Patient Teaching Essay

Introduction: I have chosen breastfeeding as my teaching topic for this assignment. The specific clientà ¨le will be the new mother at between 2 and 7 days postpartum, newly discharged from hospital. As a community health nurse working with children and young families, I do initial postpartum visits at home. Breastfeeding is a very complex skill, natural, yet sometimes difficult to do. The client is often overwhelmed with information received in hospital, so sessions must be kept short, and made easy to understand. The area in which I work is multicultural. There is often a language barrier which further complicates teaching and learning. Finding a teachable moment is easy (London, p. 95). New mothers are eager for help in providing the best for their babies. Mothers whose babies refuse to latch onto the breast or who have an incorrect latch, may sometimes become very tense and stressed. It is important to remain calm and supportive during teaching. The client must be educated, not simply taught new skills (Rankin, p. 73). The newly acquired information will allow her to make her own decisions and to be the head of her own health care team. Assessment: I have been working with postpartum women for the past 6 years, and have 3 children of my own. I am able to use my own personal experiences with breastfeeding, my last having stopped only 2 years ago. I work well with my co-workers, I know that I cannot do it alone (London, p.51). We help each other every step of the way and have a good back-up system available in the community. These include lactation consultants, breastfeeding clinics, doctors, social workers and community agencies. The learner and her family are at the head of the team (London, p.47). They are usually very motivated to learn and ultimately want what is best for the baby. It is easier to form relationships with the client at home (London, p. 63). The environment is non-threatening to the learner and teacher. I can also learn a lot about the client by observing the home. I have had many clients tell me they were breastfeeding exclusively who had half empty bottles of formula on the kitchen counter. The assessment process begins on the telephone before the visit. All new mothers are contacted when they arrive home. All are offered a home visit, some refuse. By help of a detailed questionnaire, we know the problems to focus on before the visit. This is very helpful as we can be better prepared with the necessary tools. Many patients are â€Å"red flag† patients (Rankin, p. 160). Some speak very little English, have financial problems, are on welfare, or are single mothers. Culture and religion can influence teaching (London, p.296). It is impossible to generalize about one culture, so we must be careful to dig deeper when presented with a situation which may be affected by one’s background. The area I work in is multicultural. The women speak many languages and I often need to have a family member translate the teaching. This is sometimes quite challenging as I am not always sure that what is being translated is actually what I am saying! I try not to let my own beliefs get in the way of my patient care. I may not always agree with the decisions of others but always stay focused on the desired outcome. Some clients would prefer to breastfeed and others would prefer to bottle feed but are being influenced by family members. Support from family members generally improves the outcome (Stalling, p.163). The client will have an easier time adjusting to breastfeeding and will breastfeed for a longer period of time with family support. We need to make adjustments in our teaching based on each individuals views. (London, p. 303). We should never make assumptions about anything. Self-efficacy is a very important factor in learning to breastfeed. The learner who thinks she can do it, will be more successful. My department organizes a group that meets at the community center once a week. New mothers have a chance to meet each other and learn about breastfeeding. Using these role-models sometimes helps a woman with low self-efficacy learn to breastfeed (London, p.311). When I walk into a home, I can often tell within the first 10 minutes whether I will have to make a follow-up visit. At a typical visit I assess the baby and mother, help with breastfeeding if necessary and provide the mother with helpful information she will need in the first few months of the baby’s life. A typical visit lasts 1-2 hours. I usually provide printed material on the common breastfeeding problems to my clients. On the website WWW.Medela.com, there is very helpful information on breastfeeding in several languages. I use this site often to print out information on latching, sore nipples and engorgement. The information on the site is generally well written and edited. The vocabulary is easy enough to understand by most women. It is grammatically correct. There are no difficult or very technical terms. The subject in this paper is a mother of two who did not breastfeed her first child. She speaks English and works as a clerk in a drugstore. She has a university degree, so can easily understand information at the 12th grade level. Planning: The general goal of this teaching is for the client to be able to breastfeed in the proper manner and to understand the benefits of breastfeeding in order to prolong breastfeeding for as long as possible. The following are the specific objectives for this clientà ¨le. At the end of the session: The client will state at least 5 benefits of breastfeeding vs bottle feeding. The client will demonstrate 3 different breastfeeding positions one time each. The client will describe the treatments for engorgement and sore nipples. The client will list 3 resources for further