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NATIONAL AMERICAN
BLOOMINGTON CAMPUS

UNIVERSITY
BSN PROGRAM

Nursing 4145: Holistic Nursing Care in Acute Illness II and End of Life Clinical
Learning Plan 3
Teaching/Learning
Discharge planning
Health Literacy
Objective of the Course:
Upon successful completion of this course, the student will be able to:
1. Utilize the nursing process to create a plan of care for the complex patient.
Knowledge and skills leading to mastery of this competency:
a. Use clinical judgment and decision-making skills in appropriate, timely nursing care during
emergency situations.
b. Demonstrate the ability to set nursing care priorities for that group.
c. Interpret, prioritize and perform a sequence of nursing actions based on the patient needs
(nursing diagnoses, interventions, identified nursing actions and evaluation).
d. Evaluate effectiveness of the nursing actions identified in the care plan for a patient.
e. Recommend modifications to the nursing care plan for a patient.
f. Revise the plan of care based on an ongoing evaluation of patient outcomes.
2. Effectively communicate with members of the healthcare team.
Knowledge and skills leading to mastery of this competency:
a. Use written, verbal, non-verbal and emerging technology methods to communicate effectively.
c. Use inter- and intra professional communication and collaborative skills to deliver evidencebased, patient-centered care.
4. Refine the ability to reflect on practice.
Knowledge and skills leading to mastery of this competency:
a. Create an intentional process to reflect on clinical reasoning and nursing experiences.
b. Engage in a reflective nursing practice to provide leadership in promoting advocacy,
collaboration and social justice.
c. Value the ideal of lifelong learning to support intentional reflection and excellence in nursing
practice.
d. Assume accountability for personal and professional behaviors.
e. Recognize the relationship between personal health, self-renewal, reflection and the ability to
deliver sustained quality care.

5. Manage and direct the care of the client with complex psychosocial and/or physiological
health needs.
Knowledge and skills leading to mastery of this competency:
d. Implement evidence-based nursing interventions as appropriate for managing the acute and
chronic care of patients and promoting health across the lifespan.
e. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions.
f. Facilitate patient-centered transitions of care, including discharge planning and ensuring the
caregivers knowledge of care requirements to promote safe care.
g. Provide nursing care based on evidence that contributes to safe and high quality patient
outcomes within healthcare microsystems.
h. Create a safe care environment that results in high quality patient outcomes.
i. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship.
j. Deliver compassionate, patient-centered, evidence-based care that respects patient and family
preferences.
6. Utilize complex teaching/learning theory to complete a teaching/learning activity with
patients and their families.
Knowledge and skills leading to mastery of this competency:
a. Evaluate the use of evidence-based practices to guide health teaching and health counseling
throughout the lifespan.
b. Critique the principles of teaching and learning to the care of patients and their families.
c. Evaluate the effectiveness of your patient teaching.
d. Explain health literacy considerations to foster patient engagement in their care.
Overview:
Client education is a very important role for a nurse. Clients have the right to know and be
informed about their health to make informed healthcare decisions. Teaching plans must be
comprehensive and fit the clients unique learning needs to reduce health care costs and improve
quality of care. Health literacy is a strong predictor of health status; therefore it is essential that
clients health literacy be assessed prior to providing instruction. The readability of printed
health education materials are often above the clients reading level and it goes unnoticed by
health care professionals. This results in unsafe care. To ensure safety, health care providers
must ensure that information is presented in a clear, culturally sensitive manner.

Learning Activities:
http://www.adultmeducation.com/AssessmentTools.html
Rapid Estimate of Adult Literacy in Medicine, Revises (REALM-R)
Medication Knowledge Assessment
http://www.ahrq.gov/populations/sahlsatool.htm
Rapid Estimate of Adult Literacy in MedicineShort Form (REALM-SF)
Review:
Come to class prepared to discuss:
o Health literacy Handout 2
o Components of Discharge planning
Post-class:
o Reflective Journal
Learning Objectives
1. Reflect on ones own beliefs and values as they relate to professional practice.
2. Identify appropriate topics for a clients health education needs.
3. Identify basic learning principles.
4. Differentiate factors that determine the readiness to learn from those that
determine the ability to learn.
5. Write learning objectives for a teaching plan.
6. Use appropriate methods to evaluate learning.

Handout 2
Health Literacy
This activity will be completed during post clinical conference. Please read the following prior to
clinical:
Center on an Aging Society (1999) Low health literacy skills increase annual health care
expenditures by $73 billion. Washington D.C.: Georgetown University. Accessed on the
web 10/6/08 at: http://ihcrp.georgetown.edu/agingsociety/pubhtml/healthlit.html
Institute for Healthcare Advancement. (2008). Easy to use California advance health care
directive. (pdf attached) Downloaded from the web on 10/6/08 at:
http://www.iha4health.org/index.cfm/MenuItemID/266/MenuSubID/195.htm
Center for Medicare Education.(2000).Considering health literacy. Issue Brief Vol. 1
No.6. http://ihcrp.georgetown.edu/agingsociety/pdfs/kieferlit.pdf
Discussion:
1. How can we overcome the frustrations experienced by nurses trying to provide health
care information to clients who have low health literacy skills or limited ESL skills?
2. How do we prevent the frustrations experienced by patients trying to assimilate
healthcare information without relying on printed materials?
3. What other factors might play a role in a patients understanding of health information?
(i.e. medications that cause memory loss, sleep deprivation).
4. What is health literacy? How can nurses assess illiteracy and adapt healthy literacy
teaching?
5. How do low health literacy skills impact patient outcomes? What healthy literacy
resources area available on your unit to assist patients with low health literacy skills?
6. Why is it important to assess patient literacy? How does health literacy play a role in
patient safety?
Reference: Young, J. & Ironside, P. Patient teaching and safety: Exploring health literacy.
Retrieved from http://www.qsen.org/teachingstrategy.php?id=57