Lesson Title: Self-care education for older adults with myocardial infarction.
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Identification and Description of the Learners
The learners for this lesson project are older adults who experienced myocardial infarction and are prepared for discharge from the hospital. Older adults with conditions such as myocardial infarction make vulnerable populations because they frequently lack self-care abilities and thus are at high risk of complications or readmission to hospital. The post-discharge period is critical for patients with this disease, therefore they need to be educated about the peculiarities of self-care to provide a successful recovery and preserve the quality of life.
The Educational Setting
The educational setting for this lesson is patient education provided at a hospital. Generally, nurses are responsible for this type of intervention. This lesson is suitable for patients with myocardial infarction before their discharge to provide them with the necessary information about the peculiarities of self-care in their condition. Moreover, this educational setting implies informing learners about risk factors for myocardial infarction and, consequently, ways to avoid its occurrence.
Learner assessments are necessary to increase the effectiveness of the educational intervention. Thus, the learners for this lesson will be assessed by a couple of parameters, which will allow their division into groups depending on their condition. One of the aspects to assess among patients with myocardial infarction is comorbid conditions that can negatively influence a patient’s treatment and limit the ability for self-care after discharge (Dickson, Buck, & Riegel, 2013).
For example, such diseases as diabetes, hypertension, anemia, and chronic obstructive pulmonary disease are typical of patients observing certain heart problems. Another component to assess is the ability to provide self-care management. It depends on the complexity of every separate case. Thus, patients who do not recover quickly will be involved in the dependent care provided by relatives or other caregivers. Also, the level of knowledge of learners about self-care interventions necessary for recovery after myocardial infarction should be assessed.
It will allow dividing learners into groups of those who do not know self-care principles and those who have the basic knowledge. Finally, a readiness to learn can be evaluated to discover the necessity of motivational strategies for those learners who prove to be not interested in self-care manipulations. On the whole, the assessment of learners is expected to provide data necessary for adjusting the lesson plan to the needs and peculiarities of the learners and making them interested and involved.
Purpose and Rationale
The purpose of this lesson is to apply an educational intervention to older adults with myocardial infarction to develop their self-care habits thus stimulating their rehabilitation in the post-discharge period. Myocardial infarction was selected as a condition for this lesson due to several reasons. First of all, it is one of the wide-spread health problems globally. Thus, every year, there are 32.4 million people all over the world who experience myocardial infarctions and strokes (World Health Organization, 2018). Moreover, myocardial infarction increases the risk of further coronary and cerebral events or recurrent infarctions. Therefore, there is a need for interventions that allow patients to adhere to the prescribed treatment and acceptance of healthier lifestyles after discharge from the hospital.
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It is evident that heart problems negatively influence the quality of life of patients. The more severe myocardial infarction is; the more serious consequences it has for the state of health of patients (Lewis et al., 2014). Consequently, patients with acute myocardial infarction have fewer opportunities for organizing self-care than individuals with mild forms. Finally, the learners need information about the risk factors for myocardial infarction to avoid them and thus prevent the reoccurrence of this condition.
Such risk factors include a poor diet rich in fats and sugar, smoking, hypertension, a lack of physical exercise, and refusal to take the prescribed medication. Therefore, an educational intervention aimed at patients with myocardial infarction has the potential to increase awareness of the significance of the appropriate self-care and its impact on successful recovery.
Theoretical Basis for Teaching Approaches
One of the nursing theories that can serve as a theoretical basis for this lesson is Dorothea Orem’s Self-Care Deficit Theory. The theory itself includes several minor theories such as the theory of self-care, the theory of dependent-care, the theory of self-care deficit, and the theory of nursing systems (Alligood, 2014). All of them are suitable to the problem of self-care in patients with myocardial infarction, who are the target learners for this lesson.
