Mid-week update

Even though it's only Tuesday, this a a mid-week update because there is no uni on Friday due to Good Friday. So far this week I've done:
• Analgesics and Anti-Inflammatories lecture
• Medications workshop
• Clinical Assessment Workshop
• Watched a movie length video on the uni website about Health Assessment and Collecting Subjective Data (it was a comedy in the sense that it more shows what not to do than what you’re meant to do, and people in it are obviously actors)
• Finished and submitted my Pre Op Patient Teaching Plan for Post-Op Wound Care. It’s not worth any marks but it’s been set as homework and I’ll get feedback on it. If you read this you'll notice that we have to provide a rationale for every single step of the care plan. When we do our skills assessment exams we also have to explain the reason for everything while we're doing it and if we don't the examiner will interrupt and ask "Why are you doing that?".

Care Plan for Pre-Operative Patient Teaching Regarding Post - Operative Wound Care

Problem
Mr Brown will have an anterior resection of his colon to remove a rectosigmoid carcinoma. He will need teaching to understand:
1. What wounds he will or may have after the surgery;
2. How the nurses will care his post-operative wounds; and
3. His own responsibilities as a patient to manage and care for his post-operative wounds.
Goals
• Establish rapport by using communication and interpersonal relationship skills. Rationale: To encourage client’s participation in the plan.
• Assess client’s learning needs related to the surgical procedure, such as how much he already knows about it and what questions he has. Rationale: To fill in knowledge gaps or correct mistaken beliefs the client may have.
• Determine clients learning style by asking how he feels he learns best, whether by reading, listening, hands-on learning, or a combination of styles. Rationale: To select appropriate teaching strategies and educational settings.
• Find out what written, visual, and audio-visual materials are available to give to the patient, such as brochures. Rationale: Different forms of learning material reinforce and clarify what you have taught the client.
• Set only one or two objectives per teaching session. Rationale: Overloading the client with information will not allow him to master the information necessary for compliance.
• Establish a specific goal at the beginning of the teaching session and stick to the plan. Rationale: Not deviating from the plan or going off on a tangent reinforces your commitment to help the client master the content, and the importance of it.
• Use professional, therapeutic, and easy to understand language. Rationale: Enhances learning. Use the following explanation to teach client about what wounds he will have or may have following the surgery:
o “For open colectomy, your surgeon will make 6-inch cut in your lower abdomen then find the part of your colon that is diseased. The surgeon will then put clamps on both ends of this part to close it off and remove the diseased part. If there is enough healthy large intestine left, your surgeon will sew or staple the healthy ends back together. Most patients have this done.
o If you do not have enough healthy large intestine to reconnect, your surgeon will make an opening called a stoma through the skin of your belly. Your large intestine will be attached to the outer wall of your belly. Stool will go through the stoma into a drainage bag outside your body. This is called a colostomy. In most cases, the colostomy is short-term. It can be closed with another operation later. But, if a large part of your bowel is removed, the colostomy may be permanent.”
• Teach client how the nurses will care his post-operative wounds. Rationale: Taking away any unpleasant surprise elements following the surgery will reduce the patient’s stress and anxiety, and promote compliance with the plan. (I have not included care for the colostomy here because it may not be necessary, just the surgical incision wound)
o You will have an incision in your abdomen which we will need to inspect regularly in the days and weeks following your surgery. It will be covered by a gauze dressing there will be drainage tubes and a drainage bag attached to the wound.
o We will check the wound for drainage amount and colour, irritation, and infection, and change the dressing as needed.
• Teach client his individual responsibilities for health behaviours regarding wound management. Rationale: Will promote wound healing.
o A small amount of oozing and drainage is normal so don’t be alarmed but you must let us know if it becomes excessive.
o The wound is likely to be painful and you should not hesitate to describe the level of pain (on a scale of 1 to 10) as well as the quality and any factors that intensify or relieve the pain such as movement or deep breathing.
o When you go home, you can have your wife do the dressing change and we will show her exactly how to do that when she is here, but it is important that you know how to do it as well, just in case she is not available to do for some reason.
o It is absolutely essential that you and whoever is changing your dressing has washed their hands very thoroughly with soap before and after, and do not touch the wound itself with your bare hands.
Evaluation:
• Request feedback during the teaching process. Rationale: Lets you know how the client is understanding the content and allows for modification as need.
• Ask client to explain the demonstration using his own words. Rationale: As above.
• After demonstrating skills, ask client to complete a return demonstration. Rationale: Allows you to observe client’s ability to perform tasks.
• Use an appropriate evaluative tool, such as a multidisciplinary teaching record used by the hospital, to record the evaluation. Rationale: Documents what teaching took place and what goals were achieved regarding patient education, which can then be placed in their file. Also can be used to avoid repeating patient teaching when it is not necessary.
• Do a self evaluation of teaching methods, teaching materials, and communication skills, by noting any problems you had, what you think went well, and questions you can look up or ask more experienced nurses. Rationale: Helps you become a better nurse.
References:
US National Library of Medicine: Medline Plus. Large Bowel Resection. http://www.nlm.nih.gov/medlineplus/ency/article/002941.htm (Accessed 30/3/10)
Smith, Duell & Martin (2008). Clinical Nursing Skills: Basic to Advanced Skills: Ch 5 Client Education and Discharge Planning. Pearson Education International, New Jersey.
Elkin, Potter & Perry (2007). Nursing Interventions & Clinical Skills 4th Edition: Ch 21 Surgical Wound Care. Mosby Elsevier, USA.