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A Guide to Educating

Patients

Patient Education - Introduction


What is Patient Education?

Skill Building and Responsibility


Patients need to know when, how, and
why they need to make a lifestyle
change

Group Effort Each member of the


patients health care team needs to be
involved

Patient Education - Introduction


Patient Education Value The results of clear communication

Increased Compliance Effective communication and patient education increases


patient motivation to comply

Patient Outcomes Patients more likely to respond well to their treatment plan
fewer complications

Informed Consent Patients feel youve provided the information they need

Satisfaction and referrals Patients more likely to stay with your practice and refer
other patients

Utilization More effective use of medical services fewer unnecessary phone calls
and visits.

Patient Education Research


Targeted Programs Reduce the Risks that Increase Costs

Patient Education Rationale


Model of Patient Education Outcomes

Knowledge
Knowledgeand
and
Attitude
AttitudeChanges
Changes

Patient
Patient
Education
Education

Print
Print
Verbal
Verbal
Multimedia
Multimedia
Combination
Combination

Increased
Increasedunderstanding
understanding
Increased
confidence
Increased confidence
Increased
Increasedsatisfaction
satisfaction
Improved
emotional
Improved emotionalstate
state

Behavior
BehaviorChanges
Changes

Health
Healthservices
servicesutilization
utilization
Compliance
Compliance
Lifestyle
Lifestyle
Self-care
Self-care

Health
HealthStatus
Status

Physical
Physicalhealth
health
Well-being
Well-being
Symptoms
Symptoms
Complications
Complications

Costs
Costs
Length
Lengthofofstay
stay

Utilization
Utilization
Provider
Providerimage
image
Regulatory
Regulatory
compliance
compliance

Patient Education - Introduction


The Effective Educator

Effective Patient Educator skills include:


+ Determining patient concerns
+ Avoiding Assumptions
+ Explaining things clearly

Question the educator must ask:


+ How do I determine patients needs and concerns?
+ How do I treat patients equally and as individuals?
+ How do I know when Ive explained things clearly?

Patient Education - Steps


Four Steps to Educating

Assess Define patient and family needs and


concerns; observe readiness to learn.

Plan Set objectives with your patient; select


materials.

Implement Put the plan in motion; help patients


along the way to reach the objectives youve set
together.

Document Create a written history and keep


records.

Evaluate - Evaluation is critical and should be continuous through all four


steps! This will help you stay on track and spot problems quickly.

Patient Education - Introduction


Maximizing Teaching Moments

Time is limited

Patient Education must be as


efficient and effective as possible

Educators must think of every


moment with patients as a
teachable moment!

Patient Education Step 1 - Assessment


Assessment

Assessment provides you with


essential information about your
patient

Patient education success


depends on the assessment of
needs, concerns, and preferences

Assessment should be ongoing


make it a part of every encounter
with your patient.

Patient Education Step 1 - Assessment


Grasping Patient Concerns

Avoiding Assumptions

+ Never assume! Incorrect assumptions can be counterproductive.


+ Gather as much information on the patients situation as you can early on.

Getting to Know Your Patient

+ Review the patients chart first


+ Introduce yourself by name and clearly explain your role
+ Ask basic, introductory questions
Support is there family or a friend who can assist with care?
Limitations address known physical or mental problems early
Cultural History Note language barriers and cultural preferences

Patient Education Step 1 - Assessment


Recognizing Diversity

Understanding Cultural Issues

+
+
+
+

Treat all patients without judgment


Show respect remain open to the unfamiliar
Gain patient trust
When in doubt ask questions!

Challenging your own views

+ Set aside all your conflicts


+ Avoid making assumptions about your patients

Patient Education Step 1 - Assessment


Grasping Patient Concerns

Establishing Rapport

+ The patient must feel comfortable with you


+ When meeting a patient:
Try to be empathetic
Avoid focusing on a chart
Make Eye Contact
Communicate nonverbally if there are language barriers
Ask whos in a photo
Ask about a book the patient may be reading

Learning the Patients Perspective

+ Fears, worries, misconceptions get everything out in the open early!