To explain the necessity of self-care for the learners, its definition can be applied. Alligood (2014) determines self-care as a set of activities designed and executed by individuals “in the interest of maintaining life, healthful functioning, continuing personal development, and well-being by meeting known requisites for functional and developmental regulations” (p. 244). In the context of myocardial infarction, it is important to include the concept of dependent care.
It is the type of care arranged for individuals who cannot provide self-care as a result of poor health or age-related factors. In case self-care is not provided in the necessary volume, self-care deficit develops. It implies the discrepancy between the therapeutic self-care demands and the ability to execute self-care. The last minor theory is that of nursing systems. As related to the problem of this lesson, nursing systems will include the sets of nursing actions aimed at coordination of care for patients with myocardial infarction to satisfy the minimal therapeutic demands and preserve the quality of life.
The major implication of self-care deficit theory is the role of a nurse who is involved in case patients, their families or caregivers fail to provide effective self-care. As for the suggested lesson, it implies a nurse as an educator able to communicate the importance of self-care to patients (learners) and assess their ability to provide this care individually.
The philosophy of self-care is interrelated with the preliminary Maslow’s Hierarchy of Needs (Doenges, Moorhouse, & Murr, 2014). In the context of this lesson, the lowest tiers of Maslow’s pyramid should be satisfied to provide patients with the minimum necessary for physical recovery after myocardial infarction. Since the basic needs are satisfied, patients are expected to be motivated to achieve psychological needs and those of self-actualization.
Speaking in more detail, a patient after myocardial infarction needs absolute satisfaction of physiological needs which, according to Maslow, include food, water, warmth, and rest. Another set of needs significant for successful recovery is those of safety. It means that the patient after myocardial infarction needs a secure and safe place for recovery. In case the condition of the patient allows providing self-care to satisfy these needs, the patient does not need help from outside. Nevertheless, for those patients who cannot provide themselves with basic physiological and safety needs, the involvement of help is appropriate. It is possible to involve family, other caregivers, or a nurse. Thus, within the lesson, learners should be informed about the sources of help in case they need it.
On the whole, teaching approaches will be directed on the development of self-care abilities and awareness of the importance of satisfying the basic needs. They are expected to teach the learners about the importance of treatment compliance as a part of self-care and a contribution to safety. For example, the usual medicine prescribed for patients after myocardial infarction is aspirin, statins, and beta-blockers (World Health Organization, 2018).
Since hypertension is a frequent comorbid condition for myocardial infarction, the peculiarities of anti-hypertensive treatment should also be included in the lesson. Another significant teaching approach will be directed at stimulating the lifestyle change. Thus, smoking, an unhealthy diet, and the lack of exercise are the risk factors for myocardial infarction and should be addressed in discharge educational intervention because healthy habits are crucial for self-care and satisfaction of the basic needs of a person.
To summarizing, it should be mentioned that lessons of patient education need to be individualized to address the needs of every patient. Thus, the assessment of learners is a necessary step that allows identifying patients with similar problems. Moreover, this assessment provides an opportunity to adjust the lesson to the needs of learners and thus increase its effectiveness. Finally, such lessons are expected to improve patient outcomes due to the evolution of awareness of the importance of self-care, which is particularly important for patients in acute conditions such as myocardial infarction.
Alligood, M.R. (Ed.). (2014). Nursing theorists and their work. St. Louis, MO: Elsevier Mosby.
Dickson, V. V., Buck, H., & Riegel, B. (2013). Multiple comorbid conditions challenge heart failure self-care by decreasing self-efficacy. Nursing Research, 62(1), 2-9.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans. Guidelines for individualizing client care across the lifespan (9th ed.). Philadelphia, PA: F.A. Davis Company.
Lewis, E., Li, Y., Pfeffer, M., Solomon, S., Weinfurt, K., Velazquez, E., … Reed, S. D. (2014). Impact of cardiovascular events on change in the quality of life and utilities in patients after myocardial infarction. JACC: Heart Failure, 2(2), 159-165.
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World Health Organization. (2018). Prevention of recurrences of myocardial infarction and stroke study. Web.