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- 1. EDUCATING PATIENTS Chapter 3 Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 2. Learning Objectives 1. List the goals and describe the function of patient education. 2. Assess the patient’s learning needs, learning style, and health literacy. 3. Plan for patient teaching by creating learning goals and learning objectives. 4. Use various teaching aids in the implementation of the teaching plan. 5. Discuss the importance of and methods for evaluating patient education and improving patient adherence. 6. Recognize the importance of documentation in patient education. Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 3. Function of Patient Education • Patient Education – sharing information and instruction that allows patients to gain knowledge and skills that improve their wellness • Primary goals: • Promote, maintain and restore health • Change health behaviors • Improve pt compliance • Allows pt to be an active participant in their care • Improves pt morale and motivation Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 4. Function of Patient Education • Generally five steps in patient education: • Assessment • Planning • Implementation • Evaluation • Documentation Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 5. Assessment of Patient Needs • The assessment should define health care needs • Determine the pt’s readiness to learn • Evaluate the pt’s learning needs • Assess the pt’s learning style Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 6. Readiness to Learn • Many factors interfere with the pt’s ability to learn • Medical language and terms • Patient is (still) sick • Learning readiness will increase as pt recovers • Hospital room may be a poor setting for learning • Patient doesn’t speak language and no interpreter Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 7. Health Literacy • Health literacy is the degree in which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions • Low health literacy • Affects pt-to-HCP communication • May prevent positive lifestyle choices or changes • Leads to difficulties navigating health care system • Overcome health literacy issues. Information should be: • Appropriate for the pt • Easy to use • Easy to read and understand • Free from jargon and slang terms Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 8. Learning Needs (1 of 2) • The difference between desired level and lack of knowledge, skills and behaviors required for pt • Determining what the pt already knows will show what information needed • Use a questionnaire or checklist • Ask exploring questions • Info gathered by pt from the internet is not a substitute • Though pts who do internet research tend to be more compliant and ask more questions • Basic needs must be met before any new learning • Maslow’s Hierarchy of Needs Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 9. Learning Needs (2 of 2) • Maslow’s Hierarchy of Needs • Basic physiological needs • Safety and security • Love and belonging • Self-esteem or ego • Self-actualization • At this level, pts are most able to seek and follow pt education • Holistic approach considers needs of the whole person • includes the patient’s spiritual, physical, emotional, sociocultural, and intellectual needs Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 10. Learning Styles • Cognitive – to acquire knowledge • Processing facts and forming conclusions based on listening or reading instructions or information • Affective – to grow emotionally or change attitude • Appeals to feelings to change beliefs or attitudes • Psychomotor – to acquire a skill • Learning by doing or actively participating • If task is crucial to treatment, pt must demonstrate • Diabetic who learns to self-inject is more compliant • Learning within all three domains makes info storing and brain recall easier Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 11. Planning for Patient Education • Formal creation of learning goals that define results • Learning goals are broad statements about the long- term expectation of a desired result • Learning objectives are statements that describe the desired results and how they will be achieved • Should be specific and measurable • Usually multiple objectives for one goal • Learning goals and objectives should be created specifically for each patient and situation Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 12. Implementing the Plan (1 of 3) • Puts the process in motion using a variety of tools • Support groups, pamphlets, videos, meetings • The most effective teaching tool varies from pt to pt • Lecture presents basic information • Pt participation is not required • Works for highly motivated pts • Not as effective if pt needs psychomotor learning • If in written form, follow-up is usually needed Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 13. Implementing the Plan (2 of 3) • Role-playing and demonstration - requires that you perform the medical procedure while the patient watches • Pt repeats same action and is evaluated by you • Should be as realistic as possible so pt understands • Written instructions should also be available • Discussion – a back-and-forth exchange or concepts • Helpful to reinforce affective or emotional retention • For lifestyle changes rather than procedures • Can be one-on-one or as a group Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 14. Implementing the Plan (3 of 3) • Patient Education Material (PEM) – any material that provides accurate and concise health information • Pts understand the lecture or discussion with take- home materials • Printed material is inexpensive • Requires a higher level of participation and does not address health literacy level • Multimedia materials work well as an alternative to print • Audiovisual format is more compelling • Streaming and interactive videos Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 15. Support Systems • Maslow’s hierarchy – basic need to belong or connect • Strong support systems lead to faster pt recovery • Families • Friends • Social Groups • Support Groups Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 16. Support Systems • Families and Caregivers • Family now means a group of people living together or closely connected by interdependent bonds • Usually everyone is affect when one member is ill • Sick child is different than sick parent • Given the impact on families, HCP or caregivers: • May be caring for more than just the patient • Could require