Transcript Patient Education and Safety/ How to build a Collaborative

NURS 230/Spring 2014/week 5
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The Joint Commission sets standards for patient
and family education.
Successful accomplishment of standards requires
collaboration among health care professionals.
All state Nurse Practice Acts recognize that
patient teaching falls within the scope of nursing
practice.
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http://www.dhp.virginia.gov/nursing/nursing_laws_r
egs.htm
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To help individuals, families, or communities
achieve optimal levels of health
Patient education includes:
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Maintenance and promotion of health and illness
prevention
Restoration of health
Coping with impaired functioning
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Teaching
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An interactive process that promotes learning
Learning
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The purposeful acquisition of knowledge, skills,
behaviors, and attitudes
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Closely parallels the communication process.
Depends in part on effective interpersonal
communication.
The learning objective describes what the learner
will be able to accomplish after instruction is given
Teach information that
the patient and the family need to make
informed decisions regarding their care.
Determine what patients need to know.
Identify when patients are ready to learn.
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Speak up if you have questions or concerns.
Pay attention to the care you get.
Educate yourself about your illness.
Ask a trusted family member or friend to be your
advocate.
Know which medicines you take and why.
Use a health care organization that has been
carefully evaluated.
Participate in all decisions about your treatment.
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Cognitive:
Includes all intellectual behaviors and requires
thinking
Affective:
Deals with expression of feelings and acceptance of
attitudes, opinions, or values
Psychomotor:
Involves acquiring skills that require integration of
mental and muscular activity
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Different teaching methods are appropriate for
each domain of learning.
Cognitive: discussion (one-on-one or group),
lecture, question-and-answer session, role play,
discovery, independent project, field experience
Affective: role play, discussion (one-on-one or
group)
Psychomotor: demonstration, practice, return
demonstration, independent projects, games
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Motivation to learn:
Addresses the client’s desire or willingness to learn
Ability to learn:
Depends on physical and cognitive abilities,
developmental level, physical wellness, thought
processes
Learning environment:
Allows a person to attend to instruction
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Developmental
capability
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Cognitive
development
Prior knowledge
Learning in
children
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Developmental
stage
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Adult learning
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Self-directed
Patient-centered
Physical capability
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Level of personal development
Physical health
Fatigue
Well lit
Good ventilation
Appropriate
furniture
Comfortable
temperature
Quiet
Private
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A relationship exists.
The nursing and teaching process are not the same.
The nursing process requires assessment of all data.
The teaching process focuses on the client’s learning
needs and ability to learn.
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See through the patient’s eyes.
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Teaching is patient-centered.
Assess the patient’s learning needs.
Ask questions to identify motivation to learn.
Determine the patient’s physical and cognitive ability to
learn.
Provide an appropriate teaching environment.
Assess the readiness and ability of a family caregiver or
other learning resource.
Assess health literacy/learning disabilities.
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Health literacy: the cognitive and social skills
that determine the motivation and ability of
individuals to gain access to, understand, and use
information in ways that promote and maintain
good health.
Health literacy includes patients’ reading and
mathematics skills, comprehension, and
decision-making and functioning skills with
regard to health care.
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Nursing diagnoses for patient education
Deficient knowledge (affective, cognitive,
psychomotor)
 Ineffective health maintenance
 Impaired home maintenance
 Ineffective family therapeutic regimen management
 Ineffective self-health management
 Noncompliance (with medications)
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Select the nursing diagnosis that reflects the client’s
learning needs after the assessment is completed.
Clarifying the diagnosis by domain helps the nurse
focus on the subject matter and teaching methods.
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Determine goals and expected outcomes that guide
the choice of teaching strategies and approaches
with a client: Patient Centered
Set priorities- specifically depends on what the patient
perceives is the most important
 Select timing to teach/when is there a right time to teach?
– plan when the patient is most alert, receptive and
attentive
 Organize the teaching material. Start from simple and
progress to complex- textbook page 376
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Maintain learning attention and participation.
Build on existing knowledge.
Select teaching approach.
Incorporate teaching with nursing care.
Select appropriate instructional methods.
Illiteracy and other disabilities.
Cultural diversity.
Using different teaching tools.
Special needs of children and older adults.
