Teaching Plan Essay Example for Free

Teaching Plan Essay Maria is a 23-year-old female on disability pension. She left school since she was 12 years old and currently staying with her grandmother in Dromana. She has a long history of Borderline Personality Disorder with a self-harming behaviour and been experiencing chronic suicidal thoughts which often occur spontaneously with clearly definable triggers. These thoughts can be managed effectively well by the use of distraction/relaxation techniques, however, her level of distress can quickly escalate to an acute crisis situation whereby Maria becomes overwhelmed by the desire to end her life and emotional pain. Maria will then attempt to self-lacerate to reduce her distress or overdose on over the counter or prescribed medication. One of the crisis plans that would prevent her from inflicting harm to self is by encouraging her to call a clinician or duty worker during business hours or call the Triage after business hours for phone coaching to de-escalate her current acute emotional state. As Maria is learning to move from her emotional mind to a ‘wise’ mind, we are encouraging her to try to balance these better. Maria understands that her emotional mind and wise mind are often unbalanced, which usually makes her emotions take hold which then often escalate, leading to self-harm behaviour. [Source: Out-Patient Record, Peninsula Community Health Service (2010)] Introduction Patient teaching plans are tools developed by nurses in facilitating a systematic and evaluative way used in communicating to their patients regarding a particular treatment or practice. According to Bastable (2008, p. 07), a teaching plan is a â€Å"blueprint for action to achieve the goal and the objectives that have been agreed upon by the educator and the learner. † In this context, the nurse is the educator while the patient is the learner where a teaching and learning activity will occur for a specific treatment of therapy will occur. Bastable (2008) further explained that patient teaching plans should have a â€Å"purpose, content, methods and tools, timing, and evaluation of instruction. † The purpose, content, methods and tools, timing and evaluation of instruction should be in line with the objectives nd goals of a teaching plan. In order to have a more comprehensive and effective teaching plan, there is a need to identify concisely the elements of an ideal education process (Bastable 2008). By using a case study of a patient with a Borderline Personality Disorder, this essay will explain the importance of a patient teaching plan. It will further discuss the underlying principles and practice in the development, implementation and evaluation of a teaching plan based on the case study cited. It will also discuss the underlying processes in the development of the patient teaching and learning plan. It will then discuss the issues that will occur in the implementation of the patient action plan. Finally, it will give an analysis of the impact of the teaching plan to the patient. Importance of Patient Teaching Plan to Patients with Borderline Personality Disorder Borderline Personality Disorder (BPD) patients have the tendency of â€Å"exercising aggression, self-mutilation, impulsive behavioural dyscontrol, or self-damaging behaviour† (Latalova Prasko, 2010 p. 239). Thus, there are chances that BPD patients have the behaviour to harm themselves like slashing, being violent to other people and they can also be impulsive. According to a letter written to the editor published in the Journal Academy of American Physicians Assistants (JAAP, 2000) by Roxane Head, the patients that have BPD â€Å"may experience simultaneous conflicting thoughts, images and emotions. † Hence, these conflicting thoughts, emotions and images could trigger higher level of suicidal tendencies. Incidence of BPD cases are brought about and associated to Post-Traumatic Stress Disorder (PTSD) which establishes the link that causes mood instability as a result of prior â€Å"parental abuse or neglect. (JAAPA, 2000) In this context, parental abuse can be attributed from childhood experience which can either be â€Å"physical or sexual. † (JAAPA, 2000) Based on the case study presented above, Maria has experienced sexual abuse from her step-grandfather. It has also been stated that she has the tendency to do self-harm and over-dosing herself with medications. Based on the symptoms of BPD, there is a need for an immediate treatment and intervention when a mental crisis occurs. However, some BPD patients are not confined in hospitals or treatment facilities but are in their homes and are away from the management of clinicians and therapists. The introduction of Dialectical Behaviour Therapy (DBT) is a kind of treatment program for BPD patients that focus on the â€Å"teaching of behavioural skills in helping and facilitating individuals in replacing maladaptive behaviours with skillful behaviours. †(Neacsiu, Rizvi, Linehan, 2010) Phone