Stroke Education in the Acute Care Setting

1. Presented By: Dana M. Smith, MS, MCHES, CCE Patient Education Specialist UAMS Medical Center Stroke Education in the Acute Care Setting

2. Objectives By the end of this presentation, participants will be able to: • Verbalize what health literacy is and it’s importance to stroke education. • Verbalize the importance of stroke education to stroke survivors and their caregivers in the acute care setting. •  Verbalize the key steps to providing effective stroke education. • Use the teach back method as an evaluation tool for stroke education.

3. What is Literacy? Using printed and written information to function in society, achieve one’s goals, and develop one’s knowledge and potential. - Kirsch et al, 1993

4. What is Health Literacy? “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” - Ratzan and Parker, 2000 / Healthy People 2010

5. Expanding the Definition • A patient's ability to obtain, understand and act on health information. • A provider’s capacity to communicate clearly, educate about health and empower their patients.

6. What is it Like?

7. GNINAELC – Oterussahgihecnamrofrep, yllacidoirepnaelcehtepatsdaehdnanatspacrevenehwuoyecitonnanoitalumuccafotsuddnanworb-deredixoselcitrap. Esu a nottocbawsdenetsiomhtiwlyporposilohocla. Eberus on lohoclasehcuotehtrebbur strap, satisdnetotyrddnayllautnevekcarcehtrebbur. Esu a pmadtholcroegnopsotnaelcehttenibac. A dlimpaos, ekilgnihsawhsidtnegreted, lliwplehevomeresaerg rolio.

8. Health Literacy Impacts Access Safety Quality Outcomes

9. Only 12% are Proficient Health Literacy results from the National Assessment of Adult Literacy, US Dept of Education, 2003

10. Why Are Patients at Risk? • Reliance on the written word for patient instruction is increasing. • Increasingly complex healthcare system • More medications • More tests and procedures • Growing self-care requirements • Esoteric language

11. Who is Most at Risk? • Elderly • Ethnic and racial minorities • Limited education immigrants • Low socioeconomic status • People with chronic disease

12. Red Flags • Making excuses • Perceived resistance • Has no questions • Frequently missed appointments, tests • Non-adherent with meds or treatment

13. So What Can We Do?

14. Why is Stroke Education Important? • Helps patient and caregivers understand why quick access to care is important after stroke symptoms. • Identifies ways that the patient can reduce the risk of having another stroke. • Provides caregivers needed information on how to care for a stroke survivor. • Increases patient compliance and decreases re-admission rates. • After TIA – Within 2 days after a TIA, 5 percent of people will have a stroke. Within 3 months after a TIA, 10 to 15 percent of people will have a stroke. -National Stroke Association, 2012

15. The Problem Life Altering Event Short Admissions Large Amounts of Information + Limited Staff Time

16. Four Steps to Effective Teaching • Assess patient for educational readiness • Plan what you will teach • Implement teaching • Evaluate teaching

17. Assessment • Who should education be targeted toward? • Are the learners emotionally ready? • Are there literacy issues? • What might be some potential barriers? • What are the learners preferred learning styles? • Are the learners motivated?

18. Planning for Education What does the patient NEED to know? “Get with the Guidelines - Stroke”: 1. Activation of emergency medical system 2. Need for follow-up after discharge 3. Medications prescribed at discharge 4. Risk factors for stroke 5. Warning signs for stroke

19. And What Else Would Be NICE to Know? • Emotions after stroke • Avoiding complications: falls, UTI, aspiration pn, etc. • Managing ADLs • Help for the caregiver • Understanding deficits: memory, communication, motor skills, etc. • Rehab • Where to get further information – support groups, websites, organizations

20. Education is Best Using a Multi-Disciplinary Approach • Physicians • Nurses • Patient Educators • Case Coordination • Speech Therapy • Occupational Therapy • Physical Therapy • And many others

21. Planning for Education • What Resources are Available? • Videos • Materials/Handouts • Other • Regarding Materials • Are handouts written in plain or common language? • Are materials written at a 6-8th grade level? • Are materials free of medical jargon?

24. Health Literacy Checklist for Stroke Materials • Font should be at least 12 point • Use ample ‘white space’ • Use 1.5 or double spaces between sentences and more space between bullets. • Organize information with the 3-5 most important “need to know” points. • Give the most important information first and last to enhance memory. • Use a conversational writing style and active voice.

25. Implement Teaching • Use plain language and avoid acronyms. • Get the learner actively involved. • Don’t make assumptions. • Use a variety of teaching strategies, if able. • Ask questions during teaching to make sure the patient is understanding. • Always give written information as a back up to all teaching.

26. Evaluate Learning “The greatest impediment to communication is the illusion that it’s actually happening.” -George Bernard Shaw

27. Evaluate Learning • Research shows that patients remember and understand less than half of what clinicians explain to them.Ley, Communicating with patients: improving communication satisfaction, and compliance 1988 Rost, Predictors of recall of medication regimens and recommendations for lifestyle change in elderly patients 1987. • Use the Teach Back Method – aka: “Show Me” or “Closing the Loop” • Is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands.

28. What Teach Back Is… • Asking patients to repeat in their own words what they need to know or do, in a non-shaming way. • NOT a test of the patient, but of how well you explained a concept. • A chance to check for understanding and, if necessary, re-teach the information.

29. Teach Back is Supported by Research • “Asking that patients recall and restate what they have been told” is one of 11 top patient safety practices based on the strength of scientific evidence.” AHRQ, 2001 Report, Making Health Care Safer • “Physicians’ application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients.” Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”

30. Stroke Education TB Questions • “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” • “What will you tell your husband about the changes the doctor made to your medicines today?” • “Can you tell me some things you might do to reduce your risk of having a stroke?” • “Can you tell me what you would do if you started to feel some of the symptoms of a stroke when you were at home?”

31. On Going Education • On-Going Education after Discharge: • Newsletters • Follow up phone calls • Stroke support groups • Listservs • Social Media • Video-conferences, etc. • Education centered on staying healthy, reducing risks, adjusting to life after stroke,etc.

33. UAMS Stroke Support Group 3rd Thursday of Each Month 11 a.m. – Noon UAMS Family Home 4300 W. Markham Little Rock, Arkansas 72205 To Register: 501-686-7791

34. Resources • American Stroke Association • Stroke Connection Magazine • Stroke Handouts www.strokeassociation.org • American Heart Association • Get With the Guidelines www.heart.org • National Stroke Association www.stroke.org • National Institutes of Health www.stroke.nih.gov