Draft of Discharge Teaching Plan Research Paper
Currently, approximately 85.4 of every Asian-American persons are suffering from osteoporosis in the USA. Across all age groups and gender, the condition is more prevalent in females above the age of 45years (post-menopause) and males below the age of 45 years (Cauley, 2011). Statistics of this kind among the Asian-Americans are in part due to the lactose intolerance that restricts their intake of calcium-rich foods.
Draft of Discharge Teaching Plan Research Paper
As such, this condition is significant to the Asian-American population and deserves a quick remedy that will help fix the current situation. Central to this aspiration is patient education, which will facilitate understanding of the condition among persons of this cultural group. In essence, this discussion aims at coming up with a discharge teaching plan that will empower the Asian-American population with information about the condition, its management and follow-up care as they leave medical facilities.
Learning Needs of the Asian-American Patients
The Asian-American patients with osteoporosis have very specific learning needs that nurses need to address in their plan of care. The focal point of all the learning needs is to manage osteoporosis and prevention of complications of osteoporosis. The learning needs of osteoporosis addressed by this teaching plan include knowledge of how to manage the disease process, knowledge of medications, activity level as well as restrictions, nutritional needs and follow-up criteria.
Goal of Discharge Teaching Plan
The overall goal of the discharge teaching plan is to impart the patient with the knowledge that will enable him/her to make self-driven behavioral changes, which will help better his/her overall health status as well as manage his/her osteoporosis.
Objectives for the Discharge Teaching Plan
The discharge teaching plan objectives for the osteoporosis patient are worth noting as they offer an end towards which patient education strives to reach. The objectives include the following:
The patient will be able to:
- demonstrate an understanding of the management of the disease process
- describe how and when to take the medications used to manage the osteoporosis
- demonstrate an understanding of the need for balance between maintenance of activity level and restrictions
- explain the nutritional needs for osteoporosis
- demonstrate an understanding of the notification or follow-up criteria with the physician
Discharge Teaching Plan for Osteoporosis
At discharge, the plan of instruction for a patient with osteoporosis will entail five crucial topic areas that encapsulate the formulated objectives for this plan. The topics include a general overview of osteoporosis, treatment, activity level as well as restrictions, nutritional needs, and follow-up criteria. Alongside these themes, a question/answer session is also a priority area of the teaching plan. Each topic area will take a maximum of 30minutes. The breakdown of how the nurse will teach these subjects is as shown in the table below:
| Topic/Activity | Duration | Doer |
| Overview of osteoporosis | 30 minutes | Nurse |
| Treatment | 30 minutes | Nurse |
| Activity level and Restrictions | 30 minutes | Nurse |
| Nutritional needs | 30 minutes | Nurse |
| Follow-up Criteria | 30 minutes | Nurse |
| Question and Answer/ Clarification session | 30 minutes | Nurse |
General Overview of Osteoporosis
Osteoporosis patients need to understand what this disease process entails. Such is the case given that persons who know what osteoporosis brings with it are more likely to comply with the instituted management strategies. As such, the content for patient teaching under this topic includes the definition of osteoporosis, risk factors, and its management.
Firstly, osteoporosis refers to a metabolic disease that affects the bones of an individual following the different bone formation and bone resorption processes. In normalcy, both the two processes are equal (Drake, Clarke, & Lewiecki, 2015).
Secondly, the patient needs to understand the risk factors for this condition so that they can they can adapt behaviors that will protect them from its complications. The predisposing factors include but not limited to the female gender (due to factors like menopause, lower bone mass), advanced age (above 65 years), race (Asian-Americans most affected in part due to the lactose intolerance that restricts their intake of calcium-rich foods) and alcohol intake(Khandewal, Chandra, & Lo, 2012).