interaction with other members with other viewpoints • Families often need as much support as patients do Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 17. Support Systems • Support Groups • People brought together with a common issue • Most have a group leader and structured setting • Open groups • Allow people to join at any time • Closed groups • More confidentiality, intimacy – helps members work more cohesively Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 18. Understanding Medication Administration (1 of 2) • HCP must teach pts how to take prescribed medicines • Which medication, dosage, frequency is individualized • Weight of pt, health history, other medications • Often a follow-up is scheduled to check progress • There are over a dozen routes of administration • Oral – by mouth and swallowed • Intravenous (IV) – injected into a vein • Intramuscular (IM) – injected into a muscle Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 19. Understanding Medication Administration (2 of 2) • It is your job to educate pts about administering drug • How – the procedure, including injection site • When – how often or at what time of day • Why – why did the provider prescribe this medicine • Follow protocol when educating pt on administration • If pt has difficulty, discuss organization and routine • Pt may have a disability preventing proper usage • Stress importance of taking medications properly Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 20. Evaluating Patient Comprehension • Evaluation is the appraisal and review of pt’s learning progress during and after the pt education • Goal is to determine if pt has retained what you taught • “Teach-back” method – ask pt to demonstrate • Praise and encourage if correct • Tactfully guide pt in the proper performance • Ask specific and relevant open-ended questions • Learning goals and objectives may need to be reevaluated as pt progresses through treatment • Evaluate your own efforts at educating Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 21. Patient Adherence (1 of 3) • Adherence is the degree to which the pt’s behavior corresponds with the agreed provider recommendation • Pt may have trouble adhering to plan despite our efforts • Both “good” and “difficult” pts are actively taking part in their health care, resulting in better adherence Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 22. Patient Adherence (2 of 3) • Adherence could be influenced by many factors • Pt cannot afford medication or stops taking • Misunderstanding between provider and pt • Lifestyle changes and treatment is too difficult • Many pts become less adherent over time • Pts who get quick relief are better with adherence • Many pts choose only parts of routine that are easier, less likely to adhere because no benefits are seen Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 23. Patient Adherence (3 of 3) • Questions to ask regarding poor pt adherence: • How involved is the family? • Were both the pt and caregiver included in the plan? • Have caregivers or family lost patience? • Was there poor communication from the HCP? • Do directives conflict with pt’s cultural beliefs? • Does the pt trust you enough to share concerns? • Can any changes be made to be more acceptable? • Does the pt know the importance of directions? • Poor adherence can lead to provider making unnecessary and possibly dangerous changes Copyright © 2020 by Elsevier, Inc. All Rights Reserved
- 24. Documenting the Results • Document every encounter to ensure quality of care and for legal reasons • Pts are often seen by many providers who all depend on a pt’s health records for continuity of care, which ensures quality of care over time • Prevents duplication of pt education • Used for accreditation purposes, a legal record and insurance reimbursement • If no documentation, HCP assume it was not done Copyright © 2020 by Elsevier, Inc. All Rights Reserved
Editor's Notes
- Understanding the patient’s physical and emotional needs will prepare you to teach the patient. Being able to effectively assess your patient’s learning needs also allows you to individualize the information for each patient. You may know most of the patient’s background information, such as sensory barriers, education and comprehension levels, and so forth, from previous interaction with the patient or from the record.
- Chapters 5 and 6 of this text explore barriers to communication in detail.
- Patients with low health literacy levels may not be familiar with medical terms, anatomy, or how the body functions. Highly educated individuals may still have health literacy issues Low health literacy levels are common in: Older adults Ethnic minorities Lower than HS diploma education English is a second language It is important to identify and understand the target patient population, specifically the demographics and their pattern of behavior, culture, and attitude. The patient information should be appropriate for the age group, culture, language, and literacy level.
- Some questions you may want to ask patients to better assess their learning needs are: “What are you most concerned about?” “What do you feel you need to learn?” “What are you most interested in learning?” “What do you know about your disease or condition?” “What specific problems are you having?” In the late 1960s, Abraham Maslow, an American psychiatrist, developed a theory to better understand basic human needs. Maslow’s theory included that a need is essential if: Without its fulfillment or presence, illness results. Fulfilling the need restores homeostasis or wellness. We feel a sense of satisfaction when the need is met.
- In addition to their medical needs, the holistic approach includes the patient’s spiritual, physical, emotional, sociocultural, and intellectual needs For example, when we have an illness, it impacts more than just our health. Will we have to miss days of work? Will we be able to care for our families? Will we be able to enjoy our hobbies? How expensive is the treatment? How will this affect my quality of life?
- Learning Goals and Objectives Example – Table 3-1 Learning Goal Patient will understand that diabetes is a lifelong disease and will be able to manage her diabetes to avoid long-term complications of diabetes Learning Objectives Self-monitoring of blood glucose: Patient will check blood glucose daily: before each meal and 2 hours after largest meal. AIC monitoring: Patient will have 3-month routine check-up with physician to monitor A1C levels.
