An alert 82-year-old with poor hearing and vision is receiving preoperative teaching from the nurse. His wife answers most questions directed to the patient. Which action should the nurse take when doing the teaching?

• A. Use printed materials for instruction so that the patient will have more time to review the material.
• B. Direct the teaching toward the wife because she is the obvious support and caregiver for the patient.
• C. Provide additional time for the patient to understand preoperative instructions and carry out procedures.
• D. Ask the patients wife to wait in the hall in order to focus preoperative teaching with the patient himself.

Answer: (C)

When teaching an older patient who has hearing and vision limitations, the focus is on ensuring understanding and preserving the patient’s participation in the process. The nurse should provide extra time for the patient to process the information, ask questions, and demonstrate steps, using clear communication and accommodations as needed. This approach supports informed consent and helps the patient actually carry out the preoperative instructions, rather than relying on the caregiver or assuming materials alone will be sufficient.

Involving the patient directly is essential even if the caregiver is present. The wife can support learning, but the patient’s autonomy and comprehension must guide teaching. Directing all questions to the wife or asking the wife to wait in the hall removes the patient’s opportunity to participate and may hinder understanding of the procedures. Printed materials can help, but they’re most effective when the patient can understand them with appropriate accommodations and when comprehension is checked—such as with a teach-back approach.