Lastly, the patient must understand the management strategies that are essential for correcting this disorder. The management of the patient with osteoporosis combines the use of nutrition, supplements, exercise and medications. The patient must understand the need for adapting to an alternative source of calcium other than dairy products that he/she is not in use because of lactose intolerance (Carne, 2015). For instance, the Asian-Americans can use the soy milk in place of the dairy products. Also, the use of supplements of calcium and vitamin D will improve the patient’s condition. Besides, medications like selective estrogen modulator (raloxifene, teriparatide) can also help improve the health status of an osteoporosis patient. That notwithstanding, the patient must comprehend the need for maintaining a healthy activity level in the form exercises (Carne, 2015). Such a practice will help improve the bone strength and prevent bone fractures.
Treatments
A reflection of the effectiveness of the patient teaching plan is in part mirrored by the patient adherence to the treatment plan. Therefore,the education plan must remind the patient of the importance of taking the medication using a particular route and time as well as maintenance of a certain dosage. Failure to abide by these directives will result in side effects, which negatively impact the wellbeing of the patient (Carne, 2015).
Furthermore, the nurse must teach the patient about medications that may worsen his/her conditions. Such medications may include corticosteroids, heparin, and antiseizure. Therefore, the nurse must reinforce avoidance of these drugs, which will in turn prevent instances of worsening the osteoporosis and its complications (Carne, 2015).
Activity Level and Restrictions
According to Carne, (2015) maintenance of a certain degree of activity for a patient with osteoporosis is beneficial to him/her. Such is the case due to the strengthening of the bones that comes with exercises. The bones develop tolerance with exposure to such an exercise program. As such, in this scenario, the patient must fathom that the condition does not limit him/her from maintaining a level activity with the fear of sustaining fractures.
Also, this teaching plan must enlighten the patient on what activities to avoid that may aggravate the current patient’s complications such as fractures, which are expensive to treat. For instance, the nurse must inform the patient to avoid carrying heavy loads, which will predispose him/her to worsening of fractures or recurrence of fractures.
Nutritional Needs
Of the essence of the management of osteoporosis is the nutrition of this patient. Given that this condition is due to a deficiency of calcium mineral, the patient must appreciate the need of sourcing calcium mineral from other sources other than dairy products. Dairy products are not tolerable to patients of this cultural group due to the problem lactose intolerance associated with them (Carne, 2015). As such, the nurse must teach the patient on other sources of calcium that he/she can tolerate, for instance, soy milk.
Additionally, the nurse should emphasize the need for the patient to stick to the calcium and vitamin D supplements. Such supplements are vital in the management of an osteoporosis patient as they increase the level of these minerals in the body (Carne, 2015).A benefit of this kind to the patient’s body signifies the need of teaching the patient on theessence of complying with the prescribed supplements.
Follow-up Care
Patients with osteoporosis just as other patients must beware of when they ought to seek care after discharge. Such is the case given that a delay in the search for care may result in disastrous effects on the patient that would have been nonexistent with the instant seeking of care (Carne, 2015). That said, the nurse must teach the patient on when to seek for follow-up care.
In this instance, the indications for follow-up care are the permanent bone loss as in the case of chronic corticosteroid use and development of complications such as fractures. According to Carne, (2015), occurrence of fractures is suggestive of non-compliance to the medications and the need for follow-up.
Teaching Aide for Asian-American Patients with Osteoporosis
This image will help the patient understand the difference between healthy bones and bones affected by osteoporosis.
Patient Handout on Osteoporosis
Central to the success of this teaching plan is a patient handout that will enhance retention of the knowledge and serve as a home reference for the patient. The handout will entail several aspects of osteoporosis ranging from its definition, risk factors, pathophysiology, diagnosis, and management strategies.
What is Osteoporosis?
Osteoporosis refers to a chronic progressive metabolic bone disease epitomized by low bone mass and structural deterioration of bone tissue that lead to bone fragility (Tung, 2012).
Am I at Risk?
Among the Asian-American persons, an important risk factor for osteoporosis is the female gender. Such is the case given their short, slender stature, diet preference of less rich calcium foods due to their lactose intolerance, lower bone mass as compared to male counterparts and post-menopause(National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2015).
