FROM

THE NURSING PROCESS
For job satisfaction
Facilitates professional growth
Avoidance of legal action
Meeting standards of accredited hospitals

PARTS OR COMPONENTS OF
THE NURSING PROCESS
Assessment Phase
Diagnosing Phase
Planning Phase
Intervention Phase
Evaluation Phase

ASSESSMENT PHASE
OF THE
NURSING PROCESS

ASSESSMENT PHASE OF
THE NURSING PROCESS
Nursing Activities in the Assessment Phase
Data Collection
Data Organization
Data Validation
Data Recording

IMPORTANT CONCEPT!
No conclusion is developed in the assessment
phase

ASSESSMENT PHASE OF
THE NURSING PROCESS
Purposes of the Assessment Phase
To create a data base of the clients response to
health and illness
To determine the nursing care needs of the
patient

FOUR TYPES OF ASSESSMENT

Initial Assessment
Focus Assessment or On-going Assessment
Emergency Assessment
Time-Lapsed Assessment

FOUR TYPES OF ASSESSMENT

1. Initial Assessment
When performed:
At specified time after admission
Where done:
Done at the ward
Where Admitted:
At the ward
Purpose of Initial Assessment:
To create a data base for problem
identification
For reference and future comparison

FOUR TYPES OF ASSESSMENT

2.
Focus
Assessment

Assessment

or

On-going

When performed:
Integrated throughout the nursing process
Purpose of On-going Assessment:
To identify problems overlooked earlier
To determine the status of a health problem
(i.e. hydration status every fifteen minutes)

FOUR TYPES OF ASSESSMENT

3. Emergency Assessment
When done:
During acute physiologic and psychologic
crisis
Where done:
Emergency Room
Comfort Room
Anywhere!!!
On site!!!
Purpose of Emergency Assessment
To identify life-threatening condition

FOUR TYPES OF ASSESSMENT

3. Emergency Assessment
Framework or Principle in Emergency Assessment
A Airway
B Breathing
C Circulation
Utilize either Maslows Hierarchy of Needs or ABC
principle

FOUR TYPES OF ASSESSMENT

4. Time-Lapsed Assessment
When done:
Several months after initial assessment
Purpose of Time-Lapsed Assessment
To compare current status of patient with
base line data (initial assessment)

ASSESSMENT PROCESS
Concept:
Data is equivalent to information

ASSESSMENT PROCESS
What is the initial output of the Assessment
Phase?
Data or Recorded Data
Never validated data!!!

TYPES OF DATA
1. Subjective or Covert Data
Felt by the patient
During the recording of data, this should be
stated using the patients own words
These are the symptoms felt by the patient

TYPES OF DATA
2. Objective or Overt Data
Capable of being observed by use of senses
sight, touch, smell, taste, hearing
These are the signs which are observable

SOURCES OF DATA
1. Primary Source
Patient himself except when:
He is unconscious
Patient is a baby
Patient is insane

SOURCES OF DATA
2. Secondary Source

Patients record
Health care members
Related literature or journals
Significant others (they become primary source
when patient is unconscious)
Family or relatives
The person who brought the patient to the
hospital

SOURCES OF DATA
3. Environment of the Patient
Example:
Patient with diabetes mellitus exhibits
acetone breath
Assess for diabetic ketoacidosis

METHODS OF DATA COLLECTION

Observing
Interviewing
Examining

METHODS OF DATA COLLECTION:

OBSERVING
It should be deliberate
Exert effort!!!

METHODS OF DATA COLLECTION:

OBSERVING
Two (2) aspects of observation process:
Noticing the stimuli
Do an interpretation of the stimuli

METHODS OF DATA COLLECTION:

INTERVIEWING

Two types of Interview

Directive Type of Interview
Non-directive Type of Interview or
Rapport-building Interview

VALIDATION OF DATA
Act of double-checking the data
Purposes of Data Validation
To

ensure the:
Correctness
Completeness
Accuracy of the data

GUIDELINES IN VALIDATION OF DATA

Compare subjective and objective data
Be familiar with word usage (particularly if the patient is a
child)
Reassess /
abnormal

double-check

data

which

are

extremely

Be sure that your data contains CUES and not INFERENCES

Be sure that your data is FREE OF BIASES
Avoid jumping to conclusions

DATA RECORDING
Concepts:
Data Recording COMPLETES the Assessment
Phase
Initial Output of the Assessment Phase is DATA
Final Output of
RECORDED DATA

the

Assessment

Phase

is

DIAGNOSING PHASE
OF THE
NURSING PROCESS

DIAGNOSING PHASE OF
THE NURSING PROCESS
Activities during the Diagnosing Phase:
This involves sorting, clustering, analyzing and
interpreting data

DIAGNOSING PHASE OF
THE NURSING PROCESS
Concept:
The final output in the Diagnosing Phase is a
NURSING DIAGNOSIS!!!