+ Ask: When you think of (this condition), what do you think of?
+ Patient concern should be primary focus in your education plan.

Patient Education Step 1 - Assessment


Asking the Right Questions

Answers should uncover core beliefs Ask specific questions - ask to discover what
motivates your patient:

+ What are you afraid might happen?


+ What barriers get in your way?
+ When you tried this before, what problems did you have

Asking open-ended questions Increases the information you get and decreases the
number of questions you need to ask.

Closed

Open

Are you upset?

Whats bothering you?

Are you in pain?

How would you describe your pain?

Is this hard for you to deal with?

What are some problems this is causing?

Are you taking your medicine every day?

How and when do you take your medicine?

Patient Education Step 1 - Assessment


Grasping Patient Concerns

Determining readiness to learn Your patient will present challenges if resistant to


education

+ Motivation Patients are motivated when they learn how their lives could improve.
Focus on the benefits of education.

+ Attitude Denial, Fear, Anger, Anxiety all could be barriers to education. Patient
must know that he or she will make gains by learning new skills.

+ Outlook A patients beliefs about their situation could effect education. Let them
know that learning new skills can help them feel better or slow disease progression.

Assessing Patient Skills Request a demonstration of what he or she has learned in


the past

Patient Education Step 1 - Assessment


Understanding the Support Network

Redefining the Family

+ Patient support is a cultural issue. Family could be anybody the patient designates.
+ When possible, let your patient designate a person to receive info from the team.

Assessing Your Patients Support

+ The patients support should be trusted and able to carry out tasks.
+ Look for the following when the patients support is present:
Does the patient . . .

Does the support person . ..

Seem pleased with this persons input?

Appear with the patient frequently?

Look forward to visits with this person?

Show concern for the patient?

Interact favorably with this person?

Encourage following medical advice?

Patient Education Step 1 - Assessment


Evaluating Your Assessment

Look back on the info you have gathered and determine if you are ready
to move on to the next phase

Needs and Concerns:


What are the patients needs?
What are his or her concerns?
What does the patient already know?

Skills:
What health-promoting skills does
the patient possess?
What skills will the patient need to
develop?

Beliefs and Attitudes:


What does your patient believe?
How are support people coping?

Behavior:
What barriers to change is the
patient showing?
What barriers do the patients
support people have?

Patient Education Step 2 - Planning


Planning

Once you know your patients needs, planning


begins.

You both should set some mutually agreeable


goals.

Gather the materials you need to meet these


goals

When building your plan, make building patient


skills and addressing concerns the top priority!

Patient Education Step 2 - Planning


Setting Goals

Thinking Realistically

+ Goals should focus on what is necessary / critical to patient survival first.


+ Pay attention to patient concerns they could stand in the way of progress
+ Respect stated limits if a patient has refused to do something, try to work around
the problem and incorporate something new as best you can.

Helping a Patient Make Life Changes

+ If your patient needs to make lifestyle changes, make sure he or she:


Understands the need for changing behavior
Has the confidence to complete the required tasks
Successfully begins to change behavior.

Patient Education Step 2 - Planning


Building Bridges

Effective Plan

+ Essential Skills what a


patient needs to know

+ Benefits and Barriers what a


patients concerns are

+ For a plan to be effective, you


must find ways to build bridges
between patient needs and
patient concerns.

+ The bridges you build will be


framed by what you learned
during assessment

Patient Needs

Bridge

Patient Concerns

Patient Education Step 2 Planning


Building Bridges

Below are some simple examples of ways in which someone might decide to bridge the gap
between needs and concerns.

Patient Needs

Patient Concerns

Bridge

Patient should exercise

Exercising hurts

By exercising, youll improve


muscle strength, which
lessens pain. Lets find an
exercise that works for you.

