Lesson Plan For Teaching Deep Breathing Coughing To A Surgical Patient

Learning program

Title of program: Teaching of Deep breathing coughing to a surgical patient

Session 1: Introduction of breathing and coughing exercise to the patient and  Educate the patient the risk factors associated with shallow breathes after a major surgery

Session 2:  Educate the patient about  the techniques for effective breathing and coughing exercise

Session title

Session 1 and 2: Introduction to deep breathing and coughing exercise and  the risk factors associated with shallow breathes after a major surgeryis being given to the patient during this lesson. after that session 2 will be taken in the evening at 6:30 pm

Date

On the 3^rd or 4^th day after the surgery, when the patient is stable and is able to participate in the learning activity

Time

The time will be chosen depending on the fit, emotional, and physical stability of the patient. However, duty changing hours such as 3 pm would be preferred because of double staffing.

Duration

45 min, as the patient would not be able to focus for more than an hour to such topic. session two will be taken for 20 minutes

Venue

In the ICU beside patient

Venue set up requirements

· All the curtains will be closed to maintain privacy

· The lights will be switched on to enhance visibility

· The bed of the patient will be risen so that he could able to engage in the conversation

· The patient will be accompanied by a family member in the room, and a chair will be placed on the other side of the bed for that family member

· A nursing staff will be inside the room for any inconvenience of the patient

Participant description

Dillon Harper, a 57-year-old man, who was admitted to hospital after having triple coronary artery disease. Recently he has completed his Coronary Artery Bypass Grafting Surgery successfully and the doctor has removed his breathing tube as well. He looks hopeful and confident that he will be fit after few weeks.

Participant numbers

Two, Mr Harper and his wife, Jamie Harper. The primary will be focused on Mr Harper and his wife can clear her doubts so that she can help her husband once they return home (Sinclair et al., 2016).

Prerequisite knowledge or skills

The patient knows about his disease and the doctors has informed him that he should do the breathing and coughing exercise. However, he and his wife are unable to figure out the purpose of these exercises. patient did not understand the reason of removal of his breathe tube as he was able to breathe from that tube easily.

Resources required

· Internet connection, laptop for video demonstrations

· Picture folders to aid understanding

· Paper and pen for notes and exercises

· Activity sheet and assessment sheet

· Few rewards for successful learnings  

Aim of the session

· To make the patient aware of the breathing and coughing exercises

· To give him a basic understanding of how breathing and coughing exercise works

· To reduce the patients anxiety and increase his confidence by providing him knowledge.

· Make the patient understand the effectiveness of the exercise and make him learn the techniques of it.

Learning outcomes

By the end of the lesson, the patient will be able to

· Explain  the basics of breathing and coughing exercise

· Identify the difference between normal breathing patterns and shallow breathing patterns

· Explain the need for coughing and breathing exercise after surgery

· Explain the reason due to which, the doctors removed his breathe tube

· understand the risk factors associated with shallow breathing after a surgery

· understand the benefits associated with the breathing and coughing exercises

Component

Time allocation

Strategy

Opening

4 minute

The session will be opened with introduction, as this will help to create a rapport with the patient and her wife. This rapport will be helpful to introduce the topic of discussion followed by a short pre-empt of following events.  

Engagement of  learners

Throughout the session

For this, different videos will be collected, video representation of the exercises will help him to be engaged in the discussion. Further knowledge assessment and rewards will make him engaged in the discussion for such long period.

Assess prior knowledge

4 minute

Few questions will be asked to the patient to understand the knowledge gap and to assess his mental and emotional strength. these questions are :

1. What do you think is happening to you?

2. Why the doctors removed your breathe tube?

3. How are feeling about your health right now? Please choose from the following face chart.

4. What can be the adverse effect of the shallow breathing you are facing right now?

5. How do you think this breathing and coughing exercise will help you in future? (Durmaz et al., 2012)

Body

Time

Content

Learning activity

Rationale supported by literature

Identify chosen educational theory

Physical resources required

Question/Anticipated difficulties

3 minute

Basic knowledge of breathing and coughing exercises including the need of it, its benefits and effects  and the adverse effect of shallow breathing after surgery

A video representation on what is breathing and coughing exercise after surgery. Explanation of shallow breathing technique and the exercise that the patient is going to practice

Verbal explanation can be boring and time consuming. The patient cannot concentrate on the verbal explanation (Smith et al., 2012)