information after the visit. The client will recognize and state 3 factors which indicate the baby is receiving sufficient milk from breastfeeding. Teaching tools used will be demonstration, discussion, and hand-outs. It is important to prioritize learning needs. There are some facts which are very interesting but which are not necessary for the client to know. (Rankin, p. 191 and 197). The breastfeeding mother does not need to know the physiology of the breast, but she does need to understand the relationship between frequent feedings and increased milk production. Content outline: Discussion of the benefits of breastfeeding. Discussion of the factors indicating that the baby is receiving sufficient milk. Observation of the client breastfeeding using 3 different positions. Demonstration of proper breastfeeding technique for each position as needed. Discussion of breast engorgement and sore nipples and their management. Discussion of resources for further information about breastfeeding and the assess the need for a follow-up visit. * The teaching is mostly done by discussion and demonstration. This is a good way to get continuous feedback from the client. It is also a good way to ensure that all the important material is not forgotten. Practice makes perfect. Adult learners need to be involved in the teaching (Rankin, p. 196) and want to apply what they learn right away. This is especially important with breastfeeding, as the new mother must be able to master it within a very short time. It is not always necessary to cover all the information with each client. Some are too overwhelmed with information already; others may already have the knowledge base and simply need help with latching. Implementation: I generally start teaching about breastfeeding immediately after having evaluated the client. I begin by discussion of the benefits of breastfeeding and the factors which indicate that the baby is receiving enough milk. Many women do not believe that they have enough milk and worry about the need to offer a supplement. It is important to explain this to them. If they do offer a supplement, their own milk supply may be reduced. Then, I assist the client at putting the baby to the breast using different positions as needed. I sometimes use a dummy breast to show the client the correct angle to use while feeding to ensure a proper latch. Visual aids sometimes help to make it seem more real. When that has been mastered, I continue with a discussion of the two most common problems found in the first weeks of breastfeeding, sore nipples and engorgement. I provide the client with written material on proper latching technique, sore nipple management and engorgement. Since these problems sometimes occur after a few days or weeks, it is helpful for the client to have this information in writing. I also provide an information sheet on the resources the client can use if she should need further help after the visit. I generally make a follow-up call one to three days after the visit and a follow-up visit as necessary. I sometimes refer the clients to the company Medela’s website, www.medela.com. This site provides helpful information on breastfeeding and the common associated problems. The computer is only a tool, however. It provides information, not education (London, p. 246). I remain available to my clients by telephone or by email at all times. Recording transcribed: (T=teacher, L=client) T: Did you breastfeed with your first child? L: No. I tried for about 3 days but gave up due to the pain. T: Did you receive any help? L: No. But it was less important to me then. I was ok with bottle feeding. T: Do you want to breastfeed Joshua? L: Yes. I will be taking a year off of work and would like to breastfeed him as long as possible. Many of my friends have had babies in the past years and all are breastfeeding. They make it look so easy. I decided to try harder this time. T: Joshua is 3 days old. How have you been feeding him? L: I tried to put him at the breast right after birth but he was too sleepy, and so was I. The first day he had a few bottles. Yesterday, I tried for the first time. I think it went ok but my nipples are very sore. I would like to learn how to breastfeed properly. T: Well, we can discuss a few things now and I can show you the proper technique for a few different positions when he wakes up. L: OK T: First of all, why do you want to breastfeed? L: Everyone is telling me that it is the best thing for my baby. T: They are right, but what do you think? L: I want to do what’s best for Joshua. T: Breast milk is definitely the best for babies. One of the best things about breastfeeding is that the milk is always ready. You don’t have any bottles to warm up or prepare, especially at 2:00 in the morning when you’re exhausted. Because it is available right away, you don’t have to make the baby wait. This will make it easier to calm him before he gets too agitated. It is also a great time to bond with the baby and will make Joshua feel more secure. Breast milk is the best thing for your baby. Do you know what colostrum is? L: Yes. I have been reading up on breastfeeding since I found out I was pregnant again. It is the yellow liquid that comes out before the milk comes in. I know that it helps to prevent jaundice. T: Yes that is true. It acts as a mild laxative to encourage the baby to pass his first stools of meconium. It can also help to prevent ear infections and allergies. It is very rich in nutrients and allergies. Did Julia have jaundice? L: No, she didn’t. T: Do you know of other benefits of breastfeeding? L: I know that breast milk is the perfect formula for babies with the exact right nutrients that they need. It keeps babies from becoming overweight. I also know that it can help me lose the baby fat