Patient Education and Patient-Centered Care in Professional Nursing Practice
Chapter 10
1
What Is Patient-Centered Care (PCC)?
Care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (IOM, 2001)
Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs (QSEN, 2014)
PCC Competency
The nurse “will provide holistic care that recognizes an individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care” (Massachusetts Department of Higher Education, 2010, p. 9).
Dimensions of PCC
Respect for patients’ values, preferences, and needs
Coordination and integration of care
Information, communication, and education
Physical comfort
Emotional support
Involvement of family and friends
Transition and continuity
Access to care
Components of Patient-Centered and Family-Centered Care Delivery Models (1 of 2)
Coordination of care conference
Hourly rounding by the nurse
Bedside report
Use of patient care partner
Individualized care established on admission
Open medical record policy
Components of Patient-Centered and Family-Centered Care Delivery Models (2 of 2)
Eliminating visiting restrictions in relation to family members
Allowing family presence with a chaperone during resuscitation and other invasive procedures
Silence and healing environment
Communication as a Strategy to Support PCC
Communication is defined as the nurse interacting “effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes” (Massachusetts Department of Higher Education, 2010, p. 27).
Empathetic Communication (1 of 2)
Behaviors that facilitate empathetic communication include:
Listening carefully and reflecting back a summary of the patient’s concerns
Using terms and vocabulary appropriate for the patient
Calling the patient by his or her preferred name
Using respectful and professional language
Empathetic Communication (2 of 2)
Behaviors that facilitate empathetic communication include (cont.):
Asking the patient what they need and responding promptly to those needs
Providing helpful information
Soliciting feedback from the patient
Using self-disclosure appropriately
Employing humor as appropriate
Providing words of comfort when appropriate
Nonempathetic Communication (1 of 2)
Behaviors can also hinder empathetic communication:
Interrupting the patient with irrelevant information
Using vocabulary that is either beneath the level of the patient or not understandable to the patient
Using language that may be perceived as patronizing or demeaning
Using nonprofessional language
Nonempathetic Communication (2 of 2)
Behaviors can also hinder empathetic communication (cont.):
Reprimanding or scolding the patient
Preaching to the patient
Providing the patient with inappropriate information
Asking questions at inappropriate times or giving patient advice inappropriately
Self-disclosing inappropriately
Kleinman’s Questions (1 of 2)
What do you think has caused your problem?
Why do you think it started when it did?
What do you think your problem does inside your body?
How severe is your problem? Will it have a short or long course?
Kleinman’s Questions (2 of 2)
What kind of treatment do you think you should receive?
What are the most important results you hope to receive from this treatment?
What are the chief problems your illness has caused you?
What do you fear most about your illness/treatment?
Patient Education as a Strategy to Support PCC
Patient education is any set of planned educational activities designed to improve patients’ health behaviors and/or health status.
14
Learning Domains
Cognitive learning encompasses the intellectual skills of knowledge acquisition, comprehension, application, analysis, and evaluation.
Psychomotor learning refers to learning skills and performance of behaviors or skills.
Affective learning requires a change in feelings, attitudes, or beliefs.
15
Andragogy
Letting learners know why something is important to learn
Showing learners how to direct themselves through information
Relating the topic to the learners’ experiences
Realizing that people will not learn until they are ready and motivated
16
Health Belief Model (HBM)
According to HBM, the likelihood of acting in response to health threat is dependent upon 6 factors:
Person’s perception of the severity of the illness
Person’s perception of susceptibility to the illness
Value of the treatment benefits
Barriers to treatment
Costs of treatment in physical and emotional terms
Cues that stimulate taking action toward treatment of illness
17
Social Learning Theory (1 of 2)
If a person believes he or she is capable of performing a behavior (self-efficacy) and also believes the behavior will lead to a desirable outcome, the person is more likely to perform the behavior.
18
Social Learning Theory (2 of 2)
Four methods for enhancing efficacy expectations:
Performance accomplishments
Vicarious experience or modeling
Verbal persuasion
Interpretation of physiological state
19
The Patient Education Process
Assessment
Planning
Implementation
Evaluation
20
Assessment of Learning Needs
What information does the patient need?
What attitudes should be explored?
What skills does the patient need to know?
What factors may be barriers?
