Discharge Teaching Plan Research Paper

Discharge Teaching Plan Research Paper

Draft of Discharge Teaching Plan Research Paper

 

Some information to consider:

 

  • Sattui SE1, Saag KG1.Fracture mortality: associations with epidemiology and osteoporosis treatment. Nat Rev Endocrinol. 2014 Oct;10(10):592-602. doi: 10.1038/nrendo.2014.125. Epub 2014 Aug 5.

 

 

Draft of Discharge Teaching Plan Research Paper

INTRO—start by setting the stage –discharge teaching scenario for an elderly Asian-American person (man / woman) who was hospitalized for complication of osteoporosis—what type of fracture and surgical repair—hip? vertebral?

 

  1. Prevalence of osteoporosis in Asian-Americans

https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/#asianamerican –states that of women over age 50 à  20% of Asian American, 10 % of Latinas,  5% of African American and 20% of non-Hispanic Caucasian women have osteoporosis

 

Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S and Dawson-Hughers B. (2014). The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. Journal of Bone and Mineral Research, 29, (11): 2520–2526. doi: 10.1002/jbmr.2269.

  • reports that data from the NHANES 2005–2010 database provided an estimate of 4% of adult women and 4.3% of adult men 50 years and older in the U.S. had osteoporosis. Did not separate out Asian subgroups in the reporting

 

 

Cauley (2011) reports approximately 85.4 of every  # __(100,000??)_  Asian-American annual hip fracture rates in persons are suffering from osteoporosis in the United States.   ßthis data cited in CAULEY’s references is from 1988     Across all age groups and gender, the condition is more prevalent in females above the age of 45years (post-menopause) and males below the age of 45 years (Cauley, 2011).  move this sentence to III. Environmental Influences à   Statistics of this kind among the   It has been reported that many Asian-Americans are in part due to the  have lactose intolerance that restricts their intake of calcium-rich dairy products  foods. As such, this condition is significant to the Asian-American population and deserves a quick remedy that will help fix the current situation. Central to this aspiration is patient education, which will facilitate understanding of the condition among persons of this cultural group. In essence, this discussion aims at coming up with a discharge teaching plan that will empower the Asian-American population with information about the condition, its management and follow-up care as they leave hospital care medical facilities.

Learning Needs of the Asian-American Patients

to intro paragraph à The Asian-American man / woman hospitalized with a problem related to patients with osteoporosis has very specific learning needs that nurses need to address in their the discharge teaching plan of care. The focal point of all the learning needs is to #1 promote surgical recovery after hospitalization for ___ ? hip fracture  ? vertebral fracture?  and #2 manage osteoporosis and prevention of complications of osteoporosis. The learning needs of osteoporosis addressed by this teaching plan include knowledge of how to manage the disease process, how to manage the recovery process after hospitalization for  ? fracture  ? orthopedic hip repair?  knowledge of medications, activity level as well as restrictions, nutritional needs and follow-up criteria.

Goal of Discharge Teaching Plan  move to VI. nursing care plan, section on outcome:  goal of nursing care plan is to prevent more osteoporotic fractures and stabilize existing bone structure

The overall goal of the discharge teaching plan is to impart the patient with the knowledge that will enable him/her to make self-driven behavioral changes, which will help better his/her overall health status as well as manage his/her osteoporosis.      

move to VI. Discharge care plan.  Objectives for the Discharge Teaching Plan

GOOD STUFF, but should shorten.  Focus on details of your plan; HOW will you do this? à  The discharge teaching plan objectives for the osteoporosis patient are worth noting as they offer an end towards which patient education strives to reach. The objectives include the following:

The patient will be able to:

  • demonstrate an understanding of the management of the disease process
  • describe how and when to take the medications used to manage the osteoporosis
  • demonstrate an understanding of the need for balance between maintenance of activity level and restrictions
  • explain the nutritional needs for osteoporosis
  • demonstrate an understanding of the notification or follow-up criteria with the physician

 

