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Fundamentals · chapter 17 · Patient and Family Education

Informed Decision Making and Self-Care

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Patient education purpose

    The purpose of patient education is to give patients the education and self-efficacy they need to maintain or improve health, and the ability to cope with new situations (Fereidouni et al., 2019).

  2. Stress and learning

    Patients who are experiencing a current health challenge may be experience stress that affects their ability to learn (Cherry, 2022).

  3. Patient rights

    There are different versions of the bill, but, in general, it safeguards a patient’s right to accurate and complete information, fair treatment, and self-determination when making healthcare decisions.

  4. Consent before care

    For almost all tests, procedures, and treatments, patients (or their designees) are required to provide consent before they can be completed.

  5. Legal and ethical rights

    Patients have legal and ethical rights to understand, guide, and approve of their own healthcare and treatment decisions.

  6. Provider consent responsibilities

    Healthcare providers such as physicians, nurse practitioners, and physician assistants are responsible for the thorough explanation of the procedure, including risks, benefits, alternatives, and any risks associated with the alternatives, and to ensure the patient or designee understands the whole process (Shah et al., 2023).

  7. Nursing consent support

    This may include providing patients informational handouts and answering questions, arranging the time and space for the specific consent-related education between provider and patient, and contributing to the assessment of the patient’s understanding of the circumstances (Strini et al., 2021).

  8. Questions after consent

    In circumstances where a patient has further questions after signing a consent form, or changes their decision, the provider is contacted by the nurse to inform them of the change in circumstance and facilitate another meeting between the parties.

  9. Health maintenance benefits

    Maintaining health also contributes to fewer complications from chronic illness or injury, shorter lengths of stay when hospitalized, and fewer readmissions after discharge (Bordonada et al., 2020).

  10. Preventive screenings

    Screenings, such as blood tests for diabetes mellitus (DM) and hyperlipidemia, and preventive diagnostic tests such as colonoscopy (a fiberoptic scope to visualize the colon) and mammography (radiographic examination of breasts) are important health maintenance activities that can provide early disease detection and prevention.

  11. Active patient involvement

    Although some people take a more passive approach to their health and rely on their healthcare providers’ advice, patients are increasingly understanding that the maintenance of their health requires active involvement.

  12. Adherence and understanding

    Adherence and compliance are supported by patient understanding. Whether the education is about a diagnosis, planned procedure, or drug therapy, the more the patient comprehends about what is required of them, the better.

  13. Teaching moments

    It is crucial for the nurse to be able to identify appropriate teaching moments, whether they be scheduled or spontaneous, and be responsive when a patient or family member asks a question.

  14. Health literacy assessment

    In anticipation of educating patients and families, it is important to assess both the level of general literacy as well as health literacy to ensure communication is effective.

Terms to know

informed consent
As the name implies, informed consent is a process that requires the education of the authorized decision-maker about the benefits, risks, and any alternatives of the procedure (Shah et al., 2023).
coercion
Persuasion to comply with care through force, or coercion, is not acceptable, and the patient should have ample opportunity to clarify any information and ask questions as a participant in a collaboration of care (Strini et al., 2021).
health maintenance
Health maintenance involves helping patients identify their needs and participate in self-care as they learn to manage risk factors and prevent or control existing disease processes and diagnoses (Wang et al., 2022).
literacy
The ability to read and write is described by the word literacy; those who are unable to either read or write are referred to as illiterate.
health literacy
Because of the specific nature of this language, it has been labeled health literacy, which is described as the ability of an individual to locate, comprehend, and make use of health-related material and make healthcare decisions (Healthy People 2030, n.d.).
intrinsic motivation
Some people are driven by intrinsic motivation, or a drive toward achieving personal pleasure or fulfillment (Santos-Longhurst, 2019).
extrinsic motivation
These people may respond to extrinsic motivation, or a willingness to participate in self-care activities when offered a reward, rather than meeting a psycho-physiologic need (Santos-Longhurst, 2019).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client signed a consent form for surgery an hour ago and now tells the nurse they have more questions about the risks. What should the nurse do?

    1. Tear up the consent form and have the client sign a new one later.
    2. Contact the provider to report the change and arrange another meeting.
    3. Reassure the client that the form is already signed.
    4. Explain the surgical risks in detail so the surgery is not delayed.

    Answer: Contact the provider to report the change and arrange another meeting.

    When a client has further questions after signing or changes their decision, the nurse contacts the provider and facilitates another meeting. Explaining risks, benefits, and alternatives is the provider's responsibility, reassurance ignores the client's rights, and destroying the form does not answer the questions.

  2. A client who had abdominal surgery will be taught to change the dressing before discharge. The client rates pain as moderate. What should the nurse do to promote learning?

    1. Give the analgesic before the teaching session.
    2. Teach now and give the pain medication afterward.
    3. Postpone teaching until the morning of discharge.
    4. Give the client written instructions only, since pain affects attention.

    Answer: Give the analgesic before the teaching session.

    Learning is best when the client is free of pain, anxiety, or worry, so giving analgesia before teaching promotes learning. Teaching while in pain limits what the client absorbs, and delaying or relying on handouts alone reduces practice time before discharge.

  3. A nurse is preparing written discharge instructions. Which finding makes it most important to choose a different teaching style?

    1. The client has limited literacy.
    2. The client asks many questions.
    3. The client is intrinsically motivated.
    4. The client's spouse wants to attend.

    Answer: The client has limited literacy.

    Recipients with limited literacy of any sort are not likely to benefit from written materials, so the nurse should establish their preferred style. Asking questions, a spouse attending, and intrinsic motivation all support learning rather than rule out written materials.

  4. A pregnant client with hyperemesis gravidarum is vomiting repeatedly while the nurse tries to teach about dehydration. Later the client cannot recall the teaching. What should the nurse expect to do?

    1. Ask the client to read about dehydration online.
    2. Conclude the client is not motivated to learn.
    3. Document that teaching is complete.
    4. Repeat the education when the client can concentrate.

    Answer: Repeat the education when the client can concentrate.

    When concentration is impaired by nausea or vomiting, the client likely will not recall the information and the education will need to be repeated. Documenting the teaching as complete, relying on self-study, or blaming motivation ignores the barrier.

  5. A nurse is arranging a room for a family teaching session. Which conditions foster learning? Select all that apply.

    1. A busy hallway so staff can help if needed
    2. Sufficient lighting
    3. Visibility of the educator and any visual aids
    4. Minimal noise and activity
    5. Privacy

    Answer: Sufficient lighting, Visibility of the educator and any visual aids, Minimal noise and activity, Privacy

    Ideal teaching conditions include privacy, sufficient lighting, minimal distractions, comfortable seating and temperature, and visibility of the educator and aids. A busy hallway adds distractions that make learning difficult.

  6. A nurse is assessing why a client is having trouble with self-care at home. Which are common causes of deficits in knowledge, skills, or attitude affecting self-care? Select all that apply.

    1. Conflicting information from multiple sources
    2. Having a family member at the teaching session
    3. Lack of time
    4. Severe anxiety or stress
    5. Cultural or spiritual beliefs

    Answer: Conflicting information from multiple sources, Lack of time, Severe anxiety or stress, Cultural or spiritual beliefs

    Common causes include conflicting information, cultural or spiritual beliefs, lack of ability, lack of engagement or motivation, lack of time, and severe anxiety or stress. Teaching family members as well as the client can reinforce learning and improve outcomes.

Where every quote comes from

Section 17.1 Informed Decision Making and Self-Care of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.