Chapter 11 Patient-Safe Communication and Patient Education

1. Chapter 11Patient-Safe Communication and Patient Education

2. Health Literacy Programs • Teach patients what to ask for their own safety: • What is my main problem? • What do I need to do? • Why is it important for me to do this?

3. What All Patients Need to Know: METHOD Daily Teaching Plan M Medications E Environment T Treatments H Health knowledge O Outpatient/inpatient D Diet

4. Medications • Name and actions • Hospital drugs: 1 sentence each • This is an antibiotic for your infection • This is a blood thinner to prevent clots • Home drugs: Add how to take to avoid complications: 1 sentence each • Take antibiotic 3X a day, morning, noon, night. Take entire prescription. Take with food to avoid upset stomach.

5. Environment • Hospital environment • Safety/falls modifications: Furniture arrangement • Activity orders • WBAT • BRP • Home environment • Safety/falls modifications: Phone, stairs, rugs • Activity/exercise : Walking, lifting, driving • Financial considerations: Drugs, dressings • Family- social support: Supplies, food

6. Treatments • Hospital • Purpose—why • Home • Procedures—correct techniques • Supplies—obtaining • Simple directions • Care of wound • Injections

7. Health Knowledge of Disease • Signs and symptoms of problems pertaining to specific health state • Wound—S/S infection • Heart Problem—S/S of heart failure • Contact physician • How • When—if s/s occur • Web site • www.diabetes.org

8. Outpatient or Inpatient Services • Hospital • Diagnostic tests: 1 sentence • Laboratory • Procedures • Home • Office appointments • Physician • Home health services • Hospice • Community-based support services • American Diabetes Association • American Cancer Society

9. Diet • Food pyramid • Serving sizes • Healthy eating guidelines • Promote wound healing- • Protein, vitamin C • Promote elimination—bladder & bowel • Fiber, water • Specific menus • Obtain samples from dietary department

10. Summary METHOD Teaching Plans • Medications—name, action, side effects • Environment—home, finances, family • Treatments—purpose and techniques • Health teaching—effects of disease, s/s • Outpatient/inpatient referrals—office appointments, support groups, diagnostic tests • Diet—appropriate diet, food restrictions, menus

11. Adult Learning Principles • Be realistic; stick to the basics • Take advantage of the teachable moment by incorporating teaching into your ongoing patient care • Reinforce all learning • Solicit feedback

12. Adult Learning Principles • Build on previous experiences • Focus on immediate concerns first • Adapt teaching to the patient’s lifestyle • Make the patient an active participant • Determine learning readiness

13. Psycho-Social-Cultural Patient Assessment Tool • Emotional state (mood, body language, eye contact, facial expressions) • Patient’s life experience (previous experiences with health care) • Family (mood of family members; are family members supportive) • Patient age (how health problem has interfered with growth and development)

14. Psycho-Social-Cultural Patient Assessment Tool • Relations with health-care providers (what is the patient/family level of understanding of the health problem; are they satisfied with the care given) • Self-esteem and body image (changes in physical appearance; changes in activity) • Cultural (religious preference and practices; favorite foods; years lived in the region; travel outside the region) • Gender(patient’s speech behaviors; patient-safe communication strategies used with this patient)

15. Assessment • Learning style—prefer to watch movie, listen to audiotape, read, computer, talk one on one • Reading level—does patient like to read (illiterate—1 of 5 adults reads at 5th-grade level or lower)

16. Assessment • Learning readiness and motivation • Age, developmental tasks, and cognitive level • Current understanding of health problem • Culture/gender issues—women as caretakers; food preferences • Economics—drugs, dressings, supplies • Support systems/family—emotional support and support of treatment plan

17. Assessment Factors Inhibiting Learning • Negative emotions—anxiety, depression, grief; may not be able to learn • Defense mechanisms—denial, rationalizing • Physiological problems—blind, deaf, cognitive impairment, pain, hunger, nausea • Cultural barriers—Amish & electricity, Jehovah's witnesses and blood, differing values and beliefs between health-care providers and patients

18. Teaching Plans • Learner/family assessment • Teaching goals and objectives/content • Planning teaching strategies • Implementation of teaching • Evaluation of teaching • Documentation of learning and teaching

19. Patient Goals and Objectives Goals: General statement—administer insulin independently Objectives: Cognitive, affective, psychomotor

20. Cognitive objectives—the patient will: • Describe the purpose of insulin • Describe the adverse effects of too much or too little insulin • State what to do if side effects occur

21. Affective objectives—the patient will: • Listen to instructions on how to give insulin • Appear relaxed without signs of anxiety during instruction

22. Psychomotor objectives—the patient will: • Assemble supplies needed to self-administer insulin • Draw correct dosage into syringe without contamination • Inject insulin without contamination of needle

23. Teaching Methods Must Coincide With Type of Knowledge Cognitive (Facts) • Explanations, descriptions, books, pamphlets, films, programmed instruction, computer programs Affective (Feelings and Beliefs) • One-on-one discussion, group discussions, role playing, discovery to guide the patient to problem-solve situations and to express feelings Psychomotor (Skill) • Use demonstrations accompanied by explanations

24. ImplementationWarning: Do Not Lecture Patients • No interaction • Puts teacher in charge • Learner is passive and dependent

25. Evaluation of Teaching: Did the Patient Learn? • Cognitive knowledge • Oral or written questions, diary or records for self-monitoring • Affective knowledge • Inferred from how patient responds and speaks, verbal expression of feelings and values • Psychomotor knowledge • Return demonstrations

26. When a patient decides not to change a behavior The patient does not want to stop smoking • You have done everything to convince a patient to change and become healthier • Do not get in an argument; agree to disagree; patients have the right to their own opinions and decisions • Document, and wait for a teachable moment, when the patient is motivated to change

27. References References for this content can be found in the text. Chapter 6: P. 91 Chapter 7: Pp. 103 and 104 Chapter 8: Pp. 116 and 117 Chapter 9: Pp. 128-130 Chapter 10: P. 142 Chapter 11: Pp. 155 and 156