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FabiaClientEducationPPT
- 1. Client Education NUR 101 – Fall
- 13. Learning Domains COGNITIVE AFFECTIVE PSYCHOMOTOR Includes all intellectual behaviors and requires thinking Deals with expression of feelings and acceptance of attitudes, opinions, or values Involves acquiring skills that require integration of mental and muscular activity
- 17. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment Collect data about physical, psychological, social, developmental, and spiritual needs from client, family, and Medical record Collect data about client’s learning needs, motivation, ability to learn, and teaching resources from client, family, and medical record Nursing Diagnosis Identify appropriate nursing diagnoses based on assessment findings Identify client’s learning needs on basis of three domains of learning Planning Develop individualized care plan collaborating with client Establish learning objectives, identify priorities and collaborate with client on teaching plan Implementation Perform nursing care therapies. Include client in care Implement teaching methods. Actively involve client/family Evaluation Identify success, alter interventions as needed Determine outcomes of teaching-learning process. Reinforce/alter
- 23. Think – Pair - Share
- 24. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment ***** Nursing Diagnosis Planning Implementation Evaluation
- 30. Think – Pair - Share
- 31. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment ***** Nursing Diagnosis ***** (indicate domain) Planning Implementation Evaluation
- 39. Think – Pair - Share
- 40. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment ***** Nursing Diagnosis ***** Planning ***** Implementation Evaluation
- 43. Think – Pair - Share
- 44. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment ***** Nursing Diagnosis ***** Planning ***** Implementation ***** Evaluation
- 47. Nursing and Teaching Processes Steps NURSING PROCESS TEACHING PROCESS Assessment ***** Nursing Diagnosis ***** Planning ***** Implementation ***** Evaluation *****
Hinweis der Redaktion
- GOOD MORNING!! TODAY WE ARE GOING TO TALK ABOUT CLIENT’S HEALTH EDUCATION
- OBJECTIVES: TO IDENTIFY BASIC PRINCIPLES OF CLIENT EDUCATION, LEARNING STYLES, AND BARRIERS TO LEARNING TO DESCRIBE DIFFERENT TEACHING STRATEGIES AND, TO DEVELOP A TEACHING PLAN COMPARING THE NURSING AND TEACHING PROCESS The North American Nursing Diagnosis Association (NANDA) developed the diagnosis of “ knowledge deficit” to express patient learning needs.
- NURSES ARE KEY TO PROVIDING EFFECTIVE EDUCATION AND EMPOWERING PATIENTS TO BECOME HEALTHIER AND MORE INDEPENDENT NURSES ARE THE ONES THAT SPEND THE MOST TIME WITH THE CLIENT…SO THEY BECOME THE PRIMARY TEACHER IN A VARIETY OF SETTINGS INCLUDING HOMES, CLINICS, SCHOOLS, AND HOSPITALS THEY CAN PROVIDE CLARIFICATION ON TOPICS FROM BASIC HYGIENE TO SURGICAL INTERVENTIONS, REINFORCE TOPICS SUCH AS IMPORTANCE OF COMPLIANCE WITH DRUG THERAPY, AND COLLABORATE AND COORDINATE INFORMATION FROM OTHER HEALTHCARE PROFESSIONALS
