Running head: PATIENT EDUCATION: ABSTAINING FROM ALCOHOL 1

Patient Education: Abstaining From Alcohol

Taylor Hughes
University of New Hampshire












PATIENT EDUCATION: ABSTAINING FROM ALCOHOL 2
Patient Education: Abstaining From Alcohol
Alcohol abuse is a major issue in the Greater Manchester area. On the medical
surgical floor at Catholic Medical Center there are any where from two to three patients
at any given time that are there for abusing alcohol. These patients abuse alcohol for
different reasons including financial problems, as coping mechanisms, to increase self-
esteem, and numerous other reasons. When working with these patients it is important to
find out where they are in their life and how ready they are to accept help. If the patient is
not ready to accept help all the teaching in the world will not do anything. However,
some patients are ready to learn and get the help that they need.
According to the CDC in 2010 64.9% of U.S. adults were current drinkers and
5.4% of adults were considered heavier drinkers. Heavy drinking is classified as women
having 7 or more drinks in a week and men having 14 or more drinks in a week
(Rothwell, 2013, p.5). Alcohol abuse accounts for around 88,000 deaths annually in the
U.S., which makes this the third leading life-style related death in the U.S. (CDC, 2014).
Excessive alcohol use can lead to many devastating consequences, including risky
behaviors, drug use, organ failure, brain damage, and even death. One disease in
particular that pertains to my patient is Wernicke encephalopathy. According to the
NIAAA (2004), 80% of alcoholics have a deficiency in thiamine which can lead to
serious brain disorders such as Wernicke encephalopathy. Symptoms of this disorder
include mental confusion, paralysis of nerves, and difficulty with muscle coordination.
This disorder can be very severe and devastating.