DIFFERENT TYPES OF
NURSING DIAGNOSES
1. Actual Nursing Diagnosis

Problem present at the time the statement

was made
Describes a clinical judgment that the nurse has
validated because of the presence of major
defining characteristics.
Example: Ineffective Airway Clearance related to
excessive and tenacious secretions

DIFFERENT TYPES OF
NURSING DIAGNOSES
2. High-Risk Nursing Diagnosis

A diagnosis that a patient is more vulnerable

or susceptible compared with others in the
same situation
Example: Risk for Impaired Skin Integrity related
to immobility secondary to fractured hip.

DIFFERENT TYPES OF
NURSING DIAGNOSES
3. Possible Nursing Diagnosis

There is an evidence of a health problem but

the causes are NOT fully understood
An option to indicate that some data are present
to confirm a diagnosis but are insufficient as of
this time
Example: Possible Self Care Deficit related to
impaired ability to use left hand secondary to
presence of intravenous therapy.

DIFFERENT TYPES OF
NURSING DIAGNOSES
4. Wellness Nursing Diagnosis
A positive statement
Indicates a healthy response
Examples:
Potential for increased compliance related to
increased level of knowledge
Potential for enhanced body image related
to regular exercise
Potential for effective coping related to
adequate support systems

DOMAINS OF NURSING DIAGNOSES

Key Concept!
It only includes health problems that a nurse is
capable and licensed to treat

PARTS OF A NURSING DIAGNOSIS

1. Problem Statement
Example:
Fluid Volume Deficit
2. Presumed Etiology
Example:
related to frequent loss of bowel
movement
3. Defining Characteristics
Example:
as manifested by decreased skin turgor

ADVANTAGES OF USING A STANDARDIZED

DIAGNOSTIC TERMINOLOGY
Provides
professional
accountability
and
autonomy by defining and describing the
independent areas of practice
Provides effective vehicle of communication
Provides an organizing principle for meaningful
research
Facilitates continuity and individualized care

PLANNING PHASE
OF THE
NURSING PROCESS

PLANNING PHASE OF
THE NURSING PROCESS
Concept:
Planning means:
Determining ahead of time
Forecasting a course of action

PLANNING PHASE OF
THE NURSING PROCESS
Key Concept!!!
For your plans to be effective, involve the patient
and the family

PLANNING PHASE OF
THE NURSING PROCESS
IMPORTANT CONCEPT!!!
Final output of the Planning Phase is a NURSING
CARE PLAN or a WRITTEN CARE PLAN

TYPES OF PLANNING
1. Initial Planning
Done by the nurse
When done:
At specified time upon or after admission of
the patient

TYPES OF PLANNING
2. On-going Planning
Who are involved:
Done by all nurses who worked with the
patient
The patient himself
The family
But primarily, the NURSE

TYPES OF PLANNING
2. On-going Planning
Purposes of On-going Planning
To determine if the clients health status has
changed
To decide which problems to focus on during
the shift
To set priorities for client care during the
shift
To coordinate the patient care and activities
so that more than one problem can be
addressed at the same time

TYPES OF PLANNING
3. Discharge Planning
Purpose of Discharge Planning
To ensure continuity of care

CHARACTERISTICS OF
THE PLANNING PROCESS
S Specific
M Measurable
A Attainable
R Realistic
T Time bound

ACTIVITIES DURING
THE PLANNING PROCESS
Set priorities
Set goals
Identify alternatives of nursing care
Select nursing measures
Write nursing orders (supervisors do this)
Write the nursing care plan

PURPOSES OF GOAL-SETTING
To set direction
To provide a time span
To have a criteria for evaluation
To enable the nurse and the patient to determine
whether the problem has been resolved or not
To help motivate the client and the patient by
providing a sense of accomplishment

KEY CONCEPT IN GOAL SETTING!

For your goal to be useful during evaluation, it
should be stated in BEHAVIORAL TERMS

IMPLEMENTATION PHASE
OF THE
NURSING PROCESS

IMPLEMENTING PHASE OF
THE NURSING PROCESS
Implementation
Putting the care plan into action

IMPLEMENTING PHASE OF
THE NURSING PROCESS
Purpose of Implementation
To carry out planned activities
To help the client

IMPLEMENTING PHASE OF
THE NURSING PROCESS
Concept!!!
The implementation phase ends upon recording
of the care given and the response of the patient
to that procedure

IMPLEMENTING PHASE OF
THE NURSING PROCESS
Requirements for Implementation

Adequate knowledge
Technical Skills
Communication skills
Therapeutic use of self
Right attitude as a requirement

NURSING ACTIVITIES DURING THE

IMPLEMENTATION PHASE
Reassess the patient
Rationale
To determine if the procedure is still needed
Determine the need for nursing assistance
Implement the nursing strategies

NURSING ACTIVITIES DURING THE

IMPLEMENTATION PHASE
Communicate the procedure
documenting the procedure

performed

Understand orders
Clarify / verify doctors orders
Encourage patient to participate actively

by

GUIDELINES FOR IMPLEMENTATION OF

NURSING STRATEGIES
It should be based on scientific knowledge,
research, professional standards of practice (care)
Rationale:
This is done to ensure safe nursing care
It should be adapted to the individual patient