- THE AMERICAN HOSPITAL ASSOCIATION DEVELOPED THE “PATIENT CARE PARTNERSHIP” FORMERLY CALLED “PATIENT BILL OF RIGHTS”, WHERE CLIENTS HAVE A RIGHT TO INFORMED DECISIONS REGARDING HEALTHCARE AND INFORMATION NEEDS TO BE ACCURATE, COMPLETE, AND RELEVANT IN 2007 THE JC CREATED THE “KNOW YOUR RIGHTS” CAMPAIGN TO HELP CLIENTS UNDERSTAND THEIR RIGHTS OFFERING TIPS TO HELP THEM BECOME INVOLVED IN THEIR TREATMENT LET PATIENTS KNOW THEY ARE ENTITLED TO INFORMATION ABOUT THE CARE -IN THEIR PREFERRED LANGUAGE, -ENCOURAGING PATIENTS TO KNOW NAMES OF THEIR HEALTHCARE PROVIDERS, -RECEIVE TREATMENT FOR PAIN AND AN UP TO DATE LIST OF MEDICATIONS AND -THAT THEY WILL BE HEARD AND TREATED WITH RESPECT
- THE VITAL TEACHING ROLE OF NURSES IS EMPHASIZED IN DOCUMENTS PUBLISHED BY THE ANA AND OTHER NURSING ORGANIZATIONS. NURSE’S LEGAL RESPONSIBILITY TO TEACH PATIENTS IS OUTLINED IN STATE NURSING PRACTICE ACTS INDICATING THAT PATIENT TEACHING FALLS WITHIN THE SCOPE OF PRACTICE OF EVERY NURSE IF A NURSE FAILS TO PROVIDE REQUIRED PATIENT EDUCATION, AND THE PATIENT CAN SHOW THAT AN INJURY RESULTED FROM A LACK OF INFORMATION OR INSTRUCTION, THE NURSE COULD BE SUED FOR NEGLIGENCE. JCAHO - USES HEALTH PROMOTION TEACHING METHODS ACCORDING TO DEVELOPMENT LEVEL, READINESS, ABILITY, LANGUAGE AND CULTURE TEACHING MUST INCLUDE EVERYONE RESPONSIBLE WITH THE PATIENT’S CARE ___________________________________________ NC NP ACT DEFINES THE PRACTICE OF NURSING IN THE VERY BEGINNING OF THE ACT…. THE “PRACTICE OF NURSING BY A REGISTERED NURSE” CONSISTS OF THE FOLLOWING TEN COMPONENTS TEACHING, ASSIGNING, DELEGATING TO OR SUPERVISING OTHER PERSONNEL IN IMPLEMENTING THE TREATMENT REGIMEN. PROVIDING TEACHING AND COUNSELING ABOUT THE PATIENT'S HEALTH
- “ CAN ANYBODY GIVE ME EXAMPLES OF TOPICS FOR HEALTH EDUCATION IN EACH CATEGORY TOPICS?” MAINTENANCE AND PROMOTION OF HEALTH AND ILLNESS PREVENTION: FIRST AID, STRESS MANAGEMENT, NUTRITION, EXERCISE, HEALTH SCREENINGS RESTORATION OF HEALTH: MEDICATIONS, NUTRITION, SURGERY, TESTS AND THERAPIES COPING WITH IMPAIRED FUNCTIONS: HOME CARE, SELF-CARE, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, PREVENTION OF COMPLICATIONS, AND ENVIRONMENTAL ALTERATIONS
- TEACHING INCLUDES ACTIONS THAT HELP CLIENTS GAIN KNOWLEDGE, CHANGE BEHAVIORS AND PERFORM NEW SKILLS TEACHING LEADS TO “CHANGE” CHARACTERISTICS OF A GOOD TEACHER SENSE OF HUMOR, PATIENCE, CARING AND NON JUDGEMENTAL ATTITUDE TEACHING AND LEARNING BEGIN WHEN A PERSON IDENTIFIES A NEED FOR KNOWING OR ACQUIRING AN ABILITY TO DO SOMETHING
- TEACHING IS EASY WHEN PATIENTS OR FAMILIES ASK FOR INFORMATION OR CLARIFICATION BUT IF CLIENT DOES NOT VERBALIZE THAT HE/SHE HAS A LEARNING NEED THEN THE NURSE MUST DETERMINE IF A LEARNING NEED EXISTS: QUESTION CLIENT DIRECTLY OBSERVE CLIENT BEHAVIORS INTERACT WITH CLIENT’S FAMILY FIND THE TIME WHEN THEY ARE READY AND EVALUATE TEACHING, MAKING ADJUSTMENTS AS NEEDED
- IMPORTANCE OF HEALTH LITERACY IT IS A STRONG PREDICTOR OF HEALTH STATUS A STUDY SHOWED THAT 75 MILLION AMERICAN ADULTS HAVE BASIC OR BELOW BASIC LEVELS OF HEALTH LITERACY MANY CANNOT UNDERSTAND IMPORTANT HEALTH-RELATED MEDICAL FORMS. FAILURE TO UNDERSTAND DIRECTIONS MAY LEAD TO MISSED APPOINTMENTS, NONCOMPLIANCE, AND IN SOME CASES, DISABILITY AND DEATH. RECENT SEMINAR IN CHARLOTTE, NP WAS SURPRISED TO SEE PATIENT WAS NOT IMPROVING AFTER 2 MONTHS OF TREATMENT AND SHE ASKED THE PATIENT “ DO YOU HAVE THE PRESCRIPTION I GAVE YOU??” - YES, BUT NOBODY TOLD ME TO TAKE THE MEDICINE…. EXAMPLES: AMA REAL VIDEOS WITH DOCTOR AND PATIENTS 1) OLDER MAN EXPLAINING HYPERTENSION 2) PATIENT SAW DOCTOR BECAUSE OF EXCESSIVE BLEEDING EVERY MONTH…..
