Problem Statement
If a patient does not know how to manage his or her condition and engage in effective self-care, negative health outcomes can be expected, including the worsening of present conditions or the development of complications. Healy, Black, Harris, Lorenz, and Dungan (2013) found that inpatient education (provided to patients with diabetes specifically) improves health outcomes and prevents negative scenarios; e.g., by reducing readmission rates.
My observations and patient education efforts at University of Miami Hospital (UMH) have shown that patients’ lack of understanding of their conditions and treatment plans and lack of motivation to comply with guidelines (both caused by ineffective education) may result in hindered recovery, obstructed disease management, further health problems, and additional complications. Ineffectively delivered patient education (or the absence of such education) is an important problem because, when they no longer have constant hospital care, insufficiently educated patients may unintentionally cause themselves harm through lifestyles, practices, and behaviors that are undesirable or unacceptable in light of the patients’ conditions.
Goals
In the context of the problem outlined above, two general goals can be pursued. First, it is important to increase patient education retention. Mackey, Doody, Werner, and Fullen (2016) reviewed the role of health literacy in managing chronic diseases in 31 studies, and only one mentioned patient education retention as an important factor. However, it can be argued that retention is crucial because the effectiveness of patient education is not measured by the quality of educational materials or methods of delivery, but by the level of patients’ understanding of the materials and their willingness to commit to the provided guidelines (Bastable, 2016). Therefore, improving retention and ensuring that relevant information is properly retained are integral parts of delivering patient education.
Second, the goal is to define effective strategies for providing patient education. My observations have found that patients may be reluctant to comply with their prescriptions and disease self-management guidelines not only due to a lack of knowledge, but also due to their attitudes toward their conditions and treatments that discourage them from engaging in proper self-care.
This can be considered a failure of patient education because such education should not only be about providing knowledge or explaining certain self-care skills, but also about ensuring that a patient understands the possible negative effects of noncompliance with his or her treatment plan (Fenerty, West, Davis, Kaplan, & Feldman, 2012). A patient education initiative that pursues these two goals can improve the overall understanding of how patient education can be provided to ensure better health outcomes.
Behavioral Objectives
The proposed format of providing patient education suggests meeting three objectives. The first objective is to assess the current knowledge of a patient about his or her condition and provide educational materials (approved by the health care facility) within the first eight hours of admission. The materials will include information on the pathophysiology of the patient’s condition, possible scenarios, and explanation of the current treatment plan (including prescribed medications). Additionally, information on non-pharmacological aspects of treatment should be delivered; this includes necessary lifestyle adjustments and dietary requirements.
The second objective is to measure patient education retention 24 hours after the educational session (or later, but before the patient is discharged). The measurement will be based on the initially provided materials. Materials should be structured for better understanding (Goldstein, 2013); e.g., several sections (such as medications, exercise, diet, contraindications, and so on) with several points in each. When testing retention, the educator will ask the patient to repeat the relevant information and will ask questions. A retention rate of 80 percent or more of the structured materials provided to the patient will be considered a success.
The third objective is to conduct a repeat evaluation of patients’ understanding of their condition and treatment before discharge. The difference of this objective from discharge planning is that the patient is not only supplied with guidelines, but also his or her knowledge and understanding are assessed against the structured materials as described above. Also, the patients will be asked to rate their willingness to comply with the guidelines on a scale from one to ten.
Action Plan
Following the objectives described above and my current practice, the action plan will incorporate three components. First, within the first eight hours of admission, as soon as a patient is available for a conversation, it is necessary to assess his or her present knowledge about the condition that led to admission. The purpose is to identify possible gaps in knowledge or attitudinal issues. The assessment is based not only on the patient’s knowledge, but also on his or her narration of how perceived disease management guidelines are followed (to see if the patient unintentionally engages in harmful practices due to a lack of education on the condition).
Second, education will be delivered in the form of approved materials and a conversation to answer the patient’s and his or her family members’ questions (White, Garbez, Carroll, Brinker, & Howie-Esquivel, 2013). Finally, an evaluation will be conducted 24 hours later (or more, but before discharge) to test the patient’s retention. If the patient remembers 80 percent or more of the provided materials, it is considered a successful outcome, but any forgotten points should be addressed again; in case less is retained, the education session should be repeated.
References
Bastable, S. B. (2016). Essentials of patient education (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Fenerty, S. D., West, C., Davis, S. A., Kaplan, S. G., & Feldman, S. R. (2012). The effect of reminder systems on patients’ adherence to treatment. Patient Preference and Adherence, 6(1), 127-135.
Goldstein, L. A. (2013). Relationships among quality of life, self-care, and affiliated individuation in persons on chronic warfarin therapy.
Healy, S. J., Black, D., Harris, C., Lorenz, A., & Dungan, K. M. (2013). Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care, 36(10), 2960-2967.
Mackey, L. M., Doody, C., Werner, E. L., & Fullen, B. (2016). Self-management skills in chronic disease management: What role does health literacy have? Medical Decision Making, 36(6), 741-759.
White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel, J. (2013). Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28(2), 137-146.