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How to educate patients


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

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. 


Readers' comments (14)

  • Methods are all well and good, but I think the biggest obstacle to teaching patients in this country is culture and attitude. Many people (not all, I admit, but a very large number) just do not want to listen. There is a general attitude of 'I will do what I like to my body, the NHS will fix it later'. It seems like it takes something serious to happen/develop, before people even START to listen, and even then a lot still won't follow your advice.

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  • The author omitted (and this responds to Mike's concern that many people do not want to listen) that we must first assess learning needs. What do the patient and family know about the purpose, dose, and side effects of the medication? Can the patient show you how the self-care treatments are done at home? How confident are the patient and family that treatments will and can continue at home? This engages them in the conversation, you can avoid teaching them what they already show you they know, and you can individualize teaching to their needs. Some people need information. Some people need coaching to change behaviors.

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  • Educating the public to be perfect in their lifestyles, behaviour, etc. and them heeding that advice, exhonerates those who don't adhere to the perfect life. Where do genetic, environmental and familial conditions fit into this? Where does the 'personal budget', currently being trialed in may trusts, fit into this? Getting the public to being healthier and living longer has it's own problems on the economy. Are we heading for a completely blame culture, if you don't follow the currect advice then you don't get treatment? However, next week there may be the result of another trial that changes that advise, what do we do then? Do we live are lives as we choose or become a controlled society? There is so much wrong with society on a much wider (more than healthcare) scale. A free world or a nanny state, what do we as citizens really want? You reap what you sow, good or bad.

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  • michael stone

    mike | 25-May-2011 2:00 pm

    Mike is correct - lots of people don't 'listen'.

    How does he explain that only about a third of frontline healthcare staff, had the flu vaccine ? (see today's Home page).

    It is always easier to tell other people what to do, than to take other people's advice !

    And, as the previous poster pointed out, this 'he didn't behave sensibly' argument leads to some tricky places - don't you treat mountain climbers, or rugby players who smash up a knee ?

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  • Michael, I explain it the same way many healthcare workers still smoke, or are obese, or ... whatever.

    There is a culture/attitude here of simply not taking care of your body. I don't know why, I cannot explain it. People STILL continue to smoke despite knowing fully what it does to them, people STILL decide to have that 24th can of lager before dinnertime or stuff that third helping of greasy chips down their throat. People NEED to start taking personal responsibility, and that goes far beyond simply 'taking advice'. Until they do, much of our 'education' will simply fall on deaf ears.

    Oh, and don't start the ridiculous argument about sports injuries as opposed to lifestyle choices. You cannot compare an ACCIDENT in the pursuit of a healthy lifestyle to PURPOSELY poisoning your body with whatever crap is out there. That is not a tricky situation at all.

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  • michael stone

    mike, I don't drink 24 cans of lager either before or after lunch - but I do sometimes do things not based on defensible rational logic, but 'because I want to'.

    And, there is also some duplicity going on, here. Smoking, is definitely bad for you: stopping smoking, is probably the greatest single thing many people could do to improve their own health.

    But where does this 'drinking is bad for you' come from ? Provided the subjects are within the same 'societal group', then almost every time a study for alcohol is performed, the people who live the longest (ignoring cause of death) are the people who drink a bit, but not very much. Nobody ever says 'so drink a bit, but not very much' - that is what the evidence seems to support, however.

    My rugby example, was exaggerated - but have you seen the death rate for serious climbers (Eversest, K2) ? That is definitely taking a serious risk, with your life !

    I suspect, that people tend to only change their lifestyle, when some 'critical shock event' is reached - but even then, not everyone can change. George Best couldn't stop drinking, and lots of people somehow become addicted to bad situations (why do some couples start arguments, already knowing it will lead to nowhere good, and simply stress you out ?). And, a lot of this is like drug addiction - people 'do things' because they are unhappy with their life in general, which tends to make you 'not bothered'.

    As someone who, because of a combination of the NHS and the Police behaviour, become very depressed a couple of years ago, I am quite aware that 'I'm not bothered' is applicable to almost any situation - if you are not bothered what happens, you lack the motivation to do things.

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  • I think I've led a reasonable healthy life, but reaching a certain age I have been subject to annual reviews and suggestions to how I should conduct my life and the medications the I should take. It is dominating my thoughts and my life. I can no longer do anything without thinking if I am doing the right thing. It is a life of no longer choice, except, do I oppose what is being imposed on me or do what I have always done and be happy, but now that has been taken away.

    Don't be too pious, Mike climb K2 and fall off. If you reach older age, think on. Don't be too jugdemental now, only to swallow your words in your advanced years.

    I think there is a great argument for people who put themselves in life threatening pursuits (are they healthy?... and expect the NHS to bail them out) against those who engage in so-called unhealthy pursuits, 'who expect the NHS to bail them out?

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  • Hardly pious Anonymous | 5-Jun-2011 1:04 am, don't be so condescending. I have climbed many mountains in my time (the last one the relatively easy trek of Mt. Kinabalu) as well as trekked through jungles and deserts and so on. The difference is, each time I had personal insurance taken out for any and all medical care. I did not expect the NHS to 'bail me out', as do many who do pursuits like that. At the other end of the scale, for those who participate in sports and other HEALTHY activities (and yes, they are healthy), I am willing to bet the total sum of treating injuries etc as a direct result of those pursuits is far, far, far less than the bill for treating the consequences of smoking, excessive drinking, drug taking, obesity, etc etc etc. Not to mention they will live healthier for much longer, thus using up less resources yet again.

    The two cannot be compared so there is no 'great argument' at all.

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  • mike | 5-Jun-2011 5:16 pm

    I look forward to reading your threads in 20, 30, 40 + years time, if life/death spares me.

    I don't think you'd have needed your personal insurance once back in the UK.

    However, none of us know what lies around the corner. Not all illnesses we may or may not suffer are purely down to lifestyle. We all hope for a comfortable life, pain-free, illness-free or a peaceful death. I don't think you maybe old enough to appreciate that.

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  • Anonymous | 6-Jun-2011 2:14 am I sincerely hope you are able to; my point is whether I would have needed insurance or not (I have NEVER needed it by the way) in the UK, any medical costs would have been covered by it.

    I know and understand not ALL illnesses are caused or exacerbated by lifestyle, but a LOT are, and a lot of serious ones too. So people SHOULD take more personal responsibility in safeguarding their health and not relying on the NHS to sort it all out later.

    I am not old, no, but I am not exactly young either anymore. But I can guarantee no illness I get in the future will be lifestyle related!

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