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Patient Background
In December of 2013 a 25-year-old white male was admitted to Catholic Medical
Center for Wernicke encephalopathy due to excessive alcohol use. This patient was found
in a snow bank unresponsive and was sent to the emergency room. Upon arrival the
patient was intubated, stabilized, and sent to the ICU. After being in the ICU for two
weeks the patient was extubated and was able to sustain all vital functions on his own.
Due to this patients diagnosis he was unable to walk, articulate words, and had terrifying
hallucinations. Although the patient was having these symptoms, he was still cleared to
leave the ICU and be admitted to the medical surgical floor.
While on the medical surgical floor this patient was slow to make progress. The
staff did not think he would recover from the significant damage that had been done to
his brain. However, over the month of February the patient started to become more vocal
and his movements became more fluent. With the help of OT and PT the patient regained
full mobility and slowly regained most of his speech back. His transformation was
unexpected and touched everyone that was involved in his care during his stay. Most
people would expect this patient to abstain from alcohol and drugs once discharged but
despite all that this patient went through he continually joked about wanting to get out so
he could have a drink. As the nurse taking care of this patient, I felt that it was vital to
teach him about abstaining from alcohol upon discharge.
Learning Needs
This patient has several learning needs that should be addressed before his
discharge. Before implementing any teaching plan though it is important to find out if the
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patient is ready to accept help. The three most important learning needs include learning
ways to cope with lifes stressors instead of using alcohol, the different consequences of
continuing to use alcohol, and the avoidance of different drugs that can be habit forming.
This patient lacks the proper information about how harmful alcohol can be and he does
not understand the consequences he could have suffered. The most important of the three
is teaching him different ways to cope with stress and life problems. Rather than drinking
to avoid dealing with these problems, he needs to find more therapeutic ways to cope.
The next most important learning need is teaching the different consequences he
could have suffered and most likely will suffer if he resumes drinking after his discharge.
This patient was lucky to have made almost a complete recovery. According to the
NIAAA (2004), 80-90% of alcoholics with Wenickes encephalopathy also develop
Korsakoffs psychosis, a chronic and debilitating syndrome characterized by persistent
learning and memory problems. He happened to be one of the 10-20% who did not get
this syndrome. However, it is important to note that with all the damage he has already
done to his body he is more susceptible to the severe consequences should he resume
drinking.
The final thing that he needs to be taught is information about the different drugs
that are habit forming and should be avoided. People with alcohol problems are more
likely than the average person to try other drugs (NIAAA, 2008). With his abusive and
habit forming characteristics this patient is much more likely to become addicted to other
drugs if he were to try them. He may think that using other drugs, instead of alcohol, will
solve his problems. To help this patient succeed after discharge, he needs to have the
proper knowledge of techniques and a support system that will aid him in recovery.
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Student Knowledge
Before going into this situation I would want to be educated on the topics that I
would be discussing and teaching the patient. For alcohol abuse I need to know different
reasons for why people abuse alcohol. According to Melemis (2014), People use alcohol
to escape, relax, reward themselves, and to relieve tension. When teaching this patient I
need to figure out what caused this patient to drink. Also, I need to know the different
effects of alcohol on a persons social life and their body. According to the CDC there are
short term and long term health risks associated with alcohol abuse. Short-term risks
include: minor injuries, violence, risky behaviors, and alcohol poisoning. Long-term risks
include: stroke, cardiovascular problems, depression, anxiety, social and family
problems, cancers, liver diseases such as hepatitis and cirrhosis, and pancreatitis (2014).
It is important to find out information on different local support groups in the
community such as AA. According to the NH Area Assembly of Alcoholics Anonymous
there are eleven different AA locations in the Manchester area alone and there are several
more in the state of NH that are readily available for patients. In reference to Alcohols
Anonymous (2014), 82% of those that attend AA meetings said it played in important
part in their recovery from alcoholism. In addition, I need to find ways to teach the
patient about the different coping mechanisms to help him deal with his issues. Melemis
gives examples of different ways to cope when he states, Recovering alcoholics need to
figure out what their high risk situations are and try to avoid them, learn to relax without
alcohol, and be honest with yourself because addictions require lying (2014). When
teaching this patient about different ways to cope I need to find out what his high-risk
situations are and teach him different ways to relax.
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The final thing I need to be educated on is the different drugs that are easily
available to patients and ways to avoid them. Patients with a history of alcohol abuse are
more likely to use drugs to help fill the void that alcohol used to. Ahmad (2004) said,
Many people begin and continue to use drugs because they want a pleasurable change in
their state of mind. Some of these drugs include cocaine, heroin, marijuana, and
hallucinogenic. All of these drugs have different but equally severe consequences. Also,
if this patient were to start using drugs it increases the risks of starting to abuse alcohol
again.
Assessment of Patients Learning Styles
After obtaining all the necessary information that is needed to teach this patient, I
need to find out what this patients particular learning needs are. How does he learn and
what will make this process easier for him and I? It was noted in the patients chart that
he did not finish high school. With this information in mind I would want to include
visual information and minimal literature. . Forty percent of all clinic patients tested
read at a 5
th
grade level or below, said experts Andurs and Roth in their recent literacy
review. Therefore, if reading material is included it should be at a lower grade level so
the patient will be able to understand the material
Although the client jokes about wanting to drink the staff has a feeling that this is
his way of asking for help. He seems as though he is too embarrassed to admit that he has
a problem. During our initial meeting to discuss the teaching plan it is important to judge
how he feels about the different ideas in the teaching plan. If he seems receptive and
understanding that he has an issue than it is okay to pursue with the teaching plan. Once I
know the patient is ready to learn about abstaining from alcohol, it is important to make
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the teaching session concise and helpful for this patient. I want him to get the most out of
this session as possible.
In the stage of change model this patient is between a stage two of contemplation
and stage three of preparation. This is due to the fact that we know the patient is aware
that he has a problem but we are not sure if he is completely ready to take actions to fix
the problem or is just saying he wants to in order to please us. However, if in fact the
patient is ready to make changes it is important for us to help him set goals and priorities
in order to move on to the next stages of action and adaptation.
