Transcript Make Interaction with the Patients a Positive Experience

‫بسم هللا الرحمن الرحیم‬
Patient Education
Educational Domains
Cognitive:
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information area (teaching joint protection principles to patient
with Rheumatoid Arthritis
Psychomotor:
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deal with motor skills; using crutches
Affective:
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deals with attitude and feelings;
How Adult Learners are Different…
Malcolm S. Knowles. 1913-1997.
Step 1: Assessment
Learning Styles
Type of Learner
Characteristics
Sample Approaches to
use in teaching
Visual
Prefers pictures,
diagrams, other visuals
Use of numerous visual
aids, process algorithms,
and trigger cards
Auditory
Prefers to learn via verbal
instruction; visuals may
distract learners
Use oral descriptions,
lectures, podcasts
Kinesthetic
Prefers to learn via
movement and hands-on
activities
Use demonstrations,
simulations, role playing,
as well as discussion
groups, where possible
Eschelman KY. Prog Transplantation.2008.
Fleming ND. A Guide to Learning Styles.2008.
Tools for Educating Pt’s, Pt’s Families &
Caregivers
Verbal Instructions:
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need to be at patient’s level of comprehension
Written Instructions:
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need to be clear, and concise
Demonstration:
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go slow, break skill into parts as needed
Other: video, patient group, three dimensional models etc.
Assessing Effectiveness of Teaching
Strategies
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Have patient repeat instructions back to you to
verify they know what you want them to do and
how to do it
Have patient demonstrate
Principles of Learning
Pt’s Learn when:
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They feel actively involved in the process
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There is respect and trust between them and the doctor
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They are working on something that meets their needs
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Doctor is supportive and non-judgmental; patients need to be able
to express their own ideas, beliefs, concerns
Principles of Learning
Pt’s Learn when:
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Adequate time to practice, must be able to make mistakes
and go at their own pace
Opportunity for self-assessment. Let them reflect on what
they might have done wrong or forgotten, give them time to
process, provide a supportive environment
Teaching a Skill
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Ensure patient understands why this skill is important to them – how it
will effect their ability to function and relate it to their goals
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Explain the skill to them
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Demonstrate skill
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Break skill into parts, demonstrate parts, have patient demonstrate parts
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Practice
Patient Compliance with Exercise
Programs
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Patient must choose to perform (Values)
Know when/how often to perform & what to
perform
Have the psychomotor skills to perform
Remain motivated to follow through
Effective Communication Skills
Effective Communication Skills
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Effective communication skills for HCWs
Ask questions and listen (use open-ended
questions)
Make interaction with the patient a positive
experience
Speak clearly and simply
Encourage patient to ask questions
Ask checking questions to determine understanding
Ask Questions and Listen
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To understand the patient’s medical
history
To understand the patient’s current
knowledge about disease
Identify and help to solve any problems
the patient may have with treatment
Use open-ended questions
Ask Questions and Listen:
Open-Ended Questions
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Cannot be answered with “yes”
or “no”
Usually start with:
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What?
Why?
Who?
When?
How?
Explain or describe to me…..
Close-Ended vs. Open-Ended
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Do you know anything about TB?
 What do you know about TB?
Do you live alone?
 Who else do you live with?
Make Interaction with the
Patients a Positive Experience
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Demonstrate a caring, respectful attitude
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actions
words
body language
tone of voice
eye contact
Praise and encourage patient
Motivate the patient to continue treatment
Be non-judgmental if patients’ views or lifestyles
differ from your own
Speak Clearly and Simply (1)
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Use simple non-medical
terms
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Use words that are familiar
to the patient
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Use appropriate language
level and visual cues
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Repeat important
information
Image source: WHO
Speak Clearly and Simply (2)
Example:
Diffcult to understand
“This drug, isoniazid is a bactericidal agent that is highly active
against Mycobacterium tuberculosis”
Simple to understand
“This isoniazid pill will help fight TB and help
you get better”
Encourage Patient to Ask Questions
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Ask patients “Do you have any questions”
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Praise patients for asking questions
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“I am glad that you asked that question…”
“Good question…”
Answer all questions thoughtfully and
carefully
Ask Checking Questions
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Ask patient questions
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to understand the patient’s current knowledge about
disease
to ensure that the patient knows exactly what to do next
An Approach to Teaching
Patients in the Hospital
Patient Misunderstandings Are
Common…
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Among Patients Discharged from the
Hospital…
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41% able to
37% able to
medications
28% able to
14% able to
meds
state discharge diagnosis(es)
recount the purpose of all
list all their medications
state common side effects of
Makaryus AN.Mayo Clin Proc.2005.
