Jackie McCarthy

Teaching Plan
CRITERIA #1:
LEARNER READINESS:
J.A. is a 69 year old female who is enjoying her retirement. She was formerly
a school nurse (for 20 years) and has a good understanding of medical diagnosis
and rationale. She is currently married and states that her husband is extremely
supportive. I witnessed this at discharge (he asked questions to clarify her
discharge orders and was making arrangements to help her follow them). She has 2
children who have started homes and families of their own, however they are still
very close with their parents. J.A. seems to be psychologically stabile, during the
time that I was speaking with her, her actions/responses were all appropriate. She
also asks appropriate questions and is interested in learning new things. She states
that she learns best by reading, visual aids and discussing material. She normally
likes to be active, however she does acknowledge the importance for rest to
promote healing of her injured hip at this time. She has a history of chronic
constipation and hemorrhoids. She had multiple hemorrhoids banded in January of
2016 and is now suspecting she has developed more.

CRITERIA #2GOAL:
The goal that is being set for J.A. is to decrease the probability of repeat
hemorrhoids by encouraging a fiber rich diet that will promote a healthy bowel
pattern. She will have a set of recipes that she enjoys within 1 month. She will
understand the importance of not straining during elimination and the significance
of maintaining a well hydrated body by discharge.

CRITERIA #3OBJECTIVES:
1. J.A. will choose recipes that include (at least) one fiber rich food each meal. I
am including an article regarding the benefits of increased fiber as well as a
list of fiber rich foods that can be chosen from. She should be able to compile
a small list of recipes that she enjoys within one months time.
2. J.A. will make sure that she has some activity each day (as tolerated). She
will gradually increase her activity as her hip heals to promote regular bowel
movements. (J.A. stated that she enjoys walking.) She will have increased
her movement to at least mile per day within one month.
3. J.A. will increase her water intake to include (at a minimum of) eight (8 oz)
glasses of water (or other noncaffeinated, nonalcoholic fluidsfruit/vegetable
juices, clear soups and herbal or decaf teas are other good choices) by the
end of each day. She will have worked up to this amount by her follow-up
appointment in 2 weeks.
4. J.A. will not ignore the urge to have a bowel movement. She will get to a
bathroom within 10 minutes (preferably sooner if possible). She will also

Jackie McCarthy
Teaching Plan
avoid excessive straining. This is to begin immediately and continue for (at
least) one month.

Jackie McCarthy
Teaching Plan

CRITERIA #4IMPLEMENTATION:
1. J.A. will use the list of fiber rich foods to create new meals and or substitute
fiber rich foods for less healthy choices in her current recipes. I will give J.A.
the list of fiber rich foods to choose from along with some sample recipes. I
will verify that she understands what she is expected to do by asking open
ended questions.
2. I will go over acceptable activities with J.A. and set daily goals (that she feels
she will be able to accomplish) with her so she is able to meet the mile
goal in 1 month. I will advise her not to overdo it and give her signs that she
should stop (extreme pain, dizziness, etc.) and rest. I will also teach her that
some pain will be normal and ways to alleviate this normal discomfort. Pain
alleviation methods that will be discussed include: medicate before/after the
activity (non-opioid if possible), ice, rest, etc. I will verify that she
understands this information by asking open ended questions.
3. I will explain the reason why staying hydrated is important to patients that
have issues with chronic constipation. (When you are dehydrated your body
pulls water from your bowels to maintain fluids and therefore causes your
stool to become dry and hard and more difficult to pass.) I will help her think
of ways to remember to drink (set an alarm, get a special cup and leave it in
open sight, etc). I will again verify understanding with open ended questions.
4. I will discuss with J.A. the reasons that going to the bathroom as soon as the
urge is felt is important and what can occur with extreme straining.

CRITERIA #5
EVIDENCE-BASED RATIONALE FOR CONTENT:
1.

