Chapter One

Patient Education: Empowering Patients and Families

Chapter Objectives

When you finish this chapter, you will be able to:

1. Define patient education and state the goals of patient education
2. Identify the nurse's role in patient education
3. Discuss JCAHO Patient and Family Education standards
4. Explain the value of interdisciplinary collaboration in patient teaching
5. Describe three theories that provide a basis for effective patient teaching
6. Recognize ways to help patients achieve compliance

Introduction

Helping patients and families learn how to manage health care problems and achieve health is one of your most important roles as a nurse. Today, short hospital stays, an explosion of sophisticated medical terminology in the home, and growing numbers of elderly Americans with chronic diseases means that patients will increasingly depend on you to help them learn needed skills, solve problems, and prevent complications.

Many of the complex procedures patients and their caregivers perform were once performed only by physicians or nurses. In addition to technical skills, patients and caregivers must also learn how to interpret data to decide when to seek medical help. Difficult decisions about what symptoms to call a physician for, when to take the patient to the emergency room, or whether a wound is healing properly is in their hands. Nurses and other health care professionals must take on the daunting task of teaching a great deal of material, often with a limited time, to patients who may not be willing, ready, or able to learn. To accommodate patients' need to know how to manage their care in a limited time, hospitals must revise existing patient teaching programs and devise teaching interventions that reach into homes, outpatient clinics, and other settings.

Education: what and why?

Patient education is the process of influencing behavior, producing changes in knowledge, attitudes, and skills needed to maintain and improve health. JACHO goals for patient and family teaching include:

• Patient participation and decision-making about health care options
• Increased potential to follow the health care plan
• Development of self-care skills
• Improved patient/family coping
• Increased participation in continuing care
• Adopting a healthy lifestyle

Cost-containment studies show that educated patients maintain better health and have fewer complications. As a result, they have fewer hospitalizations, emergency department visits, and clinic and physician visits. Studies by managed care organizations have consistently shown patient teaching to be cost-effective. One study showed the following results:

An asthma group education program reduced emergency room admissions and hospitalizations. The cost per patient was $37 and savings were $217 per patient, resulting in a cost benefit ratio of 1:5:8 (Cost benefit ratio= cost of education per patient divided by total savings per patient)

A prenatal care, nutrition counseling, and smoking cessation program reduced pre-term births from 6.9 percent to 1.7 percent. The cost per patient was $93 and savings were $193, resulting in a cost benefit ratio of 1:2.

A chronic pain-counseling program reduced clinic visits by 36 percent. The cost was $101 per patient, and the savings were $312 per patient a cost benefit ratio of 1:3:1.

In none of the programs studied, did costs exceed savings. On the average, between $3 and $4 dollars were saved for each dollar invested in health promotion programs.

To obtain JCAHO accreditation, health care organizations must show evidence that all patients receive teaching and that health care providers can demonstrate that learning has taken place. JCAHO standards require an interdisciplinary approach that includes the patient and family as part of the health care team. Education must be ongoing, interactive, and consistent with the patient's plan of care, educational level, and needs for continuity of care. Patient and family education is addressed in the Education (PF), Patients Rights and Organization Ethics(RI), Continuum of Care (CC), Improving Organization Performance(PI), Leadership (LD) and Management of Information (IM) standards in the Accreditation Manual for Hospitals. Table 1 outlines the education standards of the JCAHO.

The JACHO promotes the concept of patient-centered care with patient education as a foundation that involves patients as important members of the health care team. Nurses can bring this concept to life by providing health care information to patients and families in the right place and at the right time. Evaluation of an organization's ability to provide patient education must show that the organization assesses the need for patient/family education and allocates resources to accomplish them. The most important resource organizations have to meet accreditation requirements for patient and family teaching staff nurses who have the skills, commitment, and time to teach patients.

RN's role, interdisciplinary collaboration

Legal responsibility for patient teaching is outlined within each nurse's scope of practice as described in Nurse State Practice Acts. The nurse's crucial teaching role is also emphasized in documents published by the American Nurses Association (ANA) and many specialty nursing associations. As a nurse, you spend more time with patients than any other team member - this contact provides you the opportunity to develop a trusting relationship with patients, to assess individual learning needs, and to provide continuity throughout the teaching-learning process. Its important to remember that patient teaching is not a procedure, but a process that involves assessment, critical thinking, negotiation, and knowledge about the content being taught. Registered nurses cannot delegate patient teaching to unlicensed personnel or nursing staff members who are not prepared to conduct a comprehensive assessment of learning needs.

Collaboration by the entire health care team is vital for effective patient and family education. Patients are often confused about the numbers of people providing care for them and frustrated by team members who repeat instructions already taught by someone else. The need to move patients through the health care system in an efficient and cost-effective way means that you and other team members must learn ways of providing patient teaching collaboratively. Nurses must collaborate with other team members, not only in the hospital, but in home care agencies, wellness settings, and rehabilitation and long-term care facilities.

In well-functioning interdisciplinary teams, team members view nurses as their "eyes and ears" - they rely on you to provide feedback about patient participation, to share information that helps them plan and adjust goals, and to reinforce the teaching they have provided. Nurse members of top performing teams communicate superbly, both verbally and through written documentation. They keep communication channels open, are active participants in team conferences, and document clearly and in a timely manner about the patient's learning progress so that other team members are kept continuously informed. Multiple disciplines should be involved in developing and teaching. Effective teaching plans should include patient/family outcomes, outlines what and when to teach, teaching resources, and indicate who is responsible for teaching specific content and skills.