  1. genetic factors related to osteoporosis risk in Asian-Americans

Caucasians with osteoporosis are much more likely to have hip and arm fractures than spinal fractures; Asians more likely to have spinal fractures (Lei et al, 2006)

 

genetics related to lactose intolerance  https://ghr.nlm.nih.gov/condition/lactose-intolerance

 

  • Environmental influences

things like insurance coverage  http://kff.org/disparities-policy/fact-sheet/health-coverage-and-access-to-care-among/

 

 

  1. Asian-American social-cultural values
  2. health beliefs that influence health behaviors
  3. social network, kinship, spirituality, values that influence health behaviors

for this section, go to CINAHL and type in search words “Asian American culture”—lots of interesting peer-reviewed materials will come up!

 

 

Discharge Teaching Plan for Osteoporosis

avoid repeating info—use headings to organize and minimize repetition in your paper   At discharge, the plan of instruction for a patient with osteoporosis will entail five crucial topic areas that encapsulate the formulated objectives for this plan. The topics include a general overview of osteoporosis, treatment, activity level as well as restrictions, nutritional needs, and follow-up criteria. Alongside these themes, a question/answer session is also a priority area of the teaching plan. Each topic area will take a maximum of 30minutes. The breakdown of how the nurse will teach these subjects is as shown in the table below:

this chart is not necessary for this paper  DELETE à

 

Topic/Activity  Duration Doer
Overview of osteoporosis 30 minutes Nurse
Treatment 30 minutes Nurse
Activity level and Restrictions 30 minutes Nurse
Nutritional needs 30 minutes Nurse
Follow-up Criteria 30 minutes Nurse
Question and Answer/ Clarification session 30 minutes Nurse

 

General Overview of Osteoporosis

separate content into I. Prevalence, II. Genetics, and III. Environment

Osteoporosis patients need to understand what this disease process entails. Such is the case given that persons who know what osteoporosis brings with it are more likely to comply with the instituted management strategies. As such, the content for patient teaching under this topic includes the definition of osteoporosis, risk factors, and its management.

Firstly, osteoporosis refers to a metabolic disease that affects the bones of an individual following the different bone formation and bone resorption processes. In normalcy, both the two processes are equal (Drake, Clarke, & Lewiecki, 2015).

 Focus on care of ONE patient who already has osteoporosis, and has been hospitalized for a ? vertebral or hip fracture or something.  Secondly, the patient needs to understand the risk factors for this condition so that they can they can adapt behaviors that will protect them from its complications. put this in II genetics and/or III environment à The predisposing factors include but not limited to the female gender (due to factors like menopause, lower bone mass), advanced age (above 65 years), race (Asian-Americans most affected in part due to the lactose intolerance that restricts their intake of calcium-rich foods) and alcohol intake (Khandewal, Chandra, & Lo, 2012).

 

put this in VI Discharge care plan Lastly, the patient must understand the management strategies that are essential for correcting this disorder.  GOING home after bone surgery! The management of the patient with osteoporosis combines the use of nutrition, supplements, exercise and medications.  put this in VI. care plan A.nursing interventions 1. medication instruction and C. nutritional needs post-op    The patient must understand the need for adapting to an alternative dietary source of calcium other than dairy products that he/she is not in use because of lactose intolerance (Carne, 2015). For instance, the Asian-Americans can use the soy milk in place of the dairy products. Also, the use of supplements of calcium and vitamin D will improve the patient's condition.  Expand on raloxifene  for osteoporosis—what are common side effects, and serious adverse effects of use?   Besides, medications like selective estrogen modulator (raloxifene, teriparatide) can also help improve the health status of an osteoporosis patient.    Put this in VI. C. exercise recommendations—NOTE this person had been in the hospital ? fracture?  hip replacement? –this will modify your advice!   That notwithstanding, the patient must comprehend the need for maintaining a healthy activity level in the form exercises (Carne, 2015). Such a practice will help improve the bone strength and prevent bone fractures.