An impairment and barrier that I should consider before going through with the
teaching plan is his inability to read well. We need to be conscious of what the level of
information I am going to present to him is at. I do not want to make it too complicated
that he will not understand what I am saying. Yet I do not want to make it so simple that
he does not understand the full seriousness of the situation.
Goals
I have all the necessary tools ready to do the teaching plan I just need to figure out
when the best time to implement the teaching plan will be. I figured after lunch would be
a good time to sit down together because it is quiet on the floor and we will be able to be
alone and undisturbed. When we get together the first thing we want to talk about is what
does the patient want from this. What does he want to learn and take away from this
session? I knew that in the time we would have together it was possible for me to teach
him about ways to relieve tension and also help him find an AA group that would work
for him. These were the most important things to teach in the time we had together
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because these are the skills that will help him be the most successful once he is
discharged.
Two behavioral objectives that I came up with included ways to relieve stress and
ways to find an AA group to meet the patients needs. The first one was about ways to
relieve stress. It states that before discharge the patient will come up with four different
methods for relieving stress that are constructive, he is also to use at least two of these
methods while in the hospital to demonstrate that he can effectively relieve stress from
these mechanisms. In order to measure his progress the nursing staff will observe him
during stressful situations and take note at how he handles them. After the situation has
deescalated, the nurse who witnessed the situation will debrief the patient to find out how
he feels he handled it and work on ways to improve. This objective is both behavioral and
affective. It is behavioral because we are trying to change the patients current behavior
of using alcohol to relieve tension by coming up with different coping mechanisms to
relieve tension. It is also affective because it is changing the patients attitude on how he
lets tension and stress affect him.
The second learning objective is aimed towards finding an AA group that will
work for the patient and improve the patients attitude about accepting outside help. It
states that the patient will come up with three different reasons why he wants support
upon discharge. It also says the patient will find an AA group that he will be able to
attend 3-4 times a week. The patient will look at the locations of the different AA
meeting places and find one that is accessible to him at his household location. He will
sign up for 3 meetings at a specific location before discharge. Nursing staff will help the
patient find out the different locations, times, and schedules of meetings in Manchester.
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Upon discharge the patient will continue to sign up for meetings because of the different
reasons he wants outside help. If he stops attending meetings, he will agree to let his
family step in and intervene. This objective is affective because it is changing his attitude
toward accepting help. It is also cognitive because AA meetings will increase his
knowledge and awareness on ways to avoid alcohol.
If in the teaching session there is extra time the third learning objective will be
about discussing different drugs that can be addictive and ways to avoid them. The
patient will name three drugs that could be potentially addictive and harmful to the
patient. He will state 2 different reasons of why he should avoid them. He will also state
3 ways to avoid using drugs should he feel the need to engage in such behaviors. Should
he start using drugs to cope he will agree to let his family step in and intervene. This
objective is cognitive because it will teach him about different habit forming drugs and
ways to avoid them.
Teaching Strategies
This teaching strategy is a cognitive learning theory. I choose this because it
seemed appropriate for this patients situation and it allowed me to measure his progress.
It also allowed the family to be involved because they could help monitor his success
after discharge. Involving family in the care of a recovering alcoholic is very important
for the patient to remain sober. There are three steps involved in cognitive teaching: the
initial teaching of the information, the creation of strategies and ways to incorporate the
information into a plan, and the determination of whether the patient feels confident in
achieving these strategies. In order to evaluate the teaching plan it is important to make
sure that step one is complete and the patient understands all the information that is being
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taught. Before discharge the staff also needs to make sure that step two is starting to be
established if not already also accomplished. The final step will not be able to be
evaluated by the staff however if his family is included in the teaching they can monitor
the final step to make sure that the patient is achieving his goals and staying on track.
Outcome
During the teaching with this patient he was very receptive to accept my advice
and help. He agreed to go to AA and told me he wanted to go see a counselor of some
sort to establish an effective coping mechanism. I had not thought to ask the patient to go
to consoling so I was thrown off guard when he asked for this. I adjusted appropriately
though and told him social work would come talk to him and set him up with a counselor.
Due to the fact that he wanted to see a counselor to establish coping mechanism, I
skipped over teaching him about coping mechanisms. I did however establish the goal of
talking about different habit forming drugs and ways to avoid them. I also helped him set
up a site to go to AA meetings at.
As I was performing this teaching plan it felt good to help the patient. He was
excited to get this information because it made him feel like he was one step closer to
recovery and getting out of the hospital. As I was teaching him I was watching to see if
the patient was paying attention and grasping the information I was giving him. The
patient did seem to understand what I was saying and seemed excited. The only thing I
was concerned about was whether or not the patient was being genuine or not. I
sometimes got a sense that the patient was just trying to please me. Other times though he
acted interested and seemed as if he was absorbing the information.
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I think that my teaching session with this patient was about 75% effective. I
covered 2 of the 3 topics I wanted to discuss and I did it in a concise manor. The learning
environment was welcoming and invited the patient to engage in the conversation. I did
not just sit there and talk on and on; I let the patient put in his input. I also made him get
involved by asking his opinion and making him come up with goals. If I were to do this
teaching plan over again I would want to be more informed about different types of
counseling services. I also would want to have talked more about coping mechanisms
despite the patient not wanting to. This could have been beneficial in his recovery.
Conclusion
In nursing you deal with all types of patients. This patient allowed me to take a
good amount of time to come up with a teaching plan and I had an adequate amount of
time to implement it. However, this is not always the case in nursing. In this career you
have to be ready to teach patient about any situation in a time crunch. Having had this
opportunity, I realized how much work it actually takes to make a teaching plan effective.
Even with all the time I had the plan was only about 75% effective. It makes me wonder
how effective patient teaching is when nurses do it quickly. It just showed me how
important patient education is and why nurses need to spend more time emphasizing it
and not just quickly doing it.





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