Scientific evidence links fiber intake to a plethora of health benefits,

including treating and preventing constipation, hemorrhoids and
diverticulosis.
a. Since this patient has chronic constipation and has already had
hemorrhoids repaired recently, I would like to encourage her bowels to
move as efficiently and as naturally as possible. Encouraging a fiber
rich diet is one method of doing that.
b. Palmer, S. (2008, July). The Top Fiber-rich Foods List. Retrieved from
http://www.todaysdietitian.com/newsarchives/063008p28.shtml
2. Physical activity increases muscle activity in your intestines.
a. J.A. needs to encourage her bowels to keep moving, increasing her
movement should help with that.
b. Mayo Clinic. (2013, August 31). Constipation Treatments and drugs.
Retrieved from http://www.mayoclinic.org/diseasesconditions/constipation/basics/treatment/con-20032773.
3. Water is important for your digestion. It keeps the food you eat moving
along through your intestines and it keeps your intestines smooth and

Jackie McCarthy
Teaching Plan
flexible, too. Dehydration is one of the most common causes of chronic
constipation.
a. J.A. has a history of dry, hard stools. Increasing her water/fluid intake
should increase the amount of water in her bowels and lead to softer
stools that are easier to pass.
b. Robinson, J. (2014, October 6). Water, Constipation, Dehydration, and
Other Fluids. Retrieved from http://www.webmd.com/digestivedisorders/water-a-fluid-way-to-manage-constipation.
4. Never ignore the urge to go to the toilet. Ignoring the urge can significantly
increase your chances of having constipation. The best time for you to pass
stools is first thing in the morning, or about 30 minutes after a meal.
Excessive straining can also lead to hemorrhoids.
a. J.A. has a long term history of constipation and hemorrhoids, therefore
we do not want to have her doing anything that may encourage her
bowels to decrease their function and/or increase the likelihood of her
straining (which may lead to more hemorrhoids).
b. Nursing Times. (2009, February 20). Constipation. Retrieved from
http://www.nursingtimes.net/constipation/1995089.fullarticle.

CRITERIA #6
TEACHING STRATEGY OR ACTION:
The strategies that I am going to use to educate J.A. are self-directed learning
and individualized one on one session. Self-directed learning is the use of written
material or media designed to assist the patient with information about health
topics, a particular disease, treatments, or a specific skill (Giddens, 2013, p. 398).
One on one education is an informal type of patient teaching that occurs between
the healthcare provider or nurse and the patient/patients family (MedlinePlus,
2014).

Giddens, J. (2013). Concepts for nursing practice. St. Louis, MO: Elsevier.
MedlinePlus. (2014, February 4). Maximizing your teaching moment:
MedlinePlus Medical Encyclopedia. Retrieved from
https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000460.htm
Updated by Linda J. Vorvick, MD, David Zieve, MD, and Isla Ogilvie, PhD on
April 5, 2016.

CRITERIA #7
EVIDENCE-BASED RATIONALES AND RATIONALES FOR TEACHING STRATEDY OR
ACTION:

