Teaching/Learning Asthma Project, Research Paper Example

Outline

Introduction – Patient Profile Assessment

• Demographics
• Developmental stage
• Learning Assessment

Teaching Plan

• Lesson content
• Theory based teaching learning principles
• Teaching strategies
• Resources
• Methods of Evaluation

Implementation

• Date; Site and Time

Evaluation

• Patient’s Response and level of understanding
• Patient’s acceptance of knowledge; modification of behavior/attitude; application of

Skills

• Teaching/ Learning Outcomes

Conclusion

• Recommendations

Abstract

Teaching plans are very useful mechanisms in organizing patient education within and without a classroom setting. However, they must adhere to protocol and specific guidelines consistent with the discipline though which they are applicable. In nursing teaching plans focus on patient and family education as it relates to helping them mange many chronic illnesses. Among these chronic diseases is Asthma. This document presents a teaching learning plan for an adult patient affected by chronic asthma.

Introduction

Asthma is classified by the Global Initiative for Asthma a ‘chronic inflammatory’ disease affecting the airway. It involves the bronchus, bronchioles and alveolar tissues in lungs fields (Bateman, et.al, 2009). Common acute signs and symptoms are manifested as recurrent episodes of wheezing accompanied by chest tightness; shortness of breath and persistent coughing. Sputum may also be produced depending on the extent of the disease, but could be difficult to expectorate (Martinez, 2007).

Its etiology has been traced to genetics and environmental factors. A diagnosis is made based on signs and symptoms, but conditions, which gimmick the attack, ought to be ruled out. These include heart failure; foreign body aspiration; allergic rhinitis or chronic obstructive pulmonary disease (COPD). Treatment encompasses a combination of beta-2 agonists and corticosteroids. The epidemiological significance relates to a figures of 230-300 million people being affected internationally with 250,000 dying yearly from complications of the disease (Martinez, 2007).

There is a prevalence of 1-18%. People living in developed countries are more affected than those in developing or underdeveloped territories. However, the mortality rate is higher in less developed nations. Epidemiologists have projected that the prognosis for asthma is becoming increasingly better with education. Recent studies show where 50% of asthma cases diagnosed during childhood are eradicated by adulthood (Martinez, 2007). Consequently, early diagnosis, careful management through teaching and education are contemporary strategies adapted by health care professionals in preventing severe lung damage, exasperation and death due to complications (Yawn, 2008).

Patient Profile Assessment

Demographics

Mr. M.R is a 20 year old male athlete, who resides in a middle class urban environment. He is the fourth of six children who grew up in an extended family household consisting of father, mother, maternal grandmother and siblings. At the age of twelve while playing football with his team he began feeling chest discomfort and shortness of breath. After taking a break and encouraged by his team mates the symptoms subsided for a while. He returned to the game only to find this time it was unbearable and a 911 call was made.

The rescue came and began assessing this 12 year old that was having these symptoms for the very first time he reported. He was rushed to the emergency and remained there the night and next day for evaluations. While being transported oxygen was administered. This intervention w helped him to breathe better. After thorough investigations he was discharged with a diagnosis of ‘asthmatic attack’ pending further observations. Since then this client has been having repeated attacks averaging once to twice every three months to the extent of limiting physical activities and educational pursuits.

It is now 8 years that Mr. M.R has been battling with asthma. He was raised Christian of African descent and very active in church choir and young people’s circles in his community. He hopes to get married and have children, but is afraid that they will develop asthma too. There is a family history of children developing asthma, but by the time they were his age it subsided.

Developmental Stage

However, his attacks came on later. According to Erikson’s (1998) psychosocial development stages this dysfunction surfaced at a time when Mr. M.R was experiencing struggling with competence in terms of Industry versus Inferiority. Typical environment where this is attribute emerges best are within social structures of neighborhood and school interactions. Some questions most operative within the mind are, ‘Can I make it in the world of people and things? Besides, will I be accepted for who I am in terms of my abilities? Academic achievements at school as well as excelling in shots are major activities through, which these kills are demonstrated (Crain, 2011).

Asthmatic attacks continued until he is now 20 years old. There seems to be very little evidence that it will stop since he looks forward to the day when it will be over and normalcy be restored in his life. Now the battle to articulate love in relation to intimacy versus isolation becomes prominent. Can I love is the question? How can I maintain friendships? Can I make new friends? (Crain, 2011). This is the psychosocial predisposition to the client’s asthmatic medical condition which must be addressed in a teaching learning intervention.

Learning Assessment

An assessment of this client learning requirements points towards a psychosocial approach towards satisfying the needs for developing competence and loving interrelationships while coping with the physical manifestation of asthma. Without even saying it verbally this client communicated a willingness to learn how a resolution of this sudden onset of tightening of the chest; shortness of breath cough and visits to the emergency could be achieved.

By this demonstration it has been realized that Mr. M.R is now ready to apply strategies that would take him to another level whereby he can enjoy life again moving on towards marriage and raising a family. Hence, the obvious motivation to learn is exposed. From observation he is a thinker; deeply spiritual and learns quickly once exposed to the correct information. Application and synthesis skills were observed to be excellent. The only barriers perceive in expressing these affective and cognitive domain attributes is an attack of asthma itself. Therefore, in planning care one of the major goals is to prevent exacerbations.