- A FORMULA WAS APPLIED TO CHANGE THE WORDING WHICH DECREASES THE READING DIFFICULTY FROM 12TH TO 6TH GRADE DID YOU KNOW THAT HALF OF THE PATIENTS AND FAMILIES YOU TEACH EVERY DAY WON’T BE ABLE TO UNDERSTAND WRITTEN TEACHING MATERIALS? PATIENTS STRUGGLE TO UNDERSTAND DISCHARGE INSTRUCTIONS, CONSENT FORMS, HANDOUTS, NUTRITION, PRESCRIPTION LABELS, AND OVER-THE-COUNTER MEDICATIONS. SEVERAL INITIATIVES REQUIRE THAT PATIENTS HAVE INFORMATION ABOUT THEIR DIAGNOSIS, TREATMENT, AND PROGNOSIS IN TERMS THAT PATIENTS AND FAMILIES CAN UNDERSTAND. CLUES - NOT EVEN ATTEMPTING TO READ BROCHURE SAYING THAT FORGOT GLASSES AT HOME AVOIDING DISCUSSION OR NOT ASKING QUESTIONS ABOUT IT
- NURSES HAVE THE SIX RIGHTS OF MEDICATION ADMINISTRATION THESE ARE THE FIVE RIGHTS OF TEACHING RIGHT TIME RIGHT CONTEXT RIGHT GOAL RIGHT CONTENT AND RIGHT METHOD
- LEARNING OCCURS IN THREE DOMAINS: THE COGNITIVE DOMAIN IS THE KNOWLEDGE THE PATIENT NEEDS TO ACQUIRE. IT INCLUDES ACQUISITION OF KNOWLEDGE, ABILITY TO UNDERSTAND, APPLICATION, ANALYSIS, RELATING IDEAS IN AN ABSTRACT MANNER, SYNTHESIS, RECOGNIZING PARTS OF A WHOLE, AND EVALUATION. THE AFFECTIVE DOMAIN IS OFTEN DIFFICULT TO IDENTIFY. ONE EXAMPLE OF AFFECTIVE LEARNING IS “ VALUES CLARIFICATION” THE PSYCHOMOTOR DOMAIN DEALS WITH SKILLS. FOR A PSYCHOMOTOR SKILL TO BE ACQUIRED, THE CLIENT NEEDS TO HAVE THE KNOWLEDGE, PHYSICAL ABILITY, AND ATTITUDE TO LEARN THE SKILL
- 1- IF A PERSON DOES NOT WANT TO LEARN LEARNING MOST LIKELY WILL NOT OCCUR 2- CONSIDER THE CLIENT’S INTELLECTUAL, DEVELOPMENTAL CAPABILITIES EXAMPLE CHILD OR ADULT AND PHYSICAL CAPABILITIES 3- PROMOTE BEST ENVIRONMENT POSSIBLE - QUIET AND NON-STRESSFUL AND AVOID DISTRACTIONS
- SOCIOECONOMIC LEVEL TEACHING SOMEONE THEY NEED TO EAT MORE FRUITS AND VEGETABLES AND THAT THEY NEED TO EXERCISE MORE THEY WILL BE ABLE TO UNDERSTAND THE INFORMATION BUT THE BEHAVIOR WILL NOT CHANGE IF -THEY CAN NOT AFFORD HEALTHIER FOODS AND HAVE NO ACCESS TO TRANSPORTATION -THEY ALSO WILL NOT BE ABLE TO EXERCISE MORE AND WALK OUTSIDE IF THEY LIVE IN HIGH CRIME AREA