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Necessary to determine whether the client has
learned the material
Helps to reinforce correct behavior and change an
incorrect behavior
Success depends on the client’s performance of
expected outcomes
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Group work:
1. Identify and assess the learning needs or knowledge
deficits of the patient.
2. Discuss what would be the best teaching strategies for this
patient and why
3. What methods or tools would you use to support the
teaching strategies you choose and why?
4. Pick one nursing diagnosis to support the assessment/
cognitive, affective, or psychomotor domains.
5. How would you evaluate the effectiveness of the patient
teaching?
6. What are some collaborative health care indicators here?
7. What are the patient safety implications if #3 and #4 are
not correctly utilized?
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Mr. Smith is a 80 year old African American male.
Admitted to the Woodland with an exacerbation of
CHF, asthma, and status post surgical procedure for
defibrillator placement. Mr. Smith has an 8th grade
reading level. Mr. Smith lives alone and is a retired
handyman. The doctor has ordered patient
education: Teach patient to check his radial pulse,
provide education for a low salt and low fat diet.
Teach signs and symptoms of CHF.
Answer questions 1-7
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On a busy and hectic Friday night Miss Green is a 20
year old college student brought to the ED by her
boyfriend. He states she had too much to drink at a party
and fell. Upon assessment she has a bump on the back
of her head and her blood alcohol level (BAL) is 2 x
greater than the legal limit in Virginia (0.8%). She is
given IV fluids and the results of the CT scan are
negative for a concussion. She has been cleared by the
ED doctor for d/c. You are assigned to review the
discharge paperwork with the boyfriend.
Answer questions 1-7
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Baby girl Maria is being discharged after a three day
hospital stay for URI (upper respiratory infection).
She will be discharged to the care of her parents
who are of Mexican origin. The doctor has ordered
Ampicillin liquid (500 mg)one (1) teaspoon by
mouth every 4 hours until medication is completed.
No follow-up clinic appointment has been made.
You are charged with discharge instructions for
medication administration.
Answer questions 1-7
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Aaron is a three old boy admitted to the pediatric unit at
Southside Hospital for an exacerbation of his asthmatic
condition. His mom, 19 year old Mary is with Aaron at
the time of admission. Mary states she attends night
school 3 x a week as she works towards her GED. She
dropped out of high school at the age of 16. Mary says
she has at least one more year of night school before she
is eligible to take the GED test. Aaron is left with his 41
year old grandmother on these nights. Aaron’s
grandmother smokes. This is Aaron’s first admission to
the pediatric unit for an asthma exacerbation.
Answer questions 1-7
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Ms. Brown is a 67 year old widowed white female.
She has two daughters both live out of state. She is
admitted to The Woodland for physical therapy
following a right total hip replacement. Her
anticipated LOS is 3 weeks. She is a newly
diagnosed insulin dependant diabetic. Mrs. Brown
has a bachelor’s degree in music and recently retired
from the public school system. The doctor has
ordered patient teaching of glucometer use and
insulin administration.
Answer the questions: 1-7
Collaboration occurs when multiple health workers
from different professional background work
together with patients, families, careers, and
communities to deliver the highest quality of care”.
(WHO, 2010: 13).
http://www.msnbc.msn.com/id/43529641/ns/healthhealth_care/t/nurses-suicide-highlights-twintragedies-medical-errors/
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Future nurses need knowledge, skills, and
attitudes to promote safety.
Continuous improvement is essential.
QSEN minimizes risk of harm to patients and
providers by
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System effectiveness
Individual performance
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Based on Communication
Health Care Team Collaboration
Involved both the patient and family in all care
decisions
Empowers the patient to participate- does this lend
itself then to patient education?
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In patient safety, critical thinking is an
ongoing process.
Standards have been developed by
American Nurses Association and The Joint
Commission.
Use of the nursing process when planning
care promotes safety.