- Since our patients have varying education needs and preferences, the types of teaching tools in patient education cannot be a one-size-fits all or all-inclusive solution. Effective teaching tools must be from a variety of different resources and use multiple modalities, including traditional print material to highly technical interactive videos.
- Group discussions: It is important to monitor the group to ensure that less vocal and assertive patients do not get lost in the discussion and group environment.
- For example, a sick child is devastating to the whole family and may result in immense demands to the parents and other siblings. A sick parent cannot productively contribute to the family safety and security and is a source of anxiety rather than comfort. As HCP dealing with families: For example, for an elderly, dependent grandparent, one family member may feel that long-term care (such as in a nursing home) is more appropriate than home care, whereas another family member may feel that long-term care should be a last resort (Figure 3-6). Some members may want a “do not resuscitate” (DNR) order signed, whereas others may strongly be against it. Families often need as much emotional support as patients do.
- Examples of support groups are Alcoholics Anonymous, Reach for Recovery (post-mastectomy), and Candlelighters (parents of children with cancer). Additionally, there are support group for most common illnesses and life experiences. Open and closed groups: There are many formats for support groups, including its size, how often it meets, for how long, and who can join and when. For example, support groups may be open or closed. Open support groups allow people to join at any time. Closed groups may allow for more confidentiality and intimacy, and help members work more cohesively.
- All routes of administration: Route Description oral taken by mouth and swallowed sublingual placed under the tongue buccal placed between the gums and cheek intravenous (IV) injected into a vein intramuscular (IM) injected into a muscle subcutaneous (sc) injected under the skin intrathecal injected around the spinal cord rectal inserted into the rectum vaginal inserted into the vagina ocular placed in the eye otic placed in the ear nasal sprayed into the nose inhaled breathed into the lungs through the mouth transdermal absorbed through the skin
- Patient administration protocol steps: 1. Ask the patient to demonstrate how he or she takes the medication. If the patient has a family member or caregiver who dispenses the medication, have him or her demonstrate, as well. 2. While the patient is demonstrating, ask the patient about the dosage, time, and frequency of taking the medication. 3. If the patient takes multiple medications, ask the patient to explain when he or she takes each medication and what each medication is for. Disabilities could prevent proper usage: Determine whether the patient is vision-impaired. Can he see the labels well enough to know which medication he is taking? Can you provide him with visual aids to make measuring and administration easier? Does she have the manual dexterity to draw up medications and self-inject? Is there a family member or caregiver who can inject it for her? Should she be referred to a home health service if there is no one available to help with administration? Can he understand which medication must be taken at what time and in what manner? Can the routine be simplified? Does he understand how important it is to take the medication as prescribed and what might happen if he does not follow the proper regimen? Does he know that he should not discontinue the medication without informing the physician’s office? Should you demonstrate with special memory aids, such as divided dosage boxes to make it easier to remember dosage times?
- Open-ended question method: For example, to determine if the patient understands the significance of glucose levels, ask “Your glucose level is 164. What do you think that means?”
- Adherence, compared to “compliance,” better describes the complex HCP-to-pt relationship A collaboration of all parties to improve pt health
- Adherence influencing factors: poor provider-patient communication economic and social factors treatment plan complexity and health care disparities Example: Adherence may be affected by cost and access barriers if the physician prescribes a medication to a patient but the patient never has the prescription filled due to an inability to afford the medication. Pts choose least interfering parts of routine: For example, the physician’s treatment plan instructs the patient to exercise more, stop smoking, and eat healthier. The patient may slightly modify his diet and cuts down to three packs a day instead of four packs. Pt doesn’t see immediate benefits so adherence is less likely.
- Example of importance of adherence to direction: For example, Mr. Smith did not finish his full course of antibiotics for his urinary tract infection (UTI). He returns to the clinic since the UTI has not been resolved, but he does not tell the LPN during intake that he did not finish taking the antibiotics. His physician prescribes a stronger antibiotic for the UTI, thinking that the first antibiotic was not effective. This not only may lead to drug resistance, but Mr. Smith may experience more adverse effects due taking the stronger antibiotic.
- In health care, it is presumed that any service that is not documented was not performed, which includes patient education. Each step of the education process must be documented and should include the following: -the patient’s learning needs, learning style, and readiness to learn -the patient’s knowledge of his or her condition and treatment options -the objectives and goals and what information was provided to the patient -how the information was provided to the patient, such as through discussion, demonstration, videos, or patient instruction sheet. -the patient, family, and caregiver response to the patient education -the evaluation and effectives of the teaching -the date and time of the session if separate from regular care, such as over the phone. Include --education given during routine patient care under the appropriate record entry. -a copy of the signed educational material provided to the patient when appropriate. The patient keeps the original and signs that the information has been explained adequately.