AMA 246 Patient Prioritizing and Instruction

1. AMA 246 Patient Prioritizing and Instruction

2. Patient Education Process Performed under direction of physician • Assessment – gather info about patient’s health needs and abilities • Planning – use info you have gathered to establish goals and objectives; objectives must be measurable so you can evaluate success • Implementation – teaching; lecture, demonstration, role-playing, discussion, audiovisual and printed materials • Evaluation – how patients are adapting or applying information • Documentation – date and time, what info taught, how taught, evaluation of learning, any additional plans

3. Learning Styles Visual Learners: • learn through seeing...                    . • These learners need to see the teacher's body language and facial expression to fully understand the content of a lesson. They tend to prefer sitting at the front of the classroom to avoid visual obstructions (e.g. people's heads). They may think in pictures and learn best from visual displays including: diagrams, illustrated text books, overhead transparencies, videos, flipcharts and hand-outs.  During a lecture or classroom discussion, visual learners often prefer to take detailed notes to absorb the information. Auditory Learners: • learn through listening... • They learn best through verbal lectures, discussions, talking things through and listening to what others have to say. Auditory learners interpret the underlying meanings of speech through listening to tone of voice, pitch, speed and other nuances. Written information may have little meaning until it is heard. These learners often benefit from reading text aloud and using a tape recorder. Tactile/Kinesthetic Learners: • learn through , moving, doing and touching... • Tactile/Kinesthetic persons learn best through a hands-on approach, actively exploring the physical world around them. They may find it hard to sit still for long periods and may become distracted by their need for activity and exploration.

4. Multiple Intelligences Conceived by Howard Gardner, Multiple Intelligences are seven different ways to demonstrate intellectual ability. Visual/Spatial Intelligence • ability to perceive the visual. These learners tend to think in pictures and need to create vivid mental images to retain information. They enjoy looking at maps, charts, pictures, videos, and movies. Verbal/Linguistic Intelligence • ability to use words and language. These learners have highly developed auditory skills and are generally elegant speakers. They think in words rather than pictures. Logical/Mathematical Intelligence • ability to use reason, logic and numbers. These learners think conceptually in logical and numerical patterns making connections between pieces of information. Always curious about the world around them, these learner ask lots of questions and like to do experiments Bodily/Kinesthetic Intelligence • ability to control body movements and handle objects skillfully. These learners express themselves through movement. They have a good sense of balance and eye-hand co-ordination. (e.g. ball play, balancing beams). Through interacting with the space around them, they are able to remember and process information.

5. Multiple Intelligences cont… Musical/Rhythmic Intelligence • ability to produce and appreciate music. These musically inclined learners think in sounds, rhythms and patterns. They immediately respond to music either appreciating or criticizing what they hear. Many of these learners are extremely sensitive to environmental sounds (e.g. crickets, bells, dripping taps). Interpersonal Intelligence • ability to relate and understand others. These learners try to see things from other people's point of view in order to understand how they think and feel. They often have an uncanny ability to sense feelings, intentions and motivations. They are great organizers, although they sometimes resort to manipulation. Generally they try to maintain peace in group settings and encourage co-operation. They use both verbal (e.g. speaking) and non-verbal language (e.g. eye contact, body language) to open communication channels with others. Intrapersonal Intelligence • ability to self-reflect and be aware of one's inner state of being. These learners try to understand their inner feelings, dreams, relationships with others, and strengths and weaknesses.

6. Abraham Maslow Basic needs must be met before progress to next level Physiological needs Safety and security needs Love and belongingness Self-Esteem Self-Actualization Maslow’s Hierarchy of Needs

7. Patient Education • Environment – must be conducive to learning; patients must feel relaxed and comfortable • Equipment – always provide written as well as verbal instructions. Psychomotor skills: - demonstrate entire skill - demonstrate step by step with explanation - have patient demonstrate with your help - have patient demonstrate without help • Knowledge – you as teacher must have knowledge of the material; never guess or imply that you know something you do not • Resources – use multiple techniques or approaches; access all learning styles and intelligences possible; use visual aids, pamphlets and models. - include family or significant others in learning when possible - patient should use any sensory devices they have such as glasses - Qualified interpreters should be used if necessary - Written instructions as well as verbal should be used

8. Patient Information

9. Barriers to Education • Existing illness – pain, weakness, terminality, mental health or cognitive impairment, multiple chronic illnesses, respiratory problems • Communication barriers – must be resolved prior to initiating education; hearing, language, cognition, age etc… • Age – speed and level of information for children, adults with multiple responsibilities or obligations, elderly with cognition or interest levels • Educational background – determines level of information given • Physical impairments – motor skills issues with disease processes, visual problems with reading, etc… Use occupational therapist if necessary • Other – culture, family, willingness, depression, focus etc… assess readiness to learn

10. Teaching Specific Topics • Preventative Medicine – regular exams, vaccinations, dental, testicular and breast self-exams, cancer screening such as mammograms and pap smears • Lifestyle Changes – diets for illness, smoking cessation, alcohol use etc… • Safety – fall prevention, fire safety, poison, helmets, seatbelts etc… • Medications – medication name, dosage, route, use, why, side effects, mixing medications, food or liquid to be avoided, activities to be avoided, telephone number for questions, scheduling multiple meds • Alternative Medicine – acupuncture, acupressure, hypnosis, yoga; educate on holistic approach to treatment • Herbal Supplements – not regulated; educate on combination with prescription drugs, safety of type and where purchased or who prescribed, always ask if patient taking any supplements, make sure physician knows • Stress Management – be aware of defense mechanisms used by patients. Encourage use of relaxation techniques such as visualization, breathing and exercise. Understand positive and negative stress and how stress affects the body physically and mentally

11. Developing Teaching Materials • Indicate objective of the information • Personalize information • Clear and well organized • Use lists and outlines rather than paragraphs • Avoid medical jargon • Focus on key points • Use diagrams that are simple, clear and well labeled • Include names and telephone numbers of people and organizations patients can call for more information

12. Triage or Prioritizing • Follow your employer’s triage algorithms • Important legal issue • Do not make decisions that are not yours to make and go outside your scope of practice • Always document what is said by both you and the patient and what is done • Always get the patient’s name and the phone number they are calling from • Standing orders: each office has standing orders on what to do in a specific situation • If necessary call 911 for the patient; always stay on the line until help arrives • ALWAYS ASK IF ANY ALLERGIES TO MEDICATIONS! • Elderly, infants or those with compromised immune systems, when ill with even an upper respiratory infection, will most likely need a same day appointment. • Do not promise meds over phone, do not prescribe at all, even OTC painkillers, act only within your scope of practice. When in doubt, consult MD • Ask complete questions: what, when, where, how long, how much, pain level, how often, what tried, did it help, meds taking, allergies….be thorough!

13. EMR Triage Tool

14. Resources • http://familydoctor.org/online/famdocen/home.html • http://www.modernmedicine.com/patienteducation • http://jama.ama-assn.org/cgi/collection/patient_page • http://www.medscape.com/medscapetoday/resource • http://www.chaminade.org/inspire/learnstl.htm • http://en.wikipedia.org/wiki/Learning_styles • http://www.ldpride.net/learningstyles.MI.htm