Learner-Centered Instruction: Teaching Patients How to Care for Themselves When They Have a Diagnosis of Congestive Heart Failure Part I

Introduction

Teaching patients how to care for themselves when they have a diagnosis of congestive heart failure has been shown to be “effective in improving self?care and reducing readmissions” (Stromberg, 2005). This project will provide a lesson plan that nurses can implement using a learner-centered instruction approach in order to help patients with congestive heart failure properly and effectively apply self-care.

Rationale

Currently there is a need for better self-care among patients with congestive heart failure, as shown by Dickson and Riegel (2009) and Harkness, Spaling, Currie, Strachan and Clark (2015), as self-care can help to empower patients to provide more effective relief and management of their own health. Moreover, Tsai, Wang, Lee, Tsai & Chen (2015) show that self-care can help reduce re-admission rates and prevent patients from misapplying treatments on their own. As congestive heart failure is responsible for “11 million physician visits each year, and more hospitalizations than all forms of cancer combined,” it is imperative that steps to help patients to better cope with this health issue be taken (Emory Healthcare, 2018). To achieve that aim, Tsai et al. (2015) conclude that “establishment of heart disease educators and professional consultation services may be helpful to improve patient education” (p. 1101). This present paper aims to provide a first step in assisting in that process by developing a lesson plan for heart disease educators.

From the patient’s point-of-view, it is important that they understand what they need to know and how to apply self-care effectively. Based on their assessment of patients with heart failure Dickson and Riegel (2009) showed that “skill-building tactics, such as role-playing in specific situations, are needed” when teaching patients with heart failure how to care for themselves. This type of approach can give patients a better sense of what to do, how to do it and when: role playing, especially, helps to give them a concrete example to go by rather than that which is provided by traditional teaching methods where information is simply relayed by the teacher and expected to be received passively by the patient. Role-playing facilitates active learning, which helps lessons to be more deeply understood by the learner (Jensen, 2005). Additionally, in their follow-up study to their earlier research, Riegel, Dickson and Faulkner (2016) show that situation-specific heart failure self care can help patients to identify their own symptoms and make better decisions for themselves. This situation-specific approach conforms with the findings of Harkness et al. (2015) who show that individualized care is essential for patients seeking to better care for themselves.

Setting

The setting for this project can be the hospital facility where congestive heart failure patients receive primary care from physicians and nurses and training in self-care from a health educator, or it can be in a non-hospital setting, such as a nursing home or the home wherein the patient lives, provided the nurse is able to make a home visit. As this project focuses on learner-centered instruction, the recommended setting is wherever the patient-learner is most comfortable so that care can be truly individualized. The audience for this project consists of the health educator who provides the self care instruction and the heart failure patient who receives the instruction.

The Learner

The learner in this case is the congestive heart failure patient. Approximately 6 million Americans are impacted by heart failure, which is the leading cause of hospitalization among the elderly population (people aged 65 and older). However, the demographic for congestive heart failure is wider than that: it actually affects people of all ages, from children to the elderly. Approximately 1.4 million individuals under the age of 60 have congestive heart failure, while 2% of individuals between the ages of 40 and 5 suffer from heart failure—though the percentage rises to 5% among persons between the ages of 60 and 69. Heart failure is just as frequent among men as it is among women, but African Americans are 1.5 times more at risk of developing heart failure than are Caucasians (Emory Healthcare, 2018). Since virtually anyone can be a learner for this type of self care, there are also various levels of education that they are likely to have—from elementary levels of education to middle school to high school to college to post-graduate levels. For the purposes of this project, the learners chosen will be from the most common demographic of elderly patients.

126). The tasks must also be such that they are not too complex to be mastered and do not conflict with the learner’s environment. For elderly patients, instructors will have to allow “more time to react and respond to stimuli” (Bastable, 2014, p. 126). For the elderly population, these conditions must be present or else self care cannot be taught.
Emotional

As Bastable (2014) notes, learners must also be “emotionally ready to learn”—i.e., they must not be too anxious; they must have a secure and stable support system; they must be motivated; they must not be prone to taking risks; their frame of mind must be balanced, and their developmental stage should be advanced so that they are mature enough to take on the responsibility of self care (p. 127). The elderly learner must meet these emotional conditions or else self care cannot be taught.

Experiential

The learners should also have be allowed and encouraged to incorporate aspects of their cultural background or beliefs into their learning process and even into the self care, as this helps to individualize the learning. The elderly learner is most likely to want to incorporate some aspect of cultural background into the self care process, such as religious devotion, music, etc.

Knowledge

Additionally, learning should build on prior knowledge that the learner has and instructors should make an effort to know what prior understanding or level of education the learner has so that the instructor can teach to this level. The elderly learner is most likely to have achieved some education in life but is also most likely to require simple instruction so is to be approached at the same level as the child learner unless otherwise indicated by the learner.

Educational Philosophy

The educational philosophy to be used for this project is Essentialism, which allows the instructor to get to the essence of teaching—which is to enable the learner to acquire a skill that is needed. The aim of this philosophy is to help the learn achieve mastery of the subject that is being taught. This philosophy aligns with the theoretical approach used for this project, which is the humanistic approach.

Educational Theory

The theory that is used for this project is the Humanistic Learning Theory. The humanistic theory of learning puts the recipient of the learning at the center of the learning process—i.e., the individual is the focus rather than the environment, the nurse, the situation, etc. This stems from the person-centered approach that Rogers (1951) developed, describing it as “the best vantage point for understanding behavior is from the internal frame of reference of the individual” (p. 495).

Computer-assisted instruction theory is also utilized as it allows learners to use the technology that is available in the Digital Age to facilitate their self care process. As Bartholomew, Gold, Parcel et al. (2000) show, computer assisted instruction theory is helpful in teaching lessons to students of all ages as it is a tool, like a calculator, that helps make processing problems easier for the learner.

The main advantages of humanistic theory are that: 1) it offers a learner-centered approach to learning that allows the needs of the individual learner to be front and center, and 2) it assists in the development of adequate motivation, relationship-building, communication, and self-efficacy (Halstead, 2007).

When individualizing a self care practice to fit a patient lifestyle, humanistic theory is especially helpful because it allows the patient’s needs to be identified and addressed first and foremost. Humanistic theory allows the nurse to identify the needs of the patient first; so instead of simply recommending the right course of action, indifferent to the patient’s underlying needs, the nurse can help the patient to identify issues that may be leading to a desire to eat unhealthy foods and avoid exercise. Perhaps the patient is depressed about something, or has a lot of anxiety. The nurse can help to address underlying issues through the humanistic theory and then implement the right course of action to help address the patient’s health issue. Humanistic theory also facilitates the essentialist philosophy by providing the instructor the perspective to be able to center the learning process on the individual learner’s needs in order to achieve the objective, which is to communicate the knowledge needed to gain the skill of self care for the patient. It can be…