Jackie McCarthy
Teaching Plan
1. Scientific evidence links fiber intake to a plethora of health benefits,
including treating and preventing constipation, hemorrhoids and
diverticulosis.
a. I will be teaching this information by self-directed learning (with the
Top Fiber Foods handout), then I will verify understanding with one on
one session. I chose to do it this way because reading is one of J.A.s
preferred methods to learn. (see pt handout)
b. Palmer, S. (2008, July). The Top Fiber-rich Foods List. Retrieved from
http://www.todaysdietitian.com/newsarchives/063008p28.shtml.
2. Physical activity increases muscle activity in your intestines.
a. I will teach this information in a one on one session with J.A. With this
method I am able to explain to J.A. exactly why decreased movement
causes constipation. I will also encourage that J.A. documents her
activity in her stool diary. I am including a sample stool diary so I am
able to explain the significance and so she has a visual aid (one of her
preferred learning methods). This should make it easier for J.A. to see
what is affecting her bowel habits and which things are not having an
effect. (see pt handout)
b. Mayo Clinic. (2013, August 31). Constipation Treatments and drugs.
Retrieved from http://www.mayoclinic.org/diseasesconditions/constipation/basics/treatment/con-20032773.
3. Water is important for your digestion. It keeps the food you eat moving
along through your intestines and it keeps your intestines smooth and
flexible, too. Dehydration is one of the most common causes of chronic
constipation.
a. I will teach this in a one on one session, I will explain, and show with a
diagram, J.A. how dehydration can affect healthy bowel movements. I
chose this method because J.A. stated that she learns well with visual
aids. (see diagram)
b. Robinson, J. (2014, October 6). Water, Constipation, Dehydration, and
Other Fluids. Retrieved from http://www.webmd.com/digestivedisorders/water-a-fluid-way-to-manage-constipation.
4.

Never ignore the urge to go to the toilet. Ignoring the urge can significantly
increase your chances of having constipation. The best time for you to pass
stools is first thing in the morning, or about 30 minutes after a meal.
Excessive straining can also lead to hemorrhoids.
a. I will teach this in a one on one session why a person should not wait
to go to the bathroom when they feel the urge (especially those with a
history of constipation). I will also use the diagram for this so J.A. can
relate this information to the picture.
b. Nursing Times. (2009, February 20). Constipation. Retrieved from
http://www.nursingtimes.net/constipation/1995089.fullarticle.

Jackie McCarthy
Teaching Plan

CRITERIA #8
PATIENT SPECIFIC RATIONALE:
I chose self-directed learning because J.A. stated that reading is one of her
preferred learning methods and it is something that she enjoys. I will also teach her
how to determine the reliability of websites. Then she will be able to do research on
her own. I decided to further educate J.A. by using a one on one session so I could
verify her understanding of the material (such as things that she can do to ease her
symptoms and promote alleviation of her constipation). I will also use this
opportunity to go over the information that I have for her (guide to fiber rich foods,
power pudding recipe, the stool diary & the diagram of the bowels) and verify that
she understands the significance of each. I added the visual aids into the one on
one session because J.A. stated that she enjoys learning from visuals. I chose to use
3 methods of teaching because I wanted to expose her to the materials using
multiple senses and give her multiple means to remember the information so she is
more likely to retain it.

Giddens, J. (2013). Concepts for nursing practice. St. Louis, MO: Elsevier.
MedlinePlus. (2014, February 4). Maximizing your teaching moment:
MedlinePlus Medical Encyclopedia. Retrieved from
https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000460.htm
Updated by Linda J. Vorvick, MD, David Zieve, MD, and Isla Ogilvie, PhD on
April 5, 2016.
Fritz, D., & Pitlick, M. (2012, October). Evidence About the Prevention and
Management of Constipation. Retrieved from
http://journals.lww.com/homehealthcarenurseonline/Fulltext/2012/10000/Evid
ence_About_the_Prevention_and_Management_of.7.aspx

CRITERIA #9
EVALUATION:
J.A. responded to the teaching well and asked questions until she was sure
that she understood the information and was able to recite back to me the things
that I had taught her. She stated that the stool diary may take some time to
remember to use for each encounter but that she will continue to record as she
remembers. She was looking through the list of fiber rich foods and working on
recipes that she could substitute these foods into. She has been attempting to walk
a couple of times a day while in the hospital so she can meet her goal in 1 month.
She is also working on going to the bathroom whenever she feels the urge and is
attempting not to stain as much.

Jackie McCarthy
Teaching Plan
CRITERIA #10
HOW WOULD YOU RIVISE FOR THE NEXT TIME:
I believe that J.A. responded to the patient teaching session/methods that
were provided. The only thing that I can think to change next time would be to
adapt the education to that particular patient and to their preferred learning
methods/learner readiness/etc.