1. Younas, Ahtisham MN, BSN

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The nursing process is the most frequently used process to guide nursing care. It's taught to nursing students during their first year in nursing schools across the world. Different countries use different formats of the nursing process. For example, in the United Kingdom, the nursing process comprises four steps: assessment, planning, implementation, and evaluation. In the United States, the nursing process has five steps: assessment, diagnosis, outcomes/planning, implementation, and evaluation. Despite different formats, the main purpose of the nursing process is to deliver standardized, holistic, and patient-focused care, and to record and determine the efficacy of provided care.

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Simply put, the nursing process is a cyclic approach that requires us to use our problem-solving and critical-thinking skills to develop a holistic patient care plan. Patient teaching is one of the essential components of holistic nursing care. This article describes the use of a five-step nursing process for developing a teaching plan to deliver effective patient teaching in clinical settings.


Follow the five steps


During assessment, you collect the patient's data to identify his or her needs through a comprehensive assessment comprising two steps: objective and subjective assessment. In the objective assessment, you collect measurable and observable information about your patient's demographics, vital signs, labs, intake/output, and other objective findings. Upon collection of objective data, you interview the patient to explore his or her needs, feelings, thoughts, and perceptions regarding health and illness. The subjective assessment also includes the patient's physical, psychological, sociologic, and spiritual data. You complete both objective and subjective assessments, validate them, and make sure that they're consistent.



Based on the assessment findings, you categorize and prioritize the patient's needs and formulate a nursing diagnosis, which is based on the NANDA International guidelines. The common format that you use for developing a nursing diagnosis is problem, etiology, and signs/symptoms.



In the planning stage, you collaborate with the patient to develop short- and long-term goals to meet his or her identified needs. Bloom's taxonomy can be used to develop SMART (specific, measurable, achievable, realistic, and time bound) goals. This taxonomy orders learning goals into three domains: affective, cognitive, and psychomotor. Each goal is measured by specific outcome criteria, which designate the goal as met, unmet, or partially met. The outcome criteria should be consistent with the goals.



After the goals are finalized, you design and implement nursing interventions to achieve these goals. Each intervention may be dependent, independent, or interdependent, given its nature and the patient's condition. A dependent intervention is one for which the patient is completely dependent on the nurse; for example, providing a sponge bath to a patient with paralysis. An independent intervention is one that the patient can perform without any assistance; for example, brushing one's teeth. An interdependent intervention is one that the patient carries out with the nurse's assistance; for example, changing position for a patient with a leg cast.



Finally, in the evaluation stage, you evaluate the patient's progress regarding the established goals, the outcome criteria, and the provided nursing care. Based on this evaluation, you modify your nursing care plan.


Developing the plan

Keeping in mind the aforementioned steps, the following case study will help you understand how to use the nursing process to develop an effective teaching plan (see Example of a nursing process based teaching plan).


A 65-year-old patient was admitted with the chief complaints of severe chest pain, diaphoresis, and progressive dyspnea. Based on the initial nursing assessment and diagnostic evaluation, the patient was diagnosed with triple vessel coronary artery disease and underwent coronary artery bypass grafting (CABG). After CABG, he was transferred to the ICU. After being cared for in the ICU for over a week, he was then transferred to the coronary care unit (CCU) in a fully conscious state. The patient stayed in the CCU for 3 days. He was then told he would be discharged from the hospital.


During the final assessment, the patient indicated his interest in learning about home care after CABG. He indicated that nurses had been providing care for him, but he didn't know how to care for himself at home. Throughout his stay, the nurses observed that no one visited him and he was totally dependent on them to provide him with the necessary care.


To develop the teaching plan, the nursing process steps are: assessment, teaching need (diagnosis), teaching objectives and outcome (outcomes/planning), teaching content and strategies (implementation), and evaluation (see Translating the nursing process into a teaching plan).


As this patient's nurse, help him identify his perceived needs, which may be physical, emotional, or psychological. Discern the perceived needs for which he needs further education. The patient's interest in learning more about home care for CABG is considered to be a subjective assessment. Use your observations and knowledge about this patient to validate the subjective assessment. Throughout the patient's stay in hospital, the nurses observed that no one visited him and he was totally dependent on them for care. These two findings validate the patient's subjective need for more education on post CABG care.

Table Translating th... - Click to enlarge in new windowTable Translating the nursing process into a teaching plan

After your subjective and objective assessments are completed, list the patient's needs based on priority and similarity. For example, this patient may inquire about physical needs, such as diet and an activity plan, and emotional needs, such as stress management. Make sure that the home care teaching plan covers all of these needs.


Now that you've determined the patient's teaching needs, the next step is to develop short- and long-term teaching objectives. Communicate with the patient to ensure that there's a mutual agreement on the objectives. This also provides you with the opportunity to reevaluate the assessment and teaching needs. Ensure that the teaching objectives are SMART so that they're feasible and useful.


As mentioned earlier, the teaching objectives should be measurable. Develop simple and straightforward outcome criteria to help achieve this, and share them with the patient to ensure that the teaching objectives are achievable.


After finalizing the outcome criteria, the next step is to write up the teaching content. This phase is critical to effectively execute the teaching objectives. The content should be specific, practical, concise, and easily understandable. Similar to the implementation phase of the nursing process, it's important to justify the purpose of each point of the teaching content.


The effective delivery of teaching content requires designing and using multiple teaching strategies. For example, if you teach this patient about wound cleaning and dressing, explain and demonstrate the procedure. The purpose of using multiple teaching strategies for a single objective is to help the patient understand the teaching point while saving time. For example, demonstrating incision care may take more time than showing a video of a nurse performing it. However, combining these two strategies, if time permits, can help the patient better understand the teaching point. Seeking the patient's suggestions about what style of learning works best for him is one way to develop effective teaching strategies.


The final step is to evaluate the delivered teaching. Evaluation is an ongoing process, so it should be done at each of the previous phases. For example, encourage the patient to ask questions, ask him about his understanding of the content, and look for nonverbal cues during the teaching. The final evaluation criteria should be pertinent to the outcome criteria.


Finally, it's important to remember that similar to the nursing care plan, each teaching plan is different. It's up to you to decide what kind of plan meets the patient's needs and works with available resources. However, using the nursing process can help you develop a teaching plan in a systematic and organized manner.


Valuable information

Using the five-step nursing process for developing a patient teaching plan will help you deliver comprehensive and effective teaching. Simple teaching plans accompanied by multiple teaching strategies provide patients with valuable information.




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