Treatments

  1. nursing discharge care plan

Look up nursing discharge teaching examples in the Lewis textbook for hip replacement

For hip replacement patientà

  • Nursing diagnoses (see also Ackley book)
  • Goals for self-care—ambulation, falls prevention, pain management, Range of motion

 

  1. nursing interventions—1. medication instruction

for all medications in plan, include specifics about side effects and serious adverse effects

A reflection of the effectiveness of the patient teaching plan is in part mirrored by the patient adherence to the treatment plan. Therefore, the education plan must remind the patient of the importance of taking the medication using a particular route and time as well as maintenance of a certain dosage. Failure to abide by these directives will result in side effects, which negatively impact the wellbeing of the patient (Carne, 2015).

NOTE: some Asian therapies the patient may want to incorporate (see PubMED database)à

 

herbal medicines for bone health:  Che CT1, Wong MS2, Lam CW3. Natural Products from Chinese Medicines with Potential Benefits to Bone Health. Molecules. 2016 Feb 27;21(3):239. doi: 10.3390/molecules21030239.

tea and bone health:  Shen CL1, Chyu MC, Wang JS. Tea and bone health: steps forward in translational nutrition. Am J Clin Nutr. 2013 Dec;98(6 Suppl):1694S-1699S. doi: 10.3945/ajcn.113.058255. Epub 2013 Oct 30.

 

 keep it simple—likely WON’T go home with any of these medications when recovering at home from a fracture or orthopedic surgery à Furthermore, the nurse must teach the patient about medications that may worsen his/her conditions. Such medications may include corticosteroids, heparin, and antiseizure. Therefore, the nurse must reinforce avoidance of these drugs, which will in turn prevent instances of worsening the osteoporosis and its complications (Carne, 2015).

Activity Level and Restrictions

  1. discharge plan—B. nursing interventions à. 2. exercise—NOTE restrictions due to ? fracture, ? hip replacement?

 

According to Carne, (2015) maintenance of a certain degree of activity for a patient with osteoporosis is beneficial to him/her. Such is the case due to the strengthening of the bones that comes with exercises. The bones develop tolerance with exposure to such an exercise program. As such, in this scenario, the patient must fathom that the condition does not limit him/her from maintaining a level activity with the fear of sustaining fractures.

SPECIFY—> handout with safe exercises in a person with a history of vertebral fractures, or hip fracture related to osteoporosis

 

Also, this teaching plan must enlighten the patient on what activities to avoid that may aggravate the current patient’s complications such as fractures, which are expensive to treat. For instance, the nurse must inform the patient to avoid carrying heavy loads, which will predispose him/her to worsening of fractures or recurrence of fractures.

Nutritional Needs

  1. discharge plan—B. nursing interventions à. 3. nutrition

what are typical foods in an Asian diet (look at Chinese, Vietnamese or Korean)? http://www.asian-nation.org/asian-food.shtml

 

NOTE: in many Asian countries (China, for example), beef is not a staple, and cattle are not traditional livestock. No one produces cheese, butter or milk products. These have never been traditional foods.

this means milk-type products are not part of the daily diet (tea served plain, no “milk”, for example).

Of the essence of the management of osteoporosis is the nutrition of this patient. Given that this condition is due to a deficiency of calcium mineral, the patient must appreciate the need of sourcing calcium mineral from other sources other than dairy products. Dairy products are not tolerable to patients of this cultural group due to the problem lactose intolerance associated with them (Carne, 2015). As such, the nurse must teach the patient on other sources of calcium that he/she can tolerate, for instance, soy milk. “milk” may not be an Asian food choice no matter what 

list vitamin D and calcium in the V. discharge plan A. interventions: 1.Medication education section à  Additionally, the nurse should emphasize the need for the patient to stick to the calcium and vitamin D supplements. Such supplements are vital in the management of an osteoporosis patient as they increase the level of these minerals in the body (Carne, 2015).A benefit of this kind to the patient's body signifies the need of teaching the patient on the essence of complying with the prescribed supplements.