Chemotherapy is required

My hair will fall out

Chemo kills quick-growing


cells, like hair and cancer. In
the meantime, lets see what
kind of hat, turban, or wig we
can find.

Heart patient should lower


cholesterol.

I wont get to eat all of my


favorite foods

Low-cholesterol foods can be


tasty. Here are some great
recipes. And you can also treat
yourself once in a while.

Patient Education Step 2 - Planning


Setting Goals

Finding Resources

+
+
+
+

Printed Materials, Video or Audio CDs/DVDs, Electronic content


Look for inconsistencies between your goals and those of the materials.
Make sure the resources are up-to-date
Patient Education publishers provide information on patient education techniques
and practices.

+ Premade plans may be available from pharmaceutical companies or other


organizations. Be careful they are not biased!!

+ Clinical pathways that your facility already uses can work as effective plans.
+ Disease-specific or voluntary organizations may provide materials.
+ Experienced colleagues can be useful resources in helping you come up with a plan.

Patient Education Step 2 Planning


Evaluating Your Plan

Make sure the plan contains the information that your patient both needs and wants to know
discuss with your patient and support people

Needs and Concerns:


How well does your plan cover what your
patient needs to know?
What part of the plan address patient
concerns?
Beliefs and Attitudes:
Where in the plan are your patients beliefs
and attitudes addressed?
How does your plan address any barriers
that the patient may have?

Skills:
How will the plan develop the lifeenhancing or essential skills your
patient needs?

Behavior:
How will the plan influence or even
change your patients behavior?

Patient Education Step 3 - Implementing


Implementing

Implementing your plan begins with


reassessment

+ Surprises can arise that will cause you to adjust


the plan.

Assess continually

+ Reassess the patient during each contact


+ The success of your plan depends on the quality
of your assessment and the patients ability to
meet goals.

Patient Education Step 3 Implementing


Getting your Message Across

Providing a Good Learning Environment


+ Tone of voice, eye contact, and touch vary for all cultural backgrounds
Use the knowledge you gained during assessment
+ Environment
Good lighting
Comfortable temperature
Low noise
Room to spread out
+ Privacy
If possible, seek out a place you can work privately with the patient and his or her
support person

Patient Education Step 3 Implementing


Getting your Message Across
Your priorities and your patients should be clearly stated, mutually understood, and mutually agreed upon.

Setting Implementation Priorities


+ Let your patients know:

What they should do and why


When they should expect results
Possible danger signs to watch for
What they should do if problems arise
Whom they should contact for referrals

Patient Education Step 3 Implementing


Working Toward Goals
Thinking in terms of improvements, recovery schedule, and follow up care

Alerting Patients to Whats Ahead


+ Develop time frames for you patients
+ Provide a number to call in case conditions change make them feel self-directed
and in control.
+ Let patients know what to accept avoiding surprises and promoting patient
acceptance
+ Emphasize on quality-of-life changes over cures

Thinking Small
+ Small steps are better than none take small steps toward achieving a goal
+ Avoid overloading the patient with information
+ Accept whatever number of steps the patient is willing to accept, and always offer
the opportunity to learn more at a later time.

Patient Education Step 3 Implementing


Getting Your Message Across

Keep content simple


+ Speak with all patients using simple language
+ Focus on one goal or behavior change per visit
+ Highlight key concepts and provide printed materials
+ Stay interactive let the patient show you what he/she learned

Use visuals
+ Drawings, visuals, illustrations can reinforce key concepts
+ Some people learn visually
+ Illustrations boost comprehension

Patient Education Step 3 Implementing


Getting Your Message Across

Mixing Education Media


+ You will never have all the time you
would like so supply your patients with
educational material

+ Give your patients printed material, or


even video or audio material - go over
what they should focus on.

