Chapter 11 Patient-Safe Communication and Patient Education

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Chapter 11Patient-Safe Communication and Patient
Education

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Health Literacy Programs

• Teach patients what to ask for their own safety
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

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What All Patients Need to Know
METHOD Daily Teaching Plan
M Medications E Environment T Treatments H
Health knowledge O Outpatient/inpatient
D Diet

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Medications

• Name and actions
• Hospital drugs 1 sentence each
• This is an antibiotic for your infection
• This is a blood thinner to prevent clots
• Home drugs Add how to take to avoid
  complications 1 sentence each
• Take antibiotic 3X a day, morning, noon, night.
  Take entire prescription. Take with food to
  avoid upset stomach.

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Environment

• Hospital environment
• Safety/falls modifications Furniture
  arrangement
• Activity orders
• WBAT
• BRP
• Home environment
• Safety/falls modifications Phone, stairs, rugs
• Activity/exercise Walking, lifting, driving
• Financial considerations Drugs, dressings
• Family- social support Supplies, food

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Treatments

• Hospital
• Purposewhy
• Home
• Procedurescorrect techniques
• Suppliesobtaining
• Simple directions
• Care of wound
• Injections

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Health Knowledge of Disease

• Signs and symptoms of problems pertaining to
  specific health state
• WoundS/S infection
• Heart ProblemS/S of heart failure
• Contact physician
• How
• Whenif s/s occur
• Web site
• www.diabetes.org

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Outpatient or Inpatient Services

• Hospital
• Diagnostic tests 1 sentence
• Laboratory
• Procedures
• Home
• Office appointments
• Physician
• Home health services
• Hospice
• Community-based support services
• American Diabetes Association
• American Cancer Society

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Diet

• Food pyramid
• Serving sizes
• Healthy eating guidelines
• Promote wound healing-
• Protein, vitamin C
• Promote eliminationbladder bowel
• Fiber, water
• Specific menus
• Obtain samples from dietary department

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Summary METHOD Teaching Plans

• Medicationsname, action, side effects
• Environmenthome, finances, family
• Treatmentspurpose and techniques
• Health teachingeffects of disease, s/s
• Outpatient/inpatient referralsoffice
  appointments, support groups, diagnostic tests
• Dietappropriate diet, food restrictions, menus

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Adult Learning Principles

• Be realistic stick to the basics
• Take advantage of the teachable moment by
  incorporating teaching into your ongoing patient
  care
• Reinforce all learning
• Solicit feedback

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Adult Learning Principles

• Build on previous experiences
• Focus on immediate concerns first
• Adapt teaching to the patients lifestyle
• Make the patient an active participant
• Determine learning readiness

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Psycho-Social-Cultural Patient Assessment Tool

• Emotional state (mood, body language, eye
  contact, facial expressions)
• Patients life experience (previous experiences
  with health care)
• Family (mood of family members are family
  members supportive)
• Patient age (how health problem has interfered
  with growth and development)

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Psycho-Social-Cultural Patient Assessment Tool

• Relations with health-care providers (what is the
  patient/family level of understanding of the
  health problem are they satisfied with the care
  given)
• Self-esteem and body image (changes in physical
  appearance changes in activity)
• Cultural (religious preference and practices
  favorite foods years lived in the region travel
  outside the region)
• Gender (patients speech behaviors patient-safe
  communication strategies used with this patient)

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Assessment

• Learning styleprefer to watch movie, listen to
  audiotape, read, computer, talk one on one
• Reading leveldoes patient like to read
  (illiterate1 of 5 adults reads at 5th-grade
  level or lower)

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Assessment

• Learning readiness and motivation
• Age, developmental tasks, and cognitive level
• Current understanding of health problem
• Culture/gender issueswomen as caretakers food
  preferences
• Economicsdrugs, dressings, supplies
• Support systems/familyemotional support and
  support of treatment plan

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Assessment Factors Inhibiting Learning

• Negative emotionsanxiety, depression, grief may
  not be able to learn
• Defense mechanismsdenial, rationalizing
• Physiological problemsblind, deaf, cognitive
  impairment, pain, hunger, nausea
• Cultural barriersAmish electricity, Jehovah's
  witnesses and blood, differing values and beliefs
  between health-care providers and patients

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Teaching Plans

• Learner/family assessment
• Teaching goals and objectives/content
• Planning teaching strategies
• Implementation of teaching
• Evaluation of teaching
• Documentation of learning and teaching

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Patient Goals and Objectives

• Goals General statementadminister insulin
  independently
• Objectives Cognitive, affective, psychomotor

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Cognitive objectivesthe patient will

• Describe the purpose of insulin
• Describe the adverse effects of too much or too
  little insulin
• State what to do if side effects occur

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Affective objectivesthe patient will

• Listen to instructions on how to give insulin
• Appear relaxed without signs of anxiety during
  instruction

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Psychomotor objectivesthe patient will

• Assemble supplies needed to self-administer
  insulin
• Draw correct dosage into syringe without
  contamination
• Inject insulin without contamination of needle

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Teaching Methods Must Coincide With Type of
Knowledge

• Cognitive (Facts)
• Explanations, descriptions, books, pamphlets,
  films, programmed instruction, computer programs
• Affective (Feelings and Beliefs)
• One-on-one discussion, group discussions, role
  playing, discovery to guide the patient to
  problem-solve situations and to express feelings
• Psychomotor (Skill)
• Use demonstrations accompanied by explanations

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ImplementationWarning Do Not Lecture Patients

• No interaction
• Puts teacher in charge
• Learner is passive and dependent

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Evaluation of Teaching Did the Patient Learn?

• Cognitive knowledge
• Oral or written questions, diary or records for
  self-monitoring
• Affective knowledge
• Inferred from how patient responds and speaks,
  verbal expression of feelings and values
• Psychomotor knowledge
• Return demonstrations

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When a patient decides not to change a behavior

• The patient does not want to stop smoking
• You have done everything to convince a patient
  to change and become healthier
• Do not get in an argument agree to disagree
  patients have the right to their own opinions and
  decisions
• Document, and wait for a teachable moment, when
  the patient is motivated to change

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References

• References for this content can be found in the
  text.
• Chapter 6 P. 91
• Chapter 7 Pp. 103 and 104
• Chapter 8 Pp. 116 and 117
• Chapter 9 Pp. 128-130
• Chapter 10 P. 142
• Chapter 11 Pp. 155 and 156