Reduces the incidence of illness and injury
Prevents extended length of treatment/stay
Improves or maintains functional status
Increases patient’s sense of well-being
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Includes meeting patients’ physical and
psychosocial needs
Applies to all places where patients receive
care
Includes patients’ and health care providers’
well-being
Reduces risk of injury and transmission of
pathogens
Maintains sanitation and reduces pollution
Oxygen
Temperature
Low concentration
 High concentration
 Carbon monoxide
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Nutrition
Proper storage
 Proper refrigeration
 Preparation area
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Normal
 Hyperthermia
 Hypothermia
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Physical hazards:
Lighting
 Obstacles
 Bathroom hazards
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Motor vehicle
accidents
Poison
Fires
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Falls
Transmission of pathogens
Pollution
Disasters
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Natural
Man-made
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Children younger
than 5 years of age
School-aged child
Adolescent
Adult
Older patient
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Factors influencing safety:
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Developmental stages
Individual risk factors
 Mobility, sensory, and cognitive status
 Impaired mobility
 Lifestyle choices
 Lack of safety awareness
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Risks in the health care agency
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“Never events” should never occur.
The Centers for Medicare and Medicaid Services
(CMS) now denies hospitals higher payments
resulting from or complicated by a “never
event.”
Many hospital-acquired conditions are nurse
sensitive indicators.
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Chemical use (Material Safety Data Sheets
[MSDSs])
Medical errors
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Medication errors
Infection
Bed sores
Failure to diagnose and treat in time
Falls
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Classification of health care agency
accidents:
Patient-inherent accidents
 Procedure-related accidents
 Equipment-related accidents
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Assessment
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Through the patient’s eyes
Patient’s home environment
Assessment questions
 Activity and exercise
 Medication history
 History of falls
 Home maintenance and safety
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Nursing history
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Assessment (cont’d)
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Health care environment
 Risks in immediate environment
 Risk for falls
 Risk for medication errors
 Disaster preparedness
Nursing diagnoses for patients with safety risk:
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Risk for falls
Impaired home maintenance
Risk for injury
Deficient knowledge
Risk for poisoning
Risk for suffocation
Risk for trauma
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Goals and outcomes
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Prevent and minimize safety threats
Are measurable and realistic
May include active patient participation
Setting priorities
Teamwork and collaboration
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Health promotion
Individualization of
implementation
Developmental stage
 Lifestyle
 Environment
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Basic needs
General preventive
measures
Lighting
 Changing the
environment
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Fall risk prevention
Restraints as a last
resort
Restraint alternatives
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Restraints
 Human, mechanical, or physical device to restrict freedom
 Can cause serious complications
 Pressure ulcers
 Constipation
 Pneumonia
 Urinary and fecal incontinence
 Urinary retention
 Contractures
 Nerve damage
 Circulatory impairment
 Loss of self-esteem, humiliation, fear, anger
 Physicians order is required based on face-to-face assessment
of client
 Order must state type of restraint
 Must have limited time factor
 Orders need to be renewed in specific time frame according to
facility’s policy
 No PRN orders
 Ongoing assessments are necessary
 Must be periodically removed and need reassessed
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Side rails on beds
Bed restraint
Jacket: vest or chest
Belt or waist
Extremity: mitt, hand, wrist, ankle, elbow
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Orient client and families to surroundings
Encourage constant companions for pt
Assign pts to rooms near nursing station
Provide meaningful audio/visual stimuli
Eliminate bothersome therapies
Use relaxation techniques
Institute exercise & ambulation schedules
Maintain toileting routines
Consult with PT and OT for ADLs
Evaluate all client medications
Conduct ongoing assessment & evaluation
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Acute care safety
Seizures
 Poisoning
 Electrical hazards
 Radiation
 Disasters
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Hospitals must have an emergency management
plan.
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Airborne precautions
Droplet precautions
Contact precautions
Protective Isolation
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i.e. Neutropenic precautions
 Reducing physical hazards
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Lighting
Obstacles
Bathroom hazards
Security
 Minimize Falls
 Minimize client-inherent
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accidents
Minimize procedure-inherent
accidents
Minimize equipment-related
accidents
Maintaining skin care
Meeting Basic Needs:
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Oxygenation
Nutrition
Sleep
Elimination
What’s wrong with this picture?
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Through the patient’s eyes
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Are the patient’s expectations met?
Are the family’s expectations met?
Patient outcomes
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Monitor care by the health care team.
Measure outcomes for each diagnosis.
Continually assess needs for additional support.
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A safe physical environment
A patient whose expectations have been
met
A patient who is knowledgeable about safety
factors and precautions
A patient free of injury