Patient Teaching and Health Literacy Chapter 2 Patient Teaching and Health Literacy Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Compliance, Noncompliance, and Concordance Compliance: When a patient follows the prescribed plan of care Noncompliance: When a patient does not follow the prescribed plan of care Concordance: When the health care provider, nurse, patient, family, and pharmacist work together as a team to implement one treatment plan. Can you identify some of the roles an LPN/LVN uses in practice? (Patient education: medication knowledge, self-management of health; identifying patient barriers) Why is the term concordance preferred over compliance and/or noncompliance? Can you think of two reasons a patient has difficulty meeting treatment goals? ([1] The patient does not understand the treatment plan. [2] The patient understands the plan but fails to carry it through, in which case the patient may [a] not agree with the plan or [b] believes in the plan but doesn’t or can’t follow it.) Barriers may be lack of money, time, or ability to follow the prescribed plan of care. What other factors may contribute to problems with following treatment plans? (Culture and lifespan considerations) Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Communicating with the Patient Nurse time constraints Cultural considerations and beliefs Patient and/or nurse Common language between nurse and patient Written education Literacy Health Literacy The nurse should use language intended for the lay person and avoid medical jargon. The nurse should be aware of cultural differences between the patient and him/herself. Different terms may mean different things to both the nurse and the patient. Clarification is frequently needed. Can you describe what “health literacy” refers to? (The ability to understand and use information important to keeping healthy.) Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Communicating with the Patient (cont.) Patient problems resulting from inability to read and write Poor health outcomes Health disparity: increased risk for disease It is important for the nurse to assess the patient for literacy. Much of the education provided regarding prescribed drugs is often complex and in writing. How do these nursing assessments reduce the patient’s difficulty in carrying out the treatment plan? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

The Process of Patient Education Patient perception of educational importance Patient education has to involve both teacher and learner and cannot be forced. Patients seek out the resource person they feel is the best source or the one they are most comfortable with Use of computers and the Internet in health care Describe the benefits of using computers and the Internet for medication education. Can you identify any barriers to using the computer? How will the patient’s perception of an illness and treatment plan affect education? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Assessment of Patient Education Patient assessment: Need to learn Willingness to learn Mutually determined (nurse + patient) What needs to be taught Teaching methods: Verbal, written, audiovisual, demonstration, return demonstration, or combination Give feedback and praise Why is it important for the patient and nurse to mutually agree to educational objectives? Objectives should be explicit and measurable. For example, “Identify five possible adverse reactions of the drug.” Why are a variety of teaching methods preferred over one method alone? Can you identify times during the clinical experience when the patient may be least receptive to education? Why should praise and feedback be included in patient education? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Preparing a Teaching Plan Nursing considerations involved with presenting education The patient must first understand what has led to illness in very general terms. The nurse teaches in simple terms and in line with their own understanding. You need to have a plan in mind for the things that need to be covered Informed consent What are some nursing considerations to be mindful of in presenting teaching? At the beginning of therapy and a new medication, the nurse should plan teaching sessions over several sessions, with information given in quantities the patient can handle easily. Why is informed consent a legal obligation all health care providers must follow? The nurse should make certain the patient understands his or her condition and the risks and benefits of treatment. The law requires the patient to be “reasonable.” Can you identify a patient who may not be considered “reasonable”? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Implementing the Teaching Plan Stress and anxiety increase the confusion they often feel and interfere with their ability to learn. Teaching needs to be offered in a systematic manner to decrease stress. Learning capacity Use a variety of ways to give patients information about their medications. What situations may cause increased anxiety and therefore interfere with learning? (Occasion of receiving bad news from diagnostic tests; occasion of being discharged from hospital When would a patient be most receptive to learning about a new medication? Research shows that people are able to remember three things from a teaching session. Allow patient learning to occur when it fits the patient’s schedule. The use of a variety of teaching methods and learning aids, including CD-ROMs or audiovisuals, can supplement face-to-face nurse/patient sessions. Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc. Verbal Education Verbal education Often direct teaching Group settings may be used for patients who have extensive needs for teaching Verbal education is accomplished face-to-face; the nurse gives information and allows time for patient questions. When can small-group education be used? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Copyright © 2016 by Mosby, an imprint of Elsevier Inc. Written Information Patient Teaching Resources (Box 2-2) Goals of hand-out Limit to 1 or 2 objectives Emphasize desired patient behaviors Use clear headings Use common words Develop materials that involve patients Prepare materials appropriate for patients who have low literacy skills Use short, simple sentences These are important considerations for the nurse to include when developing written education for the patient. A wide selection of written educational materials is available. Some of these may come from the Internet, where the quality of information may require close scrutiny for accuracy. What may be other concerns related to the use of written publications and education? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Audiovisual Resources Internet and Navigating the Web (Table 2-2) Slide-tape programs, videocassettes, and CD-ROMs or DVDs are available for patient teaching. Television ads are called direct-to-consumer advertising. Television ads that are created by drug companies are another source of audiovisual education to which the patient is frequently exposed. Many of these ads prompt patient questions, which can serve as an opportunity for the nurse to assess patient knowledge and provide accurate drug information. Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Nurse and Patient Use of the Internet Nurses may want to spend some time with patients using the Internet to help them find sites and evaluate whether the site has reliable, accurate, or up to date information. Ask the patient questions and help them find the answers. Praise them when they identify good sites or raise questions about sites that are just promoting products. Although many business websites have accurate information, others may be more interested in selling something. How can you identify the difference in commercial, nonprofit groups, educational groups, and educational websites? Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Evaluation of Learning Patient education occurs to help change patient behavior and increase satisfaction. The process breaks down when a patient does not understand what to do, cannot afford the treatment plan, or loses confidence in being able to change. Why is it important for the nurse to review objectives when evaluating learning? Patient education sessions should allow time for questions and answers, thereby making the teaching process an active process. Remember, the patient usually recalls three things during a session. Summarize frequently, repeat, and keep it simple. Teaching sessions should be documented in the patient’s record and include the topics discussed, the written material provided, and your evaluation of the patient’s willingness to learn and overall comprehension of the topics covered. Copyright © 2016 by Mosby, an imprint of Elsevier Inc.

Ways to Enhance Learning Plan for frequent nurse-patient contact Fit the plan to patient’s needs and culture Provide feedback and encouragement Encourage active patient involvement in care Employ behavioral contract between patient and nurse Use reminder cards and send reminder e-mails Behavior contracts list things that the patient will or will not do. Copyright © 2016 by Mosby, an imprint of Elsevier Inc.