Transcript Patient Education

© 2009 The McGraw-Hill Companies, Inc. All rights reserved
‫‪14-2‬‬
‫‪Patient Education‬‬
‫‪‬‬
‫‪ ‬دکتر لیلی یکه فالح‬
‫‪ ‬دکتری تخصصی آموزش پرستاری‬
‫‪ ‬استادیار دانشگاه علوم پزشکی قزوین‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
14-3
Learning Outcomes
1 Identify the benefits of patient education.
2 Explain the role of the medical assistant in patient
education.
3 Discuss factors that affect teaching and learning.
4 Describe patient education materials used in the
medical office.
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Learning Outcomes (cont.)
5 Explain how patient education can be used to
promote good health habits.
6 Identify the types of information that should be
included in the patient information packet.
7 Discuss techniques for educating patients with
special needs.
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14-5
Learning Outcomes (cont.)
8
Explain the benefits of patient education prior to
surgery, and identify types of preoperative
teaching.
9
List educational resources that are available
outside the medical office.
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14-6
Patient
Education:
why??
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Patient Education Prior to Surgery
Educational
Legal
Preoperative
Instructions
Informed Consent
Postoperative Instructions
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The Educated Patient
Is better informed about how
to maintain a healthy state
Is often more compliant with
treatment programs
Takes a more active role in medical care
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The Educated Patient (cont.)

Benefits to the medical office

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
Patients are more satisfied
Patients are more likely to follow instructions so tests do
not have to be rescheduled
Patients are less likely to call the office with questions, so
staff spends less time on the telephone
Medical assistant


More interaction with the patient
Assess educational needs at every visit
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Patient Education Prior to Surgery (cont.)
Benefits of Preoperative Education
 Increases patients’ overall satisfaction
 Reduces patient anxiety and fear
 Reduces use of pain medication
 Reduces complications following surgery
 Reduces recovery time
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Patient Education Rationale
Model of Patient Education Outcomes
Health Status
Knowledge and
Attitude Changes
 Increased understanding
 Increased confidence
 Increased satisfaction
 Improved emotional state
 Physical health
 Well-being
 Symptoms
 Complications
Patient
Education
 Print
 Verbal
 Multimedia
 Combination
Behavior Changes
 Health services utilization
 Compliance
 Lifestyle
 Self-care
Costs
 Length of stay
 Utilization
 Provider image
 Regulatory
compliance
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
•
•
The Effective Educator
??????
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The Effective Educator

Effective Patient Educator skills
include:
 Determining patient concerns
 Avoiding Assumptions
 Explaining things clearly
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Four Steps to Educating
•
Assess – Define patient and
family needs and concerns;
observe readiness to learn.
•
Plan – Set objectives with
your patient; select
materials.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
Patient Education - Steps
•
Implement – Put the
plan in motion; help
patients along the way to
reach the objectives
you’ve set together.
•
Document – Create a
written history and keep
records.
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14-16
Patient Education Prior to Surgery (cont.)
Factual
Sensory
Participatory
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types of patient education.

Factual–Informs patients of specific details about a
procedure and needed restrictions before and/or after
surgery.

Sensory–Provides patients with descriptions of
various sensations that may be felt during the
procedure.
Participatory–Includes explanations and demonstrations
of certain techniques required after surgery and
requires that patients perform a return demonstration
of the technique to validate understanding and
technique accuracy.
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Types of Patient Education:
Printed Materials
Brochures, Booklets, and Fact Sheets
 Explain procedures that are performed in
the medical office
 Provide information about specific
diseases
and medical conditions
 Provide information to help patients stay
healthy
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Types of Patient Education:
Printed Materials
Educational Newsletters
Medical office newsletters :
 Are written by the doctor or office staff
 Contain practical health care tips
 Offer updates on office policies
 Provides information about new diagnostic
tests and equipment
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Types of Patient Education:
Visual Materials
Videotapes and DVDs are used effectively to
educate about complex subjects and procedures
Many physicians arrange classes
and seminars for their patients
Health information
web sites for general
consumer health
information
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Patient Education Prior to Surgery (cont.)

Using anatomical models


A visual representation helps
patients better understand what
will take place
Helping patients relieve
anxiety



Allow extra time for patients to
grasp information
Use positive words when possible
Have family members present
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Patient Education Prior to Surgery (cont.)

Verifying patient
understanding

Have patients explain to you
in their own words their
understanding of what has
been taught

Use return demonstrations to
validate understanding of
procedural instructions
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Additional Educational Resources

Libraries


Public libraries
Hospital patient
resource rooms

Computer resources


Online services
CD-ROMs
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14-24
Additional Educational Resources (cont.)

