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Many health care professionals required to educate patients are poor teachers. Others understand the principles of adult learning, but they don’t know how to effectively apply them when teaching.
While patient education managers are aware of staff deficiencies, they don’t always have the time or resources to help staff improve their teaching skills. To remedy the situation, hospitals are contracting with outside businesses that have created seminars and workshops to help staff become better teachers.
Krames Communications in San Bruno, CA, developed a course titled Educating Patients: A Skill-Building Seminar. The eight-hour seminar covers the four steps to effective education: assessing, planning, implementing, and documenting.
"Health care professionals usually know these elements of teaching patients, but we go into detail on each topic and use role-playing to show them how to apply their knowledge," explains Carol Louisell, associate market manager for Krames Communications. "They learn how to assess patients and develop an education plan with the patient."
The course was first piloted at Henry Ford Health System in Detroit in November 1996. The integrated health care system was in the process of implementing guidelines for chronic disease management such as asthma, diabetes, and congestive heart failure. Management realized that education played a key role in the success of the guidelines.
"When rolling out the asthma guidelines, we realized that people at the point of service needed some support and some inservicing on how to do patient education. Chronic disease requires a lot of patient self management skills," says Nancy Combs Habel, MA, director of communications at the Center for Health Promotion and Disease Prevention at Henry Ford.
For facilities with ongoing needs, Krames also offers a two-day course that trains staff to conduct the skill-building seminar. At Henry Ford, 32 facilitators have been trained from various departments and outpatient clinics so they are available on site to conduct patient education inservices.
"Staff who are trained to implement the course are also advocates for patient education. By training these trainers, we were able to increase knowledge at the point of service on an ongoing basis so other staff members have someone to go to on site with their patient education questions," explains Combs Habel. The course is offered monthly at Henry Ford for the 17,000 employees who care for 800,000 patients annually.
Consultant Barbara Hebert Snyder, MPH, CHES, president of Making Change in Cleveland, conducts workshops on patient-centered teaching.
"I teach staff to apply the techniques and strategies of education in the context of being patient centered," she explains.
The focus of most seminars is on patient partnering techniques staff can use when teaching. For example, there may be nine items to cover to complete discharge instructions. Yet the nurse can’t cover them effectively in the 10 minutes allotted for teaching. Therefore, it would be important to find out what concerns the patient the most and focus on that issue. If the patient is worried about getting medications mixed up, the teaching session would cover medications. Other issues could be addressed later by soliciting help from other staff such as the dietitian.
Hebert Snyder tailors each workshop to the needs of the institution.
"Some institutions want to focus on needs assessment while on the unit and others want more emphasis on the face-to-face partnering with patients. I talk to management to find out staff needs," she says.
Also, she tailors the workshop to the time management can commit to staff training, although most of her workshops are a day long.
The Krames course, in addition to managed care settings implementing chronic disease management programs, works well for health care systems that serve a diverse patient population, says Combs Habel.
"An important part of the skill-building course is to teach staff to recognize and understand issues of diversity. So for organizations who are working with culturally diverse populations, this course would be valuable," she says.
Also, the course helps staff develop the skills required for a facility to meet accreditation standards set for patient education by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations. Vanderbilt University Medical Center in Nashville offered the course to employees in May 1997 to improve knowledge on assessing readiness to learn and documentation of patient education before its Joint Commission survey in August.
Marie Glaser, RN, MSN, consultant in the Learning Center at Vanderbilt, says, "From chart audits, we knew that the documentation of patient education in general and specifically around eliminating learning barriers or assessing for readiness to learn was deficient. Although we weren’t able to do a major turnaround before the Joint Commission, we showed that we were working on the problem."
The "Educating Patients: A Train the Facilitator Seminar" costs $8,000 for the two-day course, with a second two-day session costing $6,000. Thirty people are allowed to enroll in each session. The "Educating Patients: A Skill-Building Seminar" costs $5,000 for the first day and $3,000 for each consecutive day. No more than 50 people are allowed to enroll in each course.