that much quicker. T: That’s true. It can also save you money. The average cost of formula for 1year is about $1800, and that doesn’t include the bottles and other supplies. Breastfeeding requires you to eat about an extra 500 calories per day. This should cost, by comparison about $300 for the year. L: With all the expenses of a new baby, we can use that money for many other things. T: That’s for sure. L: Can breastfeeding keep me from getting pregnant again? T: No. It is not a sure form of contraception. Although it is relatively effective in the first 6 months if you breastfeed exclusively. Some women ovulate as early as 6 weeks postpartum even when breastfeeding. L: Good to know. T: Do you know how to tell if the baby is receiving enough milk? L: He will gain weight. T: Yes. That’s a very good sign in the long run. There are other things as well. He should have at least 3 urines today since he is 3 days old. Then, you should see one more each day until the sixth day. That means that on the 4th day, he should have at least 4, on the 5th day at least 5 and from the 6th day onwards, at least 6 per day. How many has he had today. L: So far he had 1 at 2:00 and another at 7:00. I don’t think that’s a problem. T: Good. We would also expect to see a few stools everyday. They should gradually change from the black meconium stools, to brown and then to yellow. Many breastfed babies have a stool with every feed, but some have only 1 or 2 per day. Both are normal. L: He has one almost every time he feeds. T: That’s great. He should also be satisfied between feeds. That means he would feed every 1 to 3 hours in the first few weeks and have some period in between when he sleeps or remains calm. You told me that he feeds about every 2.5 hours and usually sleeps in between, so it sounds like he is right on target. A baby who is too sleepy and needs to be woken up for feedings may also not be getting enough. Do you have any questions so far? L: No. I’m glad he’s getting enough milk and can’t wait to see if he’s gained weight. T: You mentioned that your nipples are very sore. Have you done anything for the pain? L: I am taking Advil and I was given some Lanolin ointment at the hospital. Do I need to wash it off before I feed the baby? T: No, it is harmless for the baby. The best way to avoid sore nipples is correct positioning at the breast. If you have sore nipples already, I will show you how to have Joshua latch on properly. Meanwhile, for the soreness, you should apply a small amount of your own breast milk on the nipples after each feeding. Then let it air dry as much as possible. After that, you can apply a bit of lanolin. Sometimes it helps to use different feeding positions during the day. L: The nurse at the hospital told me to let my breasts air dry, but that is not easy in the hospital. How often can I use the lanolin? T: You can use it 2-3 times per day. L: Ok. I will try that. T: Your milk has not come it yet, but should come in in the next few days. It usually comes in by the 3rd to 5th day. It is important to feed regularly to encourage your milk production and also to prevent engorgement. Do you know what engorgement is? L: Yes. I was very engorged about a week after Julia was born. T: Engorgement can be very painful and can make it impossible for the baby to latch on properly. (baby wakes up. L gets the baby) L: What should I do if I get engorged? T: Engorgement usually lasts only a few days. Some women just produce more milk than others. If you get engorged, it is important to continue feeding often. You can apply warm compresses and massage your breasts. If it is more severe, you may need to express a bit of milk for relief, which you can do manually or you may need to use a pump. A well-fitted supportive bra may help. L: I have bought a good bra, but haven’t worn it yet. I will send my husband out to buy a pump today. What kind do you recommend? T: It depends on how often you would like to use it. If you are planning to breastfeed all the time, then a manual pump may be enough. There are however, some inexpensive electrical pumps which you can buy for under $40. These may be easier and quicker to use. You can use them to relieve engorgement and to pump if you go out from time to time. L: My friend uses a Safety First pump which is electric. She bought it at Walmart for about $35 and says it works well. T: That’s probably a good choice for you too. Do you have access to the internet? L: Yes T: If you check out the site www.medela.com, you can find information about choosing a pump. If you pump to relieve engorgement, you should only pump for a few minutes. If you pump too much milk, you will only encourage more milk production. L: Thank you, I’ll check the site. Would you like to see how I feed him now? T: Sure. (L puts baby to the breast using cross cradle positioning. The baby does not take enough of the areola so L has pain.) T: He is not on properly. To release the suction, place your finger gently between his gums, like this. In order to get him to latch on well, you first need to make sure that you are comfortable since you will be breastfeeding so often. Use pillows to get yourself comfortable. Take your time and relax before you start. When you are ready, make sure the baby’s nose is facing the nipple. His head should be aligned with his body. Gently stroke his upper lip with your nipple. When he opens his mouth, pull him quickly towards you, so that he can take as much of the areola as possible. L: How do I know if he is taking enough? T: The most important cue is that you will have no pain. Generally the baby’s chin is touching the bottom of the breast, and there is a small space between his nose and your breast. Hold your baby close to you and support his head. There is no normal or standard