coaching or therapy is one of the common DBT methods that are being used in treating BPD patients. Thus, there is a need for nurses and other medical practitioners to educate BPD patients on how to contact and communicate to clinicians and phone therapists. Hence, an effective teaching plan is needed to be designed and implemented which is tailor-made for BPD patients using some learning theories. Principles and Practices Development and Implementation of Teaching and Learning Plans Patient teaching and learning plans are aimed to assist nurses and other health educators in formulating a comprehensive of plan of teaching activities that for a certain type of patient, just like BPD (Falvo, 2010). Since BPD patients are known to have irregular emotions, DBT treatments such as phone coaching or therapies target emotion dysregulation and its after-effects by enhancing motivation and teaching skills aimed at areas of deficit (Vitaliano, Lynch Linehan 2010). Thus, in developing a teaching plan for BPD patients, it would be helpful to use specific learning theories that explains and targets the emotions and behaviours of individuals. One of the learning theories that could be applied in formulating a teaching plan is the Cognitive Learning Theory. According to Ziegler (2005, p. 60) Cognitive Learning Theory focuses on â€Å"cognitive restructuring† process of the mental state of the learner. Thus, it is beyond duplicating certain behaviour but rather it is more on storing and remembering some information in the learner’s mind. Emerson (2007, p. 19) suggested that the learning process using the cognitive learning theory would entail some cognitive steps in a progressive manner in â€Å"acquiring, processing, and structuring† information which makes the learning to be involved or â€Å"active† in the learning process. Hence, in formulating a teaching plan it is also essential to make the learner or the patient as the centre of the learning process. Nurses who are geared toward educating their patients or clients must initially focus and assess their patient’s behaviour as well as their mental and physical capacity (Sarman, Daugherty Riegel, 2000). Sarman, Daugherty Riegel (2000) further explained that it is important to consider the patient’s â€Å"physical condition, medications, culture, and psychosocial attributes but not always dependent on whether the patient perceives the need for change and is motivated to do so. Hence, the patient’s behaviour, especially with current mental illness or disorders should not be considered as a hindrance in patient teaching, but it is also part of a nurse’s â€Å"professional responsibility† to initiate a process in â€Å"teaching, motivating, providing resources to support in maintaining and sustaining the change† (Sarman, Daugherty Riegel, 2000). In Maria’s case, it is helpful to consider the Cognitive Learning Theory in formulating a teaching technique for phone coaching. According to Binks, Fenton, McCarthy, Lee, Adams Duggan, 2009) the initial step in teaching, is to help the client establish a link between their thoughts, feelings, emotions, actions to target a patient’s symptoms. † In Maria’s case, she has the tendency to harm herself when a crisis arises. Further, it is also essential to teach the client to â€Å"monitor his or her own thoughts, feelings and behaviours and also providing alternative ways of coping with regards to the specific symptoms of her current illness,† which is BPD (Binks, et. al 2009). In this step, it is essential to help Maria identify the level of feeling or emotion that she is currently experiencing or feeling at a specific attack. As part of the cognitive learning process, the use of visual aids such as mood charts and graphs would be helpful for the learner in acquiring, processing and structuring and applying it. According to Mountain (2008, p. 105), mood charts can help in understanding the â€Å"intensity of emotions, anxiety, emotions and the patient’s symptoms. † Mountain (2008, p. 105) further explained that mood chart will help in the learner to be â€Å"more aware on the moods and how they change. Thus, in the case study being cited, it will use a mood ring chart that classifies different emotions and level of anxiety with a corresponding colour. The mood ring chart would facilitate in Maria’s learning process as it would facilitate her in communicating to the phone coach therapist the level of emotion or anxiety she currently experiencing. The mood chart would be very helpful in Maria’s case since she will be seeking treatment from a phone therapist who would help her manage the crisis attack by either distraction or relaxation techniques, which would cause a change of her emotion or mood. Another teaching style that will be used is by demonstration. This teaching technique can be implemented and used in the case study since there is a need for the nurse-educator to teach the patient how to use the phone in contacting the phone therapist or