  1. discharge plan A nursing intervention 4. when to get dr follow up

Follow-up Care

personal communication, C. Robertson NP, Feb 14, 2017:  1st post-discharge visit to physician in one week. Then see health care provider (physician or nurse practitioner) again in one month for assessment of fracture / hip replacement, etc. BE EXPLICIT  Patients with osteoporosis just as other patients must beware of when they ought to seek care after discharge. Such is the case given that a delay in the search for care may result in disastrous effects on the patient that would have been nonexistent with the instant seeking of care (Carne, 2015). That said, the nurse must teach the patient on when to seek for follow-up care.

not part of RN discharge teaching à In this instance, the indications for follow-up care are the permanent bone loss as in the case of chronic corticosteroid use and development of complications such as fractures. According to Carne, (2015), occurrence of fractures is suggestive of non-compliance to the medications and the need for follow-up.

What health promotion should be included in the discharge teaching plan for the elderly Asian hip replacement patient?

1st—locate and include hip replacement or fracture handouts—SAFETY—mobility, wound care, pain control, safe range-of-motion, crutches, etc.

NEXT—osteoporosis education

Edmonds SW1, Solimeo SL2, Nguyen VT3, Wright NC4, Roblin DW5, Saag KG6, Cram P7.(2016). Understanding Preferences for Osteoporosis Information to Develop an Osteoporosis Patient Education Brochure.  Perm J. 2016;21. doi: 10.7812/TPP/16-024. Epub 2016 Nov 18.

 

provide osteoporosis information in a SIMPLE format, such as ONE page education handout with a drawing. Keep it to 5th grade level.

See https://medlineplus.gov/osteoporosis.html; use SIMPLE illustrations such as  https://www.iofbonehealth.org/data-publications/bone-health-brochures

 

OK to use these instead of creating your own! cite the source in the reference list; label as Appendix A, Appendix B, etc.

 

consider providing one in Chinese, or Vietnamese, or Korean, etc.—these are the 3 ethnic groups most common in Albuquerque 

 

Teaching Aide for Asian-American Patients with Osteoporosis

Label illustration below as “Figure 1” and place after the References but before the appendixes. Cite source of illustration in APA style; list source in references as well.

 

This image will help the patient understand the difference between healthy bones and bones affected by osteoporosis.

Patient Handout on Osteoporosis – TOO COMPLICATED! aim for easy-to-recall bullet points, and 5th grade reading level

 

Central to the success of this teaching plan is a patient handout that will enhance retention of the knowledge and serve as a home reference for the patient. The handout will entail several aspects of osteoporosis ranging from its definition, risk factors, pathophysiology, diagnosis, and management strategies.

Handout should be labeled as Appendix A and placed after References and Figures.


What is Osteoporosis?

Osteoporosis refers to a chronic progressive metabolic bone disease epitomized by low bone mass and structural deterioration of bone tissue that lead to bone fragility (Tung, 2012).

Am I at Risk?

Among the Asian-American persons, an important risk factor for osteoporosis is the female gender. Such is the case given their short, slender stature, diet preference of less rich calcium foods due to their lactose intolerance, lower bone mass as compared to male counterparts and post-menopause (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2015).

Another risk factor that may predispose other people to osteoporosis is the age of the individual an advanced age (above 65years). At this age, the bone resorption is faster than bone remodeling. As such, the bones become extremely fragile (Tung, 2012).

Other notable risk factors include but not limited to cigarette smoking, family history of osteoporosis, excessive use of alcohol, non-traumatic fracture, inactive lifestyles and chronic use of corticosteroids, heparin, and antiseizure medications (Gupta, et al., 2014).

How does the Disease Develop?

Normally, in bone remodeling, bone formation is equal to bone resorption. However, in an osteoporotic state, the bone resorption exceeds the bone formation. The affected bones in osteoporosis are mainly those of the spine, hips, and wrists (Drake, Clarke, & Lewiecki, 2015).

The affected people will present clinically with signs and symptoms such as back pain, loss of height and spinal deformity like kyphosis. All these clinical manifestations are due to collapsed vertebrae (Khandewal, Chandra, & Lo, 2012).

In what Way will the Doctor Know it is Osteoporosis?

