Patient Education

1. Patient Education

2. Learning outcomes from the session Following this session you will be able to: • Define the term ‘Patient Education’ • Underpin practice with an appropriate theoretical model • Select a suitable method of delivering Patient Education • Discuss the effectiveness of Patient Education

3. What do we mean by the term Patient Education?

4. Is there a difference between PE and Improving Knowledge?

5. Definitions of PE ‘Patient Education is any set of planned, educational activities designed to improve patients’ health behaviours and/or health status’ Lorig et al (1996) In: Patient Education a Practical Approach. Sage

6. Definitions of patient education Notice, there is nothing in this definition about improving knowledge Lorig et al (1996)

7. PE and improving knowledge • Activities aimed at improving knowledge are patient teaching • Changes in knowledge may be necessary before we can change behaviours or health status

8. Patient Education Does knowledge automatically lead to behavioural changes?

9. Patient Education Factors influencing behavioural change • Want to make a change • Believe that a behavioural change will have a beneficial effect • Believe that you have the ability to execute the change

10. Can you think of any theories that could underpin PE?

11. Theory Underpinning Patient Education Self Efficacy Theory ‘a person’s confidence in their ability to perform a specific task or achieve a particular objective’ Bandura, 1986

12. Self Efficacy Patients who demonstrate a high degree of self-efficacy: • Believe they can make a positive difference to their health • Are more likely to maintain a positive sense of well being • Undertake constructive coping strategies

13. Self Efficacy Self efficacy is behaviour specific • A patient may believe they can control their pain • The same patient may have little expectation that they can control their weight or sleep pattern

14. Can we enhance a persons self-efficacy?

15. Enhancing self efficacy • Mastery of skills - achieving proficiency • Modelling - comparing ones self with others • Persuasion - nurses usecommunication skills • Reinterpretation of physiological state - dissociating symptoms from reactions to therapies

16. Other useful theories • Stress and coping theory (Lazarus and Folkman, 1984) • Health belief model (Becker, 1974) • Learned Helplessness (Seligman, 1975)

17. Exercise • Read the information about different theoretical models and bear in mind self efficacy theory • Read the Case History • State which 2 models are appropriate and say why

18. What are the aims of PE?

19. Aims of patient education • To enhance the patient’s health status and ultimately their outcome • This goal is not always attainable • Minimum requirement is that PE should improve the patient’s perception of the quality of life during their illness journey

20. Following a PE programme what aspects of self care would you expect a patient to be proficient in?

21. Effective self management Patients should be able to: • Tailor the dosage of NSAID’s and analgesics according to their symptoms • Know what action to take if side effects occur • Regulate their daily exercise programmes

22. Effective self management Patients should be able to: • Employ pacing and prioritising techniques • Treat a flare • Use effective coping strategies

23. Planning a PE Programme • Demographic factors • Content of the programme • Type of Programme • Teaching aids

24. Demographic factors When teaching in groups consider: • Disease duration • Age range • Diagnosis

25. Disease duration - considerations • Can be counter productive to mix newly diagnosed patients with patients who have obvious physically disfigurement • Disease management has changed particularly for those with RA • Drug therapy has improved considerably over the last 5 years

26. Disease duration - considerations • Teach newly diagnosed patients in a separate group • Include a patient who is a good role model in the education team

27. Age range Younger patients often see their needs as being different from older patients: • Body/sexual image • Marriage/partnership prospects • Becoming pregnant • Employment expectations

28. Diagnosis Should we teach patients with different diseases in the same group? • Pain control • Principles of joint protection • Pacing and prioritising • Analgesics, NSAID’s, intra articular injections

29. Diagnosis Not appropriate to include: • Specific disease process • DMARD therapy to OA patients • Oral steroids to OA patients • Specific exercise regimens

30. Content of the PE Programme Important to include topics: • That patients themselves believe are important • That have been shown to work in health professionals literature

31. Disease process Drug therapy Exercise Joint protection Fatigue management Pain control Coping strategies Diet Relaxation Complementary therapy Communication skills Self-help strategies Goal setting techniques Source data: Bishop et al,1997 (ARC) Topics chosen by patients

32. Topics chosen by patientsfor an osteoarthritis PE programme Methodology: • Face to face interviews • 14 patients with OA • Opportunity sample selected from OP clinic LGI

33. 13 Drug therapy 13 The use of IAI 13 Exercise 8 Diagnosis 7 Pain control 7 Self management 5 Sleep 4 Complimentary therapy 3 Home adaptations 3 Diet 3 Surgery 2 Shoes 2 Work Patient elicited topics

34. OA PE Programme Underlying theme - Self Management • Diagnosis: Living with OA -What is it and how to deal with it • Exercise, diet, complementary therapies: Osteoarthritis - Helping yourself • Drugs, heat/cold, rest, pacing, splints, relaxation: Osteoarthritis - Ways to lessen your pain • ADL and home adaptations: Osteoarthritis - Adapting your lifestyle

35. Type of PE programmes • Individual / one to one • Groups • Arthritis Self Management Programme • Opportunity Education

36. Individual PE • The most common form of delivery used by specialist nurses in the UK • Very flexible and can be tailored to the individual • Expensive!!!!

37. Group education - positive aspects • Effective method of teaching skills • Patients meet others with the same problems • Share experiences and solutions • Socially beneficial • Powerful role models • Relatively cheap

38. Group education - negative aspects • Wide range of knowledge • Different rates of learning • Discrepancies in the levels of skills • Some patients are not articulate • Feel disinclined to express their feelings • Fear of failure • Fear of criticism

39. Arthritis Self Management Programme (ASMP) • The most successful programme in the world • Best researched PE programme • Devised by Kate Lorig (USA) in late 1970’s

40. The ASMP • Community based • Taught in groups • 6 x 2 hourly sessions over a few months • Taught by lay teachers who have arthritis • Topics are similar to other programmes • Patients pay a small fee • Based on self efficacy theory

41. The ASMP The programme lays emphasis on: • Problem solving • Developing coping skills • Symptom management • Utilisation of information

42. The ASMP • USA • Australia • Sweden • Norway • Holland • Belgium • UK

43. Opportunity Education Almost any occasion is an opportunity to teach!!

44. Teaching aids • Written material - make sure its written at correct level for the recipient • Videos - useful for those with reading difficulties • Audiocassettes - can be used almost anywhere • Computer programmes - expert systems

45. Teaching Aids Get information from whoever and however you can, but don’t waste time reinventing the wheel!!!

46. Does PE Work? Changes in health status: 96 data sets - 10 clinical measures: • Pain • Stiffness • Functional ability • Psychological status Source data: Lorig et al, 1987

47. Does PE Work? Literature review - Hirano et al (1994) 45 studies • 20 - 50% improvement in health status using standard rheumatology care • 15 - 30% improvement by the addition of PE

48. Does PE Work? Effect of PE on adherence with drug therapy: • 100 RA patients randomised to control or experimental group • All received DPA as their DMARD therapy • Statistical differences found in levels of adherence with DMARD Hill et al, 2001 Annals Rheum Dis

49. Cochrane Review Reimsma RP, Kirwan JR, Taal E, Rasker JJ. Patient education for adults with rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software.

50. Main Findings(24 RCT included) Moderate short term effects in: disability joint counts patient global assessment psychological status