clinician. In Maria’s case, it is very important that the nurse-educator should teach the patient a step-step process by demonstrating and giving instructions on where to locate a phone, who and what number to call, how to use the phone and how she will communicate to the phone therapist or clinician. In this way, the Maria will learn to use the phone with much confidence because the inability to use the phone and other technologies could hinder the success and effectiveness of the treatment. Evaluation of Te aching and Learning Plans In the development of a teaching in a patient education process, it is essential to consider the importance of evaluation. Bastable (2008, p. 558) argued that evaluation is defined as â€Å"a systematic process by which the worth or value of something-in this case, teaching-and learning- is judged. In this context, evaluation is a process in measuring the effectiveness of the development and implementation of patient teaching plans. The significance of the evaluation process is a critical aspect in the nurse teaching process and decision making since it would create an impact in its outcome and to future development and implementation of further patient teaching plans (Bastable, 2008). Hence, it is important to measure the effectiveness of the outcome of the teaching process to determine which aspects of the teaching plan needs to be improved and corrected as well as for the benefit of future teaching plans. In evaluating the teaching plan developed for Maria, it is essential to determine of what guidelines and methods to use in its evaluation. As the teaching plan has been developed for Maria which was patterned from Bastable (2008), the purpose, goal and objectives were clearly defined as well as its methods of instruction, resources needed and the methods of how it would be evaluated. To evaluate the teaching plan for Maria, it is essential to focus on the objectives set and its content outline which could be verifiable by the methods of evaluation being set. The first objective in the teaching plan is to help er recognize if she’s depressed or needs therapy, this can be recognized by post-testing. The second and third objective is to help her locate phone numbers of clinicians as well as how to use the phone to communicate with a clinician, this can be evaluated a return-demonstration by Maria after the nurse-educator teaches her how to perform these processes. The fourth and fifth objectives is to teach Maria how to distinguish the type of mood she is experiencing and associate it with the corresponding colour based on the mood chart and these processes can be evaluated by post-testing. The last objective is to teach Maria to listen and comprehend what the phone therapist is advising while is undergoing phone coaching and this could be evaluated through question and answer with the nurse-educator. Possible Issues that Might Occur in the Implementation of the Patient Teaching Plan In the implementation of patient teaching plans, there is a tendency that there is a difficulty in motivating patients to learn what have been taught in the patient teaching plans. There is also a possibility that the patient will not follow the skills and steps being taught. In the case of Maria, there will be a tendency that she will not listen of what the nurse-educator will be teaching her, like by recognizing her level of emotions. There also might be a possibility that she will insist a certain level of emotion which in reality is not real emotion that she is experiencing which would cause a contradicting intervention or treatment from the phone therapist. Impact of Teaching Plans to the Patient The evaluation on the implementation of patient teaching plans is not the ultimate indicator that the teaching plan for a certain patient is successful. However, Falvo (2010) argued that a teaching plan can be deliberately considered successful when a patient like Maria can be able to manage her crisis attacks even without the help of phone coaching therapists. By using the case study, Maria will be able to perform the prescribed distraction or relaxation techniques when she is experiencing depression or anxiety attacks. Conclusion The development of teaching and learning plans is a very important step in the treatment of mental disorder patients. It is vital that these teaching and learning plans should be meticulously developed in a way that would suit to specific individual needs, especially to patients with serious mental disorders like Maria who is suffering from Borderline Personality Disorder. The development of patient teaching plans should be carefully planned and could be flexibly adjust depending on the circumstance that could possibly occur during its implementation. Lastly, careful monitoring and evaluation in the implementation of teaching plans is very important in the learning processes to identify positive results to be maintained and at the same time improve areas that needs to be addressed.