Primarily, the history and physical examination are essential in establishing the existence of this condition. With such tools, health care personnel will determine the signs and symptoms that will point out to this diagnosis. For instance, a reduced height or a medical history of glucocorticoid medications will give a clue of this condition.

Of the essence, however, to the diagnosis of this disease process, is the bone mineral density (BMD) measurement. The BMD assesses tightness of bone package. The health care professionals may also use dual-energy x-ray absorptiometry (DEXA). It measures the bone density in the spine, hips, and forearms. Moreover, DEXA evaluates the changes in bone density over time and assesses the effectiveness of the medications on use (Drake, Clarke, & Lewiecki, 2015).

Other diagnostic tests include blood assays, namely, serum calcium, phosphorus, alkaline phosphatase and vitamin D levels (Drake, Clarke, & Lewiecki, 2015).

What are the Management Strategies of Osteoporosis?

The management of osteoporosis mainly focuses on good dietary practices, calcium as well as vitamin D supplementations, exercise, prevention of fractures and medications.

Primarily, one needs to take food rich in calcium such as soy milk. Dairy products like milk and cheese are not desirable in this case given that most of the people of this cultural group are lactose intolerance (Carne, 2015).

Supplements of calcium and vitamin D are also essential to the management of this condition. Such is the case given that both calcium and vitamin D, which are deficient, have a role to play in bone formation (Carne, 2015).

Also, the patient should engage in an exercise program that is not strenuous to precipitate complications of osteoporosis such as fractures due to falls. As such, patient teaching is of the essence to ensure that an individual understands and adheres to an exercise program that will strengthen the bones instead of precipitating complications like fractures (Carne, 2015).

Besides, an individual with osteoporosis has an entitlement to medications like calcitonin that regulates the metabolism of calcium. Additionally, a class of drugs like selective estrogen modulator (raloxifene, teriparatide) can also improve the health status of an osteoporosis patient (Carne, 2015).

Finally, surgical procedures such as vertebroplasty and kyphoplasty are also of the essence in the management of complications of this condition. The complications include vertebral collapse and kyphosis respectively (Carne, 2015).

 move to III. Asian-American Social -Cultural Considerations of the Asian-Americans

Given the specific nature of health care preferences of persons from Asian-American culture, the nurse must factor into the plan of care cultural consideration if he/she intends to offer culturally sensitive care for this patient. As such, it is worth noting the steps that the nurse intends to follow through with the teaching plan so that the patient receives culturally appropriate care that will enhance his/her commitment to the instituted plan of care.

First and most importantly, Asian-American patients are unique to any other cultural group residing within the USA. That is the case given that they have specific health beliefs about disease causation and health, which are incongruent to other cultural groups' beliefs.  ßtrue for ALL population minority subgroups when compared to the dominant U.S. cultural group For instance, many Asian-Americans believe in the theory hot-cold imbalance https://agelessherbs.com/yin-yang-theory/  for disease causation. As such, an Asian-American individual will most likely MAY refuse to take a medication that he/she perceives hot if he/she is having a condition that causes him/her to feel feverish (Andrews, & Boyle, 2008, p. 280). not so simple! Can simply state that the patient may prefer to discuss all medications with their traditional medicine specialist. The patient may also prefer to take in traditional herbal medications instead of “western” medications. Personal communication, C. Robertson NP, Feb 14, 2017.à  In the teaching plan, the nurse should take into consideration this health belief by allaying the fears of the patients that medications used are neither hot nor cold and therefore will not cause a progression of the condition. Furthermore, the health care professional can match the drugs if possible to ensure that patient takes medicines perceived as cold whenever they are feverish and vice versa.

CAUTION! Lim et al (2012) state that Asian women in their sample felt if they were able to communicate their concerns, there was much more trust in recommendations by health care providers, and more likely to be compliant. The study did NOT support an authoritarian approach for care! 