- Expectation of learning – WHAT THE CLIENT VIEW AS IMPORTANT TO KNOW Learning needs - WHAT IS CRITICAL FOR THE CLIENT TO KNOW Motivation to learn – ASSESS THEIR BEHAVIOR, BELIEFS, AND DESIRE TO LEARN Ability to learn – PHYSICAL STRENGHT, READING LEVEL, PAIN AND ANXIETY Teaching environment – DISTRACTIONS, COMFORT OF THE ROOM, AVAILABLE EQUIPMENT Resources for learning - INVOLVEMENT OF FAMILY MEMBERS, TOOLS SUCH AS BROCHURES, POSTERS, HEALTH CARE EQUIPMENT Health literacy - EXAMPLES OF SCREENING TOOLS IN YOUR TEXTBOOK BUT A BASIC TEST WOULD BE ASKING THE PATIENT TO READ A HANDOUT AND DESCRIBE IN HIS/HER WORDS WHAT IT MEANS Learning disability - CLIENTS WITH ADHD ( ATTENTION DEFICIT/HYPERACTIVITY DISORDER) HAVE DIFFICULTY STAYING FOCUSED DURING EDUCATIONAL SESSIONS _____________________________________________________________
- IS THE PATIENT READY TO LEARN BOTH, PHYSICALLY AND MENTALLY? PAIN, EFFECTS OF ANESTHESIA, VISUAL OR AUDITORY IMPAIRMENT, LACK OF PRIVACY, SLEEP DEPRIVATION, AND HUNGER AFFECTS PHYSICAL READINESS TO LEARN -ALSO, CLIENT WILL RESPOND DIFFERENTLY ACCORDING TO THE STAGE OF GRIEVING - HOW WOULD YOU YOU TEACH A CLIENT THAT IS IN THE STAGE OF DENIAL AND HOW WOULD YOU TEACH SOMEBODY THAT HAS ALREADY ACCEPTED /HER CONDITION? EX - ADOLESCENT IN DENIAL ABOUT A DIABETES DIAGNOSIS MAY NOT BE READY TO LEARN HOW TO INJECT INSULIN HOW CAN YOU CAN TELL WHEN A PATIENT IS READY? ASSESSMENT DATA CAN BE OBTAINED DIRECTLY FROM CLIENT OR FAMILY BUT ALSO FROM CHARTS AND REPORTS THEY BEGIN TO ASK QUESTIONS AND PARTICIPATE IN THEIR OWN CARE.
- CLIENTS MAY HAVE A VARIETY OF LEARNING NEEDS BUT STILL A LACK OF MOTIVATION CAN SERIOUSLY AFFECT LEARNING AND ULTIMATELY AFFECT THEIR WELLNESS HOW ARE YOU GOING TO ASSESS FOR MOTIVATION? CLIENT'S BEHAVIOR HEALTH BELIEFS, PERCEPTION OF SEVERITY DESIRE TO LEARN ATTITUDE ABOUT HEALTHCARE PROVIDERS PAIN, FATIGUE, STRESS SOCIAL AND CULTURAL BACKGROUND LEARNING STYLE PREFERENCE UNMOTIVATED SIGNS… WATCH THEIR BEHAVIORS - ARE THEY PAYING ATTENTION? - WHAT IS THE ATTITUDE, RESPONSE, NON- VERBAL COMMUNICATION
- LEARNING VARIES FROM PERSON TO PERSON AND SITUATION TO SITUATION THE CLIENT MUST HAVE THE ABILITY TO PERCEIVE THE KNOWLEDGE IN THE WAY YOU ARE PRESENTING IT…. -CAN THEY SEE, HEAR, UNDERSTAND, AND RESPOND? THERE ARE ALL CRITICAL TO LEARNING KEEP IN MIND ISSUES SUCH AS AGE, DEVELOPMENTAL STAGE, PHYSICAL CAPABILITY AND INTELLECT ALSO REMEMBER, LEARNING NEEDS AND LEARNING ABILITY CHANGE THROUGHOUT LIFE
- COMMON SENSE TELLS US THAT LEARNING OCCURS WHEN CONDITIONS ARE OPTIMAL! KEEP IN MIND THESE ISSUES PRIVACY, TEMPERATURE, LIGHTING, DISTRACTIONS - TOO MANY FAMILY MEMBERS, CRYING BABY, CELL PHONES EVEN NOISE AND SMELLS TRY TO MANIPULATE THE ENVIRONMENT AS MUCH AS POSSIBLE TO FACILITATE LEARNING !!