Hebert Snyder’s usual fee is $1,000 plus travel expenses for a day-long seminar. She asks that health care facilities limit enrollment to 30 participants and gives discounts on additional sessions to accommodate more staff. The workshops are very interactive with lots of role-playing and skill practice.
At Henry Ford, working with someone outside the institution was well worth the expense, says Combs Habel.
Don’t get strapped for staff when expanding
Plans for the Fountain of Healthy Living Learning Center at the VA Medical Center in Albuquerque, NM, were grand. Carol Maller, MS, RN, CHES, patient education coordinator, proposed a spacious center located in the clinic waiting area. Her vision included several learning stations with hands-on activities, patterned after children’s museums, that patients could visit while waiting for an appointment. Also, a classroom with theater style seating and two-way mirrors was envisioned.
The administration approved 334 square feet of space in the primary care section of the medical center. No special funds were allotted to support the learning center, so it is funded from the general budget for patient education. Yet Maller has creatively overcome barriers to create a well-run center for health promotion and prevention. Following are her strategies for a well-run center operating within a tight budget:
• Use qualified volunteers to run the center.
The original plan for the learning center included using people from the hospital’s service area on the board of directors. Yet, without funding for staff, they soon became an integral part of the center’s operation. Maller let the volunteer office know about her need so they could recommend people suited for the task and she could interview interested volunteers. She had an informal list of criteria for volunteers that included:
articulate, and comfortable giving out information;
comfortable around patients;
outgoing and likes to be with people.
In addition to recruiting through the volunteer office, she talked to clinicians and asked them to recommend patients that were interested in having a unique role working at the learning center and being involved with patients and their families. Maller says she received some excellent referrals from providers.
Curtis Heckel, MA, a retired teacher and patient is one example. He helps people find the information they need, and he understands the value of the Fountain of Healthy Living Learning Center. "Being in education all my life I think that knowledge about the health problem is just as important to the cure as the medicine," says Heckel.
Seven volunteers are involved in the learning center with five assigned to run the center one day a week from 9 a.m. to 3 p.m. All the volunteers sit on the board along with several medical professionals that include physicians, physician’s assistants, nurses, and nurse educators. "Having volunteers as part of the board is a good way to keep the learning center on track and focused on patient needs," says Maller.
• Create traffic for best use of facility.
Although the learning center is not in the waiting area, it has large plate glass windows that are 5 feet high, so people can see into the room, and a neon sign in the window to draw attention.
"Patients can see in the center as they pass by, and that is inviting," says Maller.
Also, providers can refer patients to the learning center. To encourage the process, Maller developed prescriptions for healthy living that lists some key materials at the learning center with room to write in specific instructions. The prescriptions have been distributed throughout the medical center to such health care professionals as physicians, dietitians, and nurses on all inpatient units. As a result, about 33% of the people who visit the center are by referral.
When the learning center opened in November 1996, Maller made sure it was a major event so medical staff would be aware of it and refer patients. She had a ribbon cutting ceremony and invited dignitaries from the hospital, such as the chief of staff, as well as veteran organizations. Food was served, and a string quartet played music.
• Show appreciation and value of volunteer’s work.
The volunteers have a great deal of responsibility. They open and close the center and keep it stocked with brochures and other handouts. In addition, each has a special interest they work on when not helping patients at the learning center. For example, one sets up a window display each month highlighting a health topic such as cholesterol during National Cholesterol Month. One calls community agencies such as the local cancer society to make sure the learning center is receiving their newsletters. Another searches for Internet resources.
To recognize the importance of the job they do, Maller had special vests created for each volunteer that has Fountain of Healthy Living Learning Center embroidered on it. She also recognizes them during National Volunteer Week, which will be held April 19-25, 1998. This year, she created a poster display with pictures and a short biography on each volunteer from the learning center. She also recognizes them during patient education week and gives them gifts at Christmas.
The volunteers notice. "Carol Maller makes sure she greets every volunteer at least once a day and has personal contact with them. It makes people feel like there is someone who cares whether they are there or not. I think how well your volunteers work for you in large part depends on the ability of the supervisor to make people feel appreciated and welcome," says Kay Sperry, RN, EdD, a retired clinical psychologist and volunteer at the learning center.