Community resources


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
Nursing home care
Visiting nurses’ care
Counseling
Rehabilitation

Associations



American Cancer
Society
American Diabetes
Association
American Heart
Association
Note: These outside resources may be used by office personnel or
patients to obtain educational information.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-25
The Patient
Information
Packet
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The Patient Information Packet

Benefits of the Information Packet

Improves relationships between the office and the patients

Simple, inexpensive, and effective medium

Provides important information about the office policies
and staff roles

Excellent marketing tool
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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The Patient Information
Packet (cont.)
Contents
•
•
•
•
•
•
Introduction to the office
Physician’s qualifications
Description of the practice
Introduction to the office staff
Office hours
Appointment scheduling
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The Patient Information
Packet (cont.)
Contents
• Telephone policy
• Payment policies
• Insurance policies
• Patient confidentiality
statement
• Other information
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Pre-Operative Nursing Interventions
Client Teaching
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Pre-operative progression & sensations
Preoperative experience
Description of Pre and Post operative events
Preoperative medication
Description of events in OR and PACU
Pain management
Coughing & Deep Breathing Exercises
Incentive Spirometry
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PREOPERATIVE TEACHING




Turning & Positioning
Leg Exercises & Ambulation
Reducing anxiety and fear, support of
coping
Special considerations related to outpatient
surgery
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Client Teaching
Pain Management
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Pre-operative assessment of individual pain
perception on 1-10 scale
Reassurance that pain reports WILL be
believed and acted upon
Use of PCA
Benefits of ATC versus PRN
Allaying of fears regarding addiction
Potential side-effects of narcotics
How pain management promotes recovery
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Client Teaching
Pulmonary Exercises



Method for diaphragmatic breathing:
Hands on ribs, inhale thru nose allowing
abdomen to expand, hold 3-5 sec, exhale thru
pursed lips, 10X /hr while awake
Method for controlled coughing
Deep breath X2 , then inhale,
hold breath 2-3 sec, cough
forcefully 2-3X consecutively
Method for splinting
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Client Teaching
Pulmonary Exercises

Instruction on use of Incentive Spirometer:
Take 2-3 normal breathes, close lips on
mouthpiece, inhale to reach set goal, hold 3-5
sec, release mouthpiece & exhale, 10X/hr while
awake.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-34
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
‫تنفس دیافراگمی‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫در حالت نيمه نشسته قرارگيرد‪.‬‬
‫از بيمار بخواهيد تا دستها را بر روي دنده ها بگذارد به طوري كه‬
‫بتواند باالرفتن و انبساط قفسه سينه را حس كند‪.‬‬
‫از بيمار بخواهيد بازدم را به طور عميق و آهسته انجام دهد‪.‬‬
‫از طريق بيني به طور آهسته و عميق عمل دم را انجام دهد‪.‬‬
‫تنفس را براي ‪ 3-5‬ثانيه نگهداشته‪ ،‬تا حد امكان از راه دهان به طور‬
‫كامل در حاليكه لبها غنچه است بازدم را در اين مرحله ‪ 3‬مرتبه تكرار‬
‫كنيد‪.‬‬
‫اين تمرينات را هر ‪ 1-2‬ساعت در هنگام بيماري و در ‪ 24-48‬ساعت‬
‫بعد از جراحي انجام دهيد‪.‬‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
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Diaphragmatic Breathing and Splinting
When Coughing
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
‫‪14-37‬‬
‫روش سرفه موثر‪:‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫دروضعیت نشسته قرارگیرید و مقداری به جلو خم شوید ‪.‬‬
‫برای آرامش و کاهش کشش عضالت شکم حین سرفه ‪،‬مفاصل زانو وران‬
‫راخم کنید‬
‫چند باربا لبهای غنچه ازطریق بینی نفس بکشید و ازدهان خارج کنید ‪.‬‬
‫محل برش جراحی را با استفاده ازدست یا بالش یا پتو برا ی جلوگیری ازدرد‬
‫حمایت کنید‪.‬‬
‫درهنگام خارج کردن نفس (بازدم )دو بارسرفه عمیق انجام دهید طوری که‬
‫عضالت شکم منقبض شوند ‪.‬این کاررابالفاصله بعد ازجراحی و به هوش‬
‫آمدن چند باردرطول روزانجام دهید‪.‬‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
‫‪14-38‬‬
‫اسپیرومتری انگیزشی‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫به مددجو آموزش دهید دروضعیت نیمه نشسته یا نشسته‬
‫قرارگیرد‪.‬‬
‫مقیاس ابزاررا تنظیم و به مددجو نشان دهید‬
‫چگونگی قراردادن قطعه دهانی اسپیرومتربه طوری که لبها کامال‬
‫آن را بپوشاند‬
‫آموزش دهید به طور آهسته عمل دم را انجام داده ‪ ،‬جریان هوا را‬
‫ثابت نگهدارد تا به حجم هدف برسد وبعد تنفس را ‪ 3-2‬ثانیه نگه‬
‫دارد ‪ .‬مجددا تکرار کند‪.‬‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
14-39
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-40
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14-41
Client Teaching
Activity