Another risk factor that may predispose other people to osteoporosis is the age of the individual an advanced age (above 65years). At this age, the bone resorption is faster than bone remodeling. As such, the bones become extremely fragile (Tung, 2012).
Other notable risk factors include but not limited to cigarette smoking, family history of osteoporosis, excessive use of alcohol, non-traumatic fracture, inactive lifestyles and chronic use of corticosteroids, heparin, and antiseizure medications (Gupta, et al., 2014).
How does the Disease Develop?
Normally, in bone remodeling, bone formation is equal to bone resorption. However, in an osteoporotic state, the bone resorption exceeds the bone formation. The affected bones in osteoporosis are mainly those of the spine, hips, and wrists (Drake, Clarke, & Lewiecki, 2015).
The affected people will present clinically with signs and symptoms such as back pain, loss of height and spinal deformity like kyphosis. All these clinical manifestations are due to collapsed vertebrae (Khandewal, Chandra, & Lo, 2012).
In what Way will the Doctor Know it is Osteoporosis?
Primarily, the history and physical examination are essential in establishing the existence of this condition. With such tools, health care personnel will determine the signs and symptoms that will point out to this diagnosis. For instance, a reduced height or a medical history of glucocorticoid medications will give a clue of this condition.
Of the essence, however, to the diagnosis of this disease process, is the bone mineral density (BMD) measurement. The BMD assesses tightness of bone package. The health care professionals may also use dual-energy x-ray absorptiometry (DEXA). It measures the bone density in the spine, hips, and forearms. Moreover, DEXA evaluates the changes in bone density over time and assesses the effectiveness of the medications on use (Drake, Clarke, & Lewiecki, 2015).
Other diagnostic tests include blood assays, namely, serum calcium, phosphorus, alkaline phosphatase and vitamin D levels (Drake, Clarke, & Lewiecki, 2015).
What are the Management Strategies of Osteoporosis?
The management of osteoporosis mainly focuses on good dietary practices, calcium as well as vitamin D supplementations, exercise, prevention of fractures and medications.
Primarily, one needs to take food rich in calcium such as soy milk. Dairy products like milk and cheese are not desirable in this case given that most of the people of this cultural group are lactose intolerance (Carne, 2015).
Supplements of calcium and vitamin D are also essential to the management of this condition. Such is the case given that both calcium and vitamin D, which are deficient, have a role to play in bone formation (Carne, 2015).
Also, the patient should engage in an exercise program that is not strenuous to precipitate complications of osteoporosis such as fractures due to falls. As such, patient teaching is of the essence to ensure that an individual understands and adheres to an exercise program that will strengthen the bones instead of precipitating complications like fractures (Carne, 2015).
Besides, an individual with osteoporosis has an entitlement to medications like calcitonin that regulates the metabolism of calcium. Additionally, a class of drugs like selective estrogen modulator (raloxifene, teriparatide) can also improve the health status of an osteoporosis patient (Carne, 2015).
Finally, surgical procedures such as vertebroplasty and kyphoplasty are also of the essence in the management of complications of this condition. The complications include vertebral collapse and kyphosis respectively (Carne, 2015).
Cultural Considerations of the Asian-Americans
Given the specific nature of health care preferences of persons from Asian-American culture, the nurse must factor into the plan of care cultural consideration if he/she intends to offer culturally sensitive care for this patient. As such, it is worth noting the steps that the nurse intends to follow through with the teaching plan so that the patient receives culturally appropriate care that will enhance his/her commitment to the instituted plan of care.