As per the cognitive theory, visual memories are the strongest, therefore video representation has been taken (Greenberg &Knowlton, 2014)

Laptop , internet connection

· Bad internet connection

· too much crowd in the corridor so that patient cannot concentrate

· patient is unable to pay attention due to the effect of medicines

15 min

After completion of the video, recap will be done through verbal discussion and positive points will be rewarded so that patient can engage in discussion

Patient may not understand the medical terms present in the video, and due to medication, his might unable to listen all the points. Hence, further discussion will be done verbally (Tekur et al., 2012)

As per the constructive theory, visual and verbal memory helps to create new concepts and ideas in brain. Therefore, the patient will learn new theories from it. Further, behavioral theory will be applied by which, the educator will engage the patient in the discussion and reinforce knowledge.

Pen, paper, color pens, picture folder. books and pamphlets

· patient is unable to pay attention

· patient do not want to share his knowledge

· patient loss patience of watching the video again after verbal discussion

5 min

Repeat watching videos so that patient can now relate to the discussion

Educator now emphasize on the important points to reinforce the understanding Brown et al., 2016)

2 min

Question and answer (Q&A)

Patient will ask questions to the educator for clarification, his wife will ask questions too.

There are too many questions that can arise after such session; hence question answer session will help to understand the theory properly (Herrman, 2015).

Cognitivism theory has been applied to the situation, as this will help to create knowledge depending on the patients way of understanding

Pamphlets, books

· the patient will not ask questions

· patient ask irrelevant question

After the completion of the session 1, second session will be started at 6:30 pm of that evening this session will last for 20 minutes.

First 4 minute

This section will be for the patient and his wife to recall the learning of previous session

The video will be shown to him to reinforce the understanding.

This will help the patient to understand that whatever is going to be taught next is for his benefit

Behavioral theory, with cognitivism is going be applied to engage patient and his wife.   

Laptop, internet connection and pen, paper.

· the patient will not remember anything

· the patient will refuse for another session on the same day

· the patient will unable to focus on the learnings

10 minutes

This session will be focused on providing training to the patient about the breathing and coughing exercises.

The patient will be shown a video about the exercise. The video will demonstrate the procedure of breathing and coughing exercise. the educator will also provide a live demonstration to reinforce the knowledge

This will help the patient to learn the norms and techniques of this exercise (Lee et al., 2014).

Cognition theory will be applied. as the patient will able to remember the video and the live demonstration for longer time.

Laptop, internet connection

· the patient loses concentration at the education

· the patient feels boring while the educator provides live demonstration

5 minutes

Doubt clearance

The patient will ask questions about the exercise and its benefits. His wife is also included in the course.

This will help to clear the doubts of the patient and educate him with the correct technique (Brown et al., 2016)

Behavioral and cognition theory is applied as the patient understand the basic nuances of the exercise

Pen paper

· the patient does not ask any question

· patient does not understand the process

Conclusion

Time

Strategy

2 min

Patient-lead strategy will be applied. Educator will lead patient to recall breathing and coughing exercise. Educator will prompt him when necessary. This will help to reinforce the understanding. As the patient was unaware of the advantages of the breathing and coughing exercises, this learning session will help to increase his knowledge about the process. Including his wife in the program was an important step as after the hospital; stay, she is going to help the patient with all the knowledge and understanding she acquired during this learning session. Dividing the entire session in two parts was necessary, as it was difficult for the patient to concentrate on the learning program for more than an hour.

Same strategy is applied to assess the learning, as the patient will perform the exercise without any help. If any assistance needed, the wife of the patient is going to help him with her best knowledge and understanding of the process.

Assessment of learning

4 min

· Open-ended questions such is explanation of breathing-coughing exercise will be asked

· His wife will be included in the course so that she can also understand it

· His experience will be assessed through smiley face chart

· The patient’s learning about the exercise will be assessed.

· His knowledge about the adverse effects of shallow breathing and benefits of breathing and coughing exercise will be assessed.

· The patient will try his best to perform the exercises without the help of the nurse and eventually, his shallow breathing problem after surgery will be treated.

· The patient’s wife will be asked the3 questions about the learni8ng and breathi8ng exercise so that the educator can assess her knowledge about this exercise. This is because; the wife of the patient is going to help him with her knowledge after the hospital stay.

· The patient’s mental status can be assessed, if the patient learns the nuances of the exercises in one go. Otherwise, the educator needs to take another session, as this eexercise is very important for the patient after the surgery.