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Create an education culture to ensure all take the time to teach
Training and resources make every minute count and work for best outcomes
Creating a patient education culture within an institution will help ensure that teaching is part of the care that is provided, not an afterthought or something that is completed if there is time.
"We are not providing quality care if we do not provide patient and family education," says Fran London, MS, RN, a health education specialist at The Emily Center at Phoenix (AZ) Children's Hospital.
"Great drugs and skilled surgeries are not enough to optimize health outcomes. Behavior changes with improved self-care skills must accompany our interventions to make them work as they were meant to work. There can be no quality health care without patient and family education."
Education is an important element for achieving good health outcomes, agrees David Wiljer, PhD, director of knowledge management and innovation for the oncology education/radiation medicine program at Princess Margaret Hospital in Toronto.
"We know from a lot of research that patient education is a huge piece of behavioral change for patients," he says.
Yet acknowledging its importance does not automatically mean it will become a part of everyday care. Steps must be put into place to make patient education part of the pattern of patient care, rather than something that is done if time allows.
Many experts in the field of patient education say that those in jobs where teaching is appropriate, such as nursing, physical therapy, or nutrition, must understand they are expected to teach.
Write patient education into job descriptions; make it part of annual competencies and annual job evaluations, advises Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children's Healthcare of Atlanta. "This helps make the idea 'stick' that patient education is not to be pushed aside, it's to be taken seriously," she explains.
It should be integrated into nursing policies and procedures as well, states Magdalyn Patyk, MS, RN, BC, patient education program manager at Northwestern Memorial Hospital in Chicago.
Staff must understand there are standards that must be maintained, adds Wiljer. "Determining best practice for patient education is really an essential part of the care so there has to be a process around educating patients in the same way there is a process around delivering chemotherapy. It has to happen according to standards and guidelines," he says.
However, policy is not enough; staff members must be trained to teach effectively. At Princess Margaret Hospital, staff can enroll in a one-and-a-half-day course titled "Maximizing Your Patient Education Skills." Curriculum includes information on learning principles including assessment of educational needs and tailoring teaching to individual learning styles; students learn through various clinical scenarios.
Ordelt says she discusses patient education during staff orientation, offers in-services and training opportunities, and speaks at meetings.
At Northwestern Memorial Hospital, all employees receive information on patient education in the general orientation packet and it is included in the professional clinical orientation. In addition, information is available in an on-line orientation packet that includes an electronic quiz. Patyk says nursing has made this on-line orientation and quiz mandatory for all RNs.
More than techniques
To prevent health care providers from teaching "only if time allows," helps them recognize that most care is self-care, as patients are eventually discharged from the hospital; education to promote optimal self-care is essential, explains London.
A good exercise for teaching this concept is to ask staff to imagine providing care without teaching, says London. Ask them: How would it look? What would you do? Could you hand over a prescription and not say what it was for or how to take it? Could you discharge a patient from a hospital without any information beyond good-bye?
"Once they recognize their job is to optimize self-care, we need to show them how education is integrated into care. We need to depend on informal education, done in conversation within the context of care for most of our assessments and teaching," says London. Staff should learn to recognize opportunities for teaching while they are providing care such as describing a medication before giving it or talking through a dressing change while doing it.
If health care providers are skilled at providing care, they have all the knowledge they need to teach self-care skills to patients and their families. The provision of care includes assessments, medical interventions, the recognition of problems, and knowing how to respond.
When caring for patients, nurses assess their condition all the time, looking for opportunities to intervene with treatments or calling in other health care team members. A nurse caring for a patient with a fever knows what signs and symptoms to look for such as whether the temperature responds to medicine or if the patient is also having chills or seizures.
"These assessment skills are some of the things patients need to learn to care for themselves at home. They must recognize problems and how to respond to them as well as learning concrete skills such as a bandage change," says London.
The content of what is taught should come out of the assessment of the learner, which determines what he or she needs to learn to provide safe self-care at home.
Ordelt agrees that educational content for one-on-one teaching should be patient-and family-specific as learning needs are assessed but she adds that teaching sheets and other patient education resources are important.
"They provide consistency throughout the health care system, help make learning better and quicker for families, help make teaching easier and quicker for staff, and can also be used as a resource at home," explains Ordelt. Of course, teaching patients is never simply checking items off an education plan but involves evaluation so staff know the patient is actually learning, absorbing, and changing as a result of the teaching.
While it is reasonable to expect staff to teach patient populations they care for routinely, educational resources are helpful for new staff or those who do not routinely care for a certain population. At Northwestern Memorial, one-page teaching guides are available on the Intranet that list key survival skill topics on the left and the supporting resources on the right.
A solid infrastructure to support patient education, including programs, procedures, and services, is important, says Wiljer. "For us, the essential question is how to bridge the gap between education and clinical care and make sure education, in general, is central to the clinical practice. We spend a lot of time on those issues," he says.
A patient and family library on the main floor of Princess Margaret Hospital serves as the hub of activity for patient education. Workshops on all types of topics are held in the library including chemotherapy, radiation, diet, and nutrition. In addition, in each clinical waiting area, there is a patient education center with a computer, printer, and in some cases, a collection of library books. Some centers are staffed by volunteers.
To make education an integral part of patient care, the institution has specially trained patient education volunteers who work in the library and resource center. They disseminate education to patients, do searches for them, and direct them to resources.
"Health care professionals are very busy, so we try to support them with volunteers as much as possible. That is part of the infrastructure," says Wiljer.
Also, initiatives are set in place to make education as easy as possible. "We try to take innovative approaches," says Wiljer. For example, an on-line support platform that consists of chat groups for patients with breast cancer has been created to educate patients. Patients access the chat line from home, and nurses, physicians, dietitians, and others can schedule special sessions to directly communicate with patients.
"We are exploring methods of making it easier for health care professionals to deliver the education and make it part of the overall process," explains Wiljer.
Yet putting the tools in place and creating innovative methods of education won't guarantee that education is completed. Getting the word out to both patients and staff that resources are available is vital.
"We do try to put infrastructural support around each of the education points to make it easier for health care professionals and to make sure if they need something they know where to get it," says Wiljer.
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