way to breastfeed. If the baby is feeding well and you have no pain, it is working well. L: I don’t feel any pain now. T: Can you hear him swallow? L: Yes. T: Excellent. Then you are doing it very well. Notice how his body is aligned with his head, he is most comfortable that way. Look at his chin and his nose. See how they are positioned. You can see that he has opened his mouth very wide and is taking enough of the breast. Would you like me to show you how to hold him in some other positions? L: Yes. I would like to learn how to lie down to feed. It would be so much easier at night. T: That’s true. When you’re very tired, it’s a lot easier. The basics are the same. You want to ensure that the baby is facing you and that his body is aligned with his head. Make yourself comfortable. Use a pillow behind your back or between your knees if you need one. (L Demonstrates the technique.) T: That is very good. Are you comfortable? L: Yes, very. And no pain! T: Breastfeeding is not always as easy as some people make it seem. It takes practice. The beginning is a learning process for you and for the baby. Let me show you one more position that you may like to use. This is the football hold. It is easier to use when the baby is small like Joshua; but is sometimes more difficult later on. Hold him so that his legs and body are under your arm, like this. Then place your hand under his head and neck. If you’ve ever played football, that’s how a football is held. L: I don’t like that one. It is much easier the other way. T: Not everybody likes that position. You have to do what’s best for you and for your baby so use the position that’s most comfortable. (Baby weighed – lost 8.5% of birth weight) T: He lost a bit more weight. But that’s normal. Most breastfed babies lose 10% or more of their birth weight in the first few days. They usually regain their birth weight within 10 days. Do you remember how to tell if he is drinking enough? L: Yes. He should have at least 6 wet diapers every day after the 6th day and a couple of stools. He should also wake up alone to feed and sleep well between feedings. And of course, he should gain weight. T: Exactly. T: I will be returning to weigh Joshua again Wednesday (in 48 hrs). I will continue to follow him until he starts to gain some weight. If you need help before then, you can call the CLSC (community clinic) at the number I gave you earlier. As I told you earlier, there is a breastfeeding clinic every Thursday morning as well. At the clinics, there are nurses available to weight the baby and to help you more with breastfeeding. Here is some information on breastfeeding that we discussed today (pamphlets on latching, sore nipples and engorgement given). If you have any questions about them, let me know. Evaluation of learner: I always do a telephone follow-up within 1-3 days. This is very effective as the client will have had some time to process all the information (London, p.62). If necessary, a repeat visit will also be planned. Unfortunately I cannot always have the client do three separate demonstrations (London, p. 386) due to budget and time constraints. Discussion worked best with the subject in this paper. She was educated and was eager to learn proper techniques. She had self-efficacy, skills and knowledge – all important factors if changing behaviors (Rankin, p 292). She was alert and very interested in learning. She participated in the discussion. She was able to apply the information immediately during my visit. At the follow-up visit 2 days later, the client was doing very well. She was able to breastfeed without any pain or difficulty. We discussed engorgement again, a problem which had developed since my first visit. She explained what she had done to relieve the engorgement, which was how I had explained it to her. The â€Å"what if† scenario had worked .(London p.386) Evaluation of teacher: I could have done more assessment of the learner while I was teaching. I find myself being drawn into a routine with my teaching that is sometimes hard to get out of. Most of the teaching is very repetitive from one client to the next, however, each client learns in her own fashion. I try to keep the client interested in what I have to say. I encourage her and give her positive feedback. Sometimes I forget the goals of the session and get off track, or provide the client with unnecessary information. I find that using a checklist helps me to stay on the right track and to not omit anything important. Evaluation of resources: The handouts I usually give out to my clients on latching, engorgement and sore nipples, all score over 70% by the SAM test (Rankin, p.238), thus making them good resources. I provide this information to my clients to use as the situations arise. Although I explain the handouts to all my clients, not all women get engorged; for those that do, it usually happens after my visit. Having the handouts at home allows them to refer to the information as a reference when they need it most. Conclusion: The teaching session went very well. The client was intelligent, educated and eager to learn. Overall this teaching technique used for teaching breastfeeding works well with most of the clientà ¨le I see at home. Every person is unique and adjustments always need to be made accordingly. Bibliography: Forrest, S. (2004). Learning and teaching: The reciprocal link. The Journal of Continuing Education in Nursing, 35(2), 74-79. London, F. (1999). No time to teach? A nurse’s guide to patient and family education. New York: Lippincott. Medela (2007) Your Resource for breastfeeding products and information. [on-line]. Available: http://www.medela.com. Rankin, S.H., Stallings, K.D., & London, F. (2005). Patient education in health and illness (5th ed.). New York: Lippincott.