+ Different patients respond to different


material the more options, the better

+ Document what youve coached on so


your team knows whats been covered

+ Ask your patient to demonstrate what he


or she has learned.

Patient Education Step 3 Implementing


Reinforce the message: Choosing the right patient education materials

Choose material with special emphasis on:

+
+
+
+
+
+

Clear focus and goals


Headings that present key concepts for busy, scanning, or low-literacy readers
Step-by-step instructions
Practical tips to improve daily living
A clear language level that matches the bulk of your patients
Translations if your patient population warrants it

Patient Education Step 3 Implementing


Reinforcing the message: How to use patient education materials

Highlight Key Concepts

+ Open and flip through the booklet or brochure with the patient
+ Write in any notes of your own
Check a Patients Understanding

+ Ask your patient to repeat complex explanations back to you


Involve a Patients Family

+ Suggest bringing in a support person to show the materials to also and to hear

your instructions
Build on Success

+ Build on skills the patient is confident in and motivated by

Patient Education Step 3 Implementing


Overcoming Challenges

Reassessing Patient Concerns

+ Patients can become resistant


+ Physical and emotional stress of illness can present challenges
+ Ask open ended questions to understand new concerns
Whats standing in your way? What concerns you about doing?
Helping a patient over a barrier

+
+
+
+
+

Reassess, looking for core concerns


Address concerns such as pain, fear, misunderstanding
Consult with other members of the health care team
Arrange for follow-up care

Get help from the patients support person when appropriate.


Reading Patient Signals

+ Continually assess and ease into your plan


+ Emphasize the benefits of education instead of nagging the patient

Patient Education Step 3 Implementing


Overcoming Challenges

Breaking Through Barriers Here are some examples of barriers you may encounter, along
with some ways to work through them

Barrier

Behavior

Implementation

Denial, anger, anxiety, or


depression

Patient is distracted,
disinterested, hostile, or doesnt
believe theres a problem.

Tell your patient that these


feelings are normal, that anyone
would be concerned. Use the
opportunity to reassess for new
concerns.

Physical Pain

Patient is unable to concentrate

Focus on managing your


patient's pain before
implementing the plan.

Acute Illness

All patients energy is focused on


coping with the illness. Patient
finds it difficult to learn

Address patients fear, pain or


anxiety first, and then focus on
developing new skills.

Learning disability

Patient finds it difficult to


comprehend educational
materials presented

Try to give a wide variety of


materials. Including
demonstrations.

Patient Education Step 3 Implementing


Evaluating Your Implementation

Needs and Concerns:


How will your patient successfully integrate
the essential new skills needed into daily
life?
How have the patients concerns been
addressed?

Skills:
What new skills has your patient
learned to improve the quality of his or
her life? Where will he or she seek
assistance when ready to learn more?

Beliefs and Attitudes:


Which new skills have positively affected
your patients perceptions about his or her
condition?

Behavior:
What elements of your patients
behavior promote healthy habits?
Which behaviors could be improved
later?

Patient Education Step 4 Documenting


Documenting

Patient records inform colleagues what


youve done.

Properly documented patient education


can help you meet Meaningful Use
Requirements for reimbursement

Patient education documentation is a large


part of TJC review standards

A record of patient education provides


future health care providers a starting
point should your patient need assistance
in the future

Patient Education Step 4 Documenting


Keeping Detailed Records

Meaningful Use documenting patient education within your EMR/EHR provides


evidence that you have met the Meaningful Use criteria for patient education.

