Chapter 3 PowerPoint

Editor's Notes

• #6: Understanding the patient’s physical and emotional needs will prepare you to teach the patient. Being able to effectively assess your patient’s learning needs also allows you to individualize the information for each patient. You may know most of the patient’s background information, such as sensory barriers, education and comprehension levels, and so forth, from previous interaction with the patient or from the record.
• #7: Chapters 5 and 6 of this text explore barriers to communication in detail.
• #8: Patients with low health literacy levels may not be familiar with medical terms, anatomy, or how the body functions. Highly educated individuals may still have health literacy issues Low health literacy levels are common in: Older adults Ethnic minorities Lower than HS diploma education English is a second language It is important to identify and understand the target patient population, specifically the demographics and their pattern of behavior, culture, and attitude. The patient information should be appropriate for the age group, culture, language, and literacy level.
• #9: Some questions you may want to ask patients to better assess their learning needs are: “What are you most concerned about?” “What do you feel you need to learn?” “What are you most interested in learning?” “What do you know about your disease or condition?” “What specific problems are you having?” In the late 1960s, Abraham Maslow, an American psychiatrist, developed a theory to better understand basic human needs. Maslow’s theory included that a need is essential if: Without its fulfillment or presence, illness results. Fulfilling the need restores homeostasis or wellness. We feel a sense of satisfaction when the need is met.
• #10: In addition to their medical needs, the holistic approach includes the patient’s spiritual, physical, emotional, sociocultural, and intellectual needs For example, when we have an illness, it impacts more than just our health. Will we have to miss days of work? Will we be able to care for our families? Will we be able to enjoy our hobbies? How expensive is the treatment? How will this affect my quality of life?
• #12: Learning Goals and Objectives Example – Table 3-1 Learning Goal Patient will understand that diabetes is a lifelong disease and will be able to manage her diabetes to avoid long-term complications of diabetes Learning Objectives Self-monitoring of blood glucose: Patient will check blood glucose daily: before each meal and 2 hours after largest meal. AIC monitoring: Patient will have 3-month routine check-up with physician to monitor A1C levels.  
• #13: Since our patients have varying education needs and preferences, the types of teaching tools in patient education cannot be a one-size-fits all or all-inclusive solution. Effective teaching tools must be from a variety of different resources and use multiple modalities, including traditional print material to highly technical interactive videos.
• #14: Group discussions: It is important to monitor the group to ensure that less vocal and assertive patients do not get lost in the discussion and group environment.
• #17: For example, a sick child is devastating to the whole family and may result in immense demands to the parents and other siblings. A sick parent cannot productively contribute to the family safety and security and is a source of anxiety rather than comfort. As HCP dealing with families: For example, for an elderly, dependent grandparent, one family member may feel that long-term care (such as in a nursing home) is more appropriate than home care, whereas another family member may feel that long-term care should be a last resort (Figure 3-6). Some members may want a “do not resuscitate” (DNR) order signed, whereas others may strongly be against it. Families often need as much emotional support as patients do.
• #18: Examples of support groups are Alcoholics Anonymous, Reach for Recovery (post-mastectomy), and Candlelighters (parents of children with cancer). Additionally, there are support group for most common illnesses and life experiences. Open and closed groups: There are many formats for support groups, including its size, how often it meets, for how long, and who can join and when. For example, support groups may be open or closed. Open support groups allow people to join at any time. Closed groups may allow for more confidentiality and intimacy, and help members work more cohesively.
• #19: All routes of administration: Route Description oral taken by mouth and swallowed sublingual placed under the tongue buccal placed between the gums and cheek intravenous (IV) injected into a vein intramuscular (IM) injected into a muscle subcutaneous (sc) injected under the skin intrathecal injected around the spinal cord rectal inserted into the rectum vaginal inserted into the vagina ocular placed in the eye otic placed in the ear nasal sprayed into the nose inhaled breathed into the lungs through the mouth transdermal absorbed through the skin
• #20: Patient administration protocol steps: 1. Ask the patient to demonstrate how he or she takes the medication. If the patient has a family member or caregiver who dispenses the medication, have him or her demonstrate, as well. 2. While the patient is demonstrating, ask the patient about the dosage, time, and frequency of taking the medication. 3. If the patient takes multiple medications, ask the patient to explain when he or she takes each medication and what each medication is for. Disabilities could prevent proper usage: Determine whether the patient is vision-impaired. Can he see the labels well enough to know which medication he is taking? Can you provide him with visual aids to make measuring and administration easier? Does she have the manual dexterity to draw up medications and self-inject? Is there a family member or caregiver who can inject it for her? Should she be referred to a home health service if there is no one available to help with administration? Can he understand which medication must be taken at what time and in what manner? Can the routine be simplified? Does he understand how important it is to take the medication as prescribed and what might happen if he does not follow the proper regimen? Does he know that he should not discontinue the medication without informing the physician’s office? Should you demonstrate with special memory aids, such as divided dosage boxes to make it easier to remember dosage times?
• #21: Open-ended question method: For example, to determine if the patient understands the significance of glucose levels, ask “Your glucose level is 164. What do you think that means?”
• #22: Adherence, compared to “compliance,” better describes the complex HCP-to-pt relationship A collaboration of all parties to improve pt health
• #23: Adherence influencing factors: poor provider-patient communication economic and social factors treatment plan complexity and health care disparities Example: Adherence may be affected by cost and access barriers if the physician prescribes a medication to a patient but the patient never has the prescription filled due to an inability to afford the medication. Pts choose least interfering parts of routine: For example, the physician’s treatment plan instructs the patient to exercise more, stop smoking, and eat healthier. The patient may slightly modify his diet and cuts down to three packs a day instead of four packs. Pt doesn’t see immediate benefits so adherence is less likely.
• #24: Example of importance of adherence to direction: For example, Mr. Smith did not finish his full course of antibiotics for his urinary tract infection (UTI). He returns to the clinic since the UTI has not been resolved, but he does not tell the LPN during intake that he did not finish taking the antibiotics. His physician prescribes a stronger antibiotic for the UTI, thinking that the first antibiotic was not effective. This not only may lead to drug resistance, but Mr. Smith may experience more adverse effects due taking the stronger antibiotic.
• #25: In health care, it is presumed that any service that is not documented was not performed, which includes patient education. Each step of the education process must be documented and should include the following: -the patient’s learning needs, learning style, and readiness to learn -the patient’s knowledge of his or her condition and treatment options -the objectives and goals and what information was provided to the patient -how the information was provided to the patient, such as through discussion, demonstration, videos, or patient instruction sheet. -the patient, family, and caregiver response to the patient education -the evaluation and effectives of the teaching -the date and time of the session if separate from regular care, such as over the phone. Include --education given during routine patient care under the appropriate record entry. -a copy of the signed educational material provided to the patient when appropriate. The patient keeps the original and signs that the information has been explained adequately.