Teaching Plan

Lesson content

The content would be designed according to objectives based on the client’s desire for speedy resolution; reduction of exacerbations; need for love and confirmation of competency. An important way to begin is by educating the patient regarding the disease and how attacks could be resolved effectively. A holistic approach would be the molded adapted.

Outline

• Asthma definition and presentation ( Chart to help in description)
• Organ systems involved (Chart to help in description)
• Factors imitating attacks
• Progress of the dysfunction
• Remedies (natural and pharmacological)- present client with samples of various treatment during teaching/ learning experience
• Discuss present treatment client is using and response.
• Allow client to provide further content regarding learning needs.
• Coping psychosocially with Asthma
• Intervention of community support groups.
• Importance of personal spiritual awareness in healing and restoration.

Theory based teaching learning principles

Theoretically, a person’s previous knowledge regarding concepts, situations or perceptions related to a subject affects effective absorption of new material. Hence, in this teaching learning mechanism Mr. M.R‘s conceptions about asthma, how it started; sequel of the disease as well as understanding of the treatment must be expressed and clarified before the process commences. Precisely, the learning theory that will be applied to Mr. M.R’s teaching/ learning experience in this project is the transformative learning model.

Its focus is hinged on explaining the way humans revise and reinterpret meanings. Essentially, it is a cognitive process aimed at effecting change of reference. In this case the frame of reference specifically is linked to how Mr. M.R perceives asthma and the prognosis, because this defines his world. Emotionally, he is connected to this dysfunction to the extent of believing that it would affect his life chances, ultimately. Due to this assumption it could become difficult eroding such false beliefs into a breakthrough remedy (Ormrod, 2012).

As such, being the facilitator in this process, it is my responsibility to adapt appropriate evidence-based theoretical teaching matching this transformative learning model. A principle applicable to all models is that every student is different and adopting a single teaching theory may just be insufficient for a single student much more a classroom of them. The advantage in this case is that the classroom contains one student. Hence, a one on one approach.

Theoretical principles embracing this teaching intervention model pivots on psychological changes is perception of the self; convictional revision of belief systems and behavioral adjustments pertaining to changes in life style. These three theoretical teaching principles form the foundation for designing teaching strategies in this teaching learning intervention. My role is to assist the Mr. M.R in becoming aware and critical of assumptions he makes from time to time. It is to provoke thinking (Taylor, 2001).

Teaching strategies

‘In teaching for transformation, teachers set the stage and

provide the environment in which students can articulate

and critically re?ect on their assumptions and

perspectives’ (Cranton, 2002, p. 63).

Theorists have posited that there are no definite teaching strategies that will ensure transformation. However, the following ones will be attempted in this intervention:-

Communicative knowledge transmission:-

• Engage Mr. M.R in a discussion concerning how he feels about himself, Asthma and life generally
• Validate his concerns and engage him in listening to alternative view presented through content.
• Allow him to express ho when feels about the information presented in the content.
• Allow him to assess his convictions/ assumptions based on the presentation regarding Asthma and his present beliefs/behavior towards the condition.

Emancipatory knowledge transmission:-

• Allow client to think/ ponder over information until next session.
• Engage client in thinking out ways in which adjustments can be made towards making alternative choices towards medication management and life style perceptions.
• Let those adjustments be articulated for the client’s deep concerns to be heard and addressed.
• Assist client in resolving concerns and together create a care plan.

(Cranton, 2002)

Resources

• Chart of the respiratory system
• Chart showing changes in an asthma affected system
• Identifying the associating structures such as the heart and rib cage
• Chart showing circulatory system
• DVD showing how patients cope with asthma.
• DVD showing complications when patients do no adhere to life style changes.
• Samples showing current treatment and developments within the science to improve quality of life (not to be given to Mr. M.R) e.g. bronchodilators

Methods of Evaluation

• Assess physical response to materials
• Assess response to attending sessions
• Allow client to fill evaluation format the end of each session

Implementation

Evaluation

 The evaluation of this teaching/learning project embraces three broad elements:-

• Patient’s response and level of understanding

This assessment was conducted by adapting two strategies. First a non-verbal evaluation observing facial expressions when terms are used that seem to make an impression on the client; body language combining verbal explanations and how comfortable the client appears to be reacting to imminent change. Secondly, is by allowing the client to write a guided evaluation of the session. Five questions were written on the sheet testing understanding of information. They pertained to the condition aligning it with the discussion from charts. This was conducted after the very first teaching/ learning experience for communicative knowledge evaluation (See Appendix A)

• Patient’s acceptance of knowledge; modification of behavior/attitude;

 application of Skills.

This evaluation process tested emancipatory knowledge receptivity and was conducted after the second session. During the interactive teaching/learning episode with family members at the client’s home each family member’s approach towards supporting this client in the change journey was observed and documented after seeking permission. In this setting the DVD showing how people lead a successful life with support of family was viewed.