First and most importantly, Asian-American patients are unique to any other cultural group residing within the USA. That is the case given that they have specific health beliefs about disease causation and health, which are incongruent to other cultural groups’ beliefs. For instance, the Asian-Americans believe in the theory hot-cold imbalance for disease causation. As such, an Asian-American individual will most likely refuse to take a medication that he/she perceives hot if he/she is having a condition that causes him/her to feel feverish (Andrews, & Boyle, 2008, p.280). In the teaching plan, the nurse should take into consideration this health belief by allaying the fears of the patients that medications used are neither hot nor cold and therefore will not cause a progression of the condition. Furthermore, the health care professional can match the drugs if possible to ensure that patient takes medicines perceived as cold whenever they are feverish and vice versa.
Also central to this cultural group is the belief that a health care professional must assume authority in the process of disease management rather than seek out to create a patient-doctor relationship. Such a preference of the Asian-American is central to their satisfaction. That is the case given that they are more likely to come back to the same hospital if the health care professionals assume authority and treat them in an appropriate way (Lim, Baik, & Ashing-Giwa, 2012). The nurse should factor into the discharge teaching plan this consideration by ensuring that he/she offers instructions to the patient without seeking to consult his/her opinion. In such a way, the patient will be more likely to accept the instructions and follow them to the latter as he/he goes home.
Additionally, addressing the clients with respect, for example, use of words such as ‘sir and madam’ is significant in ensuring that the client’s agrees with the content being taught by the nurse. According to Poulin, Deng, Ingersoll, Witt, and Swain, (2012) respect and harmony are the main core values that hold this cultural group together. As such, showing respect to them while relaying the information will enhance their commitment to the taught issues.
Lastly, in this teaching plan, the nurse can ensure acceptability of the learned information through taking into consideration the correct pronunciation of words when talking to the Asian-American clients or patients. For instance, when calling out their names, the nurse must be keen to pronounce their names correctly. Failure to do so will only but result in a bad reception of the transmitted information (Poulin, et.al., 2012).
Conclusion
In closure, from this discussion, it is clear that a discharge teaching plan for an Asian-American patient with osteoporosis entails many aspects. For example, it includes the knowledge of disease process management, treatment, nutritional needs, activity level and restriction as well as the follow-up criteria. In essence, this paper has addressed all these issues and cited the cultural consideration that the nurse must take in the teaching plan.
References
Andrews, M. & Boyle, J. (2008). Transcultural concepts in nursing care (1st ed., p. 280). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Carne, K. (2015). Osteoporosis and fractures: diagnosis and management. Practice Nurse, 45(5), 42-46.
Cauley, J. (2011). Defining Ethnic and Racial Differences in Osteoporosis and Fragility Fractures. Clinical Orthopaedics And Related Research®, 469(7), 1891-1899. http://dx.doi.org/10.1007/s11999-011-1863-5
Drake, M. T., Clarke, B. L., & Lewiecki, E. M. (2015). The Pathophysiology and Treatment of Osteoporosis. Clinical Therapeutics, 37(8), 1837-1850. doi:10.1016/j.clinthera.2015.06.006
Khandewal, S., Chandra, M., & Lo, J. C. (2012). Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal US South Asian Women. Bone, 51(6), 1025-1028.
Lim, J., Baik, O. M., & Ashing-Giwa, K. T. (2012). Cultural Health Beliefs and Health Behaviors in Asian American Breast Cancer Survivors: A Mixed-Methods Approach. Oncology Nursing Forum, 39(4), 388-397.
National Institute of Arthritis and Musculoskeletal and Skin Diseases,. (2015). Osteoporosis and Asian American Women. Niams.nih.gov. Retrieved 4 January 2017, from https://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Background/asian_american_women.asp
Poulin, J., Deng, R., Ingersoll, T., Witt, H., & Swain, M. (2012). Perceived Family and Friend Support and the Psychological Well-Being of American and Chinese Elderly Persons. Journal Of Cross-Cultural Gerontology, 27(4), 305-317. doi:10.1007/s10823-012-9177-y
Tung, W. (2012). Osteoporosis Among Asian American Women. Home Health Care Management & Practice, 24(4), 205-207. doi:10.1177/1084822312441702