- Use the NANDA diagnosis. DECIDE IF THE TOPIC FALLS UNDER THE COGNITIVE, AFFECTIVE, OR PSYCHOMOTOR DOMAINS.
- THE THREE MOST COMMON NURSING DIAGNOSES ASSOCIATED WITH TEACHING ARE Knowledge deficit Noncompliance Ineffective Mgmt of Therapeutic regimen
- SO, ONE EXAMPLEOF NURSING DIAGNOSIS UNDER THE COGNITIVE DOMAIN IS: KNOWLEDGE DEFICIT RELATED TO NEW EXPERIENCE OF MANAGING DIABETES WITH INSULIN
- NOW, AN EXAMPLE OF NURSING DIAGNOSIS UNDER THE AFFECTIVE DOMAIN IS: KNOWLEDGE DEFICIT RELATED TO FEAR OF SELF-ADMINISTERING INSULIN AND MANAGING A DIABETIC DIET
- AND, AN EXAMPLE OF NURSING DIAGNOSIS UNDER THE PSYCHOMOTOR DOMAIN IS: KNOWLEDGE DEFICIT RELATED TO LACK OF EXPERIENCE WITH ADMINISTRATION OF INSULIN AND GLUCOSE MONITORING
- WE ARE READY TO INITIATE A TEACHING PLAN THE BEST WAY TO START IS TO DETERMINE YOUR GOALS IN ORDER TO DO THIS, EVALUATE YOUR CLIENT’S KNOWLEDGE BASE AND PERCEPTIONS THEN PRIORITIZE YOUR CLIENT’S NEEDS, FOR EXAMPLE, YOU TEACH SURVIVAL SKILLS BEFORE “NICE TO KNOW” ISSUES.
- OBJECTIVES: COGNITIVE - DESCRIBES THE FIVE SITES FOR INSULIN INJECTION WITH 100% ACCURACY) AFFECTIVE - SHARES ANY CONCERNS ABOUT SELF-ADMINISTRATION OF INSULIN PSYCHOMOTOR - GIVE INSULIN IN THIGH AREA WITH 100 %ACCURACY - DEMONSTRATES PROPER TECHNIQUE FOR DRAWING UP INSULIN FROM A MULTIDOSE VIAL)
- Set priorities – IMMEDIATE NEEDS, NURSING DIAGNOSIS, AND GOALS FOR THE CLIENT Select timing to teach – WHEN? Organize the teaching material – LOGICAL SEQUENCE FROM SIMPLE TO COMPLEX IDEAS THE MORE SPECIFIC THE PLAN, THE EASIER IT IS FOR NURSES TO FOLLOW.
- ACTIVELY INVOLVE THE PATIENT IN THE LEARNING PROCESS PEOPLE LEARN BETTER WHEN MORE THAN ONE OF THE BODY’S SENSES ARE STIMULATED BEGIN WITH WHAT IS KNOWN; THEN MOVE TOWARD NEW INFORMATION EXPLAIN MEDICATION SIDE EFFECTS WHILE GIVING MEDICATION GROUP DISCUSSIONS, ROLE PLAY, ANALOGIES AND CULTURAL BELIEFS ( MANGO/ MILK AND HONEY FOR BABIES) REMEMBER, EVERY INTERACTION WITH YOUR CLIENT PROVIDES AN OPPORTUNITY TO TEACH. TEACHING APPROACHES INCLUDE: TELLING, PARTICIPATING, ENTRUSTING, REINFORCEMENT. INSTRUCTIONAL METHODS INCLUDE: GROUP INSTRUCTION, ONE-ON-ONE DISCUSSION, PREPARATORY INSTRUCTION, DEMONSTRATION, ANALOGY, ROLE PLAYING AND SIMULATION. BOX 25-9 PRESENTS TIPS ON HOW TO DEAL WITH THE ELDERLY
- PROVIDE ENVIRONMENT CONDUCIVE TO LEARNING -IDEAL LIGHTING AND TEMPERATURE CONTROL -COMFORTABLY POSITIONED IN CHAIR OR BED -FREE OF UNPLEASANT ODORS OR PERFUME PRESENT INFORMATION AN AN APPROPRIATE RATE, -CONSIDER TIME AVAILABLE -PHYSICAL LIIMTATIONS AND -PRIOR EXPERIENCE WITH THE INFORMATION BEING TAUGHT AUDIOVISUALS - USE THEM EFFICIENTLY CLARIFY UNDERSTANDING, OFFER ENCOURAGEMENT AND POSITIVE FEEDBACK REPEATING INFORMATION ENHANCES LEARNING - PRESENT IT IN VARIETY OF WAYS, REWORD THE INFORMATION
- EVALUATION IS THE FINAL STEP OF THE TEACHING PLAN. AT THIS POINT, YOU WILL DISCONTINUE, ADJUST, OR AMEND THE PLAN.