Each family member’s support input will be validated and clarifications made. They were asked to fill out an evaluation form. The first section tested an understanding of the content presented and the second assessed whether the verbal support commitments were sincere (See Appendix B).

• Teaching/ Learning Outcomes

The evaluation will consist of follow up after teaching learning three week experience for two months at biweekly intervalls.This evaluation pertains to whether the care plan designed between the client and I along with a family member is working or modifications have to be made. Criteria for evaluating this plan are:-

• Following medication management regime appropriately
• Keeping doctor’s appointments
• Level of engagement in stress relieving activities
• Number of attacks within a week/month
• Number of exacerbation
• Levels of intimacy/ friendships
• Educational attainment
• Spiritual well-being level.

(See Appendix C)

Conclusion

Recommendations

One of the major strengths embodying transformative teaching/learning theory it its focus on interactive teaching/ learning strategies instead of a lecture format where only the educator/ facilitator has a voice in the process. This moves the educator/ facilitator away from a position of imposition towards conciliation and compromise. The truth is that no person has the right to impose his/her values on another even when it seems that it is to the individual’s benefit (Cranton, 2002). This is the transformative feature of modern healthcare culture. Despite ethical implications regarding the right to delivery of care this must happen within the boundaries of mutual consent.

Therefore, recommendations for this client and the teaching/learning project pivot upon utilizing power to transform behavior within professional ethical boundaries. Mr. M.R is challenged by self-esteem being what he considered ‘a sick young man in the prime of life.’ This perception must be transformed for treatment to be effective; asthmatic attacks reduced; exacerbations nullified and normalcy restored as before age twelve. It would take repeated teaching/learning interactions for this to be achieved. As such, based on the outcome of this project measures should be taken to continue education with adjustments until is the situation is fully resolved. 

Appendix A: Evaluation Questionnaire

Please circle the correct answers

1. Asthma is a condition affecting the:-

• Lungs
• Heart
• Legs
• Heart and lungs

1. People live normal lives with the condition if they:-

• Do not take their medication
• If medications are taken as prescribed
• If medications are taken sometimes
• If medications are taken when an attack comes on

1. When my chest begins to tighten:-

• An attack is coming on
• The attack is leaving
• It is a sign of anxiety
• It is nothing to worrying about

1. Bronchodilators improve breathing during an attack:-

• Yes
• No
• Often
• Sometimes

1. I can live a better quality of life:-

• With life style changes
• If I smoke frequently
• If I worry sometimes
• If I continue doing what I always did

Appendix B: Evaluation Questionnaire

Please circle the correct answer

Section 1 

1. Asthma is a condition affecting the:-

(a) Lungs

(b) Heart

(c) Legs

(d) Heart and lungs

1. Bronchodilators improve breathing during an attack:-

(a) Yes

(b) No

(c) Often

(d) Sometimes

Section 11

1. With support from family members:-

• Management of asthma could become worse
• There is remarkable improvement in management of the asthma
• There is no improvement in the management of asthma
• There would be less exacerbations

1. If I know of a family member with Asthma:-

(a) I will endeavor to be supportive

(b) I would not have time for that

(c) I may be available sometimes

(d) I don’t think it is my problem

1. It is a family culture to care for relatives when they are ill:-

(a) Yes

(b) No

(c) Sometimes

(d) Occasionally

Appendix C: Evaluation Questionnaire

Rate yourself.

Using the scale 1-5; 1 being the lowest and 5 the highest, rate your performance of these skills by circling the most appropriate number

1. Following medication management regime appropriately– (1, 2,3,4,5)
2. Keeping doctor’s appointments— (1, 2, 3, 4, 5)
3. Engagement in stress relieving activities — (1, 2, 3, 4, 5)
4. Reducing number of attacks within a week/month – (1, 2, 3, 4, 5)
5. Reducing number of exacerbation—(1, 2, 3, 4, 5)
6. Improving intimacy/ friendships— (1, 2, 3, 4, 5)
7. Engagement in educational advancement—(1, 2, 3, 4, 5)
8. Engaging in activities for enhancing spiritual well-being– (1, 2, 3, 4, 5)

References

Bateman, E. Hurd, S. Barnes, P. Bousquet, J. Drazen, J. Fitzgerald, M. Gibson, P. Ohta, K. (2008). Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal 31 (1): 143–178.

Cranton, P.(2002). Teaching for Transformation. New Directions for Adult Continuing Education, 23, 63- 70

Crain, W. (2011). Theories of Development: Concepts and Applications (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

Martinez, D. (2007). Genes, environments, development and asthma: a reappraisal. Eur Respir 29 (1), 179–84.

Ormrod, J. (2012). Human learning (6th ed.). Boston. Pearson.

Taylor, W. (2001). Transformative learning theory: a neurobiological perspective of the role of emotions and unconscious ways of knowing. International Journal of Lifelong Learning, 20 (3), 218-236.

Yawn, P. (2008). Factors accounting for asthma variability: achieving optimal symptom control for individual patients. Primary Care Respiratory Journal. 17 (3), 138–147.