Transcript Document

ASSESSING ADULT LEARNING PREFERENCE FOR SUCCESSFUL WOUND CARE IN A COMPREHENSIVE WOUND CENTER
Ranjita Misra, PhD, CHES1, Lynn Lambert, BS, CWS. CHT3, David Vera2 , Ashley Mangaraj2 , Suchin R Khanna2 ,Chandan Sen, PhD2
1
Texas A&M University, College Station, Texas, 2The Ohio State University Comprehensive Wound Center, Columbus Ohio , 3 National Healing Corporation (NHC), Boca Raton, Florida
s
s
Abstract
BACKGROUND: Understanding the adult learning principles as well as assessing
learning preferences can aid clinicians and health providers in successful plan of care
designed to initiate a change in behavior, knowledge, and skills. Patient motivation is
also an important pedagogical and andragogical strategy for adult learners.
OBJECTIVE: The overall goal of this study was to examine adult patient's learning
preference and motivation by gender, age, and race/ethnicity. DESIGN: This
retrospective study sample comprised of 1003 patients (72 % whites, 53% females)
treated for acute, acute traumatic or chronic wounds at a hospital-affiliated
Comprehensive Wound Center in the Midwest. RESULTS: Demographic characteristics
indicated 99% adults (mean age = 55.2±17; 29% > 65 years), with low levels of education
(48% HS education) and socioeconomic status (17% on Medicaid). The majority of
patients indicated their learning preference as explanation (59%) or demonstration
(56%) by their health care providers. Printed materials was preferred by only one-third
(34%) of the patients. Use of video and group/class room environment was not favored
by 99%. Assessment by a nurse manager showed half (51%) were eager to learn and
asked questions (69%). However, 11% were anxious, and 6% were
uninterested/confused/uncooperative. Knowledge of their health problems was low to
medium by 60% of the patients. Learning preference and motivation varied with females
having lower knowledge of health problems, not preferring to ask questions, being
anxious, and preferring demonstration/printed materials more than their male peers
(p<.05). Minority patients had lower knowledge and preferred explanation by providers.
Older patients had lower knowledge, did not ask questions, were more anxious and
confused, and not interested to learn. CONCLUSIONS: With the projected demographic
changes in the US population (i.e., aging; increase in minorities), knowledge of the adult
learning preference and pedagogical strategies will help to improve effective patient and
caregiver education.
Introduction
Chronic wounds represent a major health burden in terms of
number of days lost from work, decreased quality adjusted life
years and disability adjusted life years.
Patient education has been identified essential to chronic
disease management and positive healing outcomes.
Accordingly, JCAHO mandates all clinics and hospitals to
assess patients’ needs and provide patient education.
Patients’ motivational levels and learning preferences are
important factors for effective patient education. They are part
of the learning assessment completed in hospitals and clinics.
Patient education in proper self management is considered
essential to chronic disease management and positive healing
outcomes.
Purpose
The purpose of this retrospective study was to examine adult
patients’ learning preference and motivation by gender, age,
and race/ ethnicity.
Results
Table 1:Demographics
Methods
Sample
Figure 3: Learning Preference of Respondents by
Gender/Race/Diabetes Status
Males
Variable
characteristics indicated 99% adults (mean age
= 55.2±17; 29% > 65 years), with low levels of
education (48% HS education) and
socioeconomic status (17% on Medicaid).
Study site and data collection
468 (46.7)
535 (53.3)
Educational Background
Grade school
High school
College
57 (6.4)
426 (47.9)
407 (45.7)
Health Insurance
Private
Medicare
Medicaid
Supplemental
Self pay
385 (38.5)
438 (43.8)
136 (13.6)
14 (1.4)
27 (2.7)
Elderly Patients
< 65 years
65 + years
Figure 4: Motivational Level of Respondents
Males
68
66
63
Females
62
67
64
69
White
African American
50
48
45
43
47
48
40
33
The majority of patients asked questions and
were eager to learn.
2.1
Non DM
Minorities and elderly patients were more
anxious (p<.05). Females, African American
and elderly patient s did not ask questions
(p<.05). Females and elderly patients were
less eager to learn (p<.05).
12
12
8
8
11
10
Anxious
Figure 5: Knowledge of Health Problem
8.8
Females
White
African American
38
40
33
30
Other Race
52
51 51
45
DM Patient
Non DM
Minorities, females and the elderly patients
had lesser knowledge of their health problems
)p<.05).
33
19
0.6
Confused
12
15 16
19
16 15
3.3
Denies need of education
0.1
Uninterested
High
2.2
Uncooperative
0.7
30
11
51
69
Asks questions
0
Medium
Low
Discussion and Conclusion
Eager to learn
10
20
30
40
50
60
70
Figure 2 : Learning preferences among Patients
Participants preferred the learning by explanation and demonstration versus printed materials
(p<.001)
60
47
DM Patient
Eager to Learn
48 48 47
60
Other Race
9
Asks Question
Anxious
56
PERCENT
50
40
Completed data collection forms were deidentified and data coded and entered into an
SPSS database (SPSS Inc., Chicago, IL).
Non DM
DM Patient
Other Race
African
White American
PERCENT
Unresponsive
60
59
Minorities, females and the elderly patients
favored learning by demonstration and
explanation by the care team. (p<.05).
Males
Other
68
59
5435 62
Non DM
Males
Figure 1: Motivational levels
Measures
Learning preference and motivational level was
assessed by the nurse case manager and patient
progress report at the beginning of their
treatment.
49
34
55 33
DM Patient
730 (73.0)
270 (27.0)
Calm
Patient’s demographics - age, gender, race,
health insurance, educational level, diabetes
status, and perception of current health status.
31
32
59
63
37
62
43 56
56
59
Other Race
603 (62.8)
357 (37.2)
Unchecked
Six trained research assistants abstracted the
data using standardized forms developed for the
project. Data collected included patient
demographics, clinical history, co-morbid disease
states, laboratory test results, and wound factors
pertinent to wound care.
African American
Females
Diabetes
Yes
No
Data were abstracted from patient charts for the
period of 2006 and 2009 from one hospitalaffiliated and research-based care at Ohio State
University’s Comprehensive Wound Center
(CWC) in Columbus Ohio. The CWCs provide
advanced care to patients with chronic, nonhealing wounds.
White
Number
(Percent)
Gender
Male
Female
The sample comprised of 1003 patients (72 %
whites, 53% females) treated for acute, acute
traumatic or chronic wounds at a hospital-affiliated
Comprehensive Wound Center. Demographic
Females
34
30
19
20
With the projected demographic changes in the US population (i.e.,
aging; increase in minorities), knowledge of the adult learning
preference and pedagogical strategies will help to improve effective
patient and caregiver education.
Providing education using patient’s preferred learning method(s)
may lead to improved patient compliance and self-management.
Generally, respondents who are females, minorities, and/or older
have lesser knowledge of their health problems, do not prefer to ask
questions, and favor learning by demonstration or explanation by the
care team.
Older patients reported a higher number of hospitalization and #
medications taken. They were more likely to be anxious and confused,
and not interested to learn that adds to the complexity of care (p<.01).
10
1
0
Preferred
explanation
Preferred
demonstration
Preferred
Printed material
Preferred
videotape
Funded by the Ohio State University and National Healing Corporation
Unchecked
These age, gender, race-specific data can be used in clinical
algorithms in clinician’s offices to serve as “prompts” for the clinician
to provide tailored education for patients.