- AGAIN : DOCUMENTATION IS ESSENTIAL TO MEET THE JOINT COMMISSION STANDARDS. IF IT IS NOT DOCUMENTED IT WAS NOT DONE !! NURSES WHO FAIL TO PROVIDE PATIENT TEACHING, OR WHO DON’T DOCUMENT THE TEACHING THEY PROVIDE, INCLUDING THE RESPONSE OF THE PATIENT TO TEACHING, INCREASE THEIR LIABILITY RISK.
- CHANGES ACROSS THE LIFESPAN AFFECT THE CLIENT’S LEARNING NEEDS AND ABILITIES. CONSIDER THE CLIENT’S DEVELOPMENTAL LEVEL TO INDIVIDUALIZE THE TEACHING AND PROMOTE OPTIMAL LEARNING NEWBORN- LEARN BY INTERACTING WITH THEIR ENVIRONMENT ENCOURAGE AN ENVIRONMENT RICH IN APPROPRIATE STIMULI TO FOSTER NORMAL COGNITIVE DEVELOPMENT ANY NECESSARY TEACHING SHOULD BE GIVEN TO PARENTS OR CAREGIVERS TEACHING THE PARENT ABOUT VARIOUS ASPECTS OF CHILD CARE HELPS PROMOTE POSITIVE BONDING TODDLER- PARENTS ARE USUALLY THE MOST EFFECTIVE TEACHERS CHILDREN LEARN THROUGH PLAY; PLAYING GAMES, DRAWING, PLAYING WITH DOLLS, STUFFED ANIMALS, OR OTHER TOYS ADOLESCENT- CRUCIAL TO DEVELOP A TRUSTING RELATIONSHIP ASK THEIR INPUT AND OPINIONS. BE SENSITIVE TO PEER PRESSURE. PROVIDE PRIVACY. ALL QUESTIONS SHOULD BE ANSWERED IMMEDIATELY AND HONESTLY. ADULT- ARE SELF-DIRECTED LEARNERS LEARNING IS BUILT ON PREVIOUS KNOWLEDGE. LEARNING IS PRACTICAL. LEARNING IS PURPOSEFUL. PROVIDE A COMFORTABLE, INFORMAL, FRIENDLY ENVIRONMENT WHERE THE CLIENT CAN FEEL APPRECIATED. ELDERLY- CAPACITY TO LEARN IS AFFECTED BY CHANGES IN FUNCTION. REACTION TIME, OR AMOUNT OF TIME REQUIRED FOR A RESPONSE WILL SLOW WITH AGE. WILL NEED MORE TIME TO PROCESS INFORMATION AND PERFORM PSYCHOMOTOR SKILLS. MOTIVATION TO LEARN MAY BE LOW IF THE CLIENT FEELS THAT LIFE IS NEAR THE END. OFTEN SUFFER FROM SHORT-TERM MEMORY LOSS OFTEN COMPENSATE BY PUTTING A GREAT DEAL OF EFFORT INTO ACCURACY. BY SLOWING PACE OF RECEIVING INFORMATION, OLDER ADULT CAN COMPENSATE FOR DECLINE IN RATE OF LEARNING.
- THANK YOU VERY MUCH AND ENJOY TEACHING YOUR PATIENTS!!!