Is the patient likely to return home?
Can the caregiver handle the care?
Is the home situation appropriate?
What kinds of assistance will be required?
21
Other Variables in the Patient Education Process
Learning styles
Readiness to learn
Health literacy
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services they need to make appropriate health decisions” (IOM, 2004, p. 31)
22
Ask Me 3® Questions
What is my main problem?
What do I need to do?
Why is it important for me to do this?
ACTS
Assess
Compare
Teach 3/Teach back
Survey
Readability of Written Materials
Written materials for patients with low health literacy skills should be fifth-grade level or below.
Several readability formulas are available to determine the grade level of materials (Flesch, 1948; Fry, 1968; McLaughlin, 1969).
SMOG formula.
26
Planning
Nurse responsible for guiding the process through the use of goals and objectives.
Objectives for patient education are stated as behavioral objectives.
Performance
Conditions
Criteria
Learning objectives should be specific, measurable, and attainable.
27
Implementation
Learning activities need to be consistent with learning objectives.
Using varied learning activities can make learning more fun and more effective.
Examples include lecture, demonstration, practice, games, simulation, role play, discussion, and self-directed learning
28
Criteria for Judging Patient Education Materials
Material contains the information that the patient wants.
Material contains the information that the patient needs.
Patient understands and uses the material as presented.
29
Patient Education with Older Adults: Age-Related Barriers (1 of 3)
Cognitive changes:
Changes in encoding and storage of information
Changes in the retrieval of information
Decreases in the speed of processing information
30
Patient Education with Older Adults: Age-Related Barriers (2 of 3)
Visual changes:
Smaller amount of light reaches the retina
Reduced ability to focus on close objects
Scattering of light resulting in glare
Changes in color perception
Decrease in depth perception and peripheral vision
31
Patient Education with Older Adults: Age-Related Barriers (3 of 3)
Changes in hearing:
Reduced ability to hear sounds as loudly
Decrease in hearing acuity
Decrease in ability to hear high-pitched sounds
Decrease in ability to filter background noise
32
Strategies to Accommodate for Age-Related Barriers: Cognitive (1 of 2)
Slow the pace of presentation.
Give smaller amounts of information.
Repeat information frequently.
Reinforce verbal teaching with audiovisuals, written materials, and practice.
Reduce distractions.
Allow more time for self-expression.
33
Strategies to Accommodate for Age-Related Barriers: Cognitive (2 of 2)
Use analogies and examples from everyday experience to illustrate abstract information.
Increase meaningfulness of content.
Teach mnemonic devices and imaging techniques.
Use printed materials and visual aids that are age specific.
34
Strategies to Accommodate for Age-Related Barriers: Visual (1 of 2)
Make sure glasses are clean and in place.
Use printed materials with 14- to 16-point font and serif letters.
Use bold type on printed materials and do not mix fonts.
Avoid use of dark colors with dark backgrounds but instead use large, distinct configurations with high contrast.
35
Strategies to Accommodate for Age-Related Barriers: Visual (2 of 2)
Avoid blue, green, and violet to differentiate type, illustrations, or graphics.
Use line drawings with high contrast.
Use soft white light to decrease glare.
Light should shine from behind learner.
Use color and touch to help differentiate depth.
Position materials directly in front of learner.
36
Strategies to Accommodate for Age-Related Barriers: Hearing
Speak distinctly.
Do not shout.
Speak in a normal voice or lower pitch.
Decrease extraneous noise.
Face person directly while speaking at a distance of 3 to 6 feet.
Reinforce verbal teaching with visual aids or easy-to-read materials.
37
Cultural Considerations
Adapt information to be more specific and use more relevant terminology.
Create descriptions or explanations that fit with different people’s understandings of key concepts.
Incorporate a group’s cultural beliefs and practices into the program content and process.
38
Evaluation
Measuring the extent to which the patient has met the learning objectives
Identifying when there is a need to clarify, correct, or review information
Noting learning objectives that are unclear
Pointing out shortcomings in patient teaching interventions
Identifying barriers that prevented learning
39
Evaluation of PCC
National Strategy for Quality Improvement in Health Care priority
Link between quality and patient satisfaction
HCAHPS standardized survey
CAHPS supplemental item sets
40
