RN, Jennifer Ward, believes educating patients is vital to reducing hospitalisations and improving patient quality of life
We as nurses have a responsibility to tend to our patients’ needs, but we have an equal responsibility to teach. Providing ‘care’ means ensuring that patients are fully educated about their condition and their proposed treatments.
Through education, patients can be made aware of their disease process and potential treatment options. But, educating our patients is not as easy as one might think. Our patients come from different ethnic and socioeconomic backgrounds; and they have different treatment priorities. It’s important to have an open discussion with patients and to get to know their expectations and needs.
So, how can effective teaching be accomplished? And, how can effective teaching be done when we, as nurses, have so many other daily demands? These tips could help:
- Computer-aided teaching: Computer or other output devices allow patients to view and to hear patient education materials in the hospital and some of these materials can be reviewed at home. Manuals are often made available to accompany the computerised programs. And there is usually a test to evaluate learning once the program is completed.
- Video education: Video education is very similar to computer-based training. But, it is more difficult to evaluate learning. A written post-test could be used after the video is reviewed. But, it is important with both of these media to consider the patients’ educational level, language, and hearing/seeing abilities.
- Demonstration: Demonstration is another effective patient-teaching technique. Patients can be showed how to complete a task or how a process works in a one-on-one setting, and then they can do the task more effectively at home. However, in an acute care setting this might be more difficult to do. The pace is much faster, but case managers or patient care assistants can be used to assist the nurse if needed. And, demonstration does ensure that patients fully understand the teaching, and it allows them to get feedback and ask questions in a safe arena.
- Written material: Written material seems so easy and routine. But, it can be effective. For instance, material with pictures can offer instructions or explanations. Written material related to prescribed medicines is also a necessity. And, it can offer instructions in a step by step fashion. Once again, it is important to evaluate the patients’ literacy level, language, and sight before handing out routine teaching materials.
- Discharge instructions: At the time of discharge, patients can be equipped with a set of instructions with follow-up appointments, medication teaching, and phone numbers. Many discharge instructions can easily be printed using PHR and EMR software systems. These instructions usually give phone numbers (of whom to call with questions) and follow-up appointment instructions.
- Discharge prescriptions: Prescriptions for discharge medications are usually included in these instructions. It is important to verify that the patient knows the names, the purpose, and the dosage instructions for these medications. If needed, verify with the case manager that the patient can afford these medications; and if needed, call them into their pharmacy before discharge.
Other information about patient teaching can be obtained from organisations such as the Arthritis Foundation, the American Diabetes Association, and the American Cancer Society. Another valuable resource is the Clinical Practice Guidelines developed by the Agency for Healthcare Research and Quality (AHRQ). These evidence-based interdisciplinary guidelines assist clinicians to prevent, diagnose, treat, and mange clinical conditions, with a focus on patient outcomes. A patient’s guide (or parent guide for pediatric problems) for each guideline is available in English and Spanish. The Web site address for AHRQ is www.ahcpr.gov.
Evaluating patient learning
Effective patient teaching also requires evaluation and documentation. Learning can be evaluated in the following ways:
- Asking questions: Simply ask the patient questions to see whether they is information that needs reinforcing.
- Observe return demonstration: Watch the patient perform a task (i.e. self inject insulin) to see if the technique is correct.
- Assess the data: Ask the patient to record his blood pressure, blood glucose, or weight at home. And, review the records at the next visit. These records will demonstrate how effective the current treatments have been.
- Talk with the patient/family: At the next visit, or before discharge, talk with the family to see how the patient has been doing, or before they leave the hospital, engage in open dialogue about barriers or concerns. This is very similar to the idea of “asking questions, “ but both methods are useful.
Documenting patient teaching
There are many computerised systems out there. And some offices might still use hand-written documentation. Whatever method you use remember that the information must become a part of the patient’s permanent medical record. You can include in the documentation:
- Information and skills you have taught
- Teaching methods used – brochures, models, videos, demonstration
- Patient and family response to teaching
- Evaluation of what the patient and family have learned and how learning outcomes were determined
Through teaching and empowering our patients, we are giving them the tools they need to manage their disease process. Managing the disease process results in fewer hospitalisations and in an improved quality of life.