A Common Approach to Patient
Education…
Step 1: Go teach the
patient.
A Better Approach to Patient Education
Step 5:
Evaluate
Learning
Process
Step 1: Assess
patient
knowledge,
learning styles,
and motivation
Step 2: Assess
barriers to
learning
Step 4: Go teach
the patient.
Step 3: Set
educational goals
with patient
Stromberg A. Eur. J. Heart Failure. 2005.
Step 1: Assessment
Disease-Specific Knowledge
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General Questions.
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“Why do you think you feel short of breath?”
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“Tell me what heart failure means to you?”
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“What things do you need to do to take care of your heart
failure?”
Perceived Importance of CHF Topics
Patients
Nurses
Rank
Topic
Rank
Topic
1.
Medications
1.
Signs/Symptoms
2.
Signs/Symptoms
2.
Medications
3.
General Information (i.e.
anatomy/physiology)
3.
Diet
4.
Risk Factors
4.
Risk Factors
5.
Prognosis
5.
General Information (i.e.
anatomy/physiology)
6.
Activity
6.
Activity
7.
Psychological (i.e. coping)
7.
Psychological (i.e. coping)
8.
Diet
8.
Prognosis
Wehby RN. Heart and Lung. 2005.
Step 1:
Assessment
Motivation to
Change
Paradis V. J. Cardiovascular Nursing.2010.
Step 2: Barriers
Health Literacy
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3 General Questions:
1.
“What was the highest grade you completed in school?”
2.
“How would you rate your ability to read?”
3.
“How often do you need to have someone help you when you read
instructions, pamphlets, or other written material from your doctor
or pharmacy?”
Assessing Health Literacy:
SOS Method
Letter
Stands for…
Question Topic
Cut Point
Odds Ratio
S
O
"Schooling"
Educational
attainment
Sub-Secondary (6th
grade or less)
1.89
"Opinion"
Patient self-rating
of reading ability
"Okay" or worse on a 5
point scale (Excellent or
very good, Good, Okay,
Poor, Terrible or very
poor)
3.37
S
"Support"
Help when
reading
Sometimes or worse on a 2.03
5 point scale (Never,
Rarely, Sometimes,
Often, Always)
Jeppesen KM, Ann Fam Med. 2009.
Additional Barriers to Learning…
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Functional
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Illness-Related
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Pain
Fatigue
Cognitive Impairment
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Visual Impairment
Hearing Impairment
Decreased mobility
Dementia
Delirium
Depression
Stromberg.EurJCard.2005.
Step 3: Goal Setting
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Potential Statements:
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“What would you like to learn more about with regards to
your heart failure?”
“It sounds like you understand a lot about how heart failure
works. How comfortable are you with managing all the
medicines?”
“What are your goals before leaving the hospital or after
you get home?”
Step 4: Go Teach the Patient
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Begin with knowledge of patient’s understanding of his/her disease,
learning styles, and motivation
Understand and adapt to barriers to learning
Present material in multiple formats, over multiple episodes, and in
coordination with other care team members
Teach Back
NEW CONCEPT: Health
information, advice,
instructions, or change
in management
Assess patient
comprehension /
Ask patient to
demonstrate
Explain new concept /
Demonstrate new skill
Clarify and tailor
explanation
Patient recalls and
comprehends /
Demonstrates skill mastery
Adherence /
Error reduction
Re-assess recall and
comprehension / Ask
patient to
demonstrate
Modified from Schillinger, D. et al. Arch Intern Med 2003;163:83-90
References
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Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. Aug 2005;80(8):991-
994.
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Knowles MS, Holton EF, Swanson RA. The Adult Learner. 5th ed. Woburn, MA: Butterworth-Heinemann; 1998.
Wehby D, Brenner PS. Perceived learning needs of patients with heart failure. Heart Lung. Jan-Feb 1999;28(1):31-40.
Eshleman KY. Adapting teaching styles to accommodate learning preferences for effective hospital development. Prog Transplant. Dec
2008;18(4):297-300.
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Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change
on self-care in heart failure patients. J Cardiovasc Nurs. Mar-Apr 2010;25(2):130-141.
Jeppesen KM, Coyle JD, Miser WF. Screening questions to predict limited health literacy: a cross-sectional study of patients with diabetes
mellitus. Ann Fam Med. Jan-Feb 2009;7(1):24-31.
Stromberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. Mar 16 2005;7(3):363-369.
Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch
Intern Med. Jan 13 2003;163(1):83-90.
Additional Resources
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London, F. No Time to Teach: The Essence of Patient
and Family Education. (2009). Atlanta, GA. Prichett &
Hull Associates.
The Institute for Patient and Family Centered Care
(http://www.ipfcc.org/)