GUIDELINES FOR IMPLEMENTATION OF

NURSING STRATEGIES
It should always be safe. Do not compromise
It should be holistic
It should be accompanied by support, comfort
and teaching

EVALUATION PHASE
OF THE
NURSING PROCESS

EVALUATION PHASE OF
THE NURSING PROCESS
Purpose of the Evaluation Phase
To determine clients progress
To determine the effectiveness of the care plan
To determine as to what extent the nursing goals
have been met

EVALUATION PHASE OF
THE NURSING PROCESS
Importance of doing an Evaluation
It determines if the care plan will be:
Continued
Modified
Discontinued

EVALUATION PHASE OF
THE NURSING PROCESS
Activities during the Evaluation Phase
Identify the OUTCOME CRITERIA to be used as
measurement
Gather information (data) relevant to the
outcome criteria
Compare outcome (data) with the criteria
Assess the reasons for the outcome
Revise the nursing care plan as needed

TYPES OF EVALUATION
1. On-going Evaluation
When done:
During or immediately after the intervention
Importance:
Allows the nurse to decide and make on-thespot modification/s in an intervention

TYPES OF EVALUATION
2. Intermittent Evaluation
When done:
At a specified time
Purpose:
It shows the extent of progress of the patient
Importance:
Enables the nurse to correct deficiencies and
modify the nursing care plan

TYPES OF EVALUATION
3. Terminal Evaluation
When done:
At or immediately before discharge
Importance:
States the status of a health problem at the
time of discharge
It determines whether the goals are:
Met
Partially met
Unmet

DOCUMENTATION

DOCUMENTATION
It is a written, formal document
A record of clients progress

PURPOSES OF DOCUMENTATION

Planning Care
Communication
For legal documentation purposes
For research
For education
Reimbursements
For statistics, reporting, epidemiology
Accreditation, licensing

GUIDELINES ON DOCUMENTATION
Timing
Document patient care as soon as possible
Observe confidentiality
Observe permanence
Use non-erasable ink
Do not use sign pen

GUIDELINES ON DOCUMENTATION
Signature
Sign full name and append R.N.
Accuracy
Ensure that data is correct
Avoid biases
Avoid ambiguous terms
Appropriateness
Write only appropriate information

GUIDELINES ON DOCUMENTATION
Completeness
Use standard terminology
Brevity
Make it concise yet meaningful
Legal Awareness
Cross out erroneous entry
Write Error
Countersign

TYPES OF RECORDS
Source-Oriented Clinical Record
Problem-Oriented Clinical Record

SOURCE-ORIENTED CLINICAL RECORD

Accumulation of chronological, variative notations
that are difficult to follow because they are not
assembled into an orderly or scientific manner
Classification of information is based on SOURCE
Each person or department maintains a different
section on chart

COMPONENTS OF A
SOURCE-ORIENTED CLINICAL RECORD
Admission Sheet
Face Sheet
Medical History and Physical Examination Sheet
Diagnostic Findings Sheet
TPR Graphic Sheet
Doctors Treatment and Order Sheet
Therapeutic Sheet

PROBLEM-ORIENTED
CLINICAL RECORD
Same as Problem Oriented Medical Record
Entry of data is based on CLIENTS PROBLEM
Example:
Problem No. 1: constipation
Increase fluid intake: doctor
Diatabs: pharmacist
NPO:
Includes observations about the patient
Example:
Radiologists notes are with doctors notes
under one problem

FOUR BASIC COMPONENTS OF

PROBLEM-ORIENTED CLINICAL RECORD

1. Baseline Data
All information gathered from a patient when he
first entered the agency

FOUR BASIC COMPONENTS OF

PROBLEM-ORIENTED CLINICAL RECORD

2. Problem List
Contains only ACTIVE problems (and relevant
information about the problem)
No potential problems (these are contained only
in the progress notes)

FOUR BASIC COMPONENTS OF

PROBLEM-ORIENTED CLINICAL RECORD

3. Initial list of orders or Care Plans

FOUR BASIC COMPONENTS OF

PROBLEM-ORIENTED CLINICAL RECORD

4. Progress Notes
Includes:
Nurses narrative notes (SOAPIE)
Flow sheets
Discharge Notes and Referral Summaries
Formats:
SOAPIE for revisions

COMMON METHODS OF COMMUNICATION

AMONG NURSES
1. Referring
To endorse patients special concern to a higher
authority or a specialized department or
personnel

COMMON METHODS OF COMMUNICATION

AMONG NURSES
2. Confer
Verifying information

COMMON METHODS OF COMMUNICATION

AMONG NURSES
3. Reporting
Giving information to a concerned person

KARDEX
Is the Kardex a part of the patients record?
No, it is not!!!
It is just a bulletin board

PURPOSES OF THE KARDEX

To make valuable information readily available
Allergies are written in red ink
It is a reminder
It is not a record

IMPORTANT CONCEPT
A Nursing Care Plan is not a record!!!