 

 Also central to this cultural group is the belief that a health care professional must assume authority in the process of disease management rather than seek out to create a patient-doctor relationship. Such a preference of the Asian-American is central to their satisfaction. That is the case given that they are more likely to come back to the same hospital if the health care professionals assume authority and treat them in an appropriate way (Lim, Baik, & Ashing-Giwa, 2012). BAD PLAN à The nurse should factor into the discharge teaching plan this consideration by ensuring that he/she offers instructions to the patient without seeking to consult his/her opinion. In such a way, the patient will be more likely to accept the instructions and follow them to the latter as he/he goes home. an Asian American patient may say “yes” if you do this, and may smile to help you preserve your dignity, but will not necessarily comply.

Additionally, addressing the clients with respect, for example, use of words such as ‘sir and madam' is significant in ensuring that the client's agrees with the content being taught by the nurse. According to Poulin, Deng, Ingersoll, Witt, and Swain, (2012) respect and harmony are the main core values that hold this cultural group together. ß VERY TRUE! As such, showing respect to them while 1) hear their concerns FIRST, 2) acknowledge that a traditional medicine approach might be sought, and 3) relaying the information will enhance their commitment to the taught issues.

Engage translation services during patient teaching, if English is not the primary language. UNMH has several options.

Have teaching materials available in Chinese, Vietnamese, etc.

 

final part of patient education plan—what signs of complications should you teach? worsening pain in wound or surgical site, etc.

be explicit—when to seek emergent care

 

Lastly, in this teaching plan, the nurse can ensure acceptability of the learned information through taking into consideration the correct pronunciation of words when talking to the Asian-American clients or patients. For instance, when calling out their names, the nurse must be keen to pronounce their names correctly. Failure to do so will only but result in a bad reception of the transmitted information (Poulin, et.al., 2012).

Conclusion

In closure, from this discussion, it is clear that a discharge teaching plan for an Asian-American patient with osteoporosis entails many aspects. For example, it includes the knowledge of disease process management, treatment, nutritional needs, activity level and restriction as well as the follow-up criteria. In essence, this paper has addressed all these issues and cited the cultural consideration that the nurse must take in the teaching plan.

 

APA section 8.03 -- label any patient care handouts (Appendix A, Appendix B) ,and place after the References

 

 

References

reference the chapter you cited à Andrews, M. & Boyle, J. (2008). Transcultural concepts in nursing care (1st 5th?  ed., p. 280). Philadelphia PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Carne, K. (2015). Osteoporosis and fractures: diagnosis and management. Practice Nurse, 45(5), 42-46.  ß British reference

APA section 7.01 –title of article in sentence case as below à 

Cauley, J. (2011). Defining ethnic and racial differences in osteoporosis and fragility fractures. Clinical Orthopaedics and Related Research, 469 (7), 1891-1899. http://dx.doi.org/10.1007/s11999-011-1863-5

Drake, M. T., Clarke, B. L., & Lewiecki, E. M. (2015). The pathophysiology and treatment of osteoporosis. Clinical Therapeutics, 37(8), 1837-1850. doi:10.1016/j.clinthera.2015.06.006

Khandewal, S., Chandra, M., & Lo, J. C. (2012). Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal U.S. South Asian women. Bone, 51(6), 1025-1028.  doi: 10.1016/j.bone.2012.08.118.

Lim, J., Baik, O. M., & Ashing-Giwa, K. T. (2012). Cultural health beliefs and health behaviors in Asian American breast cancer survivors: A mixed-methods approach. Oncology Nursing Forum, 39(4), 388-397.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2015). Osteoporosis and Asian American Women. Niams.nih.gov. Bethesda MD: U.S. Department of Health and Human Services, National Institutes of Health. Retrieved 4 January 2017, from  https://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Background/asian_american_women.asp

Poulin, J., Deng, R., Ingersoll, T., Witt, H., & Swain, M. (2012). Perceived family and friend support and the psychological well-being of American and Chinese elderly persons. Journal Of Cross-Cultural Gerontology, 27(4), 305-317. doi:10.1007/s10823-012-9177-y

Tung, W. (2012). Osteoporosis among Asian American women. Home Health Care Management & Practice, 24(4), 205-207.  DOI: 10.2277/1084822312441702.

 

 

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