Patient Education Step 4 Documenting


Keeping Detailed Records
Joint Commission documenting patient education and the individual learning
preferences of each patient also provides evidence for the Joint Commission whose
minimum compliance goals for patient communication and education are summarized
below
PC.02.01.21 The hospital effectively communicates with patients when providing care,
treatment, and services.
PC.02.03.01 The hospital provides patient education and training based on each patients
needs and abilities.
RI.01.01.03 The hospital respects the patients right to receive information in a manner he or
she understands
RI.01.02.01 The hospital respects the patients right to participate in decisions about his or her
care, treatment, and services.
RC.02.01.01 The medical record contains information that reflects the patient's care,
treatment, and services. (EP 1 notes specifically: The patients communication needs,
including preferred language for discussing health care)

Patient Education Step 4 Documenting


Additional Joint Commission Requirements

Core Measures
Smoking Cessation
Heart Failure
Heart Attack
Pneumonia
Pregnancy
Stroke
Pediatric Asthma
Mental Health
Influenza
Risk Factors
http://www.jointcommission.org/performanc
e_measurement.aspx

National Patient Safety Goals


Comprehensive drug information
Anticoagulant information
Infection Control
Hand washing
Healthcare Associated infections
o MRSA, VRE, C-DIFF, PNEUMONIA
Central Line
Pre-Op / Post-Op care
Fall Prevention
Focus on behavior change
Suicide prevention
Warning sign content for patients and
families
http://www.jointcommission.org/standards_information/nps
gs.aspx

Patient Education Step 4 Documenting


Keeping Detailed Records

Knowing the Education Process

+ TJC surveyors want to see whether you understand the patient education
process.

+ TJC wants to see documentation, and what kind of education materials you use
Making Use of Forms

+ The documents you keep can be used for training, to help outpatient specialists,

or for future patient assistance if needed


Getting Patient Feedback

+ Feedback from the patient and family provides valuable perspective on the
effectiveness of patient education

+ Consider surveys, documents for patients to sign, questionnaires

Resources
The following national organizations
provide material that may enhance your
patient education goals. Many of these
organizations have regional chapters that
present workshops and offer community
services. Also consult local health care
organizations, your Area Agency on Aging,
senior centers, and county health
departments for more support.
American Cancer Society

American Lung Association


800-LUNG-USA (800-586-4872)
Arthritis Foundation
800-283-7800
Centers for Disease Control National
AIDS Clearinghouse
800-458-5231

800-227-2345

National Digestive Diseases


Information Clearinghouse

American Diabetes Association

301-654-3810

800-ADA-DISC (800-232-3472)

National Head Injury Foundation

American Heart Association

800-444-6443

214-373-6300

Resources
National Heart, Lung, and Blood Institute
301-251-1222
National Jewish Center for Immunology
and Respiratory Medicine
800-222-LUNG (800-222-5864)
National Library Service for the Blind and
Physically Handicapped
800-424-8567
National Organization for Rare Disorders
800-999-NORD (800-999-6673)

The following books will provide


additional guidance and in-depth
discussion on patient education theory
and technique.
Doak, Cecilia C.; Doak, Leonard G.;
Root, Jane H.: Teaching Patients with
Low Literacy Skills (Lippincott, 1996)
Lorig, Kate: Patient Education: A
Practical Approach (Sage Publications,
1996)
Rankin, Sally H.; Stallings, Karen Duffy:
Patient Education: Issues, Principles,
Practices (Lippincott, 1996)

Sources
Consultants:
Kate Lorig, RN, Dr.PH
Associate Professor (Research)
Patient Education Research Center
Stanford University School of Medicine,
Palo Alto, CA
Virginia M. Gonzlez, MPH
Health Educator
Patient Education Research Center
Stanford University School of Medicine,
Palo Alto, CA
Louise M. Romer, MPH, CHES
Health Education Coordinator
Kaiser Permanente Medical Center,
San Jose, CA

With contributions by:


Minerva R. de Pacheco, RN, MSN
Southwest Hospital,
Louisville, KY
Madeline L. Pimenta, RN
Boston Regional Medical Center,
Stoneham, MA
Rose Mary Pries, MSPH, CHES
U.S. Department of Veterans
Affairs, St. Louis, MO

With special thanks to:


Kaiser Permanente Medical
Center, San Jose, CA