In this era of nursing shortages and documentation demands, how do you manage all the things you have to do and not neglect that most important part, patient education?

Part of that is making the commitment that no patient’s educational needs will be put to the side because other tasks are more important. Sending a patient home unprepared to take care of themselves and deal with their safety issues is unacceptable and legally, morally and ethically reprehensible.

Sending a patient home unprepared to take care of themselves and deal with their safety issues is unacceptable and legally, morally and ethically reprehensible.

In 2005, I wrote that it was getting harder and harder to include patient education in daily work plans and schedules. I assure you it is only getting harder and regulatory agencies are now monitoring patient education as a primary criteria for certification and accreditation. Great!

It was timely twenty years ago and it’s certainly timely now for us to consider education of patients as a major professional responsibility. Whatever role you fill; dietitian, nurse, physician, pharmacist, physical therapist, social worker or anyone I missed, this is what makes the difference between a health care professional and a caregiver!!

That said, just how do you get it done? How do you get everyone to do it? How does everyone learn to do it? How do you do it without it being a burden? How do you do it quickly and effectively? How do you prepare?

Step 1: Make it a facility-wide policy that everyone does patient education

The biggest frustration in patient education is being the only one who does it. When you start teaching patients and there is no follow-up by your colleagues, it can be so destructive and demoralizing. If you teach a patient how to suction their tracheostomy and no one else lets them do it because it takes less time for the respiratory therapist to do it themselves, the patient will never manage it successfully.

If other professionals are allowed to sabotage your work, why would you want to continue? It’s like fighting a war by yourself. So the commitment to patient education must start at the top with an organizational philosophy that education is included in the job description of each employee and they are to be held accountable that it is done. It should be a criteria on any performance appraisal form and scored the same way or even higher than most other evaluation items.

Step 2: Make sure everyone has the skills to teach patients

This is a lot easier than it used to be but it is still not guaranteed by professional credentials. Patient education is now included in the curriculums of most health care professionals. They are taught to teach patients and are expected to do it as part of their educational sessions. Some schools even grade students on their ability to teach patients.

Interestingly enough, the faculty who teach students may be wonderful professionals who are incredible teachers, but lack the skills set for teaching patients. Add to that a shortage of health care professionals on the faculty in most universities and you have a problem.

How do you overcome this? Use the staff development department of your facility. These are the experts in adult and patient education and they should be preparing all staff for the skills they need. If you conduct classes on how to teach patients, make sure to invite other health care providers in your community. This way they will follow through on the education you started when the patient is discharged from your facility. This continuity of care is very important.

Don’t reinvent the wheel. Utilize the experts in your facility. We all have them and if you aren’t using them, why not? Most patient educators are more than willing to share their ideas and methods and are pleased to mentor fellow health professionals. There are many resources available now, wonderful articles written by patient educators in all fields, websites, workshops, and excellent books. Seeing a need and having a desire to share with colleagues what I learned over the years motivated me to write my book, Patient Education: You Can Do It!

Step 3: How do you do it without it being a burden?

Include patient education in everything you do and do not consider it a separate task. You don’t say that today is the day you do patient education because the floor isn’t too crazy or you have an extra staff person. If you have to think about doing it, you’re missing the point. Here are a few examples.

If you take a patients temperature, teach them about fevers and what the numbers mean. Ask if they have a thermometer at home and if they know how to read it. In our out-patient surgery unit we would teach people how to identify an infection. We would tell them to call the doctor if they developed a fever and then we would teach them what a fever was. We’d then hand them a glass thermometer and ask them to read it. If they could, we documented that they had the skill. If not, we taught them how to do it. All patients got to keep the thermometer with the hospital’s name on it, and at about 50 cents this was a great public relations tool that made an impact on family health. Every member of the family benefits if someone can take their temperature. Simple, yet very effective.

When you change a dressing, explain what you are doing and why you do it that way. Wound care is simple if you know what to do and know a little bit about aseptic technique. Hand washing is so important. When you wash your hands before and after a dressing change and mention it to the patient, it makes an impact.

Insulin administration should be taught immediately and then the staff should never give an injection to that patient again unless they are unconscious or have two arms in a sling. If the patient already knows how to administer their insulin, have them demonstrate it to you so you can validate that they can actually do it well. I see patients all the time who are giving their insulin incorrectly or taking their oral medications incorrectly. Their education level or socio-economic status doesn’t seem to matter either.

The bottom line is you can teach patients without adding hours to your day.

Step 4: Doing it quickly and effectively.

The biggest mistake health care providers make is that they try to teach patients everything they know. You cannot teach ten years of learning in ten minutes and it really doesn’t pay to overwhelm someone who just found out they are going to live the rest of their life with a chronic disease. So think about what they really need to learn.

I call it the Do-Know-Deficit.

• What do they have to do? i.e. take medication, change a dressing, etc.
• What do they need to know in order to do it? i.e. side effects of the medication, aseptic technique, etc.
• What do they already know? Ask them. Have them show you, Validate that it’s correct.

Teach the deficit. Please give the patient the respect they deserve and find out what they already know. Do not waste their time and yours by teaching them something they already know.

Now what are the components?

Needs to know. What are the survival skills, basic safety issues, i.e. medications, treatments, etc? In diabetes, it’s the four Ms: meal planning, medications, monitoring and movement. The rest can come later

Wants to know. They have things they want to know and you need to address that or they won’t hear anything else you have to say. So ask, “What questions do you have?”

Nice to know. These are the fun things but not really necessary at this time. Sometimes we teach a subject because we like these topics. If the patient doesn’t need it, don’t waste their time.

Step 5: Preparing for patient education

Patient education can be done effectively, efficiently, and without becoming a burden, but someone needs to develop the programs and provide the needed materials. It should not have to be the staff when health care educators have made this their jobs. Professional educators have developed all the materials you need and should make them available to you at your work setting. You may have to approach a colleague and ask them where these materials are available.

Mary Lemesveski, a wonderful colleague of mine, put patient education materials in a fishing tackle box and put one on each patient unit. That way if materials were needed any time or any shift, they were available. Pharmaceutical companies make wonderful patient education tools and provide them free of charge through the company representatives or online.

Not optional

It should be clear and simple that patient education needs to be done and should not be avoided because time is tight and staff is short. If the facility makes it a policy that it will be done...it will be done. If the staff is taught how to do it and how to incorporate it into their daily routine…it will be done. If the burden is removed and it can be done quickly and effectively…it will be done. If everyone works together to plan and deliver patient education…it will be done.

And we will all achieve the satisfaction we get when patients safely walk out the door knowledgeable about their health care needs.

It’s sad that approximately 90 million Americans lack adequate health literacy. Now we really should do something about that. But that’s a discussion for another day…