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LEG EXERCISES
Dorsi/Plantar flexion, ankle rotation, knee/hip
flexion, 5X each leg/hr w.a.
AMBULATION
Discuss importance of early ambulation and method
for getting out of bed
TURNING AND
POSITIONING
Use of side rails
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
‫‪14-42‬‬
‫ورزشهای ساق پا مانند‪:‬‬
‫‪‬‬
‫هرمچ پا را دریک دایره کامل بچرخاند ‪ .‬به مددجو آموزش دهید تا‬
‫با شست پای خود یک دایره فرض ی ترسیم کند ‪ .‬این کاررا چند بار‬
‫تکرار کند‪.‬‬
‫‪‬‬
‫به طور متناوب هردو پا را ازناحیه مچ به سمت باال و پائین خم‬
‫کنیدو باید احساس کند ماهیچه های پا منبسط و منقبض شوند ‪.‬‬
‫‪‬‬
‫تمرینات چهارسرران را با سفت کردن ران و پایین آوردن زانو به‬
‫سمت تشک انجام دهد‪.‬‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
14-43
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-44
Leg Exercises and Foot Exercises
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
‫‪14-45‬‬
‫چرخیدن در تخت‬
‫‪‬‬
‫در وضعیت به پشت خوابیده به یک سمت تخت حرکت کند و سپس‬
‫با خم کردن زانو و فشار دادن پاشنه های پا روی تشک باسن را بلند‬
‫کند و به راست و چپ بغلتد‪.‬با گذاشتن بالش یا دست روی ناحیه‬
‫عمل شده بخیه راحمایت و در تخت بچرخد‪.‬‬
‫‪‬‬
‫به مددجو آموزش دهید در هنگام بیداری هر ‪ 2‬ساعت در تخت‬
‫بچرخد‪.‬‬
‫‪© 2009 The McGraw-Hill Companies, Inc. All rights reserved‬‬
14-46
Educating Patients with Special Needs

Elderly patients

Show respect

Put information in
writing

Adjust procedures as
needed when limitations
are present
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-47
Educating Patients with Special Needs
(cont.)

Patients with mental impairments
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Use tact and empathy
Speak at the patient’s level of understanding
Common conditions

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Dementia
Alzheimer’s disease
Emotional problems
Drug addiction
Mental retardation
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-48
Educating Patients with Special Needs
(cont.)

Patients with hearing impairments

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Patients with visual impairments

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The ability to hear is not a measure of intelligence
Use normal tone of voice
Verify that all verbal instructions have been heard correctly
Multicultural issues

Patients from diverse cultures may have different beliefs
about the causes and treatments of their illness.
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-49
The Patient Information Packet:
Special Concerns

Patients who cannot read well or cannot speak or
understand English



Use pictures and charts
Translations
Family or friends may be
able to read it to them
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-50
Promoting Good Health Through
Education: Healthful Habits
Adequate Rest
Good Nutrition
Regular Exercise
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-51
Promoting Good Health Through
Education: Healthful Habits
Limit Alcohol
Intake
No Smoking
Work
Leisure
Balance
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-52
Promoting Good Health Through
Education: Protection from Injury

Safety tips to
prevent injuries
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At home
At work
At play

Proper use of
medications
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Do not change dosage
Do not mix medications
Report unusual
reactions
Tell doctor about any
OTC medications
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
In Summary

Patient education is
key to patient care

Reasons for patient
education
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Knowledgeable
patient


Active in own medical
care
Aware of benefits of
activities to promote
and protect health

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Understand condition
Prepare for
procedures
Policies of office
Use resources
available
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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© 2009 The McGraw-Hill Companies, Inc. All rights reserved
14-55
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
© 2009 The McGraw-Hill Companies, Inc. All rights reserved